In the treament of the non-union or delayed union of the long bone, it is very difficult to achieve union. We have experienced 15 cases of non-union or delayed union of the tibia who were treated by sliding inlay bone graft with cancellous chip bone graft from June, 1979 to April, 1984. The results were as follows: l. In all cases cancellous iliac bone graft were performed, and additionally internal fixation or simple cast immobilization were done for stabilization of the fracture site. 2. The average bone union time was 2.8 months in delayed union and 4.4 months in non-union. 3. 1n 5 failed cases there were reactivation of previous infections. 4. In 5 cases of postoperative infection, sliding grafts were sequestrated in all. 5. The advantage of this procedure in the cases without infection were: 1) In the anteromedial cortex of tibia, such a surgical intervention permits easy skin closure and prevents skin necrosis. 2) Such a procedure can recanalize the obliterated medullary cavity without disturbance of the fracture ends during operation. 6. This procedure was proved to be one of valuable adjuvant method in the treatment of uninfected non or delayed union of the tibiae.
Immobilization ; Inlays ; Methods ; Necrosis ; Skin ; Tibia ; Transplants

We have experienced 7 cases of resurfacing prosthesis in comminuted patellar fracture in 5 patients, The follow up time was from 1 year and 6 months to 3 years and 6 months. The dome-shaped plastic patellar prosthesis was used after fracture healing. Each case was evaluated by Levitt's method of evaluation and we compared with patellectomy in “End results of patellectomy” reported by West, F. E. in 1962 in quadriceps power, range of motion, appearance and pain on the knee. The results were as follows: 1. By Levitt's method of evaluation, 6 cases were satisfactory, but 1 case was unsatisfactory. 2. The resurfacing prosthesis was better than patellectomy in quadriceps power, range of motion and appearance, but it was a little more painful.
Follow-Up Studies ; Fracture Healing ; Fractures, Comminuted ; Humans ; Knee ; Methods ; Patella ; Plastics ; Prostheses and Implants ; Range of Motion, Articular

No abstract available.
Humans ; Magnetic Resonance Imaging, Cine* ; Spinal Cord Diseases*

No abstract available.

BACKGROUND: Traditional visual reading of patch-test reactions is a rather subjective method, lacking the sensitivity and reproducibility needed in experimental studies. Recently the laser Doppler perfusion imaging (LDPI) has been used to measure objectively the increase in superficial blood flow which results in the appearance of erythema. OBJECTIVE: We designed this study to examine the relationship between the LDPI measurement and visual reading after patch test to several different irritants. METHODS: In this study, reading of erythema in experimentally-induced irritant contact dermatitis was performed visually and by laser Doppler perfusion imaging (LDPI). In addition, we investigated whether the LDPI measurement was appropriate in the routine patch test clinic. RESULTS: A close correlation was shown between the 2 methods (r=0.9046, p<0.001) and the LDPI producing mean adjusted perfusion values (APVs) was able to discriminate between the different visual grades. CONCLUSION: LDPI is a valuable instrument to objectively assess intensity of irritant patch-test reaction, and is indeed one of the few methods which overcomes the inter-individual variations in visual reading, but this instrument is not appropriate to use routinely in patch test clinic because of unacceptably long measurement time.
Dermatitis, Contact ; Erythema ; Irritants ; Methods ; Patch Tests ; Perfusion Imaging* ; Perfusion*

A case is presented in which left-sided hemiparesis was caused by a fibromuscular dysplasia of the right internal carotid artery in the neck, and it used as a basis for discussion of the angiographic features. The 24-year-old woman was admitted to our Department of Neurosurgery, Korea University hospital, with the complaints of headache and left-sided hemiparesis which developed abruptly about one month before this admission. The carotid angiography was performed by puncture of the right common carotid artery under the clinical impression of cerebral thrombosis, which showed no gross intracranial abnormalities. But the characteristic findings were observed under and widening of the arterial lumen which are so-called loose stocking appearance or 'string of beads' appearance and are the typical feature of fibromuscular dysplasia. No surgical interventions such as arterial reconstruction and grafting, or arterial dilatation with bougies were applied on the patient, and she was discharged from the hospital three days after the admission. Fibromuscular dysplasia is a rare sclerotic, noninflammatory lesion of unknown etiology involving the wall of large arteries. This disease is found most frequently in early adult life and women are afflicted more often than men, This condition has been described most often in the renal arteries, where it has been found to be a cause of hypertension. Among the involvement of carotid system, the cervical portion of the internal carotid artery is most often affected, and the involvements are often bilateral. When localized to the internal carotid arteries, it can give symptoms of intermittent or permanent cerebral ischemia, but is usually asymptomatic. The typical angiographic appearance is the main parameter for diagnosis of fibromuscular dysplasia.
Adult ; Angiography ; Arteries ; Brain Ischemia ; Carotid Artery, Common ; Carotid Artery, Internal* ; Diagnosis ; Dilatation ; Female ; Fibromuscular Dysplasia* ; Headache ; Humans ; Hypertension ; Intracranial Thrombosis ; Korea ; Male ; Neck ; Neurosurgery ; Paresis ; Punctures ; Renal Artery ; Transplants ; Young Adult

A turret exostosis is a rare complication of minor trauma to the dorsum of the fingers. In 1966, Wissinger reported first and called turret exostosis. Until now any case have not been reported in Korea. A twenty year-old man complained a painful mass on dorsum of the middle phalanx of the left 4th finger. Thirteen months ago, he had deep laceration of the left 4th finger and extensor tendon was ruptured totally with dorsal cortical breakage of the middle phalanx. Radiologically, there is a smooth, dome shaped, and well-defined osseous mass fused to the underlying bony cortex on the earlier injury site. This is a finding that suggest turret exostosis. We report a case and a brief review of literature.
Exostoses ; Fingers ; Korea ; Lacerations ; Rupture ; Tendons

PURPOSE: There are several methods for the reconstruction of partial urethral defect. Split-thickness skin graft, full-thickness skin graft, prepuce flap and free flap are those. Despite partial success using these methods, most results are unsatisfactory due to frequent complications such as postoperative infection, fistula formation, hair growth and stricture. There has been several pioneering experiments in this field using autogenous vein graft, but the results of this procedures were controversial. Therefore, this study was designed to illustrate the possibility of using vein graft for the reconstruction of partial urethral defect. MATERIALS AND METHODS: Two different types of vein graft method were performed in total 20 New Zealand White rabbits with partial urethral defect. Firstly, for the patch graft group, 1x cm rectangular vein graft was sutured at defective area of the same size. Secondly, for the tubed graft group, vein graft segment of 1 cm long was replaced at segmental urethral defect of the same length. Histologic study was performed at 3 and 8 weeks postoperatively in each group. And retrograde urethrogram was checked at eight weeks postoperatively. RESULTS: On histologic study, the process of transitional cell epithelial replacement within grafted vein was uniformly observed in both experimental group at three week postoperatively. At eight weeks postoperatively, the epithelial replacement was almost complete and histologically undistinguishable. In the retrograde urethrogram performed on the day of the 8th week postoperatively, in patch graft group, contrast material was well advanced to the bladder and showed no stricture, and two of five rabbits of tubed graft group showed mild stricture with luminal patency at the graft site. CONCLUSIONS: Natural urethral epithelium was restored in grafted venous segment irrespective of type of graft. Mild stricture was observed in 40% of tubed graft group while complete reconstruction was possible in patch graft group.
Constriction, Pathologic ; Epithelium ; Fistula ; Free Tissue Flaps ; Hair ; Phenobarbital ; Rabbits* ; Skin ; Transplants* ; Urethra ; Urinary Bladder ; Veins*

BACKGROUND: This study was conducted to determine the effect of glycopyrrolate or atropine on attenuating hemodynamic responses such as bradycardia and hypotension during anesthetic induction with remifentanil and sevoflurane in elderly patients, in a randomized placebo-controlled double blinded manner. METHODS: 60 patients over 65 years with ASA physical status 1 or 2 were allocated to one of three groups of 20 each. Each group received saline placebo (group C) or glycopyrrolate 4microgram/kg (group G) or atropine 0.5 mg (group A) immediately after induction of anesthesia, and then remifentanil 1microgram/kg bolus was given over 30s. Mean arterial pressure (MAP) and heart rate (HR) were measured before anesthetic induction, before intubation, and during 5 minutes after intubation at 1 minute interval. RESULTS: MAP remained stable and HR increased significantly 1 min after intubation in all groups. MAP decreased significantly during 2-5 minute after intubation in all groups. HR decreased in the group C, remained stable in the group G, and increased in the group A significantly during 3-5 minute after intubation. Hypotension (systolic blood pressure < 90 mmHg checked twice) occurred in 8 patients in the group C, 1 patient in the group G, and none in the group A. CONCLUSIONS: Glycopyrrolate and atropine attenuated the hemodynamic responses to laryngoscropy and intubation during anesthetic induction with remifentanil 1microgram/kg bolus dose and sevoflurane.
Aged* ; Anesthesia ; Arterial Pressure ; Atropine* ; Blood Pressure ; Bradycardia ; Glycopyrrolate* ; Heart Rate ; Hemodynamics* ; Humans ; Hypotension ; Intubation

BACKGROUND: Laryngoscopy and endotracheal intubation cause hemodynamic changes such as hypertension and tachycardia. Adjuvant fentanyl administration have been used to reduce the hemodynamic changes. Remifentanil, a newly developed ultra short acting opioid, has recently been used to reduce the hemodynamic changes. This study investigated the effects of fentanyl and remifentanil on hemodynamic responses to laryngoscopy and endotracheal intubation. METHODS: Sixth ASA class I or II patients who scheduled for elective surgery were divided randomly into 3 groups. Each patient received normal saline, fentanyl 1.5microgram/kg or remifentanil 1.5microgram/kg, respectively. Predetermined drugs for each group were administered over 30 seconds after induction of anesthesia with TCI of propofol effect site target concentration 4.0microgram/ml and rocuronium 1.0 mg/kg. Laryngoscopy and endotracheal intubation was carried out and systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and heart rate (HR) were measured baseline (initial), before intubation (BI) and during 5 minutes after intubation (I1 to I5). RESULTS: In the fentanyl group, I1 HR value was significantly higher than baseline. In the remifentanil group, SBP and MAP were significantly lower than baseline during post-intubation period. Fentanyl and remifentanil groups show lesser hemodynamic changes than those in the control group. There were no significant differences of hemodynamic changes between fentanyl and remifentanil group. CONCLUSIONS: Fentanyl and remifentanil can attenuate hemodynamic responses after laryngoscopy and endotracheal intubation.
Anesthesia* ; Arterial Pressure ; Blood Pressure ; Fentanyl* ; Heart Rate ; Hemodynamics* ; Humans ; Hypertension ; Intubation ; Intubation, Intratracheal* ; Laryngoscopy ; Propofol* ; Tachycardia