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

OBJECTIVE: There were few reports about statistically significant factor which contribute to low back pain(LBP) after microscopic discectomy. We analyzed the result of percutaneous radiofrequency neurotomy(PRN) for low back pain after microscopic discectomy in lumbar disc herniation. METHODS: Forty four patients with LBP after microscopic discectomy who were treated by one level microscopic discectomy from January 2003 to March 2004 were included in this study. They were divided into two groups by the presence of preoperative LBP into preoperative back pain group (group I) and postoperative back pain group (group II). Radiofrequency procedures were performed in the usual manner, targetting the medial branch of L4, L5 and Sl. Pain relief was estimated at 1 week, 1 month and 6 months following the procedure, using the visual analogue scale. Above 50% pain relief was defined as the positive response. RESULTS: Positive responders were 16 patients (73%) at 1 week, 12 patients (55%) at 1 month, and 7 patients (32%) at 6 months after PRN in group I. In Group II, 18 patients, 15 patients and 13 patients responded positively after 1 week, 1 month and 6 months after PRN, respectively. CONCLUSION: PRN is an effective treatment for newly developed low back pain after microscopic discectomy. There was no morbidity in our series, but long-term follow up is necessary.
Back Pain ; Denervation* ; Diskectomy* ; Follow-Up Studies ; Humans ; Low Back Pain*

A 69-year-old-male patient was admitted because of left upper quadrant (LUQ) abdominal pain He had hard palpable mass (abaut 15x l0cm) in LUQ abdomen and mild elevated serum alkaline phosphatase (349 IU/L) and amylase (216 U/L) levels at the admission time. Abdominal CT scan revealed huge, well-marginated cystic mass in enlarged spleen with increased densities in dependent portion of cystic mass, about 8x13cm in size. Another small well-capsulated. cystic mass in anterior aspect of spleen was also seen. After ERCP, urgent surgical intervention was done. Final diagnosis was chronic pancreatitis with large intrasplenic (l2x9.5 cm) and retroperitoneal pseudocysts. So we are reporting above case with pertinent review of literatures.
Abdomen ; Abdominal Pain ; Alkaline Phosphatase ; Amylases ; Cholangiopancreatography, Endoscopic Retrograde ; Diagnosis ; Humans ; Pancreatitis, Chronic* ; Spleen ; Splenomegaly ; Tomography, X-Ray Computed

No abstract available.
Leiomyoma*

OBJECTIVE: The study was performed to evaluate whether thallium reinjection (RI) distinguishes viable from nonviable myocardium among myocardial segments which showed persistent perfusion defect (PD) in patients with acute myocardial infarction (AMI). MATERIALS AND METHODS: We studied 22 patients underwent PTCA after AMI. SPECT was performed in all patients using dipyridamole stress- 4 hour redistribution (RD) followed by 24 hour RI protocols. Dysfunctional segs were classified into 5 groups: 1) normal, 2) reversible, 3) mild to moderate PD, 4) severe PD and 5) reverse redistribution (RR). All patients underwent follow up echocardiography after 4 months to assess regional wall motion (WM) improvement such as a criteria of viable myocardium. RESULTS: A total of 127 segs with abnormal WM was analyzed. Of 74 segs with PD, 17 (23%) showed enhanced uptake after 24 hour RI. Five of 17 segs (29%) with PD that responded to RI with enhanced thallium uptake showed WM improvement. WM improvement were seen in the 24 of 57 segs (42%) not responding to RI. All four segs (100%) with RR that responded to RI showed improvement. WM improvement were not seen in the 5 of 8 segs (71%) with RR not responding to thallium RI. Eleven (73%) of 15 segs with mild-moderate PD after RI showed improvement, but 33% of segs with severe PD after RI did not showed improvement. Segs with mild-moderate PD after RI and fill in after RI showed improvement in comparison to segs with severe PD after RI(p<0.05). CONCLUSIONS: These data indicate that because only small proportion of PD showed further perfusion improvement after RI and predictive value by the uptake after RI was low, there was limited role of RI after myocardial infarction. Usefulness of RI could be found in segs showing RR responding to RI in AMI reflects viable myocardium.
Dipyridamole ; Echocardiography ; Follow-Up Studies ; Humans ; Myocardial Infarction* ; Myocardium ; Perfusion ; Thallium ; Tomography, Emission-Computed, Single-Photon

Double primary cancer is defined as the case of primary malignant tumors in one person, which must be arisen in different sites and have a different histologic appearances in each other. The number of reported cases of multiple primary malignant tumors has increased in recent years, because of more developed diagnostic procedure and long survival of cancer patients, We have experienced 4 cases of double primary malignant tumors which were stomach cancer with colon, bronchus and esophagus cancer, and report these cases with review of literatures.
Bronchi ; Colon ; Esophageal Neoplasms ; Humans ; Stomach Neoplasms

Double primary cancer is defined as the case of primary malignant tumors in one person, which must be arisen in different sites and have a different histologic appearances in each other. The number of reported cases of multiple primary malignant tumors has increased in recent years, because of more developed diagnostic procedure and long survival of cancer patients, We have experienced 4 cases of double primary malignant tumors which were stomach cancer with colon, bronchus and esophagus cancer, and report these cases with review of literatures.
Bronchi ; Colon ; Esophageal Neoplasms ; Humans ; Stomach Neoplasms

No abstract available.
Chromatin* ; Humans* ; Population Characteristics* ; Sperm-Ovum Interactions* ; Spermatozoa*

Esophageal pH monitoring is considered the gold standard for the diagnosis of gastroesophageal reflux disease because of the normal ranges across the pediatric age range. However, this method can only detect acid reflux. Multichannel intraluminal impedance-pH (MII-pH) monitoring has recently been used for the detection of bolus reflux in infants and children. This method allows for the detection of liquid, gas or mixed reflux in addition to acid, weakly acidic or weakly alkaline reflux. MII-pH monitoring can record the direction of flow and the height of reflux, which are useful parameters to identify an association between symptoms and reflux. However, the technique is limited by its high cost and the lack of normative data of MII-pH in the pediatric population. Despite certain limitations, MII-pH monitoring will become more common and gradually replace pH monitoring in the future, because pH monitoring is part of MII-pH.
Child* ; Diagnosis ; Esophageal pH Monitoring ; Gastroesophageal Reflux ; Humans ; Hydrogen-Ion Concentration* ; Infant ; Reference Values

No abstract available.
Fertilization in Vitro* ; Fertilization* ; Humans*