The authors attempted a clinical study on 45 patients of the Pathologic fracture treated at Orthopedic Department, the National Medical Center in the period of 1959 through 1969. Sixty eight established pathologic fractures in 45 patients were analsyed and classified, namey 21 Osteomyelitis, 15 Bone tumors, 3 Osteogenesis Imperfecta and etc. Treatment was variably selected according to the underlying diseases and type of fractures. Special consideration and review of literatures for the different circumstances of pathologic fractures were empirically depicted.
Clinical Study ; Fractures, Spontaneous ; Humans ; Orthopedics ; Osteogenesis Imperfecta ; Osteomyelitis

Three cases of Volkmann's ischemic contracture in the lower extremity, which is relatively rare manifestation, are reported, One case has occurred as a complication of snake-bite, another was followed by CO intoxication and the third was caused by a direct trauma, which gave a rupture of the main artery in the thigh. The common clinical manifestation were deformity of the foot as equinus, equinovarus and cavus deformities. One case had an additional flexion contracture of the knee. One case was opearted by Achilles tendon lengthening, posterior capsulotomy of the ankle, and plantar fasciotomy, another case was operated by supracondylar osteotomy of the femur in order to correct flexion deformity of the knee followed by B-K amputation, the third was operated by triple arthrodesis of the foot with dorsal wedging.
Achilles Tendon ; Amputation ; Ankle ; Arteries ; Arthrodesis ; Clubfoot ; Congenital Abnormalities ; Contracture ; Femur ; Foot ; Foot Deformities ; Ischemic Contracture ; Knee ; Lower Extremity ; Osteotomy ; Posterior Capsulotomy ; Rupture ; Thigh

No abstract available.
Internship and Residency* ; Korea*

BACKGROUND: Bupivacaine is a amide type local anesthetic agent, widely used for its excellent quality of analgesia and long duration of action. But unintended intravenous injection causes severe complication such as convulsion and cardiovascular collapse, which is known for its difficulty in resuscitation. With all the study, the exact mechanism is still unclear and there are much debate on the method of resuscitation. METHOD: We studied the effect of clonidine pretreatment on bupivacaine-induced cardiac toxicity and resuscitation in anesthetized dog. Twelve dogs were divided into two groups. : saline pretreatment group (control, N=6) and clonidine pretreatment group (clonidine group, N=6). The dogs were anesthetized with N2O-O2-enflurane and vecuronium. Thoracotomy was done in 4th or 5th intercostal space for open cardiac massage. After confirming stability of vital signs, we administered clonidine (10 mcg/kg) or saline, and then administered bupivacaine with the rate of 2 mg/kg/min. When the electeocardiogram showed asystole, 20 mcg/kg of epinephrine was administered via central venous line and open cardiac massage with the rate of 120 beat/min. was performed. We observed electrocardiogram (lead II), arterial blood pressure, heart rate, dose of infused bupivacaine to be required for QRS widening and arrest, required time and administered dose of epinephrine for resuscitation. RESULTS: Clonidine group showed significant decrease of heart rate after pretreatment (p<0.05). There was no significant difference in required dose for QRS widening between two groups. The dose administered for inducing arrest was less in clonidine group than control group (p<0.05). The time required for resuscitation was shorter in clonidine group than control group (p<0.05). The total dose of epinephrine required for resuscitation was less in clonidine group than control group (p<0.05). The blood concentration of catecholamine did not showed significant difference during the whole course of experiment. CONCLUSIONS: Above results demonstrated that clonidine, a central nervous system-mediated sympatholytic agent, facilitated cardiac arrest when bupivacaine was infused intravenously and cardiac rescucitation.
Analgesia ; Animals ; Arterial Pressure ; Bupivacaine ; Clonidine* ; Dogs* ; Electrocardiography ; Epinephrine ; Heart Arrest ; Heart Massage ; Heart Rate ; Injections, Intravenous ; Resuscitation* ; Seizures ; Thoracotomy ; Vecuronium Bromide ; Vital Signs

Immediate postoperative changes in intraocular pressure (IOP) were prospectively studied in 60 patients after extracapsular cataract extraction and posterior chamber lens implantations, according to three different preoperative managements for cecreasing IOPs. In group 1 (24 patients), no ocular pressure reducing agents were given but only ocular massage was performed preoperatively. In group 2 (17 patients), intravenous mannitol (1.52g/kg of body weight) and/or 60ml of 50% oral glycerine was administered 1 hour before surgery. In group 3 (19 patients), 500mg of acetazolamide was administered orally 90 minutes before operation in addition to the regimen of group 2. A significant lllcrease in mean IOP was found 6 hours after the operation in group 1 by 5.6mmHg and in group 2 by 8.8mmHg when compared witt baseline IOP (p<0.05). However, there was no significant IOP rise in group 3. Postoperative IOPs in excess of 21mmHg occurred in 10 patients (42% )of group 1, seven patients (41 %) of group 2 and six patients(30%) of group 3. An IOP greater than 30mmHg was found in two patients (8%) in group 1, two patients (12%) in group 2 and one patient (5%) in group 3. From this study, it was concluded that acetazolamide 500mg given 90 minutes before operation resulted in a reduction of immediate postoperative IOP rise.
Acetazolamide ; Cataract Extraction ; Cataract* ; Glycerol ; Humans ; Intraocular Pressure ; Mannitol ; Massage ; Ocular Hypertension* ; Prospective Studies ; Reducing Agents

A 7-years-old female patient was first seen in our out-patient clinic on June 21, 1975 with five day history of progressive proptosis of the left eye. Biopsy was taken from the orbit and the submandibular lymphnodes. Exploratory laparotomy revealed ovarian malignancy. Pathologic examination confirmed generalization of ovarian granulosa-theca cell tumor.
Biopsy ; Exophthalmos ; Female ; Generalization (Psychology) ; Granulosa Cell Tumor* ; Granulosa Cells* ; Humans ; Laparotomy ; Neoplasm Metastasis* ; Orbit* ; Outpatients

Posterior chamber intraocular lenses were implanted into 20 eyes without the posterior capsular capsular support by securing both haptics of the lens to the sclera with 10-0 prolene suture. The follow-up period ranged from 6 to 24 months(average 9.4 months). At the last follow-up visit, 17 eyes(85%) had a vision of 0.7 or better. The position of the implanted lens was proved satisfactory when compard with eyes with posterior chamber intraocular lens without scleral fixation suture by postoperative A-scan measurement of the anterior chamber depth, the results of refraction and slit-lamp examination. There were no eyes with remarkable decentration or tilt of the implanted lens. In two eyes, intraoperative bleeding occurred from the inferior chamber angle and ceased spontaneously. Postoperatively there were no remarkable inflammatory responses or complications. From the results, we suggest that the position of scleral puncture with a hypodermic needle is 1.2 - 1.4mm from the posterior surgical limbus in the upper quadrant and the advancement of the needle is directing parallel to the posterior surface of the iris.
Anterior Chamber ; Follow-Up Studies ; Hemorrhage ; Iris ; Lens Implantation, Intraocular* ; Lenses, Intraocular* ; Needles ; Polypropylenes ; Punctures ; Sclera ; Sutures*

In this experiment using 30 rabbits(40 normal eyes), the applicability of ocular adhesive, HISTOACRYL blue, as an implant beneath the scleral and conjunctival flap. Group 1 consisted of 10 left eyes. These eyes had undergone a fornix-based conjunctival flap and a triangular lamellar scleral flap without sclerectomy and served as a control on histologic examination. Group 2 consisted of 10 right eyes of the rabbits used in group 1. The Histoacryl was pasted on the sclera under the lamellar scleral flap and the conjunctiva. The pasted Histoacryl turned into a thin membrane. Group 3 consisted of 10 right eyes which had undergone a conventional trabeculectomy. Group 4 consisted of 10 right eyes. These eyes had undergone a trabeculectomy and placement of a Histoacryl membrane. The adhesive was applied closely to the limbus in 5 eyes and posteriorly away from the limbus in the remaining 5 eyes of group 4. At the eighth week after operation a filtering bleb was observed in all of the eyes in group In contrast to this, only two eyes showed filtering blebs in group 3. Filtering blebs were so confined over the Histoacryl membrane that their size and location was in accordance with the membrane. The vessels of the conjunctiva overlying the Histoacryl membrane were dilated and congested. This vascular congestion lasted long. The light microscopic examinations of the operation site showed a thick layer composed of macrophages, eosinophils, neutrophils, foreign body giant cells, and fibroblasts surrounding the Histoacryl membrane with cystic space between them. At the eight postoperative week, this wall remained thick measuring about 50-70 micro thick. From the result, Histoacryl appeared to be effective in preventing the fibrotic scarring down of the filtering bleb, but postoperative inflammatory changes indicated that the Histoacryl seemed to be rather unsuitable for clinical application.
Adhesives ; Blister* ; Cicatrix ; Conjunctiva ; Enbucrilate ; Eosinophils ; Estrogens, Conjugated (USP) ; Fibroblasts ; Filtration* ; Giant Cells, Foreign-Body ; Macrophages ; Membranes ; Neutrophils ; Rabbits ; Sclera ; Tissue Adhesives* ; Trabeculectomy

Traumatic implantation cyst of the conjunctiva has often been reported. We have observed two cases of conjunctival cyst following surgery of retinal detachment. A small vesicular lesion developed at the operation site of the conjunctiva about 5 weeks after the surgery. The cyst filled with clear fluid was located deep in the subconjunctival connective tissues. The wall of the cyst consisted of a few layers of epithelial cells very similar to the conjunctival epithelium and had not any direct connection with the overlying conjunctival epithelium. In order to prevent it a great care must be taken during surgery. A careful accurate apposition of the conjunctival wound will be required. An excessive and forceful retraction of the conjunctival flap for exposure of the operation field should be avoided. And also, an appropriate suture material (i.e. a round, tapered needle with smooth surfaced suture) seems to be necessary.
Conjunctiva ; Connective Tissue ; Epithelial Cells ; Epithelium ; Needles ; Retinal Detachment* ; Retinaldehyde* ; Sutures ; Wounds and Injuries

The beneficial effects of a hydrophilic contact lens of the corneal lesions, such as bandage or splint effect and prolonged delivery of drugs from a soaked hydrophilic contact lens were well informed by the previous reports. The authors investigated the effectiveness of the soft contact lens soaked with antibiotics for the treatment of experimentally induced bacterial corneal ulcer of the rabbits. In group 1, corneal defects of both eyes were made with a trephine of 5mm in diameter and 0.2mm in depth in 6 rabbits. A sterilized soft contact lens was inserted into one eye of each animal and lens was changed everyday. The other eye was not treated. The mean duration for the epithelial coverage of the defects were 7.4 days in the lens inserted eyes and 7.2 days in the untreated eyes. There were no significant statistical differences in the healing rate between the lens imerted eyes and control ones. In group 2, seven rabbits were inoculated with staphylococcus aureus suspension, which was susceptible to chloramphenicol (CM). Corneal ulcers developed 24 hours later. The soft contact lens soaked with 1% CM solution was placed in one eye of each animal for 24 hours and changed everyday. The other eye was treated with 1% CM solution dropping 4 times daily. The ulcer began to heal about 6 days later. Evaluation of the heaJing was performed by measurement of the size of ulcer for the first 12 days and grading of the healed cornea by modified Wiggins grading system at the end of the experiment. In grout 3, corneal ulcer developed in 7 rabbits 48 hours later after inoculation of pseudomonas aeruginosa. One eye of each animal was treated with soft contact lens soaked with 1% gentamicin solution and the lens was changed everyday. The other eye was treated with 1% gentamicin solution dropping 4 times daily. The mean duration of healing of the corneal ulcer in group 2 was 15.2 days in the lens inserted eyes and 13.7 days in the control ones. By the modified Wiggins grade the outcome of the infection revealed better results in the eyes treated with 1% CM solution dropping. In group 3, the mean duration of healing of the corneal ulcer was 16.2 days in the lens ineerted eyes and 15.7 days in the control eyes. The modified Wiggins grade showed no significant statistical differences between the lens inserted eyes and control ones.
Animals ; Anti-Bacterial Agents ; Bandages ; Chloramphenicol ; Contact Lenses, Hydrophilic* ; Cornea ; Corneal Ulcer* ; Gentamicins ; Pseudomonas aeruginosa ; Rabbits ; Splints ; Staphylococcus aureus ; Ulcer