Most proximal humeral fractures respond satisfactory to simple conservative treatment. But operative treatment is recornmended in the cases that poor results are anticipated by prolonged immobilization, or because of the severe displacement and comminution. After Neer. in 1970, emphasized the need for operative treatment in displaced proximal humeral fractures, many papers reported better results with the operative management. Twenty five cases of displaced fractures and fracture dislocations of the proximal humerus treated at the department of orthopaedic surgery, Keimyung University with open reduction and internal fixation were analyzed clinically and radiologically. The following results were obtained. 1. The prevalent age distribution was the second snd third decades(average 42.6 years) and ratio of male and female was 2.1: 1. 2. In 10 of the 25 cases, wire loop was used for internal fixation, and the result was satisfactory in 8 cases. However, the disadvantage was difficulty in wire removal after bony union because the loop was buried in the callus or cortex. 3. Over-all results were excellent or satisfactory in 64% of 25 cases. There were 4 excellent and 1 satisfsctory in 5 cases of type Il fracture, 7 excellent, 2 satisfactory and 3 unsatisfactory in 12 cases of type III fracture, 1 excellent and 4 unsatisfactory in 5 cases of type 1V fracture, and 1 excellent, 1 unsatisfactory and 1 failure in 3 cases of fracture dislocation. 4. In 6 patients with four part lesions treated with open reduction and internal fixation and followed up for an average of 23 months(from 18 months to 3 years and 2 months), only one case of fracture dislocation revealed avascular necrosis with resorption of the head.
Age Distribution ; Bony Callus ; Dislocations ; Female ; Head ; Humans ; Humerus ; Immobilization ; Male ; Necrosis ; Shoulder Fractures

BACKGROUND: Acyclovir is a highly effective antiviral agent specifically inhibiting the replication of members of the herpes virus group, in particular the has been used extensively herpes simplex virus types 1 and 2 and the varicella zoster virus. Although acyclovir it has not caused for the treatment or prevention of herpes simplex and varicella zoster virus infections, significant changes in virus sensitivity. OBJECTIVE: The purpose of this study was to evaluate the sensitivity of HSV to acyclovir. METHODS: A total of 80 strains were used 43 strains of non-genital herpes and 37 strains of genital gerpes. These were isolated from 80 patients and were studied to evaluate their sensitivities to acyclovir by the plaque reduction assay. The methods employed to monitor the sensitivity of virus isolates rely on simple dose-response experiments, looking at the effects of increasing concentrations of acyclovir on infected cell culture specimen. The assay is based on quantified plaque counting. The sensitivity of virus strains are then expressed as ID50(concentrations of drug reducing viral cytopathic effect by 50%) and MIC(minimum inhibitory concentration). RESULTS: The results were summarized as follows. 1. The ID50 values of acyclovir for HSV ranged between 0.0625 - 4.0 microgram / ml. For non-genital herpes isolates the mean and median values were 0.459 microgram / ml (SD = 0.624) and 0.250 microgram / ml ; for genital herpes isolates these values were 0.649 microgram / ml (SD = 0.746) and 0.50 microgram / ml . 2. The MIC values of acyclovir for HSV ranged between 0.250 - 32 microgram / ml . For non-genital herpes isolates the mean and median values were 2.605 microgram / ml (SD = 5.270) and 1.00 microgram / ml ; for genital herpes isolates these values were 2.716 microgram / ml (SD = 3.015) and 2.00 microgram / ml . 5. 93.75%(75 strains) of HSV isolates were within the ranges of sensitive HSV strains for acyclovir. CONCLUSION: We are concerned about the resistance of viruses to antiviral drugs, but so far, this has not been documented to be a big problem. With the increasing interest and ability to measure sensitivity of viruses to antiviral drugs we will find out more about viral resistance and its clinical significance.
Acyclovir* ; Antiviral Agents ; Cell Culture Techniques ; Cytopathogenic Effect, Viral ; Herpes Genitalis ; Herpes Simplex* ; Herpesvirus 3, Human ; Humans ; Simplexvirus*

No abstract available.
Fetal Macrosomia*

The distance fmm skin to the lumber epidural space was measured in 60 male patients receiving epidural analgesia. The mean distance was found to be 4.45cm. The epidural depths were identified most frequently at 4.0 to 4.5cm deep and over 90% of total cases were less than 5.5cm deep. The epidural depths had correlations with weight and PI(P < 0.001), but not correlated with height.
Adult* ; Analgesia, Epidural ; Epidural Space* ; Humans ; Male* ; Skin*

BACKGROUND: The objective responses of cisplatin and etoposide (PVP) combination chemotherapy as second-line therapy following CAV was high (40~50%) and, in several reports, PVP yields survival results that are at least as good as those obtained with cyclophosphamide or doxorubicin-based regimens and with less host-related toxicity in chemotherapy-naive patients. We conducted a phase II study to evaluate the effect of a combination of cisplatin and etoposide as a first-line therapy in patients with small cell lung cancer. METHODS: Sixty-one previously untreated small cell lung cancer patients with measurable lesion(s) received cisplatin(30 mg/m2 IV, day 1~3) and etoposide(100 mg/m2 IV, day 1~3). In patients with limited disease, after completion of 6 cycles of PVP chemotherapy, chest and prophylatic brain irradiation was performed in case of complete responder, chest irradiation only in partial responder. RESULTS: 1) Of 55 evaluable patients, 13(24%) had a complete response and 29(53%) had a partial response. 2) The median survival time was 55.8 weeks for all patients(N=55), 61.1 weeks for limited disease(N=31), 51.3 weeks for extensive disease(N=24). 3) The response duration was 29.1 weeks for responders(N=42). 4) There was no significant prognostic factors iufluencing response rates. 5) The toxicity was tolerable and there was no treatment-related deaths. CONCLUSION: The PVP combination chemotherapy as a first-line therapy was effective and well-tolerated in patients with small cell lung cancer.
Brain ; Cisplatin* ; Cyclophosphamide ; Drug Therapy ; Drug Therapy, Combination* ; Etoposide* ; Humans ; Small Cell Lung Carcinoma* ; Thorax

OBJECTIVES: The MVV reflects subjective dyspnea, exercise capacity, postoperative complication. But, the MVV embodies certain disadvantages and is dependent on coordination, endurance and motivation. A timed vital capacity for calculation of an indirect maximal voluntary ventilation is used. We evaluated differences in prediction formulas for the MUV according to the status of ventilatory function. METHODS: Forty-seven normal subjects, 68 patients with obstructive ventilatory impairment, and 23 patients with restrictive ventilatory impairment were studied. The relationships between the MVV and Flow or time parameters in forced expiratory volume and flow volume curves were compared among normal subjects and patients with obstructive or restrictive ventilatory impairment. RESULTS: 1) High correlation coefficients(R>or=0.87) were found between the FEV0.5, 0.75, 1 and the MVV in 47 normal subjects and 91 patients with ventilatory impairment. 2) The MVV can be conveniently estimated from the FEV1 values. The following regression formulas for the prediction of the MVV were obtained. Normal: MVV=44.01 X FEV1-21.09(r(2)=0.771, SEE=11.085) Obstructive ventilatory impairment: MVV=38.34 X FEV1-4.58(r(2)0.812, SEE=4.816) Restrictive ventilatory impairment: MVV=45.20 X FEV1-3.80(r(2)=0.899, SEE=6.929). 3) There were significant differences in prediction formulas for the MVV obtained by FEV1 between each group (P<0.05). CONCLUSION: These results suggest that different prediction formulas for the MVV, by multiplying the FEV1 by a constant, are respectively required in normal subjects and patients with obstructive or restrictive ventilatory impairment.
Dyspnea ; Forced Expiratory Volume ; Humans ; Maximal Voluntary Ventilation ; Motivation ; Postoperative Complications

PURPOSE: During August 2010, a natural gas fuel cylinder on a bus exploded in downtown Seoul, injuring 20 citizens. This kind of blast injury has never been reported in Korea before. Thus, the goal of this study was to review the clinical features of these victims to help physicians manage similar cases and to understand the risk factors associated with blast injuries in everyday life. METHODS: Twenty (20) victims who visited nearby emergency departments, and 3 peoples left hospital without care. Seventeen (17) victims were included in this study, and the following factors were investigated: age, sex, type of hospital, diagnosis of injury, injury mechanism, position of victim (in-bus/out of bus), classification of injury severity with START (simple triage and rapid treatment), and classification of injury according to the mechanism of the blast injury. RESULTS: The victims included 8 males (47%), 9 females (53%). The mean age was 37.5+/-12. Thirteen (13) victims were transferred to two tertiary hospitals, and 4 were transferred to two secondary hospitals. The types of injury were 3 fractures, 2 ligaments injuries, 6 contusions, 4 abrasions, and 3 open wounds (one of them was combined fracture). According to START classification, 17 victims were 1 immediate, 11 minor, 5 delayed, and no death. Classifications according to the mechanism of the blast injury were 1 primary injury, 6 secondary injuries (2 of them combined other mechanism), 3 tertiary injuries and 9 quaternary injuries. CONCLUSION: Trauma care physicians should be familiar with not only the specific types of injuries from blast accidents, but also the potential accidents that may occur in public facilities.
Blast Injuries ; Contusions ; Emergencies ; Explosions ; Female ; Gas, Natural ; Humans ; Korea ; Ligaments ; Male ; Multiple Trauma ; Public Facilities ; Risk Factors ; Tertiary Care Centers ; Triage

PURPOSE: We use many electronic devices for treating patients in our emergency department. Several studies have reported an association between electromagnetic field exposure and risk of cancer and other diseases. Our purpose was to measure the intensity of power-frequency magnetic fields in the emergency department and evaluate the conditions exceeded regulation guidelines for power-frequency magnetic fields. METHODS: Extremely low frequency magnetic fields were measured at 78 ordinary working spots in our tertiary hospital's emergency department (ED) and evaluated according to national regulatory guidelines and SWEDAC. Each spot was measured four times. During measurement, every electrical device in the emergency department was turned on. RESULTS: The average intensity of the magnetic fields in our emergency department was 0.99+/-1.27 mG. The maximum intensity was 8.3 mG, which was found in the pediatric section. CONCLUSION: The power-frequency magnetic field intensities of the various sections of our ED did not exceed national regulatory guidelines. However, pediatric and the minor emergency section showed magnetic fields intensities far above 2 mG. We found these high values outside the pediatric and waiting sections, where the electrical cabinet panel was located. We conclude that the electrical cabinet panel should be shielded and that similar studies are needed for other emergency departments.
Electromagnetic Fields ; Electronics ; Electrons ; Emergencies ; Emergency Service, Hospital ; Environmental Exposure ; Humans ; Magnetic Fields ; Magnetics ; Magnets

PURPOSE: Personal protection equipment (PPE) is compulsory for the safety of physicians and patients in the presence of biological hazards. In particular, such equipment is required for airway management of patients with highly contagious respiratory diseases. However, there are only a few studies about the effect of PPE on airway management with various advanced airway devices including the newly developed video-laryngoscope. We conducted a study on the effect of PPE level C on airway management with five different types of advanced airway devices including the laryngeal mask airway (LMA), direct laryngoscope (DL), airwayscope (AWS), video-laryngoscope made by Stortz (DCI), and the Levitanscope (LE). METHODS: Twenty-two emergency physician and residents in two emergency centers were trained to do trials with PPE and without PPE while performing airway management with five different airway devices. The procedures were done on two types of manikins. We compared the time from the start of the procedure to the first successful ventilation for each device and for each type of manikin. A short questionnaire was used to examine participants' subjective experiences. RESULTS: For both types of manikin, there were no significant differences in performance time between the group not wearing PPE and the PPE wearing group for any device. However, when compared with the other devices, the performance time for the LMA was faster than the other devices, and the Levitanscope(R) took a significantly longer time in both groups. According to the questionnaires, the most comfortable & uncomfortable airway devices were the LMA and the Levitanscope(R). CONCLUSION: When PPE level C was compared with the no protection state, there were no significant statistical time differences for performing advanced airway management with any particular airway device.
Airway Management ; Biohazard Release ; Emergencies ; Humans ; Laryngeal Masks ; Laryngoscopes ; Manikins ; Protective Clothing ; Surveys and Questionnaires ; Ventilation

BACKGROUND: Nonliving chickens are commonly used as a microvascular anastomosis training model. However, previous studies have investigated only a few types of vessel, and no study has compared the characteristics of the various vessels. The present study evaluated the anatomic characteristics of various chicken vessels as a training model. METHODS: Eight vessels—the brachial artery, basilic vein, radial artery, ulnar artery, ischiatic artery and vein, cranial tibial artery, and common dorsal metatarsal artery—were evaluated in 26 fresh chickens and 30 chicken feet for external diameter (ED) and thicknesses of the tunica adventitia and media. The dissection time from skin incision to application of vessel clamps was also measured. RESULTS: The EDs of the vessels varied. The ischiatic vein had the largest ED of 2.69±0.33 mm, followed by the basilic vein (1.88±0.36 mm), ischiatic artery (1.68±0.24 mm), common dorsal metatarsal artery (1.23±0.23 mm), cranial tibial artery (1.18±0.19 mm), brachial artery (1.08±0.15 mm), ulnar artery (0.82±0.13 mm), and radial artery (0.56±0.12 mm), and the order of size was consistent across all subjects. Thicknesses of the tunica adventitia and media were also diverse, ranging from 74.09±19.91 µm to 158.66±40.25 µm (adventitia) and from 31.2±7.13 µm to 154.15±46.48 µm (media), respectively. Mean dissection time was <3 minutes for all vessels. CONCLUSIONS: Our results suggest that nonliving chickens can provide various vessels with different anatomic characteristics, which can allow trainees the choice of an appropriate microvascular anastomosis training model depending on their purpose and skillfulness.
Adventitia ; Anastomosis, Surgical ; Arteries ; Brachial Artery ; Chickens* ; Foot ; Metatarsal Bones ; Models, Educational ; Ocimum basilicum ; Radial Artery ; Skin ; Tibial Arteries ; Ulnar Artery ; Veins