Fracture of the tibial shaft is one of the most common fractures of the long bones and frequently followed by malunion, delayed union and nonunion. We experienced the cases of further increase in the angulation after clinical union of the tibial shaft fractures treated by conservative method. So we analyzed 39 cases of tibial shaft fractures which were followed up from 12 weeks to 37 weeks after clinical union in adults. The results were as follows; l. 7 of the 39 cases(18%) showed the increase in the angulation, and all of them were male. 2. Increase in the angulation occurred more frequenlty in the comminuted fractures than simple fractures. 3. The increment of angulation was more marked in group of patients with higher angulation at the time of clinical union. 4. Increase in the angulation occurred more commonly in the cases not associated with fibula fracture than in the cases associated with fibula fracture. 5. Further increase in the angulation was less common in the cases in whom early weight bearing with PTB cast was started.
Adult ; Fibula ; Fractures, Comminuted ; Humans ; Male ; Methods ; Tibia ; Weight-Bearing

PURPOSE: For the early diagnosis of Henoch-Schonlein purpura(HSP) presenting with acute abdominal pain preceding skin rash. METHODS: The clinical, endoscopic and radiological records of 23 cases of HSP, presenting with gastrointestinal symptoms preceding skin rash were reviewed. RESULTS: The intervals from the onset of abdominal pain to the development of the skin rash were one day to 30 days(median five days), most of them were within two weeks. The presenting abdominal symptoms were abdominal pain(23 cases), vomiting(16 cases), hematochezia or melena(eight cases) and hematemesis(three cases). The abnormal endoscopic findings include coalescing erythematous lesions, areas of submucosal hemorrhage and superficial erosions and ulcers. The upper gastro intestinal endoscopy showed the abnormalities in 21 of 23 cases, which were observed in the duodenum(21 cases), the stomach(12 cases) and the esophagus(one case). Duodenitis with hemorrhage and/or erosions in the descending duodenum was the sole endoscopic abnormality in two cases and was the most marked finding in three cases. Sigmoidoscopy showed the abnormalities in six of eight cases. The abdominal ultrasonogram showed abnormalities in 12 of 17 cases, which included small bowel wall thickening(eight cases) and intramural hemorrhage(three cases). Recurrences after three months of symptom free intervals developed in four cases; three of them had persistent nephritis beyond one year. CONCLUSION: The erosive hemorrhagic duodenitis in the descending duodenum in the upper endoscopy and the small bowel wall thickening in the abdominal ultrasonogram can be useful findings in the diagnosis of HSP presenting with acute abdomen.
Abdomen, Acute ; Abdominal Pain* ; Diagnosis ; Duodenitis ; Duodenum ; Early Diagnosis ; Endoscopy ; Exanthema* ; Gastrointestinal Hemorrhage ; Hemorrhage ; Nephritis ; Purpura* ; Recurrence ; Sigmoidoscopy ; Skin* ; Ulcer ; Ultrasonography

The courses of the progression in the fibrous dysplasia are characterized by asymptomatic progression or spontaneous regression in some cases after the growth has ceased and the aims of treatment for a fibrous dysplasia are prevention of the pathologic fractures and correction of the deformities. The osteogenic potentiality of the cambium layer in the periosteum and the beneficial effect on the osteogenesis of the impregnating bone graft with autologous red marrow are well documented. We experienced an extensive fibrous dysplasia with cortical thinning and pathologic fracture and it was managed with subperiosteal combined xenograft of Kiel bone with autologous red marrow for the induction of cortical thickening and prevention of the pathologic fractures because of the inoperability of curettage due to extensive lesion over the entire femur, limitations in obtaining large amount of autogenous cancellous bone for the graft and lack of the facilities of the bone bank. This subperiosteal composite xenograft with autologous red marrow for a fibrous dysplasia gave an excellent result of a remarkable cortical thickening and we think this can be a type of management for a entensive fibrous dysplasia. So we are reporting this case with bibliographic reviews.
Bone Banks ; Bone Marrow ; Cambium ; Congenital Abnormalities ; Curettage ; Femur ; Fractures, Spontaneous ; Heterografts ; Osteogenesis ; Periosteum ; Transplants

Wide resection is an acceptable alternative to amputation for the management of primary sarcomas of the long bones or pelvis. The resected bone can be debrided of gross tumor tissue, autoclaved, and than replaced to reconstruct the limb anatomically. The procedure can be combined with prosthetic reconstruction of adjacent joints with sufficient strength to allow early unprotected weight-bearing. We had an experience of a large segmental defect in the shaft of the humerus after wide resection due to.a low grade malignant chondrosarcoma without extension to the surrounding soft tissues and this case had been managed by reimplantation after autoclaving the locally resected segment and autogenous iliac bone graft with a sound union and the favorable functional outcomes. So we are reporting this case with bibliographic reviews as a possible method of reconstruction for the management of the segmental defect which was produced by a local resection for a low grade malignancy.
Amputation ; Chondrosarcoma ; Extremities ; Humerus ; Joints ; Methods ; Pelvis ; Replantation ; Sarcoma ; Transplants ; Weight-Bearing

Since osseous healing in the fracture of the femoral neck is carried out by endosteal bone formation, the size of contact area of the fracture fragments and impaction are of prime importance. It is not uncommon to be faced with the problem of back out of the internal fixation devices during healing period. It seems unnecessary to emphasize the benefit of sliding to close the gap between the fracture fragments. We report a retrospective study of 25 cases of the femoral neck fractures treated by closed reduction and fixation with multiple Knowles pins, paying particular attention to the amount and duration of sliding back out of the fixation devices and relating these to the final results of fracture union. Our clinical study led us to the following conclusions; 1. The shortoning of the femoral neck over 3mm occurred in 16 cases(64%) out of 25 cases. The average amount of back out of Knowles pin is 6mm. 2. Most of the shortening occurred during the first 8 weeks after surgery and extrusion of the nail is frequent findings in unstable fractures and osteoporoses. 3. Backing out over 12 weeks after surgery was associated frequently with delayed union and non-union. 4. Collapse or shortening is nceessary to promote a bone to bone contact and bone healing.
Clinical Study ; Femoral Neck Fractures ; Femur Neck ; Internal Fixators ; Osteogenesis ; Osteoporosis ; Retrospective Studies

Moriccas technique, neuroadenolysis of the pituitary gland through direct injection of alcohol, was performed 5 times on three cancer patients at chonnam university hospital. Two of the three patients had complete pain relief. During this procedure there was no any severe complications except diabetes insipidus, but it was treated uneventfully with indomethacin and fluid administration. Although several theories including destructiorr of the thalamic and hypothalamic nerve pathway, pituitary hormone and endorphin on the mechanism of pain relief by the neuroadenolysis have been reported, it is still not clearly determined. This technique is considered to be an exceedingly useful method for management of intractable pain in inoperable cancer patients.
Diabetes Insipidus ; Endorphins ; Humans ; Indomethacin ; Jeollanam-do ; Pain, Intractable ; Phenol* ; Pituitary Gland

INTRODUNTION: The objective of the present study was to investigate bedtime, rise time and time-in-bed of Korean college students, separately on weekday and on weekend and to compare them. In addition, this study also aimed to evaluate the influence of gender, age and grade on the above sleep parmeters in Korean college students. METHODS: Information regarding bedtime and rise time, separately on weekday and on weekend, of Korean college students were obtained by self-administered questionnaire. Questionnaires of 1,825 students (1,416 females and 409 males, age 18-30 ; mean age 21.1+/-2.2) were used for statistical analyses. RESULTS: Korean college students retired to bed 50 minutes later (00 : 49 on weekday ; 01 : 40 on weekend ; t=39.67, p<0.001), rose 1 hour 58 minutes later (07 : 52 on weekday ; 09 : 50 on weekend ; t=39.46, p<0.001), and slept 1 hour 8 minutes longer (t=13.33, p<0.001) on weekend. Compared to male students, female students had earlier rise time (t=8.96, p<0.01 ; t=3.89, p<0.01) and earlier bedtime both on weekday and weekend (t=7.10, p<0.01; t=6.04, p<0.01), and shorter time-in-bed on weekday (t=1.99, p<0.01). In addition, rise time delay and time-in-bed increase on weekend were more prominent in female students than in male students (t=3.41, p<0.01 ; t=3.68, p<0.01). Grade was correlated with bedtime and rise time on weekday (beta=0.1022, p<0.01 ; beta=0.1009, p<0.01), bedtime and time-in-bed on weekend (beta=0.1096, p<0.01 ; beta=-0.0990, p<0.01), and differences between weekday and weekend of the rise time and the time-in-bed (beta=-0.0906, p<0.01 ; beta=-0.1115, p=0.02). CONCLUSIONS: In this study, Korean college students had earlier bedtime/rise time and shorter time-in-bed on weekday than on weekend. These findings suggest that weekday sleep-wake schedule of Korean college students may be advanced relative to their biological sleep-wake cycle and that this discrepancy may be associated with weekday sleep deprivation. In addition, differences of sleep patterns between weekday and weekend were more prominent in female students and students with lower grade. Therefore, discrepancy between weekday sleep-wake schedule and biological sleep-wake cycle, as well as weekday sleep deprivation, might be more serious in female or lower-grade students.
Appointments and Schedules ; Female ; Humans ; Male ; Surveys and Questionnaires ; Sleep Deprivation

Acetabular bone deficiencies encountered during the revision hip arthroplasties should be recon- structed to provide the implant stability and to restore the normal center of rotation of hip and the leg length. We revised the loosened acetabular cup by grafting fresh-frozen bulk femoral head and inserting uncemented cup in 17 hips of 15 patients. The average follow-up period was 2 years and 3 months. The acetabular bone deficiencies were type 2A in 6 hips, type 2B in 8, type 3A in 1 and type 3B in 2 by Paprosky's classification. Three blocks of femoral head were grafted in 3 type 3 deficiencies, but only one in type 2 deficiencies. The cup-host bone contact was 41% on the average. However, the cup-host bone contact in the zone I was present only in 12 out of 17 hips and its average was 14%. Incorporation of the allograft into the host bone occurred between 5 months and 1 year and 7 months (average, 8,6 months) after revision surgery. Significant radiographic loosening sign was noted only in 2 hips which had not only type 3B bone deficiencies reconstructed with 3 blocks of femoral head allograft but also no cup-host bone contact in zone I . The bulk allograft of fresh-frozen femoral head demonstrated acceptable results in type 2 acetabular bone deficiencies, although the follow-up period was relatively short. Reconstruction of type 3B acetabular bone deficiencies by using multiple blocks of femoral head allograft had been failed. We presumed that the lack of the graft stability and the intimate contact between the grafts and host bone was the cause of failure.
Acetabulum* ; Allografts* ; Arthroplasty ; Classification ; Follow-Up Studies ; Head* ; Hip ; Humans ; Leg ; Transplants

Background and Objectives: The serum galactomannan test (GM test) and the (1,3)-β-D-glucan test (G test) are utilized in diagnosing invasive fungal sinusitis. However, their effectiveness in detecting paranasal sinus fungus balls (FBs) has not been established. This study aimed to explore their diagnostic value in patients with FBs. Methods: We retrospectively reviewed the medical records of 105 patients (42 with FBs and 63 with chronic rhinosinusitis [CRS]) who underwent serum GM and G tests between June 2020 and May 2021. Olfactory test results and demographics were also analyzed. Results: There were 42 FB patients (10 men, 32 women) and 63 CRS patients (27 men, 36 women). The positivity rates for serum GM (7.1% in the FB group vs. 3.2% in the CRS group, p=0.640) and G test (9.5% in the FB group vs. 11.1% in the CRS group, p=0.482) did not differ significantly between groups. The sensitivities of the GM and G tests were 7.1% and 9.5%, respectively, and their specificities were 96.8% and 88.9%, respectively. The positive predictive values were 60.0% for the GM test and 36.3% for the G test, and the negative predictive values were 61.0% for the GM test and 59.6% for the G test. Conclusion Serum GM and G tests demonstrated low sensitivity and high specificity, indicating limited effectiveness in differentiating between patients with FBs and those with CRS. Histological examination remains the gold standard for the definitive diagnosis of FBs.

To study the effects of small amounts of non-depolarizing neuromuscular blockers on the muscle fasciculation, postoperative muscle pains and relaxation time by succinylcholine, three groups of patients were pretreated with vecuronium (0.01 mg/kg), pancuronium (0.015 mg/kg) and gallamine (0, 2 mg/kg) 3 minutes before succinylcholine injection, respectively and compared their results with control group-saline pretreated group. The results are as follows; 1) Intensity of muscle fasciculation deereased significantly in all groups with non-depolarizing neuromuscular blockers, and frequency had the fewest in pancuronium pretreated group than the others. 2) Intensity of postoperative muscle pains decreased significantly in groups pretreated with pancuronium and gallamine, and frequency had the fewest in gallamine pretreated group than the others. 3) Pretreatment with non-depolarzing neuromuscular blocker had no effects on the onset time of muscle relaxation of succinylcholine but recovery of muscle relaxation by succinylchoine was more rapidly occured than control group. Above results, it will be suggest that gallamine and pancuronium can be used more effectively to prevent muscle fasciculation and postoperative muscle pain without influence on succinylcholine-induced muscle relaxation.
Fasciculation* ; Gallamine Triethiodide ; Humans ; Muscle Relaxation ; Myalgia ; Neuromuscular Blockade* ; Neuromuscular Blocking Agents* ; Pancuronium ; Relaxation* ; Succinylcholine* ; Vecuronium Bromide