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

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

OBJECTIVE: To evaluate transverse skeletal and dental changes, including those in the buccolingual dental axis, between patients with skeletal Class III malocclusion and facial asymmetry after bilateral intraoral vertical ramus osteotomy with and without presurgical orthodontic treatment. METHODS: This retrospective study included 29 patients with skeletal Class III malocclusion and facial asymmetry including menton deviation > 4 mm from the midsagittal plane. To evaluate changes in transverse skeletal and dental variables (i.e., buccolingual inclination of the upper and lower canines and first molars), the data for 16 patients who underwent conventional orthognathic surgery (CS) were compared with those for 13 patients who underwent preorthodontic orthognathic surgery (POGS), using three-dimensional computed tomography at initial examination, 1 month before surgery, and at 7 days and 1 year after surgery. RESULTS: The 1-year postsurgical examination revealed no significant changes in the postoperative transverse dental axis in the CS group. In the POGS group, the upper first molar inclined lingually on both sides (deviated side, −1.8°± 2.8°, p = 0.044; nondeviated side, −3.7°± 3.3°, p = 0.001) and the lower canine inclined lingually on the nondeviated side (4.0°± 5.4°, p = 0.022) during postsurgical orthodontic treatment. There were no significant differences in the skeletal and dental variables between the two groups at 1 year after surgery. CONCLUSIONS: POGS may be a clinically acceptable alternative to CS as a treatment to achieve stable transverse axes of the dentition in both arches in patients with skeletal Class III malocclusion and facial asymmetry.
Dentition ; Facial Asymmetry* ; Humans ; Malocclusion* ; Molar ; Orthognathic Surgery* ; Osteotomy ; Retrospective Studies

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

BACKGROUND: The laparoscopic adrenalectomy has become the standard procedure of adrenal surgery owing to its advantage of minimally invasive surgery and to rapid developments in the laparoscopic technique and apparatus. A posterior retroperitoneoscopic adrenalectomy is a new alternative to both the conventional open approach and a transperitoneal laparoscopic adrenalectomy. This technique is known to be technically difficult and is less frequently done than a transperitoneal laparoscopic adrenalectomy. However, recently, a number of acceptable results have been reported for this procedure. GOAL: We report our experience with and the results from 16 cases involving a retroperitoneoscopic adrenalectomy and evaluate the advantages and disadvantages of this technique. MATERIALS AND METHOD: Between November 1996 and November 1997, a total of 16 retroperitoneoscopic adrenalectomies were performed. All 16 cases had unilateral adrenal tumors(size 1.5-6 cm): 8 Conn adenomas, 4 Cushing adenomas, 2 neurogenic tumors, 1 nonfunctioning adenoma, and 1 vascular cyst. The operations were carried out in the prone position in all cases. Three trochars were inserted below the lower posterior costal margin. The balloon dilatation technique with a surgical globe was used to induce pneumoretroperitoneum in the first 10 cases but in the last 6 cases, the cavity was made only by blunt dissection with the scope and laparoscopic dissector. RESULTS: Fourteen adrenalectomies were completed endoscopically. One was converted to an open posterior approach due to severe skin emphysema and the other case was converted to an open anterior approach due to technical difficulty. The average operating time of the completed endoscopic adrenalectomies was 183 minutes (85-315 minutes) and the average time of the last 8 cases was 148 minutes. There was no operative morbidity or mortality. Immediate mobilization and food uptake was possible on the day of the operation in all cases. Postoperative analgesic injection was needed only one time on the day of the operation in 12 cases and was not needed in 2 cases. The average hospital stay was 4 days after the surgery.
Adenoma ; Adrenalectomy* ; Adrenocortical Adenoma ; Dilatation ; Emphysema ; Length of Stay ; Mortality ; Prone Position ; Retropneumoperitoneum ; Skin ; Surgical Procedures, Minimally Invasive