A 23-month-old male patient with treated bronchitis underwent a surgery for the repair of bilateral Hutch's diverticulum of bladder under general anesthesia. He treated bronchitis during 2 weeks since 3 weeks before operation. Arriving operating room, he had mild coughing with sputum. During anesthesia, he was well ventilated but endotracheal secretion was profuse. At ABGA of 2 hours after starting anesthesia, severe hypercapnea(PaCO2: 190.2 mmHg) and severe acidosis(PH: 6.746) were checked. Active treatment was done by suction of endotracheal secretion, hyperventilation, PEEP(5~10 cmH2O), increasing fresh gas flow rate(3.6 L/min --> 7 L/min), and administration of sodium bicarbonate, orciprenaline sulfate and methyl- prednisolone. After 3 hours of treatment, ABGA was normalized and symptoms including wheezing were relieved.
Anesthesia ; Anesthesia, General ; Bronchitis* ; Child* ; Cough ; Diverticulum* ; Humans ; Hypercapnia* ; Hyperventilation ; Infant ; Male ; Metaproterenol ; Operating Rooms ; Prednisolone ; Respiratory Sounds ; Sodium Bicarbonate ; Sputum ; Suction ; Urinary Bladder*

No abstract available.
Adult* ; Humans ; Lower Extremity*

In dealing with lateral condylar injuries of humerus, the chance of pitfalls and having a poor functional result with poor management is much greater because it is a physeal injury involving intraarticular surface. Lateral condylar physeal injuries of distal humerus have been regarded as Salter-Harris Type IV injury. But indeed, true Salter-Harris type IV injury of lateral condyle of distal humerus are rare. It should be regarded as Salter-Harris type II injury. Previously Milch classified the lateral condyle fracture of distal humerus as type I and type II after Stimson's description. It seems to be most useful to plan therapeutic modalities by classification of lateral condyle fracture on the basis of stage of displacement proposed by Jakob et al and Milch's type. Authors performed clinical analysis about lateral condyle fracture of distal humerus in children. Among 79 cases, who were treated at department of orthopaedic surgery, Hyundai haesung hospital from Mar. 1982 to Mar. 1988, it was possible to follow up in 30 cases. The result were as follows ; 1. The age incidence was confined from age of 3 to age of 12. Peak age was around 6. 2. Most of fractures were Milch's type II (75 cases) in contrast to Milch's type I (4 cases). 3. Precise differentiation of stage I and II displacement was needed for evaluation of stability of fracture and planning treatment modalities. 4. In case of stage II displacement, cast immobilization alone was insufficient. K-wire fixation was needed for prevention of displacement and better result. 5. In all of cases(30 cases) overgrowth of lateral condyle and spur formation were noticed but it has no clinical disabilities. 6. There were no significant differences of outcome between different fracture types and different stage of displacement. But significant differences of outcome were noticed how treatment performed. Accurate anatomical reduction and stable fixation was needed. 7. 2 cases of severe cubitus varus(20') were occured. In 21 cases, carrying angle were changed, valgus change were more common than varus change. It was thought to be relative undergrowth of lateral condyle of humerus and malunion as its causes. 8. In all cases, there were no loss of R.O.M.
Child ; Classification ; Clinical Study ; Follow-Up Studies ; Humans ; Humerus ; Immobilization ; Incidence

Septic arthritis of the children's hip causes acute or chronic inflammatory change in structure about the joint, and results in serious destruction. Due to recent advance of the diagnostic technique and of the antibiotics, the incidence of it's sequelae is decreased. The management of acute stage with antibiotics and early surgical drainage has been well established in the literature, but the management of residual anatomic deformity is less documented, and little comprehensive classification or treatment program has been outlined. We experienced two patients who had sequelae induced by delayed diagnosis and improper treatment. One had a complete loss of femoral neck with femoral head remaining in the acetabulum. Femoral neck reconstruction was performed using proximal femur : i.e., Open reduction of femoral head to femur shaft with distal transfer of greater trochanter (1st stage) followed by varus osteotomy(2nd stage) and follow-up period was 3.5 years. Another had loss of femoral head and neck, dislocation of the hip, and Larsen's trochanteric arthroplasty was performed with 6 Years follow-up. Satisfactory results were obtained in both patients who had reconstructive surgery, so we report these cases with related literatures.
Acetabulum ; Anti-Bacterial Agents ; Arthritis, Infectious ; Arthroplasty ; Child ; Classification ; Congenital Abnormalities ; Delayed Diagnosis ; Dislocations ; Drainage ; Femur ; Femur Neck ; Follow-Up Studies ; Head ; Hip ; Humans ; Incidence ; Joints ; Neck

Various methods of spinal instrumentation have been used for treatment of unstable fracture & fracture-dislocation of thoraco-lumbar spine. Recently, newly designed short segment fixation devices using pedicle screw were designed and there was a trend to use this posterior short segment instrumentation using pedicle screw. We have used AO internal fixator as posterior instrumentation for unstable spine fracture of thoracolumbar spine since November, 1987. Previously we used Harrington instrumentation and Luque rod wiring for treatment of unstable fracture of thoracolumbar spine and we reported the results of clinical analysis of those systems on Feb, 1987. We analyzed the clinical results of 93 cases those who underwent operative treatment using each posterior instrumentation system for unstable fracture and fracture-dislocation of thoraco-lumabr spine at our hospital from Dec. 1983 to Oct. 1989. Among that 93 cases, the Harrington instrumentation were 35 cases, Luque rod instrumentation were 36 cases and AO internal fixator were 22 cases. The results were as follows:1. The most commonly injured level was Ll (44 case) and followed by T12(33 cases, 86%). 2. By Francis Denis classification, Burst type fracture was most common(42 cases, 45%). 3. Change of kyphotic angle were checked on lateral X-ray view. There no significant differences between those groups using H-rod(58.64%), Luque-rod(54.8%), and AO internal fixator(60.1%) on immediate post-op X-ray. But there noticed least loss of correction of kyphotic angle when using AO internal fixator comparing with other groups. 4. The correction rates of height of anterior and middle column were checked by Denis-Edward method, there noticed best correction rate in AO internal fixator group. 5. The ROM of trunk were checked, there were no significant differences in H-rod, L-rod, and AO internal fixator group in long term follow up.
Classification ; Dislocations ; Follow-Up Studies ; Internal Fixators ; Methods ; Pedicle Screws ; Spine

Since the first report of completely amputated thumb replantation by Tamai in 1965, replantation surgery has been popularized with increasing success rate and improving functional regain. Recently, difficult replantation such as traction avulsion amputation has been challenged and good success rate and function have been reported. We have analized 34 cases of upper extremity and finger replantation in 23 patients, which were performed at the Dept. of Orthopedic surgery. Hyun Dai Hae Seong Hospital, Ulsan, Korea, from June 1982 to January 1986. The results were as follows: 1. Male patients were 22, female was 1, left upper limbs and digits injuries were more prevalent(16: 7), and average age was 25 years old. 2. The most common injury was done by cutting machine. 3. The number of amputations of fingers were almost same in all fingers and most prevalent in zone III(26 cases, Danial classification). 4. Success rate of replantation was 82.4% In cases of less than 6 hrs ischemic time, the rate was 93.4%, and more than 6 hrs ischemic time, rate was 33.3% 5. Performing arterial anastomosis prior to venous anastomosis, can find out main draining vein, and with one vein and one artery anastomosis, can get good results distal to zone IV. 6. Functional results were satisfactory, evaluating by modified. Tamai score, average 87.5. 7. 6 cases of digital replantations distal to sublimis tendon insertion have good results functionally, cosmetically and technically easy (Tamai score 98). 8. 5 cases of traction avulsion amputations needed many additional surgery to restore function, but end results were relatively satisfactory.
Amputation ; Arteries ; Clinical Study ; Female ; Fingers ; Humans ; Korea ; Male ; Orthopedics ; Replantation ; Tendons ; Thumb ; Traction ; Ulsan ; Upper Extremity ; Veins

Segmental Spinal Instrumentation is effective operative procedure in unstable fracture and fracture-dislocation of the thoracolumbar spine, providing rigid spinal stability and reduces needs of external support and complications. Fifty nine patients with unstable fracture and fracture-dislocation of thoracolumbar spine were treated with Harrington rod instrumentation and sublaminar wiring(31 patients) and Luque rod instrumentation with sublaminar wiring(28 patients) in Hyun Dai Hae Seong Hospital, Ulsan, Paik Hospital, Pusan from Dec. 1983 to April 1986. We have analyzed the results of treatment about two type of S.S.I. and obtained following conclusions; l. In 59 patients, T12 level injury was 17 cases, Ll level was 25 cases and so T12 and Ll involvement were 71%. 2. By Francis Denis classification, 28 cases were burst type fracture, 20 cases were fracture-dislocation type, 6 cases were seat belt type and 5 cases were wedge compression type. 3. In Harrington rod with S.S.I., initial kyphotic angle was 22.4° and postoperative angle was 7.4° and correction rate was 66.9%; in Luque rod with S.S.I., preoperative kyphotic angle was 21.7° and postoperative angle was 6.5° and correction rate 69.6%. So there was no difference of correction rate in two type of S.S.I. 4. In Harrington rod with S.S.I., the loss of reduction was 1.2° and the loss was 7%; in Luque rod with S.S.I., the loss of reduction was 7.2° and the loss rate was 48%. So the loss of reduction of Luque rod with S.S.I. was greater than that of Harrington rod with S.S.I. 5. After removal of implants, Luque rod with S.S.I. patients have better range of motion than Harrington rod with S.S.I. patients clinically, but it needs more follow-up because of a few cases(18 cases).
Busan ; Classification ; Follow-Up Studies ; Humans ; Range of Motion, Articular ; Seat Belts ; Spine ; Surgical Procedures, Operative ; Ulsan

The ankle is a modified complex hinge joint consisting of the distal tibio-fibula joint (Syndesmosis), and the ankle joint proper(hinge joint), and is important in weight bearing, standing and walking. So, the goals of treatment of ankle fracture are anatomical positioning of talus in the mortise and regaining a smooth articular suface. Unless these requisites are achieved by treatment, post-traumatic arthritis is likely to occur. We analyzed 120 cases of ankle fracture, most of which were treated surgically by A-0 method, in Department of Orthopaedic Surgery, Hyundai Haesung Hospital from January, 1982 to December 1985. The results are as follows; 1. The most common victim was 3rd–4th decades man, and the cause was direct blow. 2. The most common type was pronation-external rotation type of Lauge-Hansen classification, and Type A of Danis-Weber type. 3. The more favorable result was noted in Danis-Weber type A than type B and type C,and noted worst result in pilon fracture. 4. Favorable results can be gained by semi-tubular plate in fibular fracture than any other fixation material. 5. On application of semi-tubular plate, there were no significant differences in results between that placed posteriorly and that placed laterally. 6. We did not transfix the distal tibio-fibular joint in stable Danis-Weber type C injury without any specific sequellae. 7. We obtained better result by removal of transfixing screw 6 weeks after operation. 8. We obtained good results with only 3 weeks immobilization after operation.
Ankle Fractures ; Ankle Joint ; Ankle ; Arthritis ; Classification ; Immobilization ; Joints ; Methods ; Talus ; Walking ; Weight-Bearing

The treatment of brain tumors metastasizing from lung cancer though the outcome has been unsatisfactory. Through an examination of the prognosis in patients treated with varying modalities, this study aims to determine which gives the best results. We analyzed 110 of 124 cases, histologically diagnosed between 1985 and 1994, in which lung cancer had meta-stasized to the brain. Radiotherapy, chemotherapy and conservative management had been implemented. The patients' mean age was 58(range 23 to 76) years: the M: F ratio was 74: 36. The histological diagnosis was squamous cell carcinoma in 25 cases, adenocarcinoma in 50, small cell carcinoma in 24, and large cell carcinoma in 11. The median metastatic period between the lung cancer and metastatic tumor was 11.5 months: the longest duration was 42 months(one case). In 63 cases primary lung cancer and brain metastasis were diagnosed simultaneously. Of the total cases, 47 involved solitary metastasis and 63, multiple. The chief complaints were headache in 38 cases, hemiparesis in 48, cognitive function defect in 16, and seizure in eight. Metastasis to other organs at the time of diagnosis was as follow: adrenal gland, 6: bone, 9: liver, 4: lung, 3: leptomeninges, 1. Four patients had undergone craniotomy, two, only chemotherapy; and 41, radiotherapy. Seven patients underwent gamma knife radiosurgery: 43 were treated with a single modality: and 53, by combined therapy. The median survival period in cases of surgery alone, radiotherapy, chemotherapy and gamma knife radiosurgery was 17 months, 5.7 months, 3.5 months and 8.0 months, respectively. In cases of combined therapy, this period was 19.2 months for conventional surgery and gamma knife radiosurgery, 14.0 months for surgery and radiotherapy, and 7.0 months for radiotherapy and chemotherapy. For those with adenocarcinoma, the median survival period was 7.7 months: those with large cell carcinoma had the shortest median survival period(4.6 months). Combined therapy proved most effective, but survival periods did not lengthen.
Adenocarcinoma ; Adrenal Glands ; Brain Neoplasms ; Brain* ; Carcinoma, Large Cell ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Craniotomy ; Diagnosis ; Drug Therapy ; Headache ; Humans ; Liver ; Lung Neoplasms ; Lung* ; Neoplasm Metastasis* ; Paresis ; Prognosis ; Radiosurgery ; Radiotherapy ; Seizures

OBJECTIVE: This study was designed to compare the efficacy of micro-vascular decompression (MVD) and Gamma knife radiosurgery (GKRS) for elderly idiopathic trigeminal neuralgia patients by analyzing the clinical outcome. METHODS: In the past 10 years, 27 elderly patients were treated with MVD while 18 patients were treated with GKRS (>65-years-old). We reviewed their clinical characteristics and clinical courses after treatment as well as the treatment outcomes. For patients who were treated with MVD, additional treatment methods such as rhizotomy were combined in some areas. In GKRS, we radiated the root entry zone (REZ) with the mean maximum dose of 77.8 (70-84.3) Gy and one 4 mm collimator. RESULTS: The mean age was 68.1 years for MVD, and 71.1 years for GKS group. The average time interval between first presenting symptom and surgery was 84.1 (1-361) months, and 51.4 (1-120) months, respectively. The mean follow-up period after the surgery was 35.9 months for MVD, and 33.1 months for GKRS. According to Pain Intensity Scale, MVD group showed better prognosis with 17 (63%) cases in grade I-II versus 10 (55.6%) cases in GKRS group after the treatment. The pain recurrence rate during follow up did not show much difference with 3 (11.1%) in MVD, and 2 (11.1%) in GKRS. After the treatment, 2 cases of facial numbness, and 1 case each of herpes zoster, cerebrospinal fluid (CSF) leakage, hearing disturbance, and subdural hematoma occurred in MVD Group. In GKRS, there was 1 (5.6%) case of dysesthesia but was not permanent. Three cases were retreated by GKRS but the prognosis was not as good as when the surgery was used as primary treatment, with 1 case of grade I-II, and 1 case of recurrence. The maximal relieve of pain was seen just after surgery in MVD group, and 1 year after treatment in GKRS group. CONCLUSION: For trigeminal neuralgia patients with advanced age, MVD showed advantages in immediately relieving the pain. However, in overall, GKRS was preferable, despite the delayed pain relief, due to the lower rate of surgical complications that arise owing to the old age.
Aged ; Decompression ; Follow-Up Studies ; Hearing ; Hematoma, Subdural ; Herpes Zoster ; Humans ; Hypesthesia ; Paresthesia ; Prognosis ; Radiosurgery ; Recurrence ; Rhizotomy ; Treatment Outcome ; Trigeminal Neuralgia