Since the first report by Tansini in 1896, the latissimus dorsi muscle free flap has been widely used for various types of soft tissue defect due to reliable anatomy with a sufficient diameter of neurovascular pedicle and a sizable muscle. However, for relatively small soft tissue defect, latissimus dorsi free flap offers several distinct disadvantages of donor site including loss of the posterior axillary fold and flattening of the posterolateral chest wall, weakness of upper arm strength in extension, adduction and internal rotation. We treated three patients having various types of soft tissue defect using segmental latissimus dorsi muscular free flap depending on its descending branch of thoracodorsal neurovascular pedicles. There were no serious complications during 18 months of mean follow-up. We concluded that this method has some advantages such as no weakness of strength of the upper arm including walking on crutches, preserving the posterior axillary fold, preventing winging of the scapula and increased chance of using a flow-through technique. Here we present our cases of reconstruction of soft tissue defect using segmental latissimus dorsi free flap with a review of the literature.
Arm ; Crutches ; Follow-Up Studies ; Free Tissue Flaps* ; Humans ; Scapula ; Superficial Back Muscles* ; Thoracic Wall ; Tissue Donors ; Walking

No abstract available.

Sacral pressure sores have been treated by a variety of surgical methods. complete treatment needs wide excision and coverage with healthy tissue which has constant and sufficient blood supply. Use of gluteus maximus muscle flap with or without overlying skin is a revolutionary method because of the reliability of blood supply. However, it is technically a little bit complicated, and future reconstruction for recurrent decubitus is especially limited in paraplegic patients. The development of gluteal perforator-based flap with para-sacral perforator introduce a new treatment modality for the sacral pressure sores. Total 10 cases of sacral pressure sores were treated with gluteal perforator-based flap. There were minimal postoperative complications except wound dehiscence in one case. This flap has a many advantage of no transection or sacrifice of the gluteus maximus muscle, elevation time for the flap is short, reliable blood flow of the perforator, large rotation arc and no post-operative hindrance to walking in patients who are not paraplegic. The disadvantages of this perforator-based flaps are the anatomical variation in the location of perforators and the need for technically careful dissection.
Humans ; Postoperative Complications ; Pressure Ulcer* ; Skin ; Walking ; Wounds and Injuries

OBJECTIVE: To evaluate the degree of streptococcal colonization in Korean pregnant women. METHODS: The study comprised of 153 singleton pregnant women who visited Severance Hospital for delivery, and their neonates. Specimens for GBS culture were collected by a sterile cotton swab from lower vagina and cervix of pregnant women, and from ear canal and throat of neonates. They were first cultured for 48 hours in Todd-Hewitt broth and then subcultured onto Tryptose blood agar plates(Difco). Group B streptococci were confirmed by the presence of beta-hemolysis and a positive reaction with Phadebact group B Streptococci reagent(Karo Biodiagnostics AB, Huddinge, Sweden). RESULTS: The prevalence of positive cultures in pregnant women and neonates were 2.61%(4/153) and 0%(0/4), respectively. In the study population there was a case of suspicious group B streptococcual sepsis in an infant whose mother was colonized. CONCLUSIONS: In our study the GBS colonization rate in Korean pregnant women was significantly lower than that of other countries. The reason for this difference may be associated with a racial differences, or social factors such as socio-economic status or a life style.
Agar ; Cervix Uteri ; Colon ; Ear Canal ; Female ; Humans ; Infant ; Infant, Newborn ; Life Style ; Mothers ; Pharynx ; Pregnancy ; Pregnant Women* ; Prevalence ; Sepsis ; Streptococcal Infections* ; Vagina

No abstract available.
Cisplatin* ; Humans ; Nausea* ; Ondansetron* ; Vomiting*

PURPOSE: To establish the CT findings and clinical characteristics of colorectal mucinous adenocarcinoma. MATERIALS AND METHODS: The CT features of 26 surgically proven cases of colorectal mucinous adenocarcinoma were reviewed. The subjects were selected from among 262 patients with colorectal cancer, of whom 40 with non-mucinous adenocarcinoma were included as a control group. Contrast-enhaneed CT images were analyzed for tumor location, the presence or absence of tumoral calcification, tumor shape (circumferential or eccentric, polypoid or infiltrative), tumor thickness-to-length ratio, and attenuation and homogeneity. In each group, the TNM stage of pathologic specimens was compared. During follow-up, the incidence of recurrence, and outcome, were also compared. RESULTS: CT images of mucinous adenocarcinoma revealed intratumoral calcification in three patients (12%, p < 0.01). Tumors were eccentric and polypoid-shaped, with a high tumoral thickness/length ratio (p < 0.01). On contrast-enhanced images, most were seen as a heterogenous hypoattenvuted mass. No differences in T-NM stage were found in surgical specimens. In patients with mucinous adenocarcinoma, recurrence during the early follow-up period is more common than in patients with non-mucinous cancer. CONCLUSION: Contrast-enhanced CT reveals mucinous adenocarcinoma as an eccentric polypoid mass with heterogeneous hypoattenuation. In patients with mucinous colorectal cancer, careful follow-up is required because tumors tend to recur early in the follow-up period.
Adenocarcinoma ; Adenocarcinoma, Mucinous* ; Colorectal Neoplasms ; Follow-Up Studies ; Humans ; Incidence ; Mucins* ; Recurrence ; Tomography, X-Ray Computed

PURPOSE: To establish the CT findings and clinical characteristics of colorectal mucinous adenocarcinoma. MATERIALS AND METHODS: The CT features of 26 surgically proven cases of colorectal mucinous adenocarcinoma were reviewed. The subjects were selected from among 262 patients with colorectal cancer, of whom 40 with non-mucinous adenocarcinoma were included as a control group. Contrast-enhaneed CT images were analyzed for tumor location, the presence or absence of tumoral calcification, tumor shape (circumferential or eccentric, polypoid or infiltrative), tumor thickness-to-length ratio, and attenuation and homogeneity. In each group, the TNM stage of pathologic specimens was compared. During follow-up, the incidence of recurrence, and outcome, were also compared. RESULTS: CT images of mucinous adenocarcinoma revealed intratumoral calcification in three patients (12%, p < 0.01). Tumors were eccentric and polypoid-shaped, with a high tumoral thickness/length ratio (p < 0.01). On contrast-enhanced images, most were seen as a heterogenous hypoattenvuted mass. No differences in T-NM stage were found in surgical specimens. In patients with mucinous adenocarcinoma, recurrence during the early follow-up period is more common than in patients with non-mucinous cancer. CONCLUSION: Contrast-enhanced CT reveals mucinous adenocarcinoma as an eccentric polypoid mass with heterogeneous hypoattenuation. In patients with mucinous colorectal cancer, careful follow-up is required because tumors tend to recur early in the follow-up period.
Adenocarcinoma ; Adenocarcinoma, Mucinous* ; Colorectal Neoplasms ; Follow-Up Studies ; Humans ; Incidence ; Mucins* ; Recurrence ; Tomography, X-Ray Computed

In patient with severe adhesion between lung and aorta, there is some limitation in approaching the distal arch or descending thoracic aorta through the usual left thoracotomy. We report a case of a successfully managed distal arch and descending thoracic aortic aneurysm through the median sternotomy without any manipulations of the lung in a 66 year old man who presented hemoptysis.
Aged ; Aorta ; Aorta, Thoracic* ; Aortic Aneurysm, Thoracic ; Hemoptysis ; Humans ; Lung ; Sternotomy* ; Thoracotomy

BACKGROUND: To examine the influencing factors on patients' satisfaction in the emergency department(ED) far quality assurance. METHODS: Patients who visited to the ED were prospectively investigated from November 1 to December 31,1997. Authors developed questionnaire to investigate influencing factors on patients' satisfaction.4 Chi-square test and 115-REL 7.0 were applied far statistical analysis. RESULTS: Patients' satisfaction was significantly related to physical environment variables, accessibility variables, kindness of hospital personnel variables, and patient's trust for doctors variables. In path analysis, willingness for revisit was influenced by patients' satisfaction, accessibility, physical environment, patients' trust for doctors in order, and willingness for recommendation was influenced by accessibility, patients' satisfaction, and kindness of hospital personnel in order. CONCLUSIONS : The influencing factors on patients' satisfaction are physical environment, accessibility, kindness of hospital personnel, and patient's trust far doctors. Willingness far revisit and willingness far recommendation are influenced by patients' satisfaction. In spite of some limitations, the results of this study can be used as a baseline information for exploring the influencing factors on patients' satisfaction. Further comprehensive research efforts should be made on the study of patients' satisfaction in the ED.
Emergencies* ; Emergency Service, Hospital* ; Humans ; Personnel, Hospital ; Prospective Studies ; Surveys and Questionnaires

Injuries to vena cava continue to be associated with a high mortality. Essentials to successful treatment are immediate recognition of the injury and prompt control of the hemorrhage. We have experienced one case of inferior vena cava perforation by a chest drainage tube in the patient with post-operative chronic empyema thoracis. The patient was 38-year old male who was taken RLL lobectomy after 6 cycle of chemotherapy due to small cell carcinoma in the RLL and suffered from post-operative chronic empyema thoracis at D hospital. He moved to our hospital for further evaluation with accidental removal of chest drainge tube. We inserted closed drainage tube and dark blood gushed out abruptly just after insertion of the drainage tube. CTscan, MRI, and angiogram were performed and showed the perforation of IVC just below RA. The IVC was repaired using simple interrupted 4-0 Prolene suture through right posterolateral thoracotomy. The patient recovered without event and doing well until now.
Adult ; Carcinoma, Small Cell ; Drainage ; Drug Therapy ; Empyema ; Hemorrhage ; Humans ; Magnetic Resonance Imaging ; Male ; Mortality ; Polypropylenes ; Sutures ; Thoracostomy ; Thoracotomy ; Thorax* ; Vena Cava, Inferior