Synovial chondromatosis is an uncommon benign lesion characterized by multiple cartilagenous and osteocartilagenous nodules of the synovium and loose bodies. The affection is monoarticular and most commonly involves the knee and has an unknown etiology. Of the five cases of synovial chondromatosis experienced by the authors, both knee joints were involved in a case, two the elbow joint, and one the proximal phalanx of the left middle finger. The diagnosis of synovial chondromatosis was made by the histopathological findings of the excised masses.
Chondromatosis, Synovial ; Diagnosis ; Elbow Joint ; Fingers ; Knee ; Knee Joint ; Synovial Membrane

This is to present the clinical analysis of 197 (165 Patients) open fractures of long bones which were treated at Han Gang Sacred Heart Hospital from December 1971 June 1975. The results obtained as follows: 1. The causes of injury were traffic accident 91, industrial accident 63, home acident 8 and other 3. 2. In this study, there were 139 males and 26 females. The main age incidence ranged 11–40 years. 3. Among the 197 cases, Tibia and fibula were affected mostly(54.8%) 4. Associated injuries included closed fracture of long bone 35, cerebral contusion 15, skull fracture 10, maxillofascial inury 9, joint dislocation 6 and other 21. 5. The method of treatment was chiefly debridement and primary closure of open wound with 16 internal fixation, followed by cast immobilization 161, skeletal traction 15 and pin & plaster. 5. 6. Consequent incidence of infection was 10.7% (deep 5.1%, superficial 5.6%) 7. The causative strains were coliform bacillus 28, pseudomonas 16, staphylococcus 6, streptococcus 1, and bacillus subtilis 1, 8. Death occured in 3 cases: the causes were sepsis due to pseudomonas 2 and anuria due to renal shut down 1.
Accidents, Occupational ; Accidents, Traffic ; Anuria ; Bacillus ; Bacillus subtilis ; Contusions ; Debridement ; Dislocations ; Female ; Fibula ; Fractures, Closed ; Fractures, Open ; Heart ; Humans ; Immobilization ; Incidence ; Joints ; Male ; Methods ; Pseudomonas ; Sepsis ; Skull Fractures ; Staphylococcus ; Streptococcus ; Tibia ; Traction ; Wounds and Injuries

One hundred and fifteen thoracolumbar vertebrel fractures Out. of 85 patients were avaluated in this study. In 97 cases out of 65 patients, angular deformity and loss of height of the fractured vertebral bodies were measured, and for 6. 3 months in average follow up study was made in 23 cases out of 18 patients. The angular deformity became increased from 18.4 degrees to 21. 0 degrees wheroas loss of height has also increased from 38.6 to 40.8%, showing little statical value. Incidence was higher in male than in female without seasonal differences. Age incidence ranged from 16 to 78, and most frequent in third and fourth decades. Causes of injury were industrial accident, traffic accident, home accident and fall from height. Location of injury was mainly twelfth thoracic and first lumbar vertebrae. As associated injury, fracture of the rib, ulna, malleolus and calcaneus in order. Conservative treatment was a method of choice, while operstive treatment was performed in 7%.
Accidents, Home ; Accidents, Occupational ; Accidents, Traffic ; Calcaneus ; Congenital Abnormalities ; Female ; Follow-Up Studies ; Humans ; Incidence ; Lumbar Vertebrae ; Male ; Methods ; Ribs ; Seasons ; Ulna

BACKGROUND: Epidural steroids injections are often used for the treatment of low back pain but their effects on the endocrine system have not been determined. Few studies have quantified the degree or duration of the suppression of the hypothalamic-pituitary-adrenal (HPA) axis in humans given epidural triamcinolone injection (ETI) for low back pain. The evaluation of the blood adrenocorticotropic hormone (ACTH) and cortisol was undertaken to determine the extent of suppression of the HPA axis in patients given ETI. METHODS: Lumbar epidural triamcinolone injections were performed on the painful lumbar intervertebral space with patients in the lateral decubitus position. The injection consisted of 40 mg of triamcinolone acetonide diluted in 10 mL of 1% lidocaine. Patients remained in the lateral position for 10 min after the procedure. Basal blood sampling was performed at 30 min before ETI and tested blood sampling was obtained at 7 days, 10 days, and 14 days after ETI. RESULTS: The blood cortisol level was significantly decreased at 7 days and 10 days but at 14 days was not significantly decreased and the blood ACTH level was not significantly decreased at 7 days, 10 days, and 14 days. CONCLUSIONS: Above results demonstrate that blood ACTH and cortisol level normalize 7 days and 14 days, respectively, after epidural triamcinolone 40 mg injection.
Adrenocorticotropic Hormone* ; Axis, Cervical Vertebra ; Endocrine System ; Humans ; Hydrocortisone* ; Lidocaine ; Low Back Pain ; Steroids ; Triamcinolone Acetonide ; Triamcinolone*

We retrospectively reviewed 100 consecutive patients who were ruptured intracranial aneurysm and were operated on in the department of neurosurgery of Wallace Memorial Baptist Hospital from August 1984 to August 1988. The patients who were operated upon within the first 3 days of their most recent subarachnoid hemorrhage formed the early group, the patients operated upon with 4-7 days formed the intermediate group, after 8 days were considered as the delayed group. Early operation was performed in 30 patients, intermediate operation in 20 patients, and delayed operation in 50 patients. On the base of their clinical outcome, the patients were allocated to one of 4 outcome categories(good, fair, poor, death) at the time of their hospital discharge. The 80% favorable outcome estimated from early operation and 85% from intermediate operation and 90% from delayed operation. The mortality was estimated 13% from early operation and 0% from intermediate operation and 8% from the delayed operation. Each 4 cases of early, intermediate and delayed operation was needed shunt operation for hydrocephalus. In operative result, after 1987 was better than before 1987. In hypertensive patients, there was a tendency to observe poor prognosis than normotensive patients, especially with vasospasm.
Aneurysm* ; Humans ; Hydrocephalus ; Hypertension ; Intracranial Aneurysm ; Mortality ; Neurosurgery ; Prognosis ; Protestantism ; Retrospective Studies ; Subarachnoid Hemorrhage

The prime objective in treating the intertrochanteric fracture is to achieve bony stability at the fracture site using an appropriate fixation nail plate to maintain a stabilized position. Since the introduction of the Smith-Petersen nail, numerous internal fixation devices have been developed. Complications after surgical treatment of intertrochanteric fractures of the femur though rarely resulting in non-unions or aseptic necrosis of the femoral head, varus deformities or delayed unions are frequent. Recently a compression hip screw is popular because it can provide more secure internal fixation. The authors treated 41 cases of intertrochanteric fractures of the femur during a 5. 5 year period from January, 1975 to June, 1980. 1. Of 41 cases of intertrochanteric fractures, 9 cases were stable fractures, and 32 cases were unstable. 2. Of 4I cases of intertrochanteric fractures, 9 were treated conservatively, and 32 were treated with open reduction and internal fixation. Of the fixation devices, compression hip screws were used in 17 cases, Jewett nail plates in 12 cases, Mclaughlin plate in 2 cases, and a Judet plate in a case. 3. Of the 32 cases treated by open reduction, reduction with medial displacement by the Dimoe- Hughston method was used in 10 cases, 3 of which were fixed with compression hip screws and 7 with Jewett nails. The remaining 22 were anatomically reduced. 4. The average time until weight bearing in conservatively treated patients began was 17. 7 weeks but in the surgically treated patients weight bearing started after 5. 5 weeks, and in patients treated with a compression hip screw patient conld bear weight 3. 7 weeks after surgery. 5. The average fracture union time was 16. 6 weeks in conservatively treated patienta, 16. 3 weeks in operatively treated patients (14. 6 weeks in compression hip screw fixation group, 18 weeks in Jewett nail, 21 weeks in Mclaughlin plate,16 weeks in Judet plate). 6. There were complications in 8 cases; 3 in the conservatively treatment group, and 5 in the internal fixation group. Of 5 internal fixation cases, 2 complications were caused by technical error. 7, After comparison of the result of treatment obtained by 4 different types of iaternal fixation devices, our conclusion is that compression hip screw is the device of choice for treatment of intertrochanteric fractures.
Clinical Study ; Congenital Abnormalities ; Femur ; Head ; Hip ; Hip Fractures ; Humans ; Internal Fixators ; Methods ; Necrosis ; Weight-Bearing

BACKGROUND: Positive end expiratory pressure (PEEP) ventilation is well established as an integral part of the management of patients with the acute lung injury. PEEP is a key element in the treatment of hypoxemia resulting from pulmonary edema. Pulmonary capillary pressure (Pcap) is the most important factor influencing lung edema formation, and an understanding of how Pcap is altered by variations of PEEP or pulmonary arterial occlusion pressure (PAOP) is important to improve the treatment of acute lung injury patients. This study was performed to evaluate the effects of PEEP on the pulmonary capillary pressure in acute lung injury patients. METHODS: This was a prospective study of 11 acute lung injury patients. The effect of PEEP on pulmonary circulation at four different levels (0,4,8, and 12cm H2O) was analyzed. Pcap was estimated visually at bed side with Swan Ganz catheters. The pulmonary vasculature was analyzed by calculating the pressure difference at the arterial and venous parts of the circulation. RESULTS: As PEEP increased from 0 to 12 cm H2O, the mean puhnonary arterial pressure (PAP) and Pcap increased respectively from 22.7 ± 7.4 to 25.3 ± 7.3 mmHg and 15.3 ± 3.3 to 17.8 ±3.2 mmHg (p<0.05). Similarly, PAOP increased from 9.8 ± 2.1 to 12.8 ± 2.1 mmHg and the central venous pressure increased from 6.1 ± 1.6 to 9.3 1: 2.3 mmHg(p<0.05). However, the pressure gradient at the arterial (PAP-Pcap) and venous (Pcap-Pcwp) part of pulmonary circulation remained unchanged at all evaluated PEEP levels. CONCLUSION: Although Pcap increasoo gradually with increased PEEP, the pressure gradient at the arterial and venous part of the pulmonary vasculature remained unchanged at all evaluated PEEP levels in acute lung injury patients.
Acute Lung Injury* ; Anoxia ; Arterial Pressure ; Capillaries* ; Catheters ; Central Venous Pressure ; Edema ; Humans ; Lung ; Positive-Pressure Respiration* ; Prospective Studies ; Pulmonary Circulation ; Pulmonary Edema ; Ventilation

Primary aldosteronism is a clinical syndrome referring to increased and inappropriate production of aldosterone from adrenal gland due to a solitery adenoma, bilateral hyperplasia or an adrenal carcinoma and this syndrome is characterized by hypertension, hyporeninemia, and hypokalemia and its manifestations. Under the general anesthesia, operation was performed on a 34-year-old male, who was diagnosed as primary aldosteronism caused by aldosterone producing adenoma and we have experienced the anesthetic management of unilateral adrenalectomy during perioperative periods.
Adenoma ; Adrenal Glands ; Adrenalectomy* ; Adult ; Aldosterone ; Anesthesia, General ; Humans ; Hyperaldosteronism* ; Hyperplasia ; Hypertension ; Hypokalemia ; Male ; Perioperative Period

Methods: Consecutive patients whose BMD had been checked using dual-energy X-ray absorptiometry at Gwangmyung Sungae Hospital were recruited. Patients were divided into two groups according to the presence of type 2 DM. Risk factors of OVCF including age, BMI, current smoking status, current alcohol consumption, and presence of osteoporosis were analyzed separately in the type 2 DM group and control group. Results: A total of 1,130 patients were enrolled in this study. The mean age was 63.2 years. BMI was positively correlated with lumbar BMD in the control group (r =0.284) and in the diabetic group (r =0.302). In subgroup analysis, BMI and age were significant risk factors of OVCF in the type 2 DM group. In multiple linear regression analysis, type 2 DM (β =0.035; 95% confidence interval [CI], 0.005–0.065; p =0.024) and BMI (β =0.015; 95% CI, 0.012–0.018; p <0.001) were positively correlated with lumbar BMD, and age was negatively correlated with BMD (β =−0.006; 95% CI, −0.007 to −0.004; p <0.001). Conclusions BMI was positively correlated with lumbar BMD and was higher in type 2 diabetic patients. Age was negatively correlated with lumbar BMD.

Spinal anesthesia has been widely used for operations performed in the lower abdomen, inguinal regions, lower extremities, and perineum. When patient have aevere systemic disease and a full . stomach, spinal anesthesia is may be more safe than general aneethesia. Bradycardia and hypotension have been accepted to be the most common complications in cardio-vascular system during spinal anesthesia. The mechanisms are a decrease in total peripheral vascular resistance, a decrease in cardiac output or a combination of both. Accessory factors include bradycardia resulting from block of accelerator impulses to the heart or decrease in endogeneous release of norepinephrine from sympathetic nerve endings, thereby reducing myocardial contractility. We report 2 cases of sudden extreme bradycardia and hypotension in patients who had received spinal anestesia. Although the exact pathophysiology of this phenomenon is unknown, the etiology is probably vagal effect. Thus the patient who receives spinal anestbesia should be required constant monitoring and vigilance throughout all procedures.
Abdomen ; Anesthesia, Spinal* ; Bradycardia* ; Cardiac Output ; Heart ; Humans ; Hypotension* ; Lower Extremity ; Nerve Endings ; Norepinephrine ; Perineum ; Stomach ; Vascular Resistance