From March 1983, 20 patients had undergone reconstruction of the upper limb with 22 vascularized composite tissue grafts. The microsurgical procedures had several advantages for reconstruction of injured upper limbs as follows: 1. Free tissue transfer was quite an important and attractive procedure for reconstruction of an injured limb, expecially an upper limb. 2. Free vascularized transfer of composite tissue with its overlying skin was a reliable technique to obtain full thickness soft tissue coverage of a severely injured upper limb when more conservative procedures, such as the use of skin graft or local muscle flaps, had failed or were not feasible. 3. A simple skin flap could be transfered to close an open wound of the limb, but a sensory flap or a special flap such as a nail-skin, tendon-skin or muscle-skin flap was a much better donor for reconstructing the function of the upper limb. 4. When appropriate, the wrap-around procedure was the method of choice for thumb reconstruction because the great toe was preserved. The procedure provided length, stability and adequate sensibility for a functional pinch and grasp. 5. The cosmetic effect of a second-toe transplant might be inferior to the wrap-around flap, but it had the great advantage of being able to provide mobile joints in the reconstructed thumb. As far as the donor foot was concerned, no patients had real trouble functional impairment.
Extremities ; Foot ; Hand Strength ; Humans ; Joints ; Methods ; Microsurgery ; Skin ; Thumb ; Tissue Donors ; Toes ; Transplants ; Upper Extremity ; Wounds and Injuries

Fracture of the scaphoid constitute 60% to 70% of all diagnosed carpal injury. The acute fracture will heal approximately 90% of the time if recognized early and properly immobilized. But nonunion are common since the symtoms do not alert patients to seek early medical treatment and the diagnosis is easily missed. Authors have experienced 19 cases of scaphoid nonunion and accomplished good result in all case by Russe procedure. The results were summerized as follow: 1 The cause of fratures was mainly due to fall down dinjury (36.8%). 2. The most common mechanism of the fracture was fall on the outstretched hand (52.7%). 3. Fractures were shown on the anterior-posterior, lateral and billiards view in all cases. 4. In ten cases, the fractures were found on the waist of scaphoid. 5. The cases of nonunion were probably inadequate intial treatment and delayed diagnosis. 6. The good results were obtained by bone graft according to Russe procedure.
Delayed Diagnosis ; Diagnosis ; Hand ; Humans ; Transplants

PURPOSE: This study was tried to evaluate the potential benefits of concurrent chemoradiation therapy (low dose daily cisplatin combined with split course radiation therapy) compared with conventional radiation therapy alone in stage III non-small cell lung cancer. The end points of analyses were response rate, overall survival, survival without locoregional failure, survival without distant metastasis, prognostic factors affecting survival and treatment related toxicities. MATERIAL AND METHODS: Between April 1992 and March 1994, 32 patients who had stage III non-small cell lung cancer were treated with concurrent chemoradiation therapy. Radiation therapy for 2 weeks (300cGy given 10 times up to 3000cGy) followed by a 3 weeks rest period and then radiation therapy for 2 more weeks (250cGy given 10 times up to 2500cGy) was combined with 6mg/M2 of cisplatin. Follow-up period ranged from 13 months to 48 months with median of 24 months. Historical control group consisted of 32 patients who had stage III non-small cell lung cancer were received conventionally fractionated (daily 170-200cGy) radiation therapy alone. Total radiation dose ranged from 5580cGy to 7000cGy with median of 5940 cGy. Follow-up period ranged from 36 months to 105 months with median of 62 months. RESULTS: Complete reponse rate was higher in chemoradiation therapy (CRT) group than radiation therapy (RT) group (18.8% vs. 6.3%). CRT group showed lower in-field failure rate compared with RT group (25% vs. 47%). The overall survival rate had no significant differences in between CRT group and RT group (17.5% vs. 9.4% at 2 years). The survival without locoregional failure (16.5% vs. 5.3% at 2 years) and survival without distant metastasis (17% vs. 4.6% at 2 years) also had no significant differences. In subgroup analyses for patients with good performance status (Karnofsky performance scale 80), CRT group showed significantly higher overall survival rate compared with RT group (62.5% vs. 15.6% at 2 years). The prognostic factors affecting survival rate were performance status and pathologic subtype (squamous cell cancer vs. nonsquamous cell cancer) in CRT group. In RT alone group, performance status and stage (IIIa vs IIIb) were identified as a prognostic factors. RTOG/EORTC grade 2-3 nausea and vomiting (22% vs. 6%) and bone marrow toxicities (25% vs. 15.6%) were significantly higher in CRT group compared with RT alone group. The incidence of RTOG/EORTC grade 3-4 pulmonary toxicity had no significant differences in between CRT group and RT group (16% vs. 6%). The incidence of WHO grade 3-4 pulmonary fibrosis also had no significant differences in both group (38% vs. 25%). In analyses for relationship of field size and pulmonary toxicity, the patients who treated with field size beyond 200cm2 had significantly higher rates of pulmonary toxicities. CONCLUSION: The CRT group showed significantly higher local control rate than RT group. There were no significant differences of survival rate in between two groups. The subgroup of patients who had good performance status showed higher overall survival rate in CRT group than RT group. In spite of higher incidence of acute toxicities with concurrent chemoradiation therapy, the survival gain in subgroup of patients with good performance status were encouraging. CRT group showed higher rate of early death within 1 year, higher 2 year survival rate compared with RT group. Therefore, to evaluate the accurate effect on survival of concurrent chemoradiation therapy, systematic follow-up for long term survivors are needed.
Bone Marrow ; Carcinoma, Non-Small-Cell Lung* ; Cisplatin ; Follow-Up Studies ; Humans ; Incidence ; Nausea ; Neoplasm Metastasis ; Pulmonary Fibrosis ; Survival Rate ; Survivors ; Vomiting

BACKGROUND: Idiopathic thromboycytopenic purpura(ITP) is one of the most common acquired bleeding disorders in childhood. The entity of chronic ITP is defined as the persistence of thrombocytopenia for more than 6 months from initial presentation. There are the controversies regarding the diagnosis and management of this disease. The aim of this study is to compare the responses to managements and clinical symptoms of children with chronic ITP. METHODS: We retrospectively analyzed patients with chronic ITP diagnosed and managed between Jan., 1992 and June, 1997. Data from 33 cases were collected. The length of follow-up ranged from 6 months to 5 years. Statistical analysis was done using Jandel Sigmastat software(version 2.0). RESULTS: 1) Mean age is 5.4+/-4.3 years. The ratio of female to male is 0.65. 2) Most common clinical symptoms at presentation were petechiae(81.8%) and mucosal bleeding(42.4%). The patients who presented only petechiae and purpurae were 18 cases(54.5%), both petechiae and mucosal bleeding were 9 cases(27.3%). 3) The platelet count was 43,015+/-39,912/mm3. Bone marrow examinations showed normal or increased megakaryocyte, no abnormal cells and normal cellularity. 4) The prolonged complete response lasting more than 6 months without maintenance therapy was attained in 15.2% of the patients. A continuous complete response was observed in 6.1% to prednisone and IV-gamma-globulin. A prolonged complete response to dexamethasone was in 23.8% and continuous complete response was in 14.3%. The splenectomy was underwent in 3 patients. All of them had a prolonged complete response. One of six patients who were treated with combination chemotherapy had a prolonged complete response. CONCLUSION: This analysis of chronic ITP patients suggests that splenectomy remains the most effective treatment and the next one is high dose dexamethasone therapy. But the number of patients was not enough, more attention should be given to the management of chronic idiopathic thrombocytopenic pupura(ITP).
Bone Marrow Examination ; Child ; Dexamethasone ; Diagnosis ; Drug Therapy, Combination ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Male ; Megakaryocytes ; Platelet Count ; Prednisone ; Purpura ; Purpura, Thrombocytopenic, Idiopathic* ; Retrospective Studies ; Splenectomy ; Thrombocytopenia

PURPOSE: To evaluate the clinical characteristics and risk factors of severe manifestation of herpes zoster ophthalmicus. METHODS: We conducted a retrospective analysis using medical records from 106 patients diagnosed with herpes zoster ophthalmicus from January 2012 to June 2015. Patients were classified according to the type and frequency of ophthalmologic manifestations. Patients with conjunctivitis, punctate keratitis, and pseudodendritic keratitis were classified into the mild group, whereas patients with deep stromal keratitis, endothelitis, scleritis, glaucoma, and extraocular muscle paralysis were classified into the severe group. The age, sex, severity, location of skin lesions, delayed time to treatment, the presence of Hutchinson's sign, and associated systemic diseases were compared between the groups. In addition, we investigated changes in vision, intraocular pressure, treatment duration, recurrence and the prevalence of postherpetic neuralgia. RESULTS: The incidence of conjunctivitis (47.2%), punctate keratitis (42.5%), pseudodendritic keratitis (12.2%), deep stromal keratitis (12.2%), endothelitis (15.1%), scleritis (18.9%), glaucoma (14.2%), and extraocular muscle (EOM) paralysis (4.7%) were observed in these patients. The group with mild disease included 70 cases with conjunctivitis, punctate keratitis and pseudodendritic keratitis. The severe group included 36 cases with deep stromal keratitis, endothelitis, scleritis, glaucoma and EOM palsy. Disease most often occurred in the distribution of the first branch of the trigeminal nerve, with no differences in the age or sex of patients in both groups. Severe manifestations were more common when a greater extent of the skin was involved, when Hutchinson's sign was present, or when treatment was significantly delayed. There were no significant differences between the two groups in recurrence or the presence of postherpetic neuralgia. CONCLUSION: Long-term treatment for herpes zoster opthalmicus is more likely to be required if severe manifestation of disease exists, such as widespread skin involvement, Hutchinson's sign, or a delay to the initiation of antiviral treatment. More active observation and treatment are required in such cases.
Conjunctivitis ; Glaucoma ; Herpes Zoster Ophthalmicus* ; Herpes Zoster* ; Humans ; Incidence ; Intraocular Pressure ; Keratitis ; Medical Records ; Neuralgia, Postherpetic ; Paralysis ; Prevalence ; Recurrence ; Retrospective Studies ; Risk Factors* ; Scleritis ; Skin ; Time-to-Treatment ; Trigeminal Nerve

PURPOSE: This study evaluated the usefulness of ultrasonography for a diagnosis of acetabular labral tear in femoroacetabular impingement (FAI). MATERIALS AND METHODS: From March 2010 to October 2011, an ultrasonographic examination was performed in 58 patients(58 hips: 26 men and 32 women) with acetabular labral tear. The sensitivity and positive predictive value of ultrasonography were evaluated for 58 cases with acetabular labral tear confirmed by hip arthroscopy. RESULTS: The sensitivity and positive predictive value for an acetabular labral tear using ultrasonography was 89.6% and 100%, respectively. The concordance rate of an acetabular labral tear between arthroscopy and ultrasonography was 84.6%. CONCLUSION: Hip ultrasonography can make a significant contribution to a pathologic diagnosis and isa useful diagnostic tool for acetabular labral tears.
Arthroscopy ; Femoracetabular Impingement ; Hip ; Humans ; Male

Traumatic tricuspid insufficiency(TI) is a relatively uncommon disorder. We experienced a case in which traumatic TI was suspected by history and the diagnosis was confirmed nonivasively by 2-D echocardiography with Doppler technique. Tricuspid valve in this case showed flail anterior leaflet during systole and Doppler echocardiography demonstrated the presence of tricuspid insufficiency.
Diagnosis ; Echocardiography ; Echocardiography, Doppler ; Systole ; Tricuspid Valve

BACKGROUND/AIMS: In the bare-metal stent era, routine follow-up coronary angiography (RFU CAG) was used to ensure stent patency. With the advent of drug-eluting stents (DESs) with better safety and efficacy profiles, RFU CAG has been performed less often. There are few data on the clinical impact of RFU CAG after second- or third-generation DES implantation in clinically stable patients with coronary artery disease; the aim of this study was to examine this issue. METHODS: We analyzed clinical outcomes retrospectively of 259 patients who were event-free at 12-month after stent implantation and did not undergo RFU CAG (clinical follow-up group) and 364 patients who were event-free prior to RFU CAG (angiographic follow-up group). Baseline characteristics were compared between the groups. RESULTS: The Kaplan-Meier estimated total survival and major adverse cardiac event (MACE)-free survival did not differ between the groups (p = 0.100 and p = 0.461, respectively). The cumulative MACE rate was also not different between the groups (hazard ratio, 0.85; 95% confidence interval, 0.35 to 2.02). In the angiographic follow-up group, 8.8% revascularization was seen at RFU CAG. CONCLUSIONS: RFU CAG did not affect long-term clinical outcome after second- or third-generation DES implantation in clinically stable patients.
Aged ; *Coronary Angiography ; Coronary Artery Bypass ; Coronary Artery Disease/radiography/*therapy ; Coronary Restenosis/etiology/radiography/surgery ; Coronary Vessels/*radiography ; Disease Progression ; Disease-Free Survival ; *Drug-Eluting Stents ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Myocardial Infarction/etiology/radiography/surgery ; Patient Selection ; Percutaneous Coronary Intervention/adverse effects/*instrumentation ; Predictive Value of Tests ; Proportional Hazards Models ; Prosthesis Design ; Retrospective Studies ; Risk Factors ; Time Factors ; Treatment Outcome

BACKGROUND: Recently, in dermatologic area, the number of skin biopsy for diagnosis and treatment has been increased and the dermatosurgery which should give patients satisfaction developed widely. As the frequency of direct contact with patients increases, we must recognize and prevent infectious diseases such as hepatitis B and C. Also, because drugs which may affect function of liver were used in many medical clinics and shops, we have more chance of evaluating liver function before the treatment. OBJECTIVE: We investigated the prevalence and associated diseases of the patients with elevated transaminase (AST,ALT), positive of hepatitis B surface antigen and anti-HCV Ab. And we tried to study the causes of elevated transaminase. METHOD: All the 1704 outpatients who visited the dermatologic clinic of Pusan National University Hospital from March 1996 to February 1999 were enrolled. AST and ALT level were assessed by kinetic method and elevated group comprised the subjects with AST and ALT levels exceeding the upper limit of normal for our laboratories (AST >40IU/L or ALT >37IU/L). HBsAg and anti-HCV Ab were tested by enzymeimmunoassay(EIA) and medical records were reviewed. RESULTS: The prevalence of elevated transaminase was 13.6% and the peak age was the sixth decade. Most common associated disease categories were drug druption, eruption & urticaria. The prevalence of positive hepatitis B surface antigen was 9.7% and the peak age was the fourth decade (42.4%). Associated diseases of antigen positive patients were lichen planus, urticaria, cryoglobulinemia, etc. The prevalence of positive anti-HCV Ab was 3.4% and the sixth decade was the peak incidence of age distribution. The diseases such as urticaria, erythema nodosum, psoriasis, alopecia, and so on were investigated in the patients. Common suspected causes of elevated transaminase(AST, ALT) were hepatotoxic drug and viral hepatitis. Conclusion: Increased hepatic parenchymal enzyme was investigated in a high percentage of studied patients. Also, the prevalence of HBV and HCV infection in dermatologic patients were relatively higher than that of reported normal Korean people. Therefore dermatologists should recognize these facts and be careful in dermatologic procedure.
Age Distribution ; Alopecia ; Biomarkers* ; Biopsy ; Busan ; Communicable Diseases ; Cryoglobulinemia ; Diagnosis ; Erythema Nodosum ; Hepatitis B Surface Antigens ; Hepatitis B* ; Hepatitis* ; Humans ; Incidence ; Lichen Planus ; Liver ; Medical Records ; Outpatients ; Prevalence* ; Psoriasis ; Skin ; Urticaria

PURPOSE: The aim of this study was to determine the advantage of adequate PTGBD in acute complicated cholecystitis patients. METHODS: We performed a retrospective review of a collected database from September 2001 to July 2008. Acute cholecystitis with gangrene or perforation was defined as acute complicated cholecystitis. A PTGBD was performed for these patients immediately after the diagnosis using US or CT and then a tubogram was performed after 5~7 days. After evaluating the gallbladder (GB) and common bile duct (CBD) with a tubogram, we removed the drainage tube and the patients underwent a LC after readmission. RESULTS: Three hundred seventy four of the 893 patients who were diagnosed with acute cholecystitis underwent PTGBD. While 19 (3.2%) of the total acute cholecystitis patients were converted to open cholecystectomy due to severe inflammation, 14 (3.7%) of the acute complicated patients were converted to open cholecystectomy. In 79 patients, the pre-operative tubogram showed the presence of CBD stone and so ERCP was performed. There were no post-operative deaths. CONCLUSION: PTBGD in acute complicated cholecystitis patients allows the early relief of acute cholecystitis symptoms. This allows sufficient evaluation and treatment for CBD during the PTGBD state. Furthermore, this decreases the mortality and morbidity in the high-risk patients due to sufficient evaluation and management of the underlying critical disease, which allows elective cholecystectomy when the patients is in better condition for surgery. Therefore, PTGBD can be useful for acute complicated cholecystitis.
Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Cholecystitis, Acute ; Common Bile Duct ; Drainage ; Gallbladder ; Gangrene ; Humans ; Imidazoles ; Inflammation ; Nitro Compounds ; Retrospective Studies