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

There are several rnethods to correct the tibial bony defect including resection, cement filling, autograft or allograft and metal augmentation. The purpose of this study is to find the adequate treatment method of tibia bony defect through analysis of the result with above methods. From Sep. 1993 to Dec. 1997, the authors analyzed 93 cases of tibial medial bony defect corrected by overresection of lateral condyle, allograft and metal wedge or block among 358 cases of primary total knee arthroplasty(TKA) operated at Asan Medical Center. All cases were devided into four groups according to the treatment method; group A(31 cases) with overresection of lateral condyle, group B(37 cases) with metal wedge, group C(21 cases) with metal block and group D(4 cases) with allograft. The mean follow up period was 23.6 months(12 56 months). The results were as follows, 1. There were no definite statistical difference between group A, B, C and D in HSS knee score, ROM, correction of deformity. But in group D, there is one case of loss of the correction. 2. Loosening of the implant was not noted, but 17 cases of mild bony resorption was found just beneath the implant. It was particularly prominent in group B(9 cases) than group A(5 cases) and C(3 cases). 3. Among 4 cases of allograft, one has developed collapse of allograft. 4. 3 cases of deep infection developed only in group C, which were followed by revision TKA. Although further follow up study should be carried out, we concluded that resection of lateral tibial condyle, allograft, metal augmentation is a good substitute to the correction of the tibial bony defect in primary TKA.
Allografts ; Autografts ; Chungcheongnam-do ; Congenital Abnormalities ; Follow-Up Studies ; Knee ; Tibia

No abstract available.
Fanconi Anemia*

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

PURPOSE: Fragile X syndrome is an X-llinked genetic disorder and is characterized by mental retardation, learning disability, behavior disorder, and autism with typical elongated face, large ears, and macro-orchidism. Recent reports have focused attention on the EEG finding of this syndrome, which is a particular paroxysmal pattern during sleep (mono or diphasic centrotemporal spikes) and awake state (background slowing). In this study, we analyzed the clinical characteristics of fragile X syndrome patients and observed whether a particular EEG pattern is associated with this syndrome or not. METHODS: 7 cases of fragile X syndrome, diagnosed at Sowha Children's Hospital and Cha General Hospital from August 1993 to February 1995, were analyzed retrospectively in terms of typical phenotypes and clinical & EEG characteristics. The patients were diagnosed by Southern blotting and polymerase chain reaction (PCR) method. RESULTS: 1) The subjects were all male and the mean age was 5.8 years old (2Y-11Y). 2) Typical phenotype of long elongated face, macro-orchidism, large ears, and large head are noted in 2/3 of the subject. 3) Developmental delay, mental retardation, learning disability, attention deficit, hyperactivity, and autism are noted in 2/3 of the subject. 4) Seizure is noted in one case and EEG was performed in 6 cases, regardless of the presence of seizures. Abnormal findings including centrotemporal sharps and background slowing are noted in one case, each. 5) By molecular diagnostic methods including Southern blotting and PCR, 3 cases of affected male and 4 of normal transmitting male were diagnosed. CONCLUSIONS: 1) The typical phenotype of fragile X syndrome is long elongated face, macro-orchidism, large ears and large head. 2) The non-physical characteristics of fragile X syndrome are developmental delay, mental retardation, learning disability, attention deficit, hyperactivity, and autism. 3) The characteristic EEG findings of fragile X syndrome known by literature are noted in 2 among 6 cases, which means the specificity is high even though the sensitivity is low. This allows us to propose this EEG pattern as an important "marker" in the diagnosis of fragile X syndrome. However, the number of the subject is too small to conclude now. Further accumulation of cases is reguired.
Autistic Disorder ; Blotting, Southern ; Diagnosis ; Ear ; Electroencephalography* ; Fragile X Syndrome* ; Head ; Hospitals, General ; Humans ; Intellectual Disability ; Learning Disorders ; Male ; Pathology, Molecular ; Phenotype ; Polymerase Chain Reaction ; Retrospective Studies ; Seizures ; Sensitivity and Specificity

In 1984, Gustilo subgrouped type III open fracture into III a, III b and III c according to the severity, soft tissue damage and vascular injury. Type III c open fracture presents serious problems especially possible amputation due to vascular insufficiency, so emergency vascular surgery with bone fixation by using plate, IM nail fixator is mandatory. We reviewed 10 cases of type III c open fracture of the forearm and evaluated the bone healing process according to fixation method, intramedullary nailing and plating treated at Orthopaedic Department of Sung-Ae General Hospital from Feb. 1986 to Aug. 1988. The folliwing results were obtained: l. All cases were industrial accidents, 9 cases in right, and the mean age was 24.1 ranging from 17 to 34. 2. There were 4 cases of the radial & ulnar artery rupture and 6 cases of the radial artery rupture, 7 cases were treated end to end anastomosis and 3 cases with vein graft. 3. The fracture level of ulna & radius was same in all cases, 7 cases in distal one-third, 2 cases in middle one-third and 1 case in proximal one-third. 4. The average time of union was 14.1 weeks in the radius and 14.5 weeks in the ulna. 5. The fixation methods were plating in 7 cases and IM nailing in 3 cases. 6. The complications were non-union in 1 case, osteomyelitis in 2 cases and refracture in 1 case. 7. The functional result was excellent in 1 case, satisfactory in 3 cases, unsatisfactory in 5 cases, and failure in 1 case according to the rating system of Anderson.
Accidents, Occupational ; Amputation ; Emergencies ; Forearm ; Fracture Fixation, Intramedullary ; Fractures, Open ; Hospitals, General ; Methods ; Osteomyelitis ; Radial Artery ; Radius ; Rupture ; Transplants ; Ulna ; Ulnar Artery ; Vascular System Injuries ; Veins

Fractures of the tibia are frequently encountered in mordern civilized society. Especially, those in distal 1/3 of the tibia have so many problems, such as angular deformity, osteomyelitis and nonunion because of anatomically scanty soft tissue. Many modalities of the treatment of fracture of distal 1/3 of the tibia were introduced. Among them, interlocking IM nailings were considered as one of the best modality. But, in interlocking IM nail, reaming of the medullary canal which destroys the endosteal circulation and causes thermal necrosis of the inner aspect of the cortical bone results in delayed union. And also, procedure for distal screw fixation is difficult and time-consuming. As for using flexible IM nails for fractures of distal 1/3 of the tibia, it was considered as not so satisfactory method due to lack of stability of fixation. However, the stability of fixation can be strengthened with fanning of the nails in distal fragment, using more than 3 nails and delay the protected weight bearing. Authors studied 25 cases of fractures of distal 1/3 of the tibia treated with closed flexible IM nailing at Sung Ae General Hospital, from July., 1987 to July., 1989, and obtained following results: 1. Among 25 cases, 4th decades were most common and males were more commonly involved. 2. Traffic accidents were the most common causes of injury and majority of 16 open fractures and 19 comminuted fractures, were caused by high energy mechanism. Among open fractures, type II were most common. 3. Two angular deformities less than 10 degrees, one proximal migration and one checkrein deformity were observed as complications, but, no clinically significant complications were noted. 4. The time for radiological union were 14.5 weeks in group without fibular fracture and 15.1 weeks in group with fibular fracture, and 14.0 weeks in closed fracture group and 17.2 weeks in open fracture group, and average in 15.6 weeks.
Accidents, Traffic ; Clinical Study ; Congenital Abnormalities ; Fractures, Closed ; Fractures, Comminuted ; Fractures, Open ; Hospitals, General ; Humans ; Male ; Methods ; Necrosis ; Osteomyelitis ; Tibia ; Weight-Bearing

The expression of nm23-H1, nm23-H2, p53, c-myc, cyclin D1, and k-ras genes were investigated in TCDD transformed human keratinocyte RHEK1 cells by exposure to UVB 200 J/m2. For 3 days after irradiation the transcriptional kinetics of these genes were evaluated. The expression of nm23-H1 and H2 were highly increased at 6 hours post-irradiation and recovered in about 3 days to level of pre-irradiation. In cyclin D1 there was a temporary increased expression at 3 hours post-irradiation, but after that time its expression increased minimally. The kinetic of p53 expression was not constant, but showed a decreased tendency. K-ras expression level was decreased by degrees. The decrease in c-myc expression might be related to wavelength-specific induction. In this experiment, S-phase prolongation was a typical alternation in early phase after UVB irradiation. The decreased p53 and k-ras expression and the increased expression of cyclin D1 pushed G1-epsilonS phase transition, and during prolonged S-phase the increased expression of nm23-H1 and H2 might be involved in cell cycle progression, suggesting a function concomitant with prolongation of S-phase after UVB irradiation. TCDD transformed human keratinocyte RHEK1 cell line had 2 heterogeneous cell clones, near diploid and hypotetraploid, and were more resistant against UVB irradiation than RHEK1 cell line. And it had S-phase prolongation instead of G1 arrest in response to UVB irradiation, which may have negative effect to be accumulated DNA mutation without DNA repair.
Blotting, Northern ; Cell Cycle ; Cell Line ; Clone Cells ; Cyclin D1 ; Diploidy ; DNA ; DNA Repair ; Genes, ras ; Humans* ; Keratinocytes* ; Kinetics ; Phase Transition ; Tetrachlorodibenzodioxin*

No abstract available.
Kallmann Syndrome*

No abstract available.
Blotting, Southern*