Application of Modified Vacuum Assisted Closure with Silver Materials in Chronic Infected Wound

PURPOSE: Chronic infected wounds sustained over 4 weeks with exposed tendon or bone are difficult challenges to plastic surgeons. Vacuum assisted closure (VAC) device has been well used for the management of chronic wounds diminishing wound edema, reducing bacterial colonization, promoting formation of granulation tissue and local blood flow by negative pressure to wounds. But Commercial ready-made VAC device might have some difficulties to use because of its high expenses and heavy weight. So we modified traditional VAC device with silver dressing materials as topical therapeutic agents for control of superimposed bacterial wound infection such as MRSA, MRSE and peudomonas. METHODS: We designed the modified VAC device using wall suction, 400 cc Hemovac and combined slow release silver dressing materials. We compared 5 consecutive patients' data treated by commercial ready-made VAC device(Group A) with 11 consecutive patients' data treated by modified VAC device combined with silver dressing materials(group B) from September 2004 to June 2007. Granulation tissue growth, wound discharge, wound culture and wound dressing expenses were compared between the two groups. RESULTS: In comparison of results, no statistical differences were identified in reducing rate of wound size between group A and B. Wound discharge was significantly decreased in both groups. Modified VAC device with silver dressing materials showed advantages of convenience, cost effectiveness and bacterial reversion. CONCLUSION: In combination of modified VAC device and silver dressing materials, our results demonstrated the usefulness of managing chronic open wounds superimposed bacterial infection, cost effectiveness compared with traditional VAC device and improvement of patient mobility.

Gullain-barre Syndrome Associated with Non-Hodgkin's Lymphoma

A 67-year-old man developed swelling of the right leg with inguinal and abdominal pain over a period of 5 days. Excisional biopsy of the left supraclavicular lymph nodes revealed the diffuse, large B cell type of malignant lymphoma. After chemotherapy, he complained of a tingling sensation and weakness in the left upper extremity, and then this progressed to quadriplegia. Electrodiagnostic testing demonstrated the characteristic findings of demyelination, which was consistent with Guillain-Barre syndrome (GBS). Non-Hodgkin's Lymphoma (NHL) leading to GBS, as was observed in the present case, suggests that physicians should be aware of GBS and non-Hodgkin's lymphoma as the full spectrum of these diseaseshas not been fully defined.

Horizontal Ratio of the Korean University Student's Face and Facial Golden Mask

PURPOSE: Many attempts have been made to describe ideal facial proportions for over two thousands year and constantly lasted till now. Dr. Marquardt has derived supposedly ideal facial proportions from the facial golden mask using golden ratio of 1:1.618. On the other hand, facial reducing surgeries such as mandible angle reduction are popularized in Asia because the width of mid and lower face of Korean is recognized to be wider. The purpose is to analyze characters of Korean university students' faces in horizontal plane and establish the objective data for facial width distributions and clinical applications. METHODS: We applied the facial golden mask to the photographs in 1000 cases, compared the width of mid and lower face between the facial golden mask and Korean university students' faces. And we first calculated the horizontal ratio(HR) of middle and lower face each for using comparative scale of width, facial golden mask. We divided 1,000 cases into 3 groups by degrees of HR and analyzed data of HR on each groups. Using calculated horizontal ratio, we newly invented the cumulative frequency of distribution graphs in Korean university students' faces. RESULTS: Mean data of HR were over 1.0 in all groups, which means that Korean university students' faces are typically wider than facial golden mask in horizontal planes. And this study was statistically significant(p- value<0.05). Clinically using the cumulative frequency distributions of Korean university students' face width, we can easily explain changes of facial width to patient after facial reducing surgery and describe the changes into objective data. CONCLUSION: This study concludes thatKorean university students' faces are wider than facial golden mask is significantly true and the cumulative frequency of distribution graphs are expected to be widely used for comparison of results in facial reducing surgery.

Waldenstrom's Macroglobulinemia: Clinical Course and Outcome of 14 Cases / 대한혈액학회지

BACKGROUND: Waldenstrom's Macroglobulinemia (WM) is a low grade lymphoproliferative disorder that produces monoclonal immunoglobulin M (IgM). Information on the clinical feature and outcome of Korean patients with WM is scanty. METHODS: Patients with WM newly diagnosed at 5 university hospitals in Daegu and Gyeongju from 1990 to 2002 were enrolled. Data on 14 patients were retrospectively analyzed. RESULTS: The median age at diagnosis was 66 years (range: 48~77) and the male/female ratio was 6:1. All patients except one were symptomatic at presentation. Anemia was observed in all patients and beta2 microglobulin was elevated in 90% of patients. Overall response rate was 45% in the patients treated with alkylating agent and steroid. The median survival of our patients was 39 months (95% confidence interval:13.7~64.3 months) and the only factor associated with poor survival was albumin level by univariate analysis. CONCLUSION: Incidence of WM was lower and the median survival of our patients was shorter than that of Western reports. Further studies are needed to confirm prognostic factors and risk adapted treatment guideline of Korean WM patients.

Primary Total Hip Arthroplasty with a CLS Expansion Acetabular Component: Mid Term Follow-Up Study / 대한정형외과학회잡지

PURPOSE: To evaluate the results of total hip arthroplasty (THA) with a CLS expansion acetabular cup using press-fit technique. MATERIALS AND METHODS: One hundred and nineteen primary THA in 102 patients with a CLS expansion cup by press-fit technique were performed consecutively. Eighty-four hips were evaluated for clinical analysis by Harris hip score (HHS) , and 70 hips were evaluated for radiographic analysis, including stability (cup migration and change of position) , remodelling (change of polar gap and trabecular pattern) , and early wear rate of polyethylene after a mean follow up of 4 years and 9 months. RESULTS: Mean HHS was improved from 44.9 points preoperatively to 90.4 points at the most recent follow up. Initial adequate contact fit was found in 64 hips (91%) . Radiolographically, optimal stabilities of acetabular cup at the most recent follow up were found in all hips. Polar gap in 38 hips (78%) of 48 hips at postoperative radiographs disappeared at most recent follow up. Periacetabular trabecular patterns were maintained or improved in all cases. CONCLUSION: CLS expansion acetabular cup fixation by press-fit technique guaranteed an excellent implant stability.

Contributing Factors for Nonunion in Open Tibial Fractures Treated with External Fixation / 대한정형외과학회잡지

We analyzed the factors of importance for nonunion in series of 91 open fractures of tibial diaphysis which were treated with external fixation. Factors analyzed included, age and sex of the patients, the mechanism of injury, the amount of soft tissue damage, the grade of comminution, the level at which the tibia was fractured, the presence of an intact fibula, the presence of the multiple injuries, the type of the external fixation used(AO external fixator, EXTOR; monotube external fixator, Ilizarov), and the need to supplement the stability of the reduction. We found that the amount of soft tissue damage and comminution of the fracture played a role in the development of the nonunion.