Clinical analysis of ths pcstoperative infection has been made on 511 traumatic patients, who had been admitted and operated in Orthopedic Department of Kyungpook National University Hospital during the period from January, 1972 to June, 1975. The following results were obtained. 1. Of the total 511 traumatic patients operated, 39 cases were infected, the infection rate being 7.6%. 2. The infection rate was higher (21.2%) in case of mutiple trauma than single trauma(3.6%) and also higher rate of infection was seen in the open wound(8.7%) than closed one(4.1%). 3. The most frequently involved sites of the trauma were the tibia and the femur occupying 51.9% of the total, and the next were the forearm and hand in decreasing order, but the highest infection rate was seen in the cases with hand injury(11.6%). 4. The incidence of infection was 15.7% in the debrided wound of crushing injury 14.0% in the cases with open fracture, and 4.1% in the closed fracture. 5. In relation to the operating time consumed, the infection rate was 5.0% in the cases of less. than 2 hours but it rose up to 9.4% when operation time exceeded 4hours, suggesting that the longer is the operating time the higher is the infection rate. 6. The infection rate was relatively low in the open wounds operated within 6 hours after injury and also it is low when operation was done within 1 week in case of closed wound. 7. Of the isolated microorganisms, tho coagulase positive staphylococcus was the most frequent offender occupying 33.3% of the total, and was relatively sensitive to kanamycin, vibramycin, and albamycin. The next frequent organism was pseudomonas and was relatively sensitive to gentamicin.
Coagulase ; Criminals ; Doxycycline ; Femur ; Forearm ; Fractures, Closed ; Fractures, Open ; Gentamicins ; Gyeongsangbuk-do ; Hand ; Humans ; Incidence ; Kanamycin ; Orthopedics ; Pseudomonas ; Staphylococcus ; Tibia ; Wounds and Injuries

BACKGROUND: Previous studies have shown that if performed without radiographic guidance, the loss of resistance (LOR) technique can result in inaccurate needle placement in up to 30% of lumbar epidural blocks. To date, no study has shown the efficacy of measuring the depth of the posterior complex (ligamentum flavum, epidural space, and posterior dura) ultrasonographically to distinguish true and false LOR. METHODS: 40 cervical epidural blocks were performed using the LOR technique and confirmed by epidurograms. Transverse ultrasound images of the C6/7 area were taken before each cervical epidural block, and the distances from the skin to the posterior complex, transverse process, and supraspinous ligament were measured on each ultrasound view. The number of LOR attempts was counted, and the depth of each LOR was measured with a standard ruler. Correlation of false and true positive LOR depth with ultrasonographically measured depth was also statistically analyzed. RESULTS: 76.5% of all cases (26 out of 34) showed false positive LOR. Concordance correlation coefficients between the measured distances on ultrasound (skin to ligamentum flavum) and actual needle depth were 0.8285 on true LOR. Depth of the true positive LOR correlated with height and weight, with a mean of 5.64 +/- 1.06 cm, while the mean depth of the false positive LOR was 4.08 +/- 1.00 cm. CONCLUSIONS: Ultrasonographic measurement of the ligamentum flavum depth (or posterior complex) preceding cervical epidural block is beneficial in excluding false LOR and increasing success rates of cervical epidural blocks.
Epidural Space ; Ligaments ; Ligamentum Flavum ; Needles ; Skin

It has been known that right side bypass tract ablation is more difficult and has higher recurrence rate than that of left side bypass tract, and often associated with atrioventricular block in patients with septal bypass tract. Multielectrode basket catheter (MBC) allows simultaneous rapid acquisition of numerous electrical signals generated by a selected surface area or volume of myocardium. We experienced two cases of successful catheter ablation of atrioventricular reentrant tachycardia by right septal bypass tract which were mapped by MBC with greater ease.
Atrioventricular Block ; Catheter Ablation* ; Catheters* ; Humans ; Myocardium ; Recurrence ; Tachycardia*

Although hypertrophic cardiomyopathy (HCM) may cause heart failure, HCM and dilated cardiomyopathy (DCM) are generally recognized as separate diseases. This report describes two cases of maternally inherited familial HCM, which, after pregnancy, rapidly deteriorated to heart failure and cardiac chamber dilatation, resembling DCM. Some members of this family also suffered sudden cardiac death (SCD).
Cardiomyopathy, Dilated ; Cardiomyopathy, Hypertrophic ; Cardiomyopathy, Hypertrophic, Familial* ; Death, Sudden, Cardiac* ; Dilatation ; Heart Failure ; Humans ; Pregnancy*

PURPOSE: To report a case of corneal and lenticular pigmentation after prolonged clozapine therapy. CASE SUMMARY: A 56-year-old male visited our hospital with a progressive decline in vision that affected both eyes. He had a history of schizophrenia. He was being treated with 200 mg clozapine and 1 mg lorazepam daily, and had been treated with clozapine for 5 years. At the first visit, his best-corrected-visual acuity was 20/32 in both eyes. Slit lamp examination of the corneas showed bright, fine, grayish-brown deposits on the endothelium, and on dilation, bilateral central stellate opacity of the anterior portion of the lens capsule was revealed. CONCLUSIONS: Clozapine may induce corneal and lenticular pigmentation and thus may lead to a decline in vision. Patients on long-term clozapine therapy should be considered for regular ophthalmic review.
Clozapine ; Cornea ; Endothelium ; Humans ; Lorazepam ; Male ; Middle Aged ; Pigmentation ; Schizophrenia ; Slit Lamp

Purpose: To compare contrast sensitivity before and after surgery in patients who underwent laser in situ keratomileusis (LASIK)and small-incision lenticule extraction (SMILE). Methods: From February 2019 to April 2019, 20 patients who underwent LASIK, and 21 who underwent SMILE, were comparedbefore, one day, one week, and one month after surgery. Results: On postoperative day (POD) 1, contrast sensitivity was better in the LASIK group than in the SMILE group under all conditionsfor 1.6, 1, and 0.64 cycles per degree (cpd). One week after surgery, the contrast sensitivity of the LASIK group was betterthan that of the SMILE group under photopic conditions with glare for 1.6, 1, and 0.64 cpd, under photopic conditions withoutglare for 1 and 0.64 cpd, and under all scotopic conditions for 2.5, 1.6, and 0.64 cpd (p< 0.05). There was no significant differencebetween the two groups, except under the scotopic conditions without glare for 0.64 cpd at one month after surgery. In theLASIK group, the contrast sensitivity was best at one week after surgery. The SMILE group showed the poorest contrast sensitivityon POD 1, but this gradually improved. Conclusions The LASIK group had better contrast sensitivity on one day and one week after surgery than the SMILE group, butthere was no significant difference at one month after surgery. In the LASIK group, the contrast sensitivity was best at one weekafter surgery. In the SMILE group, the contrast sensitivity was worst on POD 1.

Purpose: To report a case of central toxic keratopathy after femtosecond laser in-situ keratomileusis (LASIK).Case summary: A 26-year-old male developed diffuse lamellar keratitis bilaterally on day 2 after femtosecond LASIK. He was applying topical steroid frequently, while also using topical antibiotics. On day 6 after LASIK, slit-lamp biomicroscopy showed a thick central corneal opacity on the right eye so a flap irrigation was performed. He was then treated with systemic methylprednisolone. A corneal epithelial crack and stromal striae were noted by slit-lamp biomicroscopy on postoperative day 10. Four weeks after LASIK, the refractive error was +4.25 Dsph = -1.25 Dcyl Axis 80°. He was treated with topical steroid, topical antibiotics, and oral doxycycline until eight weeks after LASIK. Eight weeks after LASIK, the patient was observed without treatment. The central corneal thickness recovered from 488 μm at eight weeks to 540 μm, and the refractive error was +1.25 Dsph = -0.75 Dcyl Axis 85° at postoperative 72 weeks. The central corneal opacity also recovered. Conclusions Because femtosecond LASIK may result in a combination of diffuse lamellar keratitis and central toxic keratopathy, the clinical characteristics and natural course of both diseases should be understood and timely treatment should be available.

The fetus is an unstable subject for an isolated physiological and biochemical study. To study the fetus in a controlled and stable environment, a trial was done using 12 goat fetuses. Extrauterine incubation system was devised using an extracorporeal membrane oxygenation system. The system consisted of a venous reservoir with a servo-controlled roller pump and a membrane oxygenator. The extra-corporeal circuit and membrane oxygenator were primed with the maternal whole blood of 200 mL. Fetal umbilical cords was exposed by Cesarean section. Fetal umbilical arterial blood was drained via the drainage cannula. The drained blood was perfused to the oxygenator by the roller pump. The highly oxygenated and decarboxylated blood was returned to an umbilical vein via the perfusion catheter. The blood flow rate was controlled manually using a roller pump. Fetal heart rate, blood pressure, and electrocardiogram were continuously recorded. Gas analysis of drained and perfused bood was performed hourly. With this system, the fetuses were able to survive under fairly stable physiological condition for periods of up to 34 hr. The extrauterine incubation system used in this study could therefore be a encouraging future experimental model in researching the artificial placenta for premature fetuses.
Animals ; Extracorporeal Membrane Oxygenation/adverse effects/*methods ; Female ; Fetal Blood/metabolism ; Fetus/*blood supply/*physiology ; Goats ; Humans ; Infant, Newborn ; Infant, Premature ; Models, Animal ; Pregnancy ; Time Factors ; Umbilical Arteries ; Umbilical Veins

Various bone grafting techniques have been reported for scaphoid nonunions. We describe surgical technique of osteosynthesis with bone graft using arthroscopic technique and percutaneous fixation as a minimal invasive procedure. Nine patients with scaphoid nonunion were treated with this technique, resulting in successful union at a mean of 10 weeks.
Arthroscopy ; Bone Transplantation ; Humans ; Transplants

This study intended to review the precedents on plastic surgery medical malpractice lawsuits in lower-court trials, classify the reasons of 'limitation of liability' by type, and suggest a standard in the acknowledgement of limitation of liability ratio. The 30 lower-court's rulings on the cases bearing the medical negligence of the defendants acknowledged the liability ratio of the defendants between 30% and 100%. Ten cases ruled that the defendants were wholly responsible for the negligence or malpractice, while 20 cases acknowledged the limitation of liability principle. In the determination of damage compensation amount, the court considered the cause of the victim side, which contributed in the occurrence of the damage. The court also believed that it is against the idea of fairness to have the assailant pay the whole compensation, even there is no victim-side cause such as previous illness or physical constitution of the patient, and applies the legal doctrine on limitation of liability, which is an independent damage compensation adjustment system. Most of the rulings also limited the ratio of responsibility to certain extent. When considering that the legal doctrine on limitation of liability which supports concrete validity for the fair sharing of damage, the tangible classification of causes of limitation of liability suggested in this study would be a useful tool in forecasting the ruling of a plastic surgery medical malpractice lawsuit.
Humans ; *Liability, Legal ; Malpractice/*legislation & jurisprudence ; Reconstructive Surgical Procedures/adverse effects/legislation & jurisprudence ; Republic of Korea ; Surgery, Plastic/*adverse effects/*legislation & jurisprudence