In the case of a soft tissue defect which requires thin & pliable tissues, the choice of donor site is limited due to flap bulkiness and donor site morbidity. To overcome these problems, a variety of perforator-based flaps such as paraspinous and parasacral perforator flap, deep inferior epigastric perforator flap, gluteal perforator flap, and thoracodorsal artery perforator flap have recently been introduced. We experienced 8 cases of soft tissue defects from December 1996 to March 1999 using the thoracodorsal artery perforator flap for reconstruction. We could elevate the cutaneous flap with preservation of the latissimus dorsi muscle flap only when it was based on one cutaneous perforator. Defatting procedure was possible for further thinning of skin flap. In one case, axillary defect after release of postburn scar contracture was repaired with island perforator flap and the other seven cases were repaired with free flap. The results were satisfactory. We believe the thoracodorsal artery perforator flap is useful for reconstruction of soft tissue defects which are large or under conditions requiring thin flap.
Arteries* ; Cicatrix ; Contracture ; Free Tissue Flaps ; Humans ; Perforator Flap ; Skin* ; Superficial Back Muscles ; Tissue Donors

INTRODUCTION: The objective of the present study was to investigate the defense style of insomnia patients and to grasp the differences in defense style between primary insomnia patients and insomnia patients with history of major depressive disorder. METHODS: Forty three subjects with insomnia (11 subjects with primary insomnia and 32 subjects with major depressive disorder) and 138 control subjects participated in this study. To diagnose insomnia and major depressive disorder, interviews including structured clinical interview for DSM-IV (SCID-IV) were done. To assess the defense style, self-reported Korean version of Defense Style Questionnaire (K-DSQ) were completed by the participants. RESULTS: Compared to normal controls, subjects with insomnia used more acting out (t=3.25, p<0.01), consumption (t=2.66, p<0.01), fantasy (t=3.51, p<0.001), resignation (t=5.42, p<0.001), suppression (t=3.28, p<0.01), projection (t=3.92, p< 0.01), splitting (t=4.31, p<0.01), undoing (t=2.66, p<0.01), withdrawal (t=6.72, p<0.001) and isolation (t=3.80, p<0.001), and less omnipotence (t=4.08, p<0.001) and humor (t=3.20, p<0.01). Compared to normal controls, subjects with primary insomnia used more undoing and withdrawal. Compared to subjects with primary insomnia, subjects with insomnia with history of major depressive disorder used more resignation and withdrawal, and less humor. CONCLUSION: In the current study, there were differences in defenses between primary insomnia patients and insomnia patients with major depressive disorder history. To evaluate the pattern of defenses through the K-DSQ might provide important clues to differentiate these two conditions.
Acting Out ; Depressive Disorder, Major ; Diagnostic and Statistical Manual of Mental Disorders ; Fantasy ; Hand Strength ; Humans ; Surveys and Questionnaires ; Sleep Initiation and Maintenance Disorders

BACKGROUND: Gastric cancer is still the leading cause of death in Korea. Pulmonary metastasis(PM) is the second most frequent form of organ metastasis from gastric cancer followed by liver metastasis. However, there have been few reports in Korea dealing with the clinicopathological characteristics of pulmonary metastasis from gastric cancer (PMGC). METHODS: Six hundread sixty seven surgeries for gastric cancer were performed during the period from June 1992 to August 1997 in our department. Fourteen cases of PMGC were included in this study. The diagnostic methods for PMGC were chest X-ray, chest CT, and CT-guided fine-needle aspiration biopsy or bronchoscopic biopsy (in doubtful cases). RESULTS: The most common symptoms in PMGC were cough and dyspnea; 4 cases (28.6%) had no symptoms related to PM. There were four types of PM: lymphangitic carcinomatosa (LC), 6 cases; nodular, 5 cases; pleuritis carcinomatosa (PC), 2 cases; and mediastinal lymphadenopathy (ML), 1 case. The mean survival duration after PM was 13.2 months for the nodular type, 2.3 months for the LC type, 2 months for the ML type, and 1.5 months for the PC type. The mean survival time after PM was 12.4 months when the disease- free interval after gastric surgery was longer than 12 months and was 2.1 months when it was less than 12 months. The mean survival durations after PM were 23 months and 6 months (still alive) for the 2 patients operated on for PM lesions and 4.7 months for the 12 not receiving operations. In summary, when the disease free interval was longer, the mean survival duration after PM was also longer. The survival duration in cases with nodular type PM was longer than that for other types of PM. CONCLUSION: On the basis of this study, we can assume that a pulmonary resection can be carried out in the case of a single metastatic nodule in order to extend the length of survival.
Biopsy ; Biopsy, Fine-Needle ; Cause of Death ; Cough ; Dyspnea ; Humans ; Korea ; Liver ; Lymphatic Diseases ; Neoplasm Metastasis* ; Pleurisy ; Stomach Neoplasms* ; Survival Rate ; Thorax ; Tomography, X-Ray Computed

INTRODUCTION: The objective of the present study was to investigate the independent effects of major depressive disorder (MDD) and insomnia on somatization, respectively. METHODS: A total of 181 participants (73 males and 108 females ; mean age 41.59+/-8.92) without serious medical problem were recruited from a community and a psychiatric clinic in Republic of Korea. Subjects were divided into 4 groups based on the Structured Clinical Interview for DSM-IV axis I disorder (SCID-IV) and sleep questionnaire : 1) normal controls (n=127), 2) primary insomnia (n=11), 3) MDD without insomnia (n=14), and 4) MDD with insomnia (n=29). All participants were requested to complete the somatization subscores of the Symptom Checklist-90-Revised (SCL-90-R). RESULTS: There were significant between-group differences in somatization score (F=25.30, p<0.001). Subjects with both MDD and insomnia showed higher somatization score compared to normal control (p<0.001), subjects with primary insomnia (p=0.01), or MDD subjects without insomnia (p<0.001). Subjects with primary insomnia had higher somatization score than normal controls (p<0.01), while there was no significant difference between MDD subjects without insomnia and normal controls. In multiple regression, presence of insomnia predicted higher somatization score (beta=0.44, p<0.001), while there was only non-significant association between MDD and somatization (beta=0.14, p=0.08). CONCLUSION: In the current study, insomnia was associated with somatization independently from major depression. Subjects with primary insomnia showed higher somatization. Within MDD patients, presence of insomnia was related to higher somatization. Our finding suggests that insomnia may partly mediate the relationship between depression and somatization.
Axis, Cervical Vertebra ; Depression ; Depressive Disorder, Major ; Diagnostic and Statistical Manual of Mental Disorders ; Female ; Humans ; Male ; Surveys and Questionnaires ; Republic of Korea ; Sleep Initiation and Maintenance Disorders

INTRODUCTION: The objective of the present study was to investigate the independent effects of major depressive disorder (MDD) and insomnia on somatization, respectively. METHODS: A total of 181 participants (73 males and 108 females ; mean age 41.59+/-8.92) without serious medical problem were recruited from a community and a psychiatric clinic in Republic of Korea. Subjects were divided into 4 groups based on the Structured Clinical Interview for DSM-IV axis I disorder (SCID-IV) and sleep questionnaire : 1) normal controls (n=127), 2) primary insomnia (n=11), 3) MDD without insomnia (n=14), and 4) MDD with insomnia (n=29). All participants were requested to complete the somatization subscores of the Symptom Checklist-90-Revised (SCL-90-R). RESULTS: There were significant between-group differences in somatization score (F=25.30, p<0.001). Subjects with both MDD and insomnia showed higher somatization score compared to normal control (p<0.001), subjects with primary insomnia (p=0.01), or MDD subjects without insomnia (p<0.001). Subjects with primary insomnia had higher somatization score than normal controls (p<0.01), while there was no significant difference between MDD subjects without insomnia and normal controls. In multiple regression, presence of insomnia predicted higher somatization score (beta=0.44, p<0.001), while there was only non-significant association between MDD and somatization (beta=0.14, p=0.08). CONCLUSION: In the current study, insomnia was associated with somatization independently from major depression. Subjects with primary insomnia showed higher somatization. Within MDD patients, presence of insomnia was related to higher somatization. Our finding suggests that insomnia may partly mediate the relationship between depression and somatization.
Axis, Cervical Vertebra ; Depression ; Depressive Disorder, Major ; Diagnostic and Statistical Manual of Mental Disorders ; Female ; Humans ; Male ; Surveys and Questionnaires ; Republic of Korea ; Sleep Initiation and Maintenance Disorders

OBJECTIVES: The present study aims to investigate the effects of physical illness on depression in North Korean Defectors. METHODS: One hundred forty-four North Korean Defectors(20 males, 124 females) and 376 South Koreans 133 males, 243 females) in Incheon Metropolitan areas participated the present study. Face-to-face interview was conducted for demographic information including presence of physical illnesses. To investigate depressive symptoms, all participants were required to complete the Center for Epidemiologic Studies-Depression scale (CES-D). RESULTS: After controlling gender, age, marital status, educational year, employment status and physical illness, North Korean Defectors showed higher CES-D score than South Koreans(beta=0.449, p<0.001). Within North Korean Defectors, the presence of physical illnesses independently was related to higher CES-D score(beta=0.243, p<0.001). However, within South Koreans, the presence of physical illnesses did not significantly predict CES-D score. North Korean Defectors with physical illness have higher CES-D score than North Korean Defectors without physical illness(26.8+/-13.8 versus 19.7+/-12.7). However, there was no significant differences of CES-D score between South Koreans with physical illness and South Koreans without physical illness(10.3+/-9.8 versus 9.3+/-8.8). CONCLUSION: Compared to South Koreans, North Korean Defector showed higher depressive symptoms independently from gender, age, education, employment, marriage. In addition, only North Korean Defectors showed the relationship between depression and physical illness. Our study suggests that depression should be assessed when North Korean Defectors have physical illness.
Depression ; Employment ; Humans ; Male ; Marital Status ; Marriage

INTRODUCTION: There has been an increasing interest in the relationship between sleep and suicidality. In addition, suicidal patients habitually report their sleep problems. Although sleep-related complaints and electroencephalographic changes are generally encountered in psychiatric disorders, sleep complaints such as insomnia, hypersomnia and nightmares are more common in suicidal patients. In current study, we aimed at investigating the relationship between self-reported sleep duration and suicidality in general population. METHODS: One thousand general population (male : female=500 : 500, mean age=39.6+/-11.6 years, ranged age=20-77 years) completed Center for Epidemiologic Study-Depression (CES-D), Beck Suicide Intent scale (BSI), Spielberger State-Trait Anger Expression Inventory (STAXI), Barratt Impulsiveness Scale (BIS), Morningness-Eveningness Scale (MES) and brief questionnaire of sleep habits. RESULTS: After controlling for age and sex, score of BSI was correlated positively with the score of CES-D, STAXI and BIS on partial correlation analysis (r(p)=0.251 ; p<0.001, r(p)=0.352 ; p<0.001, and r(p)=0.175 ; p<0.001, respectively). In addition, score of BSI was inversely correlated with the score of MES (r(p)=-0.066; p=0.037). However, score of BSI showed no significant correlation with sleep duration. However, regression analysis revealed that short (<6 hrs) or long (>10 hrs) sleep duration, the family history of psychiatric illness, the score of CES-D, and the score of STAXI predicted higher score of BSI significantly in total subjects (F=17.837, adjusted R2 =0.166 ; p=0.003, p=0.003, p<0.001, and p=0.003, respectively). This model was explained better in depressed subjects with 16 or higher score of CES-D (F=9.920, adjusted R2=0.298). CONCLUSION: Current result suggested that not only short sleep duration (<6 hrs) but also long sleep duration (>10 hrs) might be related to suicidality.
Anger ; Depression ; Disorders of Excessive Somnolence ; Dreams ; Humans ; Surveys and Questionnaires ; Republic of Korea ; Sleep Initiation and Maintenance Disorders ; Suicide

OBJECTIVES: Working at other times than the regular day shift has been reported to be a stressor associated with health consequences and mental disorders as well as disturbance of sleep. In current study, we aimed at investigating the relationship between work schedule, sleep quality and depression among police officers. METHODS: Eleven hundreds and forty five police officers (male:1040, female:105) completed questionnaires of basic socio-demographic data, Pittsburgh Sleep Quality Index (PSQI), Korean Scale of Occupational Stress (KOSS), Impact of Event Scale - Revised (IES-R) and Center for Epidemiologic Study-Depression (CES-D). RESULTS: After controlling for age, sex and educational level, score of CES-D was correlated positively with the score of KOSS, PSQI and IES-R on partial correlation analysis (r=-0.077;p=0.009, r=0.262;p<0.000 and r=0.421, p<0.000, respectively). Logistic regression analysis revealed that female sex, age, the score of KOSS and IES-R and schedule of rotating shift work predicted higher score than 16 score of CES-D significantly in total subjects (p=0.023, p=0.015, p=0.000, p=0.000 and p=0.022, respectively). CONCLUSION: Current result suggested that not only female sex, age, higher occupational stress and impact of event scale but also rotating shift work schedule might be related to depression among police officers.
Appointments and Schedules ; Depression ; Female ; Humans ; Logistic Models ; Mental Disorders ; Police ; Surveys and Questionnaires ; Risk Factors

Enterococcus is a gram positive coccus and a normal flora in gastrointestinal tract, but it could raise opportunistic infection. In 1986, vancomycin resistant enterococcus(VRE) was reported in Europe at first. Recently, the incidence is increasing in USA and Korea(2~8%). In our hospital, sore and stool cultures for enterococcal identification were carried out on 4 patients with sore wound. By screening stool culture, VRE was detected in 3 of 4 pressure sore patients. VRE was also identified from the sore wound in 2 of 3 patients who had VRE positive in screening stool culture. 2 of 4, enterococcal positive patients, have the history of vancomycin use in the past. An increasing number of VRE infection in hospital suggest that VRE become an important cause of infected pressure sore. Therefore, culture of sore wound and stool for the identification of VRE should be performed routinely.
Enterococcus ; Europe ; Gastrointestinal Tract ; Humans ; Incidence ; Mass Screening ; Opportunistic Infections ; Pressure Ulcer ; Vancomycin ; Wounds and Injuries*

OBJECTIVE: The aim of this study was to determine the optimal loading conditions for pure intrusion of the six maxillary anterior teeth with miniscrews according to alveolar bone loss. METHODS: A three-dimensional finite element model was created for a segment of the six anterior teeth, and the positions of the miniscrews and hooks were varied after setting the alveolar bone loss to 0, 2, or 4 mm. Under 100 g of intrusive force, initial displacement of the individual teeth in three directions and the degree of labial tilting were measured. RESULTS: The degree of labial tilting increased with reduced alveolar bone height under the same load. When a miniscrew was inserted between the two central incisors, the amounts of medial-lateral and anterior-posterior displacement of the central incisor were significantly greater than in the other conditions. When the miniscrews were inserted distally to the canines and an intrusion force was applied distal to the lateral incisors, the degree of labial tilting and the amounts of displacement of the six anterior teeth were the lowest, and the maximum von Mises stress was distributed evenly across all the teeth, regardless of the bone loss. CONCLUSIONS: Initial tooth displacement similar to pure intrusion of the six maxillary anterior teeth was induced when miniscrews were inserted distal to the maxillary canines and an intrusion force was applied distal to the lateral incisors. In this condition, the maximum von Mises stresses were relatively evenly distributed across all the teeth, regardless of the bone loss.
Alveolar Bone Loss* ; Finite Element Analysis* ; Incisor ; Tooth*