Treatment of Fingertip Amputation in Adults by Palmar Pocketing of the Amputated Part

BACKGROUND: First suggested by Brent in 1979, the pocket principle is an alternative method for patients for whom a microsurgical replantation is not feasible. We report the successful results of a modified palmar pocket method in adults. METHODS: Between 2004 and 2008, we treated 10 patients by nonmicrosurgical replantation using palmar pocketing. All patients were adults who sustained a complete fingertip amputation from the tip to lunula in a digits. In all of these patients, the amputation occurred due to a crush or avulsion-type injury, and a microsurgical replantation was not feasible. We used the palmar pocketing method following a composite graft in these patients and prepared the pocket in the subcutaneous layer of the ipsilateral palm. RESULTS: Of a total of 10 cases, nine had complete survival of the replantation and one had 20% partial necrosis. All of the cases were managed to conserve the fingernails, which led to acceptable cosmetic results. CONCLUSIONS: A composite graft and palmar pocketing in adult cases of fingertip injury constitute a simple, reliable operation for digital amputation extending from the tip to the lunula. These methods had satisfactory results.

A treatment of atreiovenous malformation on mandible

The treatment of intraosseous ateriovenous malformation in the jaw is difficult because of life threatening frequent bleeding tendency. The surgical resection of AVM may be mortal due to massive blood loss .In the growing pediatric patient, surgery may cause facial deformity and growth disturbance. So currently, the treatment of AVM is only embolization using various material through endovascular access, direct-puncture or embolization in conjunction with surgical resection. We report a case of combined techniques.

Serum Fluoride Level in Normal Adult Women and Changes in Serum Fluoride Level after Disodium Monofluorophosphate Administration / 대한내분비학회지

BACKGROUND: Since the morning fluoride level of 10 uM is recommended for adults patients being treated for osteoporosis so far, measurement of serum fluoride level is important to detect abnormally high levels or to detect levels below the therapeutic windows. Aims of this study are to determine the normal range of serum ionic fluoride levels in Korean female adults (from 5th to 7th decade), and to evaluate the in vivo fluoride pharmacokinetics of monofluorophosphate in Korean adults. METHODS: Serum level of fluoride was measured from blood samples of 72 female subjects (age 43-69years) using an ion selective electrode. For pharrnacokinetics of monofluorophosphate-calcium (MFP-Ca), 6 subjects (age 27~45 years) were included to be withdrawn the blood hourly for the first S hours and the blood was withdrawn at 24 hours after a single dose of MFP-Ca. RESULTS: Mean level of serum fluoride was 1.64+-0.12uM in 5th, 6th, 7th decades adults, and there was no difference of serum fluoride levels among age groups. Peak serum fluoride level exhibited 5.02+-0.67pM, and returned to basal level on 24 hours after a single dose of MFP-Ca. CONCLUSION: This study shows that mean serutn fluoride of Korean female adults (from 5th to 7th decade) is not different from that of other reports, and a single dose of MFP-Ca does not cause serum fluoride levels above the recommended therapeutic windows of 5-10uM for 24 hours.

Acquired Cystic Kindey Disease in Dialysis and Renal Transplant Patients: Ultrasonography and CT Analysis

PURPOSE: To evaluate by US and CT the incidence and complications of acquired cystic kidney disease (ACKD) in dialysis and renal transplant patients and to compare the effectiveness of US and CT in the diagnosis of this entity. MATERIALS AND METHODS: This study was prospectively performed in 70 dialysis patients and 13 renal transplant patients, and excluded any with multiple renal cysts or polycystic kidney disease, on as seen on initial films. US were obtained in all patients, and CT scans were randomly obtained in 27 who had been on dialysis for 3 years or more; all these US and CT scans were analyzed, with particular emphasis on whether or not cysts were present. In order to correlate the numbers of cysts with duration of dialysis, all patients were assigned to one of three groups, according to the number of cysts found (group 1, 0; group 2, 1-4; group 3, >4).Only group 3 was diagnosed as suffering from ACKD. In order to compare the cyst-detection capability of US with that of CT, 27 dialysis patients who had undergone US and CT were divided into four groups according to the numberof cysts found (grade 1, 0; grade 2, 1-4; grade 3, 5-10; grade 4, >10). RESULTS: Seventy dialysis patients were divided according to the results of US, as follows : group 1, 20%; group 2, 47.1%; group 3, 32.9%. The mean duration of dialysis in group 1 (31.9 months) was statistically different from that in group 2 (50.6 months) and in group 3 (95.8 months) (p<0.000). Thirteen renal transplant patients were divided as follows : group1, 61.5%; group 2, 38.5%; group 3, 0%. In dialysis patients with ACKD, complications noted were renal cell carcinoma(n=1), hemorrhagic cysts(n=2), and hematomas(n=2) Among the 27 dialysis patients who underwent CT, this and US showed an equal grade of cystic change in 53.7%, while CT showed a higher grade in 46.3%. The detection rate of ACKD in these 27 patients was 46% on US and 63% on CT. CONCLUSION: A prolongation of dialysis corresponded to an increased incidence of ACKD; renal neoplasm and hemorrhage may occur in dialysis patients, but ACKD and its complications did not develop in renal transplant patients. In long-term dyalysis patients, regular follow-up studies of kidneys using US or CT are therefore needed. CT was superior to US in diagnosing ACKD.

Correlation of Color Doppler Image and Thyroid Function Test in Diffuse Goiter

PURPOSE: To determine whether CDI can differentiate Graves' disease from other cases of thyroiditis and to determine the relationship between CDI findings and TFT. MATERIALS AND METHODS: Between October, 1995 and January, 1996, 22 cases of diffuse goiter without nodule were prospectively assessed for CDI and TFT. CDI was classified into three groups : Grade 1 (minimal), Grade 2 (moderate), and Grade 3 (marked) ; TFT was also classified into three groups : decreased, normal, and increased thyroid function. The correlation between CDI and TFT was statistically assessed ; each case was diagnosed by aspiration biopsy or clinical laboratory studies. RESULTS: All Graves' disease patients showed good correlation between marked color flows and increased thyroid function. The CDI findings of other cases of thyroiditis showed variable color flow and TFT. We found significant differences between the two disease groups. CONCLUSION: CDI can help differentiate Graves' disease from other cases of thyroiditis and additional assesment using TFT will help in the diagnosis of diffuse goiter. The "thyroidinferno" pattern is not a specific finding of Graves' disease.

CT and MR Findings in Patients with Mild Head Injury

PURPOSE: To assess the prevalence, lesion sites and characteristics of MR findings in patients with mild head injury and the relationship between MR findings and the postconcussion syndrome. MATERIALS AND METHODS: Our study involved 26 patients with mild head injury (Glasgow Coma Scale, 13 to 15 ; no subsequent deterioration ; loss ofconsciousness < 30 minutes). Prospective CT and MR Imaging was performed and the prevalence rate of abnormalities, sites and characteristics of lesions were evaluated, as well as the relationship between MR findings and the postconcussion syndrome. RESULTS: In 17 of 26 patients(65%) there were abnormal findings on MR, and in 8 of the 26(31%), abnormal findings were seen on CT. Abnormalities consisted of cerebral contusion in nine patients, diffuse axonal injury in six and small thin extracerebral hematomas in nine. MR is more sensitive than CT, especially when the lesion is non-hemorrhagic and is closer to the cranial vault. In 16 patients who wereclinically followed up, the prevalence rate of postconcussion syndrome was higher in those with abnormal MR than in those with normal MRI. CONCLUSION: The greater sensitivity of MR makes it a better indicator than CT for the presence and extent of injuries and thus potentially a better predictor of outcome, even in patients with mildhead injuries. Positive MR findings are an objective predictors for the evaluation of patients with postconcussion syndrome after mild head injury.

CT and MR Imaging in 3 Patients with Hyperammonemia Due to Ornithine Transcarbamylase Deficiency

CT and MR appearance of the brain in three children with ornithine transcarbamylase (OTC) deficiency are described. They showed clinical signs of vomiting and convulsion and were diagnosed by measurement of plasma ammonium, amino acids, acid-base balance, and urinary orotic acid levels. CT and MR were performed within one month from the onset of the symptom. CT and MRI demonstrated brain swelling with small ventricles and diffuse low density of white matter, which indicated cerebral hypoperfusion secondary to elevated intracranial pressure. With more prolonged survival hyperammonemia may cause cerebral atrophy. CT and MR appearance in these cases resembled a hypoxic brain damage and this finding should be included in the differential diagnosis.