PURPOSE: Thumb reconstruction plays most important role in hand injuries because total loss of a thumb constitutes about 40% disability in the hand. The reconstruction can be accomplished by pollicization, free toe-to-thumb transfer, wrap around procedure and lengthening extraction. However, we sometimes need consecutive or double free flaps in the reconstruction of mutilating hand injuries. METHODS: We reconstructed a mutilating hand injury in a 54-years old man. Because of severe crushing injury of right thumb and index fingers, we reconstructed a thumb with pollicization using nearly amputated middle finger. Although it survived completely, the adjacent soft tissues which had been covered by fillet flap from the space past was necrosed on 1 month. We debrided the necrotic tissues and covered it with anteromedial thigh perforator free flap consecutively because he had an anatomical variation in branches of lateral femoral circumflex artery. RESULTS: He had an uneventful postoperative course without any complication such as infection, dehiscence and flap necrosis. Three months later, he had undergone tenolysis and defatting procedure of flap site. He recovered the some amount of grip function and was happy with the result. CONCLUSIONS: In severe hand trauma including thumb amputation, thumb reconstruction using pollicization and perforator free flap could be an alternative option. It provides minimal donor site morbidity and an acceptable functional result.
Amputation ; Fingers ; Free Tissue Flaps ; Hand ; Hand Injuries ; Hand Strength ; Humans ; Necrosis ; Thigh ; Thumb ; Tissue Donors

OBJECTIVE: The aim of this study was to analyze the effects of total abdominal hysterectomy (TAH) versus supracervical hysterectomy (SCH) on sexual function in patients with non-malignant conditions. METHODS: We choose fifty patients who were operated by SCH and forty-six patients who were operated by TAH. They were interviewed that effects of the two operations on sexual desire, coital frequency, quality and frequency of orgasms, post-op development of dyspareunia and overall sexual satisfaction. RESULTS: 1. The sexual desire significantly decreased in TAH group compared with SCH group (46% vs 8%, P<0.001). And the coital frequency also decreased in TAH group (48% vs 6%, P<0.001). 2. Orgasm frequency and quality decreased in more patients with TAH compared with SCH (22% vs 2%, 33% vs 2%). 3. After SCH and TAH, there was no change in dyspareunia and significantly decreased sexual satisfaction was noted in TAH group (35% vs 4%). CONCLUSION: It suggest that TAH patients experienced worse postoperative sexual function than SCH patients. therefore, it should be considered to conserving the cervix at hysterectomy.
Cervix Uteri ; Coitus ; Dyspareunia ; Female ; Humans ; Hysterectomy* ; Orgasm

PURPOSE: Trochanteric pressure sores management has been improved through the development of musculocutaneous flaps. But it has many drawbacks such as donor site morbidity and functional muscle sacrifice. With the introduction of perforator flap, it is possible to use in every location where musculocutaneous perforators are present. We have reconstructed trochanteric pressure sores using perforator-based flaps from the ascending branch of lateral circumflex femoral artery. METHODS: Between May of 2006 and April of 2008, we performed six cases of perforator-based flap from the ascending branch of lateral circumflex femoral artery for the coverage of trochanteric pressure sores. For identifying perforators, a line was drawn from the anterior superior iliac spine to the superolateral border of the patella as the vertical axis, from the pubis to the trochanteric prominence as the horizontal axis. In the lateral aspect of the intersection of these two axes, various flap were designed according to its defects. The flap was raised in the subcutaneous plane above the fascia and the pedicle was traced by doppler and identified. The pedicle was meticulously dissected not to injure the periadventitial tissues and transposed to the defect. The donor site was closed primarily. RESULTS: The mean age of patients was 56.2 years. Four male and two female patients were studied. Five patients were paraplegic. The mean defect size was 6 x 4 cm. The largest flap dimension was 14 x 7 cm. Donor sites were closed primarily without any complications. All flaps survived completely without necrosis, hematoma or infection. There were no recurrence during the follow-up period. CONCLUSION: Trochanteric pressure sores using perforator-based flap from the ascending branch of lateral circumflex femoral artery can be performed safely and it would be a reliable option for coverage of trochanteric pressure sores with minimal donor site morbidity.
Axis, Cervical Vertebra ; Fascia ; Female ; Femoral Artery ; Femur ; Follow-Up Studies ; Hematoma ; Humans ; Male ; Muscles ; Necrosis ; Patella ; Perforator Flap ; Pressure Ulcer ; Recurrence ; Spine ; Tissue Donors

Dupuytren's contracture is a condition commonly encountered by hand surgeons, although it is rare in the Asian population. Various surgical procedures for Dupuytren's contracture have been reported, and the outcomes vary according to the treatment modalities. We report the treatment results of segmental fasciectomies with multiple transverse incisions for patients with Dupuytren's contracture. The cases of seven patients who underwent multiple segmental fasciectomies with multiple transverse incisions for Dupuytren's contracture from 2006 to 2011 were reviewed retrospectively. Multiple transverse incisions to the severe contracture sites were performed initially, and additional incisions to the metacarpophalangeal (MCP) joints, and the proximal interphalangeal (PIP) joints were performed if necessary. Segmental fasciectomies by removing the fibromatous nodules or cords between the incision lines were performed and the wound margins were approximated. The mean range of motion of the involved MCP joints and PIP joints was fully recovered. During the follow-up periods, there was no evidence of recurrence or progression of disease. Multiple transverse incisions for Dupuytren's contracture are technically challenging, and require a high skill level of hand surgeons. However, we achieved excellent correction of contractures with no associated complications. Therefore, segmental fasciectomies with multiple transverse incisions can be a good treatment option for Dupuytren's contracture.
Asian Continental Ancestry Group ; Contracture ; Dupuytren Contracture ; Follow-Up Studies ; Hand ; Humans ; Joints ; Range of Motion, Articular ; Recurrence ; Retrospective Studies ; Surgical Procedures, Operative

PURPOSE: Herpes zoster, or shingles is caused by reactivation of varicella zoster virus lying latent in the ganglion of the dorsal root. It is rare in hand and upper extremities. The aim of this study is to report the shingles occurred in the hand, upper extremity along the various dermatome. MATERIALS AND METHODS: Between October of 2006 and August of 2009, patients with herpes zoster infection in hand and upper extremity were reviewed. The mean age of the patients was 61.4 years, and there were four female patients, one male patient. With the appropriate diagnosis, antiviral agent such as acyclovir(Zovirax(R)), Zovirax(R) cream were applied within 72 hours of skin lesions. Analgesics and wet dressing were commonly applied for relief of acute pain. To prevent the secondary infection and postherpetic neuralgia, tricyclic antidepressants, anticonvulsants and opioids were also prescribed. RESULTS: Herpes zoster infection was occurred along the distribution of ulnar nerve in three cases, radial nerve in one case and medial antebrachial cutaneous nerve in one case. Four patients developed unilateral vesicular eruption with dermatomal rash in addition to severe pain. But, one patient did not show any significant signs on physical exam except dysesthesia along the ulnar nerve distribution in hand and forearm. All of the patients were relieved acute pain, skin rash within 1-2 weeks. There were no recurrence and complications during the one year follow-up period. CONCLUSIONS: It is important that hand surgeons should not misdiagnose the possibility of herpes zoster infection even without developed skin rash. Early diagnosis, appropriate treatment can lower the risk of its complications.
Acute Pain ; Acyclovir ; Analgesics ; Analgesics, Opioid ; Anticonvulsants ; Antidepressive Agents, Tricyclic ; Bandages ; Coinfection ; Deception ; Early Diagnosis ; Exanthema ; Female ; Follow-Up Studies ; Forearm ; Ganglion Cysts ; Hand ; Herpes Zoster ; Herpesvirus 3, Human ; Humans ; Male ; Neuralgia, Postherpetic ; Paresthesia ; Radial Nerve ; Recurrence ; Skin ; Spinal Nerve Roots ; Ulnar Nerve ; Upper Extremity

PURPOSE: We reported results of percutaneous multiple K-wire fixation technique without passing through the joint in patients with a hand fracture. METHODS: We evaluated a total of 116 cases in 94 patients who underwent percutaneous multiple K-wire fixation on dorsal cortex over a 10-year period between 2001 and 2010. The treatment outcomes were evaluated based on total active motion (TAM), as proposed by Widegrow. RESULTS: Our clinical series of patients achieved good functional outcomes. Of total patients, 89% (84/94) had excellent TAM, 2% (2/94) did good TAM and 9% (8/94) did poor TAM. Postoperatively, our clinical series of patients had such a good compliance as to achieve a TAM of >181degrees when performing the early active movement. There were no notable postoperative complications during the follow-up period. CONCLUSION: Our results indicate that percutaneous multiple K-wire fixation technique without passing through the joint from normal bone density patients is effective in providing the rigid fixation. Thus, our patients could perform the early movement as promptly as possible and maintaining the full mobility of the rest of the hand.
Bone Density ; Bone Wires ; Compliance ; Follow-Up Studies ; Fracture Fixation ; Hand ; Humans ; Joints ; Postoperative Complications

As in other domains, artificial intelligence is becoming increasingly important in medicine. In particular, deep learning-based pattern recognition methods can advance the field of pathology by incorporating clinical, radiologic, and genomic data to accurately diagnose diseases and predict patient prognoses. In this review, we present an overview of artificial intelligence, the brief history of artificial intelligence in the medical domain, recent advances in artificial intelligence applied to pathology, and future prospects of pathology driven by artificial intelligence.
Artificial Intelligence ; Humans ; Pathology ; Prognosis

OBJECTIVE: This study examined whether the depth of chest compression (CC) recommended by current cardiopulmonary resuscitation guidelines is equally appropriate to both men and women. METHODS: Retrospective analysis of the chest computed tomography (CT) findings was performed. The anteroposterior diameter (APD), internal compressible depth (ICD), and anterior chest wall thickness were measured at the midpoint of the lower half of the sternum. The residual diameter (RD) for simulated CC was also obtained. If the RD was less than 20 mm, it was assumed that a potential injury would occur. RESULTS: A total of 319 adults (173 men, 141 women), who underwent chest CT at the emergency room, were enrolled. A statistically significant difference was observed between the mean APD and ICD between men and women. The mean APD and IPD were 8 mm shorter and 9.5 mm shorter, respectively, in women than in men. When adjusted for age, height, weight, and body mass index (BMI), the differences in the value of these parameters increased even more. In simulated CC with a 60 mm depth, the predictors of RD of less than 20 mm were weighed (odds ratio [OR], 0.888; 95% confidence interval [CI], 0.826–0.954; P=0.001) and BMI (OR, 0.706; 95% CI, 0.579–0.862; P=0.001), and all cases with RD of less than 20 mm were women. CONCLUSION: Chest compression of more than 60 mm may increase the potential risk of injury, particularly in women. The maximum allowable chest compression depth of less than 60 mm should be emphasized for women.
Adult ; Body Mass Index ; Cardiopulmonary Resuscitation ; Emergency Service, Hospital ; Female ; Humans ; Male ; Retrospective Studies ; Sternum ; Thoracic Wall ; Thorax ; Tomography, X-Ray Computed

Background: Genome-wide association studies (GWAS) on type 2 diabetes mellitus (T2DM) have identified more than 400 distinct genetic loci associated with diabetes and nearly 120 loci for fasting plasma glucose (FPG) and fasting insulin level to date. However, genetic risk factors for the longitudinal deterioration of FPG have not been thoroughly evaluated. We aimed to identify genetic variants associated with longitudinal change of FPG over time. Methods: We used two prospective cohorts in Korean population, which included a total of 10,528 individuals without T2DM. GWAS of repeated measure of FPG using linear mixed model was performed to investigate the interaction of genetic variants and time, and meta-analysis was conducted. Genome-wide complex trait analysis was used for heritability calculation. In addition, expression quantitative trait loci (eQTL) analysis was performed using the Genotype-Tissue Expression project. Results: A small portion (4%) of the genome-wide single nucleotide polymorphism (SNP) interaction with time explained the total phenotypic variance of longitudinal change in FPG. A total of four known genetic variants of FPG were associated with repeated measure of FPG levels. One SNP (rs11187850) showed a genome-wide significant association for genetic interaction with time. The variant is an eQTL for NOC3 like DNA replication regulator (NOC3L) gene in pancreas and adipose tissue. Furthermore, NOC3L is also differentially expressed in pancreatic β-cells between subjects with or without T2DM. However, this variant was not associated with increased risk of T2DM nor elevated FPG level. Conclusion We identified rs11187850, which is an eQTL of NOC3L, to be associated with longitudinal change of FPG in Korean population.

Compressed air can cause serious damage to internal organs. The stomach is an organ that is rarely perforated due to its elasticity. However, intestines are weaker and thinner compared to the stomach. A 40-year-old male came to the emergency room with severe abdominal pain due to dyspnea. The patient experienced abdominal pain right after his coworker shot compressed air into the patient's pants. The patient suffered from a rigid abdomen, and bed-side ultrasonography was carried out as soon as possible. Pneumoperitoneum was diagnosed by portable X-ray. After computed tomography, emergency paracentesis was carried out for decompression. After emergency paracentesis, the patient's symptoms and vital signs were stabilized. After the procedure, the patient had an emergency laparotomy.
Abdomen ; Abdominal Pain ; Adult ; Compressed Air* ; Decompression ; Dyspnea ; Elasticity ; Emergencies ; Emergency Service, Hospital ; Humans ; Intestinal Perforation ; Intestines ; Laparotomy ; Male ; Paracentesis ; Pneumoperitoneum* ; Stomach ; Ultrasonography ; Vital Signs