No abstract available.
Femur Neck*

The treatment of open tibial fracture has become one of the most controversial subjects in orthopedic surgery. Recently flexible intramedullary nails have been used successfully in treatment of Type I, II open fractures of the tibial shaft. In this paper we are reporting our experience with the method in 20 open fractures of the tibia in 18 patients. The results were ss follows. 1. The patients were predominantly more common in male(90%) and the average age was 42.7 years old and the most common cause of fracture was traffic accident. 2. The most common site and shape were at midshaft and comminuted fracture. 3. With early operation the incidence of infection was greatly reduced and wound healing was relatively rapid. 4. The patients were applied with long leg or P.T.B. cast for at least 4 weeks in order to the prevention of re-displacement. 5. The average healing time was 17.7 weeks in 14 cases and union was most rapid at upper third and Type I fractures. 6. The complication was developed in 14 cases, 3 cases of delayed union, nonunion and ankle stiffness was seen respectively. 7. Infection rate was greatly reduced because Ender's nailing procedure was easy to perform, operation time was shortened, good fixation and alignment of fracture fragment was done without periosteal stripping. 8. Ender's nailing is considered to be a good method in the treatment of open tibial fracture associated with soft tissue injurv and multiole iniuries.
Accidents, Traffic ; Ankle ; Fractures, Comminuted ; Fractures, Open ; Humans ; Incidence ; Leg ; Methods ; Orthopedics ; Tibia ; Tibial Fractures ; Wound Healing

PURPOSE: To evaluate the treatment results of geriatric intertrochanteric fractures by using Asian-Pacific Gamma nails. MATERIALS AND METHODS: From June 1994 to June 1997, 58 cases of the intertrochanteric fractures were treated with Asian-Pacific Gamma nail, particularly compression hip screw fixation complications such as communited fracture involving lesser trochanter, transverse or reverse oblique intertrochanteric fracture. We evaluated the bone union time, neck-shaft angle, lag screw sliding by follow up radiographs, and studied complications and intraoperative cautions. RESULTS: The average age was 74.4 years old, the mean duration of follow-up was 17 months, the mean duration of bone union was 14.2 weeks, the average neck-shaft angle was postop. 133+/-2.78 degree and last follow-up was 129.5+/-3.37 degree, and the average lag screw sliding was 4.7+/-3.16 mm. Intraoperative complications were difficulty in distal drilling (posterior drilling) in 4 cases, fracture displacement by nail insertion in 3 cases, and postoperative complications were coxa vara in 13 cases, superior cutting out of lag screw with nonunion in 1 case and superficial infection in 1 case. The entry portal must be formed by awling. The fracture displacement when inserting nail could be prevented by proper reaming after inserting the C-shaped guide pin, and posterior drilling could be avoided by confirming the locking between target device and nail. CONCLUSIONS: We conclude that the Asian-Pacific Gamma nail could appropriately treat the osteoporotic, communited intertrochanteric fracture in elderly patients and we obtained satisfactory results.
Aged ; Coxa Vara ; Femur* ; Follow-Up Studies ; Hip ; Hip Fractures ; Humans ; Intraoperative Complications ; Postoperative Complications

No abstract available.
Femur*

Fracture of the femur during total hip arthroplasty presents the simultaneous problems of prosthetic stability and fracture treatment. The treatment of such fractures can be complex and is one of the major challenges and this complication is associated with a high morbidity and a significant delay in convalescence. Among the 237 cases, who were treated by cementless total hip arthroplasty from Jan. 1986 to Dec. 1992, 13 cases of femoral fracture were experienced. They usually occured during insertion of prosthesis and preparation of the medullary canal. There were 6 cases of type II fracture, 1 case of type III fracture, 5 cases of type IV fracture and 1 case of type V fracture according to AAOS classification. All of the fracture healed, but the prognosis of these cases must be determined by follow up. We recommend that femoral fractures can be prevented by accurate preoperative evaluation of the size of the femoral canal, identification and management of the predisposing factors for intraoperative fractures.
Arthroplasty, Replacement, Hip ; Causality ; Classification ; Convalescence ; Femoral Fractures ; Femur ; Follow-Up Studies ; Prognosis ; Prostheses and Implants

No abstract available.
Cerebrospinal Fluid* ; Child* ; Humans ; Lactic Acid*

PURPOSE: We compared the first postoperative diagnostic and post-therapy scans of patients who received therapeutic doses of I-131, to investigate the difference in clinical outcomes between patients with concordant findings of diagnostic and post-therapy scans and patients with discrepant (more lesions in post-therapy scan) findings. MATERIALS AND METHODS: The first postoperative diagnostic and post-therapy radioiodine scans of one hundred forty three patients with well differentiated thyroid carcinoma were reviewed. Diagnostic scans were obtained following ingestion of 185 MBq of I-131 and post-therapy scans were obtained after therapeutic dose of 3.7~9.3 GBq of I-131. Successful ablation was defined as no radioiodine uptake on diagnostic radioiodine scan and normal range of serum thyroglobulin level (<10 ng/ml) during serum TSH elevation. RESULTS: Discrepant scan findings were noted in 25 (17.5%) patients. Twenty-two patients (15.4%) showed more lesions in post-therapy scan and 3 patients (2.1%) showed stunning effect. Nine (64.3%) of 14 patients with distant metastasis revealed metastatic lesion(s) only on post-therapy scan. Stunning effect was considered as sublethal damage in 1 patient and treatment by a diagnostic dose in 2 patients. Ablation was achieved in 52.4% (75/143) of all patients. Ablation rate and mean cumulative radioiodine dose were not different statistically between concordant and discrepant groups. CONCLUSION: There were 17.5% difference between diagnostic and post-therapy scan findings when using 185 MBq of I-131 as a diagnostic dose. However, 64.3% of distant metastases were revealed only on post-therapy scan. Ablation rate and mean cumulative radioiodine dose were not different statistically between concordant and discrepant groups. The stunning effect was considered as not only sublethal damage but also treatment by a small diagnostic dose of radioiodine.
Eating ; Humans ; Neoplasm Metastasis ; Reference Values ; Thyroglobulin ; Thyroid Gland* ; Thyroid Neoplasms*

No abstract available.

Tuberous sclerosis is a complex neurocutaneous disease inherited as an autosomal dominant pattern, which is characterized by facial angio-fibroma, mental retardation and seizures. Many cases have been reported in the literatures, but familial cases are relatively rare. We present 9 cases of tuberous sclerois occuring througb 3 generations, which are 3 cases of angiofibroma, mental retardation and seizures, 2 cases of facial angiofibroma and seizures, 1 case of mental retardation and seizures and 3 cases who showed facial angiofibroma only. Two brothers in this family reveald icthyosis vulgaris without tuberous sclerosis.
Angiofibroma ; Family Characteristics* ; Humans ; Intellectual Disability ; Seizures ; Siblings ; Tuberous Sclerosis*

BACKGROUND: Exogenously administered epinephrine under enflurane anesthesia was known to have mild myocardial sensitizing effect. And N2O activates the sympathetic nervous system mildly. We planed this study to confirm cadiovascular effects of clinically administered epinephrine for hemostasis under the enflurane-N2O anesthesia during tonsillectomy. METHODS: Eighty children scheduled to have tonsillectomy were selected randomly and divided into 2 groups as follows; Group E: 1:100,000 epinephrine 2ug/kg and Group EL: 1:100,000 epinephrine containing 1% lidocaine 2 g/kg. Blood pressure, heart rate, and the occurrence of arrhythmia were evaluated before injection, at injection, 1 min, 2 min, 3 min, 5 min and 10 min after injection and 1 min after operation start. RESULTS: In both groups, systolic and diastolic blood pressure and heart rate are increased. But there are no significant statistical differences in each group and between groups. One min after operation, there are significant increases in systolic and diastolic blood pressure and heart rate in both groups (p<0.05), but there is no significant difference between groups. CONCLUSION: Under the enflurane-N2O anesthesia of children, 1:100,000 epinephrine 2ug/kg used for hemostasis could be used comparatively safe without any significant hemodynamic changes. But because there is always the possibility of myocardial sensitization, careful observation is necessary during epinephrine injection under the enflurane-N2O anesthesia.
Anesthesia* ; Arrhythmias, Cardiac ; Blood Pressure ; Child ; Enflurane ; Epinephrine* ; Heart Rate ; Hemodynamics ; Hemostasis* ; Humans ; Lidocaine ; Sympathetic Nervous System ; Tonsillectomy*