Many difficult problems are encountered in the treatrnent of infected nonunion of long bone. To solve these difficult fractures, authors adopted an active approach-thorough debridement of the infected and necrotic soft tissue and bone, rigid internal fixation with autogenous cancellous bone graft and opening of the wound to ensure continuous drainage until union of the fracture. Authors treated 28 cases of infected nonunions with this method from Mar. 1980 to Feb. 1989, and the results are as follows ;1. Femur(54%) and tibia(43%) were most frequently involved sites. 2. Most of the cases(86%) were treated by rigid internal fixation and cancellous bone graft. 3. In most cases(64%), infection was controlled spontaneously by the time of bony union, but in 5 cases which showed persistent drainage, implant removal controlled the problem, and residual soft tissue and bony defect were solved by Papineau's technique or musculocutaneous flap. 4. Revision was required in 5 cases(18%) because of insercure fixation. 5. Union could be obtained in average 4.8 months, and infection could be controlled in all except 1 case.
Debridement ; Drainage ; Methods ; Myocutaneous Flap ; Transplants ; Wounds and Injuries

With the aging process, the senile lids are manifested by the excessive skin, decreased height of palpebral fissures with interference of the vision. Sometimes these patients often complained the blepharitis on the lateral canthal area and phtophobia. But there are many diseases to differentiate from senile lids such as dermatochalasia, blepharochalasia, hypertrophy of orbicularis oculi, herniation of orbital fat, myasthenia gravis, and blepharoptosis. Blepharospasm must also be differentiated because of sysmptoms similar to the above described senile lids. Essential blepharospam is an idiopathic progressively debilitating desease which involve bilateral spasm of the orbicularis oculi. So just only an conventional blepharoplasty could not get an improvement of symptoms and some times it makes the symptoms worsen. This case report is about blepharospasm patients visiting for blepharoplasty. And the patients got relatively the satisfied results with the injection of botulinum A toxin, aided by neurologist, instead of blepharoplasty. In conslutions, The blepharospasm in required to detect in preoperative evaluation for blepharoplasty. Once the blepharospasm is diagnosed, it is better to cooperate with neurologist and to do the blepharoplasty.
Aging ; Blepharitis ; Blepharoplasty* ; Blepharoptosis ; Blepharospasm* ; Botulinum Toxins ; Botulinum Toxins, Type A ; Humans ; Hypertrophy ; Myasthenia Gravis ; Orbit ; Skin ; Spasm

PURPOSE: This study was performed to examine if CT classification of renal blunt injury could aid in expectation of hemodynamic stability and clinical decision of whether to intervene surgically. MATERIALS AND METHODS: Over a 80-month period between July 1987 and March 1994, 41 patients were admitted to our hospital with the diagnosis of renal blunt injury. The renal blunt injuries were classified on Fedede's three-point scale CT classification methods :grade I, contusion, intrarenal hematoma, segmental infarction, and small subcapsular hematoma;grade II, complete or incomplete laceration, large subcapsular hematoma, and renal fracture;grade Ill, shattered kidney and renal pedicle injury. Hemodynamic stability, treatment method and clinical outcome of the patients with different CT grade were analyzed retrospectively. RESULTS: All 34 patients with grade I or II CT findings were hemodynamically stable and were successfully managed with conservative method. Among 7 patients with grade III CT findings, 6 patients were hemodynamically unstable. Out of the 6, One patient with grade IIIb or renal pedicle injury was expired before surgical intervention due to ischemic shock. Four patients were intervened surgically with one failure to thrive. The remaining one patient refused to be intervened surgically, and was discharged against medical advice. Only one out of 7 patients was hemodynamically stable and was managed conservatively. CONCLUSION: The patients with grade I or II CT findings are prone to be hemodynamically stable and to be managed with conservative method. But the patients with grade III CT findings are more likely to be hemodynamically unstable. Therefore patients with grade III CT findings should be closely monitored and be pre- pared for the possibility of immediate surgical intervention
Classification* ; Contusions ; Diagnosis ; Failure to Thrive ; Hematoma ; Hemodynamics ; Humans ; Infarction ; Kidney ; Lacerations ; Retrospective Studies ; Shock ; Wounds, Nonpenetrating

No abstract available.
Animal Experimentation* ; Animals* ; Botulism* ; Humans

OBJECTIVES: Hemophilia B has been known to result from more than 500 kinds of mutations. And it is difficult to find out a mutation specific for each family. Therefore, linkage analysis of DNA polymorphism within or near the factor IX gene has been frequently used in the clinical practice for molecular genetic diagnosis of hemophilia B. But the ethnic variation makes more difficult to apply useful markers in Caucasian population. To investigate the usefulness of the MseI and HhaI polymorphism in Korean population, we analysed the MseI and HhaI polymorphism. METHODS: Forty-five normal Korean and thirteen parents of the hemophilia B patients, using PCR and restriction enzyme analysis. RESULTS: The heterozygosity rate of MseI polymorphism was 49.7% and that of HhaI polymorphism was 25.5%. CONCLUSION: These data indicated that PCR-based analysis of MseI and HhaI polymorphism of factor IX was useful in molecular genetic diagnosis of hemophilia B in Korean population.
Diagnosis* ; DNA* ; Factor IX* ; Hemophilia A* ; Hemophilia B* ; Humans ; Molecular Biology* ; Parents ; Polymerase Chain Reaction ; Prenatal Diagnosis ; Restriction Mapping

BACKGROUND: Propofol is a useful induction agent, but it can cause hypotention and bradycardia. Meanwhile, ephedrine has alpha-vasoconstriction and beta-cardiac stimulant effect. The purpose of this study was to assess the hemodynamic effects of adding various doses of ephedrine to propofol to obtund adverse hemodynamic response and to determine the optimal dose. METHODS: Unpremedicated 120 ASA physical status I adult patients (20~50yrs) scheduled for elective surgery were randomly allocated into four groups according to the doses of ephedrine added to propofol (1%, 20 ml). Group 1 (control group) was given propofol alone and 10, 15 and 20 mg of ephedrine was added to propofol in Group 2, 3 and 4, respectively (n=30 for each group). Propofol was loaded at 150 ml/hr using a syringe pump and no response to verbal command was ascertained as the end-point of induction. Vital signs and SpO2 were checked every 1 min during the induction period. RESULTS: In group 1, there was a significant decrease in both systolic and diastolic pressure prior to intubation. Group 2 and 3 showed relatively stable hemodynamic changes and significant systolic or diastolic changes occured only in the pre or post 1 min periods of intubation. But, in pulse rate, group 3 showed significant change 1 and 2 min after intubation, in contrary to group 2. Group 4 showed significant changes in systolic and diastolic pressure 1 and 2 min after intubation, and in pulse rate throughout the postintubation period. CONCLUSIONS: Ephedrine 10mg may be safely employed to reduce the hemodynamic changes during induction preiod with propofol.
Adult ; Anesthesia* ; Blood Pressure ; Bradycardia ; Ephedrine* ; Heart Rate ; Hemodynamics* ; Humans ; Intubation ; Propofol* ; Syringes ; Vital Signs

From October 1990 through July 1991, 187 women who complained of urinary incontinence underwent investigation in the department of urology, especially urodynamically, compared with 42 women with female urethral syndrome as control group. The following results were obtained ; mean functional urethral length was 3.1+/-0.9cm and mean maximal urethral closure pressure was 80.2+/-2.4cmH2O in genuine stress incontinence patients. But each results of female urethral syndrome were 3.6+/-0.7cm and 121.1+/-3.8cmH2O, respectively, and were higher than those of genuine stress incontinence (p <0.05 ). The incidence of positive pressure equalization of genuine stress incontinence was higher than that of control group, as 85.6% and 14.3% (p<0.05). The findings of uroflowmetry and cystometry showed within normal limits in genuine stress incontinence and poor voiding pattern in female urethral syndrome. Conclusively. urodynamic study was important for diagnosis and follow up of genuine stress incontinence.
Diagnosis ; Female ; Humans ; Incidence ; Urinary Incontinence ; Urodynamics* ; Urology

In some clinical situations such as cerebrovascular accident, pelvic bone fracture or any bed ridden states patients do not have self control of their bowel movement. Nursing care around the perianal area is not an easy job. There is no devices which substitude the work because of the chracteristics of the anatomy of the anorectum and the fecal matter made of solid and gel state component. AIM: to evaluate the possibility of passive evacuation of the fecal matter from the rectum with a newly developed silicon device. MATERIAL AND METHODS: A New Colostomy Device (NCD; US Patent No. 5,569,216) for fixing in the stoma or rectum of human body, includes an internal balloon, a ring figured external balloon surrounding the internal balloon, a connecting tube disposed under the both internal and external balloons and supply tube containing a pair of air passages and an enema fluid passages. It is designed to be inserted into the rectum and is held in place by an inflatable external balloon and drains irrigated fecal matter through a thin collapsible connecting tube which exist in the anal canal. Six mongrel dog with 20~25 kg of body weight was used for the acute experiment. Three types (1.5, 2.0, 2.5 cm in luminal diameter of the solid portion) of NCD were applied in 3 consecutive every other days. For softening of the stool, normally harder than that of human, Psyllium dextrose 30 gm was added to the daily food. Average 750 cc of tepid water was administered through the device for bowel irrigation. Anesthesia was not used in each procedures. The amount evacuated fecal matter and remained solid stool in rectum were checked. To evaluate the rectal mucosal injury anoscopic examinations were performed. RESULTS: Stool evacuation was closely correlated with the intemal diameter of the device and stool component. The device with 2.5 cm in luminal diameter passed fecal matter well enough in 5 of 6 dogs however, smaller devices did not. Accidental prolapse of NCD were noted in 4 of 6 cases with 2.5 cm sized and all of 1.5 and 2.0 sized devices eventually until last push. CONCLUSION: The NCD with 2.5 cm of internal diameter could be used in selected clinical situations.
Anal Canal ; Anesthesia ; Animals ; Body Weight ; Colostomy* ; Dogs* ; Enema ; Glucose ; Human Body ; Humans ; Nursing Care ; Pelvic Bones ; Phenobarbital ; Prolapse ; Psyllium ; Rectum ; Silicones ; Stroke ; Water

BACKGROUND: The neuroprotective effects of 1,25-dihydroxyvitamin D3 on neurotoxicity have already been documented. However, the mechanisms underlying these effects are not fully understood. Extracellular signal-regulated kinase (ERK), one of the mitogen-activated protein kinases (MAPKs), is a serine-threonine kinase activated by phosphorylation in response to a variety of extracellular mitogenic or stress signals. The ERK signaling cascade plays an important role in the regulation of several cellular processes that include mainly proliferation, but differentiation, survival and ERK activation has also been linked to neuroprotection. We explored whether 1,25-dihydroxyvitamin D3 protects against kainic acid-induced toxiticy on neurons and, if so, whether the 1,25-dihydroxyvitamin D3 protection is mediated by ERK. METHODS: Experiments were carried out on Sprague-Dawley rats. Under anesthesia, a solution containing the drug being investigated (e.g. 1.25-dihydoxyvitamin D3) was stereotaxically infused into the hippocampus or ventricle. In the rat hippocampus, brain slices were stained with cresyl violet for the visualization of neuronal cell bodies and ERK phophorylation was assayed. RESULTS: The injection of kainic acid into the hippocampi of male rats produced a loss of cresyl violet-stained neurons. Pretreatment with U0126, an inhibitor of MAPK/ERK kinase, inhibited the rapid activation of ERK by 1,25-dihydroxyvitamin D3 in the rat hippocampus. Moreover, the neuroprotective effects of 1,25-dihydroxyvitamin D3 against kainic acid toxicity were blocked by the pretreatment with U0126. CONCLUSIONS: These results indicate that ERK mediates 1,25-dihydroxyvitamin D3 neuroprotection after kainic acid toxicity in the rat hippocampus.
Anesthesia ; Animals ; Brain ; Calcitriol ; Hippocampus* ; Humans ; Kainic Acid ; Male ; Mitogen-Activated Protein Kinases ; Neurons ; Neuroprotective Agents ; Phosphorylation ; Phosphotransferases ; Protein-Serine-Threonine Kinases ; Rats* ; Rats, Sprague-Dawley ; Viola

We rotated the nucleus up to 270 degree and dislocated it into anterior chamber through the diameter of capsulorhexis after hydrodissection by using the planned extracapsular cataract extraction. And later on we delivered the nucleus with hydroexpression using the irrigating Vectis or with rotation using a lens spatuala. As a result of this procedure, the nucleus was safely delivered in all cases without zonular rupture and vitreous prolapse.
Anterior Chamber ; Capsulorhexis* ; Cataract Extraction* ; Cataract* ; Prolapse ; Rupture