It has been generally agreed that most fractures of the humeral shaft are best treated non-operatively although occasionally there are indications for primary operative treatment. Recent advances in internal fixation techniques and instrumentation have led to an expansion of surgical indications, and operative treatment produces higher rates of nonunion, infection and other associated complication when compared with closed treatmet techniques. Because of the significant morbidity of the operative treatment, closed intramedullary fixation techniques that provide stability of the fracture site without opening and reduce the postoperative complications, were developed. In this paper we document forty two fractures of the humeral shafts that were treated by functional bracing(Group I: 24 cases) and intramedullary fixation with functional bracing(Group II: 18 cases) between October, 1982 and August, 1986. And the obtained results were as follows: 1. The everage healing time was 9 weeks in the Group I, and 11 weeks in the Group II . 2. The non-union has not been encountered in the Group I, but non-union and delayed union were 4 cases (22.2%) in the Group II. 3. The complication rate was 9 cases(37.5%) in the Group I, and was 12 cases(66.7%) in the Group II, but deep infection did not occured in all cases. 4. The residual angulation more than 5 degrees was 20 cases(83.3%) in the Group I, and was 2 cases(11.1%) in the Group Il. However the results of the group Il were inferior ot the group I, of more proper selection of the patients, more accurate technique and adequate type of nails have been used, the better results will be taken.
Braces ; Humans ; Postoperative Complications

Many plastic surgeons have been tried to attain ultimate goal lies in restoring the original shape and function of the facial aesthetics, in reconstruction of deformities resulting from facial hypertrophic scar and skin defects. This would require consideration in terms of hanmony in color match, skin texture and thickness. Various forms of skin graft, local flap, distant flaps, free flap and tissue expander have been employed in restoring skin defects and deformities of the cheek and submental area, and the use of large local flaps utilizing the cervicofacial skin flaps or tissue expander have brought about improved aesthetic results. the authers have obtained satisfactory results in treating 2 cases of wide hypertrophic scar of the cheek and submental area with combination of wide cervical flap and intraoperative tissue expansion using foley catheter. the merits of this combined operative methods are as follows : 1. It is not necessory to keep tissue expander for a long period. 2. This technique is able to diminish the cost of multistage operation and using of tissue expander. 3. There is no psychologic problems due to undesirable facial appearance during tissue expansion period. 4. Rapid intraoperative tissue expansion by foley catheter during elevating wide cervical flap can allow to dissect one, preserving the perforators without bleeding in a short time. 5. Wide cervical flap and additional expanded tissue by means of intraoperative tissue expansion could brought into suturing avoiding tension of oral commissure and lip eversion. 6. Preservation of perforators of cervical flap above the platysma muscle raised flap's survival rate and then this result could prevent distal ischemic necrosis after flap coverage.
Catheters ; Cheek ; Cicatrix, Hypertrophic* ; Congenital Abnormalities ; Esthetics ; Free Tissue Flaps ; Hemorrhage ; Lip ; Necrosis ; Skin ; Survival Rate ; Tissue Expansion Devices ; Tissue Expansion* ; Transplants

BACKGROUND: Among the various mechanisms of Myocardial reperfusion injuries, neutrophil is thought to be one of them. Endogenous coronary vasodilator adenosine is known to have myocardial protective effect through variable pharmacologic action, influencing the function of several cell types involved in the pathogenesis of myocardial reperfusion injury. This study was designed to determine the beneficial effect of adenosine on the left ventricular function during reperfusion and whether this effect is due to the adenosine on the role of neutrophil. METHODS: 27 open-chest cats were randomly divided into 3 groups. 6 cats received ischemic injury without reperfusion(group 1). 21 cats were subjected to 60 minutes of proximal left anterior descending coronary artery occlusion followed by a 60-minute reperfusion. 11 of 21 cats received intravenous adenosine(0.15mg/Kg/min) infusion starting 5 minutes before reperfusion throughout the entire period(group 3). 10 cats received equal volume of saline instead of adenosine(group 2). RESULTS: 1) During the experimental period, significant decrease of heart rate, blood pressure, RPI, negative dP/dT and increase of LVEDP were noted in group 2 and 3 with no difference between the two groups. The reduction of positve dP/dT was more significant in group 2 at 30 and 60 minute of reperfusion than the preocclusion value(1404+/-111, 1631+/-161 vs 1832+/-169mmHg/sec at baseline, p<0.05). In contrast, positive dP/dT in group 3 at 30 and 60 minute of reperfusion were similar to baseline values(1890+/-92, 2052+/-112 vs 2025+/-227mmHg/sec at baseline, p=NS). These were significantly higher(p<0.05) than untreated group 2. 2) Infarct size was significantly reduced in adenosine-treated group 3, when expressed as a percentage of the area at risk(28.4+/-3.3% vs 44.5+/-3.2% of group 2, p<0.05). The significant increase in myeloperoxidase activity observed after reperfusion was not detected in adenosine treated group 3.(0.18+/-0.05 vs 0.46+/-0.09 unit/100mg wet tissue weight, p<0.05). A significant correlation was present between infarct size (% of left ventricle) and myeloperoxidase activity(r=0.72, p<0.01). 3) Light microscopic examination demonstrated the decreased acute interstitial and intra vascular inflammatory infiltration and capillary plugging together with decreased tendency of incidence of contraction band necrosis in adenosine treated group 3. CONCLUSION: These findings suggest that intravenous administration of adenosine during the early reperfusion period significantly reduces infarct size, improving the early recovery of global ventricular function. The probable cause is the effect of adenosine on neutrophil as one of the various protective mechanisms of adenosine in feline heart model subjected to coronary occlusion and reperfusion, 60 minutes each.
Adenosine* ; Administration, Intravenous ; Animals ; Blood Pressure ; Capillaries ; Cats ; Coronary Occlusion ; Coronary Vessels ; Heart Rate ; Heart* ; Incidence ; Myocardial Reperfusion Injury* ; Myocardial Reperfusion* ; Necrosis ; Neutrophils ; Peroxidase ; Reperfusion ; Reperfusion Injury ; Ventricular Function ; Ventricular Function, Left

No abstract available.
Female* ; Humans ; Neck* ; Urinary Bladder* ; Urinary Incontinence*

No abstract available.
Pancytopenia*

The neuromuscular blocking effsct of mivscurium 0.15mg/kg and atracurium 0.5mg/kg were compared in 17 adult patients (ASA class I and II) during N2O propofol-fentanyl anesthesia. Neuromuscular transmission was monitored by recording the compound electromyogram of the hypothenar muscles resulting from supramaximal train of four stimulation applied to the ulnar nerve. Neuromuscular block was recovered spontaneously in all cases. Onset time of over 95% block was not different significantly between mivacurium and atraeurium (201+/-37.6vs 176.6+/-28.5sec, p>0.05, mean SD). Duration from injection of mivacurium to 25% recovery of control twitch height was significantly shorter than that of atracurium (13.0+/-2.2vs 38.8+/-4.9min, p<0.05). The recovery index was also significantly shorter for mivacurium than for atracurium (6.9+/-1.1vs 14.5+/-53.0min, p<0.05). In conclusion, we have confirmed that duration and recovery of action of mivacurium were shorter than those of atracurium, but onset times of both agents were not different.
Adult* ; Anesthesia* ; Atracurium* ; Humans ; Muscles ; Neuromuscular Blockade* ; Ulnar Nerve

BACKGROUND: Streptococcus viridans group (SVG) is the normal flora of the upper respiratory tract, skin and genitourinary tract, and is the major causative agent isolated in 30-40% of bacterial endocarditis patients. However, SVG has not been properly identified to the species level for lack of diagnostic system which enables the accurate identification of SVG. Poyart et al. have recently described the identification of SVG to the species level by DNA sequencing of superoxide dismutase gene (sodAint). Using this method, we report here the identification of SVG isolated from the patients in Seoul National University Hospital within recent 2 years. METHODS: According to the method by Poyart et al., a set of two oligonucleotides, D1 (5 '-CCI TAY ICI TAY GAY GCI YTI GAR CC-3 ') and D2 (5 '-ARR TAR TAI GCR TGY TCC CAI ACR TC-3 ') were used as PCR primers, and PCR products of 480-bp size were obtained. The PCR products purified by MicroSpin S-400 HR Column were sequenced using ABI-PRISM 3700 Sequence Analyzer. D1 and D2 were used as sequencing primers. The clinical isolates were respectively identified as the species showing the greatest sequence homology which was demonstrated by the BLAST program provided by NCBI(USA). RESULTS: Clinical strains isolated from 26 patients who had shown two or more positive blood cultures were analyzed by DNA sequencing of superoxide dismutase gene, which showed 6 strains of S. salivarius, five S. oralis, four S. sanguis, three S. pasteuri, three S. equisimilis, two S. gordonii, one S. constellatus, one S. luteciae, and one S. mitis. S. salivarius and S. sanguis were clearly discriminated, while S. equisimilis and S. pyogenes were not. Species identification results by conventional method seldom corresponded to those by DNA sequencing. Among 7 patients suspected to have bacterial endocarditis, S. sanguis were isolated in 4 patients, and S. gordonii, S. oralis, S. pasteuri in one, respectively. Among 17 patients with liver cirrhosis or cancer, S. salivarius were isolated in 6 patients, and S. oralis in four. CONCLUSIONS: In this study, we could identify the species of SVG isolated from the patients with bacteremia; S. sanguis were frequently isolated from patients with bacterial endocarditis, while S. salivarius from ones with malignancy. These results imply that a different group of underlying diseases could show correspondingly different group of SVG species which cause bacteremia, and we suggest that further pathophysiological study on the correlations between underlying disease and the species of SVG be performed.
Bacteremia ; Endocarditis, Bacterial ; Homosexuality, Male ; Humans ; Liver Cirrhosis ; Male ; Oligonucleotides ; Polymerase Chain Reaction ; Respiratory System ; Seoul ; Sequence Analysis ; Sequence Analysis, DNA ; Sequence Homology ; Skin ; Streptococcus* ; Superoxide Dismutase ; Viridans Streptococci*

BACKGROUND: Inter-observer and intra-observer variation in histologic tumor grading are well documented. To determine whether histologic disorderliness in the arrangement of tumor cells may serve as an objective criterion for grading, we tested the hypothesis the degree of disorderliness is related to the degree of tumor differentiation on which tumor grading is primarily based. METHODS: Borrowing from the statistical thermodynamic definition of entropy, we defined a novel mathematical formula to compute the relative degree of histologic disorderliness of tumor cells. We then analyzed a total of 51 photomicrographs of normal colorectal mucosa and colorectal adenocarcinoma with varying degrees of differentiation using our formula. RESULTS: A one-way analysis of variance followed by post hoc pairwise comparisons using Bonferroni correction indicated that the mean disorderliness score was the lowest for the normal colorectal mucosa and increased with decreasing tumor differentiation. CONCLUSIONS: Disorderliness, a pathologic feature of malignant tumors that originate from highly organized structures is useful as an objective tumor grading proxy in the field of digital pathology.
Adenocarcinoma ; Colonic Neoplasms ; Entropy ; Humans ; Mucous Membrane ; Neoplasm Grading ; Observer Variation ; Pathology ; Proxy ; Thermodynamics

The present study was firstly undertaken in an attempt to compare simultaneously EMG(electromyography) and two new ACC(accelerography) reponses in the both hand following vecuronium administration in 26 ASA 1 or 2 adult patients undergoing general anesthesia. In the three NMT monitors, stimulating electrodes are applied similarly over the ulnar nerve on the volar side of the wrist, but the evoked EMG(Relaxograph, Datex Co.) responses obtained from the hypothenar muscles, TOFGUARD(Biometer Co.) responses from adductor pollicis and ParaGraph(Utah Med. Prod. Co.) responses from both muscles of hypothenar and thenar muscle of the hand respectively. Following induction of anesthesia with thiopental sodium(5 mg/kg) and vecuronium(0.08 mg/kg) intravenously, endotracheal intubation was facilitated and anesthesia was maintained with a mixture of enflurane(1~2%) and N2O(50%) . After loss of consciousness, the assessment of the neuromuscular blockade was started. We compared simultaneously TR(train-of-four ratio) responses of EMG at the one hand, and two new ACC named TOF-GUARD and ParaGraph at the other hand respectively during evoked recovery from vecuronium induced neuromuscular blockade. The result was the greater depression of TR response in TOF-GUARD and the lesser depression of TR response in ParaGraph than those in EMG. But test for parallelism did not show a statistically significant difference between the slope of these regression lines. Conclusively, the regression line for TR seems to be tend to give an impression that two new ACC named TOF-GUARD and ParaGraph would be suitable in the assessment of neuromuscular blockade in clinical anesthesia.
Adult ; Anesthesia ; Anesthesia, General ; Cytochrome P-450 CYP2B1 ; Depression ; Electrodes ; Hand ; Humans ; Intubation, Intratracheal ; Muscles ; Neuromuscular Blockade ; Thiopental ; Ulnar Nerve ; Unconsciousness ; Vecuronium Bromide* ; Wrist

The prognosis of invasive aspergillosis in allogeneic bone marrow transplantation recipients is grave in the absence of bone marrow recovery in spite of antifungal treatment with amphotericin B. Beneficial role of granulocyte transfusion in neutropenic patients with fungal infection has been re-evaluated since granulocyte colony-stimulating factor made effective collection of granulocyte possible. And Liposomal amphotericin appears to be an effective alternative to conventional amphotericin B with much less toxicity. A 34-year-old patient with acute lymphoblastic leukemia developed invasive pulmonary aspergillosis during very early period of allogeneic hemopoietic stem cell transplantation. We treated the case successfully with liposomal amphotericin and granulocyte transfusion and surgery in spite of known high mortality of invasive aspergillosis in transplantation patients.
Adult ; Amphotericin B* ; Aspergillosis ; Bone Marrow ; Bone Marrow Transplantation ; Granulocyte Colony-Stimulating Factor ; Granulocytes* ; Humans ; Invasive Pulmonary Aspergillosis* ; Leukemia ; Mortality ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Prognosis ; Stem Cell Transplantation* ; Stem Cells*