The provision of adequate soft tissue cover for a complex hand and forearm wound-dirty, infected and exposed bone can be a challenging problem. Conventionally, a distant flap or free flap have been used, but these have been associated with several problems such as joint stiffness, risk of microsurgical procedures, negligible donor site morbidity, prolonged operation time and economic restriction. As well, fasciocutaneous flap has been the limitation of infection control. In these situations, the ipsilateral muscle flap provides the ideal cover with its rich blood supply and single operative field. Previously described by Lendrum(1980), by Lae et al.(1981), and later by McGeorge(1991), the brachioradilis muscle is the most superficial muscle on the radial side of the forearm. Its flap is based on the radial artery and venae comitantes. From August 1996 to October 1997, we performed branchioradialis muscle flap in seven patients. Despite the sacrifice of the major hand artery, brachioradialis muscle flap has many advantages including the reliability of flap survival, easy dissection, early mobilization and absence of functional and aesthetic problems at the donor site. It is a relatively simple and rapid method for resurfacing soft tissue defect in the hand and forearm. We obtained satisfactory and reliable results.
Arteries ; Early Ambulation ; Forearm* ; Free Tissue Flaps ; Hand* ; Humans ; Infection Control ; Joints ; Radial Artery ; Tissue Donors

Astasia-abasia refers to the inability to stand or walk despite possessing good motor strength and conserved voluntary coordination. Although it is usually regarded as a psychogenic disorder, organic causes have been reported. Herein we describe a patient who presented with alcohol-induced episodic astasia-abasia. Interestingly, SPECT performed during an episode showed hyperperfusion in the dorsal brainstem and subthalamic region. These areas roughly coincide with the mesencephalic locomotor region and subthalamic locomotor region, respectively, and it is conceivable that abnormal neural activity in these areas is related to the symptoms in our patient.

Although most of the known pathogenic mutations in the progranulin gene (PGRN) are null mutations leading to a reduction in the serum PGRN protein levels, missense mutations also have been identifi ed in patients with frontotemporal lobar degeneration and in patients with Alzheimer disease. Among these, p.R564C mutation was identifi ed in a late-onset AD patient with a reduced serum PGRN level. However, recently, we found the p.R564C mutation in a healthy control subject raising doubts whether this is a pathogenic mutation. In this report, we measured the serum PGRN levels in 20 subjects without the p.R564C mutation and in one subject with the p.R564C mutation, to determine whether the p.R564C mutation is associated with reduced serum PGRN levels. We found that the serum PGRN level in the subject with the p.R564C mutation was not reduced compared to the subjects without the p.R564C mutation. Our result reiterates that p.R564C may not be a pathogenic mutation.

PURPOSE: The purpose of this study was to analyze the clinical manifestations of elbow dislocation in children and to suggest an appro-priate treatment modality for this rare injury. MATERIALS AND METHODS: We analyzed 17 cases, treated from September 1989 to July 2000. The factors examined included; age, sex, etiology, direction, associated injuries, method of treatment, results and complications. Clinical results were evaluated using the grading system of Linscheid and Wheeler. RESULTS: The mean age was 10 years 4 months. Etiologies were; fall from a height 8 cases, slip down 7 cases and unknown 2 cases. The directions of the dislocations were posterior 14 cases, posterolateral 2 cases, and posteromedial 1 case, with no anterior dislocation. Associated injuries were noted in 14 cases (82.4%), and 8 of these cases were treated by open reduction and internal fixation. The remaining 9 cases were treated by closed reduction followed by a long arm cast. The mean period of immobilization was 3.8 weeks. One case was complicated with a myositis ossificans, which resulted in spontanous remission. Results were excellent in 15 cases, and good in 2 cases with no poor cases. CONCLUSION: The incidence of associated fractures (82.4%) was higher in this study than in previous reports. A careful examination is necessary to identify associated injuries and achieve stability with the surgical procedure, which should be followed by early active exercise.
Arm ; Child* ; Dislocations* ; Elbow* ; Humans ; Immobilization ; Incidence ; Myositis Ossificans

Purpose: To report a case of recovery from deepening of the upper eyelid sulcus after switching from prostaglandin FP receptor agonists to an EP2 receptor agonist.Case summary: A 65-year-old male patient with suspicion of glaucoma presented for detailed examinations. At the initial visit, his best-corrected visual acuity was 1.0 in both eyes, and the intraocular pressure (IOP) was 14/14 mmHg. Examination revealed no specific findings in the anterior segment, mild early cataracts bilaterally, and moderate glaucomatous changes. Therefore, bimatoprost/timolol fixed-combination eye drops were administered in both eyes. After 1 month, the IOP was 11/11 mmHg and no evidence of glaucoma progression was found. After 10 months, the IOP was 17/18 mmHg and there was deepening of the upper eyelid sulcus bilaterally. Consequently, bimatoprost/timolol fixed combination eye drops were switched to omidenepag isopropyl. Within 2 months of the switch, the deepening of the upper eyelid sulcus recovered completely and the IOP was 14/13 mmHg. Conclusions Patients with prostaglandin-associated periorbitopathy should be switched to non-prostaglandin drugs or EP2 receptor agonists. Our patient exhibited complete recovery of the upper eyelid sulcus deepening after switching to an EP2 agonist.

Background and Objectives: This study aimed to examine factors of poor outcome by analyzing the outcomes of bilateral subthalamic deep brain stimulation in Parkinson’s disease after 3 years. Methods: We assumed that patients who could not manage independent life in their best stimulationon/medication-on condition after a defi ned period might not have been a good surgical candidate. A poor outcome is defi ned as a failure to maintain functional independence at three years during a stimulation-on/medication-on state. Results: A total of 84 patients underwent bilateral subthalamic deep brain stimulation and all were followed up for 3 years. We excluded one patient who had intracranial hemorrhage. Twenty-one patients of the 83 patients could not keep up independent life even during their best condition for the following reasons: freezing in 15 patients, dementia in 5, depression in 3, musculoskeletal problems in 7, and cancer in one patient. Conclusions: Many patients could not keep up independent life during their best condition as early as three years after deep brain stimulation. Musculoskeletal problems were one major cause of disabilities, as were freezing and dementia. We emphasize that musculoskeletal problems need more attention in the preoperative screening of deep brain stimulation candidates and during the follow up.

Purpose: To report a case of subacute methicillin-resistant coagulase-negative Staphylococcus hominis endophthalmitis after re-operation for penetrating keratoplasty in a patient who had a penetrating keratoplasty rejection.Case summary: A 74-year-old man with underlying diabetes and hypertension who underwent bilateral penetrating keratoplasty at another hospital underwent penetrating keratoplasty reoperation due to corneal transplant rejection in the right eye. He had a history of end-stage glaucoma in the right eye and the visual acuity was finger counting at 30 cm. About 25 days postoperatively, the corneal epithelial defect was first found. Treatment based on suspicion of herpes simplex virus infection did not result in improvement and endophthalmitis was suspected in the right eye about 35 days after surgery. Anterior chamber irrigation, pars planar vitrectomy, and intravitreal antibiotic injection were performed. Culture revealed methicillin-resistant coagulase negative Staphylococcus hominis. After 2 months of treatment, the anterior chamber and vitreous inflammation decreased and best corrected visual acuity in the right eye recovered to 0.06. Conclusions Subacute endophthalmitis caused by methicillin-resistant coagulase-negative Staphylococcus may occur after penetrating keratoplasty. Transplant failure due to infection can be avoided with vitrectomy and antibiotic treatment at the right time.

Supraaortic stenosis is a localized or diffuse congenital narrowing of the ascending aorta at the levels of superior margin of the sinus of Valsalva, just above coronary arteries. Hemodynamically, it is a usually manifestated as aortic stenosis especially when it combined with subaortic membrane. And there is no case report of supraaortic stenosis combined with subaortic membrane which has aortic valvular reurgitation due to secondary change of dilated sinus of Valsalva by supraaortic ridge. We have experienced a case of aortic regurgitation associated with supraaortic ridge combined with subvalvular aortic membrane.
Aorta ; Aortic Valve Insufficiency* ; Aortic Valve Stenosis ; Constriction, Pathologic ; Coronary Vessels ; Membranes* ; Sinus of Valsalva

BACKGROUND: Increasing numbers of young people go to clubs. In Korea, however, no studies have been conducted regarding the exposure of club patrons to secondhand smoke. The present study was conducted to evaluate the degree of club customers' exposure to secondhand smoke. METHODS: The study subjects included 10 male and 12 female non-smokers. The investigational site was a club located in Daegu. Urine samples were collected before exposure to secondhand smoke in the club and 6 hours after a 3-hour exposure. The urine cotinine levels were measured via the LC-MS/MS method. A survey was conducted to collect data regarding the subjects' smoking experiences and the degree of exposure to secondhand smoke in their daily lives. RESULTS: The average urine cotinine level increased from 1.09 microg/L to 5.55 microg/L (p<0.05). No significant difference existed in the change in urine cotinine level between the male and female subjects. In addition, there was no significant difference in the change in urine cotinine level by the degree of exposure to secondhand smoke in daily life. CONCLUSIONS: The average urine cotinine level in all the subjects significantly increased after exposure to secondhand smoke. This is the first study on exposure to secondhand smoke in clubs; these results can be used to craft measures that reduce exposure to secondhand smoke in public places, such as clubs.
Cotinine ; Female ; Humans ; Korea ; Male ; Smoke ; Smoking ; Tobacco Smoke Pollution