Although the clavicle is probably the most commonly fractured bone, nonunions are rare. We experienced 19 cases of clavicle nonunions, trested at the Depatment of Orthopedic Surgery of Wonju Christian Hospital, between January 1980 and June 1988(seven years and six months). This study focused on predisposing factors in relation to nonunion of clavicle and treatment. The factors predisposing to nonunion were middle and lateral 1/3 of clavicle, primary open reduction, severe trauma with associated injury and persistent gross displscement of fregment. Among the 19 patients, 16 patients were treated with semitubular plating and iliac bone grafting, 2 patients with the resection of the distal fregment and one patient was treated with treated with K-wire fixation and bone graft. All patients achived good union by the postoperative 10.7 week on average and symptomes disappeared. It was concluded that symptomatic nonunion of the clavicle could be trested by operation, and the procedure of choice seemed to be rigid internal fixation with plate applied in compression and bone graft.
Bone Transplantation ; Causality ; Clavicle ; Gangwon-do ; Humans ; Orthopedics ; Transplants

The results of treatment of fracture of the femoral shaft with interlocking nailing were evaluated to determine the clinical usefulness. Eighty-two femoral fractures that had been treated by interloking nailing between October 1988 and June 1993 and had been followed for more than one year were included in this study. Fifty-one cases were fresh closed fracture and twenty-four, fresh open fracture. Five cases were delayed union and two were non-union. Closed intramedullary nailing was used in seventy-five cases and open intramedullary nailing in seven cases. The results were as follows; 1.According to Winquist-Hansen classification, 30 cases were type I, 16 type II, 13 type III, 14 type IV, and 9 type V 2. Static and dynamic interlocking nailing were done in 67 and 15 cases respectively. 3. The mean fracture healing period was 17 weeks with a range of 9 to 52 weeks. 4. Intraoperative complications were new fracture near the original fracture site(7 cases), femur neck fracture(l case), pudendal nerve neuropraxia(1 case). Postoperative compliction were delayed union(13 cases), limb shorteniln(4 cases), nonunion(3 cases), infection(3 cases), disal screw brokening(3 cases), nail breakage(l case), proximal screw brodening(1 case) and 12 valgus angulation(l case).
Classification ; Extremities ; Femoral Fractures ; Femur Neck ; Femur ; Fracture Fixation, Intramedullary ; Fracture Healing ; Fractures, Closed ; Fractures, Open ; Intraoperative Complications ; Pudendal Nerve

No abstract available.
Osteoporosis* ; Tibial Fractures*

Deformities of the leg and ankle may result from growth abnormalities of the tibia and fibula. The appearance of the secondary ossification center and growth plate closure of the tibial and fibular epiphyses, and the pattern of closure of the epiphyses, were observed in a different age. Normal radiographs were reviewed in one hundred and fifty patients at age from two days after birth to 20 years, who were injured on the contralateral leg, at Wonju Medical College, Yonsei University from Feb., 1980 to May, 1984. The results were as follows: 1. The time of the appearance of secondary ossification center and the closure of growth plates; The proximal tibial epiphysis usually forms secondary ossification center at birth to second postnatal months, the physeal closure occurs from 13 year and 11 months to 18 year 3 months in male, from 13 year 4 months to 15 year 5 months in female. The secondary ossification center of the distal tibial epiphysis appears from 8th postnatal months to one year, and physeal closure occurs from 15 years to 17 year and 4 months in male, from 15 year 2 months to 16 year 8 months in female. The secondary ossification center of the tibial tuberosity appears from 9 year 3month to 12 year 2 months, and closure occurs from 16 year 3 months to 18 year 7 months inmale, from 14 year 10 months to 19 year 1 months in female. The proximal fibular epiphysis forms secondary ossification center from 2 year 5 months to 5 year 4 months, closure occurs from 15year 8 months to 17 year 4 months in male, from 14 year 9 months to 16 year 9 months in female. The secondary ossification center of the distal fibular epiphysis appears from 2 year 5 months to 3rd years, and closure occurs from 13 year 11 months to 17 year 6 months in male, from 13 year 4 months to 16 year 7 months in female. 2. The growth and the pattern of the closure of growth plates of the tibia; The proximal tibial epiphysis is elliptic for the first 3 years of life. The epiphysis is slightly conical centrally as it extends toward the tibial spines, and becomes more prominent from 8 years to adolescence. The closure of the proximal tibial growth plate occurs initially along the anteromedial aspect of the tibia and tibial tuberosity during 12 years and proceeds posterolaterally. Complete closure of the proximal tibial physis occurs about from 13 years to 18 years. The secondary ossification center of the distal tibial epiphysis is oval in shape initially, becomes thicken medially by 3rd year of life, then the tibial plafond is valgoid, and becomes horizontal at age 10 approximately. The distal epiphysis of tibia unites first at about 13 years, starting centrally and proceeding toward anteromedial portion. And the posterolateral portion unites finally by about 15 to 17 years. The tibial tuberosity develops a secondary ossification center by 7 to 9 years, usually in the most distal region, and gradually elongates and extends toward the secondary ossification center of the proximal tibia.From about 12 years, the tuberosity epiphyseal center fuses with the proximal tibial center, and the fusion with the tibial metaphysis extends distally, the tuberosity physis closes completely from about 15 to 19 years. 3. The growth and development of the tibia, fibula and ankle; The growth of the proximal tibial and the distal fibular epiphyses play an important role of the growth rate in lower extremities unber ten years. The distal tibial growth plate inclines laterally and distally prior to the first year of life, the inclination is on the decrease and it finally horizontal at about 12 years. The distal tibia talus angle is about 90° prior to the age one year, becomes mildly valgoid by 12 years.
Adolescent ; Ankle ; Congenital Abnormalities ; Epiphyses ; Female ; Fibula ; Gangwon-do ; Growth and Development ; Growth Plate ; Humans ; Leg ; Lower Extremity ; Male ; Parturition ; Spine ; Talus ; Tibia

Glycogen storage diseases(GSD) are inherited disorders affecting glycogen metabolism and type I GSD is due to the absence or deficiency of glucose-6-phosphatase(G6Pase) enzyme in the liver, kidney, and intestinal mucosa. The defect leads to inadequate hepatic conversion of G6P to glucose and thus make affected individuals susceptible to fasting hypoglycemia, and the accumulation of glycogen occurs in the liver and other organs. Type Ia is the most common form of GSD and clinically growth retardation may manifest of GSD itself rather than growth hormone deficiency(GHD), but we experienced a case of type I GSD with GHD in a 14-year-o1d male. The height was 125 cm, compatible with 50 th percentile of height of 8 years of age. He has doll-like face with fat cheek, relatively thin extremities, and metabolic acidosis, hyperuricemia, hypoglycemia, hyperlipidemia. GH stimulation test with clonidine and L-dopa revealed that the patient had decreased GH secretion. After laboratory work up including liver biopsy, he was diagnosed as type I GSD. Hypoglycemia was managed with frequent feeding with high starch diet(uncooked cornstarch). Metabolic acidosis and hyperuricemia were treated with sodium bicarbonate, allopurinol and probenecid. The patient is being followed at out-patient clinic with clinical improvement after of diet therapy and GH administration.
Acidosis ; Allopurinol ; Biopsy ; Cheek ; Clonidine ; Diet Therapy ; Extremities ; Glucose ; Glycogen Storage Disease* ; Glycogen* ; Growth Hormone* ; Humans ; Hyperlipidemias ; Hyperuricemia ; Hypoglycemia ; Intestinal Mucosa ; Kidney ; Levodopa ; Liver ; Male ; Metabolism ; Outpatients ; Probenecid ; Sodium Bicarbonate ; Starch

PURPOSE: The purpose of this study was to analyze the clinical features and to assess the risk factors in the treatment of small-bowel obstructions. METHODS: This retrospective clinical report was based on the medical records of 67 patients who were treated between Jan. 1992 and Dec. 1999 and who had had a history of abdominal surgery due to cancer. RESULTS: The distribution of primary cancer was as follows: stomach cancer 36 (53.7%), colorectal cancer 25 (37.3%), uterine and ovarian cancer 4 (6.0%), and other cancers 2 (3.0%). The mean interval from the primary operation to the development of a small- bowel obstruction was 27 months. Conservative treatment produced a successful outcome in 36 patients (59.0%), but recurrences of obstruction were noted in 18 of those patients. There were 34 operations in 30 patients. The initial success rate of operative treatment was 80% (24/30), obstructions recurred in 6 patients. The causes of obstructions in the surgically treated patients were adhesion (53.3%) and recurrence of cancer (46.7%). The postoperative complication rate was 44.1%, and the mortality rate was 20.0%. The mean survival time of the patients with benign causes of obstruction was significantly longer than that of the patients with malignant causes of obstruction (46 months vs 11 months). CONCLUSION: In the treatment of such patients, conservative treatment should be considered first. However if conservative treatment fails, surgery should be done without hesitation, especially in patients with no definite evidence of recurrence.
Colorectal Neoplasms ; Humans ; Medical Records ; Mortality ; Ovarian Neoplasms ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms ; Survival Rate

PURPOSE: Long-term follow-up results of concurrent bilateral or unilateral cementless hip arthroplasty were compared. MATERIALS AND METHODS: Forty eight and 49 patients with concurrent bilateral and unilateral hip artrhoplasties who had more than a 17-year follow-up time were selected. At final follow-up, mean ages were 69.1 and 66.7 years old in the bilateral and unilateral groups, respectively. Mean follow-up times were 21.5 and 22.4 years in the bilateral and unilateral groups, respectively. Clinical results were attained using Harris hip score and standardized anteroposterior and lateral view X-rays. RESULTS: The bilateral group had mean Harris scores of 44.3(standard deviation 3.78) preoperatively, and 81.2 (10.75) at final follow-up. For the unilateral group, the mean scores were 46.5(3.27) preoperatively, and 80.1 (12.05) at final follow-up. At final follow-up, an acetabular cup was securely located in 78.9% and 82.8% of the bilateral and unilateral groups, respectively, and all cases showed firm fixation of the femoral stem in both groups. Osteolysis around the cup and stem were found in 26.3% and 31.4% of the bilateral group and 16.6% and 17.1% of the unilateral group, respectively. Polyethylene wear rate was 0.17 mm/yr and 0.16 mm/yr in the unilateral and bilateral groups, respectively. Using the Kaplan-Meier method, 17-year survival rates for cup and stem were 78% and 89% in the bilateral group, respectively, and 78% and 86% in the unilateral group, respectively. CONCLUSION: In 17-year long-term follow-up, concurrent bilateral hip arthroplasty was insignificantly different clinically and radiologically from the result of unilateral hip arthroplasty.
Arthroplasty ; Follow-Up Studies ; Hip ; Humans ; Osteolysis ; Polyethylene ; Survival Rate

Aims: Biofouling is a common biology phenomenon occuring on ship surface. This phenomenon has become serious threat in marine industries because of great economic loss. Tributyltin has been used to prevent biofouling, but it turned to cause the environmental problem. Therefore, the discovery of alternative environment-friendly compound is necessarily needed. Methodology and results: Five Actinobacteria isolates and fourteen marine bacteria isolates were tested against the biofilm formation of eight biofouling bacteria isolates that isolated from boat surface and the attachment of three biofouling diatoms (Amphora, Navicula, Nitzschia). Actinobacteria CW17 supernatant showed the broad spectrum activity against all fouling bacteria, whereas BC 11-5 supernatant was the only marine bacteria that capable to inhibit biofilm formation of V. neocaledonicus. Moreover, three representative diatoms attachment could be inhibited by the bioactive compounds produced by Actinobacteria and marine bacteria. CW01 supernatant showed broad spectrum and high activity against all three representative diatoms which is very promising. Molecular identification based on 16S rDNA gene sequence showed eight fouling bacteria isolates were biofilm-forming bacteria. Conclusions, significance and impact of study: This research showed aquatic Actinobacteria and coral-associated marine bacteria have the potential to prevent biofouling formation. Further studies are needed to purify and characterize these antibiofouling compounds for environmental application.
Biofouling ; Biofilms

PURPOSE: In recent years, colonic diverticular disease has increased rapidly because of high intraluminal pressure in the colon due to the low fiber westernized diet and the increasing number of elderly people. Furthermore, emergency operation is required in many cases. Therefore, the aim of this study is proposed to review the optimal treatment guide. METHODS: This study is a retrospective review of the hospital records of 34 patients who underwent surgical treatment for colonic diverticular diseases at the National Medical Center from March 1992 to July 2003. RESULTS: The patients consisted of 23 males and 11 females, with mean age of 49 years. The lesion sites were cecum (62%), sigmoid colon (20%), ascending colon (9%), transverse colon (6%) and descending colon (3%), in descending orders of frequency. The patients were staged by Thorsen classification at the right colon and by Hinchey classification at the other sites. At the right colon, there were no cases of stage IV and 2 of bleeding. At the transverse colon and left colon, there were 3 cases of stage II, 5 of III, and 2 of IV. For the right colon, all patients underwent one- stage operation. For the other sites, 3 one- stage operations and 7 two- stage operations were performed. Major or minor postoperative complications occurred in 12 patients, including 2 mortality cases. Among them, 2 cases with colocutaneous fistulas might have been prevented if the operation had been made on the basis of stage. CONCLUSION: Because diverticular disease occurs at the various sites of the colon and has potential risk, it is important that patient treatment is based on stage.
Aged ; Cecum ; Classification ; Colon* ; Colon, Ascending ; Colon, Descending ; Colon, Sigmoid ; Colon, Transverse ; Diet ; Emergencies ; Female ; Fistula ; Hemorrhage ; Hospital Records ; Humans ; Male ; Mortality ; Postoperative Complications ; Retrospective Studies

BACKGROUND: Although current dietary guidelines recommend to increase the consumption of whole grain, these recommendations are mainly derived from the belief that replacing fats with carbohydrate may reduce risk of coronary artery disease (CAD) by improving serum lipids. Our objective was to evaluate whether the isocalorical replacement of refined rice with whole grain reduce CAD risk factors such as insulin demand and lipid peroxidation in CAD patients. METHODS: Thirty-eight male patients with CAD were provided with 70 g powder of whole grain (220 kcal) for 16 weeks, replacing cooked refined rice as a carbohydrate source of breakfast. An oral glucose tolerance test (OGTT) was performed in all subjects to determine the effect of whole grain consumption on serum concentrations of insulin and glucose in CAD patients with different degree of glucose tolerance. RESULTS: With the substitution of whole grain for refined rice, serum glucose concentrations decreased by 24% without altering body weight and energy intake. Estimates of daily fiber and vitamin E intakes increased by 24% and 50%, respectively. Whole grain consumption in CAD patients without diabetes decreased fasting glucose (22%) and the area under the curve (AUC) for insulin (26%) and glucose (19%) during an OGTT. CAD patients with diabetes also showed reductions in fasting glucose (27%) and AUC for glucose (25%) during the OGTT, compared with baseline values. Whole grain consumption reduced plasma malondialdehyde and homocysteine and urinary 8-epi-prostaglandin F 2alpha concentrations by about 30%. Lipid-corrected concentrations of alpha-carotene, retinol, alpha- and gamma-tocopherol and lycopene increased by 22-46%, compared with baseline values. Whole grain consumption decreased the percentage composition of w6 fatty acids of serum phospholipid increased by 14%. CONCLUSION: The replacement of refined rice with whole grain as a carbohydrate source of a meal showed significant beneficial effects on glucose, insulin and homocysteine concentrations and lipid peroxidation in CAD patients. These effects are likely to substantially reduce the risk factors of CAD and diabetes in CAD patients.
Area Under Curve ; Blood Glucose ; Body Weight ; Breakfast ; Edible Grain* ; Coronary Artery Disease* ; Coronary Vessels* ; Energy Intake ; Fasting ; Fats ; Fatty Acids ; gamma-Tocopherol ; Glucose ; Glucose Tolerance Test ; Homocysteine* ; Humans ; Insulin* ; Lipid Peroxidation* ; Male ; Malondialdehyde ; Meals ; Nutrition Policy ; Plasma* ; Risk Factors ; Vitamin A ; Vitamin E ; Vitamins