PURPOSE: This retrospective study was to determine the functional results of patients who were amputated of their fingertip between patients who were treated with replantation and patients who were treated with thenar flap. MATERIALS AND METHODS: From 2004 to 2007, we identified and operated 159 patients who were diagnosed with fingertip amputations. Of 159 patients, Eighty-two patients were treated by replantation (67 in men and 14 in women) and the mean age at the operation was 41 years (range, 15-68 years). Seventy-nine patients was treated with thenar flap(54 in men and 25 in women) and the mean age at the operation was 43 years(range, 21-70 years). We compared variables between two groups including, age, gender, diagnosis, duration of hospital admission, grip strength, two-point discrimination, Semmes Weinstein monofilament test, active range of motion (ROM) of the proximal and distal interphalangeal (PIP and DIP) joint, pain (or tenderness), paresthesia, cold intolerance, the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and finger for activities of daily living (ADLs). RESULTS: The duration of admission was longer in Replantation group than in Thenar flap group(p=0.001). However, the grip strength (p=0.003) and Semmes Weinstein monofilament test (p=0.029) in the Replanation group were statistically superior to the Thenar flap group. The average DASH disability (p=0.003)/symptom score (p=0.007) and ADLs (p<0.001) in the Replantation group was statistically better. In addition, cold intoleranace test of Thenar flap group is worse than the Replantation group. CONCLUSION: This study demonstrate that fingertip replantation have demonstrated not only to obtain the best appearance but also to gain better functional outcome. However, it is impossible to perform replatation, the thenar flap can be limited alternative method for fingertip amputation in aspect of preservation of range of motion and hospitalization time.
Activities of Daily Living ; Amputation ; Arm ; Cold Temperature ; Discrimination (Psychology) ; Fingers ; Hand ; Hand Strength ; Hospitalization ; Humans ; Joints ; Male ; Paresthesia ; Surveys and Questionnaires ; Range of Motion, Articular ; Replantation ; Retrospective Studies ; Shoulder

No abstract available.
Nipples*

PURPOSE: Free flaps from the great toe are an established method for reconstruction of absent or partially amputated thumbs. However, options differ as to which technique represents the ideal solution for each level of amputation. Various methods of distal thumb reconstruction have been proposed. We prefer to transplant the entire great toe nail complex with the almost all of the pulp rather than a portion of the nail. This paper reflects our experience in using the great toe mini wrap-around flap for distal thumb reconstruction. MATERIALS AND METHODS: In the period from October of 2005 to July of 2007, 9 patients were treated for traumatic thumb defects localized at the distal phalanx of the thumb. The patients included seven men and two women. The mean age was 44 years (range, 21~60) and the dominant right hand was involved in seven of nine patients. RESULTS: The transferred flaps have survived completely in all cases. The mean range of motion in the interphalangeal joints was 51o, with 73% of the normal uninjured opposite hands. The two-point discrimination was 10.5 mm (range, 5~13 mm). In Semmes-Weinstein monofilament test, the sensibility was 4.31 in 4 cases, 3.61 in 3 cases and 2.83 in 2 cases. The pinch power was 64% (range, 55~95%) of the opposite hand. All patients were satisfied with the appearance of the reconstructed thumb and felt comfortable at final follow-up. CONCLUSION: We have successfully reconstructed 9 cases of traumatic distal thumb defects using the mini wrap-around free flap. The mini wrap-around free flap in great toe is an excellent alternative method for distal thumb reconstruction in selected patients.
Amputation ; Discrimination (Psychology) ; Female ; Follow-Up Studies ; Free Tissue Flaps ; Hand ; Humans ; Joints ; Male ; Nails ; Range of Motion, Articular ; Thumb ; Toes ; Transplants

Pickling salt, also known as curing salt, is a mixture of sodium chloride and sodium nitrite, which is used for color agent and a means to facilitate food preservation. Recently, online purchase of pure sodium nitrite has been restricted, and pickling salts have been used as replacements in cases of suicidal nitrite intoxication. From November 2020 to December 2021, there were four autopsy cases of nitrite poisoning caused by pickling salt, and 10 autopsy cases of nitrite poisoning by pure sodium nitrite. Due to the low nitrite concentration in pickling salts, serum nitrite and nitrate concentration, and methemoglobin levels were relatively low in pickling salts cases. Especially, low methemoglobin levels may cause confusion in the postmortem diagnosis of fatal nitrite intoxication, so caution is required.

Pregabalin is a gamma-aminobutyric acid analogue; it has been used clinically as an anticonvulsant and analgesic agent. Few documented reports exist of deaths resulting from pregabalin overdose. This report discusses a case of pregabalin intoxication in a 27-year-old male, who was found unconscious in a prison and later pronounced dead at a local hospital. An autopsy and toxicological analysis revealed the presence of pregabalin, alprazolam, diazepam, escitalopram, fluoxetine, lorazepam, bromazepam, flunitrazepam, zolpidem, and piroxicam. The concentrations of pregabalin and alprazolam were 10.3 mg/L and 0.10 mg/L in heart blood, and 11.4 mg/L and 0.08 mg/L in femoral blood, respectively. The other detected drugs were within therapeutic concentrations. Ethyl alcohol was not detected in the blood. Although the pregabalin concentration was within the therapeutic or toxic range, the concomitant use of other drugs, particularly benzodiazepines and zolpidem, likely enhanced its toxicity. Based on the autopsy findings and toxicological results, the cause of death was determined to be multidrug intoxication, including pregabalin. Although pregabalin is generally considered safe and deaths from its use alone are very rare, it can be fatal at relatively low blood concentrations when combined with opioids or other medications. The rising use of pregabalin in Korea increases the risk of overdose deaths, similar to this case. Therefore, in forensic practice, the possibility of such fatalities should be considered when pregabalin is detected.

PURPOSE: This study aimed to identify changes in smart device usage trends of young children using two studies conducted in 2015-2016 and 2017 respectively. METHODS: We compared the data of the previous study of 130 children (Group A) and the new study of 162 children (Group B). The children and parents were recruited from kindergartens in Seoul and Guri/Namyangju cities. We used the “Parental questionnaire for smart device usage status.” RESULTS: There were some changes in the smart device usage in young children and parental perception. In the 2017 study, smart device usage time increased during weekends (P < 0.05) and the usage with siblings decreased (P < 0.05). In 2017, the smart device was mostly used when children had to be quiet without disturbing others (36.8%). No significant difference existed in the main purpose of use: watching video clips (79.3% vs 76.6%). Overall control of the usage was still largely exercised by mothers; however, when using applications, mothers still only helped the children on request (51.8% vs 49.7%). Regarding the effect of smart device on children, responses of “not knowing” decreased and “will be negative” and “will be positive” increased (P < 0.05). Additionally, most mothers thought that “Although the smart device is currently unnecessary, it will be needed in future” in 2017 (46.3%). CONCLUSION: Limiting the smart device usage time during the weekends and increasing parental involvements are recommended. Guidelines for smart devices usage in young children are also necessary considering the changes in parental attitudes in recognizing the smart device usage as unavoidable.
Child ; Humans ; Mothers ; Parents ; Seoul ; Siblings ; Smartphone

When the lungs are infected with bacteria, alveolar macrophages (AMs) are recruited to the site and play a crucial role in protecting the host by reducing excessive lung inflammation.However, the regulatory mechanisms that trigger the recruitment of AMs to lung alveoli during an infection are still not fully understood. In this study, we identified a critical role for NADPH oxidase 4 (NOX4) in the recruitment of AMs during Staphylococcus aureus lung infection. We found that NOX4 knockout (KO) mice showed decreased recruitment of AMs and increased lung neutrophils and injury in response to S. aureus infection compared to wildtype (WT) mice. Interestingly, the burden of S. aureus in the lungs was not different between NOX4 KO and WT mice. Furthermore, we observed that depletion of AMs in WT mice during S. aureus infection increased the number of neutrophils and lung injury to a similar level as that observed in NOX4 KO mice. Additionally, we found that expression of intercellular adhesion molecule-1 (ICAM1) in NOX4 KO mice-derived lung endothelial cells was lower than that in WT mice-derived endothelial cells. Therefore, we conclude that NOX4 plays a crucial role in inducing the recruitment of AMs by controlling ICAM1 expression in lung endothelial cells, which is responsible for resolving lung inflammation during acute S. aureus infection.

In South Korea, deaths caused by poisoning are mostly suicides due to drug overdoses, or agrochemical poisonings. Even though the latter is becoming less frequent, they are still occurring in large numbers across the country. In some cases, deaths result from toxicity of organic solvents contained in the agrochemical products. In this study, we identified organic solvents in post-mortem blood of acute agrochemical poisoning cases using solid phase microextraction-gas chromatography/mass spectrometry with black fiber. Out of 42 cases, organic solvents were detected in 29, with toluene and butanol detected simultaneously in 13 cases. In these 13 cases, the original pesticides were of various types, including organophosphorus compounds, carbamate, nicotine, and oxadiazine. Xylene and ethyl benzene were simultaneously detected six times. In these six cases, the original pesticides were mainly pyrethroid-based pesticides, such as cypermethrin and deltamethrin. Methoxypropanol was detected in five cases in which the water-soluble pesticide glufosinate was detected. These organic solvents may cause acute poisoning and even death in some agrochemical poisoning cases.

Infective endocarditis usually involves cardiac valves and perivalvular tissue. Sometimes it can penetrate through the free wall of myocardium and form burrowing abscess, usually in patients with congenital heart diseases, such as ventricular septal defect. We experienced a case of mural endocarditis of right atrium in a patient without underlying cardiac diseases. A 55-year old man was admitted due to chest tightness, fever and dyspnea. Streptococcus intermedius grew in 3 pairs of blood culture tests and transesopha- phageal echocardiography revealed a 2 cm-sized vege-tation in the right atrial auricle. Lung ventilation and perfusion scans were checked due to aggravation of dyspnea, which showed pulmonary embolism with high probability. The vegetation penetrated through the free wall of the right atrial auricle and formed a mural abscess, which was removed by surgery and its wall defect repaired with bovine patch.
Abscess* ; Dyspnea ; Echocardiography ; Endocarditis* ; Fever ; Heart Atria* ; Heart Diseases ; Heart Septal Defects, Ventricular ; Heart Valves ; Humans ; Lung ; Middle Aged ; Myocardium ; Perfusion ; Pulmonary Embolism* ; Streptococcus intermedius ; Thorax ; Ventilation

This study was undertaken to evaluate the in vitro activities of arbekacin-based combination regimens against vancomycin hetero-intermediate Staphylococcus aureus (hetero-VISA). Combinations of arbekacin with vancomycin, rifampin, ampicillin-sulbactam, teicoplanin, or quinipristin-dalfopristin against seven hetero-VISA strains and two methicillin-resistant S. aureus strains were evaluated by the time-kill assay. The combinations of arbekacin with vancomycin, teicoplanin, or ampicillinsulbactam showed the synergistic interaction against hetero-VISA strains. Data suggest that these arbekacin-based combination regimens may be useful candidates for treatment options of hetero-VISA infections.
Virginiamycin/administration & dosage ; Vancomycin/*administration & dosage ; Teicoplanin/administration & dosage ; Sulbactam/administration & dosage ; Staphylococcus aureus/*drug effects/isolation & purification ; Staphylococcal Infections/drug therapy/microbiology ; Microbial Sensitivity Tests ; Methicillin Resistance ; Humans ; Drug Synergism ; Drug Resistance, Bacterial ; Dibekacin/administration & dosage/*analogs & derivatives ; Anti-Bacterial Agents/*administration & dosage ; Ampicillin/administration & dosage ; Aminoglycosides/*administration & dosage