Acute unstable tibial shaft fractures are common in these days of high energy trauma. There are many options for this common and complicated fracture. Flexible intramedullary nailing using closed technique is prevalent in that this has much technical, functional, and physiological advantages. We reviewed 51 cases of acute tibial shaft fractures treated with flexible intramedullary nailing. There were 3 nonunions (6%), and two refractures. Among 46 united cases, 8 cases (17 %) showed no bridging callus formation within 20 weeks. Followings are the results of average time reaching each of radiological bony progression stage for 46 united cases. l. Average time to earliest discernible callus formation (stage I) was 13.3 weeks (range:8-21 weeks). 2. Average time to definite and bridging callus formation (stage II) was 18.1 weeks (range:8-32 weeks). 3. Average time to some oblitetation of fracture line (stage III) was 32.8 weeks (range:17-50 weeks). 4. Average time to complete obliteration of fracture line (stage IV) was 14.0 months(range:12-18 months).
Bony Callus ; Fracture Fixation, Intramedullary ; Tibia

BACKGROUND: The purpose of this study was to compare the time course of the bradycardia and hypotensive effects of esmolol. METHODS: Thirty patients who undergoing gynecologic operation were anesthetized with nitrous oxide and enflurane. After the steady state of anesthesia was achieved, esmolol 500microgram/kg for 1 minute followed by 25, 50, or 100microgram/kg/min for 60minuts infused by intravenous catheter. Heart rate, mean arterial pressure, cardiac index, stroke volume, and systemic vascular resistance was measured by 1, 3, 5, 10, 15, 20, 25, 30, 45, and 60 minutes. RESULTS: Heart rate was changed abruptly within 3 to 5 minutes, and decreased rapidly for 15minutes. Mean arteral pressure was decreased rapidly for 30 minutes, but slower than heart rate. Cardiac index was decreased rapidly for 20 minutes and differed significantly on the dose of 25, 50, 100microgram/kg. Stroke volume was decreased for 30 minutes, and systemic vascular resistance was increased rapidly for 10 minutes. It was decided the onset time that was expressed 90% of ultimate response of esmolol effect, and was calculated in each group. The onset time of heart rate of esmolol 25, 50, 100microgram/kg were 8.0 +/- 4.1, 4.8 +/- 2.3, 8.1 +/- 4.4 minutes, the time of mean arterial pressure were 30.0 +/- 7.5, 21.1 +/- 6.2, 19.9 +/- 7.8 minutes, and the time of cardiac index were 25.1 +/- 4.7, 14.8 +/- 5.0, 14.2 +/- 4.6 minutes. Thus heart rate, mean arterial pressure, cardiac index, stroke volume, and systemic vascular resistance responses of administration of esmolol did not occur with equal rapidity. CONCLUSIONS: Thus although esmolol has an ultrashort kinetic half life, only the heart rate effect can be considered to have an ultrashort onset.
Anesthesia ; Arterial Pressure ; Bradycardia ; Catheters ; Enflurane ; Half-Life ; Heart Rate ; Humans ; Nitrous Oxide ; Stroke Volume ; Vascular Resistance

Many kinds of operations have been devised to treat Kienböck's disease with variable results. But no one have mentioned about the advantage of early motion in distraction to prevent the fibro-osseous ankylosis and carpal collapse. Two cases with Kienböck's disease were treated by the complete excision of the lunate and replacement of it with pronator quadratus muscle pedicled rectangular bone graft. Once these procedures were accomplished, the distraction-motion devices were used to maintain the joint surfaces separated at predetermined distances while kinematically normal joint motion was gradually restored. Although the experience is limited to two cases, the final results seem to be very promising.
Ankylosis ; Arthroplasty ; Joints ; Transplants

Treatment of femoral shaft fractures in children is varying according to age. Satisfactory results have been obtained with longitudinal skin traction, split Russell traction, ordinary Russell traction, 90-90 skeletal traction, and immediate application of a spica cast(2,4,6,11,15). Most authors use one or more techinques routinely. It is safe and convenient to use single treatment protocol to treat all fractures of same type, Distal femoral skeletal traction with the knee and hip flexed 90 degrees and with the thigh hanging free, using the trunk as counter traction, has been used routinely for femoral shaft fractures in children(age 4-12). We reviewed 30 cases of femoral shaft fractures in children treated with 90-90 skeletal traction. 1. The average age of the patients was 6.8 years(range, 4-12 years), and almost all were caused by pedestrian injury. 2. The average time of traction was 48 days(range, 28-75), and 12 cases(40%) were treated without spica cast application. 3. Four among 30 cases developed angular deformity exceeding acceptable range(15° in AP view, 20° in lateral view), and three of them were proximal third fractures. 4. The older the patient, the longer the duration of limited activity and the more tendency of angular deformity. 5. 90-90 skeletal traction is easy, safe and convenient to treat all femoral shaft fractures of the children between four and ten years old.
Child ; Clinical Protocols ; Congenital Abnormalities ; Hip ; Humans ; Knee ; Skin ; Thigh ; Traction

The Palmaris longus tendon is important not because of its function but because of its usefulness as a donor tendon. Variations in the palmaris longus muscle ar elfrequent and the most common variation of the muscle is its absence. The incidence of absence of this muscle varies in different racial groups. Reinmann and his coworkers found the palmaris longus muscle absent in 12.9% of in their 1,600 limbs surgery. We have experiened 307 cases of palmaris longus graft surgery and found that there were 4 cases of absence of the palmaris longus tendon. We examined 2,000 limbs of Korean to see the presence of the palmaris longus muscle. Among 1,000 persons, the muscle was absent bilaterally in 11 persons(1.1%). It was absent unilaterally in 32 persons(3.2%). The probability that the muscle is absent in any single limb is 2.7%. There was no significant differences in the incidence of absence by sex or right and left side.
Extremities ; Humans ; Incidence ; Tendons ; Tissue Donors ; Transplants

Under the Korean Association of External Quality Assessment Service,autoimmune proficiency testings (PT) for six test items were performed in2018–2019 for laboratory quality improvement. We conducted two trials peryear and sent three PT materials for anti-nuclear antibody (ANA) testing andtwo PT materials for anti-mitochondrial antibody (AMA), anti-smooth muscleantibody (SMA), anti-thyroglobulin antibody (anti-Tg), anti-thyroperoxidaseantibody (anti-TPO), and anti-double stranded DNA antibody (anti-dsDNA)testing in each trial. The analysis was conducted based on the informationand results of each test item entered by the laboratory. The report comprisedof a common report that showed the characteristics of all the participatinglaboratories and a laboratory-specific report that showed the assessmentdata of individual laboratories. The intended response rates for ANA, AMA,SMA, and anti-dsDNA qualitative tests were over 97.5%, 88.2%, 85.0%, and90.4%, respectively. The coefficient of variations for anti-Tg and anti-TPO was10.4%–70.1% and 16.6%–21.0%, respectively. The number of participatinglaboratories in 2019 was more than that in 2018. We believe this statisticalreport will be useful to interpret external PT results and set up autoimmuneassays at each laboratory.

Elucidation of the mechanism of fracture seems to be important to prevent to it and determin the position on immobilization most conducive to union. The scaphoid is more susceptable to injury than any of other carpal bones due to its position in bridging the proximal and distal raws of carpal bones and the mechnism of fracture has been a subject of considerable controversy. Reviewing 20 cases of scaphoid nonunion, we incidentally had found that 4 patients had the history of striking a punch bag with the heads of the second and third metacarpals (Punching injury), and a review of the literatures failed to find any reports of such an injury as a mechanism of fracture. On a scale, the wrist was subjected to progressive loading via the heads of the second and third metacarpals and lateral roentgenograms of the wrist were obtained at Okg, 20kg and 35kg and we measured the carpal angles. With progressive loading there is a volar flexion of proximal carpal raw and the volar flexion of scaphoid is smaller than that of lunate. We believed that the violent impact applied at the second and third metacarpal heads forced the scaphoid into the position of extreme dorsiflexion as compared with lunate, so compression force is exerted on the dorsal side of scaphoid and tension on volar side leading the fracture of scaphoid. We also recognized that the fracture of the scaphoid could be occurred by the compression and shearing force of capitate and the bending force of volar radiocapitate ligament.
Carpal Bones ; Head ; Humans ; Immobilization ; Ligaments ; Metacarpal Bones ; Strikes, Employee ; Wrist

Inflammatory pseudotumor, originally described in the lung, is a relatively rare tumor-like lesion that occurs in various organs and tissues. It is usually well demarcated from the surrounding tissue, however it can be unfortunately resected as a malignant tumor. A few inflammtory pseudotumor in the kidney have been reported in English literature, but there have been no reports in Korea. We report a case with inflammatory pseudotumor of the kidney. A 48 year old woman had an intermittent flank pain on the right side. An ultrasonographic study suggested a renal cell carcinoma and a nephrectomy was done. Grossly, there were two separate masses with a well demarcated yellowish appearance, measuring 2.3 cm and 1.3 cm in diameter, respectively. Histologically, they were composed of smooth muscle actin positive spindle cells and a large number of foamy histiocytes, lymphocytes, and plasma cells in the fibrotic backgound.
Actins ; Carcinoma, Renal Cell ; Female ; Flank Pain ; Granuloma, Plasma Cell* ; Histiocytes ; Humans ; Kidney* ; Korea ; Lung ; Lymphocytes ; Middle Aged ; Muscle, Smooth ; Nephrectomy ; Plasma Cells

OBJECTIVE: To investigate whether the serum levels of IL-10 in patients with rheumatoid arthritis are different from those of normal controls and SLE patients and to find out any correlation with disease activity parameters of rheumatoid arthritis. METHODS: Sera from 20 healthy normal persons, 16 rheumatoid arthritis patients and 16 patients with systemic lupus erythematosus were collected and measured for IL-10 and IL-6. Various disease activity parameters were measured in RA patients. RESULTS: The serum level of IL-10 in RA patients was significantly elevated compared to normal controls but lower than those of SLE patients. In RA patients there was no definite correlation between the disease activity parameters and serum IL-10 levels. Despite significant improvements in terms of various disease activity parameters, there was no significant change of serum IL-10 levels after treatment in RA patients. In seropositive RA patients, positive correlation was found between serun IL-10 and rheumatoid factor levels. CONCLUSION: Our findings show that the serum IL-10 levels in patietns with RA are elevated compared to normal controls but lower than those of SLE patients. There was no correlation between serum IL-10 levels and disease acivity parameters of RA.
Arthritis, Rheumatoid* ; Humans ; Interleukin-10* ; Interleukin-6 ; Lupus Erythematosus, Systemic ; Rheumatoid Factor

Hyperglycemia has been noted to occur in pediatric patients undergoing cardiac surgery with hypothermia. Because even moderate hyperglycemia during cerebral ischemia may predispose patients to an increased risk of neurologic deficit, the authors wished to determine whether the large dosage of fentanyl might contribute significantly to the decrease in blood glucose, The authors examined 20 infants who underwent cardiac surgery with small dosage of fentanyl(Group I, n= l0) or large dosage of fentanyl (Group II, n=10), none of whom received dextrose in the clear cardiopulmonary bypass pump prime, maintenance iv fluids, or cardioplegic solution. Blood samples were obtained after induction, during cardiopulmonary by-pass, after cardiopulmonary bypass and after operation. There was no hypoglycemia during the entire surgical periods in all patients. During cardio-pulmonary bypass in group I and group II, after cardiopulmonary bypass, after operation in group II, blood glucose levels were significantly decreased compared with after induction values(p<0.05). Compared with group L the rates of changes from the values after induction were significant during cardiopulmonary bypass and after operation in group II(p<0.05). In conclusion, large dosage of fentanyl is valuable in control the hyperglycemia during open heart surgery in infants.
Blood Glucose* ; Brain Ischemia ; Cardioplegic Solutions ; Cardiopulmonary Bypass ; Fentanyl ; Glucose ; Heart* ; Humans ; Hyperglycemia ; Hypoglycemia ; Hypothermia ; Infant* ; Neurologic Manifestations ; Thoracic Surgery*