Reconstruction of Postburn Scar Contracture of the Sole Using the Medialis Pedis Free Flap

Postburn scar contracture of sole can cause musculoskeletal deformity, restricted range of motion, and decreased quality of life. It is very important to exhibit similar characteristics of the sole when reconstructing the sole because it has to resist shearing force and weight bearing. In this case, we performed medialis pedis free flap for the postburn scar contracture of the sole and the flap survived without complication. The patient satisfied with functional and aesthetic outcomes. Medialis pedis free flap, which is harvested adjacent to the sole, can show similar characteristic of the sole and maintain adequate contour.Moreover, this flap can be harvested without sacrifice of major vessel or nerve. Due to these advantages, medialis pedis free flap can be an ideal option for the reconstruction of the sole.

Usefulness of the Lower Trapezius Myocutaneous Pedicle Flap for Reconstruction of Third Degree Facial Burn

Free flap surgery is commonly used for extensive facial burn. However, free flap surgery requires long operation time and difficult technique. Also, it requires further procedure to prepare the recipient vessels. Hence, applying pedicle flap surgery instead of free flap surgery is effective for patients with facial burn. Among a wide range of pedicle flaps, we performed lower trapezius myocutaneous pedicle flap to patients with third degree facial burn and got satisfactory results without complications. Lower trapezius myocutaneous pedicle flap has a wide arc of rotation so that it can cover middle and lower part of the face. Furthermore, it is thinner than other myocutaneous pedicle flap that can be used for facial reconstruction. Due to these advantages, lower trapezius myocutaneous pedicle can be an attractive option for the reconstruction of facial burn.

Coping Experiences of Spouses of Males with Gambling Disorders / 정신간호학회지

Purpose@#This study aimed to understand the coping experiences of spouses of males with gambling disorders. @*Methods@#This study used narrative inquiry. Four spouses were recruited from Gam-Anon family groups. In-depth, semi-structured interviews with each participant were conducted from November to December 2020. @*Results@#The coping experiences of spouses ranged from daily stress to traumatic stress. The coping strategy was modified and developed by the perception of their husbands' gambling. Changes in participants' coping strategies were related to emotions that arose from the context of social interaction and internal emotions. The coping experiences of spouses were the process of learning a new way of recognizing the true meaning of life and finding happiness. @*Conclusion@#This study proposed an efficient coping strategy for families of people with gambling disorder by understanding the spouse's coping experiences. Reducing social stigma and creating a supportive environment for families of people with gambling disorders is essential, and perceived social support can be related to the spouse's adoption of effective coping strategies.

Coping Experiences of Spouses of Males with Gambling Disorders / 정신간호학회지

Purpose@#This study aimed to understand the coping experiences of spouses of males with gambling disorders. @*Methods@#This study used narrative inquiry. Four spouses were recruited from Gam-Anon family groups. In-depth, semi-structured interviews with each participant were conducted from November to December 2020. @*Results@#The coping experiences of spouses ranged from daily stress to traumatic stress. The coping strategy was modified and developed by the perception of their husbands' gambling. Changes in participants' coping strategies were related to emotions that arose from the context of social interaction and internal emotions. The coping experiences of spouses were the process of learning a new way of recognizing the true meaning of life and finding happiness. @*Conclusion@#This study proposed an efficient coping strategy for families of people with gambling disorder by understanding the spouse's coping experiences. Reducing social stigma and creating a supportive environment for families of people with gambling disorders is essential, and perceived social support can be related to the spouse's adoption of effective coping strategies.

Post-traumatic Growth in Spouses of Alcoholic Husbands, who have Suffered from Domestic Violence / 정신간호학회지

Purpose@#This study aimed to elucidate the experiences of post-traumatic growth among spouses of alcoholics. @*Methods@#This study used narrative inquiry. The participants were three middle-aged women who had suffered domestic violence from their husbands, the latter of whom had been diagnosed with alcohol use disorders. In-depth interviews with each participant were conducted twice from June to July 2019. @*Results@#The participants reappraised the intrusive symptoms and negative feelings caused by their husbands' drinking problems and domestic violence, and they deliberately repeated reflective pondering through cognitive and emotional flexibility. The perception of social support from actively explored support resources led them to choose a problem-focused coping strategy. Their views of themselves, interpersonal relationships, and philosophical views that had collapsed due to trauma were reconstructed, thus attaining self-transformation. @*Conclusion@#The subjective perception of social support among spouses of alcoholics was affected by the social and cultural contexts and the means of support. Using an emotional-focused coping strategy to accommodate negative emotional response from trauma as well as helping deal with the emotions themselves are important for driving growth motivation and post-traumatic growth. Post-traumatic growth is the process of reconstructing narratives and integrating them into life stories, thereby giving meaning to life.

Post-traumatic Growth in Spouses of Alcoholic Husbands, who have Suffered from Domestic Violence / 정신간호학회지

Purpose@#This study aimed to elucidate the experiences of post-traumatic growth among spouses of alcoholics. @*Methods@#This study used narrative inquiry. The participants were three middle-aged women who had suffered domestic violence from their husbands, the latter of whom had been diagnosed with alcohol use disorders. In-depth interviews with each participant were conducted twice from June to July 2019. @*Results@#The participants reappraised the intrusive symptoms and negative feelings caused by their husbands' drinking problems and domestic violence, and they deliberately repeated reflective pondering through cognitive and emotional flexibility. The perception of social support from actively explored support resources led them to choose a problem-focused coping strategy. Their views of themselves, interpersonal relationships, and philosophical views that had collapsed due to trauma were reconstructed, thus attaining self-transformation. @*Conclusion@#The subjective perception of social support among spouses of alcoholics was affected by the social and cultural contexts and the means of support. Using an emotional-focused coping strategy to accommodate negative emotional response from trauma as well as helping deal with the emotions themselves are important for driving growth motivation and post-traumatic growth. Post-traumatic growth is the process of reconstructing narratives and integrating them into life stories, thereby giving meaning to life.

Perioperative Results and Complications after Posterior Lumbar Interbody Fusion for Spinal Stenosis in Geriatric Patients over than 70 Years Old

OBJECTIVE: As increasing the size of the geriatric population, the number of elderly patients, who need the surgery for painful degenerative spinal stenosis has been increasing. The geriatric population may be relatively high complications, because of age and age-associated medical conditions. However, there is a lack of studies addressing the perioperative complications and outcomes in elderly patients with posterior lumbar inter body fusion with screw augmentation (PLIF). METHODS: We retrospectively reviewed the medical records and radiographic studies of geriatric patients who had spine surgery of PLIF due to spinal stenosis for 11 years. We divided into 2 groups (A; 70–75 years, B; over then 76 years) according to the age. Surgical level of each groups, hospital day and postoperative day, co-morbidities, complications, clinical outcomes were analyzed. Operative reports, hospital and outpatient clinic charts, and radiographic studies were reviewed. RESULTS: Group A was composed of 80 patients, their mean age was 72.21 and female dominant (n=46), and their mean surgically fused level was 1.52 level. Group B was 36 patients, their mean age was 78.83 and female dominant (n=20), and their mean surgically fused level was 1.36 level. Comparing between two groups, complications, postoperative hospital stay were slightly increase in group B and co-morbidity was statistically high in group B, however clinical outcomes were similar between two groups. CONCLUSION: Increasing age might be an important risk factor for complications in patients undergoing PLIF, however, we would like to recommend that if the situation of spine of extreme geriatric patients need PLIF, it should be in the surgeon’s consideration after careful selection and clinical judgement.

Diffuse Skeletal Hemangiomatosis Mimicking Sacroiliitis

Hemangiomatosis of the skeletal system is a rare disease without specific symptoms and signs. We describe a 20-year-old patient with low back pain, whose plain radiographs of sacroiliac (SI) joint showed irregular sclerotic lesions. The patient was finally confirmed with skeletal hemangiomatosis by magnetic resonance imaging (MRI) and excisional biopsy of the lesion. The present case suggests that if patients with abnormal lesions of the SI joint in the plain radiographs do not have typical inflammatory back pain, advanced imaging is required to make an accurate diagnosis. Our case also emphasizes the importance of MRI and biopsy in establishing the diagnosis.

IgG4-related Sclerosing Cholangitis Presented as a Mass in the Liver / 대한췌담도학회지

Autoimmune pancreatitis or IgG4-related sclerosing cholangitis often involves the liver. Most common lesion involving the liver is shown as mass or masses often referred as inflammatory pseudotumor. Inflammatory pseudotumor usually needs to be discriminated with malignancy. Here we report a case of IgG4-related sclerosing cholangitis with liver involvement presented as a mass. It was proven by biopsy and did not show any evidence of autoimmune pancreatitis. The mass infiltrated around the portal tract and portal vein thrombosis was also present.

Idiopathic Phlebosclerotic Colitis: A Rare Entity of Chronic Ischemic Colitis / 대한소화기학회지

Colonic wall thickening is frequently encountered in various conditions, from acute or chronic inflammatory disease to colorectal carcinoma. Colonic wall thickening may be accompanied by calcifications in mucinous adenocarcinoma of the colon, leiomyosarcoma of the colon, schistosomiasis japonica, and phlebosclerotic colitis. Phlebosclerotic colitis is a rare entity of chronic ischemic colitis associated with sclerosis and fibrosis of mesenteric veins. Although its development is usually insidious, and, thus its diagnosis can be delayed, characteristic findings in phlebosclerotic colitis are calcifications of mesenteric veins as well as colonic wall thickening with calcifications. We report on a 71-year-old woman who presented with chronic diarrhea and intermittent hematochezia, who was first misdiagnosed as mucinous adenocarcinoma of the colon, but finally diagnosed as a rare entity of chronic ischemic colitis, phlebosclerotic colitis. Differential points of phlebosclerotic colitis from other diseases, including leiomyosarcoma and schistosomiasis japonica, are also described.

A Case of Ischemic Steal Syndrome in a Renal Transplantation Recipient / 대한이식학회지

Ischemic steal syndrome (ISS) is one of the serious complications that can occur after construction of an arteriovenous fistula (AVF) for hemodialysis (HD). Because AVF-related ISS symptoms are usually aggravated during HD sessions, a few cases of ISS in kidney transplantation (KT) recipients have been reported in the literature. We describe a 63-year-old male with diabetic nephropathy who created AVF for maintenance HD and presented with pain at rest and tissue necrosis of the left distal fingers at 10 years post-KT. Brachial angiography revealed the presence of attenuated blood flow through the distal ulnar artery. He underwent finger amputation and AVF ligation, leading to complete relief of ischemic symptoms. The aim of this case report is to help clinicians to diagnosis a steal syndrome in kidney transplantation with a careless AVF for a long period of time.

Disseminated Cryptococcosis with Cutaneous Manifestation in a Renal Transplant Recipient: A Case Report / 대한이식학회지

Cryptococcosis commonly affects patients with immune dysfunction, as in the case of immunosuppression in organ transplant patients or as acquired immunodeficiency syndrome in patients afflicted with human immunodeficiency virus. The varied appearance of cryptococcal skin lesion makes clinical diagnosis of cutaneous cryptococcosis difficult. Cryptococcosis proves to be a fatal fungal infection in the immunocompromised patient. Therefore, diagnosis and early treatment of cryptococcosis become vital. A 56-year-old renal transplant recipient, with an ongoing immunosuppression regimen of cyclosporine, prednisolone, and mycophenolate mofetil, was admitted with a 2-week history of pain and edema of right arm without respiratory symptoms. Despite empiric antibiotic therapy, the patient continued to complain of severe tenderness of the involved arm and fever persisted as well. On the third day of hospital stay, a biopsy of the erythematous skin lesion was acquired. On the eighth day of hospital stay, results of both skin biopsy and blood cultures showed the presence of Cryptococcus neoformans. The treatment was begun with intravenous fluconazole (400 mg/day). After 4 days of antifungal treatment, the patient developed fever along with cough with purulent sputum. As the new developing symptoms were suggestive of pneumonia, especially of pulmonary cryptococcosis, the antifungal agent was changed from fluconazole to amphotericin B treatment (0.8 mg/kg, 50 mg/day). Chest computer tomography showed improvement in the pneumonic infiltration and consolidation after 4 weeks of amphotericin B treatment. In conclusion, cellulitis in immunocompromised patients should be suspected in case of highly atypical infectious etiology, and skin biopsy should not be delayed if empiric antibiotic therapy does not control the inflammatory response. Additionally, the patient should be treated with intravenous amphotericin B treatment in case of severe cryptococcosis.

Midterm Results of Total Hip Arthroplasty Using the VerSys Fiber Metal Tapered Femoral Stem / 대한고관절학회지

PURPOSE: We evaluated the clinical and radiological results of patients who received the cementless VerSys fiber metal tapered stem for total hip arthroplasty. MATERIALS AND METHODS: Thirty seven hip joint replacements(31 patients) were evaluated over a minimum four year period following the procedure with an average follow-up period of 56 months(48-96 months). The mean patient age was 47.9 years old. Clinical results were analyzed using Harris hip scores, incidence of thigh pain and radiographic analysis was used to assess fixation of the stem, stress shielding, cortical hypertrophy and radiolucent lines around the femoral stem. RESULTS: The average Harris hip score was 90.7 points(82-99 points). Thigh pain was noticed in 6 hips(16%). Proximal femoral bone resorption by stress shielding was observed in 32 hips(86.5%). Cortical hypertrophy was noticed in 16 hips(43.2%) and was statistically correlated with stress shielding of 2nd degree or more according to the Engh classification. Stable bone ingrowth at the last follow-up was seen in 36 hips(97.2%). CONCLUSION: Cementless total hip arthroplasty using the cementless VerSys fiber metal tapered stem demonstrated excellent midterm clinical results as well as excellent radiologic results for stable fixation and endosteal new bone formtion. However, long term follow-up evaluation will be required because of the high rates of proximal bone resorption by stress shielding.

Usefulness of the Cementless Stem for the Treatment of Hip Fracture in Elderly Patients with Osteoporosis: Comparative Analysis between Cementless Stem and Cemented Stem

PURPOSE: We evaluated the usefulness of the cementless stem in treating hip fracture patients older than 70. MATERIALS AND METHODS: We studied elderly osteoporotic hip fractures in the neck and intertrochanter area who had received hip arthroplasty with over 2 years of follow up period. Among those, we analyzed the clinical and radiological results of hip arthroplasty with cemented stem (group 1) and hip arthroplasty with cementless stem (group 2). Each group was consists of fifty hips. RESULTS: The mean age at surgery was 75 years and mean follow-up period was 40 months (minimum 24 months). The admission period was 28.68+/-8.8 days for group 1 and 28.05+/-8.7 days for group 2 (p>0.05) and the average operation time was 87+/-21.2 minutes, and 80+/-17 minutes (p>0.05) and the total blood loss was 611+/-141.3 cc and 557+/-120.5 cc (p>0.05) respectively. There was no statistically significant difference in all aspects. One case of pulmonary embolism occurred in group 1. Stem loosening was not observed in both groups at the last follow-up radiologic study. CONCLUSION: The hip arthroplasty with cementless stem for the osteoporotic hip fractures showed a competent results clinically and radiologically in short term follow up as compared with the cemented stem.

Continuous Measurement of Suspension Force during Suspension Laryngoscopy: Preliminary Report / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although suspension laryngoscopy is a very common procedure in the otolaryngoloical field and suspension force (Fs) is suspected to be related with the complications or laryngeal exposure, Fs has not been objectively measured yet. The objective of this study is to measure suspension force continuously during suspension laryngoscopy. SUBJECTS AND METHOD: Sixteen patients who had undergone laryngoscopic surgery were evaluated. The value measured with a load cell during the procedure was converted to Fs with calculation. The maximum force (Fsmax) and the mean force (Fsmean) were evaluated. The angle between the laryngoscope and the chest holder(angle alpha), and the angle between the chest holder and the horizontal plane (angle beta) were gauged. RESULTS: The mean values of Fsmax and Fsmean were 14.2 and 25.5 kgf, respectively. The mean values of angle alpha and angle beta were 124.0+/-4.3 degrees, and 19.0+/-2.6 degrees, respectively. CONCLUSION: The continuous measurement of the suspension force was executed successfully and quantitatively with a simple method.