Leg amputation causes serious complications in walking and ultimately leads to functional impairment. Usually, the non-amputated side is considered as the dominant leg during prosthetic gait training. However, if the non-amputated side is affected by pathological conditions and has associated pain, it is necessary to determine whether it can be considered as the dominant leg. This case series presents four individuals who underwent leg amputations who also had pathologic conditions and pain in the non-amputated legs. A functional goal was established for each patient and individualized step-by step prosthetic gait training strategies were applied. Consequently, we found out that functional outcomes could be achieved even in cases with accompanying complications, such as fractures, nerve injuries, or pain, in the non-amputated leg.

PURPOSE: The transversely oriented fracture lines are very difficult to reduce during operations, even after clear exposure of the fracture site, in acetabular fractures. The purpose of this study is to verify the quality of reduction between the different subtypes (transtectal, juxtatectal, and infratectal) of transverse fractures. This study also determined the proper type of clamps to use and the proper zone for achieving accurate reductions in Sawbones models. MATERIALS AND METHODS: Six fractures in 3 different subtypes of transverse fractures were artificially created. Ten different reduction clamps were applied for reduction of the fractures. Twelve holes around the fracture were drilled for the maintenance of the clamps. The fracture displacements were measured at the extra-articular area and the intra-articular joint portion. The pictures of the intra-articular fracture displacements were taken by a camera and these were uploaded and analyzed by the TraumaCad® computer program (Brainlab). RESULTS: The reduction quality was poor in order of transtectal, juxtatectal and infratectal. The intraarticular opening was more prominent in the transtectal subtype. The safe zone, when giving consideration of the neurovascular bundles, was a quadrilateral surface of the ilium. Drill holes are useful for maintenance of the reduction clamps. Reduction clamps with points (Weber clamp) were the best for maintenance and accurate reduction. Regarding the concerns of placement of clamps, the middle to posterior combination was the best. The upper hole among the posterior holes in the ilium was the most likely to well reduce the intra-articular opening. CONCLUSION: Transtectal was the more complicated subtype in the aspect of reduction quality. The Weber type reduction clamp was the best for reduction by centrally located holes in the quadrilateral surface and posteriorly located iliac holes in transverse acetabular fractures. The upper hole, among the posterior holes in the ilium, was the best for reduction of the fracture displacements in the intraarticular portion of acetabulum.
Acetabulum ; Ilium ; Intra-Articular Fractures ; Joints

PURPOSE: Burn wound infection, sepsis and organ failure have been major causes of death in massive burn patient. Because it is difficult to fundamentally prevent bacterial colonization by medical treatment, the need of surgical intervention is advocated by many authors. Therefore the effects of early excision and optimal time were studied. METHODS: Twenty four patients with thermal injuries, on whom early excision of eschar was performed, between June and Aug. 2003, were studied. Fascial excision over third and fourth degree burns and tangential excision over indeterminate areas were performed. Superficial and deep layers of eschar was separated and cultivated, and bacterial colony counts performed. The patients were divided into two groups: a colony count equal or greater than 10(5)/g (group A) and less than 10(5)/g (group B), and studied. The plasma endotoxin levels were assayed and compared. RESULTS: Sepsis occurred at a higher rate when the bacterial colony counts were equal or greater than 10(5)/g at the wound site. Bacterial colonization appears to be greatly increased on the 4th in of escharectomy in superficial layers, and on the 5th in deep layers, in old aged or young child patients tends to occur earlier and with greater severity. The microorganism isolated in all patients was Pseudomonas aeruginosa. There was no statistical difference in the plasma endotoxin levels between groups A and B. CONCLUSION: It is suggested that all massive burn injuries would be better treated with early excision, within 3 days after burns, especially in old aged or young child patients.
Burns* ; Cause of Death ; Child ; Colon ; Humans ; Plasma ; Pseudomonas aeruginosa ; Sepsis ; Wound Infection ; Wounds and Injuries

PURPOSE: Severe burns induce multiple derangements in normal homeostasis. In this conditions, the value of proper nutritional supports can not be overemphasized. The purpose of this study was to evaluate the nutritional, immunological, catabolic and clinical effects of early enteral support in major burn patients. METHODS: The subjects were 49 major burned adults admitted to the Hangang Sacred Heart Hospital between June 1, 2003 and August 31, 2003. The patients qualified for study participation if they were over 20 years of age, sustained burns in excess of a 35% total body surface area or a 25% full-thickness burn. The early feeding (EF) group started enteral feeding within 48 hours of injury, and the delayed feeding (DF) group started after 48 hours. Each patients received entreral feeing through a nasogastric tube. The calorifice requirements were calculated by a modified Long's formula. Enteral feeding was discontinued when the patients could voluntarily orally take at least 60~70 percent of their estimated calorific or protein needs. The serum prealbumin, transferrin and immunoglobulin (IgG, IgA and IgM) concentrations, total lymphocyte counts and cortisol were monitored as a nutritional, immunological and catabolic marker. The clinical outcomes of the two groups were compared. RESULTS: Several of the markers were in an arithmtically high state for the EF group, but these were not statistical significance. There were no significant differences in the clinical outcomes between the two groups. CONCLUSION: More active trials and many-sided studies will be needed to maximize the effect of early enteral nutritional support as a method to improve treatment for major burned patients.
Adult ; Body Surface Area ; Burns* ; Enteral Nutrition* ; Fees and Charges ; Heart ; Homeostasis ; Humans ; Hydrocortisone ; Immunoglobulin A ; Immunoglobulins ; Lymphocyte Count ; Nutritional Support ; Prealbumin ; Transferrin

BACKGROUND: Early escharectomy has been shown to improve survival rates and treatment outcomes in major burn patients. However, its mechanism, especially in human immune systems, has not been fully elucidated. This observational study, focusing on cytokines, was conducted to assess changes in the levels of tumor necrosis factor alpha (TNF alpha) and interleukin-10 (IL-10) in major burn patients that underwent early tissue excision. METHODS: Seventeen ASA physical status II or III adults major burn patients, admitted to general surgery for burn wound care, were initially recruited. When early escharectomy was scheduled, a series of blood samples was obtained four times at 72 and 24 hours preop and at 24 and 72 hours postop. Changing levels of TNF alpha and IL-10 were measured by quantitative sandwich immnuoassay. RESULTS: Subjects suffered from 70% TBSA burns. Both cytokines demonstrated a significant tendency to increase in the blood during the study period. Although they temporarily decreased 24 hours after surgery, this effect did not last. CONCLUSIONS: Burn injury certainly increases cytokine response. Early escharectomy appears to decrease the pro and anti-inflammatory cytokines only temporarily. It did not seem to have any long term effect in the human immune system in major burn patients, probably due to the complex nature of the injury.
Adult ; Burns* ; Cytokines* ; Humans ; Immune System ; Interleukin-10 ; Observational Study ; Survival Rate ; Tumor Necrosis Factor-alpha ; Wounds and Injuries

Since its introduction, laparoscopic surgery has been often preferred over open surgery in obstetrics and gynecology due to its advantages, such as less bleeding, lower incidence of adhesions, reduced postoperative pain, short hospital stay, and quick return to daily life. However, in the case of complex surgeries, laparoscopy presented some limitations. Nonetheless, since the 1980s, medical robots have been introduced to overcome the technical limitations of laparoscopy and start a new age for minimally invasive surgery. In this review, we explore the indications and advantages and disadvantages of robotic surgery in the field of gynecology, and try to assess the recent trend of robotic surgery.

BACKGROUND/AIMS: The exercise ECG test (XECG) and computed tomography coronary angiography (CTCA) have been used widely in initial evaluations of coronary artery disease (CAD) in real-world practice. In this study, we compared the diagnostic power of CTCA and XECG, based on conventional coronary angiography (CCA). METHODS: We enrolled 589 consecutive patients retrospectively who had been examined with both XECG and CTCA for the evaluation of CAD in outpatient clinics. Significant stenosis was defined as more than 50% diameter stenosis. Triage to CCA and/or revascularization treatment (RT) by the results of XECG and CTCA and the diagnostic accuracy of both exams, based on CCA, were investigated. RESULTS: In the 589 patients, 107 (19%) were triaged to CCA for further evaluation; in 77 (12.8%) significant stenosis was detected on CCA. Also, 65 (11%) patients underwent RT. In the CTCA results, 120 patients had significant stenosis. Of them, 58 (48%) and 75 (62%) patients were triaged to RT and CCA, respectively. Based on the XECG, 115 positive patients were triaged to RT and CCA (23 [20%]/41 [35%]). Among 107 patients with CCA, the sensitivity, specificity, positive predictive value, and negative predictive value for significant stenosis on CCA of CTCA were 89.9%, 74.0%, 90.6%, and 71.4%, respectively, and those of XECG were 50.0, 67.9, 78.0, and 37.3, respectively. The kappa value of CCA and CTCA was 0.62 (p < 0.001) and that of CCA and XECG was 0.145 (p = 0.113). CONCLUSIONS: In real-world practice, CCA was decided on more frequently, based on CTCA. CTCA showed better diagnostic accuracy than XECG.
Ambulatory Care Facilities ; Constriction, Pathologic ; Coronary Angiography* ; Coronary Artery Disease ; Electrocardiography* ; Humans ; Retrospective Studies ; Sensitivity and Specificity ; Triage