The purpose of this study is to evaluate the effectiveness of Ilizarov external fixator in the treatment of difficult tibial fractures. We analyzed 37 cases with closed or open comminuted tibial fractures and unstable segmental fractures, treated with Ilizarov external fixator between August 1993 and August 1997. Among them, 21 cases were treated with simple application of Ilizarov external fixator. A compression of the fracture site (6 cases), translation (2 cases) and internal transportation technique (2 cases) were applied, and bone graft was applied in 5 cases. We obtained bony union in all cases with Ilizarov method except one case converted to intramedullary nailing due to delayed union. The average time required for bone union were 21 weeks in closed fractures, 26.2 weeks in open fractures. The complications developed were as follows; pin irritation in 14 cases, pin tract infection in 9 cases, adjacent joint contracture in 3 cases, delayed union in 1 case and malunion in 1 case. According to Tuckers classification, the results were graded as excellent in 18 cases, good in 14 cases, fair in 3 cases, poor in 2 cases. In conclusion, Ilizarov external fixation is one of the useful treatment option in closed or open comminuted tibial fractures and unstable segmental fractures.
Classification ; Contracture ; External Fixators* ; Fracture Fixation, Intramedullary ; Fractures, Closed ; Fractures, Open ; Ilizarov Technique ; Joints ; Tibia ; Tibial Fractures* ; Transplants ; Transportation

PURPOSE: The purpose of this study was to analyze the clinical manifestations of elbow dislocation in children and to suggest an appro-priate treatment modality for this rare injury. MATERIALS AND METHODS: We analyzed 17 cases, treated from September 1989 to July 2000. The factors examined included; age, sex, etiology, direction, associated injuries, method of treatment, results and complications. Clinical results were evaluated using the grading system of Linscheid and Wheeler. RESULTS: The mean age was 10 years 4 months. Etiologies were; fall from a height 8 cases, slip down 7 cases and unknown 2 cases. The directions of the dislocations were posterior 14 cases, posterolateral 2 cases, and posteromedial 1 case, with no anterior dislocation. Associated injuries were noted in 14 cases (82.4%), and 8 of these cases were treated by open reduction and internal fixation. The remaining 9 cases were treated by closed reduction followed by a long arm cast. The mean period of immobilization was 3.8 weeks. One case was complicated with a myositis ossificans, which resulted in spontanous remission. Results were excellent in 15 cases, and good in 2 cases with no poor cases. CONCLUSION: The incidence of associated fractures (82.4%) was higher in this study than in previous reports. A careful examination is necessary to identify associated injuries and achieve stability with the surgical procedure, which should be followed by early active exercise.
Arm ; Child* ; Dislocations* ; Elbow* ; Humans ; Immobilization ; Incidence ; Myositis Ossificans

No abstract available.
Saliva*

BACKGROUND: The aim of study was to determine the influence of pH-adjusted lidocaine of epidural anesthesia on the maternal and fetal blood lidocaine concentration. METHODS: Thirty parturients having epidural anesthesia for cesarean section were assigned to two group. Plain group (n=15) received 18 ml of 1.8% lidocaine (2% lidocaine plus 1ml saline per 10 ml lidocaine) with added 1:200,000 epinephrine. Patients in the alkalinized group (n=15) were given 18 ml of 1.8% lidocaine (2% lidocaine plus 1ml sodium bicarbonate per 10 ml lidocaine) with added 1:200,000 epinephrine. The level of analgesia was assessed 5 min after injection and then reassessed every 1min in the middle line. Maternal and umbilical venous blood were obtained at birth and the concentrations of lidocaine in these samples were determined by Immunofluorescence assay. Apar score was also assessed. RESULTS: The peak level of sensory blockade were similiar (T5) but The time to peak level was significantly more rapid in alkalinized group than plain group. The plasma lidocaine levels in the maternal venous blood and umbilical venous blood were similar in both groups. The ratios of umbilical vein to maternal vein concentration of lidocaine were 0.76+/-0.36 in alkalinized group and 0.62+/-0.21 in plain group. CONCLUSIONS: We conclude that alkalinization of lidocaine in epidural anesthesia results in a faster onset of sensory block and more rapid time to peak level but no adverse effects on Apgar score. Alkalinization of lidocaine is therefore recommended when epidural anesthesia is planned for Cesarean section.
Analgesia ; Anesthesia, Epidural* ; Anesthetics ; Apgar Score ; Cesarean Section* ; Epinephrine ; Female ; Fetal Blood ; Fetus* ; Fluorescent Antibody Technique ; Humans ; Lidocaine* ; Mothers* ; Parturition ; Plasma ; Pregnancy ; Sodium Bicarbonate ; Umbilical Veins ; Veins

BACKGROUND: Currently establishment of public pharmaceutical companies became an issue for securing stable supply of national essential drugs in order to respond appropriately to national public health crisis. Pharmacy students as future pharmacists need to be interested in drug related issues under the discussion in our society. This study aimed to investigate perceptions of pharmacy students on the national drug supply strategy through public pharmaceutical companies. METHODS: A 20-items questionnaire designed for this study was used. Pharmacy students nationwide were enrolled in July 2017. They responded to questions through on-line survey program. Data were analyzed descriptively. RESULTS: 160 students from 26 pharmacy schools participated. 5th and 6th grade students accounted for two-thirds, and one third aspired future jobs in pharmaceutical industry. Among responders, 71.3% was unaware of current national essential drugs, 52.5% did not know the Rare and Essential Drug Center, and 91.9% was unaware of the legislation on the supply and management of essential drugs. 82.5% favored the establishment of public pharmaceutical companies. 80.6% agreed that government should intervene in pharmaceutical market for ensuring drug accessibilities, 73.8% agreed that public pharmaceutical companies make possible to reach a goal of stable supply of pharmaceuticals, and 85.1% agreed that active compulsory license by public pharmaceutical companies is necessary. CONCLUSION: We found that pharmacy students recognized the need for governmental control to achieve social values of pharmaceuticals. More attention and participation of the pharmacy students as well as pharmacists in the process of national debate on public pharmaceutical companies are expected.

PURPOSE: This study was conducted to evaluate the results and usefulness of the unipolar release of sternocleidomastoideus for the treatment of congenital muscular torticollis in children. MATERIALS AND METHODS: From March 1991 to March 1999, we retrospectively reviewed and analyzed 19 congenital muscular torticollis patients who were treated by the unipolar release of sternocleidomastoideus. Patients were followed for an average of 4.3 (range, 1.3 to 9.3) years. Clinical results were evaluated cosmetically and functionally, in a manner similar to that used by Canale et al. RESULTS: Of the 19 cases, 15 patients (79%) were good, 4 (21%) poor, and none were fair in the initial operation. Overall results were 79% good after initial operation and 89% good including after reoperating upon 2 cases. CONCLUSION: Simple unipolar release of sternocleidomastoideus in congenital muscular torticollis showed high rate of success (79%). Therefore, we considered it to be an effective primary surgical procedure for the treatment of congenital muscular torticollis.
Child* ; Humans ; Retrospective Studies ; Torticollis*

These experiments were performed to investigate the effect of photoperiod and melatonin on serotonergic immunoreactivity in rat brain stem. The animals were injected with melatonin (1 mg/kg, i.p.) after light and dark treatment. The results by immunohistochemical method were as follows; 1. Immunohistochemical serotonin intensity in brain stem (dorsal raphe nucleus of midbrain, nucleus tractus solitarius and dorsal raphe nucleus of vagus nerve in medulla) appeard weakly in medium in control group compared with light and dark treated group. It suggest that enhanced effect in single injection (light or dark) was canceled by complex mechanism when two factors (light and dark) bring about together. 2. Serotonin immunoreactive neurons in brain stem (dorsal raphe nucleus of midbrain, nucleus tractus solitarius and dorsal raphe nucleus of vagus nerve in medulla) were significantly increased in light and dark treated group compared with control group. These results show that serotonin pathways are more important in mediating the effects of retinally perceived light in the rat. 3. Serotonin immunoreactive neurons in brain stem (dorsal raphe nucleus of midbrain, nucleus tractus solitarius and dorsal raphe nucleus of vagus nerve in medulla) were incresesed in melatonin treated group compared with melatonin non-treated group in light and dark. These results indicated that melatonin injection during photo and dark period enhanced serotonergic neurons activity and then light control influenced the development of serotonergic systems in brain stem including dorsal raphe nucleus of midbrain, nucleus tractus solitarius and dorsal nucleus of vagus nerve in medulla.
Animals ; Brain Stem* ; Brain* ; Melatonin* ; Mesencephalon ; Negotiating ; Neurons ; Photoperiod* ; Raphe Nuclei ; Rats* ; Serotonergic Neurons ; Serotonin ; Solitary Nucleus ; Vagus Nerve

No abstract available.
Leukemia, Neutrophilic, Chronic*

Membranous glomerulonephropathy is the most common cause of nephrotic syndrome in adults and idiopathic autoimmune thrombocytopenic purpura is autoimmune disease caused by autoantibody to platelet membrane glycoprotein. Although there are some pathologic similarity between two diseases that 'membrane attack complex' play a role in pathologic process, but only 3 cases worldwide are reported about membranous glomerulonephropathy associated with idiopathic autoimmune thrombocytopenic purpura. So we report a case of sixty eight years of woman who had symptoms of generalized edema, foamy urine, anorexia and thrombocytopenia on admission and developed more severe symptomatic thrombocytopenia there after. She was diagnosed membranous glomeulonephropathy on renal biopsy and also diagnosed idiopathic autoimmune thrombocytopenic purpra on bone marrow biopsy and on the basis of exclusion.
Adult ; Anorexia ; Autoimmune Diseases ; Biopsy ; Blood Platelets ; Bone Marrow ; Edema ; Female ; Glomerulonephritis, Membranous* ; Humans ; Membrane Glycoproteins ; Nephrotic Syndrome ; Purpura, Thrombocytopenic, Idiopathic* ; Thrombocytopenia

Ulcerative colitis is a chronic relapsing inflammatory disease of the colonic and rectal mucosa, which affects children as well as adults. Inflammation caused by ulcerative colitis is limited to the colon and rectum, to the mucosa and submucosa, and is involved continuously, with varying degrees of ulceration, hemorrhage, edema, and regenerating epithelium. Ulcerative colitis most commonly presents with the onset of diarrhea, later associated with hematochezia, but usually without systemic signs of fever, weight loss, or hypoalbuminemia. Approximately 30% of cases have moderate signs of systemic illness. Although less commonly seen than in Crohn's disease, the first sign of ulcerative colitis may be growth failure characterized by decreased linear growth velocity. We experienced a case of ulcerative colitis with growth disturbance and treated with sulfasalazine. During follow up for a year, the symptoms subsided, and the height and weight increased.
Adult ; Child ; Colitis, Ulcerative* ; Colon ; Crohn Disease ; Diarrhea ; Edema ; Epithelium ; Fever ; Follow-Up Studies ; Gastrointestinal Hemorrhage ; Hemorrhage ; Humans ; Hypoalbuminemia ; Inflammation ; Mucous Membrane ; Rectum ; Sulfasalazine ; Ulcer* ; Weight Loss