The development of the microvascular surgery revolutionalized the reconstructive surgery of the lower ext tremity. Especially, the defects of the heel and sole, the weight bearing area, were quite difficult and complicate to reconstruct by conventional methods. Many papers reported successful resurfacing the heel pad by free cutaneous or myocutaneous flaps. However, only few reports were conceming the late results of the reconstructed free flaps. The authors studied the histological and histochemical changes of the free flaps under the weight bearing stress in 10 cases. 1. The authors reconstructed 10 cases of the heel pad defects by dorsalis pedis free Aaps (5 cases) and latissimus dorsi myocutaneous flaps(5 cases). 2. Before transfer, the homy layer was very thin(about 0.16–0.2 mm) and had an arrangement of basket-weave pattem in both flaps. Until one year after transfer, this layer was wom out (0.02–0.08mm) However, after one year, this layer became thick (0.05–0.7 mm) and the arrangement was compact in both free flaps. 3. The granular and prickle cell layers were also increased in thickness after one year. 4. In the suprabasilar area, friction blisters were observed before one year, especially in latissimus dorsi myocutaneous flap. However, they slowly disappeared after one year and then the epidermis was stabilized. 5. In the dermis, the contents of the amyloid and acid mucopolysaccharides were increased up to the level of those of the normal heel pad in both flaps. 6. As a conclusion, the transferred free flaps were in distress before one year. But after one year, they began to adapt well histologically and histochemically to the weight bearing stress.
Amyloid ; Blister ; Dermis ; Epidermis ; Follow-Up Studies ; Free Tissue Flaps ; Friction ; Glycosaminoglycans ; Heel ; Myocutaneous Flap ; Superficial Back Muscles ; Weight-Bearing

No abstract available.
Animals ; Rats* ; Sepsis*

OBJECTIVE: To evaluate the viability and the characteristics of shed endometrial tissues obtained from menstrual fluid during in-vitro culture. METHODS: The menstrual fluids were collected using Wallace catheter from uterine cavity in 10 women with regular menstruation. The menstrual fluids were washed twice, and the pellets, containing blood cells and shed endometrium, were collected and diluted fivefold with Ham's F-10 medium containing 10% fetal bovine serum. The cell suspension was placed on culture dishes, and cultured for 7 days in an incubator. To evaluate the characteristics of the cultured endometrial cells, immunohistochemical (IHC) staining was performed using anti-cytokeratin and anti-vimentin antibody. RESULTS: The mean volume of menstrual fluids and pellets were 0.7ml and 0.3ml, respectively. Only 15% of the shed endometrial tissues were attached and proliferated in culture dishes, which was considered to have viability. Initially, endometrial epithelial cells and fibroblasts were attached and proliferated, and the area of these cells was increased according to prolong the culture time. Stromal cell colonys were located and proliferated on the epithelial cells. IHC staining showed strongly positive for cytokeratin in epithelial cells and for vimentin in stromal cells. In the confocal microscopic observation of 3-dimensional structure of cultured endometrium, cytokeratin-positive cells (epithelial cells) were located in the pheriphery and cytokeratin-negative cells (stromal cells) inside of the structure. CONCLUSION: From our study, shed endometrial tissues in menstrual fluid showed meaningful viability and closed relationship between epithelial cells and stromal cells during in-vitro culture. Thus, we suggest that the in-vitro culture system of shed endometrium is a suitable model for researches of endometriosis.
Blood Cells ; Catheters ; Endometriosis ; Endometrium ; Epithelial Cells ; Female ; Fibroblasts ; Humans ; Incubators ; Keratins ; Menstruation ; Stromal Cells ; Vimentin

Neutrophilic eccrine hidradenitis(NEH) was originally described in 1982 by Harrist et al. in a patient with myelogenous leukemia receiving chemotherapy. Clinically NEH represents various cutaneous manifestations with or without tenderness and pruritus. Histologic examination demonstrates a neutrophilic infiltrate within and around the eccrine gland and degeneration of the eccrine gland structures. Although the pathogenesis and possible cause of NEH remain unknown, it is probably an unusual cutaneous reaction to chemotherapeutic agents. A few cases of infection associated eccrine hidradenitis are found in the literature. We report three cases of neutrophilic eccrine hidradenitis. Two cases were associated with hematologic malignancy. The third case was associated with an infection of Vibrio vulnificus.
Drug Therapy ; Eccrine Glands ; Hematologic Neoplasms ; Hidradenitis* ; Humans ; Leukemia, Myeloid ; Neutrophils* ; Pruritus ; Vibrio vulnificus

OBJECTIVES: The purpose of this study was to use decision tree analysis to explore the factors associated with pressure ulcers (PUs) among elderly people admitted to Korean long-term care facilities. METHODS: The data were extracted from the 2014 National Inpatient Sample (NIS)—data of Health Insurance Review and Assessment Service (HIRA). A MapReduce-based program was implemented to join and filter 5 tables of the NIS. The outcome predicted by the decision tree model was the prevalence of PUs as defined by the Korean Standard Classification of Disease-7 (KCD-7; code L89*). Using R 3.3.1, a decision tree was generated with the finalized 15,856 cases and 830 variables. RESULTS: The decision tree displayed 15 subgroups with 8 variables showing 0.804 accuracy, 0.820 sensitivity, and 0.787 specificity. The most significant primary predictor of PUs was length of stay less than 0.5 day. Other predictors were the presence of an infectious wound dressing, followed by having diagnoses numbering less than 3.5 and the presence of a simple dressing. Among diagnoses, “injuries to the hip and thigh” was the top predictor ranking 5th overall. Total hospital cost exceeding 2,200,000 Korean won (US $2,000) rounded out the top 7. CONCLUSIONS: These results support previous studies that showed length of stay, comorbidity, and total hospital cost were associated with PUs. Moreover, wound dressings were commonly used to treat PUs. They also show that machine learning, such as a decision tree, could effectively predict PUs using big data.
Aged ; Bandages ; Classification ; Comorbidity ; Data Mining ; Decision Trees* ; Diagnosis ; Hip ; Hospital Costs ; Humans ; Inpatients ; Insurance, Health ; Length of Stay ; Long-Term Care* ; Machine Learning ; Pressure Ulcer* ; Prevalence ; Risk Factors* ; Sensitivity and Specificity ; Suppuration ; Wounds and Injuries

BACKGROUND: Urticaria pigmentosa(UP) is primarily a disease of children. There have been no clinical studies of UP in Korea. OBJECTIVE: This study was performed to find the clinical characteristics of UP in Korean child-hood patients. METHOD: Twenty-nine cases of urticaria pigmentosa confirmed clinically and histopathologically were analyzed. RESULTS: The maculopapular type was the most common with the usual age of onset before the age of 6 months, and the lesions tended to be distributed in the central portion of the body. Darier sign was positive in 92% of the patients(24/26). No systemic involvements were detected in any of the patients with minimal associated symptoms. Seven patients of the maculopapular type and one patient of the multiple nodular type followed up for more than 2 years showed a tendency to improve or clear by the age of 6 years. CONCLUSION: Neonatal or infantile-onset patients of UP in Korean pediatric population were considered to have a benign clinical course and to require no aggressive therapy.
Age of Onset ; Child* ; Clinical Study* ; Humans ; Korea ; Methods ; Urticaria Pigmentosa* ; Urticaria*

The ankle joint is a modified complex hinge joint which plays an important role in weight bearing, walking and standing. Hence, the ankle injuries include not only fractures of bone but often also the rupture of ligaments and soft tissues, so if the structures were not accurately repaired, many complications may be developed. The authors have reviewed a series of 70 cases of ankle fractures which were treated in department of orthopaedic surgery of Inha hospital from January 1988 to February 1992. Among the seventy cases, 41 patients (59.4%) were male, and 28 patients (40.6%) were female. Average age was 41.4 years and 3 cases (4.35%) were open fracture. The most common cause was slipping 34 cases (48.6%) and the other causes were traffic accident 23 cases (32.9%), fall from height 6 cases (8.6%), direct blow 5 cases (7.0%) and sports injury 2 cases (2.9%) in order. The rusults obtained form this study were as follows. l. According to the classification fo Lauge-Hansen, the most common fracture mechanism was supination-external rotation injury (24 cases: 34.4%). 2. Among them, 51 cases were treated by operative treatment and 19 cases by conservative treatment. 3. Ten cases (14.3%) in this series were complicated; traumatic arthritis in 7 cases, infection in 2 cases and nonunion 1 case. 4. Open reduction and internal fixation and early anatomical reduction were better than closed reduction and delayed reduction. 5. The incidence of traumatic arthritis occured higher in the cases treated with closed method.
Accidents, Traffic ; Ankle Fractures ; Ankle Injuries ; Ankle Joint ; Ankle ; Arthritis ; Athletic Injuries ; Classification ; Female ; Fractures, Open ; Humans ; Incidence ; Joints ; Ligaments ; Male ; Methods ; Rupture ; Walking ; Weight-Bearing

From July 1989 to February 1993, twelve patients were analysed for infected bone loss which treated with radically debriding all infected dead bone and closed suction-irrigation system with antibiotics and internal lengthening by using the external fixator. The results are summarized as follows. 1, The average time for application of external fixation was 30.7 weeks in tibia, 27 weeks in femur and average time for bone union was 31.5 weeks in femur, 34.2 weeks in tibia. 2. Soft tissue defects were treated with split thickness skin graft in 6 cases, secondary closure in 4 cases, gastrocnemius rotational flap in 2 cases. 3. The length of bone defects after infected bone excision ranged from 2cm to 9.3cm, averaging 4.5cm. The bone defect was treated by internal lengthening after corticotomy with the Ilizarov apparatus in 4 cases, the Orthofix external fixator in 8 cases. 4. Four cases in this series were complicated; one pin tract infection, one angulation deformity, one checkrein deformity, one flexion contracture of knee joint. 5. Infection was managed with radical debriding infected dead bone and closed suction-irrigation system with antibiotics in all cases. 6. We recommend that the infected bone loss can be effectively managed with radically debriding dead bone and closed suction-irrigation system with antibiotics and lengthening with Ilizarov apparatus or Orthofix external fixator.
Anti-Bacterial Agents ; Congenital Abnormalities ; Contracture ; External Fixators ; Femur ; Humans ; Knee Joint ; Skin ; Tibia ; Transplants

Intertrochanteric fractures of femur were increasing in their incidence in morden life. The compression hip screw and Ender nail are popular treatment modalities of the interochanteric fracture of femur. We had tried to clarify the complications of intertrochanteric fracture according to the treatment modality-compression hip screw and Ender nail. We obtained the results as followings with the patients who had intertrochanteric fracture of femur which were managed by compression hip screw (56 cases) and Ender nail (22 cases) through the period of March 1987 to June 1993. The summary of the results; 1. Mechanical complications were developed in 9 patients(16%), 9 complications in the group with compression hip screw and 7 patients(32%), 12 complications in Ender nail. 2. Local complications were developed in 4 patients(7%) in compression hip screw and 10 patients (46%) in Ender nail and the most common local complication was the knee joint pain(7 patients; 32%). 3. Statistically, more significant decrease of neck-shaft angle was shown with group using Ender nail for unstable fracture than stable fracture group and compression hip screw group. 4. The degree of shortening was incrased in group with Ender nail than in group with compression hip screw, but there was no statistical significance. 5. The grade of osteoporosis was not related to the change of neck-shaft angle and shortening and also to the development of mechanical complication. According to the above results, compression hip screw was a more stable fixation device than Ender nail in the unstable intertrochanteric fracutre.
Femur ; Hip ; Hip Fractures ; Humans ; Incidence ; Knee Joint ; Osteoporosis

There have long been a lot of controversies on the treatment of unstable thoracolumbar spine fracture, and the role of decompression is also controversial. Compression of the neural elements by retropulsed bone fragments can be relieved indirectly by the reduction with posterior instrumentation or directly by the exploration of the spinal canal through a posterolateral or anterior approach. There is no universal agreement about the indications for each of these method. Authors analyzed the result of 24 cases of thoracolumbar spine fracture which had been operated by anterior decompression and Kaneda instrumentation from the February 1990 to May 1993 at Inha general hospital. The results were as follows: 1. The most common cause of injury was falling from a height, 20 cases (83.3%). And the 12 cases were in the 4th decade, with an average age of 37.7 years. 2. According to McAfee classification, there were 7 stable(29.2%) and 15 unstable bursting fractures(62.5%). And the most common level of injury was L1(11 cases, 45.8%). 3. Neurologic status was improved one or more grade(Frankel grade) in 21 cases except one case of complete paraplegia. 4. The average correctional angle of kyphotic deformity was 13.1° immediate postoperatively, and the loss of correction(average, 6.7°) was observed during the follow-up period. 5. The segmental instability was found at the level below the fusion in three cases during the follow-up period. 6. There was neither failure of instrument, dislodgement of graft bone nor lateral wedging during the follow-up period.
Accidental Falls ; Classification ; Congenital Abnormalities ; Decompression ; Follow-Up Studies ; Hospitals, General ; Methods ; Paraplegia ; Spinal Canal ; Spine ; Transplants