The reconstruction of soft tissue defects with open fracture around the knee joint is limited by its unique location. Free tissue transfer is hindered by the selection of the recipient vessel and problems of microsurgery. The arc of rotation, defect size, and location must be taken into consideration in the use of regional muscle transfer such as gastrocnemius. According to Mathes et al, the flap survival can be enhanced by selective division of the dominant segmental pedicles, only a part of which can normally be transposed safely on its minor segmental pedicle. Neovascularization, vascular proliferation, and dilatation have also been produced by the delay procedure using silicone sheets. The authors have used the delay procedures with wrapping of the gracilis or sartorius muscle which enabled distally-based transposition of these muscles. The method showed satisfactory outcome in resurfacing the wound around the knee joint. The indictions for this procedure were defects of moderate size and those difficult to reach with conventional muscle flaps. The flap could reach the upper one-third of the lower leg. Other merits are relative simplicity and reliability without significant extension of hospital stay. The drawbacks are the two operative procedures necessary and the risk of infection due to silicone sheets.
Dilatation ; Fractures, Open ; Knee Joint* ; Knee* ; Leg ; Length of Stay ; Microsurgery ; Muscles ; Silicones ; Surgical Procedures, Operative ; Wounds and Injuries*

Here we report a case of Strongyloides stercoralis infection of the gastric and pancolonic mucosa in a 79-year-old female with a monoclonal gammopathy of undetermined significance. Endoscopic biopsies were performed in gastric antrum, cecum, distal ascending colon, and hepatic flexure of the colon. On microscopic examination, there were many adult worms, larvae and eggs in the gastric and colonic mucosa. Worms, larvae, and eggs were located in the crypts and within the lumen of the crypts. The body wall of the adult worm was composed of cuticle and a weak muscle layer. A routine stool examination failed to detect larvae or ova. Based on the histopathologic examination, these parasites were confirmed as S. stercoralis.
Adult ; Aged ; Biopsy ; Cecum ; Colon ; Colon, Ascending ; Eggs ; Female ; Humans ; Larva ; Monoclonal Gammopathy of Undetermined Significance ; Mucous Membrane ; Muscles ; Ovum ; Paraproteinemias ; Parasites ; Pyloric Antrum ; Stomach ; Strongyloides stercoralis ; Strongyloidiasis

Here we report a case of Strongyloides stercoralis infection of the gastric and pancolonic mucosa in a 79-year-old female with a monoclonal gammopathy of undetermined significance. Endoscopic biopsies were performed in gastric antrum, cecum, distal ascending colon, and hepatic flexure of the colon. On microscopic examination, there were many adult worms, larvae and eggs in the gastric and colonic mucosa. Worms, larvae, and eggs were located in the crypts and within the lumen of the crypts. The body wall of the adult worm was composed of cuticle and a weak muscle layer. A routine stool examination failed to detect larvae or ova. Based on the histopathologic examination, these parasites were confirmed as S. stercoralis.
Adult ; Aged ; Biopsy ; Cecum ; Colon ; Colon, Ascending ; Eggs ; Female ; Humans ; Larva ; Monoclonal Gammopathy of Undetermined Significance ; Mucous Membrane ; Muscles ; Ovum ; Paraproteinemias ; Parasites ; Pyloric Antrum ; Stomach ; Strongyloides stercoralis ; Strongyloidiasis

We evaluated median value and lower confidence limit of total serum IgE level in each age group of 1,493 pure atopic dermatitis patient without respiratory atopic diseases. The results were as follows . 1. The median value of total serum IgE level of each age group in patients with atopic dermatitis distributed from 56.5 IU/@Ll to 660It.J/C. The distributions of the median value of total serum IgE levels of total patients with atopic dermatitis, total male patients with atopic dermatitis, and total female patients with atopic dermatitis were 185 IU/C, 220 IUj'@C, and 165 IUj'C. There was no statistical significance of median value of total serum IgE level between mole patients and female patients. 2. The 95% and 99% lower confidence limit(one-sided) of total serum IgE level of ea.ch age group in patients with atopic dermatitis distributed from 32.6 IU /n4 to 287IU/v4 and from 31 IU/m0 to 202 IU4. The 95% lower confidence limit (one-sided) of total serum IgE level of total patients with atopic dermatitis, tatal male patients with atopic dermatitis, and. total female patients with atopic dermatitis were 170 II.J/m0, 185 IU,m/l, and 133 IUm/l. The 99% lower confidence limit.(one-sided) of total serum IgE level of total patient with atopic dermatitis, total male patient with atopic dermatitis, and total female patients with atopic dermatitis were 165 IU/ml, 180 IU/ml, and 125 IU/ml.
Dermatitis, Atopic* ; Female ; Humans ; Immunoglobulin E* ; Male

No abstract available.
Fetus* ; Humans ; Pregnancy, Twin*

The hepatobiliary system is one of the most common sites of extraintestinal manifestation in patients with inflammatory bowel disease (IBD). The progression of IBD can lead to a primary hepatobiliary manifestation and can occur secondary to multiple drugs or accompanying viral infections. Primary sclerosing cholangitis is the representative hepatobiliary manifestation of IBD, particularly in ulcerative colitis. Although most agents used in the treatment of IBD are potentially hepatotoxic, the risk of serious hepatitis or liver failure is low. The prevalence of HBV and HCV in IBD is similar to the general population, but the clinical concern is HBV reactivation associated with immunosuppressive therapy. Patients undergoing cytotoxic chemotherapy or immunosuppressive therapy with a moderate to high risk of HBV reactivation require prophylactic antiviral therapy. On the other hand, HCV has little risk of reactivation. Patients with IBD are more likely to have nonalcoholic fatty liver disease than the general population and tend to occur at younger ages. IBD and cholelithiasis are closely related, especially in Crohn's disease.
Cholangitis, Sclerosing ; Cholelithiasis ; Colitis, Ulcerative ; Crohn Disease ; Drug Therapy ; Drug-Induced Liver Injury ; Hand ; Hepatitis ; Hepatitis Viruses ; Humans ; Inflammatory Bowel Diseases ; Liver Failure ; Non-alcoholic Fatty Liver Disease ; Prevalence

The hepatobiliary system is one of the most common sites of extraintestinal manifestation in patients with inflammatory bowel disease (IBD). The progression of IBD can lead to a primary hepatobiliary manifestation and can occur secondary to multiple drugs or accompanying viral infections. Primary sclerosing cholangitis is the representative hepatobiliary manifestation of IBD, particularly in ulcerative colitis. Although most agents used in the treatment of IBD are potentially hepatotoxic, the risk of serious hepatitis or liver failure is low. The prevalence of HBV and HCV in IBD is similar to the general population, but the clinical concern is HBV reactivation associated with immunosuppressive therapy. Patients undergoing cytotoxic chemotherapy or immunosuppressive therapy with a moderate to high risk of HBV reactivation require prophylactic antiviral therapy. On the other hand, HCV has little risk of reactivation. Patients with IBD are more likely to have nonalcoholic fatty liver disease than the general population and tend to occur at younger ages. IBD and cholelithiasis are closely related, especially in Crohn's disease.
Cholangitis, Sclerosing ; Cholelithiasis ; Colitis, Ulcerative ; Crohn Disease ; Drug Therapy ; Drug-Induced Liver Injury ; Hand ; Hepatitis ; Hepatitis Viruses ; Humans ; Inflammatory Bowel Diseases ; Liver Failure ; Non-alcoholic Fatty Liver Disease ; Prevalence

OBJECTIVES: We review the sleep problems of the alcohol dependence patients. Especially we are interested in the prevalence, the severity of symptoms, anxiety, depression, and sleep quality of restless legs syndrome (RLS) in the alcohol dependence patients. METHODS: We recruit 86 alcohol dependence patients who were admitted from October 6th, 2008 to October 17th, 2008. We interviewed each patient and evaluated sleep questionnaires such as the Sleep Disorder Questionnaire (SDQ), the Pittsburgh Sleep Quality Index (PSQI) and the International Restless Legs Syndrome Study Group (IRLSSG) rating scale. The presence of RLS and its severity were assessed using the IRLSSG diagnostic criteria and the IRLSSG severity scale, respectively. Depression and anxiety were evaluated by the Beck Depression Inventory (BDI) and the Beck anxiety inventory (BAI). RESULTS: Of all 86 patients, 59 patients have insomnia, 33 patients have RLS, 30 patients have Periodic limb movement disorder (PLMD), 29 patients have nightmare. RLS patients have more high score in the BAI (21.70+/-10.36 vs 14.67+/-11.98), and their sleep quality was poor in the PSQI (11.09+/-4.08 vs 7.92+/-3.91) than non-RLS patients. CONCLUSION: This study shows that alcohol dependence patients show many sleep problems such as insomnia and RLS. So we should notice that the sleep problems of alcohol dependence patients are important in clinical approach and treatment.
Alcoholism ; Anxiety ; Depression ; Dreams ; Humans ; Nocturnal Myoclonus Syndrome ; Prevalence ; Surveys and Questionnaires ; Restless Legs Syndrome ; Sleep Wake Disorders ; Sleep Initiation and Maintenance Disorders

To overcome the problems of classical pulmonary banding procedure, we developed a percutaneously adjustable pulmonary artery banding device. The banding device consists of banding portion of zig-zag shaped self-expandable stainless steel wire, shaft portion made by a polyvinyl catheter and a screw adjuster which includes a bolt and a nut. As the screw moves, the diameter of banding portion changes. Four Mongrel dogs ranging from 15 kg to 20 kg in weight underwent the banding of the mid portion of descending aorta with this devices through the left thoracotomy. One month after operation, we evaluated the pressure changes by controling the banding with the devices and then the dogs were sacrificed to study the microscopic changes in the aorta. The diameter and circumference of the band could be easily and finely adjustable by the screw control. The pressure recordings revealed a linear increase and decrease in pressure gradient according to percutaneous adjustment of the banding device. Since the banding device can be easily placed and simply adjusted percutaneously, we hope the banding device may be applicable clinically to improving the safety of pulmonary artery banding and debanding procedures in the future.
Animals ; Aorta ; Aorta, Thoracic ; Catheters ; Dogs ; Hope ; Nuts ; Polyvinyls ; Pulmonary Artery* ; Stainless Steel ; Thoracotomy

PURPOSE: This study examined the effects a partial hepatectomy through an analysis of survival rates and examine the recurrence pattern after a partial hepatic resection for HCC according to the Milan criteria combined with Child-Pugh A cirrhosis. METHODS: On hundred and twenty seven HCC patients with Child-Pugh A liver cirrhosis undergoing a hepatic resection for HCC from September 1987 through July 2004 in the hospital were retrospectively reviewed. Among them, 85 cases met the Milan criteria (M group). However, the remaining 42 cases did not (N group). The median age was 52 years and males outnumbered females by almost five times. The median follow up period was 39.8 months. RESULTS: No in-hospital mortality occurred in the M group, but there was a single mortality case in the N group. The size of the tumor, multiplicity and major resection rate were different between the two groups. The 5 years overall survival rate of each group was 62.3% and 37.3%, respectively (P=0.002) and the 5 year disease free survival rates were 44.0% and 24.5%, respectively (P=0.023). Forty one patients in the M group developed recurrences, of which 35 had only intrahepatic recurrences. Among them, 28 recurrences still met the Milan criteria. CONCLUSION: A partial hepatic resection should be considered a standard treatment method for a HCC meeting the Milan criteria with compensated liver cirrhosis in terms of safety and long-term survival. A salvage transplantation may play a role after a recurrence because most recurrences are intrahepatic recurrences that meet the Milan criteria.
Carcinoma, Hepatocellular* ; Disease-Free Survival ; Female ; Fibrosis ; Follow-Up Studies ; Hepatectomy* ; Hospital Mortality ; Humans ; Liver Cirrhosis* ; Liver* ; Male ; Mortality ; Recurrence ; Retrospective Studies ; Survival Rate