Reconstruction of extensive soft tissue defects of the lower extremity, especially when complicated by open fracture and bone loss, is usually a difficult problem for the plastic surgeon. Many methods have been devised to treat these conditions Musculocutaneous flaps add a valuable surgical alternative that bring vascularized cover to the defects, and the free microvascular transfer of these flaps gives the surgeon an added dimension of versatility. The latissimus dorsi is an extremly reliable musculocutaneous flap with a long, large-caliber vascular pedicle, so that dissection of the muscle can be performed with relative ease. The size of the latissimus dorsi muscle lends itself to coverage of large defects. While these characteristics appear to make the free latissimus dorsi musculocutaneous transfer ideal in many circumstances, it has some disadvantages. At the recipient site, the flap is ofter too bulky, and donor-site closure requires skin grafts if the flap is wider than 10cm. These skin grafts on the posterior thorax seriously detract from the final appearance of the donor site. The authors have experienced 12 cases of reconstruction of extensive lower extremity soft tissue defect in which the latissimus dorsi muscle alone was transferred and covered with a split-thickness skin graft. This method improves the recipient-site contour by decreasing the bulk of the flap and it also improves the donor-site appearance. We described technical considerations in each case and the advantages of free latissimus dorsi muscle flap and skin graft for the reconstruction of extensive soft tissue defect in the lower extremity.
Fractures, Open ; Humans ; Lower Extremity ; Myocutaneous Flap ; Skin ; Superficial Back Muscles* ; Thorax ; Tissue Donors ; Transplants

No abstract available.
Arthroplasty* ; Arthroplasty, Replacement, Hip*

No abstract available.

No abstract available.
Lipomatosis*

Behcet's disease is characterized by recurrent orogenital ulcers and ocular and cutaneous inflammatory lesions. Cardiovascular involvement, which may be artrial or venous, is rare but carries a particularly poor prognosis. One of the known vascular complications of Behcet's disease is aneurysm formation or venous thrombosis. We recently experienced a Behect's disease with multiple arterial aneurysms and thrombosis and report this case with review of literatures.
Aneurysm* ; Prognosis ; Thrombosis* ; Ulcer ; Vasculitis ; Venous Thrombosis

Excess hair growth in unwanted areas may result from heredity, endocrine disease, or drug therapy. Conventional methods of hair removal include shaving, wax epilation and chemical depilatories that frequently cause side effects such as contact dermatitis and that also have temporary effects. Electrolysis is a well-established medical method for permanent destruction of terminal hair follicles. However, this method is tedious and efficacy has been reported to range from 15-to-50% permanent hair loss. The evolution of the laser use for hair removal continues a year after Food and Drug Administration (FDA) approval of the first laser for these applications. The authors have experienced hair removal utilizing a long-pulsed alexandrite laser. This laser system employs the principle of thermokinetic selectivity, a revolutionary concept. The principle of thermokinetic selectivity involves the use of lasers with pulse durations below the thermal relaxation on a the large target such as the hair folllicle (40-100 msec), and significantly longer than the thermal relaxation time of smaller structures of the same chromophore (melanin) in epidermis (3-10 msec). The study was based on 76 patients treated with 20 msec pulse duration laser set to energy densities of 17-21 J/cm2. Treated areas included arms, legs, beard-chin, upper lips and bikini lines. Gross observation showed leaching of hair color, decresed size of the skin pores, easily broken hair shafts, and elimination of hair. Therefore, it can be assumed that the majority of hair follicles were destroyed by this procedure, Side effects included intermediary risk of hyperpigmentation and blister. Over 80% of treated patients were satisfied with the results. As the process of research and clinical application continues, we need the long-term results of this laser system to ensure its efficacy.
Arm ; Blister ; Dermatitis, Contact ; Drug Therapy ; Electrolysis ; Endocrine System Diseases ; Epidermis ; Hair Color ; Hair Follicle ; Hair Removal ; Hair* ; Heredity ; Humans ; Hyperpigmentation ; Lasers, Solid-State* ; Leg ; Lip ; Relaxation ; Skin ; United States Food and Drug Administration

Although the histologic grade of astrocytic neoplasms of the brain have been used as a prognostic factor, the lack of an objective criteria is possible to create the disagreement of classification. We evaluated 25 cases of astrocytic neoplasms of brain to document the usefulness of prolifera-tive potential of tumor as a prognostic indicator and the correlation with histologic grade by Nils Ringertz. The Ringertz's classification was relatively simple in an application among the variable systems and easy to define the differentiate from grade to grade. The examined cases were com-prised of 7 astrocytomas, 9 anaplastic astrocytomas and 9 glioblastoma multif6rmes. The prolife-rative potential of tumors were measured by Ag-NORs count, PCNA labeling index and flow cytometric analysis. The mean numbers of Ag-NORs per cell and PCNA labeling index were sig-nificantly differ among each histologic grade. In addition, abnormal DNA content and high prolif-erative index were frequently identified in anaplastic astrocytoma and glioblastoma multiforme. Therefore, the Ag-NORs counts, PCNA labeling index, DNA index and proliferative index were well correlated with the histologic grade.

Mitral valvular orifice area is important for the evaluation of prognosis and treatment of patients with mitral valvular stenosis. Until recently, Gorlin's formula using cardiac catheterization has been utilized in the measurement of mitral valve area, but it is invasive and impractical to examine repeatedly. Recently 2-Dimensional echocardiography appeared to be a practical and useful substitute in measurement of valve area and also it is economical and has no risk to patients. In 31 patients with mitral valvular stenosis examined at the echocardiography room of Busan national University Hospital from March 1982 to March 1983, we measured the mitral valve area with 2-Dimensional echocardiography and evaluated its relationship with the left ventricular functions measured on M-mode echocardiogram. Among many parameters on M-mode measurements EF slope, excursion amplitude and the ratio of left atrial dimension to aortic root dimension were rather helpful for the assessment of severity of mitral valvular stenosis than other parameters. And each relationship with the valve area showed correlation coefficient of 0.60, 0.05 and -0.58, respectively.
Busan ; Cardiac Catheterization ; Cardiac Catheters ; Constriction, Pathologic* ; Echocardiography* ; Humans ; Mitral Valve* ; Prognosis ; Ventricular Function, Left

Primary malignant melanornn of the vagina is rare, with only about 130 reported cases worldwide. They presumably arise from melanocytes that are present in the vagina in 3% of normal wornen. Vaginal melanoma accounts for less than 1% of melanomas and less than 3% of primary malignant tumors of the vagina. Most of patients complain vaginal bleeding, vaginal discharge, foreign body sensation in order. The best treatment of vaginal melanoma rernains eni.gmatic, Many authors indicate that radical surgery may be the pcferred approach and the number of reported cases treated with radical surgery is increasing. But other author comment that no significant change in survival is apparent with radical surgery. Overall prognosis is poor as most patients have deeply penetrating lesions at the time of diagnosis. Recently, not only the effort to increase the survival rate but the quality of life including sexual function after treatment is becoming an important issue about treatment ot cancer patients. We experienced a case of primary malignant melanoma of the vagina treated with radical surgery and restored the sexual function by vulvovaginal reconstruction using gracilis myocutaneous flap. So we report this case with brief literature review.
Diagnosis ; Foreign Bodies ; Humans ; Melanocytes ; Melanoma* ; Myocutaneous Flap ; Prognosis ; Quality of Life ; Sensation ; Survival Rate ; Uterine Hemorrhage ; Vagina* ; Vaginal Discharge

Minoxidil is a potent direct-acting peripheral vasodilator indicated in the management of severe or refractory hypertension. Well-known adverse effects include reflex tachycardia, fluid retention and hypertrichosis. This drug has also been reported to cause pericardial effusion in about three percent of nondialyzed patients with compromised renal function and to cause cardiac tamponade less frequently. Many studies have reported that the mean duration of therapy that caused pericardial effusion was about 8 months (range 1 month-53 months). We report a case of cardiac tamponade in nondialyzed patient with chronic renal failure receiving minoxidil for 10 years. A 58-year-old female was admitted to our hospital with dyspnea of NYHA III. She was a chronic renal failure patient without dialysis treatment and received kidney transplantation from cadaver donor and was dignosed chronic rejection in 1994. Minoxidil 10mg has been used for past 10 years. Lasix has been used for past 2 years, with dosage of 40mg to 240mg. On admission, blood pressure was 90/60mm Hg. Cardiomegaly was seen on chest radiograph. The two-dimensional echocardiogram showed a large amount of pericardial effusion. Emergency treatment with pericardiocentesis removed 2500ml of straw- colored pericardial fluid and resulted in marked improvement of dyspnea and stabilized blood pressure. The minoxidil was discontinued. The evidence of pericardial effusion was not seen for 12 months after minoxidil had been discontinued.
Blood Pressure ; Cadaver ; Cardiac Tamponade* ; Cardiomegaly ; Dialysis ; Dyspnea ; Emergency Treatment ; Female ; Furosemide ; Humans ; Hypertension ; Hypertrichosis ; Kidney Failure, Chronic* ; Kidney Transplantation ; Middle Aged ; Minoxidil* ; Pericardial Effusion ; Pericardiocentesis ; Radiography, Thoracic ; Reflex ; Tachycardia ; Tissue Donors