Diabetic and nondiabetic vascular diseases cause significant foot problems and it frequently progress to osteomyelitis and amputation. Advances in vascular surgical techniques, including distal arterial bypass via synthetic grafts or autogenous vein grafting have opened the way for higher rate of limb salvage. We have experienced patients with ischemic vascular foot disease and combined skin ulceration and varing degree of soft tissue defect. In three patient with major vessel obstruction, we could preserve limb and avoid major amputation using greater saphenous vein graft with or without microvascular free tissue transfer.
Amputation ; Extremities ; Foot Diseases ; Foot* ; Humans ; Limb Salvage ; Osteomyelitis ; Saphenous Vein ; Skin Ulcer ; Transplants ; Vascular Diseases ; Veins

No abstract available.
Adult* ; Electrodes* ; Humans ; Neural Conduction*

Raynaud's phenomenon manifests as triphasic color change episodes of blanching, cyanosis, and reddening of the digits, induced by exposure to low temperature or emotional stress. It is a relatively common disorder, estimated to affect 5-10% of the general population and 20-30% of otherwise healthy women. Most cases of primary Raynaud's phenomenon also called Raynaud's disease, are mild and self-limited. Secondary Raynaud's phenomenon presents as a secondary manifestation of an underlying disease and are complicated by ulcerations and tissue necrosis. From March 1996 to August 1998, we experienced 4 patients with Raynaud's phenomenon. Two patients were diagnosed Raynaud's disease and the other two were secondary. Raynaud's disease responded to drug therapy and sympatetic ganglion block. Secondary Raynaud's syndrome was treated with vein graft and free tissue transfer. During postoperative follow-up of 33-49 months, both severity and symptomatic intervals were improved.
Cyanosis ; Drug Therapy ; Female ; Follow-Up Studies ; Ganglion Cysts ; Humans ; Necrosis ; Raynaud Disease ; Stress, Psychological ; Transplants ; Ulcer ; Veins

PURPOSE: To treat burn and burn scar contracture, many types of skin grafts have been developed. Skin allograft is a recently introduced option for reconstruction of skin defects. The science of skin allotransplanation is rooted in progressive thinking by surgeons, fueled by innovative solutions, and aided by understanding the immunology of tolerance and rejection. METHODS: This study assesses the effect of dendritic cell pretreatment in induction of survival increase in a rat skin allograft model. Recipient derived dendritic cells were harvested from rat whole blood and cultured with GM-CSF and IL-4 for 2 weeks. Then donor-specific alloantigen pulsed dendritic cells were reinjected into subdermal tissue before skin graft. Rat left dorsal skin allografts were transplanted in 3 subgroups. Groups: I) untreated, II) FK-506 (2 mg/kg), III) dendritic cell pretreatment and FK-506. Graft appearance and histologic analysis were assessed postoperatively. RESULTS: The group III showed longest graft survival rate than other groups. CONCLUSION: Donor antigen pulsed host dendritic cell combined with short-term immunosuppression prolong skin allograft survival and has potential therapeutic application for induction of tolerance.
Animals ; Burns ; Cicatrix ; Contracture ; Dendritic Cells ; Graft Survival ; Granulocyte-Macrophage Colony-Stimulating Factor ; Humans ; Immunosuppression ; Interleukin-4 ; Isoantigens ; Rats ; Skin ; Tacrolimus ; Thinking ; Tissue Donors ; Transplantation, Homologous ; Transplants

The standard treatment of adult femoral shaft fractures is the closed intramedullary nailing using a fracture table, but in polytraumatized patients, this method may be difficult due to concomitant adjacent injury. So, we report on the technique of closed intramedullary nailing without a fracture table for adult femoral shaft fracture using "joystick" technique on radiolucent table in supine position. Among 15 cases, two were open fractures, three were proximal 1/3, seven were middle 1/3, two were distal 1/3, and theree were segmental fractures. According to the Winquist Hansen classification, five type I, four type II, three type III, three were type IV. The eleven patients out of the fifteen were operated within 48 hours. The average operation time was 105 minutes, and the amount of bleeding was below 300cc. Forty-seven percent was anatomically reduced, forty percent had below five degree of angular deformity or below five milimeter of shortening, thirteen percent had above five degree of angular deformity of above five milimeter of shortening. The closed intramedullary nailing of femoral shaft fractures without fracture table using radiolucent table and "joy stick" technique is an effective and safe method in multiple injuries. And it reduced the operation time by reducing the preoperation time including preparing of a fracture table.
Adult ; Classification ; Congenital Abnormalities ; Femoral Fractures ; Fracture Fixation, Intramedullary ; Fractures, Open ; Hemorrhage ; Humans ; Methods ; Multiple Trauma ; Supine Position

The need for routine radionuclide bone scan as part of the preoperative metastatic work-up in patients with renal cell carcinoma has been debated by several investigators more than 10 years. To investigate the value of radionuclide bone scan, radionuclide bone scans were performed preoperatively as part of staging procedures in 79 patients of 91 patients with renal cell carcinoma from 1989 to 1994. We analyzed the findings of bone scan according to the clinical and laboratory variables. When hot uptake was detected on the preoperative bone scan, it was interpreted positive if there was no history of trauma or absence of bone and joint disease such as degenerative Joint disease or arthritis. The bone scans were positive in 21 cases ( 26.6%) and negative in 58 cases (73.4%). The bone scans were neither correlated with the clinical variables such as incidentaloma, age of the patient, performance status, bone pain, the size of the tumor, T category of the tumor, thrombosis of renal vein or IVC, lymph node metastasis and extraskeletal metastasis nor with laboratory variables such as serum alkaline phosphatase, hemoglobin, serum calcium and ESR. We also analyzed positive scan according to the number of bony lesions. There was no correlation between the number of lesions on bone scan and clinica1 and laboratory variables. In conclusion, there was no clinical and laboratory parameters predicting positivity of bone scan. This suggests that all patients with renal cell carcinoma should be staged routinely with preoperative bone scan as the part of the initial clinical work up.
Alkaline Phosphatase ; Arthritis ; Calcium ; Carcinoma, Renal Cell* ; Humans ; Joint Diseases ; Lymph Nodes ; Neoplasm Metastasis ; Renal Veins ; Research Personnel ; Thrombosis

PURPOSE: The majority of nasal bone fractures have been managed by routine procedure of closed reduction, intranasal packing or intranasal Kirschner wire (K-wire) splinting. But it leaves rooms for many complaints from patients such as pain, rhinorrhea and nasal obstructioon. Another option is, of course, no packing at all. The study was initiated to assess the necessity to pack or splint the nasal bone after routine closed reduction. METHODS: We analysed the medical records of 35 patients with nasal bone fracture who were operated by closed reduction in the last 2 years. We evaluated the postoperative CT scan scores and external deviation criterias 1 month after the operation. RESULTS: The postoperative deviation criteria and postoperative CT scan score were favorable and there were no serious complications using this technique. CONCLUSION: The present study demonstrates that the use of packing or splinting need not be routine in the majority of cases. The risks and discomforts associated with these procedures can often be avoided.
Humans ; Medical Records ; Nasal Bone ; Splints

Primary transitional cell carcinoma of ovary has been recently recognized as a separate subtype of epithelial cancer. It is unusual tumor and in which definite urothelial features are present, but no benign Brenner component is identified. These tumor are more aggressive and tend to present at a higher stage than malignant Brenner tumors, but they appear to respond better to chemotherapy than other type of ovarian epithelial cancer. We have experienced two cases of ptimary transitioaal cell carcinoma of ovary. So we report these cases with a brief review of literature.
Brenner Tumor ; Carcinoma, Transitional Cell* ; Drug Therapy ; Female ; Ovary*

Severely disfiguring facial injuries can have a devastating impact on the patient's quality of life. During the past decade, vascularized facial allotransplantation has progressed from an experimental possibility to a clinical reality in the fields of disease, trauma, and congenital malformations. This technique may now be considered a viable option for repairing complex craniofacial defects for which the results of autologous reconstruction remain suboptimal. Vascularized facial allotransplantation permits optimal anatomical reconstruction and provides desired functional, esthetic, and psychosocial benefits that are far superior to those achieved with conventional methods. Along with dramatic improvements in their functional statuses, patients regain the ability to make facial expressions such as smiling and to perform various functions such as smelling, eating, drinking, and speaking. The ideas in the 1997 movie "Face/Off" have now been realized in the clinical field. The objective of this article is to introduce this new surgical field, provide a basis for examining the status of the field of face transplantation, and stimulate and enhance facial transplantation studies in Korea.
Evidence-Based Medicine ; Face/*surgery ; Facial Injuries/*surgery ; Facial Transplantation/*methods/trends ; Forecasting ; Humans ; Reconstructive Surgical Procedures/*methods/trends ; Surgical Flaps/*trends ; Treatment Outcome

Cervical pregnancy is a rare and dangerous form of ectopic pregnancy in which the blastocyst implants within the cervical canal below the internal os of the uterine cervix. The characteristic clinical sign is a severe asymptomatic uterine bleeding in early pregnancy or during curettage. Most cervical pregnancies result in early spontaneous abortion, complicated by severe hemorrhage from the eroded blood vessels within the cervical tissue. Because of uncontrolled profuse vaginal bleeding, total hysterectomy has been the mostly necessitated to control life-threatening bleeding. Transvaginal sonography allows early diagnosis, and conservative treatment (two-time treatment : first treatement with systemic or intraamnionic methotrexate, secondly with curettage or ligature of the uterine arteries) improves the patient's fertility. Successful treatment is defined as elimination of the cervical pregnancy with preservation of the uterus. We report two cases of cervical pregnancy managed, successfully with methotrexate, leucovorin and curettage.
Abortion, Spontaneous ; Blastocyst ; Blood Vessels ; Cervix Uteri ; Curettage ; Cytochrome P-450 CYP1A1 ; Early Diagnosis ; Female ; Fertility ; Hemorrhage ; Humans ; Hysterectomy ; Leucovorin ; Ligation ; Methotrexate ; Pregnancy* ; Pregnancy, Ectopic ; Uterine Hemorrhage ; Uterus