The treatment of massive bone and soft tissue defect in the lower leg has a high complication rate of nonunion, chronic infection, and amputation without well-vascularized tissue coverage of the open fracture. Despite adequate free soft tissue coverage, massive skeletal defect may result in segmental bone defects, angulation deformity, and limb length discrepancies. In the last decade, major advances have occurred in the Ilizarov method of distraction osteogenesis in lower leg salvage as a delayed procedure or simultaneous distraction after free-tissue transfer. The authors have performed Ilizarov transport in conjunction with muscle and musculocutaneous flap coverage in nine cases of lower leg salvage. The flaps consist of rectus, gracilis, latissimus dorsi, parascapular, and serratus muscle or musculocutaneous fashioning using ipsilateral or contralateral pedicle in consideration of vessel condiation. Revision, recorticotomy and flap elevation were also used as a secondary procedure for satisfactory results. The conclusions, were as follows: 1) Multidisciplinary team approach with conjoining departments at the time of preoperative evaluation, postoperative care and rehabilitation care; 2) Muscle flap covered with split-thickness skin graft was preferred to musculocutaneous flap; 3) To reduce the total reconstructive period, simultaneous free tissue transfer with Ilizarov distraction should be considered.
Amputation ; Congenital Abnormalities ; Extremities ; Fractures, Open ; Ilizarov Technique ; Leg* ; Myocutaneous Flap ; Osteogenesis* ; Osteogenesis, Distraction ; Postoperative Care ; Rehabilitation ; Skin ; Superficial Back Muscles ; Transplants

The hyperimmunoglobulin E syndrome is a primary immunodificiency disorder characterized by recurrent staphylococcal infections and markedly elevated serum IgE level. Clinical features are coarse face and severe infections of the skin-furunculosis or chronically pruritic dermatitis and sinopulmonary tract infection from infancy by coagulase positive Staphylococcus aureus, or Candida albicans etc. The patients's serum IgE level is elevated but the basic immunologic pathogenesis not fully understood. We have experienced a case of hyperimmunoglobulin E syndrome in a 26/12-year-old who had suffered from recurrent staphylococcal pneumonias and abscesses and chronically pruritic dermatitis from 1 month of age with elevated serum IgE level. A brief review of the related literature is presented.
Abscess ; Candida albicans ; Coagulase ; Dermatitis ; Immunoglobulin E ; Pneumonia, Staphylococcal ; Staphylococcal Infections ; Staphylococcus aureus

PURPOSE: The purpose of this study was to identify post-operative discomfort, sense of loss, family support, and resilience in breast cancer surgery patients, and to investigate factors that affect resilience.METHOD: The sample of this study consisted of 108 patients who underwent surgery for breast cancer in two university hospitals located in B city. The collected data was analyzed with descriptive statistics, t-test, ANOVA, and Scheffé test, Pearson's correlation coefficients, and hierarchical multiple regression.RESULTS: The factors that significantly affected resilience were as follows: having a religion (β=-.20, p=.006), having an occupation (β=.14, p=.049), having a high school diploma (β=.31 p=.001), making less than 2–3 million won (β=-.19, p=.036) per month, experiencing a sense of loss (β=-.22, p=.003) and family support (β=.44, p < .001). The total explanatory power amounted to 53.8% (F=14.83, p < .001, AdjR²=.54).CONCLUSION: Educational intervention programs for breast cancer surgery patients that improve resilience by reducing the sense of loss and increasing family support must be developed.
Breast Neoplasms ; Breast ; Hospitals, University ; Humans ; Methods ; Occupations

Since 1949, lithium has been widely used for treatment of manic depressive disorder. It has also been used for agranulocytosis after anticaneer chemotherapy and partially for hyperthyroidism. But it is well known that the long term administration of this drug is associated wih various antithyroid effects such as hypothyroidism, simple goiter, nodules and even thyrotoxicosis. Although the exact mechanism for leading hypothyroidism or goiter is still unknown, the incidence of lithium-induced hypothyroidism is 1-37% during lithium atment. We had an experience of newly developing goiter with or without hypothyroidism during lithium treatment in 4 MDP patients. Among our patients, the duration of lithium administration was from 0.7 months to 11 years, and the development of thyroid abnormality was impossible to predict. They were treated with thyroxine while lithium was discontinued causing favorable outcome. We suggest that routine thyroid function test include thyroid autoimmune antibody screening in patients planning to undergo lithium treatment.
Agranulocytosis ; Antithyroid Agents ; Depressive Disorder ; Drug Therapy ; Goiter* ; Humans ; Hyperthyroidism ; Hypothyroidism ; Incidence ; Lithium Carbonate* ; Lithium* ; Mass Screening ; Thyroid Function Tests ; Thyroid Gland ; Thyrotoxicosis ; Thyroxine

Down syndrome is perhaps the most common genetic condition associated with mental retardation. In cytogenetic examination, trisomy 21 is in 95% of Down syndrome, and the others are mosaicism, translocation or deletion. There are many associated diseases with Down syndrome such as, thyroid function abnormality, congenital heart disease, intestinal blockage, and so on. Hypothyroidism appeared in 15% before adolescent in Down syndrome patients. In Korea, there were several reports of Down syndrome with hypothyroidism in childhood but not in adulthood. And we had three cases of hypothyroidism with Down syndrome in adulthood. Cytogenetic examination revealed trisomy 21 in the 2 cases and 1 case of mosaicism. Antithyroid antibody was positive in one case. None of these cases was admitted due to symptoms of hypothyroidism. It is very difficult to make the diagnosis of hypothyroidism in Down syndrome because of similarity in symptoms between Down syndrome and hypothyroidism. Thus, periodic thyroid function test should be made in Down syndrome, and this could be a part of improving quality of life in Down syndrome.
Adolescent ; Adult* ; Congenital Abnormalities ; Cytogenetics ; Diagnosis ; Down Syndrome* ; Heart Diseases ; Humans ; Hypothyroidism* ; Intellectual Disability ; Korea ; Mosaicism ; Quality of Life ; Thyroid Function Tests ; Thyroid Gland

It was known that lateral view of caucasian's face is projected roundly, however, that of Asian's face is flat relatively. The aim of this study was to investigate the facial depths of Korean and to find the existence of the difference with Caucasian. We used the standardized photographs of 852 individuals (559 men, 293 women) of Korean young adults between 20~39 years old and measured items using image analyzer. Measurement items were five anterior-posterior lengths between points from tragion to sellion, pronasale, subnasale, stomion, and gnathion. The facial depth of the Korean showed no significant difference based on laterality. Items such as tragion-sellion length, tragion-pronasale length, and tragion-subnasale length were showed minor difference according to gender. As results that compared upper, middle, and lower facial depths with caucasian, Korean had generally short facial depths. The lateral shape of face of Korean showed relatively flat, because the lower facial depth was longest due to projection of mandibular part especially.
Humans ; Male ; Young Adult

Background: Although an ambulatory surgical practice continues to increase, there is a few data exist about patient discharge criteria. This study was undertaken to evaluate the usefulness and safety of Aldrete PAR (postanesthetic recovery) score and modified PADSS (modified postaneathesia discharge scoring system) on ambulatory surgery patients for recovery in Korea. Methods: Demographic, anesthetic data, Aldrete PAR score and modified PADSS on 279 patients were recorded. The time to dicharge, from recovery room and postoperative complications were evaluated, also. Results: PAR score and modified PADSS are correlated to length of stay in ambulatory surgery center. 24hr after discharge, 16% patients complained postoperative complications. Pain was most frequent postoperative complication. The PAR score was correlated with the occurrence of the complication. Conclusion: PAR score and modified PADSS are useful scoring systems to evaluate patients and make a decision to discharge the patients from ambulatory surgery center in safe.
Ambulatory Surgical Procedures* ; Humans ; Korea ; Length of Stay ; Patient Discharge* ; Postoperative Complications ; Recovery Room

Hypoglycemia due to non-islet cell tumor is usually associated with hypersecretion of big insulin-like growth factor II (IGF-II). This big IGF-II cannot form ternary IGF complex, and is biologically more active in peripheral tissue, inducing increased glucose utilization and hypoglycemia. A 57-year-old man developed severe hypoglycemia due to hepatocellular carcinoma. To control hypoglycemia, the patient required continuous glucose infusion. The circulating levels of cortisol and free T4 were in the normal range. The plasma levels of insulin, C-peptide, IGF-I, IGF binding protein-3 (IGFBP-3), and total IGF-II levels were decreased. Radioimmunoassay of IGF-II revealed that big IGF-II immunoreactivity markedly increased compared to that of normal control. In this patient, it was strongly suggested that big IGF-II might be a cause of severe intractable hypoglycemia.
C-Peptide ; Carcinoma, Hepatocellular ; Glucose ; Humans ; Hydrocortisone ; Hypoglycemia* ; Insulin ; Insulin-Like Growth Factor I ; Insulin-Like Growth Factor II* ; Middle Aged ; Plasma ; Radioimmunoassay ; Reference Values

The diagnosis of acute inflammation of the placenta, represented as acute chorioamnionitis, is important in that it is associated with a poor clinical outcome for both the mother and the fetus, including major perinatal morbidities such as sepsis, respiratory distress syndrome, and CNS damage. However, current medical trends in Korea seem to overlook the significance of a histopathological diagnosis of acute placental inflammation, mainly due to the indifferences of clinicians and pathologists. Since late 1993, histopathological examinations have been performed on preterm placentas at Seoul National University. These examinations have demonstrated acute placental inflammation in a significant number of cases. In the present study the incidence of acute placental inflammation was analyzed in 521 placentas which were submitted for pathological examinations in 1995. Examinations were performed to provide basic information on the incidence and profile of acute placental inflammation in this hospital and, thereby, to emphasize the significance of histopathological examinations of the placenta in the routine surgical pathology service. Among the 521 placentas, acute inflammation was found in 194 cases (37.2%). In preterm placentas acute inflammation was found in 39.6% of the cases (67/169), while 36.1% (127/352) of term placentas showed acute inflammation. Taking the delivery mode into account, 26.3% (49/186) of the placentas delivered by cesarean section showed acute inflammation, while 43.3% (145/335) of the transvaginally delivered placentas showed inflammation. The present analysis demonstrates the existence of acute inflammation in a significant proportion of placentas with different clinical settings. The importance of a histopathological examination in routine hospital practice should be emphasized.
Incidence

SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome designates a group of articular and osseous manifestations frequently combined with skin disorders. Its fundamental component is inflammatory, pseudoinfectious, and sterile osteitis. The anterior chest wall is the most frequent localization and all the components of this structure may be involved. Palmoplantar pustulosis, psoriasis, acne conglobata, acne ulcerans, acne fulminans, pyoderma gangrenosum can be associated with the characteristic bone lesions. We report two cases of SAPHO syndrome : A 40-year-old female presented with both buttock pain with hyperostosis, costochondritis, synovitis and pustulosis palmaris and a 23-year-old male presented with migrating polyarthritis with costochondritis, synovitis, acne, pustulosis.
Acne Vulgaris ; Acquired Hyperostosis Syndrome* ; Adult ; Arthritis ; Buttocks ; Female ; Humans ; Hyperostosis ; Male ; Osteitis ; Psoriasis ; Pyoderma Gangrenosum ; Skin ; Synovitis ; Thoracic Wall ; Young Adult