Several techniques are now avallable for the treatment of fractuers of the shaft of the femur. We must be aware of the advantages, disadvantages and Ilmitation of each if we are to select the proper treatment for each patient. During last decades treatment had been varied markedly from time to time and from place to place. Before Word War II, most fractures of the femoral shaft were treated conservatively either by skeletal traction or by manipulation and immobilization in a spica cast. After medullary fixation was Introduced during that war, it became popular, and until 1960 many surgeons considered it as the treatment of choice for most of these fractures. If the case is properly selected the medullary fixation is almost perfect, provlded no complications develop; convalescence can be shortened and resldual disability can be decreased. We had experienced 14 complications among the 78 cases of Kuntscher nailing from may, 1974, to May, 1980. The results are as follows: 1. We operated 78 cases with Kuntscher nail among the 121 femoral shaft fractures. 2. 14 (17.95%) complications developed among the 78 cases of the Kuntscher nailing. 3. Technical errors were incarcerated nailing with thick nail, too long nail and thin nailing. 4. Early postoperative complications within a year were infection, bendlng, bursitis, angulation and rotation. 5. Late complications after one year were proximal or distal migration and refracture.
Bursitis ; Convalescence ; Femur ; Humans ; Immobilization ; Postoperative Complications ; Surgeons ; Traction

BACKGROUND: The dose-responses of neuromuscular blocking agents may be influenced by many factors including age and inhalation anesthetics. This study was designed to determine the dose-response relationships of a new, short-acting muscle relaxant, mivacurium during nitrous oxide-halothane or nitrous oxide-enflurane anesthesia in two age groups, infants and 1 to 6 years old preschool children. METHODS: Neuromuscular blockade was monitored by recording the accelerographic activity of the adductor pollicis muscle resulting from supramaximal stimulation at the ulnar nerve at 2 Hz for 2 seconds at 10-second intervals. To estimate dose-response relationships, 24 infants or children of two anesthetic subgroups for each age group received single bolus doses of 45~100 g/kg of mivacurium. The ED50 and ED95 were estimated from linear regression plots of log-dose vs probit of twitch depression. The lag time, onset time and maximal depression of twitch height for the selective medium dose were mesured. RESULTS: The ED50 and ED95 for the infants group were 38.2 and 53.3 g/kg during halothane anesthesia, and 29.8 and 48.6 g/kg during enflurane anesthesia, respectively. And, those for preschool children group were 49.4 and 90.7 g/kg during halothane anesthesia, and 32.3 and 81.4 g/kg during enflurane anesthesia, respectively. There was a parallelism of the dose-response curve between halothane and enflurane anesthesia in either age group. Also, there was statistically significant difference in the maximal twitch depression for the selective medium dose of mivacurium between halothane and enflurane anesthesia in either group. CONCLUSIONS: The potency of mivacurium during enflurane anesthesia is higher than that during halothane anesthesia in infants and preschool children, and during either inhalation anesthesia the dose of mivacurium is less required in infants than preschool children.
Anesthesia* ; Anesthesia, Inhalation ; Anesthetics, Inhalation ; Child ; Child, Preschool* ; Depression ; Enflurane* ; Halothane* ; Humans ; Infant* ; Linear Models ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Ulnar Nerve

PURPOSE: To evaluate the efficacy and safety of brinzolamide 1%/brimonidine 0.2% fixed combination (BBFC) in normal tension glaucoma (NTG) patients. METHODS: This prospective study included patients treated with brinzolamide 1% monotherapy, brimonidine 0.2% monotherapy or brinzolamide 1% and brimonidine 0.2% concomitant therapy, as well as newly diagnosed NTG patients. The enrolled patients who used brinzolamide 1% or brimonidine 0.2% switched to BBFC and newly diagnosed NTG patients were treated with BBFC. The patients receiving brinzolamide 1% or brimonidine 0.2% monotherapy or brinzolamide 1% and brimonidine 0.2% concomitant therapy switched antiglaucoma drugs to BBFC. Newly diagnosed NTG patients used BBFC as the first therapy. The study consisted of 1 screening/baseline visit and 3 follow-up visits conducted after 1, 4, 8, 12 and 24 weeks of treatment. Intraocular pressure (IOP), mean deviation value and adverse drug reactions were evaluated before treatment and after treatment with BBFC. RESULTS: The mean IOP in the brinzolamide 1% monotherapy group was 13.5 ± 1.6 mm Hg and the mean IOP after switched from brinzolamide 1% monotherapy to BBFC was 12.1 ± 1.5 mm Hg. The mean IOP in the brimonidine 0.2% monotherapy group was 14.2 ± 1.3 mm Hg and the mean IOP after switched from brimonidine 0.2% monotherapy to BBFC was 11.7 ± 1.5 mm Hg. The mean IOP was 11.9 ± 2.1 mm Hg in the brinzolamide 1% and brimonidine 0.2% concomitant therapy group and the mean IOP after switched from brinzolamide 1% and brimonidine 0.2% concomitant therapy to BBFC was 12.0 ± 1.1 mm Hg. The mean IOP and reduction rate were 10.7 ± 2.1 mm Hg and 35.5%, respectively,in the newly diagnosed NTG patients treated with BBFC. There was no serious adverse drug reaction causing ocular damage. CONCLUSIONS: BBFC provides a significant IOP reduction and is a safe antiglaucoma medication for NTG patients.
Brimonidine Tartrate ; Drug-Related Side Effects and Adverse Reactions ; Follow-Up Studies ; Humans ; Intraocular Pressure ; Low Tension Glaucoma* ; Prospective Studies

A variety of therapeutic options are available for managing arteriovenous malformations(AVM's) including microsurgical resection, embolization, stereotactic radiosurgery or a combination of these treatments. The primary advantages of neurosurgical resection include immediate and almost certain cure, immediate elimination of the risk of hemorrhage, and the absence of longterm delayed complications. Surgery, however, is more invasive than other therapeutic options and is associated with the potential for perioperative morbidity or mortality. A series of 42 patients undergoing microsurgical resection of AVM's of the brain between January 1990 and March 1998 were analyzed for complications and postoperative outcomes. Twelve patients(28.6%) had complications. There were 5 deaths(11.9%) which were thought to be caused by increased intracranial pressure(3 cases), venous infarction(1 case) and postoperative hemorrhage(1 case). Other nonfatal complications were 3 cases of motor weakness, a case of visual field defect following occipital lobe retraction, a case of dilated cardiomyopathy in children and two cases of new onset of seizures. All cases were graded according to the Spetzler-Martin classification. There were six cases of complications in 22 patients with Grade I AVM'(22.7%), three cases of complications in 10 patients with Grade II AVM'(30.0%), one case of complications in 7 patients with Grade III AVM'(14.2%), no complications in 1 patient with Grade IV AVM', and two cases of complications in 2 patients with Grade V AVM'(100%). The various components of the AVM' grading system were analyzed for the ability to predict complications, but there was no statistical significance in this study. The preoperative Glasgow coma scale accurately correlated with the incidence of postoperative complications(p=0.004).
Arteriovenous Malformations* ; Brain* ; Cardiomyopathy, Dilated ; Child ; Classification ; Glasgow Coma Scale ; Hemorrhage ; Humans ; Incidence ; Microsurgery ; Mortality ; Occipital Lobe ; Radiosurgery ; Seizures ; Visual Fields

Disseminated superficial porokeratosis (DSP) is a rare variant of porokeratosis, which is characterized histologically by cornoid lamella and clinically by central atrophy with elevated borders. DSP is usually associated with immunosuppressive states and hematopoietic malignancies, but rarely with malignancies of visceral organs. A 65-year-old male presented with numerous brownish macules with elevated borders on the trunk and limbs that had been present for 1 year. Before the visit to our clinic, gastric cancer was diagnosed at about the same time the skin lesions suddenly increased in size and number. Clinical and histopathological examination revealed that the lesions were consistent with DSP. We herein report a rare case of disseminated superficial porokeratosis that occurred in association with gastric cancer.
Aged ; Atrophy ; Extremities ; Hematologic Neoplasms ; Humans ; Male ; Porokeratosis ; Skin ; Stomach Neoplasms

PURPOSE: To investigate the preoperative factors affecting the visual outcome after a vitrectomy in a rhegmatogenous retinal detachment (RRD). METHODS: A retrospective study of 79 eyes was carried out. The 41 eyes were macula-off RRD (group I), the 38 eyes were macula-on RRD (group II). The preoperative factors examined in this study included the preoperative best corrected visual acuity (BCVA), age, the duration of macular detachment, the extent of the detached retina, the delay of operation. The correlation between these factors and the postoperative 6 months BCVA were investigated. RESULTS: In group I, preoperative BCVA (r = 0.313, p = 0.037) and preoperative retinal detachment (RD) extent (r = 0.483, p = 0.001) were significantly correlated with postoperative 6 months BCVA. In group II, preoperative BCVA and preoperative RD extent were not significantly correlated with postoperative 6 months BCVA. Regardless of including macula, the patient's age, duration of symptom and delay of operation after clinic visit were not affected to the visual outcome. Patients with symptom duration of 7 days or less achieved better final BCVA (0.36 ± 0.45 log MAR, n = 29) than patients with longer symptom duration (0.79 ± 0.55 log MAR, n = 16) (p = 0.008). CONCLUSIONS: After vitrectomy for macula-off RRD, the factors related to favorable visual outcome were the better preoperative BCVA, the less extent of the detached retina. And surgical repair within 7 days of the symptom onset yielded better visual outcomes. Otherwise, in macula-on RRD, preoperative BCVA, age, the duration of retinal detachment, the extent of the detached retina, the delay of operation did not impact on visual outcome.
Ambulatory Care ; Humans ; Retina ; Retinal Detachment* ; Retinaldehyde* ; Retrospective Studies ; Visual Acuity ; Vitrectomy*

STUDY DESIGN: Case report OBJECTIVES: To report a case of sacral stress fracture that developed after lumbosacral fusion. SUMMARY OF LITERATURE REVIEW: Sacral stress fractures rarely develop after lumbosacral fusion, and osteoporosis, female sex, being over 60 years old, and long segment fusion are known risk factors. MATERIALS AND METHODS: A 66-year-old woman with spondylolisthesis at L5 on S1 underwent posterior lumbar interbody fusion and posterior instrumentation. A sacral stress fracture was found 4 weeks after the first operation, and we performed posterior reduction and posterior instrumentation with S2 alar screws. RESULTS: The patient was free from symptoms and no further displacement was found at 3 months after the last operation. CONCLUSIONS: Sacral stress fracture after lumbosacral fusion can be treated with posterior reduction and posterior instrumentation with S2 alar screws.
Aged ; Female ; Fractures, Stress ; Humans ; Osteoporosis ; Risk Factors ; Sacrum ; Spondylolisthesis

OBJECTIVES: To report a case of sacral stress fracture that developed after lumbosacral fusion.SUMMARY OF LITERATURE REVIEW: Sacral stress fractures rarely develop after lumbosacral fusion, and osteoporosis, female sex, being over 60 years old, and long segment fusion are known risk factors. MATERIALS AND METHODS: A 66-year-old woman with spondylolisthesis at L5 on S1 underwent posterior lumbar interbody fusion and posterior instrumentation. A sacral stress fracture was found 4 weeks after the first operation, and we performed posterior reduction and posterior instrumentation with S2 alar screws. RESULTS: The patient was free from symptoms and no further displacement was found at 3 months after the last operation. CONCLUSIONS Sacral stress fracture after lumbosacral fusion can be treated with posterior reduction and posterior instrumentation with S2 alar screws.

No abstract available.
Humans ; Mesenteric Veins* ; Nephrotic Syndrome* ; Thrombosis*

BACKGROUND: Hyperhomocysteinemia has been known to be associated with cerebrovascular disease. It is toxic to vascular endothelial cell and promotes arteriosclerotic detachment. There was no study of the homocysteine level in ischemic stroke patients in Korea except case report. Therefore we measured total plasma homocysteine level in ischemic stroke patients and evaluated association with other stroke risk factors. METHODS: We measured total plasma homocysteine level in 44 patients with ischemic stroke and 16 age-matched normal controls, and analyzed its relationship to other stroke risk factors. Total plasma homocysteine level was determined by using a radioenzymatic method. RESULTS: Total plasma homocysteine level was 12.12 5.11 micromol/L in patients and 9.40 1.93 micromol/L in controls. It was 13.03 5.78 micromol/L in lacunar infarction and 9.96 1.57 micromol/L in territory infarction. The total plasma homocysteine level of the patients with hypertension, DM, hyperlipidemia, heart disease, smoking, alcohol, previous stroke, carotid bruit was not different statistically from those without them. CONCLUSIONS: Total plasma homocysteine level was significantly higher in the ischemic stroke patients than that of controls. Lacunar infarction showed significantly higher level of total plasma homocysteine compared to territory infarction.
Cerebral Infarction* ; Endothelial Cells ; Heart Diseases ; Homocysteine* ; Humans ; Hyperhomocysteinemia ; Hyperlipidemias ; Hypertension ; Infarction ; Korea ; Pilot Projects* ; Plasma* ; Risk Factors ; Smoke ; Smoking ; Stroke ; Stroke, Lacunar