Free flaps have been widely used in lower leg reconstruction. However, in cases with extensive injury to the vessels as well as to the bone and soft tissues, and having only one intact major vessel in the lower leg(single vessel leg), careful selection of recipient vessels for the free flap transfer is mandatory for preventing further vascular compromise of the distal lower leg. The sural artery and its vena comitantes are frequently protected form externally harmful forces by the bulky surrounding gastrocnemius muscle and can be used as recipient vessles for free flaps without any detrimental influence on the vascularity of the distal lower leg. In our department, three latissimus dorsi muscle free flap were transferred with sural vessels as recipient vessels in the reconstruction of the single vessel legs. Except for one case of flap failure due to serious infection at the microvascular anastomoses site, all the other cases were successfully reconstructed without any necrosis of the gastrocnemius muscle or the distal leg. In addition, the sural vessels were easily accessed in any patient position and their caliber was similar to that of the vascular pedicles of the donor muscle flaps. In conclusion, the sural vessels can be another useful option in selecting recipient vessels for free flap transfer in the reconstruction of the single vessel leg.
Arteries ; Free Tissue Flaps* ; Humans ; Leg* ; Muscle, Skeletal ; Necrosis ; Superficial Back Muscles ; Tissue Donors

Scars on anterior chest after operative correction of funnel chest have been the challenging problem despite introduction of refined techiniques by numerous authors. From December 1996 to September 1998, the authors have performed prefabricated silicone implant insertion in eight female patients presenting funnel chest, using transaxillary approaches instead of substernal or inframammary incisions. In two of eight patients, augmentation mammaplasty was performed simultaneously. Except one case of seroma occurred in early stages, all eight cases of pectus excavatum were satisfactorily reconstructed by this technique. All eight patients expressed their satisfaction with the results during the follow-up visits made between 3 months and 3 years. In conclusion, endoscopic transaxillary approach for the scarless anterior chest can be useful technique in aesthetic correction of the funnel chest.
Cicatrix ; Female ; Follow-Up Studies ; Funnel Chest* ; Humans ; Mammaplasty ; Seroma ; Silicones* ; Thorax

BACKGROUND: The aim of this study was to evaluate the sensitivity of a clinicians' self-report method for the detection of nosocomial infections (NIs) in comparison with a total surveillance method in a neonatal intensive care unit (NICU). METHODS: Two surveillance methods were concurrently performed in the NICU of a university hospital during 5 months in 2003. Clinicians' self-report surveillance (CSRS) was based on the retrospective verification of monthly reports of positive bacteriologic results by NICU clinicians. Total surveillance (TS) was done prospectively by an infection control nurse based on chart review and laboratory data. RESULTS: One hundred fifty nine patients accounting to 2759 patient-days were included in the study. Twenty-seven NIs among 26 patients were identified by TS. The sensitivity of CSRS compared to TS was 14.8% (4 of 27 NIs). The specificity was 98.5% (131 of 133 non-NIs). Kappa measures of agreement were -0.309. CONCLUSIONS: Our results confirm that the retrospective review of charts and laboratory data by clinicians lacks sensitivity and agreement for the surveillance of nosocomial infections.
Cross Infection* ; Humans ; Infant, Newborn ; Infection Control ; Intensive Care, Neonatal* ; Prospective Studies ; Retrospective Studies ; Sensitivity and Specificity

No abstract available.

No abstract available.

No abstract available.
Candidemia* ; Humans

Accessory renal artery (ARA) is a kind of developmental anomaly in renal artery. It is important in respect to clinical medicine, for example primary hypertension, renovascular disease, inferior vena caval obstruction, ureteral obstruction, occurrence of other vascular anomalies such as accessory renal veins, surgical importance and renal transplantation. However, up to few research of ARA was reported in dissection of cadavers. In our dissecting theater, 12 accessory renal arteries for 10 cadavers were found during dissection the 22 cadavers from 1995 to 1996. 1. Two cases were bilateral and 8 cases were unilateral accessory renal arteries. 2. Seven cases were left and 5 cases were right accessory renal arteries. 3. Two cases originated at the abdominal aorta between celiac trunk and superior mesenteric artery, 7 cases originated between superior mesenteric artery and inferior mesenteric artery, and 3 cases originated below inferior mesenteric artery. 4. Seven cases have no branches during their courses, 4 cases have 3 branches, and a case has 2 branches. 5. Seven cases entered into renal parenchyma through renal hilum, 5 cases entered into apical and arterosuperior segments, and 6 cases entered into inferior segment.
Aorta, Abdominal ; Cadaver ; Clinical Medicine ; Hypertension, Renovascular ; Kidney Transplantation ; Mesenteric Arteries ; Mesenteric Artery, Inferior ; Mesenteric Artery, Superior ; Renal Artery* ; Renal Veins ; Ureteral Obstruction

BACKGROUND: The HBV-PCR assay seems to be potentially valuable diagnostic tool for the evaluation of variable serologic status. However, the selection of the primer for HBV-PCR test may be very important because they can influence the HBV-PCR positivity. METHODS: We compared the results of primer HBV1/2 including famous 1896 and 1899 mutation sites with those of primer PHBV1/2 at precore/core region. HBV-PCR was tested in 87 HBsAg-positive patients using two sets of primers. The results were evaluated according to the primers and also compared the results with the clinical diagnosis and the alanine aminotransferase (ALT) level. RESULTS: The positive rate of PHBV primer was higher than HBV primer including mutation sites (nucleotide 1896 and 1899) in HBeAg-negative patients. According to the clinical diagnosis, the sensitivity of PHBV primer was higher than that of HBV primer in chronic hepatitis patients. There was no significant correlation between ALT level and HBV-PCR results. CONCLUSIONS: It is important that the selection of primer in HBV-PCR is important, because the primer including mutation sites may result in false negative results. PHBV primer used in this study could be useful for the detection of HBV-DNA by HBV-PCR.
Alanine Transaminase ; Diagnosis ; Hepatitis, Chronic ; Humans ; Polymerase Chain Reaction*

Backgound: The aim of this study was to compare the levels of perception of and compliance with handwashing between the groups of direct patient contact and indirect contact in a tertiary-care university hospital. METHODS: A cross-sectional study was conducted in a university hospital with 4,500 employees. A questionnaire, containing questions on demographic data and the perception of and compliance with handwashing, was distributed to and collected from a total of 1,087 employees from June 25 to July 10, 2005. RESULTS: The study subjects washed their hands an average of 11.2 times (range, 1-100) per day: nurses washed their hands more frequently than others. The average duration of handwashing by employees was 18.8 seconds. Those in the direct patient contact group scored significantly higher points than did those in the indirect contact group in both perception (P<.021) of and compliance (P<.001) with handwashing. CONCLUSION: Education for handwashing is needed direction employees who have indirect contact with patients to improve their compliance with handwashing.
Compliance* ; Cross-Sectional Studies ; Education ; Hand ; Hand Disinfection* ; Humans ; Surveys and Questionnaires

Objectives: This study aimed to assess the antibacterial, bactericidal, and mouth freshener effects of lysozyme hydrochloride 0.01%, sodium fluoride 0.02%, and cetylpyridinium chloride 0.05%. Methods: Eight oral disease-related bacteria were cultivated anaerobically. Four samples were prepared with or without 0.5% cetylpyridinium chloride, 0.2% sodium fluoride, and 0.1% lysozyme hydrochloride. Antimicrobial activity was tested in 96-well microplates. After assessing the bacterial count, the bacterial suspension was mixed with samples and spread on agar. The bactericidal rate was calculated by counting and comparing treated and untreated colonies. Results: Lysozyme hydrochloride 0.01%, sodium fluoride 0.02%, and cetylpyridinium chloride 0.05% mouth fresheners sterilized 99.99% of 8 oral bacteria, including Streprococcus mutans. Lysozyme hydrochloride 0.01%, sodium fluoride 0.02%, and cetylpyridinium chloride 0.05% mouth fresheners showed 99.97% bactericidal activity against Lactobacillus acidophilus. Conclusions Lysozyme hydrochloride 0.01%, sodium fluoride 0.02%, and cetylpyridinium chloride 0.05% mouth fresheners confirmed the sterilization and antibacterial effects on oral disease-causing bacteria.