BACKGROUND: Lesions in distal target arteries hinder surgical bypass procedures in patients with peripheral arterial occlusive disease. METHODS: Between April 2012 and October 2015, 16 patients (18 limbs) with lifestyle-limiting claudication (n=12) or chronic critical limb ischemia (n=6) underwent femoral–above-knee (AK) polytetrafluoroethylene (PTFE) bypass grafts with a bridging stent graft placement between the distal target popliteal artery and the PTFE graft. Ring-supported PTFE grafts were used in all patients with no available vein for graft material. Follow-up evaluations assessed clinical symptoms, the ankle-brachial index, ultrasonographic imaging and/or computed tomography angiography, the primary patency rate, and complications. RESULTS: All procedures were successful. The mean follow-up was 12.6 months (range, 11 to 14 months), and there were no major complications. The median baseline ankle-brachial index of 0.4 (range, 0.2 to 0.55) significantly increased to 0.8 (range, 0.5 to 1.0) at 12 months (p<0.01). The primary patency rate at 12 months was 83.3%. The presenting symptoms resolved within 2 weeks. CONCLUSION: In AK bypasses with a diffusely diseased distal target popliteal artery or when below-knee (BK) bypass surgery is impossible, this procedure could be clinically effective and safe when used as an alternative to femoral-BK bypass surgery.
Angiography ; Ankle Brachial Index ; Arterial Occlusive Diseases ; Arteries ; Blood Vessel Prosthesis* ; Extremities ; Follow-Up Studies ; Humans ; Ischemia ; Polytetrafluoroethylene* ; Popliteal Artery* ; Stents* ; Transplants ; Veins

BACKGROUND: Lesions in distal target arteries hinder surgical bypass procedures in patients with peripheral arterial occlusive disease. METHODS: Between April 2012 and October 2015, 16 patients (18 limbs) with lifestyle-limiting claudication (n=12) or chronic critical limb ischemia (n=6) underwent femoral–above-knee (AK) polytetrafluoroethylene (PTFE) bypass grafts with a bridging stent graft placement between the distal target popliteal artery and the PTFE graft. Ring-supported PTFE grafts were used in all patients with no available vein for graft material. Follow-up evaluations assessed clinical symptoms, the ankle-brachial index, ultrasonographic imaging and/or computed tomography angiography, the primary patency rate, and complications. RESULTS: All procedures were successful. The mean follow-up was 12.6 months (range, 11 to 14 months), and there were no major complications. The median baseline ankle-brachial index of 0.4 (range, 0.2 to 0.55) significantly increased to 0.8 (range, 0.5 to 1.0) at 12 months (p<0.01). The primary patency rate at 12 months was 83.3%. The presenting symptoms resolved within 2 weeks. CONCLUSION: In AK bypasses with a diffusely diseased distal target popliteal artery or when below-knee (BK) bypass surgery is impossible, this procedure could be clinically effective and safe when used as an alternative to femoral-BK bypass surgery.
Angiography ; Ankle Brachial Index ; Arterial Occlusive Diseases ; Arteries ; Blood Vessel Prosthesis* ; Extremities ; Follow-Up Studies ; Humans ; Ischemia ; Polytetrafluoroethylene* ; Popliteal Artery* ; Stents* ; Transplants ; Veins

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

This study was conducted to evaluate prevalence of intestinal helminthic infections and skin tests and Paragonimus and Clonorchis in tuberculosis(TB) patients in Korea. Stool examinations by formalin-ether technique and intradermal tests were carried out in 2 areas; Masan TB hospital and Kong-Ju TB hospital. The positive rate of intestinal helminths of any kind was 51.7 percent among 329 patients in Masan hospital, but 18.1 percent among 215 patients in Kong-Ju hospital. The infection rates of Trichocephalus trichiurus and Clonorchis sinensis were 20.7 percent and 17.6 percent respectively in Masan hospital patients, but the infection rates of T. trichiurus and C. sinensis were 6.5 percent and 6.0 percent respectively in Kong-Ju hospital patients. In skin tests, positive reactions to Paragonimus and Clonorchis antigens were 22.0 percent and 37.6 percent respectively in Masan hospital patients. On the contrary, Kong-Ju hospital patients showed the positive rates of 15.2 percent for Paragonimus and 27.2 percent for Clonorchis respectively.
parasitology-helminth-trematoda ; Ascaris lumbricoides ; Trichuris trichiura ; hookworm ; Trichostrongylus orientalis ; Clonorchis sinensis ; Paragonimus westermani ; Metagonimus yokogawai ; Taenis sp. ; Hymneolepis nana ; epidemiology ; skin test

The posterolateral approaches to the spine is an effective method for the neural decompression and the spinal stabilization. This procedure has an advantages of an one-stage posterolateral decompression-stabilization. We have experienced 8 patients with burst fracture in the thoracolumbar junction. A three-quater prone position was used for patient positioning. No patient showed neurologic deterioration after surgery. Patient positioning and the operative approach are described and illustrated.
Decompression* ; Humans ; Patient Positioning ; Prone Position ; Spine*

PURPOSE: This study was done to compare clinical nurses' knowledge and visual differentiation diagnostic ability for the pressure ulcer classification system (PUCS) and incontinence-associated dermatitis (IAD). METHODS: A convenience sample of 602 nurses took the pressure ulcer classification system and incontinence-associated dermatitis knowledge test (PUCS & IAD KT) and completed the visual differentiation tool (VDT), consisting of 21 photographs with clinical information. RESULTS: The overall mean score for correct answers was 14.5 (+/-3.2) in PUCS & IAD KT and 11.15 (+/-4.9) in PUCS & IAD VDT. Incorrect responses were most common for statements related to stage III, IAD for PUCS & IAD KT, and suspected deep tissue injury (SDTI), unstageable, and stage III for PUCS & IAD VDT. Significant correlations were found between PUCS & IAD KT and VDT (r=.48, p<.001). Factors affecting scores for PUCS & IAD VDT were PUCS & IAD KT, frequency of pressure ulcer, IAD management and participation in wound care education programs. CONCLUSION: Results indicate that nurses have an overall understanding of PUCS & IAD, but low visual differentiation ability regarding stage III, SDTI, and unstageable ulcers. Continuing education is needed to further improve knowledge and visual differentiation ability for PUCS & IAD.
Adult ; Dermatitis/*classification/complications/pathology ; Education, Continuing ; Educational Measurement ; Fecal Incontinence/complications ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Male ; Nurses/*psychology ; Pressure Ulcer/*classification/pathology ; Questionnaires ; Urinary Incontinence/complications

PURPOSE: Mesenteric and omental cysts are uncommon lesions found all age groups. They elicit interest because of their unclear pathogenesis and confusing terminology. MATERIALS AND METHODS: CT findings of 12 case with mesenteric and omental cysts were described and compared with surgical and pathologic findings. RESULTS: In mesenteric and omental cyst, the histologic diagnoses were lymphangioma(7 cases), nonpancreatic pseudocyst(3 cases), mesothelial cyst(2 cases). Lymphangiomas were usually multiloculated with enhancing wall, located in the small bowel mesentery. And these cystic lesions were frequently attached to bowel and required resection of a bowel segment. In three cases of pseudocyst, thick and enhancing wall was shown in unilocular cyst. Two cases of mesothlial cyst were located in greater omenturn, showed very thin wall in unilocuation. CONCLUSION: The CT features of the mesenteric and omental cysts are fairly characteristic. Identification of lymphangioma, which shows a multilocuation and enhancing wall, is important due to frequent bowel resection in operative field.
Diagnosis ; Humans ; Lymphangioma ; Mesentery

PURPOSE: A study was performed to compare the detectability of extrahepatic duct stones between nonenhanced and enhanced computed tomography(CT). MATERIALS AND METHODS: Consecutive 30 patients with extrahepatic duct stones were analyzed with special attention to the detectability of stones between nonenhanced and enhanced CT. The extrahepatic duct was further divided into two segments, one above(suprapancereatic) and the other in(intrapancreatic) the head of the pancreas. Conspicuity of the stone was graded as "visible", "suspicious", and "invisible". Three radiologists reviewed the CT images without prior information and determined the location of stone and grade of their conspicuity. RESULTS: The stones were located at the suprapancreatic common duct in 5 patients, intrapancreatic common duct, in 15 patients and both portion of the duct in 10 patients. There was no difference in the detection rate of stones between the two images at suprapancreatic common duct, and was 93%, However, the rate at intrapancreatic common duct was 95% and 64% on nonenhanced and enhanced CT scans, respectively. The overall detection rate was 95% on nonenhance CT and 75% on enhanced CT. CONCLUSION: We concluded that nonenhanced CT was prerequisite to evaluate the extrahepatic duct stones in addition to enhanced CT.
Head ; Humans ; Pancreas ; Tomography, X-Ray Computed

We report a case of suprasellar arachnoid cyst with hydrocephalus which was diagnosed incidentally. This 41-year-old housewife had sympoms of hydrocephalus and hypophyseal dysfunction. Despite of well-functioning ventriculoperitioneal shunt and communication of the cyst with the ventricular system, the size of the ventricular system was never been normalized. She deteriorated progressively and eventually died shortly after the seventh operation. Unusual hospital couse is presented with brief review of the related literatures.
Adult ; Arachnoid* ; Humans ; Hydrocephalus

PURPOSE: Although the process by which intravitreal perfluorocarbon gas is absorbed is incompletely understood, it is known that considerable absorption of intravitreal perfluorocarbon gas occurs through the aqueous humor. The aim of the study was to evaluate experimentally the effect of topical aqueous humor suppressants on the intravitreal perfluorocarbon gas bubble duration. METHODS: After sulfur hexafluoride and perfluoropropane were injected intravitreally in ten rabbits, we measured the time of gas bubble disappearance in eyes treated with topical aqueous humor suppressants and in those not treated. RESULTS: The mean time(+/-SD) to disappearance of 0.4 cc of sulfur hexafluoride was 6.0+/-0.71 days, which was prolonged to 8.0+/-0.71 days with topical aqueous humor suppressants. The mean time(+/-SD) to disappearance of 0.2 cc perfluoropropane was 14.8+/-0.84 days, while it was prolonged to 22.0+/-1.58 days with topical aqueous humor suppressants. CONCLUSIONS: Sulfur hexafluoride and perfluoropropane intravitreal gas bubbles last longer in rabbit eyes treated with aqueous humor suppressants than in fellow control eyes.
Absorption ; Aqueous Humor* ; Rabbits* ; Sulfur Hexafluoride