Complications after a median sternotomy incision, which is used currently in most open heart surgery, are serious, although it is infrequent. Reconstruction of the sternal defect resulting from dehiscence of median sternotomy is still big challenge to the most plastic surgeons. Since vascularized greater omentum was transposed to eliminate mediastinal wound problems, many vascularized regional muscle flaps became mainstay in reconstruction of median sternotomy wound. We treated 13 patients with median sternotomy dehiscence between October of 1993 and March of 1998. In two patients, the wound problems were so confined to superficial tissue that debrided and closed primarily. Eleven patients with deep wound infection were managed with vigorous debridement of all necrotic tissues and resultant defects were covered with regional muscle flaps: rectus myocutaneous flap(3) and bilateral pectoralis advancement flap(8). We used the pectoralis major advancement flaps without counter incision at humeral insertion site and the dissections were limited only medial to the anterior axillary line to preserve the axillary fold. In five patients with larger defects, we elevated muscle and cutaneous flaps separately to make these flaps more mobile. Large portion of two rectus abdominis flaps could not survive, whereas pectoralis advancement flaps had mo special wound problems. Only one patient developed fistula due to remained wire, regardless to flap surgery.
Debridement ; Fistula ; Humans ; Omentum ; Rectus Abdominis ; Sternotomy* ; Thoracic Surgery ; Wound Infection ; Wounds and Injuries

A statistical study of soldiers who visited the outpatient ciepartment of the Capital Armed Forces General Fiospital from 1987 to 1989 was performed. The results were as follows : 1. The total number of outpatients was 9969 with peak clinic visits in June(11.2%) and the lowest number of clinic visits in February(6.4% ). 2. The most frequent age was 22 years(20.7% ). Soldiers between 19 and 24 years old comprised 68.1% of total patients. 3. By rank 69.3% of the outpatients were private', 16.0% sergeant and 14,4% officers. 4. The most common dermatoses were dermatophytosis, contact dermatitis, scabies, acne, seborrheic dermatosis, urticaria, alopecia, condyloma acuminatum, verruca, folliculitis, psoriasis, insect bite reactions, pityriasis rosea, herpes zoster and corns. 5. Frequent diseases, which occured during summer season, included dermatophytosis, contact dermatitis and inser,t bites. The incidence of scabies, pityriasis prsea was increased during winter and that of psoriasis was increased during spring.
Acne Vulgaris ; Alopecia ; Ambulatory Care ; Arm ; Callosities ; Dermatitis, Contact ; Folliculitis ; Herpes Zoster ; Humans ; Incidence ; Insect Bites and Stings ; Military Personnel* ; Outpatients ; Pityriasis ; Pityriasis Rosea ; Psoriasis ; Scabies ; Seasons ; Skin Diseases* ; Statistics as Topic* ; Tinea ; Urticaria ; Warts ; Young Adult ; Zea mays

No abstract available.
De Lange Syndrome*

No abstract available.
Anemia, Hemolytic* ; Humans ; Infant, Newborn ; Infant, Premature* ; Vitamin E* ; Vitamins*

PURPOSE: Mycoplasma pneumonia (MP) is a major cause of community-acquired pneumonia in children and young adults. We aimed to investigate the factors that may influence on the clinical manifestations of MP in children. METHODS: A total of 109 admitted children from October 2011 to February 2012 were prospectively enrolled with physical examination and laboratory tests (complete blood count, C-reactive protein [CRP], and particle agglutinin assay). The diagnosis of MP was made when there was an infiltration on the chest X-ray and the particle agglutination test was once over 1:640 or showed 4-fold increase in serial tests. They were grouped by age, fever duration after treatment, presence of pleural effusion and wheezing. RESULTS: Preschool children showed shorter duration of fever (P=0.001), more wheezing (P<0.001), lower segmented neutrophil (P<0.001), and lower CRP levels (P=0.004) compared to schoolchildren. Prolonged fever (>3 days) and pleural effusion were developed in children with higher CRP (P=0.018 and P=0.007). Wheezing has been developed in children with younger age (P=0.007). CONCLUSION: Younger age was a risk factor to develop wheezing in MP and prolonged fever and pleural effusion were more likely to develop in children with higher CRP.
Age Factors ; Agglutination Tests ; C-Reactive Protein ; Child* ; Child, Preschool ; Diagnosis ; Fever ; Humans ; Mycoplasma* ; Neutrophils ; Physical Examination ; Pleural Effusion ; Pneumonia ; Pneumonia, Mycoplasma* ; Prospective Studies ; Respiratory Sounds ; Risk Factors ; Thorax ; Young Adult

PURPOSE: We studied the association between systemic risk factors and idiopathic macular hole. In addition, we analyzed the mechanism by which systemic risk factors affect the development and progression of macular hole. METHODS: Seventy patients with idiopathic macular holes were compared with 30 sex- and age- matched controls. The vascular viscosity profiles, and coagulation, biochemical and hormone factors were evaluated as systemic risk factors. RESULTS: The levels of fibrinogen and blood estrogen were significantly higher in the idiopathic macular hole group than in the control group. Also the fibrinogen level increased with the progression of macular hole. But there was no significant difference between the two groups with respect to the remaining factors. CONCLUSIONS: These results support the possibility that fibroproliferative factors from platelet increase in patients with idiopathic macular hole, and that fibrinogen is the parameter that increases among the fibroproliferative factors. This study also suggests that blood estrogen is important in the development of macular hole.
Blood Platelets ; Estrogens ; Fibrinogen ; Humans ; Retinal Perforations* ; Risk Factors* ; Viscosity

The present study was performed to observe the time course of behavioral signs of painful sensations in sciatic neurectomy animal model and to test the effects of sympathectomy and saphenous nerve section on these behavioral signs. Sciatic nerve was ligated and cut at the mid-thigh level under gaseous anesthesia. The application of von Frey filaments to the medial plantar surface of foot revealed weak and long-lasting mechanical allodynia (until end of test period, 20 weeks PO). Acetone application to the plantar surface of foot was used ti measure the sensitivity to cold stimulation. Cold allodynia which is interpreted as increased response to acetone application developed fairly well and lasted the end of test period (20 weeks PO). The cumulative duration of foot lifts off neutral or cold plate was used to test spontaneous, ongoing pain and was increased until 16 weeks PO and 20 weeks PO respectively. These results suggest that sciatic neurectomy which has been widely used as chronic pain model shows behavioral signs suggsting painful sensations except autotomy, which has been used as index of pain in experimental animal. Surgical sympathectomy performed 1 week after sciatic neurectomy partially reduced the behavioral signs of mechanical allodynia and cold allodynia, suggesting behavioral changes developed following section of sciatic nerve was partially sympathetic dependent. Saphenous nerve section 1 week after sciatic neurectomy almost completely reduced mechanical allodynia and cold allodynia, but did not change spontaneous, ongoing pain. These results suggest that evoked responses such as mechanical and cold allodynia are mediated by saphenous nerve activity and activating and/or maintaining mechanisms of spontanous, ongoing pain and evoked pain may be different.
Acetone ; Anesthesia ; Animals ; Chronic Pain ; Cold Temperature ; Foot ; Hyperalgesia ; Models, Animal ; Neuralgia ; Rats ; Sciatic Nerve ; Sensation ; Sympathectomy

Purpose: Initial conservative treatment with selective endovascular or surgical intervention has shown successful outcomes in the treatment of spontaneous isolated superior mesenteric artery dissection (SISMAD). However, the benefits of antithrombotic therapy as a part of conservative treatment have not been clarified. This study aimed to investigate the clinical course of SISMAD patients and determine differences in clinical outcomes between the antithrombotic and noantithrombotic groups. Methods: We retrospectively reviewed 79 cases of SISMAD that were treated conservatively from January 2004 to December 2019 at Chonnam National University Hospital. Clinical outcomes, including the length of hospital stay, pain resolution time, image remodeling, and maximal remodeling time, were compared between the antithrombotic and noantithrombotic groups. Results: There were 30 patients in the no-antithrombotic group and 49 patients in the antithrombotic group. There was no significant difference in clinical characteristics between the 2 groups, except for dyslipidemia (P = 0.011). The follow-up period (32.6 months vs. 14.6 months, P = 0.009) and imaging follow-up period (31.6 months vs. 13.9 months, P = 0.011) were longer in the antithrombotic group than in the no-antithrombotic group. The length of hospital stay (5.1 days vs. 7.7 days, P = 0.002) was significantly shorter in the no-antithrombotic group than in the antithrombotic group because patients in the antithrombotic group required longer hospitalization for warfarin titration. Conclusion In patients with SISMAD, conservative treatment without antithrombotic therapy may have clinical benefits such as decreased length of hospital stay compared with conservative treatment with antithrombotic therapy.

Purpose: This descriptive study investigated the effects of nurses’ knowledge of withdrawalof life-sustaining treatment, death anxiety, and perceptions of hospice care on their attitudes toward withdrawal of life-sustaining treatment. Methods: Data were collected from 262 nurses at tertiary hospitals, general hospitals, or primary hospitals in Busan, Korea, and statistically analyzed using the t-test, analysis of variance, the Scheffé test, Pearson correlation coefficients, and hierarchical regression analysis. Results: The participants’ scores were 3.68±0.45 (out of 5) for attitudes toward withdrawal of life-sustaining treatment, 0.65± 0.15 (out of 1) for knowledge of withdrawal of life-sustaining treatment, 2.61±0.26 (out of 4) for death anxiety, and 4.06±0.43 (out of 5) for perceptions of hospice care. Furthermore, knowledge of withdrawal of life-sustaining treatment and perceptions of hospice care showed positive correlations with attitudes toward withdrawal of life-sustaining treatment, while death anxiety showed a negative correlation. The most significant factors influencing attitudes toward withdrawal of life-sustaining treatment were perceptions of hospice care, followed by having experienced caring for patients who withdrew life-sustaining treatment, death anxiety, having a spouse, and ethical values, and the overall explanatory power was 43.0%. Conclusion This study showed that perceptions of hospice were an important fac-tor influencing nurses’ attitudes toward withdrawal of life-sustaining treatment. Therefore,it is necessary to develop and validate educational intervention programs that can improve perceptions of hospice care.

Objective: This study aims to identify the usefulness of voice function in early screening for dysphagia. We sought to evaluate if screening tests through the functions of production and quality of voice were correlated with aspiration in dysphagic patients. Methods: This study involved 55 participants who were referred to videofluoroscopic swallowing study (VFSS) for suspected dysphagia. Blinded examiners rated the voice production function (MVI, MPT) using a portable instrument and evaluated the quality of voice (jitter, shimmer, NHR) using Visi-pitch. Swallowing functions were also evaluated by utilizing the penetration-aspiration scale (PAS), American Speech-Language-Hearing Association (ASHA), National Outcome Measurement System (NOMS) swallowing scale and VDS. The patients were divided into two groups, the penetration group, and the aspiration group according to the PAS score. The difference in variables was analyzed using the Mann-Whitney U test between the two groups. The relationship between voice parameters and swallow-related parameters was determined using the Spearman correlation coefficient. In addition, the cut-off, sensitivity, and specificity of meaningful variables in silent aspiration were analyzed using the ROC curve analysis. Results: The functions of production and quality of voice were found to be significantly different between the penetration and aspiration groups (P＜.000). The PAS score was correlated with all parameters of the functions of production and quality of voice (P＜.001). VDS was correlated with MVI, ASHA was correlated with MVI, and Shimmer (P＜.001). The meaningful variables for silent aspiration were jitter and shimmer. Conclusion Through a clinical screening test, it may be possible to predict the difference between penetration and aspiration through the functions of production and quality of voice.