Recently, tibial shaft fractures become more severe because of high speed traffic accidents. The open tibial fracture is a difficult one to treat because of its common complications such as infection, soft tissue defect, delayed union and non-union. We studied 37 cases of open tibial fractures which were treated with external fixation. The results are as follows: 1. The average patient age was 29.3 years and male predominated by a ratio of 4.3: l. 2. The traffic accidents were the most common cause of injury. 3. Most cases(67.6%) were type III fracture(by classification of Gustilo and Anderson). 4. Hoffmann external fixator gave rigid fixation and good wound access. 5. There were 28 cases(75.7%) which needed secondary soft tissue reconstruction. 6. The infection rate was 21.5%(8 cases). These all healed with conservative management. There were 5 cases of pin tract infection which healed without developing osteitis. 7. The average union time was 28.7 weeks. In type III fracture there was marked delay in union (average 32.1 weeks). 8. The rate of development of delayed or non-union was 35.1%. In these cases, bony union was obtained with cancellous bone graft.
Accidents, Traffic ; Classification ; External Fixators ; Humans ; Male ; Osteitis ; Soft Tissue Infections ; Tibia ; Tibial Fractures ; Transplants ; Wounds and Injuries

No abstract available.
Gallium* ; Neoplasm, Residual* ; Wounds and Injuries*

We retrospecively analyzed MRI findings of 14 patients with intracranial tuberculosis according to the disease process before anti-tuberculous medication. We also analyzed the correlativity between these findings and the clinical outcome after anti-tuberculous medication in 8 patients who had taken follow-up MR imaging. MR imaging was performed with either a 0.5T(1 patients) or 1.0T(13 patients) superconducting system with spinecho pulse sequences. Abnormalities on MRI were seen in 87%(12/14) of the patients. MRI findings consisted of meningeal enhancement(n=10), parenchymal tuberculoma(n=6), hydrocephalus(n=5), and infarction(n=5). Most of them were found within 3 months from symptom-onset. Parenchymal tuberculomas were found after 1 month of symptom-onset. All cases of hydrocephalus and infarction were associated with meningeal enhancement. On follow-up MRI after anti-tuberculous medication, changes of MR imaging did not correlate with clinical outocome in 4(50%) of 8 patients. Improvement of MRI findings were observed in patient treated for more than 3 weeks. In conclusion, MRI is a good modality in the diagnosis of intracranial tuberculosis, however, the MRI findings are not always correlated with clinical outcome after, anti-tuberculous medication.
Diagnosis ; Follow-Up Studies ; Humans ; Hydrocephalus ; Infarction ; Magnetic Resonance Imaging* ; Tuberculoma ; Tuberculosis*

Purpose: To explore the correlations between tear osmolarity, as measured using I-PEN® (I-MED Pharma, Inc., Dollard-des-Ormeaux, QC, Canada), and various dry eye indicators, including the Schirmer test, tear break-up time (TBUT), Oxford scale, and Ocular Surface Disease Index (OSDI), in patients with obstructive meibomian gland dysfunction (MGD). Methods: The medical records of 44 cases of obstructive MGD were reviewed. Tear osmolarity was obtained using I-PEN® (I-MED Pharma, Inc.). The TBUT, Schirmer test, Oxford scale, OSDI, and MGD grade were used to assess the cases, and their correlations with tear osmolarity were analyzed. Results: Spearman and Pearson correlation analyses showed a significant correlation between tear osmolarity and MGD grade (p < 0.001) and OSDI (p = 0.005). However, the results of the TBUT, Schirmer test, and Oxford scale were not significantly related to tear osmolarity. The patients were divided according to MGD severity into those with MGD grades ≤ 2 and those with MGD grades ≥ 3. Tear osmolarity (p < 0.001) and OSDI (p = 0.014) showed significant differences between the two groups. Conclusions In patients with obstructive MGD, tear osmolarity, assessed using I-PEN® (I-MED Pharma, Inc.), is significantly correlated with MGD grade and OSDI.

Cryptococcosis is a systemic opportunistic infection mostly occurred in immunosuppressed patients. Pulmonary cryptococcosis in immunocompetent host is usually localized and self-limiting disease. Pulmonary nodule or mass is the most common radiologic finding, however involvement of mediastinal lymph nodes is rare. Here we report a case of pulmonary cryptococcosis with massive mediastinal lymph nodes involvement in immunocompetent host.
Cryptococcosis* ; Humans ; Lymph Nodes* ; Opportunistic Infections ; Pneumonia

Charcot-Marie-Tooth disease (CMTD) comprises a group of disorders characterized by progressive distal muscle weakness and atrophy. We report the management of a 37-year-old multigravida with CMTD scheduled for Cesarean section. The combined spinal-epidural anesthesia was selected as the anesthetic management and postoperative pain control. Mother and baby had an uneventful recovery and they discharged home on the seventh postoperative day. Combined spinal-epidural anesthesia is thought to be a safe and effective method of anesthesia for Cesarean section in a patient with CMTD.
Adult ; Anesthesia* ; Atrophy ; Cesarean Section* ; Charcot-Marie-Tooth Disease ; Female ; Humans ; Mothers ; Muscle Weakness ; Pain, Postoperative ; Pregnancy

We report on a first case of bone marrow metastasis by dedifferentiated liposarcoma. A 39-year-old male diagnosed with retroperitoneal dedifferentiated liposarcoma underwent surgery and postoperative radiotherapy. In spite of radiotherapy, his whole-body positron emission tomography showed high uptake in multiple bone metastasis. With thrombocytopenia, bone scan suggested bone marrow involvement. After bone marrow biopsy, bone marrow metastasis by dedifferentiated liposarcoma was finally confirmed. He was administered with systemic chemotherapy with doxorubicin. But he died 3 months after chemotherapy due to disease progression. This case revealed that in a patient of unexplained cytopenia with dedifferentiated liposarcoma, bone marrow metastasis should be in consideration.
Adult ; Biopsy ; Bone Marrow* ; Disease Progression ; Doxorubicin ; Drug Therapy ; Humans ; Liposarcoma* ; Male ; Neoplasm Metastasis ; Positron-Emission Tomography ; Radiotherapy ; Thrombocytopenia

Diatomology has provided important evidences for diagnosis of drowning in forensic practice. However, conflicting opinions about the reliability of diatom test still exist. As a part of efforts to end this controversy, it is very important to secure the diatom profile in the water sample of drowning site. Our results obtained in this study show the characteristics of temporal and spatial distribution of diatom collected from the main drowning sites of Han river in Korea. During spring, 111 taxa (98 species and 13 varieties) were identified from 31 genera, and 87 taxa (77 species and 10 varieties) were identified from 22 genera during summer. At the level of genus Achnanthes, Cyclotella, Cymbella, Fragilaria, Navicula, Nitzschia, and Stephanodiscus represented the highest numbers, and were the most widely occurred during two seasons. The centric diatoms, Stephanodiscus hantzschii f. tenuis and Cyclotella atomus were typical of spring and summer, respectively, and identified as dominant indicator species. The commonly occurred species, including dominant species in the seasonal cluster analysis influenced the formation of site - specific groups. As a result, our results will be able to be used not only as the comparison data of diatom found in the drowning victim's tissue but also a reference data to rule out the possibility of contamination.
Diatoms ; Drowning ; Korea ; Rivers ; Seasons ; Water

Pulmonary aspiration of gastric contents is a very rare but one of the most feared complications of anesthesia. The risk factors are gastroesophageal reflux, previous aspiration, renal failure, difficult intubation and trauma. The incidence of aspiration during anesthesia of children has been reported to be more common than adults. This report describes the case of a 7-year-old female patient who had experienced pulmonary aspiration during induction of anesthesia. With fiberoptic brochoscopy, the aspirates in both bronchi were carefully suctioned, and the following chest X-ray and blood gas findings improved. She was transferred to the intensive care unit for respiratory support and showed no further problems.
Adult ; Anesthesia* ; Bronchi ; Child* ; Female ; Gastroesophageal Reflux ; Humans ; Incidence ; Intensive Care Units ; Intubation ; Renal Insufficiency ; Risk Factors ; Suction ; Thorax

PURPOSE: The gonadotropin-releasing hormone agonist (GnRHa) is widely used to treat patients with precocious puberty. However, its effect on growth is often difficult to predict because of the diverse nature of its causes and presentation. This study aims to show the impact of GnRHa treatment on insulin-like growth factor-1 (IGF-I) and IGF binding protein-3 (IGFBP-3) secretion, growth, and on other parameters that may help estimate the height velocity. METHODS: Data from 60 girls (mean age, 8.8+/-0.7 years) treated with GnRHa were analyzed. Their height, bone age (BA), serum IGF-I, and IGFBP-3 concentrations were measured at the start and after a year of GnRHa treatment. To eliminate the confounding effect of chronological age (CA), the standard deviation scores (SDSs) of their height, IGF-I, and IGFBP-3 concentrations according to their CA at the start and after a year of GnRHa treatment were calculated. We looked for possible correlations between these variables and compared the subgroups based on their height velocities and midparental heights. RESULTS: During their one-year GnRHa therapy, height SDS for CA significantly decreased to 0.81+/-0.83 (P<0.001), but height SDS for BA increased to -0.28+/-0.68 (P<0.001). There was no significant change in serum IGF-I SDS, IGFBP-3 SDS, and IGF-I/IGFBP-3 ratio. The advanced BA was the factor most strongly correlated to the height velocity (R=0.265, P=0.041). CONCLUSION: These findings suggest that GnRHa treatment may affect the height velocity due to mechanisms other than suppression of the IGF-I and IGFBP-3 secretory axis.
Axis ; Body Height* ; Female ; Gonadotropin-Releasing Hormone* ; Humans ; Insulin-Like Growth Factor Binding Protein 3 ; Insulin-Like Growth Factor I ; Puberty, Precocious