• Title/Summary/Keyword: Lower Extremity

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Immediate Partial Breast Reconstruction with Endoscopic Latissimus Dorsi Muscle Flap Harvest

  • Yang, Chae Eun;Roh, Tai Suk;Yun, In Sik;Kim, Young Seok;Lew, Dae Hyun
    • Archives of Plastic Surgery
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    • v.41 no.5
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    • pp.513-519
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    • 2014
  • Background Currently, breast conservation therapy is commonly performed for the treatment of early breast cancer. Depending on the volume excised, patients may require volume replacement, even in cases of partial mastectomy. The use of the latissimus dorsi muscle is the standard method, but this procedure leaves an unfavorable scar on the donor site. We used an endoscope for latissimus dorsi harvesting to minimize the incision, thus reducing postoperative scars. Methods Ten patients who underwent partial mastectomy and immediate partial breast reconstruction with endoscopic latissimus dorsi muscle flap harvest were reviewed retrospectively. The total operation time, hospital stay, and complications were reviewed. Postoperative scarring, overall shape of the reconstructed breast, and donor site deformity were assessed using a 10-point scale. Results In the mean follow-up of 11 weeks, no tumor recurrence was reported. The mean operation time was 294.5 (${\pm}38.2$) minutes. The postoperative hospital stay was 11.4 days. Donor site seroma was reported in four cases and managed by office aspiration and compressive dressing. Postoperative scarring, donor site deformity, and the overall shape of the neobreast were acceptable, scoring above 7. Conclusions Replacement of 20% to 40% of breast volume in the upper and the lower outer quadrants with a latissimus dorsi muscle flap by using endoscopic harvesting is a good alternative reconstruction technique after partial mastectomy. Short incision benefits from a very acceptable postoperative scar, less pain, and early upper extremity movement.

Difference in Lower Extremity Landing Biomechanics between Male and Female Ballet Dancers During the Box Drop Landing (박스 드롭 착지 시 남자와 여자 발레 무용수들의 하지의 생체역학적 요인의 차이)

  • Choi, In-Ae;Lim, Bee-Oh
    • Korean Journal of Applied Biomechanics
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    • v.19 no.4
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    • pp.647-653
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    • 2009
  • The purpose of this study was to investigate the differences between female and male ballet dancers in anterior cruciate ligament injury risk factors during the box drop landing task. Nine female and nine male collegiate ballet dancers participated in this study. Kinematic and ground reaction data were collected and combined with inverse dynamics to estimate the knee extensor and abductor moment. EMG data from the biceps femoris and rectus femoris were used to estimate the ratio of quadriceps-hamstrings muscle activity. No gender differences in anterior cruciate ligament injury risk factors were found during the box drop landing task. A significant relationship was found between female and male ballet dancers in the knee flexion angle.

Low Grade Fibromyxoid Sarcoma of the Visceral Pleura - A case report - (장측 늑막에서 발생한 저등급 섬유점액성 육종 - 1예 보고 -)

  • Kim, Yeon-Soo;Chang, Sun-Hee;Lee, Sung-Soon;Ryoo, Ji-Yoon;Park, Kyung-Taek;Chang, Woo-Ik;Kim, Chang-Young;Cho, Seong-Joon
    • Journal of Chest Surgery
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    • v.41 no.1
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    • pp.141-144
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    • 2008
  • Low grade fibromyxoid sarcoma (LGFM) is a rare, deep soft-tissue malignant tumor. Although its histologic features are benign, the clinical course is malignant. The usual tumor locations are the lower extremity and chest wall. LGFM originating from the visceral pleura is extremely rare. We report here on a 37 year old man with a LGFM of the visceral pleura. Thirty three months after surgery, the patient is alive without any sign of local recurrence or distant metastasis.

Spinal Cauda Equina Stimulation for Alternative Location of Spinal Cord Stimulation in Intractable Phantom Limb Pain Syndrome -A Case Report-

  • Lee, Pil Moo;So, Yun;Park, Jung Min;Park, Chul Min;Kim, Hae Kyoung;Kim, Jae Hun
    • The Korean Journal of Pain
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    • v.29 no.2
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    • pp.123-128
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    • 2016
  • Phantom limb pain is a phenomenon in which patients experience pain in a part of the body that no longer exists. In several treatment modalities, spinal cord stimulation (SCS) has been introduced for the management of intractable post-amputation pain. A 46-year-old male patient complained of severe ankle and foot pain, following above-the-knee amputation surgery on the right side amputation surgery three years earlier. Despite undergoing treatment with multiple modalities for pain management involving numerous oral and intravenous medications, nerve blocks, and pulsed radiofrequency (RF) treatment, the effect duration was temporary and the decreases in the patient's pain score were not acceptable. Even the use of SCS did not provide completely satisfactory pain management. However, the trial lead positioning in the cauda equina was able to stimulate the site of the severe pain, and the patient's pain score was dramatically decreased. We report a case of successful pain management with spinal cauda equina stimulation following the failure of SCS in the treatment of intractable phantom limb pain.

The Effects of Cognition-Exercise Program Using Step on Cognitive Function, Gait, and Depression in Elderly with Mild Cognitive Impairment (스텝을 활용한 인지-운동프로그램이 경도인지장애 노인의 인지기능, 보행, 우울에 미치는 효과)

  • Ju, Eunsol;Bang, Yosoon;Oh, Eunju
    • Journal of The Korean Society of Integrative Medicine
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    • v.8 no.3
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    • pp.21-31
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    • 2020
  • Purpose : The purpose of this study was to determine the effects of a cognitive-exercise program using step on the cognitive function, gait, and depression of elderly with mild cognitive impairment. Methods : The subjects comprised 30 elderly people with mild cognitive impairment who used elderly welfare centers in the provinces A, B, and C between March 21 and June 7, 2019. They were divided into an experimental group (n=15) and a control group (n=15) before undergoing an experiment based on a pretest-posttest control group design. The lowenstein occupational therapy cognitive assessment-geriatric population was used to assess the subjects' cognitive function, while the 4-stage balance test, 30-second chair-stand test, timed up & go test, and functional reach test were employed to evaluate their gait. In addition, the beck depression inventory was used to measure their levels of depression. Results : The cognitive-exercise program using step enhanced the subjects' cognitive function and gait and reduced their levels of depression. Furthermore, statistically significant differences were found between the experimental group and the control group. Conclusion : The cognitive-exercise program using step promoted the process of sensorimotor and cognition through the learning process of various steps taking left and right steps and cognitive activities. It improves gait by activating the coordination of the musculoskeletal and nervous systems of the body and positively affecting posture control, balance, flexibility, and lower extremity muscles. It also relieved depression by performing successful step learning and cognitive activities with forward-looking (doing) that leads to pleasure and achievement. The present study confirmed the value of a cognitive-exercise program using step to treat multiple domains of functional decline in elderly patients with mild cognitive impairment. This is therefore proposed as an intervention program for this patient group.

Segmented Ulnar Transposition to Defect of Ipsilateral Radius in the Forearm (전완골 분절의 전위 이식술)

  • Chung, Duke-Whan;Han, Soo-Hong;Lee, Jae-Hoon;Kwon, Boo-Kyung
    • Archives of Reconstructive Microsurgery
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    • v.16 no.2
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    • pp.125-132
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    • 2007
  • Introduction: Ulna is nearly equal to radius in function and bony architecture and strength in forearm. But in lower extremity, fibula is 1/5 of tibia in anatomic and functional point so we can find fibula transposition is commonly used in defect of tibia. We cannot find other article about segmental forearm bone transposition in man. The purpose of this study was to report our clinical and functional result of undergoing segmented transposition of ipsilateral ulna with its own vascular supply in defect of radius in 6 cases. Material and method: From June 1994 to October 2007, 7 segmented bone transpositional grafts in forearm were performed in Kyung Hee Medical Center. The distribution of age was from 20 years old to 73 years old. There was male in 6 cases and female in 1 case. The causes of operation were giant cell tumor in 1 case and traumatic origin in 6 cases; it was nonunion in 2 cases and fracture with severe comminution in 4 cases. Ipsilaterally segmented ulna keeping its own vascular supply was transported to defect of radius in severe traumatic patients and one patient whose tumor in radius had been excised. Transported ulna was fixed to proximal and distal radius remnants by plate and screw. In one case with giant cell tumor, transported ulna was connected to radius across wrist joint as wrist joint fusion. Joint preserving procedures were performed in 6 cases with crushing injury of radius. Results: We could obtain solid bony union in all cases and good functional results. The disadvantage was relative shortening of forearm, but we could overcome this problem. Conclusion: We think that ipsilateral segmented ulna transposition keeping its own vascular supply to radius can be perfomed with one of procedures in cases with wide defect in radius.

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A Review of Effects of Osteoarthritic Patient with a Varus Deformity of the Knee on Laterally Wedged Insole (외측 쐐기 깔창이 골관절염 환자의 내반슬에 미치는 영향에 관한 고찰)

  • Lee, Sang-Yong;Shin, Hyung-Soo;Bae, Sung-Soo
    • The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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    • v.11 no.1
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    • pp.65-73
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    • 2005
  • Osteoarthritis has been considered a disease of the elderly because it is uncommon before the age of 40 years and is seen in approximately 80% of United States citizens older than 65 years. general population on kuri city in korea revealed that prevalence of knee osteoarthritis is 10.2%, increasing with age. High level of physical activity in men and age, post-menopause and obesity in women can be risk factor. Osteoarthritis is no evidence that a acquired process initiated much earlier in life through mechanical, metabolic, genetic, or other origins. A high tibial osteotomy alters static lower extremity alignment thereby decreasing medial compartment loading. As well, conservative treatment strategies, such as knee braces and valgus heel wedges, affect lover limb mechanics and attempt to reduce medial compartment loading. It was hypothesized that valgus heel wedges and modified orthoses would shift the center of pressure laterally on the foot during level walking, reducing the moment arm of the adduction moment in the frontal plane, thereby resulting in a decrease in the knee adduction moment. In the 1980s, the effect of wearing a laterally wedged insole on osteoarthritic patients with a varus deformity of the knee was firsted, and since then, kinematic and kinetic analyses concerning this condition have mainly focused on a static standing position. Since the early 1990s, the beneficial effect of wearing a laterally wedged insole to treat osteoarthritis of the knee has also been reported in dynamic conditions, but these studies did not answer the question of the kinematic and kinetic mechanisms that resulted in the reduced symptoms in patents with knee osteoarthritis. therefore, the effect of wearing laterally wedged insole has not been sufficiently studied.

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The Influences of Visual Information and Different Elevations of Medially Wedged Insoles on Knee Joint Proprioception in Healthy Persons (시각적 정보와 내측 쐐기 인솔의 높이 차이가 정상 성인의 슬관절 고유수용성 감각에 미치는 영향)

  • Kim, Do-Kyun;Ko, Eun-Hye;Lee, Kang-Sung;Cynn, Heon-Seock
    • Physical Therapy Korea
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    • v.12 no.1
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    • pp.22-27
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    • 2005
  • The purpose of this study was to investigate the effects of visual information and different elevations of medially wedged insoles on the proprioceptive sense of the knee joint. The subjects of this study were 16 able-bodied men who were not athletic. An electrogoniometer was used to determine the error value between calculated 50% of full flexion (target position) and performed 50% of full flexion in a standing position with the upper extremities crossed. Tests were randomly performed in $2{\times}4$ conditions. Visual variations included open eyes vs. closed eyes, while the elevation was adjusted through the use (or lack thereof) of medially wedged insoles of 10 mm, 14 mm, and 18 mm. The average error value in each condition was statistically analyzed. The findings of this study revealed as follows: 1) The average error value was significantly higher with the subjects' eyes open than with their eyes closed (p<.05). 2) The averaged error value was also significantly higher when the subjects were elevated 18 mm than with no elevation at all (p<.05). The findings of this study should be considered in lower extremity rehabilitation programs when medially wedged insoles used.

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Effect of Shoe Size on Foot Pressure, Ground Reaction Force, and Fatigue During Walking and Running (보행과 달리기 시 신발의 크기가 족저압과 지면반발력, 하지의 근피로에 미치는 영향)

  • Kim, Tack-Hoon
    • Physical Therapy Korea
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    • v.15 no.1
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    • pp.1-11
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    • 2008
  • The purpose of this study was to assess the influence of two shoe size conditions on foot pressure, ground reaction force (GRF), and lower extremity muscle fatigue. Seven healthy men participated. They randomly performed walking and running in two different conditions: proper shoe size and 10 mm greater than proper shoe size. Peak foot pressure, and vertical, anterior and mediolateral force components were recorded with the Parotec system and Kisler force platform. To assess fatigue, the participants performed treadmill running for twenty-five minutes twice, each time wearing a different shoe size. Surface electromyography was used to confirm localized muscle fatigue using power spectral analysis of four muscles (tibialis anterior, gastrocnemius medialis, rectus femoris, and biceps femoris). The results were as follows: 1) In walking conditions, there was a significantly higher peak pressure in the 10 mm greater than proper shoe size insole sensor 1, 2, 14, and 18 (p<.05). 2) In running conditions, there was a significantly higher peak pressure in the 10 mm greater than proper shoe size insole sensor 5, 14, and 15 (p<.05). 3) In walking conditions, there was a significantly higher first maximal vertical GRF in the 10 mm greater than proper shoe size (p<.05). 4) In running conditions, no GRF components were significantly different between each shoe size condition (p>.05). 5) Muscle fatigue indexes of the tibialis anterior and rectus femoris were significantly increased in the 10 mm greater than proper shoe size condition. These results indicate that wearing shoes that are too large could further exacerbate the problems of increased foot pressure, vertical GRF, and muscle fatigue.

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Effects of Less Affected Lower Extremity Insole on Balance in Chronic Stroke Patients during Treadmill Walking -A Preliminary Study- (트레드밀 훈련 시 비마비측 하지에 적용한 인솔이 만성 뇌졸중 환자의 균형에 미치는 영향 -예비 연구-)

  • An, Bo-Ra;Woo, Young-Keun;Park, Kyeu-Nam;Kim, Su-Jin
    • PNF and Movement
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    • v.18 no.2
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    • pp.215-222
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    • 2020
  • Purpose: The study investigated the effect on chronic stroke patients' balance of a weight shift to the affected side using an insole on the less affected side during treadmill walking training. Methods: The subjects were 7 patients who had been diagnosed with stroke 6-24 months prior to the study. In each case, an insole was applied on the patient's less affected side during treadmill walking training. Each training session lasted 30 minutes and was undertaken 5 times per week for 4 weeks. Biorescue equipment that measures shifts in center of pressure was used to assess balance ability as measured by the Korea-Berg balance scale (K-BBS) before and after each training intervention. The Wilcoxon signed-rank test was used to evaluate within-group effects. Results: The results revealed statistically significant before and after differences in area, pressure, length, and mean velocity of the balance test and on K-BBS (p < 0.05). Conclusion: In chronic stroke patients, using an insole to adjust the height of the shoe on the less affected side is an effective means of increasing weight-shifting on the paralyzed side during treadmill gait training.