Since introduction of venous flap in 1980, many experimental studies and clinical applications of various kinds of venous flaps were reported. Venous flap has the following advantages : (1) nonbulky and goo-quality of flap (2) long & large vascular pedicle (3) easy & rapid elevation of flap (4) no sacrifice of major arteries (5) a single operative field. But, we also have some disadvantages of difficult handling of the pliable veins and the tmcertainty of flap survival. For the better result we had to design the size of the flap larger than that of defect and increase the number of draining vein to reduce the postoperative edema of the flap. We have treated the defects of soft tissue of the hand using free arterialized venous flap from the flexor aspect of the forearm & had an excellent results.
Arteries ; Edema ; Forearm ; Hand* ; Veins ; Wounds and Injuries*

OBJECTIVE: Paraclinoid segment internal carotid artery (ICA) aneurysms have historically been a technical challenge for neurovascular surgeons. The development of microsurgical approach, advances in surgical techniques, and endovascular procedures have improved the outcome for paraclinoid aneurysms. However, many authors have reported high complication rates from microsurgical treatments. Therefore, the present study reviews the microsurgical complications of the extradural anterior clinoidectomy for treating paraclinoid aneurysms and investigates the prevention and management of observed complications. METHODS: Between January 2004 and April 2008, 22 patients with 24 paraclinoid aneurysms underwent microsurgical direct clipping by a cerebrovascular team at a regional neurosurgical center. Microsurgery was performed via an ipsilateral pterional approach with extradural anterior clinoidectomy. We retrospectively reviewed patients' medical charts, office records, radiographic studies, and operative records. RESULTS: In our series, the clinical outcomes after an ipsilateral pterional approach with extradural anterior clinoidectomy for paraclinoid aneurysms were excellent or good (Glasgows Outcome Scale : GOS 5 or 4) in 87.5% of cases. The microsurgical complications related directly to the extradural anterior clinoidectomy included transient cranial nerve palsy (6), cerebrospinal fluid leak (1), worsened change in vision (1), unplanned ICA occlusion (1), and epidural hematoma (1). Only one of the complications resulted in permanent morbidity (4.2%), and none resulted in death. CONCLUSION: Although surgical complications are still reported to occur more frequently for the treatment of paraclinoid aneurysms, the permanent morbidity and mortality resulting from a extradural anterior clinoidectomy in our series were lower than previously reported. Precise anatomical knowledge combined with several microsurgical tactics can help to achieve good outcomes with minimal complications.
Aneurysm ; Carotid Artery, Internal ; Cerebrospinal Fluid Rhinorrhea ; Cranial Nerve Diseases ; Endovascular Procedures ; Hematoma ; Humans ; Microsurgery ; Retrospective Studies ; Vision, Ocular

BACKGOUND: Interferon-alpha2b has already proven to be effective in the clinical treatment of virus-originated diseases such as hairy cell leukemia, condyloma acuminatum, and AIDS-related Kaposi's sarcoma. The use of recombinant interferon-alpha2b may allow various types of wart to be treated relatively atraumatically and with less incidence of recurrence. OBJECTIVE: We tried to compare the effectiveness and safety of intralesional injections of recombinant interferon-alpha2b with natural interferon-alpha2b in the treatment of patients with various types of wart. METHOD: Patients with more than two warts were treated by injecting the different warts with 0.5 to 1.0X105 IU/1mm3 of recombinant and natural interferon-alpha2b, twice per week for 4 to 20 weeks. The response to treatment was followed up at 36 weeks. RESULTS: At the end of treatment, clearing of the treated warts had occurred in 83.3% of the recombinant interferon-alpha2b group and 91.6% of the natural interferon-alpha2b group. A more rapid cure rate was observed in the natural interferon-alpha2b group than in the recombinant interferon-alpha2b group. The rest showed partial improvement. With evaluation for relapse up to 16 weeks after treatment, warts were found to relapse in 11.1% of both the recombinant and natural interferon groups. CONCLUSION: Intralesional natural interferon-alpha2b has a better therapeutic effect than recombinant interferon-alpha2b, and may be considered as a therapeutic modality of recalcitrant verruca or when it can be anticipated that destructive techniques or blistering agents will not be tolerated.
Blister ; Humans ; Incidence ; Injections, Intralesional ; Interferons ; Leukemia, Hairy Cell ; Recurrence ; Sarcoma, Kaposi ; Warts*

We report a case of a 30 year-old woman who presented with acute scalp hair loss induced by isonicotinic acid hydrazide gap (INH). Considerable hair loss started within 4 weeks of INH administration. There was no evidence of dermatitis, allergic reaction, or any other cause for the hair loss. INH was discontinued, and the hair loss stopped within 4 weeks, with new hair growth seen. There was complete recovery of hair loss after 12 weeks of alopecia. Medication-induced hair loss is an occasional adverse effect of many drugs, however hair loss induced by INH has been reported in only 1 case. The complete recovery from anagen effluvium is difficult to explain, but it could have been due to the early discontinuance of INH.
Adult ; Alopecia ; Dermatitis ; Female ; Hair ; Humans ; Hypersensitivity ; Isoniazid ; Scalp

A giant colonic diverticulum is a rare complication of diverticulosis, and an inguinal hernia is a common diagnosis for patients presenting with a painful groin mass. A 52-year-old male presented to the emergency room with a 3-hour complaint of progressive, constant, right-groin pain with an inguinal mass. After manual reduction of the inguinal hernia, the patient complained of pain in the right upper quadrant. Operative findings showed a transverse colon diverticulitis without perforation. We report here that case of a transverse colon giant diverticulum presenting as an atypical incarcerated inguinal hernia.
Colon, Transverse* ; Diagnosis ; Diverticulitis* ; Diverticulum ; Diverticulum, Colon ; Emergency Service, Hospital ; Groin ; Hernia, Inguinal* ; Humans ; Male ; Middle Aged

OBJECTIVE: The purpose of study was to demonstrate the presence of motor input from the spinal accessory and the branches of the upper cervical plexus. METHOD: Twenty-four patients were studied during modified radical neck dissection. The entire length of the spinal accessory nerve, the contributions from the upper cervical plexus and some cervical plexus branches to run to the trapezius independently were preserved in each of these patients. Compound muscle action potentials were measured to each part of the trapezius muscle on stimulation of the spinal accessory, C2, C3, and C4 nerves. RESULTS: Spinal motor nerve evoked responses were obtained from all 24 patients in the upper, middle, and lower trapezius. C2 contributions were seen in 2 out of 24 patients, but were in no patient supplying all three parts of the muscle. C3 contributions were seen in 11 out of 24 patients, but C3 nerve supplied all three parts of the muscle in 8. C4 contributions were seen in 20 out of 24 patients, supplying all three parts of the muscle in 16. CONCLUSION: This study demonstrated that the spinal accessory nerve provided the most important and consistent motor input to the trapezius muscle. Although C2, C3, and C4 provided motor input to the trapezius muscle, they were not consistently present and if present, did not consistently innervate all three parts of the trapezius. Compared with other studies, it was interesting to note that C4 gave more consistent motor input to the trapezius than other cervical branches.
Accessory Nerve ; Action Potentials ; Cervical Plexus ; Humans ; Neck Dissection ; Neural Conduction* ; Superficial Back Muscles*

We report here on an uncommon case of peliosis hepatis with hemorrhagic necrosis that was complicated by massive intrahepatic bleeding and rupture, and treated by emergent right lobectomy. We demonstrate the imaging findings, with emphasis on the triphasic, contrast-enhanced multidetector CT findings, as well as reporting the clinical outcome in a case of peliosis hepatis with fatal hemorrhage.
Tomography, X-Ray Computed/*methods ; Rupture ; Peliosis Hepatis/complications/*radiography/surgery ; Necrosis ; Humans ; Hemorrhage/etiology/*radiography/surgery ; Female ; Adult

BACKGROUND: Most recently, there is an increased use of EGD (esophagogastroduodenoscopy) for primary care among family physicians, which tends to promote EGD training programs in the course of Family Practice Residency. This study determined to survey current status of EGD training programs among residents in family medicine, identify relevant problems, and present some suggestions for their improvement. METHODS: The subjects were residents selected among family medicine training hospitals, which were registered in the KAFM (Korean Academy of Family Medicine). The residents were in their 3rd year of training or had already completed the EGD training program. Surveys were sent out to those hospitals by mail and electronic mail surveys were performed by researchers. RESULTS: Among 66 subject hospitals a total of 27 surveys (40.9%) were returned. Most EGD training were performed in the department of internal medicine. The mean duration of training period was 8 weeks. The averale number of hands on experience of the procedure was 62. It was found that most residents thought that EGD training period and the number of hands on experience of the procedure were insufficient. The longer period of actual experience of the procedure and the more number of EGD caseloads they had, the more they were satisfied with their EGD training programs. It was also found that there was a high demand for a follow-up learning opportunities for EGD (p<.05), because the residents who had already had many EGD caseloads further wanted to receive continuous education even, after they acquired license. There were no relationships observation period, period of actual experience of the procedure, and number of EGD caseloads during residency with demand for follow-up learning opportunities. CONCLUSION: In summary, there was insufficient EGD training period and actual experience of the EGD procedure in family practice residency. There was low satisfaction of EGD training programs and high demand for continuous education. Therefore, it is recommended to establish EGD training program, proper practice training, and regular continuing education after completing residency.
Education ; Education, Continuing ; Electronic Mail ; Endoscopy, Digestive System* ; Family Practice* ; Hand ; Humans ; Internal Medicine ; Internship and Residency* ; Learning ; Licensure ; Physicians, Family ; Postal Service ; Primary Health Care

Pudendal neuralgia is characterized by severe sharp pain along the innervation area of pudendal nerve, which may be worsened when sitting position. Successful pudendal nerve block is crucial to the diagnosis of pudendal neuralgia. Although fluoroscopy-guided pudendal nerve blocks have traditionally been performed, recently ultrasound-guided pudendal nerve blocks were reported. For the long term effect of nerve block, pulsed radiofrequency was performed under fluoroscopic guidance in some reports. We report our successful experiences of three cases using ultrasound-guided pulsed radiofrequency.
Diagnosis ; Humans ; Nerve Block ; Pudendal Nerve* ; Pudendal Neuralgia*

BACKGROUND: It has been known that the prevalence of depression is increasing and depressive mood is accompanied with various physical symptoms in the elderly. In this research, we studied various physical symptoms of the elderly patients and how many of those symptoms were associated to depressive mood. We also investigated how much their doctors were concerned about depressive symptoms of the patients. METHODS: The subjects were 135 patients over 60 years old, who visited geriatric center and department of family medicine in a university hospital from December 2002 to May 2003. Individual interviews were conducted among the subjects and all symptoms who suffered from within a month from the time of inter view, depression score, stress score, functional status and their sociodemographic factors were assessed. Finally, doctor's diagnosis or comments on depressive mood were assessed based on the medical documents of the elderly patients with depression. RESULTS: 56% of the subjects had depressive mood. Common symptoms of subjects were memory impairment, visual disturbance, fatigue, arthralgia, and thirsty sense. The more depressive mood the elderly have, the more physical symptoms they have. The physician paid their attention to depressive mood in 13% of the cases among the elderly with depressive mood. Depressive mood was affected by whom they lived together with, regular exercise and stress. CONCLUSION: This study shows that most of the elderly patients had depressive mood and their common symptoms were associated to depressive mood. The stress and living together with their children were risk factors for depression of the elderly. However, depressive mood was less found among those patients who had spouse and who exercised regularly. Though physicians more likely recognize the depressive mood of the elderly as depression was severer, still little attention was paid to depressive mood in the elderly.
Aged* ; Arthralgia ; Child ; Depression* ; Diagnosis ; Fatigue ; Humans ; Memory ; Prevalence ; Risk Factors ; Spouses ; Vision Disorders