It would be naive to assume that any operative procedure is the solution to the problem of sacral pressure sore in the field of the orthopaedic surgery. The procedures outlined here involve the creation of compound myocutaneous flaps of the gluteus maximus muscle, skin, and the subcutaneous tissue. The myocutaneous flap us- ing the gluteus maximus muscle is a vascular flap instead of a random flap, with better blood supply for healing and advantage of an increased amount of cushion effect. We present an alternative method which will provide satisfactory and substantial soft tissue coverage in sscral pressure sores.
Methods ; Myocutaneous Flap ; Pressure Ulcer ; Skin ; Subcutaneous Tissue ; Surgical Procedures, Operative

No abstract available.
Humans ; Muscular Dystrophies*

No abstract available.
Muscle Spasticity* ; Paraplegia*

No abstract available.
Down Syndrome* ; Leukemia, Megakaryoblastic, Acute*

Rectovagianl fistula(RVF) is a congenital or acquired communication between the two epithelial-lined surface of the rectum and the vagina. We present our experience with 62 patients with RVF. There were various etiologies and repair methods of rectovaginal fistula. The purpose of this study was to retospectively review the clinical course of the patients we treated and to evaluate the efficacy of various treatment options. The mean age was 40.5 yr, The type of RVF was classified to one of two(simple and complex), according to their location, size and etiology. RVF was developed most commonly after radiotherapy due to cervical cancer(n=17), then after pelvic surgery due to malignancy(n=16), obstetric trauma after episiotomy at delivery(n=7), congenital malformation(n=4), inflammatory bowel disease(n=1), Bechet's disease(n=1), infections such as perianal fistula or abscess(n=2), direct invasion of carcinoma(n=3), after chemotherapy(n=1), and idiopathic(n=6). Three cases of them associated with rectovesicovaginal fistula. Surgical therapeutic option was divided to local repair, abdominal approach and tissue transposition by the type of RVF. Most simple RVFs were repaired with local approach through the vagina or rectum. Most complex RVFs were repaired through abdominal approach or tissue transposition. With an average follow up of 20 months, the treatment results were as follows: completely healed(n=36, 58.1%), persistent symptom(n=6, 9.7%), recurrence after repair(n=5, 8.1%), loss of search or death(n=15, 24.1%). Therefore we assist that the management of RVF depends on size, location, and cause. anal sphincter function and overall health status of the patient. Careful preoperative assessment of the fistula, surrounding tissues, and anal sphincter and exclusion of associated disease are essential. With through evaluation, thoughtful consideration of treatment options, and meticulous operative technique, patient can be assured of an optimal outcome.
Anal Canal ; Episiotomy ; Female ; Fistula ; Follow-Up Studies ; Humans ; Radiotherapy ; Rectovaginal Fistula* ; Rectum ; Recurrence ; Vagina

No abstract available.

No abstract available.
Extremities* ; Limb Salvage* ; Tendons*

The calcaneal fractures, the most common tarsal bone fracture are one of the difficult fractures in diagnosis and treatment because of its anatomic complexity and fracture pattern. The authors had taken pre-operative computed tomographies(CTs) and plain X-rays on calcaneal fractures prospectively since March 1992 and the calcaneal fractures were classified according to fracture patterns and locations. Twenty nine fracture were treated with open reduction and internal fixation. Following open reduction and internal fixation of displaced fractures mostly involving posterior facet of subtalar joint or closed reduction with axial pinning by Essex-Lopresti method, we have taken CT on 32 fractures and analyzed anatomic status and observed the relationship between anatomic status and clinical results. The results were as follows: 1. According to Sanders classification, type II was the most common(69%), and then type III(22%), type IV(6%), type I(3%) in frequently. 2. In the relationship between preoperative CT classification and postoperative reduction state, reduction state was in case of more communication. 3. We can expect excellent or good result when the postoperative displacement is within 2mm. 4. The Sanders classification appears to be helpful in predicting prognosis since preoperative CT significantly influenced the clinical outcome, as noted in the relationship between preoperative CT and clinical results.
Classification ; Diagnosis ; Methods ; Prognosis ; Prospective Studies ; Subtalar Joint ; Tarsal Bones

We evaluated the association between body mass index (BMI) and the prevalence of asthma. Using data from the 2015 Korean Community Health Survey, 214,971 participants aged between 19 and 106 years were included in this study. Asthma was defined based on the self-report of physician diagnosis. BMI was classified as underweight (<18.5 kg/m²), normal weight (18.5 kg/m²≤BMI<23.0 kg/m²), overweight (23.0 kg/m²≤ BMI<27.4 kg/m²), and obese (≥27.5 kg/m²) based on the BMI categories for Asians by the World Health Organization. Multiple logistic regression analysis was performed with sampling weights to evaluate the association between BMI and asthma after adjusting for age, educational level, income, type of residential area, smoking status, alcohol consumption, physical activity, hypertension, and diabetes. In men, BMI had an inverted J-shaped association with the prevalence of asthma, with an odds ratio of 1.88 (95% confidence interval [CI]: 1.89–2.24) for underweight and 1.12 (95% CIs: 0.97–1.29) for obesity. In women, BMI had a J-shaped association with the prevalence of asthma, with an odds ratio of 1.05 (95% CIs: 0.91–1.22) for underweight and 2.29 (95% CIs: 2.06–2.56) for obesity. In conclusion, in a nationally representative sample of Korean adults, the association between BMI and the prevalence of asthma varied between the sexes. This suggests that malnutrition and obesity are involved in the pathophysiology of asthma.

PURPOSE: Study purposes were to exam effects of self-care education for children with type 1 diabetes on their diabetes management behaviors and to explore the relationship among diabetes management behaviors, knowledge, self-efficacy and clinical variables. METHODS: This study was a one group quasi-experimental study. Study participants were children with type 1 diabetes and attended a four hour self-care education of a diabetes camp. Data were collected using structured questionnaires including Diabetes Management Behavior Scale (DMBS), Michigan Diabetes Research and Training Center's Brief Diabetes Knowledge Test and Self-Efficacy for Diabetes Self-Management. RESULTS: The mean age of the participants was 12 (+/-2.3) years. After the education, their DMBS and knowledge improved, but the improvement was not statistically significant (t=1.758, p=.101; t=0.528, p=.606). Two areas of DMBS, daily prevention behaviors and modification of care plan, were associated with study variables. Daily prevention behaviors were associated with duration of diabetes (r=.653, p=.008), HbA1c (r=.563, p=.038) and having a complication (r=-2.788, p=.015). Modification of care plan was associated with age at diagnosis (r=-.552, p=.033). CONCLUSION: Children with type 1 diabetes could improve some parts of their diabetes management behaviors even after a short diabetes camp.
Child* ; Diabetes Mellitus, Type 1 ; Diagnosis ; Disease Management ; Education* ; Humans ; Michigan ; Self Care* ; Self Efficacy