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

Pulmonary Fibrosis*

Transurethral resection of Prostate(TURP) is the current optimal therapy for benign prostatic hypertrophy. But in some cases of BPH patients, TURP cannot be performed because the patients have medical disorders not to be operated. Thus several alternatives have been used in the management of BPH patients, especially who had anesthetic contraindications to an operation. We experienced 12 cases of BPH patients applied with Intraurethral Cath(IUC) from April 1991 to September 1995. Eleven patients became able to void after IUC insertion. The maximal flow rates were 5.1 to 15.7 ml/sec and average value was 11.8 ml/sec. Almost all patients showed irritative voiding symptoms such as urgency, urge incontinence, frequency, and dysuria at first. In 7 patients, these symptoms disappeared spontaneously within 2 to 5 days and oxybutynin chloride was used orally in 2 patients. Suprapubic cystostomy was done in three patients because two patients had severe irritative voiding symptoms and one patient had persistent urinary retention. The stent was changed every 3 to 6 months. Stone formation around the device was noted in 2 patients and migration of device into the bladder was found in 2 patients. In 4 patients, TURP was performed when the patient's condition improved enough to be operated under epidural anesthesia. In conclusion, the use of IUC is thought to be a valid, cost effective and safe alternative to TURP in the treatment of highly operative risk patients with benign prostatic hypertrophy.
Anesthesia, Epidural ; Cystostomy ; Dysuria ; Humans ; Prostatic Hyperplasia* ; Stents* ; Transurethral Resection of Prostate ; Urinary Bladder ; Urinary Incontinence, Urge ; Urinary Retention

Double crown prostheses can be used in patients who have a few remaining teeth and poor periodontal condition because of secondary splinting of abutments, vertical loading, decrease of the length of lever arm due to fulcrum line located on margin of inner and outer crown. Successful results of treatments using double crown prostheses for the partially edentulous patients who have a few remaining teeth and implant overdenture using a small number of implants have been reported. In this case, there were a few remaining teeth with a very poor periodontal condition in maxilla, and there were a failed implant with severe alveolar bone resorption and shrinkage in the mandible. The main objective of this report is to introduce our case because a double crown partial denture showed satisfactory results in functional and esthetical aspects during more than one-year follow-up period.
Arm ; Bone Resorption ; Crowns* ; Denture, Overlay* ; Denture, Partial ; Dentures* ; Follow-Up Studies ; Humans ; Mandible ; Maxilla ; Prostheses and Implants ; Splints ; Tooth*

PURPOSE: Benign prostatic hyperplasia (BPH) is not uncommon, and its prevalence is increasing; its treatment is also undergoing certain changes, which are quite different from previously used treatments. The purpose of this study was to investigate the trend in BPH treatment over the last 5 years, at the Yonsei Medical Center, with its clinical implications. Materials and Methods: A retrospective analysis was performed on patients diagnosed with BPH, and treated surgically and/or medically at our hospital, on an outpatient or inpatient basis, over the 5 year period from Jan 1998 to Nov 2002. The subjects were divided into surgically and medically treated groups. Prostate volume was measured by means of transrectal ultrasonography, and the proportion of the total number of BPH patients in each group identified. RESULTS: The mean age of the medically and surgically treated groups were 65.9 and 68.5 years, respectively, with no significant difference between the groups (p>0.05). The numbers of patients diagnosed and treated for BPH increased annually over the 5 years, and were 3,934, 5,318, 6,612, 8,466 and 9,457, respectively, and the numbers of transurethral prostate resection (TURP) performed were 241, 273, 288, 332 and 333, respectively. Although the absolute number of surgical treatments seem similar, the actual proportion; 6.1, 5.1, 4.3, 3.9 and 3.5%, respectively, showed significant decreases year-on-year (p<0.05). Interestingly, while the overall mean prostate volume remained constant (p>0.05), the mean prostate volume in the surgically treated group for the 5 consecutive years were 37.1, 39.3, 44.2, 49.1 and 53.6cc, respectively, showing a significant increase (p<0.05). CONCLUSIONS: The number of BPH patients attending Yonsei Medical Center has rapidly increased over the last 5 years, with medical rather than surgical treatment becoming the primary treatment of BPH. However, despite the number of patients requiring surgical treatment appearing to have change little, the prostate volume of these patients has shown a tendency to increase.
Disease Management ; Humans ; Inpatients ; Outpatients ; Prevalence ; Prostate ; Prostatic Hyperplasia* ; Retrospective Studies ; Transurethral Resection of Prostate ; Ultrasonography

PURPOSE: The purposes of this study are to evaluate the internal and marginal adaptation of two widely used CAD/CAM systems and to study the effect of porcelain press veneering process on the prosthesis adaptation. MATERIALS AND METHODS: Molar of a lower jaw typodont resin model was prepared by adjusting a 1.0 mm circumferential chamfer, an occlusal reduction of 2.0 mm, and a 5° convergence angle and was duplicated as an abrasion-resistant master die. The monolithic crowns and copings were fabricated with two different CAD/CAM system-Ceramil and Zirkonzahn systems. Two kinds of non-destructive analysis methods are used in this study. First, weight technique was used to determine the overall fitting accuracy. And, to evaluate internal and marginal fit of specific part, replica technique procedures were performed. RESULTS: The silicone weight for the cement space of monolithic crowns and copings manufactured with Ceramil system was significantly higher than that from Zirkonzahn system. This gap might cause the differences in the silicone weight because the prostheses were manufactured according to the recommendation of each system. Marginal discrepancies of copings made with Ceramil system were between 106 and 117 µm and those from Zirkonzahn system were between 111 and 115 µm. Marginal discrepancies of copings made with Ceramil system were between 101 and 131 µm and those from Zirkonzahn system were between 116 and 131 µm. CONCLUSION: Marginal discrepancy was relatively lower in Ceramil system and internal gap was smaller in Zirkonzahn system. There were significant differences in the internal gap of monolithic crown and coping among the 2 CAD/CAM systems. Marginal discrepancy produced from the 2 CAD/CAM systems were within a reported clinically acceptable range of marginal discrepancy.
Crowns ; Dental Porcelain ; Jaw ; Molar ; Prostheses and Implants* ; Replica Techniques ; Silicon ; Silicones

PURPOSE: The aim of this study was to investigate the effect of implant thread profile on the marginal bone stresses which develop during implant insertion. MATERIALS AND METHODS: Four experimental implants were created by placing four different thread systems on the body (4.1 mm x 10 mm) of the ITI standard implant. The thread types studied in this study included the buttress, v-shape, reverse buttress, and square shape threads. In order to examine the insertion stress generation, 3D dynamic finite element analysis was performed which simulated the insertion process of implants into a 1.2 mm thick cortical bone plate (containing 3.5 mm pilot hole) using a PC-based DEFORM 3D (ver 6.1, SFTC, Columbus, OH, USA) program. RESULTS: Insertion stresses higher than human cortical bone developed around the implants. The level of insertion stresses was much different depending on the thread. Stress level was lowest near the v-shape thread, and highest near the square shaped thread. Difference in the interfacial bone stress level was more noticeable near the valley than the tip of the threads. CONCLUSION: Among the four threads, the v-shape thread was turned out to minimize the insertion stress level and thereby create better conditions for implant osseointegration.
Bone Plates ; Finite Element Analysis ; Humans ; Implants, Experimental ; Osseointegration

OBJECTIVES: This study was performed to examine the healthy lifestyle influenced on the metabolic syndrome among the elderly in the rural area. We examined the changes of risk factors of metabolic syndrome after two years. METHOD: Out of 134 who did health screening at the J county health center from July 1 to August 31, 2006, 65 aged people confirmed to metabolism syndrome were selected as subjects. For the final analysis, 62 aged people who revisited after two years were selected our subjects. The data were analyzed using SPSS PC+ 12.0 program for descriptive, Chi-square test, t-test and ANOVA analysis. RESULT: The result of this study indicated that 62 metabolic syndrome patients in 2006 decreased into 53, and women were higher than men. The difference in the metabolic syndrome came from level of education, smoking, health practices, and past illness history. CONCLUSION: Therefore, the change of lifestyle needs to be induced by the level of education, and for the group of smoking, non-exercise, and past illness history not only regular checkups to prevent metabolic syndrome but also education to have interest on themselves may need intensively.
Aged ; Female ; Humans ; Life Style ; Male ; Mass Screening ; Porphyrins ; Risk Factors ; Smoke ; Smoking

PURPOSE: Recently, the change to a more complex social structure has led to an increased frequency of traumas due to violence, accident and so on. In addition, the severity of the traumas and the frequency of penetrating injuries have also increased. Traumas to cervical and abdominal areas, what are commonly seen by general surgeons, can have mild to fatal consequences because in these areas, various organs that are vital to sustaining life are located. The exact location and characteristics of the injury are vital to treating patients with the trauma to these areas. Thus, with this background in mind, we studied, compared, and analyzed clinical manifestations of patients who were admitted to Wonju Christian hospital for penetrating injuries inflicted by themselves or others. METHODS: We selected and performed a retrospective study of 64 patients who had been admitted to Wonju Christian Hospital from January 2005 to December 2009 and who had cervical or abdominal penetrating injuries clearly inflicted by themselves or others. RESULTS: There were 51 male (79.7%) and 13 female (20.3%) patients, and the number of male patients was more dominant in this study, having a sex ratio of 3.9 to 1. The range of ages was between 20 and 86 years, and mean age was 43.2 years. There were 5 self-inflicted cervical injuries, and 19 self-inflicted abdominal injuries, making the total number of self-inflicted injury 24. Cervical and abdominal injuries caused by others were found in 11 and 29 patients, respectively. The most common area involved in self-inflicted injuries to the abdomen was the epigastric area, nine cases, and the right-side zone II was the most commonly involved area. On the other hand, in injuries inflicted by others, the left upper quadrant of the abdomen was the most common site of the injury, 14 cases. In the neck, the left-side zone II was the most injured site. In cases of self-inflicted neck injury, jugular vein damage and cervical muscle damage without deep organ injury were observed in two cases each, making them the most common. In cases with abdominal injuries, seven cases had limited abdominal wall injury, making it the most common injury. The most common deep organ injury was small bowel wounds, five cases. In patients with injuries caused by others, six had cervical muscle damage, making it the most common injury found in that area. In the abdomen, small bowel injury was found to be the most common injury, being evidenced in 13 cases. In self-inflicted injuries, a statistical analysis discovered that the total duration of admission and the number of patients admitted to the intensive care unit were significantly shorter and smaller, retrospectively, than in the patient group that had injuries caused by others. No statistically significant difference was found when the injury sequels were compared between the self-inflicted-injury and the injury-inflicted-by-others groups. CONCLUSION: This study revealed that, in self-inflicted abdominal injuries, injuries limited to the abdominal wall were found to be the most common, and in injuries to the cervical area inflicted by others, injuries restricted to the cervical muscle were found to be the most common. As a whole, the total duration of admission and the ICU admission time were significantly shorter in cases of self-inflicted injury. Especially, in cases of self inflicted injuries, abdominal injuries generally had a limited degree of injury. Thus, in our consideration, accurate injury assessment and an ideal treatment plan are necessary to treat these patients, and minimally invasive equipment, such as laparoscope, should be used. Also, further studies that persistently utilize aggressive surgical observations, such as abdominal ultrasound and computed tomography, for patients with penetrating injuries are needed.
Abdomen ; Abdominal Injuries ; Abdominal Wall ; Female ; Hand ; Humans ; Intensive Care Units ; Jugular Veins ; Laparoscopes ; Male ; Muscles ; Neck ; Neck Injuries ; Retrospective Studies ; Sex Ratio ; Violence

This study was undertaken to determine incidence, associated risk factors, and clinical outcomes of a diastasis of pubic symphysis. Among 4,151 women, who delivered 4,554 babies at the Department of Obstetrics of Seoul National University Bundang hospital from January 2004 to December 2006, eleven women were diagnosed as having a symptomatic diastasis of pubic symphysis. We estimated the incidence of the diastasis and identified the associated risk factors. To evaluate the pain relief and reduction of diastasis we followed up the 11 diastatic patients. The incidence of the diastasis was 1/385. Primiparity (P = 0.010) and twin gestation (P = 0.016) appeared as risk factors for diastasis by univairable analysis; and twin gestation appeared to be the only risk factor (P = 0.006) by logistic analysis. Two patients were operated due to intractable pain; and the remaining nine patients were treated conservatively. The diastatic gap decreased to less than 1.5 cm by 2 to 6 weeks after the diagnosis and then remained stationary. At a mean follow-up of 22.1 months (range, 12 to 47 months), five of 11 patients had persistent symphysis pubis dysfunction. Diastasis is more frequent than generally acknowledged. Pregnant women with multiple gestations should be informed about the potential risk of pubic symphysis diastasis.
Adolescent ; Adult ; Birth Weight ; Female ; Follow-Up Studies ; Gestational Age ; Humans ; Incidence ; Logistic Models ; Male ; Middle Aged ; Peripartum Period ; Pregnancy ; Pregnancy, Twin ; Pubic Symphysis/radiography ; Pubic Symphysis Diastasis/diagnosis/*epidemiology ; Risk Factors ; Young Adult