Vascularized free fibula head transfer is an established method for reconstruction of long bone defects of the upper limb involving the distal radius or the proximal humerus. For the wrist following tumor resection, in cases of resection of the radial articular surface, three reconstructive options are possible: 1. fibular head transfer to replace the radial joint surface, 2. fixation of the fibula to the scaphoid and lunate, 3. complete wrist fusion. The decision on the type of the operation depends on the amount of the resection and the remained normal anatomical structures, and also the necessity of function of the wrist in the future. The authors believe that the vascularized free fibula head graft is a safe and reliable method for reconstructing the upper limb, especially for patients with a defect of the distal radius, and report the operative methods, donor vascular consideration, complications, and functional result after this operation.
Fibula ; Head ; Humans ; Humerus ; Joints ; Radius ; Tissue Donors ; Transplants ; Upper Extremity ; Wrist ; Wrist Joint

BACKGROUND: Systemic arterial hypotension is relatively common following initiation of cardiopulmonary bypass (CPB). Decreased blood viscosity is induced by acute normovolemic hemodilution (ANH) and by the use of crystalloid oxygenator prime. The purpose of this paper is to study the effect of ANH on mean arterial pressure, perfusion flow index and PaO2/FiO2 upon initiation of CPB, and on homologous blood usage during CPB in coronary artery bypass grafting (CABG) surgery. METHODS: We reviewed 30 patients constituting an ANH group, and 30 patients in a control group who had undergone CABG surgery within the past 2 years. In the ANH group, 1 or 2 units of fresh autologous whole blood were sequestrated following induction of anesthesia. We compared mean arterial pressure, perfusion flow index, PaO2/FiO2, and hematocrit on the initiation of CPB, and homologous blood usage during and post CPB periods between the groups. RESULTS: Upon initiation of CPB, hematocrit in the ANH group was significantly less than in the control group, but there was no significant difference in mean arterial pressure, perfusion flow index or PaO2/FiO2 between the groups. The use of homologous blood during CPB in the ANH group was not significantly higher than in the control group. CONCLUSIONS: Acute intraoperative normovolemic hemodilution in CABG surgery was safely performed without significant hypotension and increased homologous blood usage during CPB.
Anesthesia ; Arterial Pressure ; Blood Viscosity ; Cardiopulmonary Bypass* ; Coronary Artery Bypass* ; Coronary Vessels* ; Hematocrit ; Hemodilution* ; Humans ; Hypotension ; Oxygen ; Oxygenators ; Perfusion

Angiosarcoma is a rare primary malignancy occurring anywhere in the body, but most often in the skin, liver or breast. The radiological findings of angiosarcoma of the breast have rarely been reported. We encountered a case in which the condition involved a 32-year-old woman in whom mammography revealed a obscuved-marginated and lobular-shaped high-density lesion, and ultrasonography demonstrated an ovalshaped, microlobular-marginated, inhomogenous hypoechoic mass which metastasized to the whole body after surgery. We report the radiological findings of this case of angiosarcoma of the breast, and review the literature.
Adult ; Breast Neoplasms ; Breast* ; Female ; Hemangiosarcoma* ; Humans ; Liver ; Mammography ; Sarcoma ; Skin ; Ultrasonography

No abstract available.
Adenoma*

PURPOSE: To determine the upper limit of peripheral nerve lengthening without loss of function, the recovery time of peripheral nerve palsy due to nerve lengthening and their histological changes. MATERIALS AND METHODS: Twelve adult New Zealand rabbits weighing about 2.5 kg were assigned to the following groups. Group 1 (n=6) was subjected to slow tissue expansion with 30% of nerve lengthening while group 2 (n=6) was rapid expansion with 40% lengthening of nerve. The expanders were refilled every 2 times during the 2nd and 4th weeks making a total four times of expansion. The rabbits were assessed in terms of affected leg paralysis, neural length gain, EMG with nerve conduction velocity and histological changes. RESULTS: In group 1 (n=6), paralysis on affected leg was found in one rabbit and was recovered spontaneously on the 4th weeks after expander removal. In Group 2 (n=6), paralysis was found in four rabbits, and three of them were recovered on 4, 5 and 9 weeks after removal of the expander. EMG study showed increase in distal latency of 2.50+/- 0.20 m/sec, and decrease in nerve conduction velocity of 62.49+/- 5.30 m/sec compared to normal side with 1.89+/- 0.14 m/sec and 75.39+/- 7.82 m/sec. The mean neural length gain was 6 mm (30% of 20 mm of initial pre-experimental nerve length) in group 1 and 8 mm (40% of 20 mm) in group 2. Light microscopic examination revealed the loss of segmental myelination, decrease of myelination, and vacuolation. Electron microscopic examination showed that the normal ring shaped contour of axon was changed to convoluted shape.
Adult ; Axons ; Humans ; Leg ; Myelin Sheath ; Nerve Expansion ; Neural Conduction ; Paralysis ; Peripheral Nerves ; Rabbits ; Sciatic Nerve* ; Tissue Expansion*

Cytochrome P450 3A4 (CYP3A4), is the dominant human liver hemoprotein enzyme localized in the endoplasmic reticulum (ER), and is responsible for the metabolism of more than 50% of clinically relevant drugs. While we were studying CYP3A4 expression and activity in human liver, we found that anti-CYP3A4 antibody cross-reacted with a lower band in liver cytoplasmic fraction. We assessed the activities of CYP3A4 and its truncated form in the microsomal and cytoplasmic fraction, respectively. In the cytoplasmic fraction, truncated CYP3A4 showed catalytic activity when reconstituted with NADPH-cytochrome P-450 reductase and cytochrome b5. In order to determine which site was deleted in the truncated form in vitro, we transfected cells with N-terminal tagged or C-terminal tagged human CYP3A4 cDNA. The truncated CYP3A4 is the N-terminal deleted form and was present in the soluble cytoplasmic fraction. Our result shows, for the first time, that N-terminal truncated, catalytically active CYP3A4 is present principally in the cytoplasm of human liver cells.
Blotting, Western ; Catalysis ; Cell Line ; Cytochrome P-450 CYP3A/chemistry/*metabolism ; Cytoplasm/*enzymology ; Humans ; Microsomes, Liver/*enzymology

For the treatment of coarction of aorta, surgical intervention has been known as a standard therapy.During last decade balloon angioplasty for coarctation of the aorta has been reported as a successful and safe procedure in about 300 cases. This angioplasty was done mainly in infants and children, and little cases in adults and adolescents. A 22 year-old adult with coarctation of aorta have recieved balloon angioplasty. He visited to emergency room due to severe headache and the blood presure of arm was 240/130mmHg at emergency room. The blood pressure at ward was 168/92mmHg in upper extremities, 104/82mmHg in lower extrimities. His aortogram showed coarctation of thoracic aorta below left subclavian artery. The pressure gradient beween ascending aorta and right femoral artery was decreased from 60mmHg to 0mmHg after balloon dilatation (2 times, balloon diameter 18mm). There were no significant complications. The follow-up magnetic resonance image in 4 month after balloon angioplasty showed no evidence of restenosis or saccular aneurysm. Initial hypertension turned to normal blood pressure in 4 months after balloon angioplasty. This adult case of successful balloon angioplasty for coarctation of aorta is the first case reported in Korea.
Adolescent ; Adult* ; Aneurysm ; Angioplasty ; Angioplasty, Balloon* ; Aorta ; Aorta, Thoracic ; Aortic Coarctation* ; Arm ; Blood Pressure ; Child ; Dilatation ; Emergency Service, Hospital ; Femoral Artery ; Follow-Up Studies ; Headache ; Humans ; Hypertension ; Infant ; Korea ; Subclavian Artery ; Upper Extremity ; Young Adult

PURPOSE: The purpose of this study was to report the clinical outcome of "modified Bouquet technique", as a simple and effective internal fixation with Kirschner-wire for the metacarpal neck fractures. METHODS: Sixty-seven patients with metacarpal neck fracture treated by modified Bouquet technique were retrospectively reviewed. The operation time and removal time were evaluated. For radiologic evaluation, posterior angulation of fracture and metacarpal shortening were measured pre and postoperatively. For clinical evaluation, range of motion of metacarpophalangeal joint, Green and O'Brien score were evaluated. RESULTS: Preoperative neck shaft angle of metacarpal bone was 46.0° and length of metacarpal bone was 51.2 mm, and postoperative neck shaft angle was 24.4° (p=0.003) and length of metacarpal length was 52.8 mm (p=0.031) in average. The mean range of motion was 86.6° and Green and O'Brien score was 96.1 points at last visit. We had one complicated case with type II complex regional pain syndrome of affected hand with hypertrophic scar formation. CONCLUSION: Modified Bouquet technique for metacarpal neck fracture is a good method using just two K-wires, plier and mallet without electric devices in short operation time. The technique can correct angulation of fracture site, rotation of finger and metacarpal shortening by controlling inserted K-wires with high bone union rate with less joint stiffness.
Causalgia ; Cicatrix, Hypertrophic ; Fingers ; Hand ; Humans ; Joints ; Metacarpophalangeal Joint ; Methods ; Neck* ; Range of Motion, Articular ; Retrospective Studies

No abstract available.
Survival Rate* ; Uterine Cervical Neoplasms*

PURPOSE: We designed this study to demonstrate recent trends in the proportion of adult hip research in orthopedics, to identify countries leading the adult hip research, and to evaluate the relationship between the economic power of the countries and their contributions. MATERIALS AND METHODS: Studies published in seven select orthopedic journals were retrieved from PubMed. Among them, we determined the number of adult hip studies. The countries-of-origin of adult hip studies, and the economic power of the countries were investigated. RESULTS: A total of 7218 orthopedic publications and 1993 (27.6%) addressed adult hip research were identified. Adult hip studies increased from 313 (23.7%) in 2000 to 555 (27.9%) in 2011. Twenty-five countries accounted for 97.6% of the total number of adult hip studies, and gross domestic product correlated with publication volume (Spearman's rho, 0.723; p=0.000). CONCLUSION: Researchers from a limited number of developed countries have published their studies in the adult hip discipline.
Adult ; Geography ; Hip/*physiology ; Humans ; PubMed ; Publications/*trends ; Research/*trends