No abstract available.
Humans ; Primary Health Care*

A fracture of the distal tibial articular surface is fortunately an uncommon injury, since it can be exeptionally difficult to manage. The term plafond is gar'nering general acceptance since there is no anatomic name for the specific location of this fracture. The term was introduced more than 50 years ago in American orthopaedic literature to describe these injuries. The literal meaning of plafond is the underside of a floor, i.e., a ceiling, so the term refers to that portion of the distal articular surface of the tibia which articulates with the superior articular surface of the talus. It excludes the medial malleolar joint surface. Fracture of the plafond have also been called compression, pylon, Malgaigne and explosion fractures. A plafond fracture is defined as one caused primarily from direct axial compression resulting in elevation andgor displacement of all or part of the distal articular surface of the tibia, excluding isolated or combined fractures of the medial and posterior malleoli that are recognizably caused by rotational forces. We reviewed 16 cases(14 patients) of tibial plafond fractures treated at the Department of Orthopaedic Surgery of Soan Chun Hyang University Hospital during 8.5 years period from June 1974 to December 1982. The longest duration of follow-up was 5 years and 6 months, the shortest, 6 months, and the average, 1 year and 6 months. They were classified according to Moore et al., and assessed according to the criteria of Joy et al. The following results were obtained: l. Of the 14 patients, male were 12, female were 2. 2. The average age of the patients was 38 years old. 3. The most common causative injury was fall-down. 4. The most common type in radiological study was dorsiflexion type. 5. In method of treatment, operative treatment was done in 9 cases and non-operative in 6 cases. 6, The average duration of the cast immobilization in non-operative treatment was 12 weeks and operative, 10 weeks. 7. Better results were obtained by operative treatment than non-operative treatment. 8, The complications were encounted in 1 case of non-operative, 2 cases of operative treatment. 9. We agree that the accurate anatomical reduction with rigid internal fixation assures better results in the tibial plafond fracture.
Clinical Study ; Explosions ; Female ; Follow-Up Studies ; Humans ; Immobilization ; Joints ; Male ; Methods ; Talus ; Tibia

PURPOSE: In spite of many published reports about the primary gastrointcstinal lymphoma in Korea, the majority of them unfortunately involved a small number of patients with diverse results conceming treatment, patient survival, and prognostic factors. There also were few reports mainly focusing on primary intestinal lymphoma alone. Therefore we studied the patient-survival and prognostic factors in 52 cases of intestinal lymphomas. MATERIALS AND METHODS: We reviewed fifty two patients who received treatment due to primary intestinal lymphoma at Severance hospital, from January 1980 to June 1995. RESULTS: The intestinal lymphomas were located in descending order of frequency at the terminal ileum, i1eocecal region, right colon, and the jejunum. The most common histologic type was diffuse large cell type and the majority showed an intermediate grade of differentiation. The average survival time was 40.7 months with a 5 year survival rate of 41.4%. The overall and complete remission rate of the intestinal lymphoma were 76.2%, 64.3%, respectively. Additional chemotherapy or radiotherapy to surgery improved remission rate. The overall 5 year survival rates were 50.4%, 47.3%, 33.3%, and 25.0% in stage I, II1, II2 and III~IV, respectively. The 5 year survival rate after curative resection was 57.0% and 16.6% after incomplete resection. The significant prognostic factors were residual tumor, site of the lesion, multiplicity, and adjacent organ invasion. However, the site of the lesion alone (worst in the jejunum) was the sole independent variable on multivariate analysis. CONCLUSION: We concluded that early diagnosis and curative resection were important to improve survival rates in the primary intestinal lymphoma. More number of such cases are needed for further comparison of various treatment methods and results.
Colon ; Drug Therapy ; Early Diagnosis ; Humans ; Ileum ; Jejunum ; Korea ; Lymphoma* ; Multivariate Analysis ; Neoplasm, Residual ; Radiotherapy ; Survival Rate

If peptic ulcer perforates in the presence of shock or concurrent medical disease or delay of operation, the postoperative morbidity and mortality are high. Years ago most discussion was on whether urgent definite surgery was the most effect therapy, nowadays there is a tendency to less invasive measures in risk situation. Although the simple closure or omental patching has its weak point of high frequency of symptomatic relapse, it is a simple and safe method with the advantage of having a low complication rate than other definite operations. So many surgeons frequently use this simple method in high risk situation. But in the rare instance of large perforation of prepyloric ulcer, this simple closure method is not safe to apply. The authors experienced an unusual case of large prepyloric ulcer perforation in an 80 year old female who had undergone a previous operation(choledocho-duodenostomy). Moreover she had suffered from several concurrent medical diseases and the operation was delayed. We succeeded in repairing the perforation using controlled gastrostomy and omental patching method, and present this case with a review of the literature.
Aged, 80 and over ; Female ; Gastrostomy* ; Humans ; Mortality ; Peptic Ulcer Perforation* ; Peptic Ulcer* ; Recurrence ; Shock ; Ulcer

No Abstract Available.
Endothelium, Corneal* ; Lidocaine*

Beh et's syndrome is a multisystem disorder presenting with recurrent oral and genital ulcerations as well as ocular involvement. Vascular complications consist of venous thromboembolism, arterial aneurysms and occlusions, and they develop in about 25% of patients. Weakening of the aortic wall may lead to aneurysms that may rupture and cause life-threatening hemorrhage, but nothing in the surgical and nonsurgical techniques proposed for the treatment for aneurysms in Beh et's syndrome has proved to be satisfactory. The traditional treatment for thoracic aotic aneurysms is the surgical replacement of a prosthetic graft. Although advances in the operative care of patients with thoracic aortic aneurysms have been achieved, the associated morbidity and mortality are considerable, especially in those with coexisting conditions such as advanced age, coronary artery disease and heart failure. Currently, transluminally placed endovascular stent-grafts offer an alternative approach to treatment that is potentially less invasive with a lower risk. We report a 37-year-old male patient with thoracic aortic aneurysm associated with Beh et's syndrome. Transluminal endovascular stent-graft placement was attempted : the stent-graft was introduced through a 22-Fr sheath using a common femoral artery cut down and expanded to 25-30 mm in diamter. There was increased thrombosis of the aneurysm on a follow-up imaging study, and the patient was discharged without complications.
Adult ; Aneurysm ; Angioplasty ; Aortic Aneurysm, Thoracic* ; Behcet Syndrome* ; Coronary Artery Disease ; Femoral Artery ; Follow-Up Studies ; Heart Failure ; Hemorrhage ; Humans ; Male ; Mortality ; Rupture ; Thrombosis ; Transplants ; Ulcer ; Venous Thromboembolism

Beh et's syndrome is a multisystem disorder presenting with recurrent oral and genital ulcerations as well as ocular involvement. Vascular complications consist of venous thromboembolism, arterial aneurysms and occlusions, and they develop in about 25% of patients. Weakening of the aortic wall may lead to aneurysms that may rupture and cause life-threatening hemorrhage, but nothing in the surgical and nonsurgical techniques proposed for the treatment for aneurysms in Beh et's syndrome has proved to be satisfactory. The traditional treatment for thoracic aotic aneurysms is the surgical replacement of a prosthetic graft. Although advances in the operative care of patients with thoracic aortic aneurysms have been achieved, the associated morbidity and mortality are considerable, especially in those with coexisting conditions such as advanced age, coronary artery disease and heart failure. Currently, transluminally placed endovascular stent-grafts offer an alternative approach to treatment that is potentially less invasive with a lower risk. We report a 37-year-old male patient with thoracic aortic aneurysm associated with Beh et's syndrome. Transluminal endovascular stent-graft placement was attempted : the stent-graft was introduced through a 22-Fr sheath using a common femoral artery cut down and expanded to 25-30 mm in diamter. There was increased thrombosis of the aneurysm on a follow-up imaging study, and the patient was discharged without complications.
Adult ; Aneurysm ; Angioplasty ; Aortic Aneurysm, Thoracic* ; Behcet Syndrome* ; Coronary Artery Disease ; Femoral Artery ; Follow-Up Studies ; Heart Failure ; Hemorrhage ; Humans ; Male ; Mortality ; Rupture ; Thrombosis ; Transplants ; Ulcer ; Venous Thromboembolism

BACKGROUND AND OBJECTIVES: Percutaneous intervention has become an established technique in the treatment of peripheral arterial obstructive disease. This study was performed to evaluate the procedural success and long-term outcome of percutaneous intervention of the superficial femoral artery (SFA), and to determine the factors that influence the long-term outcome. SUBJECTS AND MEHTODS: Eighty-eight consecutive lesions, in 76 subjects (mean age 65) with chronic lower limb ischemia and SFA obstruction, diagnosed with angiography were included in this study. The angiographic success was defined as residual stenosis <30% and the clinical success as an improvement by at least one clinical category. The clinical patency was defined as an absence of symptom recurrence and target lesion revascularization during the follow up period. The predictors of the outcome were also determined. RESULTS: Balloon angioplasty only was performed in 39 lesions and thrombolysis only in 2, whereas stenting was performed in 47 lesions. Seventy four of the 88 attempts (84%) at recanalization were angiographically successful, while 73 (83%) experienced clinical improvement. The twelve month patency was 67%. Critical ischemia (versus intermittent claudication)(relative risk 4.2, p=0.020) and renal failure (relative risk 4.1, p=0.016) were independent negative predictors of the patency. CONCLUSION: Percutaneous intervention of the SFA yielded a high procedural success rate, with an acceptable long-term outcome. Symptoms of critical ischemia and renal failure were predictive of a low long-term patency.
Angiography ; Angioplasty ; Angioplasty, Balloon ; Arterial Occlusive Diseases ; Constriction, Pathologic ; Femoral Artery* ; Follow-Up Studies ; Ischemia ; Lower Extremity ; Outcome Assessment (Health Care) ; Recurrence ; Renal Insufficiency ; Stents

BACKGROUND: The need for a new healthcare system is growing due to the paradigm shift from health supervision to health maintenance. Previously, we performed a pilot study that examined the effectiveness of a ubiquitous healthcare (U-healthcare) diabetes management program which consists of self-monitoring of blood glucose (SMBG) and mobile phone services for elderly patients with type 2 diabetes mellitus. In this study, we investigated the effect of a diabetes management program using U-healthcare based on the self-care skills of elderly patients with diabetes mellitus. METHODS: From July to October 2005, 17 patients were recruited and provided with a blood glucometer with the ZigBee module and a mobile phone. In addition, the patients' understanding of diabetes self-care skills was examined at the beginning and end of the study. At the end of the study, we determined the level of patient satisfaction regarding U-healthcare services. RESULTS: The patients' test scores on their understanding of diabetes mellitus improved from 57.2 +/- 20.7 to 72.7 +/- 13.4%. Specifically, patient knowledge of the basic principles for a proper diabetic diet (52.9% vs. 82.4%, P = 0.046), foods that influence blood sugar level (41.2% vs. 76.5%, P = 0.007) and the influence of beverage choice (41.2% vs. 64.7%, P = 0.007), all increased. In addition, a significant increase in knowledge of living standards regarding diabetes mellitus was observed (64.7% vs. 88.2%, P = 0.0032). CONCLUSION: We conclude that the U-healthcare incorporating SMBG could be promising, as it improves self-management skills of diabetes mellitus patients, as well as their understanding of the disease.
Aged ; Beverages ; Blood Glucose ; Blood Glucose Self-Monitoring ; Cellular Phone ; Delivery of Health Care ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Diet, Diabetic ; Health Services Research ; Humans ; Organization and Administration ; Patient Satisfaction ; Pilot Projects ; Self Care ; Socioeconomic Factors

This animal study was conducted to investigate the effect of holmium:YAG laser thermokeratoplasty on correction of hyperopic astigmatism. A pulsed holmium:YAG laser emitting a wavelength of 2.06 micrometer was used. Arcuate, reverse arcuate, linear patterns of laser burn were applied along the flat corneal meridian and their effects on the rabbit corneal curvature were studied. Keratometric measurements and cycloplegic refractive error were determined preoperatively, one, two, and three months after operation. The changes of refractive astigmatism in three patterns of laser burn were 0.8130, 3.0243, 0.8437 diopter, respectively, compared to that of the control group on postoperative three months. The changes of keratometric astigmatism were 1.1719, 3.0737, 0.7812 diopter, respectively, compared to that of the control group on postoperative three months. We found that holmium:YAG laser thermokeratoplasty is effective in steepening flat corneal meridian, and the most effective pattern is reverse arcuate type. In future holmium:YAG laser thermokeratoplasty might be clinically applicable as a operation of hyperopic astigmatism correction.
Animals ; Astigmatism* ; Burns ; Rabbits* ; Refractive Errors