Microsurgical reconstruction is necessary for children to correct severe trauma and congenital or acuqired deformity. The aim of this study was to evaluate whether or not microsurgical reconstruction is a safe and reliable operation in children and to analyze the differences of microsurgical reconstruction in children compared to adults. The study included 12 children who underwent 13 microsurgical reconstructions among a total of 251 cases of microsurgical reconstruction from May, 1986 to August, 1998. Their ages ranged from 24 months to 14 years and 8 months. There were 7 males and 6 females. The involved sites were 9 legs, 3 hands and 1 face. The causes of microsurgical reconstruction were 9 traumas, 2 congenital anomalies, 1 acquired deformity and 1 cancer. The applied flaps were 4 scapular flaps, 2 rectus abdominis muscle flaps, 1 de-epithelized groin flap, 1 lateral arm flap, 1 forearm tendocutaneous flap, 1 forearm tendocutaneous flap, 1 latissimus dorsi muscle flap, 1 fibula flap, 1 second toe transfer, and 1 wrap-around flap. All patients have had normal growth of the donor and recipient sites without specific complications during an average 2 years follow-up. We concluded that microvascular reconstruction is a very useful and reliable procedure in children if it is performed in consideration of each child's specific characteristics and conditions.
Adult ; Arm ; Child ; Congenital Abnormalities ; Female ; Fibula ; Follow-Up Studies ; Forearm ; Groin ; Hand ; Humans ; Leg ; Male ; Rectus Abdominis ; Superficial Back Muscles ; Tissue Donors ; Toes

PURPOSE: Functional MR imaging is the method of demonstrating changes in regional cerebral blood flow produced by sensory, motor, and any other tasks. Functional MR of visual cortex os performed as a patient stares a photic stimulation, so adaptable photic stimulation is necessary. The purpose of this study to evaluate whether the size of photic stimulation can affect the degree of visual cortex activation. MATERIALS AND METHODS: Functional MR imaging was performed in 5 volunteers with normal visual acuity. Photic stimulator was made by 39 light-emitting diodes on a plate ,operating at 8 Hz. The sizes of photic stimulator were full field, half field and focal central field. The MR imager was Siemens 1.5-T Magenton Vision system, using standard head coil. Functional MRI utilized EPI sequence (TR/TE=1.0/51. 0msec, matrix No.=98x128, slice thickness=8mm) with 3sets of 6 imaging during stimulation and 6 imaging during stimulation and 6 imaging during rest, all 36 scanning were obtained. Activated images were obtained using postprocessing software(statistical analysis by Z-zone, and these images were combined with T-1 weighted anatomical images. The activated signals were quantified by numbering the activated pixels, and activation index was obtained by dividing the pixel number of each stimulator size with the sum of the pixel number of 3 study using 3 kinds of stimulators. The correlation between the activation index and the stimulation size was analysed. RESULTS: Mean increase of signal intensities on the activation area using full field photic stimulator was about 9.6%. The activation index was greatest on full field. second on half field and smallest in focal central field in 4, The index of half field was greater than that of full field in 1. The ranges of activation index were full field 43-73%(mean 55%), half field 22-40%(mean 32%), and focal central field 5-24%(13%). CONCLUSION: The degree of visual cortex activation increases with the size of photic stimulator.
Head ; Humans ; Magnetic Resonance Imaging* ; Photic Stimulation ; Visual Acuity ; Visual Cortex* ; Volunteers

Diabetic foot is one of the most frequent complications with diabetic nephropathy and diabetic retinopathy in diabetic patient. Ischemia and peripheral neuropathy are the primary pathologic mechanism leading to diabetic foot. Approximately 20% of all diabetic patients admitted for foot problems, and about 80% of these patients need leg amputations. The objective of this article is to analyze the result of strategic treatment for limb salvage and to suggest appropriate surgical management in patients with diabetic foot. This study included 97 cases of treatment of diabetic foot for 6 years since August, 1995. The patients' age ranged from 34 to 83 years. There were 59 males and 38 females. According to the wound grade, extent, and involved site, we classified into 4 groups of diabetic foot. Conservative treatment was accomplished in 53 cases, local flap and/or skin graft in 13 cases, free flaps were in 12 cases, and amputations in 19 cases. The relatively superficial defects were treated with reversed adipofascial flap and split thickness skin graft. The used free flaps were 10 radial forearm free flap, 1 radial forearm osteocutaneous free flap, 1 latissimus dorsi muscle free flap. One flap loss occurred in latissimus dorsi free flap and the patient was treated with below knee amputation. The amputations included 9 toe amputations, 3 Syme amputations, 5 below knee amputations, and 2 above knee amputations. Except one patient, all patients had primary wound healing in operated site without specific complications. We conclude that selection of treatment method is very important for diabetic foot patient. Appropriate surgical treatment for limb salvage consists of infection control, coverage of exposed tendon, joint, and bone, and prevention of recurrence. In case of rapid progression of necrosis, amputations can be considered in order to prevent sepsis and provide early rehabilitation with prosthesis.
Amputation ; Diabetic Foot* ; Diabetic Nephropathies ; Diabetic Retinopathy ; Female ; Foot ; Forearm ; Free Tissue Flaps ; Humans ; Infection Control ; Ischemia ; Joints ; Knee ; Leg ; Limb Salvage ; Lower Extremity* ; Male ; Necrosis ; Peripheral Nervous System Diseases ; Prostheses and Implants ; Recurrence ; Rehabilitation ; Sepsis ; Skin ; Superficial Back Muscles ; Tendons ; Toes ; Transplants ; Wound Healing ; Wounds and Injuries

PURPOSE: The use of synthetic mesh to reinforce the anterior vaginal wall support for cystocele repair has been proposed to prevent recurrence. We evaluated the efficacy and safety of cystocele repair using monofilament polypropylene mesh (Gynemesh PS(TM)). MATERIALS AND METHODS: This study was performed in 53 patents who underwent cystocele repair using monofilament polypropylene mesh between January 2006 and January 2009. According to the ICS (International Continence Society) stage classification, 33, 17 and 3 women had stage II, III and IV cystocele. The operation were performed through the vaginal approach. Patients were followed up for 9 to 36 months. We defined the cure of cystocele as stage 0, improvement as stage I, and failed as stage II or greater RESULTS: The mean follow-up was 23.8 months. At follow-up, 41 women were anatomically cured (77.4%), 12 women were improved as stage I (22.6%) and no one was failed. Six cases were previously ICS stage II, 5 cases were stage III and 1 case was stage IV in improved group. No significant intraoperative complications occurred. The postoperative complications were de novo urgency (4 cases, 7.6%), erosion of mesh (2 cases, 3.8%) and anterior vaginal wall hematoma (1 case, 1.9%). CONCLUSION: The use of polypropylene mesh for correction of cystocele by transvaginal route with tension free technique seems to be a safe and effective procedure.
Classification ; Cystocele* ; Female ; Follow-Up Studies ; Hematoma ; Humans ; Intraoperative Complications ; Polypropylenes* ; Postoperative Complications ; Recurrence

Blow-in orbit fracture is relatively rare fracture which is an inward displacement of the orbital rim or wall fragment, resulting in decreased orbital volume. The objective of this article is to analyze blow-in fracture status of orbit and to suggest appropriate management in this unusual fracture. The study included 23 cases who had treatment of blow-in fractures of orbit from July, 1995 to June, 2001. Their ages ranged from 4 years to 63 years. There were 17 males and 6 females. The diagnosis of blow-in fracture was accomplished with physical examination, ophthalmologic examination, plain X-ray, and facial CT scan. According to Antonyshyn's classification, we classified them into 2 large groups which were pure type and impure type. Pure type blow-in fractures are relatively uncommon and 5 cases were documented in a series of 23 patients. Impure type fractures included the orbital rim and 18 cases were documented. Clinical symptoms of blow-in fractures were proptosis, limitation of eyeball movement, diplopia, blepharoptosis, subconjunctival hemorrage and blindness. 2 patients with globe rupture and blindness underwent enucleation due to direct injury by bony segment. We conclude that early and appropriate surgical treatment with complete examination is very important to prevent blepharoptosis, proptosis, limitation of eyeball movement and optic nerve compression. However, when globe rupture and blindness by direct injury of bony segment happened, the operation of enucleation was needed in this particular case.
Blepharoptosis ; Blindness ; Classification ; Diagnosis ; Diplopia ; Exophthalmos ; Female ; Humans ; Male ; Optic Nerve ; Orbit* ; Physical Examination ; Rupture ; Tomography, X-Ray Computed

PURPOSE: Ganglioglioma is a rare primary brain tumor usually found in the temporal lobe. The purpose of thisstudy is to describe the characteristic MR findings of temporal lobe ganglioglioma. MATERILA AND METHODS: Over aseven-year period, ten patients with cerebral ganglioglioma were evaluated at our institution. Seven cases oftemporal lobe ganglioma were found ; six of these involved men, and one, a woman ; their mean age was 29.6 years.In three patients, Gd-DTPA-enhanced T1 weighted images were also obtained. We retrospectively analysed the MRIfindings with respect to location, size, cortical involvement, margin, cystic change, degree of enhancement, MRsignal intensity, calcification and peritumoral change. RESULTS: In five cases, tumors were located within thetemporal lobe. In one, a tumor extended from the temporal lobe to the thalamus, and in one from the temporal lobeto the thalamus and cerebral peduncle. All temporal gangliogliomas measured 1.6-3.8cm in their greatestdiameter(mean diameter, 2.7cm). In all cases, the cortices were involved with the maintenance of gyriform. Thetumor margin was ill defined in five cases and well defined in two. Tumors showed multiple small cystic changes infour cases, a large cyst in two, and a solid nodule in one. In three cases in which contrast media wasadministered, no lesions were enhanced. On T1-weighted images, iso-signal intensities were seen in five cases andhigh signal intensities in two. On T2-weighted images, the corresponding figures were five and two. On MRI, tumorcalcification and calvarial erosion were each detected in two cases. CONCLUSION: In patients with temporal lobeepilepsy in whom cortical solid or cystic and poorly enhanced lesions were seen on brain MRI, and in whomaccociated findings such as calcification and or adjacent bony erosion were noted, ganglioglioma must beconsidered.
Brain ; Brain Neoplasms ; Contrast Media ; Female ; Ganglioglioma* ; Humans ; Magnetic Resonance Imaging* ; Male ; Retrospective Studies ; Tegmentum Mesencephali ; Temporal Lobe* ; Thalamus

PURPOSE: Among the fracture patients, there is a tendency to form more callus and get fracture united earlier in groups with traumatic brain injury. This retrospective study is to evaluate the factors that might accelerate the bone formation by comparing two groups in serologic tests, clinical and radiologic results. MATERIALS AND METHODS: From March 2001 to July 2009, femur shaft fracture patients were divided in two groups 1) without traumatic brain injury (32cases), 2) fracture with traumatic brain injury combined (30cases). We evaluated the routine serologic exams, amount of callus formations during the follow up period. RESULTS: There was no statistical difference in WBC, CRP, total calcium, LDH level between two groups, except Alkaline phosphatase level. Amount of callus formation on AP radiograph at the last follow up period was 74.9% in study, 42.6% in control group. Lateral radiograph showed 73.2% of callus formation rate in study group and 32.0% in control group. CONCLUSION: Two groups had no significant difference with the routine serologic exam except Alkaline phosphatase. Group with traumatic brain injury had much more amount of callus formation but there was no evidence of traumatic brain injury accelerate the fracture healing.
Alkaline Phosphatase ; Bony Callus ; Brain ; Brain Injuries ; Calcium ; Femur ; Follow-Up Studies ; Fracture Healing ; Humans ; Osteogenesis ; Retrospective Studies ; Serologic Tests

PURPOSE: The objective of this study is to report our initial experience about the feasibility, effectiveness, and safety of transobturator tension-free vaginal mesh (Prolift(TM)) and concomitant tension-free vaginal tape (TVT) as a treatment of female anterior vaginal wall prolapse associated with stress urinary incontinence (SUI). MATERIALS AND METHODS: We reviewed the charts of patients who underwent Prolift(TM) and TVT between April 2009 and March 2010. All patients had a physical examination and staging of cystocele. According to the International Continence Society system 2, 5 and 3 women had stage grade II, III and IV respectively. All the patients underwent pelvic examination 1, 3, 6 month and 1 year after operation and anatomical and functional outcomes were recorded. An anatomic cure after intervention was defined as stage 0 and an improvement was defined as stage I. Anatomic failures were defined as stage II or higher on the last physical examination. RESULTS: The mean follow-up was 7.1 (1-11) months. Overall success rate of cystocele repair was 90%. The anatomical cure rate of cystocele was 50%. The cystocele repair improved 4 patients, but failed in 1. SUI was cured in all patients. No significant complications including bladder or vessel injury and mesh related erosion occurred. The postoperative complication was transient voiding difficulty (2 cases). CONCLUSIONS: These preliminary results suggest that Prolift(TM) and TVT offer a safe and effective treatment for female anterior vaginal wall prolapse and SUI. However, a long-term follow up is necessary in order to support the good result maintenance.
Cystocele ; Female ; Follow-Up Studies ; Glycosaminoglycans ; Gynecological Examination ; Humans ; Physical Examination ; Postoperative Complications ; Prolapse ; Suburethral Slings ; Urinary Bladder ; Urinary Incontinence

PURPOSE: Brown's syndrome is characterized by the limited elevation in adduction from mechanical causes around the superior oblique tendon trochlea complex. In this particular case, post-traumatic facial deformity accompanied by Brown's syndrome was observed. We would like to report the satisfying cosmetic results obtained by reconstructing orbital roof and superior orbital rim and repositioning of zygoma. METHODS: A 12-year-old patient was observed with facial deformity with strabismus in her right eye and orbital dystopia after the car accident and was eventually diagnosed with traumatic Brown's syndrome. Reconstructive surgeries could not be performed at the time of trauma due to the cerebral hemorrhage. At the second year after the trauma, a depressed fracture of the right orbital roof and superior orbital rim were reconstructed via the intracranial approach, and orbital dystopia was corrected via the zygoma triple ostectomy. In addition, a strabismus surgery was performed one year after her plastic surgery. RESULTS: Facial deformity with orbital dystopia and strabismus was confirmed to be fully reconstructed after the surgery. Moreover, when the patient came in for a follow-up thirteen years after the operation, a developmental imbalance of the facial bones, diplopia, or any other surgical complications were not to be found. CONCLUSION: After the trauma, the patient with Brown's Syndrome accompanied by post-traumatic facial deformity, who went under the corrective surgeries after the meticulous examination and assessment pre-surgically, was able to acquire cosmetic satisfaction via those operations.
Cerebral Hemorrhage ; Child ; Congenital Abnormalities ; Cosmetics ; Diplopia ; Eye ; Facial Bones ; Follow-Up Studies ; Humans ; Orbit ; Porphyrins ; Strabismus ; Surgery, Plastic ; Tendons ; Zygoma

Adenoviridae ; Animals ; Epithelial Cells ; Epithelium ; Genetic Therapy ; Mice ; Mouth Mucosa ; Organ Culture Techniques ; Palate ; Stainless Steel ; Tongue ; Viruses