In open wounds of the hand that have exposed bone or tendons, management may be difficult. Compared with conventional cutaneous pedicle flaps, the fascial radial flap transfer has several advantages : (1) one operation is required by one operating team reliably and easy to perform, (2) the appearance is not bulky, (3) the donor area is closed primarily, and (4) the hand is free for early motion of the shoulder and the elbow. One potential disadvantage is the permanent loss of the contribution of the radial artery to the circulation of the hand. One case of the fascial radial flap transfer was performed at the Department of Orthopaedic Surgery of Hanyang University Hospital, and satisfactory result was obtained.
Elbow ; Hand ; Humans ; Radial Artery ; Shoulder ; Tendons ; Tissue Donors ; Wounds and Injuries

PURPOSE: Nutritional as well as genetic and hormonal factors play an important role in the bone mineralization during childhood and adolescence. There are several physical and metabolic changes in obese children, and these changes may influence on the mineralization of the skeleton. The studies about bone mineralization of obese children are rare and contradictory. This study was performed to evaluate the influence of childhood obesity on bone mineral density(BMD). METHODS: The BMD of 49 obese and 41 non-obese children were measured at lumbar spines(L2-L4) using dual energy X-ray bone absorptiometry. Then, the results were assessed and compared according to the degree of obesity and pubertal sex maturation. RESULTS: There were no significant differences in BMD between obese children and non-obese children(0.87+/-.19 g/cm2 vs 0.81+/-.13 g/cm2). BMD increased according to the Tanner' pubertal staging, and the most marked increment was observed at overt puberty. No sex difference in BMD was seen in both obese and non-obese children. BMD was highly correlated with age, height, weight and body mass index(BMI), but there was no significant correlation between BMD and osteocalcin. CONCLUSION: BMD of obese children was not significantly different from that of non-obese children, and BMD also was not changed according to the degree of obesity. These findings suggest that BMD is not influenced by obesity in children.
Adolescent ; Bone Density* ; Calcification, Physiologic ; Child* ; Humans ; Obesity* ; Osteocalcin ; Pediatric Obesity ; Puberty ; Sex Characteristics ; Sexual Maturation ; Skeleton

Along with traditional goal of 'straightening teeth', today's orthodontics put more and more emphasis on facial esthetics. Naturally, the importance of soft tissue, which dictates one's facial form, is noticed. There have been many cephalometric studies on growth of hard tissue; however, only a few on that of soft tissue. In Korea, various methods of sampling, measuring and analysing were used to study soft tissue changes, and yet, soft tissue changes along with process of normal growth have not been studied. The author carried out this study as a part of semi-longitudinal study on craniofacial growth and development of Korean children from ages of six to seventeen. 409 boys and 436 girls who'd had no systemic disease for the last three years and shown normal developmental and occlusal status were chosen as subjects. Cephalometric X -rays were taken of each subject, and facial form, lip position & form, nose form, and lip thickness were measured, Mean values and standard deviations were calculated according to age and gender, and figures and tables were drawn accordingly. The following results were obtained: 1. In respect to facial form, boys showed growth for longer period compared to girls. Also, lower face showed higher growth rate than upper face. 2. There was not much change in thickness of upper and lower lips with age; however , they appeared more prominent compared to caucasian children. 3. Nose grew horizontally with age. 4. Horizontal thickness of lower face increased with age, and upper lip thickness at nose base[A-Sn(FH)] showed more growth than anywhere else.
Child* ; Esthetics ; Female ; Growth and Development* ; Humans ; Korea ; Lip ; Nose ; Orthodontics

Background: Multiple endocrine neoplasia type I(MEN I) is a rare, eomplex, and potentially lethal disease. In Korean, only five anecdotal cases were reported as yet. The authors rescently experienced four cases of MEN I, and analysed the clinieal characteristics of MEN I in Koreans. Methods: The authors evaluated nine cases of MEN I, retrospectively. Four cases were analysed by clinical records in patients admitted to Asan Medical Center and five cases were reviewed by previously reported Korean literature from 1986 to 1995. Results: The average age was 39 years(ranged from 33 to 59 years). Eight of the nine patients had hyperparathyroidism documented by elevated serum calcium and PTH level with or without evidence of parathyroid mass. Initial presenting manifestations were symptomatic urinary stone, hypoglycernia due to insulinoma, hypogonadism, acromegaly, or peptic ulcer. Eight of nine patients had pancreatic islet cell tumors, and three of them were be malignant by radiologic and/or pathologic findings. The pancreatic tumors produced various hormones, such as gastrin, insulin, glucagon, or combination of them. Six of the nine cases had pituitary lesion. The most cornmon pituitary tumor was prolactinoma and the remaining was GH or GH and TSH producing tumor. In addition to the major components of MEN I, four had adrenocortical hyperplasia or adenoma and two had carcinoid tumor. There was only one familial case. Conclusion: The clinical charateristics of MEN I in Korean are mostly not different from the previous reports except older age at diagnosis, more comrnon adrenal involvement(44%) and gastrointestinal carcinoid tumor(22%). Although only one case was familial, more cases could be found if careful screening were done for the family members of the MBN I patients. In addition, screening and close follow up for endocrine pancreatic tumors are required for MEN I patients without detectable pancreatic lesion becau~se the malignant potential of pancreatic tumors has beeome an increasing concem for the prognosis of MEN I.
Acromegaly ; Adenoma ; Asian Continental Ancestry Group ; Calcium ; Carcinoid Tumor ; Chungcheongnam-do ; Diagnosis ; Follow-Up Studies ; Gastrins ; Glucagon ; Humans ; Hyperparathyroidism ; Hyperplasia ; Hypogonadism ; Insulin ; Insulinoma ; Islets of Langerhans ; Mass Screening ; Multiple Endocrine Neoplasia Type 1 ; Multiple Endocrine Neoplasia ; Peptic Ulcer ; Pituitary Neoplasms ; Prognosis ; Prolactinoma ; Retrospective Studies ; Urinary Calculi

Primary carcinoma of the pituitary is only rarely reported. About half of the reported cases are nonfunctional. It is generally agreed that the presence of distant metastasis is required to clearly establish the diagnosis of pituitary carcinoma. We have experienced a case of ACTH-producing pituitary carcinoma causing Cushing's syndrome which could be diagnosed by histologic features only without evidence of distant metastasis. A 35-year-old female with Cushingoid appearance was diagnosed as Cushing's disease after biochemical and neuroradiological evaluation. Near total removal of the pituitary tumor was performed. By histopathologic examination, the tumor revealed evidences of histological malignancy such as prominent nuclear pleomorphism, frequent mitoses and extensive tumor necrosis. Pseudosarcomatous components were also noted. By immunohistochemical studies, the tumor cells expressed ACTH. However, there was no evidence of distant metastasis at the initial operation. She was diagnosed as having ACTH producing pituitary carcinoma by histologic feature only. One month later, she complained progressive nausea and vomiting, and follow-up brain MRI revealed regrowing pituitary mass. She was reoperated and near total tumor bulk was removed again followed by radiotherapy with 5580 rads. Four month after the second operation, she developed generalized tonic clonic seizure. Brain CT showed multiple enhancing nodules on left temporal and frontal lobes, and around falx cerebri. She refused further treatment and was managed only with anticonvalsants. About month after discharge she died at home.
Adrenocorticotropic Hormone ; Adult ; Brain ; Cushing Syndrome ; Diagnosis ; Female ; Follow-Up Studies ; Frontal Lobe ; Humans ; Magnetic Resonance Imaging ; Mitosis ; Nausea ; Necrosis ; Neoplasm Metastasis ; Pituitary Neoplasms ; Radiotherapy ; Seizures ; Spinal Cord ; Vomiting

PURPOSE: To determine whether the significant relationship exists between radiographic appearance, whether it is unilocular or multilocular, and its corresponding clinical and histologic features by examining the odontogenic keratocyst clinically, radiologically and histologically. MATERIALS AND METHODS: This study was conducted on 48 cases of odontogenic keratocyst from the files of Dental Hospital, Yonsei University for the years 1982 through 1995. RESULTS AND CONCLUSIONS: The mean age of patients was 30.5 years in the unilocular group and 35.5 years in the multilocular group. The male to female ratio was 1:1.06 in the unilocular group and 1:1.75 in the multilocular group. The chief complaint was swelling in both groups(unilocular 35.1%, multilocular 54.5%). In the occurrence site, the border of the lesion, the displacement and external root resorption of the adjacent teeth, there were no statistically significant difference between the unilocular group and multilocular group, but in the border type, there was statistically significant difference( x2-test, p<0.05). Two recurred cases were observed among 11 cases of odontogenic keratocyst. One was unilocular case and the other was multilocular case.
Female ; Humans ; Male ; Odontogenic Cysts* ; Root Resorption ; Tooth

Several noninfectious pulmonary complications can be associated with chronic graft versus host disease (GVHD). Obstructive airway disease can be a clinical feature of chronic GVHD and the histopathology reveals characteristic lesions of bronchiolitis obliterans. Bronchiolitis obliterans is an obstructive pulmonary disorder affecting the small airways, and it was first described as a late complication of allogeneic bone marrow transplantation (BMT). Spontaneous pneumomediastinum and subcutaneous emphysema can occur in the setting of severe bronchiolitis obliterans and only rarely are they the first sign of such disease. We describe here a case of a 27-year old woman who developed recurrent pneumomediastinum and subcutaneous emphysema that were secondary to the bronchiolitis obliterans that complicated chronic GVHD after allogeneic BMT.
Adult ; Bone Marrow Transplantation* ; Bone Marrow* ; Bronchiolitis Obliterans ; Female ; Graft vs Host Disease* ; Humans ; Mediastinal Emphysema* ; Subcutaneous Emphysema* ; Transplants*

PURPOSE: To clarify the clinical and radiologic parameters that can be used to differentiate odontogenic keratocyst and ameloblastoma MATERIALS AND METHODS: The records of 46 patients of ameloblstoma and 48 patients of odontogenic keratocyst at the Yonsei University Dental Hospital during the period of 1979 to 1995 were retrospestively reviewed. As a possible means for differentiating between the odontogenic keratocyst and ameloblastoma, the clinical parameters and the radiologic parameters were evaluated. RESULTS: In the clinical parameters, there was no significant defference in age, sex, and sign and symptoms(p>0.05).In the radiologic parameters, there was significant difference in site, shape of the lesion, and external root resorption of adjacent teeth(p<0.05). CONCLUSION: The site, shape of the lesion, and external root resorption of adjacent teeth can be the parameters to differentiate odontogenic keratocyst and ameloblastoma, but a definite differentiation of these two lesions needs a more specialized imaging modality.
Ameloblastoma* ; Diagnosis, Differential* ; Humans ; Odontogenic Cysts* ; Root Resorption ; Tooth

There are several reports suggesting Helicobacter pylori can initiate and perpetuate idiopathic thrombocytopenic purpura (ITP) and eradication of H. pylori can increase the platelet counts, however, the prevalence of H. pylori infection in patients with ITP is similar to that found in the general population and a recovery of thrombocytopenia after H. pylori eradication therapy has not been identified reliably. We report three different cases of H. pylori infected patients with ITP who recovered completely after eradication of H. pylori. The first case was refractory, the second was recurred after conventional treatment for ITP, and the third was treated with H. pylori eradication on first line treatment. We believe that the eradication of H. pylori is useful in some patients with ITP in Korea and well controlled randomized study is necessary for further identification of such population.
Helicobacter ; Helicobacter pylori ; Humans ; Korea ; Platelet Count ; Prevalence ; Purpura, Thrombocytopenic, Idiopathic ; Thrombocytopenia

BACKGROUND: Rapid adrenocorticotropin (ACTH) stimulation test using 250ug of ACTH (1-24) has been used as a standard test in the initial assessment of adrenal function. However, it has recently been suggested that a rnaximal cortisol response can be achieved with a much lower ACTH dose, and reducing the dose might further enhance the sensitivity of the test in the detection of mild adrenal insufficiency. This study was performed to evaluate the role of low-dose (lug) ACTH stimulation test in the assessment of adrenal function and the diagnosis of subtle adrenal insufficiency. METHODS: Twenty-two subjects with suspected adrenal insufficiency due to long-term corticosteroid use were included in this study. The correlations between clinical features and the serum cortisol responses to low dose (lug) and high dose (250 ug) ACTH stimulation were evaluated. RESULTS: In high dose test, 10 (67%) out of 15 subjects with clinical features of adrenal insufficiency showed decreased serum cortisol response (peak cortisol level <18 ug/dL), but 5 (33%) subjects showed normal response (peak cortisol level > 18ug/dL). On the other hand, 14 (93%) subjects with clinical features of adrenal insufficiency showed decreased serum cortisol response in low dose test, while only one showed normal response. In 7 subjects without clinical features of adrenal insufficiency, 5 subject (71%) showed normal response, and 2 subjects (29%) showed decreased response in both low and high dose tests. CONCLUSION: These results suggest that the 1-ug low dose ACTH stimulation test might be more sensitive than conventional 250-ug test in the detection of mild adrenal insufficiency. Further studies are needed to determine the optimal dose of ACTH and the criteria for normal response to ACTH stimulation.
Adrenal Insufficiency* ; Adrenocorticotropic Hormone* ; Cosyntropin ; Diagnosis* ; Hand ; Hydrocortisone