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

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

From January 1988 to December 1991, 39 fractures of the lateral condyle of humerus in children were treated at the Department of Orthopaedic Surgery, Sung-Ac General Hospital. It was possible to follow up from one year to four years and eleven months. The authors have analyzed the method of treatment on the basis of the degree of displacement in the change of Carrying angle and Baumann's angle. The results were as follows; 1. Of the 39 cases, the age incidence was confined to 2 to 12 years of age and the average age of the patients were 5 years. 2. Most fractures were Milch type II (29 cases) in contrast to Milch type I (10 cases). 3. According to the initial displacement of the fracture, 8 cases were Jokob's stage I, 21 cases of stage II & 10 cases of stage III. 4. There were no significant difference in the range of change of Carrying angle and Baumann's angle according to initial displacement of fracture site. However, significant difference in outcome were noticed from open reduction and internal fixation in comparison to closed reduction and percutaneous pinning. 5. In all 39 cases, lateral condylar overgrowth (10 cases), cubitus varus (1 cases) and cubitus valgus (3 cases) were noticed as complications but clinical significance was not noted. 6. The above results suggest that internal fixation is recommended for firm fixation although displacement is not severe. In case of Jakob's stage III, anatomical reduction is required in order to reduce additional damage on articular surface and epiphyseal plate caused by excessive manipulation.
Child ; Clinical Study ; Follow-Up Studies ; Growth Plate ; Hospitals, General ; Humans ; Humerus ; Incidence ; Methods

Congenital fibrosarcoma of neonate is a very rare malignant tumor prone to behave aggressively with a tendency to local recurrence without metastasis. It is characteristically composed of collagenous fibroblasts and herringbone pattern in histology. We experienced a case of congenital fibrosarcoma on the left thigh and report this case with some review in literature with 1½ year follow up.
Collagen ; Fibroblasts ; Fibrosarcoma ; Follow-Up Studies ; Humans ; Infant, Newborn ; Neoplasm Metastasis ; Recurrence ; Thigh

STUDY DESIGN: Literature review. OBJECTIVE: Ultrasound-guided injections are a common clinical treatment for lower lumbosacral pain that are usually performed before surgical treatment if conservative treatment fails. The aim of this article was to review ultrasound-guided injections in the lumbar and sacral spine. SUMMARY OF LITERATURE REVIEW: Ultrasound-guided injections, unlike conventional interventions using computed tomography or C-arm fluoroscopy, can be performed under simultaneous observation of muscles, ligaments, vessels, and nerves. Additionally, they have no radiation exposure and do not require a large space for the installation of equipment, so they are increasingly selected as an alternative method. MATERIALS AND METHODS: We searched for and reviewed studies related to the use of ultrasound-guided injections in the lumbar and sacral spine. RESULTS: In order to perform accurate ultrasound-guided injections, it is necessary to understand the patient's posture during the intervention, the relevant anatomy, and normal and abnormal ultrasonographic findings. Facet joint intra-articular injections, medial branch block, epidural block, selective nerve root block, and sacroiliac joint injections can be effectively performed under ultrasound guidance. CONCLUSIONS: Ultrasound-guided injections in the lumbar and sacral spine are an efficient method for treating lumbosacral pain.
Fluoroscopy ; Injections, Intra-Articular ; Ligaments ; Methods ; Muscles ; Posture ; Radiation Exposure ; Sacroiliac Joint ; Spine ; Ultrasonography ; Zygapophyseal Joint

OBJECTIVE: Ultrasound-guided injections are a common clinical treatment for lower lumbosacral pain that are usually performed before surgical treatment if conservative treatment fails. The aim of this article was to review ultrasound-guided injections in the lumbar and sacral spine.SUMMARY OF LITERATURE REVIEW: Ultrasound-guided injections, unlike conventional interventions using computed tomography or C-arm fluoroscopy, can be performed under simultaneous observation of muscles, ligaments, vessels, and nerves. Additionally, they have no radiation exposure and do not require a large space for the installation of equipment, so they are increasingly selected as an alternative method. MATERIALS AND METHODS: We searched for and reviewed studies related to the use of ultrasound-guided injections in the lumbar and sacral spine. RESULTS: In order to perform accurate ultrasound-guided injections, it is necessary to understand the patient's posture during the intervention, the relevant anatomy, and normal and abnormal ultrasonographic findings. Facet joint intra-articular injections, medial branch block, epidural block, selective nerve root block, and sacroiliac joint injections can be effectively performed under ultrasound guidance. CONCLUSIONS Ultrasound-guided injections in the lumbar and sacral spine are an efficient method for treating lumbosacral pain.

In 25 aortic regurgitation patients relationship between degree of aortic regurgitation graded by 2-D color Doppler echocardiography and diastolic fluttering of anterior mitral leaflet on M-mode echocardiography was evaluated. The results were that all 13 aortic regurgitation patients, not associated with mitral stenosis, showed diastolic fluttering of anterior mitral leaflet; but only 3 patients among 12 patients (25%), associated with mitral stenosis, had characteristic mitral fluttering. On the whole, regardless of associated mitral stenosis, the sensitivity was 64%. In severe aortic regurgitation (Grade 3, 4 group) 12/13 patients revealed diastolic fluttering of anterior mitral leaflet (sensitivity of 92%); in mild to moderate aortic regurgitation (Grade 1, 2 group), only 4/12 patients (sensitivity of 33%). In conclusion, 2-D color Doppler echocardiography is a very useful method for detection of aortic regurgitation without difficulty. And in aortic regurgitation, not associated with mitral stenosis, fine fluttering of anterior mitral leaflet is a very sensitive sign of existence of aortic regurgitation, though there may be some false positive findings in normal individuals.
Aortic Valve Insufficiency* ; Echocardiography ; Echocardiography, Doppler, Color* ; Humans ; Mitral Valve Stenosis

To evaluate the clinical significance of anomalous pancreaticobiliary ductal union(PBDU), we analysed 11 cases(0.19%) of anomalous PBDU among 5675 cases performed ERCP from Jan. 1973 to Aug. 1992. According to the classification of Kimura et al., 4 cases were type 1(P-C union) and 7 cases type 2(C-P union). The length of common channel ranged from 1.5 cm to 3.1 cm(mean 1.9 cm). The common associated disease were choledochal cyst(7 cases), carcinoma of the gallbladder(5 cases) and biliary stone(3 cases). Four cases of carcinoma of the gallbladder were type 1. The incidence of anomalous PBDU was significantly higher in cases with carcinoma of the gallbladder(5 cases among 49 cases) than in case without carcinoma of the gallbladder(6 cases among 5626 cases). And the incidence of gallbladder carcinoma(45%) among the 11 cases of anomalous PBDU was significantly higher than that(0.78%) among those who did not have anomalous PBDU. In conclusion, the common associated diseases with the anomalous PBDU were choledochal cyst, carcinoma of the gallbladder and stone, and the anomalous PBDU may be risk factor in the development of carcinoma of the gllbladder.
Cholangiopancreatography, Endoscopic Retrograde* ; Choledochal Cyst ; Classification ; Gallbladder ; Incidence ; Risk Factors

PURPOSE: The surgical treatment of anal stenosis includes internal sphincterotomy, rotaton flap and advancement flap according to the stenosis degree, recently, Christensen performed house shaped advancement flap and reported fair results. We compared and analyzed the surgical methods and results in patients with moderate and severe anal stenosis who underwent house shaped advancement flap and C-anoplasty. METHODS: We have performed this study with 6 cases using the house shaped advancement flap and 6 cases using the C-anoplasty. The out come was assessed by clinical characteristics, surgical method, operation time, duration of hospitalization, healing time, postoperative complications, results. RESULTS: The average operation time was 38 min in those house shaped advancement flap cases and 63 min in C-anoplasty cases. The average time of hospitalization was 6 days and 9 days, respectively, and the average time of healing was 28 days and 46 days, respectively. In those house advancement flap cases, surgery could be done in 2 directions at the same time in 4 cases and 3 directions in 2 cases; as for those C-anoplasty cases, surgery could be done in 1 direction in 4 cases and 2 directions in 1 case. Two complications were observed in C-anoplasty, one flap infection and one flap necrosis, and in house shaped advancement flap, no complication was observed. CONCLUSIONS: House shaped advancement flap have several advantages compared to the C-anoplasty, and since house shaped advancement flap could be performed in 2 to 3 directions or even 4 directions at the same time, the anus could sufficiently expanded in severe anal stenosis patients. The house shaped advancement flap might be one of the good method in treating anal stenosis.
Anal Canal ; Constriction, Pathologic* ; Hospitalization ; Humans ; Necrosis ; Postoperative Complications

We analyzed 5,504 ICU patients who were admitted between Mar. 1985 and Feb. 1989 to obtain better guidance and management in the ICU. The results of analysis are as follows ; 1) The total number of patients was 5,504; 792 patients in 1981, 771 patients in 1986, 1,036 patients in 1987, 1.393 patients in 1988, and 1.512 patients in 1989. There were continual increment annually since 1986, and 95% increment in 1989 compared to 1985. 2) The male patients were 3,681 and female patients were 1,823, and the ratio of male to female patients was about 2:1. The most frequent age group was 40-49 and the rate of which was 23.%. 3) The mean admission day was 5.9 days. There were continual increment annually and 13.3 % increment in 1989 compared to 1985, The number of patients stayed in the ICU for 1-2 days was highest and the rate of which was 36.1%. 4) The number of patients of neurosurgical department was 49.5% being the highest among all the patients. 5) The mortality rate was 10.4% and shows decreasing tendency annually. The mortality rate of 1-2 admission day was highest (13.3%). In age distribution, the mortaUty rate under the 10 years old was highest (17.4%) and in distribution by department, highest in the pediatric patients (24.5%). From the above results, we can conclude that in spite of increase in number of patients and admission days, the mortality rate has decreased annually due to improved equipments, support of nursing care, and specially qualified staffs.
Age Distribution ; Child ; Female ; Gangwon-do* ; Humans ; Intensive Care Units* ; Critical Care* ; Male ; Mortality ; Nursing Care