The TRAM flap provides the safe creation of a durable, soft, natural-appearing breast mound and has thus become the most popular method of breast reconstruction. On the other hand, the rectus muscle can be used as a good donor site for a flap reconstruction in trauma or osteomyelitis cases on the lower extremity. The abdominal sequelae, including abdominal wall dysfunction after free rectus muscle transfer, was evaluated. Thirty-seven patients underwent free TRAM (n=29) or rectus abdominis muscular free flap(n = 8) operations between 1994 and 1997. In harvesting of the TRAM flap, a muscle-splitting technique was used and thus one-quarter of the muscle was preserved. In rectus muscular free flap, the entire width of the rectus abdominis muscle was harvested. Among the 37 patients, 26 patients (20 free TRAM flap and 6 rectus muscular free flap) were studied, for they were followed up postoperatively for at least 6 months and had provided preoperative data of abdominal strength. Cosmetic results of the abdomem were appraised by four independent judges on photographs taken of 26 patients. The global appearance of the abdomen was rated as "natural" in 75%. The scar on the umbilicus and lower abdomen was rated as acceptable or not visible in 65%. The replies to questionnaires were analyzed Patient self-assessment showed general satisfaction. In 24 of 26 answers, they said they would recommend the operation to others, and 70% of the patients found their abdominal strength and sports ability the same or improved. Thirty percent of the patients complained that back pain developed or became aggravated after surgery. Abdominal muscular strength was tested both preoperatively and 6 months to 1 year period after surgery according to Lacote. The abdominal wall function was impaired, especially in the upper rectus and external oblique muscle. In conclusion even though the abdominal sequelae after free TRAM or rectus muscular free flap reconstruction should not be urderestimated, no problem of clinical significance was encountered, and patients showed a high degree of satisfaction with the operation
Abdomen ; Abdominal Wall ; Back Pain ; Breast ; Cicatrix ; Female ; Free Tissue Flaps* ; Hand ; Humans ; Lower Extremity ; Mammaplasty ; Osteomyelitis ; Surveys and Questionnaires ; Rectus Abdominis* ; Self-Assessment ; Sports ; Tissue Donors ; Umbilicus

Skin graft has been widely used for facial skin reconstruction. Inguinal area is the common donor site for full-thickness skin graft of various area. Especially for facial skin graft, retroauricular area or upper eyelid skin has been used as a donor site. But these donor sites have some limitations as perfect ones in terms of size, color and texture when applied onto facial area. Even retroauricular skin shows color and texture differences from normal facial skin after it is grafted. Authors performed expansion of the skin of preauricular area or forehead where minimal scars would come out after final operation. We harvested this expanded skin and performed skin graft following excision of nevus, poor scar, or hemangioma in face.We achieved satisfactory results in terms of color and texture by applying this method in 11 clinical cases; 4 cases of hemangioma, 4 nevus, and 3 cases of traumatic scar. Donor site scars were clinically inspicuous in all these 11 cases.
Cicatrix ; Eyelids ; Forehead* ; Hemangioma ; Humans ; Nevus ; Skin* ; Tissue Donors ; Transplants*

The management of malignant left colon obstruction remains a difficult problem. Conventional surgical treatment is muti-staged and each stage carries its own morbidity and mortality. The purpose of this study is to identify the feasibility and safety of one stage operation in patients presenting with acute obstruction of the left colon. From January 1991 to June 1996, 29 patients received one stage resection for acutely obstructed carcinoma of the left colon at Soonchunhyang University Chunan Hospital. Subtotal colectomies were performed in 9 patients(31.0%), left hemicolectomies in 6(20.7%), low anterior resection in 6(20.7%), sigmoid colectomy in 4(13.8%), anterior resection in 4 patients(13.8%). Subtotal colectomy was performed in patients with massively distended colon of dubious viability and to contain ischemic lesions at proximal colon. Total operative mortality was 6.9%: 5% in the immediate resection with anastomosis group, 11.1% in subtotal colectomy group. Complications included wound infection(4), fecal incontinence(2), intestinal obstruction(2), anastomotic leakage(1), upper G-I bleeding(1), postoperative bleeding(1), pulmonary complication(1). Our results suggest that resection and primary anastomosis can be performed with acceptable morbidity and mortality in patients with acute malignant obstruction of the left colon.
Chungcheongnam-do ; Colectomy ; Colon* ; Colon, Sigmoid ; Humans ; Mortality ; Wounds and Injuries

No abstract available.
Collagen Type I* ; Skin* ; Wound Healing* ; Wounds and Injuries*

BACKGROUND: Maligant pleural effusions are common and significant problems in patient with advanced malignancies. In comparison with traditional sclerosing agent, intrapleural chemotherapy has a potential advantage of treating the underlying malignancy in addition to providing local control of th effusion. This study evaluated efficacy of intrapleural chemotherapy with cisplatin and cytarabine in the management of malignant pleural effusion from lung cancer and others. METHODS: 29 patients with pathology-proven malignant pleural effusion were prospectively analyzed to estimate the effect of intrapleural chemotherapy. A single dose of cisplatin 100mg/m plus cytarabine 1200mg/m in the 250ml normal saline were instilled into the pleural space via a chest tube and drained 4 hours later. Patients were evaluated for toxicity and response at 24hours, 1st, 2nd, 3rd week, and monthly interval. No recurrence of the effusion was considered a complete response(CR). Partial responses (PR) was defined as a 75% or greater decrease in the amount of effusion on serial chest radiographs. RESULTS: The overall response rate(CR plus PR) was 93.1% (27 of 29 patients). The median length of response was 7.5 months. Among 17 patients who were assessable until they died, 14 patients(82%) maintained complete response at the last follow-up. One patient experienced reversible grade 4 myelosuppression, 3 patients had grade 3 nausea & vomiting. 2 patients had empyema, and 2 patients had wound infection. CONCLUSIONS: The outcome of this trial indicated that the intrapleural chemotherapy with cisplatin and cytarabine with little treatment related mortality and morbidity.
Chest Tubes ; Cisplatin* ; Cytarabine* ; Drug Therapy* ; Empyema ; Follow-Up Studies ; Humans ; Lung Neoplasms ; Mortality ; Nausea ; Pleural Effusion ; Pleural Effusion, Malignant* ; Prospective Studies ; Radiography, Thoracic ; Recurrence ; Vomiting ; Wound Infection

Nephrogenic systemic fibrosis is a systemic illness that only affects patients with kidney failure. Exposure to gadolinium-based contrast agents has been associated with the subsequent development of nephrogenic systemic fibrosis in patients with decreased renal function. Nephrogenic systemic fibrosis is characterized by skin induration after swelling and limited joint movement through a loss in flexibility that preferentially affects the extremities. A 58-year-old man in peritoneal dialysis developed swelling and stiffness of the lower limbs following gadolinium exposure for brain magnetic resonance imaging. This patient was diagnosed with nephrogenic systemic fibrosis by CD34 immunoreactivity of subcutaneous fibroblasts in a skin biopsy. We report, for the first time in Korea, that nephrogenic systemic fibrosis developed after gadolinium exposure in a peritoneal dialysis patient.
Biopsy ; Brain ; Contrast Media ; Extremities ; Fibroblasts ; Gadolinium ; Humans ; Joints ; Korea ; Lower Extremity ; Magnetic Resonance Imaging ; Middle Aged ; Nephrogenic Fibrosing Dermopathy ; Peritoneal Dialysis ; Pliability ; Renal Insufficiency ; Skin

OBJECTIVES: To evaluate the patterns of changes in maternal weight and fetal weight discordance in twin pregnancies during consecutive gestational periods. METHODS: A retrospective chart review was done for a total of 148 twin pregnancies taken care of throughout pregnancies between February 2002 and May 2004. They were divided into two groups; group A consisting of 109 cases without postnatal complications and with no more than 25% twin weight discordance at birth, and group B consisting of 39 cases with more than 25% twin weight discordance. Both ultrasound examination and maternal weight measurement were conducted in the three gestational intervals; between prepregnant times to gestational age 18 weeks, between gestational ages 18 to 28 weeks, and from gestational age 28 weeks to delivery. RESULTS: Except for maternal weights, none of the pregnancy factors such as maternal age, parity, gravity, height, prepregnant weight, duration of pregnancy, natural or artificial pregnant status, gender and chorionicity showed any significant difference by means between the two groups. The maternal BMI of the group A vs. the group B at the first, the second, and the third period were 0.53+/-0.10% and 2.01+/-1.28%, 2.97+/-0.11% and 4.84+/-1.23%, and 3.29+/-0.16% and 2.15+/-0.63% respectively. Inter-twin weight discordances between the two groups were 8.29+/-0.67% vs. 11.26+/-1.25 %, 7.79+/-0.05% vs. 11.03+/-1.36%, and 9.07+/-0.55% vs. 32.79+/-1.13%, respectively. CONCLUSIONS: Although several factors that affect twin weight discordance may be considered, we showed that the pattern of maternal weight gain during the gestational period is associated with the estimated values of twin weight discordances in the first gestational period.
Chorion ; Female ; Fetal Weight ; Gestational Age ; Gravitation ; Humans ; Maternal Age ; Parity ; Parturition ; Pregnancy ; Pregnancy, Twin ; Retrospective Studies ; Twins* ; Ultrasonography ; Weight Gain ; Weights and Measures

This study aims to investigate the status of agricultural injuries and to suggest measures to prevent and to manage them. To determine the scale of agricultural injuries in Korea, fatal injury data were analyzed by securing from the Annual Report on the Cause of Death Statistics and moderate to severe injuries were analyzed from the Emergency Department-based Injury Surveillance System (EDBISS). Nationwide data on minor injuries were analyzed from the Korea National Health and Nutrition Examination Survey (KNHANES), the Korean Working Condition Survey (KWCS), and the Farmers Survey of Occupational Injuries and Illness. The SMR of farmers was significantly higher than that of other occupations. When the distribution of severity of injury was investigated from the EDBISS data, the injury severity of farmers was higher than that of other occupations. The rate of industrial injuries from the KWCS data was 4.51% in skilled agricultural and fishery workers, which was around twice as high as those of craft and related trade workers (2.27%) and plant and machine operators and assemblers (2.13%). The occupational injury reporting rate from KNHANES was the second highest, or 4.3%, in skilled agricultural and fishery workers, following that of plant and machine operators (6.2%), while the rates of manual workers, sales and service workers, clerks and professionals, and managers and administrators were 3.5%, 3.0%, 2.7%, and 2.1%, respectively (P<0.001). Social concern over this issue, a reporting system for occupational injuries, preventive measures such as safety education programs, and an accident compensation system are needed to prevent and manage agricultural injuries.
Administrative Personnel ; Agriculture ; Cause of Death ; Commerce ; Compensation and Redress ; Emergencies ; Fisheries ; Humans ; Korea ; Nutrition Surveys ; Occupational Injuries ; Occupations ; Plants

PURPOSE: This study was conducted to determine the correlation between the incidence of chronic lung disease and the combined use of gentle ventilation and high-frequency ventilation. METHODS: The subject group consisted of 63 very low birthweight infants of less than 1500gm who were born and survived through ventilator treatment in the Fatima neonatal intensive care unit for four years from January 1995 to December 1998. The analysis was performed retrospectively with medical records. Ventilator treatment was based on the combined use of gentle ventilation and high-frequency ventilation by means of the flow interruptor type of Infant star. High- frequency ventilation was carried out for 24 hours after surfactant replacement, when PaCO2 exceeded 60mmHg, or if the period of gentle ventilation exceeded one week. When the results of arterial blood gas analysis and the state of the body became stable, the aggressive weaning was performed. RESULTS: For 49(77.8%) of 63 infants, the weaning was possible within seven days. The other 14 infants(22.2%) needed ventilator treatment for more than seven days. The mean duration of ventilator treatment was 12.3 days. The causes of weaning failure included sepsis, patent ductus arteriosus, chronic lung disease, and intraventricular hemorrhage. Two infants who had received ventialtor treatment for more than two weeks were found to have incidence of chronic lung disease. CONCLUSION: It is suggested that the combined use of gentle ventilation and high-frequency ventilation can help reduce pulmonary damage, and it will be important to shorten the period of ventilator treatment.
Blood Gas Analysis ; Ductus Arteriosus, Patent ; Hemorrhage ; High-Frequency Ventilation ; Humans ; Incidence* ; Infant ; Infant, Newborn ; Intensive Care, Neonatal ; Lung Diseases* ; Lung* ; Medical Records ; Retrospective Studies ; Sepsis ; Ventilation* ; Ventilators, Mechanical ; Weaning

There has been a dramatic increase in the number and type of procedures performed in the field of cardiac intervention in the past decade. Percutaneous intervention is becoming an increasingly recognized modality for the management of prosthetic paravalvular leakages (PVLs) in severely symptomatic non-surgical candidates. Herein, we report our experience of percutaneous closure using the Amplatzer duct occluder for a PVL in a patient who underwent tricuspid valve replacement.
Heart Valve Prosthesis ; Humans ; Septal Occluder Device ; Tricuspid Valve ; Tricuspid Valve Insufficiency