This treatise summarizes the medical facts about the persistent vegetative state(PVS) and the associated issues. In August 1998, the opinions of the 380 neurologists and the 1007 neurosurgeons are inquired about the diagnostic criteria of PVS, the degree and the withdrawal of treatment on PVS patients. The response rate is 18.8%. The diagnostic criteria of PVS is determined by the items approved above 5007o of responses. (1) no evidence of cerebral function and an inability to interact with visual, auditory stimuli and follow commands. (2) maintaining the respiratory function with spontaneous respiration and normal respiratory pattern. (3) spontaneous eye opening and eye ball movements without sustained tracking. (4) variably preserved brain stem reflexes. (5) presence of sleep-wake cycles. (6) (1)-(5) symptoms should be persist for 6 months after the development of vegetative state. (7) the diagnostic criteria of PVS should be applied more than 3 times during the minimum observation period. (8) this diagnostic criteria of PVS could be applied to adults over 7 ages. As to the degree of treatment, nasogastric tube feeding and air-way keeping through the tracheostomy are approved over 9007b. Also antibiotics can be used in infection. As to the withdrawal of treatment, do not resuscitate order of patient s family is accepted by 46.1% in an emergency condition like cardiac arrest. But discharge against medical advice by the patient s family is accepted by 73.107o in non-emergency condition. In the case of neonates, parents decision is more determinative than any other thing.
Adult ; Anti-Bacterial Agents ; Brain Stem ; Emergencies ; Enteral Nutrition ; Heart Arrest ; Humans ; Infant, Newborn ; Korea* ; Parents ; Persistent Vegetative State* ; Reflex ; Respiration ; Tracheostomy

Although osteltis fibrosa cystica was the clinical manifestation originally recognized as a feature of the primary hyperparathyroidism, its frequency in diagnosed cases currently has decreased. Affected patients are now being detected in earlier stages of the disease. We have experienced a case of primary hyperparathyroldism with the typical bony changes and the pathologic, subtrochanteric fracture of left femur. We have treated the fracture with Zickel nalling and parathyroidectomy was performed. Four months after the removal of parathyoid adenoma the fractured femur healed well.
Adenoma ; Femur ; Fractures, Spontaneous ; Humans ; Hyperparathyroidism, Primary ; Parathyroidectomy

More than 100 surgical methods were described as the treatment of recurrent patella dislocation. These can be divided into two categories, the proximal, dynamic reconstruction and the distal, static reconstruction. We treated a case of recurrent patella dislocation with a new method, using gracilis. The tendon of gracilis was dissected and cut at the point about 7cm proximal to the insertion. A 'H' shaped slot was made subperiosteally in the anterior surface of patella. The both ends of cut gracilis tendon were imbedded into the 'H' shaped slot of patella and sutured. So the gracilis tendon could act as a static and dynamic stabilizer. The result was excellent at 1 year follow up.
Dislocations ; Follow-Up Studies ; Methods ; Patella ; Tendons

No abstract available in English.
Orthopedics

Spinal stenosis is a localized narrowing of spinal canal due to strurctural abnormalities. Its symptoms are obscure, and characterized by chronic, poorly localized, bilateral nerve root compression signs. Computerized tomography(CT) has been accepted as almost an absolute diagnostic method for spinal stenosis after its application in the orthopedic field. During the period of 2 years, from March 1982 to March 1984, 26 cases of spinal stenosis were treated surgically after botlt CT scanning and myelography. We obtained following results about advantage of CT scanning in spinal stenosis. 1. Myelography showed following findings: Hourglass defect 9, Complete block 8, Unilateral focal defect 4, Uniform narrowing 1, Mixed 2, Negative finding 2. Myelographic finding was not specific for spinal stenosis and diagnostic accuracy was inferior to CT. 2. The type of spinal stenosis was identified by CT scan finding. Of 26 cases, 21 cases were degenerative spinal stenosis, of which central stenosis was present in 7 cases, and lateral stenosis was present in all cases. The remaining 5 cases were combined type, and both central and lateral stenosis were present in all cases. 3. The diagnostic accuracy,in localizing the level of stenosis was 61.5% by myelography, and 96.2% by CT scan. CT was especially superior to myelography in the localization of the multi-segmental stenosis. 4. CT gives valuable information about extent and degree of stenosis, especially lateral recess stenosis, thus helping the surgeon to decide on the extent of decompressive lamininectomy preoperatively.
Clothing ; Constriction, Pathologic ; Methods ; Myelography ; Orthopedics ; Radiculopathy ; Spinal Canal ; Spinal Stenosis ; Tomography, X-Ray Computed

A 66-year-old female patient had a firm, non-tender, dome shaped mass on the scalp. The lesion had enlarged slowly for 2 years, and measured about 4 × 6 cm. The histologic finding of the skin biopsy specimen demonstrated an infiltration of immature plasma cells in the dermis, which express monoclonal cytoplasmic lambda light chain by immunohistochemical stainings, and staging work-up after the biopsy revealed no evidence of disease in other foci. The mass on the scalp was treated successfully by radiation therapy, with the diagnosis of primary cutaneous plasmacytoma.
Aged ; Biopsy ; Cytoplasm ; Dermis ; Diagnosis ; Female ; Humans ; Plasma Cells ; Plasmacytoma* ; Scalp ; Skin

In certain low-grade malignant tumors such as chondrosarcoma and giant cell tumor, radical treatments may provide a good chance for cure. And large bony defect after the radical treatment can be filled with the massive bone graft. Recent advances in clinical microsurgery have made free tissue transfer a clinical reality, and Taylor in 1975, first reported the technique of free vascularized fibula graft for the reconstruction of large tibial defects with excellent clinical results. We tried wide excision and free vascularized bone graft in 6 patients with malignant or aggressive bone tumor from April 1981 to November 1985 and followed up for more one year. Mean follow up of free vascularized bone graft is 26.4 months and that of devascularized bone graft is 22.6 months. The results of the free vascularized bone graft were compared with 10 patients who were treated with the wide excision and the devascularized bone graft. In this analysis, free vascularized bone graft is superior to devascularized bone graft in bony union, complications and functional results.
Chondrosarcoma ; Fibula ; Follow-Up Studies ; Giant Cell Tumors ; Humans ; Microsurgery ; Transplants

Purpose: Diabetic foot ulcers and gangrene are major complications of diabetes, often accompanied by peripheral vascular occlusion.Revascularization is performed to restore blood flow and reduce complications such as amputation surgery. Nevertheless, reocclusion, a frequently reported complication after revascularization, often necessitates further lower limb amputations to facilitate rehabilitation and ambulation. This study examined the factors influencing the performance of secondary revascularization procedures in patients with diabetic foot gangrene who even underwent transtibial amputation (TTA) following revascularization. Materials and Methods: A retrospective study was conducted on 36 patients with diabetic foot gangrene who underwent TTA after revascularization from March 2005 to March 2022. The factors influencing restenosis were classified into three categories: revascularization factors, preoperative factors, and intraoperative factors. The revascularization factors were categorized based on whether percutaneous transluminal angioplasty (PTA) or bypass surgery had been performed. Preoperative factors included the patient’s age, gender, body mass index (BMI), hypertension, and other relevant factors. Intraoperative factors included surgery duration, blood loss, and transfusion. The study examined the factors influencing secondary revascularization in these three categories. Results: Among the 36 patients in the study, 27.8% (11 patients) underwent secondary revascularization procedures. There was no significant correlation between the performance of secondary revascularization and the type of revascularization procedure, whether PTA or bypass surgery (p>0.05). Similarly, no significant differences were observed in preoperative factors (including age, BMI, smoking status, HbA1c, and underlying diseases) and intraoperative factors (surgery duration, blood loss, and transfusion). On the other hand, regarding gender, all patients who underwent revascularization procedures were male, indicating a statistically significant result (p=0.039). Conclusion This study suggests that while most clinical variables showed no association with reocclusion, the fact that all patients who underwent secondary revascularization procedures were male indicates that gender may be a significant predictive factor of revascularization.

BACKGROUND: Proximal humerus fracture is considered to be the third most common fracture for patients aged 65 years or older. Conservative treatment has been known to treat most of humerus fracture. However, fractures with severe displacement or dislocation may require surgical treatment. Intramedullary fibular allograft with a locking plate is frequently used in patients accompanying medial metaphyseal disruption. In this study, author intends to evaluate clinical and imaging results based on patients who underwent surgical treatment using fibular allograft with a locking plate. METHODS: This study is conducted prospectively at Wonju Severance Christian Hospital, targeting patients who previously underwent surgical treatment using open reduction and intramedullary fibular allograft with a locking plate between 2011 and 2015. A total of 26 patients were evaluated on the following: postoperational clinical assessment measuring Constant score, American Shoulder and Elbow Society (ASES) score, and the Disabilities of the Arm, Shoulder and Hand (DASH) score. Postoperational imaging assessments are evaluated via measuring the neck-shaft angle. The study subject were Neer classification type 3, 4 proximal humerus fracture cases with disrupted medial hinge and having cortical comminution in the region of the surgical neck. RESULTS: The average period of progression was 22.5 months, and the average age of patients was 72.6 years. At the final follow-up, the average Constant, average ASES, and average DASH scores were 80.1, 78.5, and 20.6 respectively. The average neck-shaft angle was 127.5°. CONCLUSIONS: In conclusion, fibular allograft augmentation with a locking plate showed satisfying results in both clinical and imaging studies.

Epidemiological and statistical observations were made of fire hazards that occurred during the past 18 years, 1948 to 1965. Injury and mortality rates for all ages were computed chronologically. For the years of 1955, 1961 and 1965, all fire accidents were epidemiologically analysed to draw characteristic pattern in relation to the seasonal and 24 hour distribution, causes and sites of accidents etc.. Fire hazards observed herein are the categorys E 916 of the International Classification of Causes of Death, 1955, and includes all accidents caused by fire and explosion of combustible materials. The following conclusion was made: 1. The average umber of annual deaths due to fire was 183 and the number of the injured due to the same cause was 335. The mortality rate per 100,000 population was 0.8 and the ratio of injures per death was 1.8. 2. The casualty rate including both the dead and injured was 5.0 per 100,000 in Seoul, the highest among the provinces and followed by 3.4 in Cheju-Do, 2.1 in Kangwon-Do, 1.7 in Kyunggi-Do accordingly. The other provinces had a range of 0.6 to 1.2. 3. The monthly distribution of fire accidents showed that the winter months, December through February, had more frequent accidents, while the summer season, June through August had less. The 24 hour distribution of accidents showed more cases from 12:00 to 18:00 and less from 4:00 to 10:00 hours. 4. The per cent distribution of causes of accidents showed; 90.0% for careless, 10.0% for arson. The cause of carelessness was further breakdown into; 15.0% for kitchen fire places, 13.8% for fire playing, 9.4% for electrical heating and wires, 8.3% for fuels, 6.3% for matches, 5.2% for ash dumps and the remaining for others. 5. The accidents as classified by place revealed that 56.8% of the total occurred at the common dwelling houses, 11.3 at various industrial workshops, 9.3% at the street shops and the remaining at the miscellaneous places.
Cause of Death ; Classification ; Education ; Explosions ; Fires* ; Firesetting Behavior ; Gangwon-do ; Gyeonggi-do ; Heating ; Hot Temperature ; Jeju-do ; Korea* ; Mortality ; Seasons ; Seoul