One of the serious and challenging problems confronting orthopaedic surgeons is an open un-united fracture of tibia. Especially, there are some difficulties in getting bone union on the condition of combining soft tissue defect with infection. In the management of infected un-united fracture of tibia with significant soft tissue loss we attempted a two-stage reconstruction : the first stage consisted of radical sequestrectomy, soft tissue reconstruction, and external fixation, and the 2nd stage consisted of various types of bone grafting and bone fixation. Fifteen patients with open infected un-united fractures of tibia treated with staged reconstruction from September 1982 to August 1987 at Department of Orthopaedic Surgery, Dae-Jeon's St. Mary's Hospital, Catholic University Medical College, were analyzed in clinical aspects and the results of treatment obtained were as follows : 1. Satisfactory bone union was obtained in an average of 6 months after bone graft with a range of 4 months to 12 months. 2. The duration from the injury to bone union was 13 months on an average with a range of 8 months to 19 months. 3. The soft tissue rer.onstruction at the first stage were performed with local flap in 11 cases and muscular flap in 2 cases and musculocuteneous flap in 2 cases. 4. The time interval between 1st stage and 2nd stage was from 1.5 months to 3 months. 5. At the 2nd stage, bone graft were performed with autogenous cancellous bone graft in 11 cases, vascularized osteocutaneous fibular graft in 2 cases and ipsilateral vascularized fibular transference in 2 cases. In summary, a two-stage reconstruction for open infected un-united fracture of tibia is a advisable procedure that leads to bone union with satisfactory return of function.
Bone Transplantation ; Fractures, Open ; Humans ; Surgeons ; Tibia ; Transplants ; United Nations

The purpose of this study was to measure the marginal fidelities and the fracture strength of IPS Empress 2. and In-Ceram. ceramic crowns. After constructed of 12 experimental dies for each group, ceramic crowns were fabricated on the metal master dies prepared on the maxillary right premolar. Marginal gaps were measured on the specimen between the margin of each crown and finishing line of the metal master die by using stereo-microscope(SZ-ST. Olympus, Japan) and all specimens were cemented on the metal master die with Bistite II.(Tokuyama soda Co, LTD., Japan) resin cement. Finally, marginal gaps were measured again. To measure of the fracture strength, buccal incline on the functional cusp of specimens were loaded until the catastrophic failure occurred by using the AGS-1000 D.(Shimadzu, Japan). The result of marginal fidelities and fracture strength were statistically analyzed with the SPSS version 8.0 programs. The results of this study were as follows : 1. No significant difference was found in the mean marginal fidelities and fracture strength between the IPS Empress 2. and In-Ceram. 2. In comparison of marginal fidelities between before and after cementation, there was significant difference(P<0.05). The IPS Empress 2 system was shown in this study that had good marginal fidelities and fracture strength compared to In-Ceram ceramics. Although this system was acceptable to clinical applications, the system still has to be considered long-term researches about marginal fidelities and fracture strength due to the lack of data about the clinical researches.
Bicuspid ; Cementation ; Ceramics ; Crowns* ; Resin Cements

Pulmonary embolism of lipiodol or ethanol may occur inadvertently during the procedure of diagnostic or therapeutic embolization. We studied the nature of pulmonary damage, and its relation to the amount of lipiodol and ethanol embolized into the lung. Various doses of embolic agents(lipiodol 0.4cc/kg, 0.08cc/kg, absolute ethanol 0.4cc/kg, 0.03cc/kg and normal saline 0.4cc/kg)were injected intravenously through femoral vein in 50 rats(10 rats in each group). Pulmonary pathologic changes were analyzed on the 3rd and 28th days subsequent to injection. On the 3rd day, three of 10 lipiodol cases and all(10) ethanol cases showed multifocal pulmonary hemorrhages. Accompanying inflammatory cell infiltration was found only in lipiodol cases. On the 28th day, one of 10 lipiodol cases and four of 10 ethanol cases showed non-specific pneumopathy suggesting mild focal pulmonary fibrosis. The degree of pulmonary damage appeared to depend on the amount of injected embolic agents although their safety doses could not be clarified exactly. Therefore, we suggest careful injection of embolic agents, especially ethanol, during the embolization procedure to prevent possible pulmonary damage by inadvertent pulmonary embolism.
Animals ; Embolization, Therapeutic ; Ethanol* ; Ethiodized Oil* ; Femoral Vein ; Hemorrhage ; Lung ; Pulmonary Embolism* ; Pulmonary Fibrosis ; Rats

PURPOSE: Local control and functional results of an intersphincteric resection are controversial in Asian, low BMI patients, even though it might a provide a chance to avoid a permanent colostomy. We tried to evaluate the potential risk of an intersphincteric resection, compared with a stapled coloanal anastomosis, in patients with low rectal cancer. METHODS: Patients with low rectal cancer, who underwent a intersphincteric resection with a hand-sewn anastomosis (ISR) or a coloanal anstomosis with staples (stapled CAA), were analyzed. RESULTS: From 1999 to 2006, 85 patients were enrolled. The distance between the anal verge and the lower margin of the tumor was 3.4+/-0.8 cm (range: 2~5 cm) in the ISR group and 4.9+/-0.8 cm (range: 3~7 cm) in the stapled CAA. The mean body mass index was 23 (range: 18~32). The patients complained postoperatively of intolerable anal incontinence (Kirwan's class > 2) in 35% of the ISR group and in 9% as the stapled CAA group, (P<0.02). The local recurrence rate was greater in the ISR group (15%) than in the stapled CAA group (2%, P<0.04). There was no significant difference in distant metastasis between the two groups. The disease-free survival rates were 80.8% and 91.2% at three years in the ISR group and the stapled CAA group, respectively. Complications, such as urinary incontinence and sexual dysfunction in male patients, were not significantly different between the two groups. CONCLUSIONS: An intersphincteric resection with hand-sewn anastomosis could be worse than a stapled coloanal anastomosis in function and local recurrence. This may indicate that careful selection is required for a intersphincteric resection even when a stapled anastomosis cannot be applied due to a narrow margin.
Asian Continental Ancestry Group ; Body Mass Index ; Colostomy ; Congenital Abnormalities ; Disease-Free Survival ; Ear ; Humans ; Male ; Neoplasm Metastasis ; Rectal Neoplasms ; Recurrence ; Urinary Incontinence

Selective posterior rhizotomy(SPR) has been known to reduce the spasticity as well as to improve the quality of life in patients with intractable spasticity. Twenty patients underwent SPR under intraoperative electrophysiological monitoring (IOM). Fifty-two percent of sacrolumbar rootlet were cut after electrical stimulation. Eighteen patients(90%) with spastic type of cerebral palsy showed marked reduction of spasticity and functional improvement without any complication. The patients who did not respond to SPR had mixed types of spasticity. IOM facilitate the selection of pathological rootlets regardless of anaesthetic level, intensity of electrical stimulation, and individual variability of responses. It is concluded that careful selection of surgical candidates and of pathological rootlets under IOM are important to reduce the spasticity, thereby to obtain a better outcome.
Cerebral Palsy ; Electric Stimulation ; Humans ; Muscle Spasticity ; Quality of Life ; Rhizotomy*

A 36-year-old man presented abrupt onset of epigastric pain with high fever for one week after pork meal. Extensive diagnostic studies including blood, urine and stool cultures and other inflammatory factors were done but only leukocytosis, 1:160 for H Ag of widal test, and increased FDP were positive findings. Abdominal CT showed multifocal hepatic and splenic arterial aneurysms which grew very rapidly during these 10 days. Emergency exploration and ligation at either side of common hepatic artery and the proximal segment of right hepatic artery were done because of impending rupture. The histologic findings of the excised aneurysmal wall were diffuse infiltration of inflammatory cells and medial necrosis. Several other arterial aneurysms at right brachial, left carotid and branch of superior mesenteric artery were identified on the follow up angiogram. Also noted right brachial artery thrombosis in aneurysmal dilatation site and this was treated by continuous intraarterial infusion of urokinase. Even though the patient had no endocarditis and no growth of blood culture, we consider this multiple artery aneurysms as an infected aneurysm by unknown bacteremia due to pork meal.
Adult ; Aneurysm* ; Aneurysm, Infected ; Arteries ; Bacteremia ; Brachial Artery ; Cerebral Palsy* ; Dilatation ; Emergencies ; Endocarditis ; Fever ; Follow-Up Studies ; Hepatic Artery ; Humans ; Infusions, Intra-Arterial ; Leukocytosis ; Ligation ; Meals ; Mesenteric Artery, Superior ; Necrosis ; Rupture ; Thrombosis ; Tomography, X-Ray Computed ; Urokinase-Type Plasminogen Activator

BACKGROUND: Epilepsy affects an individual's ability to work as well as their daily activities. Patients with epilepsy have difficulties in finding and maintaining jobs, and they may not have opportunities to perform adequately. Therefore, evaluation of work-fitness is important for patients with epilepsy. In this report, the authors reviewed a case of epilepsy and discussed aspects of the case for evaluation of work-fitness. CASE REPORT: A 43-year-old man with epilepsy visited the hospital for evaluation of work-fitness. His job consisted of forklift driving and crane operation using a remote control. As a seizure attack could threaten worker's safety, we recommended a job change. The employer refused to approve a job change due to the company's circumstances, so we recommended several conditions, including continuous medication, use of protective equipment, restriction of night-shift work, restriction of strenuous exercise, and profound sleep. An epilepsy event occurred during the follow-up period, prompting his company to evaluate his work. There were frequent movements of forklift operations and workers in the workplace, so we recommended restriction of forklift driving and a job change if possible. As a result, the employer changed his job and we recommended "capable of performing work without any conditions". CONCLUSION: For evaluation of work-fitness in patients with epilepsy, adequate job analysis, assessment of patient's medical conditions, and interviews of coworker and employers should be conducted. It is also important to let the employer make the best decision in terms of the patient's health and coworker's safety.
Adult ; Epilepsy ; Follow-Up Studies ; Humans ; Linear Energy Transfer ; Seizures ; Work Capacity Evaluation

No abstract available.

OBJECTIVE: The aim of this paper was to develop efficient and practical health promotion strategies in the workplace by investigating both the present status of health promotion and the barriers to its practice. METHODS: A questionnaire was administered to 20% of industrial workers in the workplaces which receives the health care agency enterprise or are supported by a grant from the national treasury, K University Hospital in Gyeong-Gi province, and C University Hospital in Seoul. RESULTS: According to the questionnaire survey, 51.3% workers were practicing health promotion activities and smoking cessation was the most common method among them. Regarding the factors that prompt workers to commence health promotion activities, TV or the mass media had a 33.4% effect, followed by a 22.1% effect for an abnormal finding at regular health screening. The most necessary health promotion activity in the workplace was exercise (41.9%), followed by stress management. When asked about their expectations of the health promotion program, 84.8% of the respondents answered that they expected it to be significantly or somewhat effective. Factors affecting the health promotion activities of workers were worker's health status and job control. CONCLUSIONS: This study demonstrated that workers evaluate health promotion activities positively and that some workers are unable to participate in these activities despite their willingness to do so due to the barrier of circumstances. To encourage worker's participation, the government and employers should remove barriers.
Community-Institutional Relations ; Data Collection ; Delivery of Health Care ; Financing, Organized ; Health Promotion* ; Mass Media ; Mass Screening ; Occupational Health ; Questionnaires ; Seoul ; Smoking Cessation

OBJECTIVES: To reveal the influence of job stress change on body mass index (BMI) and waist circumference in white-collar male workers. METHODS: A total of 277 male workers in a Korean R&D company were enrolled between 2008 and 2010. Baseline and follow-up data were collected with structured self-administered questionnaires and anthropometric measurements by nurses. The questionnaire survey included general and work-related characteristics and the Korean Occupational Stress Scale-Short Form (KOSS-SF). The job stress scores in each examination were dichotomized at the median values for the Korean workers and categorized into four groups as follows: Group I: Both low job stress (2008, 2010), Group II: High job stress (2008) & low job stress (2010), Group III: Low job stress (2008) & high job stress (2010), Group IV: Both high job stress (2008, 2010). Multiple logistic regression modeling was used to determine the influence of job stress change on BMI and waist circumference. RESULTS: The adjusted odds ratio for the change in waist circumference above the 75th percentile for Group IV in 'job demand' increased more than in Group I (OR = 2.54 95% CI=1.06~5.55). Also, Group IV in 'job demand' has higher odds ratio for change in BMI above the 75th percentile than Group I (OR=2.25 95% CI=1.01~5.00). Adjusted odds ratios comparing Group II to Group I for the change in waist circumference above the 75th percentile were 0.36 (95% CI=0.15~0.87) in 'inadequate social support', 0.12 (95% CI=0.02~0.98) in 'lack of reward', 0.25 (95% CI=0.08~0.80) in 'total score', respectively. CONCLUSIONS: These results suggest that sustained high job control is a risk factor for abdominal obesity and weight gain. Also, diminished job stress has a negative influence on change in abdominal obesity. Further studies are required to establish job stress intervention plans.
Body Mass Index ; Follow-Up Studies ; Humans ; Logistic Models ; Longitudinal Studies ; Male ; Obesity, Abdominal ; Odds Ratio ; Questionnaires ; Risk Factors ; Waist Circumference ; Weight Gain