Since the first experimental nerve graft by Philipeaux and Vulpian in 1870, many successful graft have been reported by Bunnell, Boyes, Millesi, Sunderland and Seddon. Advances in microsurgery techniques prompted Millesi to introduce the concepts of interfascicular nerve grafting whereby groups of fascicles, and not whole nerve, are connected together. Hunt and Taylor described a free vasculized nerve graft with microvascular anastomoses and obtained rapid axonal advance and maturation of grafted nerve in a clinical case. It is true that a nerve graft should be inferior to an end-to-end nerve repair, because in the case of nerve grafting the axon have to cross two suture lines instead of one. On the other hand, nerve grafting is indicated whenever a significant gap is produced in a nerve as a result of injury. In a retrospective study of 46 patients, defect of the nerve with treated by nerve graft were analyzed from March, 1983 to January, 1993 and following results were obtained. 1. Nerve graft was useful method to repair nerve whenever a significant gap is produced in a nerve as a result of injury. 2. The sural nerve was used as a donor nerve and vasculized nerve graft can be useful. 3. Postoperative results of cases caused by electric burns were worse than others. 4. There were little significant value in the treatment results between epineural and perineural nerve graft. 5. Recovery of intrinsic function in median and ulnar nerve lesion above the elbow was poor and recovery of the intrinsic function in median nerve graft at the forearm level was better than level for lesion in the ulnar nerve at the same level.
Axons ; Burns, Electric ; Elbow ; Forearm ; Hand ; Humans ; Male ; Median Nerve ; Methods ; Microsurgery ; Retrospective Studies ; Sural Nerve ; Sutures ; Tissue Donors ; Transplants ; Ulnar Nerve

A 63 Year-old-lady has had substernal chest pain on exertion for 8 years. The chest pain has been increased over the last 3 years. A continuous murmur was heard at the left second to third inercostal spaces along the left sternal border. The electrocardiogram showed the inverted T-waves in the precordial leads. The right heart catheterization revealed 5% oxygen step up between RV and PA. The right sided pressures were normal. The coronary arteriography revealed markedly tortuous vessels starting shortly after the left main stem coronary artery was normally originated. One of the large vessel was shown to be drained into the pulmonary artery. In the operation room, without using heart-lung machine this abnormally drained vessel was simply ligated at it's draining site into pulmonary artery. After the operation the patient is feeling well with little symptoms and the continuous murmur is no longer heard.
Angiography ; Arteriovenous Fistula* ; Cardiac Catheterization ; Cardiac Catheters ; Chest Pain ; Coronary Vessels* ; Electrocardiography ; Heart-Lung Machine ; Humans ; Middle Aged* ; Oxygen ; Pulmonary Artery*

We present a case of pulmonary artery catheter (PAC) placement through the right internal jugular vein, bridging vein and coronary sinus in a patient with previously unrecognized persistent left superior vena cava (LSVC) and diminutive right superior vena cava. A 61-year-old male patient was scheduled for mitral valve repair for regurgitation. Preoperative transthoracic echocardiography revealed dilated coronary sinus, but no further evaluations were performed. During advancement of the PAC, right ventricular and pulmonary arterial pressure tracing was observed at 50 and 60 cm, respectively. Transesophageal echocardiography ruled out intracardiac knotting and revealed the presence of the PAC in the LSVC, entering the right ventricle from the coronary sinus. Diminutive right superior vena cava was observed after sternotomy. The PAC was left in place for 2 days postoperatively without any complications. This case emphasizes that the possibility of LSVC and associated anomalies should always be ruled out in patients with dilated coronary sinus.
Arterial Pressure ; Catheterization, Swan-Ganz* ; Catheters ; Coronary Sinus ; Echocardiography ; Echocardiography, Transesophageal ; Heart Ventricles ; Humans ; Jugular Veins ; Male ; Middle Aged ; Mitral Valve ; Pulmonary Artery ; Sternotomy ; Vascular Malformations ; Veins ; Vena Cava, Superior*

Adenosine is well known as a safe and effective drug for the termination of paroxysmal supraventricular tachycardia (PSVT), and is also widely used for the termination of both narrow and wide QRS-complex tachycardia of unknown origin in the setting of hemodynamic stability. However, due to a shortening of atrial refractoriness, adenosine can facilitate the induction of atrial fibrillation. A life threatening tachycardia may result from a potential rapid conduction of the atrial fibrillation over an accessory pathway. A case of patient, where the intravenous administration of adenosine, during regular, narrow QRS tachycardia, was followed by atrial fibrillation with rapid conduction over a manifest accessory pathway, is reported.
Adenosine* ; Administration, Intravenous ; Atrial Fibrillation* ; Hemodynamics ; Humans ; Tachycardia ; Tachycardia, Supraventricular* ; Wolff-Parkinson-White Syndrome

Reliable and valid evaluation of hand strength is of paramount importance in determining the effectiveness of various normative data area needed to interpret evaluation data, to set realistic treatment goals and to assess a patient's ability to return to employment. The primary purpose of this study was to establish normal value of grip and pinch strength for men women in normal Korean adult. A Jamar dynamometer(Hydraulic Hand Dynamometer. PC 5030, USA) was used to measure grip strength and Jamar pinch gauge(Hydraulic Pinch Gauge, PC 5030HPG, USA)was used to measure tip, key and palmar pinch. Two hundreds forty eight male and two hundreds thiry one female adults, aged 20 to 74 years were tested for using standardized positioning with their shoulder adducted and neutrally rotated, elbow flexed at 90。 and the forearm and wrist in neutral position. Right and left hand data were stratified into age groups for both sexes. This stratification provides a means of comparing the scores of individuals to that of normal subjects of the same aged and sex. The following results were obtained; 1. The average grip strength of the dominant hand was highest(43.9±7.3kg)in 3rd decade male group. 2. The average tip pinch strength of the dominant hand was highest in 4th decade(7.3±3.5kg)and 5th decade (7.3±2.4kg) male group. 3. The average key pinch strength of the dominant hand was highest in 5th decade(8.3±2.3 kg)male group. 4. The average palmar pinch strength of the dominant hand was highest in 4th decade(9.6±3.3 kg)male group. 5. A high correlation was seen between grip strength and age, but a low correlation between pinch strength and age. 6. The average grip strength of dominant hand was 5.6% higher than that of nondominant hand in men, and 6.5% higher in women. 7. In pinch strength, palmer pinch strength was highest among the three groups of pinch strength, then key pinch and tip pinch strength in order. 8. The mean scores of the dominant hand were larger than that of the nondominant hand on all hand strength.
Adult ; Clinical Study ; Elbow ; Employment ; Female ; Forearm ; Hand ; Hand Strength ; Humans ; Male ; Pinch Strength ; Reference Values ; Shoulder ; Wrist

Twenty nine cases of segmental tibial fracture were treated at Ewha Womans University Hopital, Department of Orthopedic Surgery, during the period from January, 1970 to December, 1984. The following results were obtained. 1. Most common fracture level was type I, high middle segment, occurred about 12 cases (41.4%). 2. In view of the higher incidence of open fracture (16 cases, 55.1%) and comminuted fracture (22 cases, 75.9%), fracture was caused by high velocity. 3. Various external and internal fixation methods were applied, but higher union rate was seen in the cases of Küntscher nailing and plating with bone graft. 4. Excluding the cases of type V, average union rate was 28.5 weeks and open fracture (ave. 29.6 weeks) required more longer union rate than closed fracture (ave. 26 weeks). 5. Higher rate of complication (21 cases, 72.4%) was noted than other types of tibial fracture. 6. Good result was obtained for treatment of 5 cases of delayed union or non-union by plating and bone graft than any other methods.
Clinical Study ; Female ; Fractures, Closed ; Fractures, Comminuted ; Fractures, Open ; Humans ; Incidence ; Orthopedics ; Tibia ; Tibial Fractures ; Transplants

Injuries to the tarsometatsrsal joint are not common, and the results or treatment are often unsatisfactory. Whatever the severity of the initisl injury, prognosis depends on accurate reduction and its maintenance. 5 cases of fracture and dislocation of the tarsometatarsal joint were treated at Department of Orthopaedic Surgery, Capital Armed Forces General Hospital. The length of follow-up period ranged from 12 months to 18 months, with a mean of 15 months.
Arm ; Dislocations ; Follow-Up Studies ; Hospitals, General ; Joints ; Prognosis

Lung cancer is the most common fatal malignant lesion in both sexes. Detection of the solitary pulmonary nodule is important because surgical series up to a third of solitary pulmonary nodules are bronchogenic carcinoma. Bronchioloalveolar cell carcinoma is a rare primary lung cancer and surgery is treatment of choice in brochioloalveolar cell carcinoma. We experienced a case of broschioloalveolar cell carcinoma in solitary pulmonary nodule with cavitary lesion in chest CT scan, which is an uncommon finding in brochioloalveolar cell carcinoma.
Carcinoma, Bronchogenic ; Lung Neoplasms ; Solitary Pulmonary Nodule ; Tomography, X-Ray Computed

Background: The prognostic consequences of transient hemodynamic deterioration due to cardiac displacement, which is most severe during left circumflex artery (LCX) grafting in off-pump coronary artery bypass surgery (OPCAB) are unknown. This study aimed to investigate the association between mixed venous oxygen saturation (SvO2) < 60% during LCX grafting and the occurrence of composite of morbidity endpoints. Methods: Data of patients who underwent elective OPCAB between January 2010 and December 2019 were reviewed. Logistic regression analysis was performed to detect risk factors for the composite of morbidity endpoints, defined as 30-day or in-hospital mortality, postoperative myocardial infarction, prolonged mechanical ventilation > 24 h, cerebrovascular accident, and acute kidney injury. Results: Among 1,071 patients, the composite of morbidity endpoints occurred in 303 (28%) patients. SvO2 < 60% during LCX grafting was significantly associated with the composite of morbidity (OR: 2.72, 95% CI [1.60, 4.61], P < 0.001) along with advanced age, chronic kidney disease, ratio of early mitral inflow velocity to mitral annular early diastolic velocity, and EuroSCORE II. Other major hemodynamic variables including the cardiac index were not associated with the outcome. Additional regression analysis revealed pre-operative anemia as a predictor of SvO2 < 60% during LCX grafting (OR: 2.09, 95% CI [1.33, 3.29], P = 0.001). Conclusions A decrease in SvO2 < 60%, albeit confined to the period of cardiac displacement, was associated with a 2.7-fold increased risk of detrimental outcomes after OPCAB, implying the prognostic importance of this transient deterioration in oxygen supply-demand balance.

The incidence of traumatic rupture of the tracheobronchial tree has been increased considerably with advent of widespread mechanization and high speed era. Rupture of the bronchus is an unusual result of nonpenetrating trauma to chest. Early diagnosis and primary repair not only restore normal lung function but also avoid difficulties and complications associated with delayed diagnosis and repair. These complications are pneumonia, atelectasis and lung abscess secondary to the bronchial obtruction. We experienced a case of partial rupture on left main bronchus caused by nonpenetrating blunt chest trauma with rib fractures 1 year ago. He was suffered from progressively developing dyspnea on exercise and treated as bronchial asthma at other hospital. Bronchoscopic finding was the narrowed lumen of left main bronchus at 1cm from carina by web-like membrane. We confirmed by bronchogram and repaired by end to end anastomosis, which is rare delayed finding in bronchial rupture without pulmonary complications. We report a case of nonpenetrating traumatic bronchial rupture, manifested by bronchial web in bronchoscopy.
Asthma ; Bronchi ; Bronchoscopy* ; Delayed Diagnosis ; Dyspnea ; Early Diagnosis ; Incidence ; Lung ; Lung Abscess ; Membranes ; Pneumonia ; Pulmonary Atelectasis ; Rib Fractures ; Rupture* ; Thorax* ; Trees