The incidences of posttraumatic avascular necrosis of the femoral head were variably reported. In 1980, Calandruccio reported its incidence of 14% in nondisplaced femoral neck fracture and 50% in displaced ones. In general, the prophylactic methods, such as core decompression, bone graft and trochanteric osteotomy were recommended for the treatment of early stages of femoral head avascular necrosis(Ficat-Arlet stage 1 or 2), while the primary replacement surgery for the advanced ones (Ficat-Arlet stage 3 or 4). One of our authors(Y.K. Chung) has performed five cases of corticocancellous bone grafts using combined autogenous free fibular graft and iliac cancellous bone graft, for the post-traumatic femoral head AVN from January 1985 to December 1989 at our hospital, and the following results are obtained: 1. Among the forty nine displaced adult femoral neck fractures, there were five eases of avascular necrosis(10. 2%). 2. There were three male patients and two female ones, and the average age of injury was 48 years old(30 to 57). 3. According to the type of fractures, there were four cases of subcapital fracture and one of transcervical fracture. All of the patients were performed closed reduction and internal fixation with compression hip screw system, including additional Knowles pinning in two cases. 4. Histological study with the excised femoral head, showed that there was no bony union between the grafted cancellous bone and the necrotic head, and the grafted bone has been changed to amorphous necrotic tissue. However, we found a solid consolidation of the grafted bone and the femoral neck portion.
Adult ; Decompression ; Female ; Femoral Neck Fractures ; Femur ; Femur Neck ; Head ; Hip ; Humans ; Incidence ; Male ; Necrosis ; Osteotomy ; Transplants

PURPOSE: The purpose of this study was to observe and compare the changes in the patterns of hemodynamic and blood profiles on the circuit of Extra-corporeal life support system (ECLS) by using a dual pulsatile pump (T-PLS). METHODS: An acute heart failure model using partial pulmonary artery banding was constructed in 12 piglets (20 -25kg). The animals were divided into centrifugal (n=6) and dual pulsatile pump (n=6) group. Each animal was placed on an ECLS system with a membrane oxygenator bypassing the right atrium and the aorta for 2 hours under general anesthesia. The parameters mainly observed were intra-circuit pressure changes, arterial pulsatility (pulse pressure), plasma free hemoglobin, hemodynamic changes, and other blood profiles. The parameters obtained just prior to the bypass were compared with the corresponding parameters obtained two hours after the bypass. RESULTS: Before bypass, the parameters were statistically the same between the groups. Two hours after the bypass, no significant differences were observed between the groups in ABGA, VBGA, AST/ALT, BUN/Cr, and electrolytes; the plasma free hemoglobin was 14.8+/-4.7 g/dl in the dual pulsatile group and 19.1+/-9.1 g/dl in the centrifugal group (p=NS). The pulse pressure was higher in the dual pulsatile pump than in the centrifugal pump group (35+/-8 vs. 11+/-7 mmHg, p=0.0253 mmHg). The highest circuit pressure was generated at the inlet of the membrane oxygenator and was higher in the dual pulsatile group than in the centrifugal group (173+/-12 mmHg vs. 222+/-8 mmHg, p=0.0000). CONCLUSION: The results demonstrate that a dual pulsating mechanism lessens blood cell trauma while providing physiologic pulsatile blood flow. The ECLS system using a dual pulsatile pump (T-PLS) can be useed as an effective and safe driving motor for an ECLS.
Anesthesia, General ; Animals ; Aorta ; Bays ; Blood Cells ; Blood Pressure ; Cardiopulmonary Resuscitation ; Electrolytes ; Heart Atria ; Heart Failure ; Hemodynamics ; Life Support Systems* ; Oxygenators, Membrane ; Plasma ; Pulmonary Artery

BACKGROUND: It has been reported that younger patients with lung cancer have characteristic features that differ from those in older patients. The prognosis for young patients with this disease is controversial. This study aimed to determine the clinicopathological characteristics, the survival rate, and the risk factors associated with the overall survival rate in younger patients with lung cancer. METHODS: The records of 120 young(age≤40) patients with histologically confirmed lug cancer in the Korea Cancer Center Hospital(KCCH) between Jan. 1992 to 1998, 120 older(age>40) patients were randomly selected as the controls. RESULTS: More female patients(45.0% vs. 20.0%, p<0.001) and more adenocarcinoma cases(64.2% vs. 38.3%, p<0.001) were found in the younger group, when compared to the older patients. In NSCLC, advanced disease(stage III B and IV) was more common in the younger patients(90.2%) than in the older patients(62.7%) (p<0.001). The Median survival was 8.6 months in the younger patients and 12.2 months in the older(p=0.003). In a multivariate analysis, only the advanced-stage was an independent negative prognostic factor. CONCLUSION: Lung cancer in the younger age group presents with a more advanced stage resulting in a poor survival rate, which suggests that lung cancer in this population is more aggressive than in older patients.
Adenocarcinoma ; Female ; Humans ; Korea ; Lung Neoplasms* ; Lung* ; Multivariate Analysis ; Prognosis ; Risk Factors ; Survival Rate

BACKGROUND AND OBJECTIVES: The excision of submandibular gland (SMG) has been commonly used for the treatment of calculi in the hilum of SMG, since intraoral removal of the hilar stone has the potential risk of lingual nerve injury and the poor surgical field. However, it would leave loss of remained gland function and external scars after the excision. Therefore, the authors modified the intraoral retrieval techniques as the marsupialization of the Wharton's duct up to the calculi in the hilum. This study reports our clinical experience with the modified intraoral retrieval technique and the advantages of this modality for calculi in the hilum of SMG. SUBJECTS AND METHOD: SMG excision and intraoral removal with marsupialization (IRM) were used from 1994 through 2003 to treat 9 and 16 cases of calculi in the hilum of SMG, respectively. We analyzed the characteristic findings of calculi, surgical morbidities and complications by comparing two different treatment groups. RESULTS: The mean diameter of the calculi was 6.1 mm in patients with SMG excision and 7.8 mm in patients with IRM. The success rate of extraction by IRM of calculi in the hilum were 86.7%. The surgical complications were similar in both groups. The proportion of palpable calculi were significantly increased in the IRM group (92.9% vs 22.2%). We failed to remove the stone by IRM from patients, and stones were impalpable intraorally preoperatively. CONCLUSION: IRM is an excellent alternative method for the removal of palpable calculi located in the hilum of SMG. Furthermore, it would preserve the salivary gland function without external scars and with acceptable surgical complications and morbidities.
Calculi* ; Cicatrix ; Humans ; Lingual Nerve Injuries ; Oral Surgical Procedures ; Salivary Ducts ; Salivary Glands ; Submandibular Gland*

0.05) 2. The mean electric activity of the masticatory muscles was found to have decreased during more clenching than resting, but there was no statistically significant difference because of individual difference of measuring values. (p>0.05) 3. The asymmetry index of masticatory muscles in asymmetric groups was significantly greater during clenching compared with controls. (p<0.05) In conclusion, no right-left difference of muscle activities was found in patients with facial asymmetry before orthognathic surgery and 4weeks afterwards. Not only muscular functioning but also many other factors, such as occlusion, temporomandibular joint disorder and trauma, probably affect facial asymmetry and will be analyzed in future studies. And we will need long term follow-up after orthognathic surgery.]]>
Deglutition ; Electromyography ; Facial Asymmetry ; Follow-Up Studies ; Humans ; Individuality ; Masticatory Muscles ; Orthognathic Surgery ; Prognathism ; Temporal Muscle ; Temporomandibular Joint Disorders

A 32-yr-old male patient with recurrent pneumothorax associated with bronchial atresia of the subsegmental branch of the posterior segmental bronchus of the right upper lobe was successfully treated with right upper lobectomy. Before surgery, the bronchial atresia with pneumothorax was suspected on the chest radiograph and CT scans, which showed the findings of bronchocele with localized hyperinflation of the right upper lobe. The examination of surgical specimen from the resected right upper lobe suggests that the cause of the recurrent pneumothorax was the rupture of the subpleural bullae in the hyperinflated lung segment distal to the atretic bronchus.
Adult ; Bronchi/*abnormalities/pathology ; Bronchial Diseases/*diagnosis ; Human ; Male ; Pneumothorax/*diagnosis ; Respiratory System Abnormalities/*pathology ; Tomography, X-Ray Computed

BACKGROUND: Bulla is an air-filled space within the lung parenchyma resulting from deterioration of the alveolar tissue. Molecular mechanism of the formation of the bulla is not well described. Fibroblast growth factor(FGF)-7, bone morphogenetic protein(BMP) receptor, and transforming growth factor(TGF)-beta receptor are known to have a stimulatory or inhibitory role in the lung formation. We investigated to see if these growth factor or cytokine receptors are involved in the bulla formation by immunohistochemical staining of bullous lung tissues from patients with primary spontaneous pneumothorax. MATERIAL AND METHOD: Bullous lung tissues were obtained from 31 patients with primary spontaneous pneumothorax, including 30 males and 1 female from 15 to 39 years old. The bullous tissues were obtained by video-thoracoscopic surgery and/or mini-thoracotomy and fixed in formalin. Blocks of the specimens were embedded with paraffin and cut into 5~6 micrometer thick slices. The sections were deparaffinized and hydrated and then incubated with primary antibodies against FGF-7, BMP-RII, or TGF-RII. RESULT: Of the 31 patients, 24 were TGF-RII positive including 18 strong and 6 weak positives. Observation with high magnification showed that strong immunostaining was detected in the boundary region between bullous and normal lung tissues. In contrast, all of the sections were negative with FGF-7 or BMP-RII antibodies. CONCLUSION: These results suggest that overexpression of TGF-beta RII may be involved in the formation of bulla, although further molecular studies are needed to find out more detailed molecular mechanisms.
Adult ; Antibodies ; Female ; Fibroblasts ; Formaldehyde ; Humans ; Lung ; Male ; Paraffin ; Pneumothorax* ; Receptors, Cytokine ; Transforming Growth Factor beta

Benign gastrobronchial fistula (GBF) after Ivor Lewis operation is a very rare and serious complication. We describe a patient with GBF who was successfully managed on the single-stage repair, 15 months after the Ivor Lewis operation. After the division of the GBF, the bronchial and gastric defects were closed directly. The omental flap and the pedicled 5th. intercostal muscle flap were interposed between the closed defects. The literature of this subject is reviewed and discussed.
Esophageal Neoplasms ; Esophagectomy* ; Fistula* ; Gastric Fistula ; Humans ; Intercostal Muscles

BACKGROUND: Thoracoscopic R3 (above the third rib)sympathicotomy has been performed as an effective method in treating palmar hyperhidrosis because it is effective in eliminating the symptoms of hyperhidrosis and has lower degree of compensatory hyperhidrosis than that of sympathectomy. Most of the results published were based on the short-term follow up. So we evaluated the intermediate term follow up results of the R3 sympathicotomy. MATERIAL AND METHOD: From April 1999 to August 2001, ninety-four patients with palmar hyperhidrosis had been treated by R3 sympathicotomy at the Inha University Hospital. Follow-up study was completed for 76 patients (male 38, female 38) and average follow-up period were 25+/-9.1 (15~50) months. The sympathetic trunk passing above the upper border of third rib was divided by electric cautery. The patient's satisfaction after surgery was estimated using the analogue scale from score 0 to 100 (100 means perfect satisfaction). RESULT: The scale of patient's satisfaction immediately after operation was 92.36+/-9.93. After 15 months, the scale of satisfaction was decreased to average 71.80+/-20.24 and it is statiscally significant. The cause of dissatisfaction were compensatory hyperhidrosis and recurrence of symptom. The degree of sweating immediately after operation was mean 0 and after 15 months it increased to mean 1.5. The degree of the compensatory hyperhidrosis immediately after operation was mean 1 and it increased to mean 5 after 15 months. CONCLUSION: R3 sympathicotomy has excellent therapeutic results immediately after operation but therapeutic effectiveness is becoming to decrease 15 months after operation. The common causes of dissatisfaction are compensatory hyperhidrosis and recurrence of hyperhidrosis.
Cautery ; Female ; Follow-Up Studies* ; Humans ; Hyperhidrosis* ; Recurrence ; Ribs ; Sweat ; Sweating ; Sympathectomy

BACKGROUND: One of the theoretical advantages of skeletonized internal mammary artery harvesting in coronary artery bypass surgery is to minimize the interruption of the sternal blood flow inevitably accompanied by internal mammary harvesting. A study using bone scan is designed to determine the effects of internal mammary artery harvesting technique on the sternal blood flow. MATERIAL AND METHOD: From April 2002 to March 2003, 27 patients out of 48 patients who underwent the isolated coronary bypass surgery were enrolled into the study. The enrolled patients underwent bone scan in the preoperative period and postoperative period respectively. Bilateral internal mammary arteries were used in 8 patients (BIMA group) and single left internal mammary artery in 19 patients (LIMA group). The patients in LIMA group were divided into two groups: LIMA_skel group, in whom left internal mammary artery was harvested in skeletonized fashion (n=12), and LIMA_ped group, in whom left internal mammary artery was harvested in pedicled fashion (n=7). After the bone scan, the region of interest (ROI) was created on the left half of the sternum and the mirror image with the same pixel numbers was placed on the right half of the sternum. The mean counts per pixel on the left side of the sternum was compared with those on the right side and expressed as left to right ratio (L/R ratio). RESULT: In LIMA group, the L/R ratio decreased from 94.6+/-4.1% to 87.9+/-6.9% (p=0.003) after the operation as compared to BIMA group, in which no change of the L/R ratio was observed. The changes of the L/R ratio in LIMA_skel group and LIMA_ped group were from 95.3+/-4.2% to 88.3+/-7.7% and from 93.4+/-3.9% to 87.4+/-5.8% respectively. The % changes in L/R ratio were -7.44+/-7.08 in LIMA_skel group and -6.17+/-9.08 in LIMA_ped group, which did not reach the statistical difference. CONCLUSION: Ipsilateral sternal blood flow is interrupted by internal mammary artery harvesting as evidenced by the decrease in L/R ratio after left internal mammary artery harvesting irrespective of the harvesting techniques. Skeletonized harvesting did not show superiority in respect to sternal blood flow as compared to pedicled harvesting.
Coronary Artery Bypass ; Humans ; Mammary Arteries* ; Postoperative Period ; Preoperative Period ; Regional Blood Flow ; Skeleton* ; Sternum