The purpose of this study is to compare 76 cases of fractures of the proximal humerus both clinically and radiologically which were treated at Pusan National University Hospital from January 1987 to December 1996. According to Neers classification, among the 76 patients, there were nine one-part fractures (11.8%), forty two-part fractures (52.6%), eighteen three-part fractures (23.7%), four four-part fractures (5.3%), and five head-splitting fractures (6.6%). In terms of treatment method, among the 76 patients, 49 patients (64.5%) were treated conservatively. Thirty seven patients (75.5%) of one-part and two-part fractures were treated conservatively, and twelve patients (54.5%) of three-part and four-part fractures were treated operatively. The results of the cases were rated by the Neer s assessment, 42 patients (85.7%) had excellent or satisfactory results in one-part and two-part fracture, and 7 patients (31.8%) had unsatisfactory or failed results in three-part and four-part fracture. Total cases with complications were 14 cases (18.4%). From the viewpoint of the type of fracture, the results in two-part and three-part fractures were much better than those of fourpart fractures. The joint stiffness which was the most common complication must be prevented by allowing the early motion of the joint to obtain a better result.
Busan ; Classification ; Humans ; Humerus* ; Joints

Solitary choroidal tubercle is rare disease nowadays although it was frequently reported in the old literatures. It is characterized by indefinite yellowish-white round nodule in the posterior pole of the eyeball in young adults with inactive disease. It is sometimes protruded toward vitreous cavity with retinal necrosis, vitreous opacity and cyclitis. Authors experienced a case of solitary choroidal tubercle which had been misdiagnosed as a malignant melanoma. We confirmed it by pathologic findings.
Choroid* ; Humans ; Melanoma ; Necrosis ; Rare Diseases ; Retinaldehyde ; Tuberculoma* ; Young Adult

Cyanosis in children is most often caused by pulmonary disease, or cyanotic heart disease but is rarely caused by hematological problems such as methemoglobinemia and sulfhemoglobinemia. Abnormal hemoglobins with a reduced oxygen affinity are an exceptionally uncommon cause of cyanosis in children. Hemoglobin-M (Hb-M) is rapidly auto-oxidized into the met-form resulting in the loss of its O2-binding ability. This hemoglobinopathy is inherited in an autosomal dominant pattern and is characterized by marked cyanosis. Hb-M affects the anesthetic management because of the anomalous absorption spectrum of Hb-M in standard pulse oximetry. Sufficient O2 delivery should be maintained by keeping a high FiO2 and intermittently checking the O2 delivery state using arterial blood gas analysis. We reported our experience of the anesthetic management of a patient with hemoglobin M.
Absorption ; Blood Gas Analysis ; Child ; Cyanosis ; Heart Diseases ; Hemoglobin M ; Hemoglobinopathies ; Hemoglobins, Abnormal ; Humans ; Lung Diseases ; Methemoglobin ; Methemoglobinemia ; Oximetry ; Oxygen ; Sulfhemoglobinemia

Clinical observation was performed on the 71 hips of 52 patients which were replaced by total hip arthroplasty, who were treated at department of Orthopedic Surgery, College of Medicine, Kyungpook National University, from 1980 to 1985. The follow up period of each case varied from 2 to 7 years. The results obtained were as follows : 1. The peak age incidence ranged from 40 to 49 years, which was comprised 55.8%(29 patients) of total cases. Male was predominant(46 patients of total cases). 2. The cause of hip diseases were ; 49 cases of idiopathic avascular necrosis, which comprised highest incidence, 15 posttraumatic avascular necrosis, 4 osteoarthritis, 3 old pyogenic hip. 3. The lesion site were ; 23 right side, 10 left side and 19 both sides. All cases were Muller type which performed the Watson-Jones approach. 4. Seversl complications were developed; 1 subtrochanteric spiral fracture, 1 perforation of acetabulum, 1 perforation of femur shaft, 1 perforation of lesser trochanter of femur, 1 nerve palsy during the operation, post-operative superficial wound infection in 1 case, deep seated infection in 1 case, and wire breakage in 6 cases. 5. Preoperative and post-operstive functional evaluation by the Harris method was done ; 1) Average improvement was 49 points from 38.2 to 87.2 points. 2) Relief of pain was the most prominent effect of the total replacement surgery.
Acetabulum ; Arthroplasty, Replacement, Hip ; Femur ; Follow-Up Studies ; Gyeongsangbuk-do ; Hip ; Humans ; Incidence ; Male ; Methods ; Necrosis ; Orthopedics ; Osteoarthritis ; Paralysis ; Wound Infection

The subtrochanteric fracture of the femur is often comminuted because the subtrochanteric area is composed mainly of cortical bone and high compression force biomechanically and its proximal fragment is severely displaced by adjacent strong muscles. Therefore, it is difficult to maintain accurate reduction and rigid fixation and delayed or nonunion, limb shortening, varus deformity, metal failure, and many other problems can be encountered. Although various devices of internal fixation have been developed to solve these problems, we found many problems to select the fixation device in different fracture type properly. We studied 40 subtrochanteric fractures treated with various devices at our hospital from 1981 to Feb. 1987. The results were obtained as follows: 1. Male (28 patients, 70%) was predominant. The majority of patients (representing 55%) were between 31 and 60 years of age. While 10 of 12 female patients were after 50 years of age. 2. In 36 of 40 patients, the fracture resulted from high energy trauma, traffic accident or fall from height. 3. Pelvic bone fracture (4 cases)and head trauma (3 cases) were the most common associated injuries. 4. Fielding's type II(19 cases) fracture and Seinsheimer's type IV (10 cases) & V (9 cases) fractures were most common. 5. Of the 40 cases, 38(95%) were treated by open reduction and internal fixation. Of fixation devices, a Jewett nail was most commonly used in 23 cases (60.5%) 6. The average time from operation to partial weight bearing was 12.2 weeks. 7. The mean duration of bony union was 25 weeks. And more longer period was needed in union as fractures goes distally 8. Of the 40 cases, 4 (10%) complications occured, those are : metal failure and fixation screw loosening (2 cases), infection (1 case), varus deformity (1 case). 9. From these series, these fractures should be treated as rigid internal fixation and Jewett nail or many other devices such as compression hip screw, condylar plate, or Judet plate could be applied successfully for the rigid fixation of subtrochanteric fractures of the femur according to the fracture displacement and stability.
Accidents, Traffic ; Clinical Study ; Congenital Abnormalities ; Craniocerebral Trauma ; Extremities ; Female ; Femur ; Hip ; Hip Fractures ; Humans ; Male ; Muscles ; Pelvic Bones ; Weight-Bearing

BACKGROUD: It is generally acknowledged that a close relationship exists between chronic alcohol abuse and the occurrence of alcohol withdrawal seizure(AWS). About one third of AWS patients have been reported to be followed by delirium tremens (DT). OBJECTIVES: We assessed the factors that have influence on the development of DT in AWS patients. METHODS: We investigated clinical features and laboratory findings of 39 AWS patients who were admitted. The following factors were analyzed ; duration of alcohol intake, interval from last drinking to onset of AWS, interval from AWS to treatment, number of seizure, fever, laboratory findings (Mg, K, Na, Ca, P, respiratory alkalosis). RESULT: Fourteen patients developed DT(35.8%). There was fever in 36% of AWS patients with DT(5/14) and in 8% of AWS patients without DT(2/25). Number of seizure (p<.05) and interval from AWS to treatment(p<.01) showed statistically significant difference. But other factors were insignificant statistically. CONCLUSION: Our study suggests that number of seizure and interval from AWS to treatment seem to be significantly related to the development of DT in AWS patients.
Alcohol Withdrawal Delirium* ; Alcohol Withdrawal Seizures* ; Alcoholism ; Delirium* ; Drinking ; Fever ; Humans ; Risk Factors* ; Seizures ; Seizures, Febrile

Although clectroencephalographic and clinical evidence of seizure activities during enfluran anesthesia have been documented in man, the incidence of post operative electro clinical partial seizure activity following enfluran anesthesia is rare phenomenon. We report a patient who developed post operative partial seizure with secondary generalized tonic clonic seizure that may have been related to the administration of enfluran.
Anesthesia* ; Humans ; Incidence ; Seizures*

PURPOSE: Internal fixation using compression hip screws (CHS) and traction tables placing patients in the supine position is a gold standard option for treating intertrochanteric fractures; however, at our institution, we approach this treatment with patients in a lateral decubitus position. Here, the results of 100 consecutive elderly (i.e., ≥45 years of age) patients who underwent internal fixation with CHS in lateral decubitus position are analyzed. MATERIALS AND METHODS: Between March 2009 and May 2011, 100 consecutive elderly patients who underwent internal fixation with CHS for femoral intertrochanteric fracture were retrospectively reviewed. Clinical outcomes (i.e., Koval score, Harris hip score [HHS]) and radiographic outcomes (i.e., bone union time, amount of sliding of lag screw, tip-apex distance [TAD]) were evaluated. RESULTS: Clinical assessments revealed that the average postoperative Koval score decreased from 1.4 to 2.6 (range, 0–5; P < 0.05); HHS was 85 (range, 72–90); and mean bone union time was 5.0 (range, 2.0–8.2) months. Radiographic assessments revealed that anteroposterior average TAD was 6.95 (range, 1.27–14.63) mm; lateral average TAD was 7.26 (range, 1.20–18.43) mm; total average TAD was 14.21 (range, 2.47–28.66) mm; average lag screw sliding was 4.63 (range, 0–44.81) mm; and average angulation was varus 0.72°(range, −7.6°−12.7°). There were no cases of screw tip migration or nonunion, however, there were four cases of excessive screw sliding and six cases of varus angulation at more than 5° CONCLUSION: CHS fixation in lateral decubitus position provides favorable clinical and radiological outcomes. This technique is advisable for regular CHS fixation of intertrochanteric fractures.
Aged ; Hip Fractures ; Hip ; Humans ; Retrospective Studies ; Supine Position ; Traction

No abstract available.
Prostatic Hyperplasia*

PURPOSE: The prognosis for primary gallbladder cancer is very poor. Because of the lack of specific symptoms, late diagnosis, advanced stage, and ineffective treatment are typical. The purpose of the present study was to investigate the early diagnostic factors that improve the survival rate, by comparing a preoperatively diagnosed group with a postoperatively diagnosed group. METHODS: This study was a clinical analysis of our surgical experience with primary gallbladder carcinomas during the 6 years from 1992 to 1997 at Chung-Ang University in Korea. RESULTS: The incidence of gallbladder carcinomas was 0.6% of the 6132 biliary-tract operations performed during the 6 years (suspected group: unsuspected group=15:23). The sex ratio of males to females was 1 to 2.46 with female predominance. Primary GB cancer was seen most commonly in patients in their 50s and 60s, and this group accounted for 68.4% of the entire group and had a median age of 65 years. The most common clinical manifestation was right upper abdominal pain in 27 cases (71.1%). The duration of the illness in preoperatively suspected patients was much shorter than that for intraoperatively or only pathologically diagnosed patients (p=0.046) As for diagnostic methods, ultrasound and abdominal CT scans were performed, and the preoperative diagnostic accuracies were 31.6% and 69.3%, respectively. The patients were grouped according to the staging system of Nevin et al. The five stages were classified as follows: stage I (suspected group-0 cases; unsuspected group-2 cases), stage II (1 case; 5 cases), stage III (1 case; 2 cases), stage IV (7 cases; 9 cases), and stage V (6 cases; 5 cases). Adenocarcinoma was the most common type of gallbladder cancer (32 cases: suspected group-10 cases; unsuspected group-22 cases), followed by squamoadenocarcinoma (3 cases: 2 cases/1 case), neurogenic carcinoma (1 case: 1 case/0 cases), histiocytoma (1 case: 1 case/0 cases), and papillary carcinoma (1 case: 1 case/0 cases). The total cumulative 1-year, 2-year, and 3-year survival rates were 67.7%, 37.6%, and 12.1%, respectively (suspected: 46.2%, 15.4%, and 0%; unsuspected: 71.4%, 52.9%, and 23.2%). The cumulative survival rates for patients in the unsuspected group were higher than those for patients in the suspected group (p=0.008). CONCLUSION: The survival rate of the preoperatively unsuspected group was better than that of the suspected group. The survival improvement depended the invasion by the gallbladder carcinoma. We suggest that the survival rate should be improved by early detection of the gallbladder carcinoma and on extended operation. Conclusively, further evaluation of patients with etiologic factors should be done, more specific exams (CT or MRI) should be evaluated, and an acceptable operation should be done.
Abdominal Pain ; Adenocarcinoma ; Carcinoma, Papillary ; Delayed Diagnosis ; Early Diagnosis* ; Female ; Gallbladder Neoplasms ; Gallbladder* ; Histiocytoma ; Humans ; Incidence ; Korea ; Male ; Prognosis ; Sex Ratio ; Survival Rate ; Tomography, X-Ray Computed ; Ultrasonography