Here, we report a case of artificial prosthesis of the knee joint combining with homogenous bone transplantation for the treatment of giant cell tumor of the right distal femur. At one year follow up, the patient complains almost no pain nor tenderness at operative site and ambulates with partial weight bearing with crutches. The X-ray finding shows satisfactory bony union with progressive bony remodelling.
Bone Transplantation ; Crutches ; Femur ; Follow-Up Studies ; Giant Cell Tumors ; Humans ; Knee Joint ; Knee ; Prostheses and Implants ; Weight-Bearing

Pure, nongestational ovarian choriocarcinomas is extremely rare. Most ovarian choriocarcinoma are combined with other malignant germ cell tumors or can arise as a metastaais from a primnry gestational choriocarcinoma. We experienced a case of primary ovarian choriocarcinoma that probably was associated with a past history of the mixture of germ cell tumor and present it with a review of literature.
Choriocarcinoma* ; Female ; Neoplasms, Germ Cell and Embryonal ; Pregnancy

The association of major fetal malformations with amniotic bands has been known for many years. However, we are apt to ignore the possibility of amniotic band syndrome. In this case, fetal anencephaly was diagnosed at 17 weeks, menstrual age on the basis of sonographic findings. Following pregnancy termination, examination of the abortus rev- ealed the cerebral remnant which is similar to that found in dysraphic anencephaly, but collateral evidence of amniotic band was found. Therefore, when confronted with severe cranial or cerebral malformation amniotic band syndrome should be in the differential dia- gnosis.
Amniotic Band Syndrome* ; Anencephaly* ; Infant, Newborn ; Pregnancy ; Skin* ; Ultrasonography

It has been emphasized that the treatment of choice for the trochantric fracture of the femur is open reduction and rigid internal fixation to reduce complications by early ambulation. The incidence of trochanteric fracture of the femur in the young age group has been considerably increased in recent years because of increased traffic and industrial accidents. The author treated 38 cases of trochanteric fracture of the femur in the year 1974 through 1979, at the Department of Orthopaedic Surgery, School of Medicine, Soon Chun Hyang College. The results were as follows: 1. In sex distribution, 24 out of 38 were males and 14 were females. 16 cases out of 24 male patients were in the age group 20-40 and 9 cases out of 14 female were over 60 years of age. Over all mortality was 7.9%. 2. The numbers of patients of type I and III were 11 cases in each type out of 38 trochanteric fracture. 3. 26 cases out of 38 cases were treated by open reduction and internal fixation and the others were by traction and cast. 4. The applied metal devices were 3 types: Smith-Peterson nail and Thornton or McLaughlin plate, compression hip screw, and multiple pinning. 5. Mean duration of bony union is shorter in the group of open reduction and internal fixation (13 weeks) than the group of traction and cast (15 weeks). The cause of difference is that the 6 out of 9 cases of type IV and V were included in conservative group. 6. The incidece of the complications such as coxa vara, slipping screw, long nail and traction palsy occurred higher in the group fixed with Smith-Peterson nail and plate than the group fixed with compression hip screw.
Accidents, Occupational ; Coxa Vara ; Early Ambulation ; Female ; Femur ; Hip ; Humans ; Incidence ; Male ; Mortality ; Paralysis ; Sex Distribution ; Traction

Several techniques are now avallable for the treatment of fractuers of the shaft of the femur. We must be aware of the advantages, disadvantages and Ilmitation of each if we are to select the proper treatment for each patient. During last decades treatment had been varied markedly from time to time and from place to place. Before Word War II, most fractures of the femoral shaft were treated conservatively either by skeletal traction or by manipulation and immobilization in a spica cast. After medullary fixation was Introduced during that war, it became popular, and until 1960 many surgeons considered it as the treatment of choice for most of these fractures. If the case is properly selected the medullary fixation is almost perfect, provlded no complications develop; convalescence can be shortened and resldual disability can be decreased. We had experienced 14 complications among the 78 cases of Kuntscher nailing from may, 1974, to May, 1980. The results are as follows: 1. We operated 78 cases with Kuntscher nail among the 121 femoral shaft fractures. 2. 14 (17.95%) complications developed among the 78 cases of the Kuntscher nailing. 3. Technical errors were incarcerated nailing with thick nail, too long nail and thin nailing. 4. Early postoperative complications within a year were infection, bendlng, bursitis, angulation and rotation. 5. Late complications after one year were proximal or distal migration and refracture.
Bursitis ; Convalescence ; Femur ; Humans ; Immobilization ; Postoperative Complications ; Surgeons ; Traction

Bupivacaine, an amide type local anesthetics, is frequently used for various type of re- gional anesthesia. Numerous in vivo and in vitro studied have examined the cardiotoxicity of bupivacaine by intravenous injection. Bupivacaine ovsrdose induced cardiac toxicity and directly depressed both eardiac electrophysiology and hemodynamie status. Several reports, however, indicate a participation of the CNS in cardiac toxicity of bupivacaine. Clonidine, an imidazolin alpha2-adrenoreceptor agonist, given prophylactically delays the toxic manifestation of bupivacaine overdose and dose not accentuate the subsequent hypotension. Benzodiazepine, such as midazolam for anxiolytics prior to regional anesthesia, raise the seizure threshold, delay the occurence of CNS toxicity, and increase the threshold of cardiac toxicity. Eighteen rabbits(six in each group) were anesthetized with pentobarbital, and controlled ventilation was started with room air. Electrocardiogram, hesrt rate and invasive srterial blood pressure were continuously recorded. Clonidine 5 ug/Kg(Clonidine group), midazolam 0. 3mg/Kg(Midazolam group) or saline(Saline group) was injected intravenously in randomized fashion. After 10 min, an intravenous infusion of bupivacaine was started at 1mg/Kg/min. The time of occurence of the bupivacaine induced toxic events(first QRS modification, first dysrhythmia, 25 and 50% reduction in baseline heart rate and mean arterial pressure, and asystole) was recorded. The results were as follows. 1) After pretreatment, the changes of heart rate were significantly reduced in the Clonidine group(P<0.01), but the changes of mean arterial pressure were signifieantly reduced in the Clonidine and the Midazolam groups(P<0.001, P<0.05). 2) Following the start of bupivacaine infusion, the time to the onset of QRS modification was significantly longer in the Midazolam group than in the Saline group, and the times to the onset of dysrhythmia, 25 and 50% reduction in baseline heart rate, each, were significantly longer in the Clonidine and the Midazolsm groups than in the Saline group. The time to 25% reduction in ine mean arterial pressure was significantly longer in the Clonidine group compared to the Saline group, but not in the Midazolam group, and the time to 50% reduction baseline mean arterial pressure and asystole, each, were increased according to the order of the Saline, the Midazolam and the clonidine groups, and significantly different between the groups.
Anesthesia ; Anesthesia, Conduction ; Anesthetics, Local ; Anti-Anxiety Agents ; Arterial Pressure ; Benzodiazepines ; Blood Pressure ; Bupivacaine* ; Clonidine* ; Electrocardiography ; Electrophysiology ; Heart Arrest ; Heart Rate ; Hypotension ; Infusions, Intravenous ; Injections, Intravenous ; Midazolam* ; Pentobarbital ; Rabbits* ; Seizures ; Ventilation

Conscious awareness with recall has always been of major concern to both patients and anesthesiologists and can, particularly when pain is experienced, lead to serious psychological sequelae characterized by a form of neurosis. And the unconsciousness storing of a traumatic memory may well act as a chronic psychic irritant. This study was designed to evaluate the effects of anesthetic induction with thiopental-ketamine and propofol on maternal awareness and neonatal outcome during cesarean section. Forty pregnant women(ASA class 1 or 11) undergoing cesarean section under general anesthesia were allocated randomly to receive either thiopental(4 mg/kg, 250 mg maximum)-ketamine(20 mg)(n=20) or propofol(2 mg/kg)(n=20). Using the isolated forearm technique, the incidence of maternal intraoperative awareness was assessed. Following recovery from anesthesia and 24 hour later, the patients were interviewed to assess any recall, dream or hallucination. And the Apgar scores of newborn at one and five minutes, as well as their umbilical blood gases also evaluated. The incidence of maternal awareness signaled by flexing fingers in respose to voice commands was significantly lower in thiopental-ketamine group(70%) than propofol group(95%)(p<0.05). And 15% of patients receiving thiopental-ketamine and 20% of propofol group made a fist(indicating pain perception). Nine patients had postoperative recall of intraoperative awareness, four in the thiopental group and five in the propofol group, but only one patient in each group remembered one of six target words. No postoperative hallucination, dream or dysphoria(including pain) were noted. The maternal intraoperative cardiovascular responses among the groups were similar. There were no significant differences in Apgar scores, maternal and umbilical blood gas values. Our data indicate that thiopental-ketamine and propofol as induction agent was associated with very high rate of maternal awareness without unpleasant recall and neonatal depression.
Anesthesia ; Anesthesia, General ; Anesthesia, Obstetrical ; Cesarean Section* ; Depression ; Dreams ; Female ; Fingers ; Forearm ; Gases ; Hallucinations ; Humans ; Incidence ; Infant, Newborn ; Intraoperative Awareness ; Ketamine ; Memory ; Pregnancy ; Propofol* ; Thiopental ; Unconsciousness ; Voice

No abstract available.
Thoracoplasty*

BACKGROUND: Endoscopic urologic surgery including transurethral resection of prostate (TURP) requires adequate sacral analgesia for insertion of resectoscope. But epidurally administered local anesthetic does not produce anesthetic effects uniformly. Failure to completely block S1 during epidural anesthesia because of the large size of nerve root has been noted. The purpose of this study to compare the relation between catheter direction and sensory anesthesia. METHODS: Thirty patients scheduled for endoscopic urologic surgery were enrolled. The epidural catheter was inserted at L3-4 using a standard 18 gauge Tuohy needle. In group A (n=15), the Tuohy needle with bevel pointed in a cephalad direction during catheter insertion. In group B (n=15), it pointed caudally. And the catheter was introduced 3 cm into the epidural space. After test dose, 2% lidocaine 5 cc, 0.5% bupivacaine 5 cc and 2% lidocaine 3 cc were administered with fractionate dose through it. The extent of the sensory anesthesia to loss of cold sensation and pin prick test was measured every 5minute for 30 minutes. RESULTS: Analgesia spread to loss of cold sensation and pin prick test was no significant statistical difference between the two groups. In 15 minutes after injection of surgical dose, complete blockade in L5, S1 dermatome was present in both groups. CONCLUSION: Our results conclude that epidural catheter direction is not significantly influence the epidural anesthetic spread including sacral area in continuous lumbar epidural anesthesia in elderly patients.
Aged ; Analgesia ; Anesthesia ; Anesthesia, Epidural* ; Anesthetics ; Bupivacaine ; Catheters* ; Epidural Space ; Humans ; Lidocaine ; Needles ; Sensation ; Transurethral Resection of Prostate

The Freeman-Sheldon syndrome (FSS) is a rare congenital myopathy. Main manifestations are "whistling face", camptodactyly with ulnar deviation of the finger and talipes equinovarus. Myopathic fibrotic circumoral musculature result in microstomia with the characteristic protruding pursed "whistling lip" and mandibular and laryngeal development may also be abnormal. Thus the patients with FSS are expected to difficult intubation and the use of muscle relaxant should not be expected to improve intubating condition. We report a children with the Freeman-Sheldon syndrome who was intubated with fiberoptic laryngoscope and discuss anesthetic consideration.
Child ; Clubfoot ; Fingers ; Humans ; Intubation* ; Laryngoscopes ; Microstomia ; Muscular Diseases