Recently there has been a noted increase in the incidence of traumatic bony gap in long bones due to accidents in industry, high speed traffic accidents and common gunshot accidents. There are several methods to treat traumatic bony gap such as bone graft (autogenous, homogenous and heterogenous), bone transplantation, periosteal osteogenesis and reinplantation of the extruded bone etc. The authors studied 26 patients of traumatic bony gap in the long bones which had been treated by autogenous bone grafting. The results of the clinical observation were as following; 1 The causes were shotgun accidents, vehicle accidennts and explosive accidents. 2 There was bony gap involved in 10 upper extremities and 16. lower extremities. The radius was the most common site in the upper extremity and the femur in the lower extremity. 3. The largest bony gaps were 10.5cm. in the tibia and next were 10.6cm. in ulna and 9.0cm. im humerus. 4. The period of the bony union in these cases was prolonged 1.5~3 times the usual healing period of simple fractures. 5. It was very important to prevent and control infection of the open fractures and to decide the correct time for bone grafting operation after healing of the infected wounds. We did the bone grafting sugery 2 or 3 months later after the infected wounds had been healed. 6 The authors could avoid some complications such as delayed union, shortening of the affected limbs and stiffness of the joints of the affected limbs etc.
Accidents, Traffic ; Bone Transplantation ; Extremities ; Femur ; Fractures, Open ; Humans ; Humerus ; Incidence ; Joints ; Lower Extremity ; Osteogenesis ; Radius ; Tibia ; Transplants ; Ulna ; Upper Extremity ; Wounds and Injuries

This study compared the microtensile bond strength (microTBS) and microscopic change of two 2-step and two 1-step self-etching adhesives to dentin according to storage times in distilled water. Occlusal dentin was exposed in 48 human molars. They were divided to four groups by different adhesives: SE Bond group (Clearfil SE Bond), AdheSE group (AdheSE), Adper group (Adper Prompt L-Pop), and Xeno group (Xeno III). Each group was stored in 37degrees C distilled water for 1, 15, and 30 days. Resin-bonded specimens were sectioned into beams and subjected to microTBS testing with a crosshead speed of 1 mm/minute. For SEM observation, one specimen was selected and sectioned in each group after each stroage time. Resin-dentin interface was observed under FE-SEM. In all storage times, mean microTBS of SE group was significantly higher than those of other groups (p < 0.05). There was no significant difference between mean microTBS of SE group and AdheSE group among all storage times, but significant difference between 1- and 30-day storage in mean microTBS of Adper group and Xeno group (p < 0.05). For 1-and 15-day storage, all groups showed the close adaptation between resindentin interfaces. For 30-day storage, resin-dentin interfaces showed wide gap in Adper group and separate pattern in Xeno III group.
Adhesives* ; Dentin* ; Humans ; Molar ; Water

BACKGROUND: Local anesthetics combined with an opioid are frequently used as a postoperative epidural analgesia, to minimize individual doses and to reduce unwanted side effects. The aims of this study were to compare analgesic effectiveness, occurrence of motor block and other side effects of a 48 hr postoperative continuous epidural infusion of 0.1% bupivacaine/morphine or 0.1% ropivacaine/ morphine. METHODS: Forty female patients scheduled for an elective total abdominal hysterectomy under general anesthesia were randomized in a double-blind fashion to receive either 0.1% bupivacaine with 0.02 mg/ml morphine or 0.1% ropivacaine with 0.02 mg/ml morphine using a continuous epidural analgesia pump at a rate of 4 ml/hr during the postoperative 48 hours. After the operation, we assessed the blood pressure, heart rate, visual analog scale (VAS), side effects, additional analgesic requirement and time to ambulation for 48 hours in 12-hour intervals. RESULTS: There were no significant differences in VAS on rest and cough between the groups, but VAS on deep breathing and position change were significantly lower in the bupivacaine group compared to the ropivacaine group. Side effects were similar in both groups except paresthesia. Time to ambulation was earlier in the ropivacaine group compared to the bupivacaine group. CONCLUSIONS: Both the postoperative continuous epidural infusion of 0.1% bupivacaine with morphine and 0.1% ropivacaine with morphine provided similar pain relief and side effects. However, earlier recovery of ambulation in patients receiving ropivacaine/morphine will improve outcome after abdominal surgery.
Analgesia, Epidural* ; Anesthesia, General ; Anesthetics, Local ; Blood Pressure ; Bupivacaine ; Cough ; Female ; Heart Rate ; Humans ; Hysterectomy* ; Morphine ; Paresthesia ; Respiration ; Visual Analog Scale ; Walking

BACKGROUND: Opioids and local anesthetics administered together intrathecally have a potent synergistic analgesic effect and less hypotention using a minidose of local anesthetic. This study was designed to investigate the safety and efficacy of two doses of intrathecal isobaric ropivacaine/fentanyl in patients undergoing an operation of the lower extremities. METHODS: Thirty patients undergoing an elective orthopedic surgical operation of the lower extremities were randomly assigned to two groups for spinal anesthesia. Patients in group I (n = 15) received 0.75% ropivacaine 14 mg/fentanyl 20microgram, and patients in group II (n = 15) received 0.75% ropivacaine 16 mg/fentanyl 20microgram. After spinal anesthesia, we measured the time to T10, peak dermatomal level, time to peak sensory level, time to maximum motor blockade, duration of complete motor block and duration of complete sensory block using the pin prick test and Bromage motor scale. Also circulatory variables were monitored every 5 min and side effects were measured for 3 days after spinal anesthesia. RESULTS: There were no significant differences between the groups in time to T10, peak dermatomal level, time to peak sensory level, time to maximum motor blockade and duration of complete motor block, but duration of complete sensory block was significantly longer in the 0.75% ropivacaine 16 mg/fentanyl 20microgram group than the 0.75% ropivacaine 14 mg/fentanyl 20microgram group. CONCLUSIONS: Intrathecal 0.75% ropivacaine 14 mg/fentanyl and 0.75% ropivacaine 16 mg/fentanyl were equally suitable for a lower extremity operation.
Analgesics, Opioid ; Anesthesia, Spinal* ; Anesthetics, Local ; Fentanyl* ; Humans ; Lower Extremity* ; Orthopedics

Tracheal bronchus is an uncommon anomaly in which an ectopic bronchus originates directly from the supracarinal trachea. It is usually an asymptomatic anatomical variant incidentally found on computed tomography or bronchoscopy. However, it can present with symptoms, such as chronic cough, wheezing, atelectasis, and recurrent pneumonia. We report a case of tracheal bronchus diagnosed in the neonatal period, in which the term baby presented with respiratory distress and persistent pulmonary hypertension of the newborn after birth, but no other congenital anomaly was found on further evaluation.
Bronchi* ; Bronchoscopy ; Cough ; Female ; Humans ; Hypertension, Pulmonary* ; Infant ; Infant, Newborn* ; Parturition ; Persistent Fetal Circulation Syndrome ; Pneumonia ; Pulmonary Atelectasis ; Respiratory Sounds ; Trachea

BACKGROUND AND OBJECTIVES: Vocal polyps and nodules are representative chronic benign laryngeal diseases, and voice overuse, misuse, and abuse are felt by most authors to be the primary causative factors. Treatment options for vocal polyps and nodules in general include voice therapy by a speech-language pathologist and laryngeal microsurgery. The purpose of this study was to determine the changes in voice quality of a group of patients diagnosed with vocal polyp or vocal nodule before and after microlaryngeal surgery. MATERIALS AND METHOD: The following patients groups were studied prior to and 2 weeks after surgery: thirty-eight males, ages 27 to 62, and twenty five females, ages 23 to 47, with vocal polyp: three males, ages 29 to 38, and twenty eight females, ages 21 to 49, with vocal nodules. Voice recordings of the first sentence of a standardized paragraph "San Chaek" were performed for acoustic analyses. The recorded samples were analyzed on the Kay CSL model 4300B using Visi-Pitch II program. For the sentence, mean speaking fundamental frequency (F0), mean jitter and mean shimmer were analyzed. RESULTS: For the polyps, male patients showed decreased mean F0 (119.28 Hz), compared to the preoperative value (125.86 Hz) (p<0.05), and female patients showed increased mean F0 (197.52 Hz), compared to the preoperative value (190.07 Hz) (p=0.06). Mean jitter and shimmer improved in both males and females 2 weeks after surgery compared to their preoperative value (p<0.01). For the nodules, male patients showed decreased mean F0 (136.24 Hz) compared to the preoperative value (138.68 Hz), and female patients showed increased mean F0 (199.98 Hz) compared to the preoperative value (192.61 Hz) (p<0.05). Mean jitter and shimmer improved in both males and females 2 weeks after the surgery compared to their preoperative value. CONCLUSION: The acoustic output generally improved after laryngeal microsurgery as evidenced by the more appropriate mean F0 and reduced level of vocal perturbation. And, mean F0 showed different changes between males and female. Further research needs to be pursued on what this changes of mean F0 mean.
Acoustics ; Female ; Humans ; Laryngeal Diseases ; Male ; Microsurgery* ; Polyps* ; Voice Quality* ; Voice*

BACKGROUND: Lung cancer has been the leading cause of cancer death in South Korea since 2000. This study examined the clinical characteristics of lung cancer patients diagnosed in a community hospital from the year 2000 to 2005, and compared these results with previously reported statistical data. METHOD: The lung cancer data in a form of an electronic medical record was downloaded from the hospital medical information system. The clinical characteristics of the 1,509 patients with lung cancer were analyzed retrospectively. RESULT: The mean age of the patients was 63.7 years. 82.5% and 74.5% of the patients were men and smokers, respectively. Squamous cell carcinoma (41.6%) was the most common pathology type followed by adenocarcinoma(32.3%) and small cell carcinoma(13.9%). When 604 patients who were diagnosed from 2000 to 2003 were compared with 905 patients diagnosed from 2004 to 2005, the age of patients increased significantly (61.5 years vs. 65.1 years; p<0.001) and the proportion of adenocarcinomas was significantly higher(29.3% vs. 34.4%; p=0.046). CONCLUSION: Among the major histology types of lung cancer, the incidence of adenocarcinoma has been increasing recently. The age of the lung cancer patients at diagnosis is getting older. This is despite the fact that the distributions of the initial anatomic stages have not changed significantly.
Adenocarcinoma ; Carcinoma, Squamous Cell ; Diagnosis ; Electronic Health Records ; Hospitals, Community ; Humans ; Incidence ; Information Systems ; Jeollanam-do* ; Korea ; Lung Neoplasms* ; Lung* ; Male ; Pathology ; Retrospective Studies

Wegener's granulomatosis is a disease with an unknown etiology that is characterized by necrotizing granulomatous vasculitis involving the upper and lower respiratory tract and the kidneys. The typical pulmonary findings are bilaterally involved multiple variable sized nodules. We report a case of Wegener's granulomatosis that presented as a single lung mass. A male patient presented with a nasal obstruction, arthralgia, cough, and intermittent dyspnea. The chest radiograph showed a mass, approximately 4.5 cm in diameter, in the right lower lobe. Lung cancer or tuberculosis was initially considered. However, the clinical, laboratory and pathological findings of the mass indicated Wegener's granulomatosis. The patient was administered prednisolone and cyclophosphamide, and improved temporarily. Unfortunately, the immunocompromised patient expired as a result of respiratory failure with pneumonia.
Arthralgia ; Cough ; Cyclophosphamide ; Dyspnea ; Humans ; Immunocompromised Host ; Kidney ; Lung Neoplasms ; Lung* ; Male ; Nasal Obstruction ; Opportunistic Infections ; Pneumonia ; Prednisolone ; Radiography, Thoracic ; Respiratory Insufficiency ; Respiratory System ; Tuberculosis ; Vasculitis ; Wegener Granulomatosis*

Sinus histiocytosis with massive lymphadenopathy (SHML) is a rare disorder characterized by a nonneoplastic proliferation of distinctive histiocyte cells within lymph node sinuses and lymphatics in extranodal sites. SHML occurs worldwide and is primarily a disease of childhood and early adulthood. A 26-yr-old man presented with painless palpable lymph node in cervical area. Radiographic studies revealed pleural effusion with lymphadenopathy and calcification in mediastinum. The cervical lymph node biopsy showed dilated sinuses filled with histiocytes with clear cytoplasm. The cells stained positive with CD68 and S-100. These cytologic and immunohistochemical findings were considered consistent with the diagnosis of SHML.
Adult ; Antigens, CD/metabolism ; Antigens, Differentiation, Myelomonocytic/metabolism ; Histiocytes/pathology ; Histiocytosis, Sinus/*diagnosis/metabolism/pathology ; Humans ; Lymph Nodes/pathology ; Male ; Neck ; Pleural Effusion/*radiography ; S100 Proteins/metabolism ; Tomography, X-Ray Computed

BACKGROUND AND OBJECTIVES: The electrophysiological properties associated with favorable outcome of radiofrequency catheter ablation (RFCA) for idiopathic ventricular arrhythmia (VA) originating from the papillary muscle (PM) remain unclear. The purpose of this study was to investigate the relationships of electrophysiological characteristics and predictors with the outcome of RFCA in patients with VAs originating from PM in the left ventricle (LV). SUBJECTS AND METHODS: Twelve (4.2%) of 284 consecutive patients with idiopathic VAs originating from LV PM were assessed. The electrophysiological data were compared between the patients in the successful group and patients in the recurrence group after RFCA. RESULTS: In 12 patients with PM VAs, non-sustained ventricular tachycardias (VTs, n=6), sustained VTs (n=4) and premature ventricular complexes (n=2) were identified as the presenting arrhythmias. Seven of eight patients showing high-amplitude discrete potentials at the ablation site had a successful outcome (85.7%), while the remaining four patients who showed low-amplitude fractionated potentials at the ablation site experienced VA recurrence. The mean duration from onset to peak downstroke (Deltat) on the unipolar electrogram was significantly longer in the successful group than in the recurrence group (58+/-8 ms vs. 37+/-9 ms, p=0.04). A slow downstroke >50 ms of the initial Q wave on the unipolar electrogram at ablation sites was also significantly associated with successful outcome (85.7% vs. 25.0%, p=0.03). CONCLUSION: In PM VAs, the high-amplitude discrete potentials before QRS and slow downstroke of the initial Q wave on the unipolar electrogram at ablation sites were related to favorable outcome after RFCA.
Arrhythmias, Cardiac* ; Catheter Ablation* ; Catheters* ; Heart Ventricles* ; Humans ; Papillary Muscles* ; Recurrence ; Tachycardia, Ventricular ; Ventricular Premature Complexes