In orthopedic trauma surgery, treatment of intraarticular distal humerus fractures is a challenge. With development of implants and biomechanical studies, surgical strategies with recommendations including preoperative computed tomography images, proper approaches and open reduction and internal fixation with dual plates have emerged. In addition, as an effort to provide stable fixation to permit early elbow motion, different methods of internal fixation, particularly plate configuration, have evolved. Using dual plates, either oriented parallel to each other or orthogonal, stable fixation has been achieved and satisfactory clinical outcomes have been reported. With rationales and advantages/disadvantages of each plate configuration, both techniques are selected according to surgeons' preference, and, in specific cases, one could be preferred over another. The key to successful fixation by either technique is obtaining anatomical reduction with restoration of two stable columns of the distal humerus.
Elbow ; Fracture Fixation ; Humeral Fractures* ; Humerus ; Orthopedics

No abstract available.

Fixation failure is a major complication of intertrochanteric fracture. The causes of fixation failure were assessed in a series of 80 patients with intertrochanteric fractures, which had been internally fixed with either a sliding hip screw or a Gamma interlocking nail. The overall rate of fixation failure was 16.3%, in which the cutting-out of the implant from the femoral head was the only cause of the instance. The cutting-out rate was influenced by the accuracy of fracture reduction, the position of implant placement within the femoral head, and the bone mineral density. Anatomical reduction and the central placement of implant within the femoral head showed the most excellent results compared to other treatment modalities. Age, gender, fracture type and a kind of fixation implant had no significant effect. Our results showed that the intertrochanteric fractures should be reduced as anatomically as possible and it is essential that the central placement of the implant within the femoral head be obtained.
Bone Density ; Head ; Hip ; Hip Fractures* ; Humans

PURPOSE: To determine the effects of hand massage on nausea and vomiting, and anxiety in children with lymphocytic leukemia receiving high dose chemotherapy. METHOD: The children were assigned to an experimental group(15) or a control group(15). All of the children were diagnosed with acute lymphocytic leukemia and admitted for high dose chemotherapy at C University Medical Center in Seoul. The hand massage was performed for 10 minutes twice a day over three days. To measure the effects of hand massage, the Index of Nausea and Vomiting by Rhodes et al. and the State-Trait Anxiety Inventory for children by Spielberger were used. The level of anxiety was measured by systolic blood pressure, diastolic blood pressure, and pulse rate. RESULTS: The score for nausea and vomiting decreased in the experimental group. State anxiety for the experimental group was significantly more positive than for the control group at the 2nd measurement. There was a significant difference in systolic blood pressure between the two groups. The level of diastolic blood pressure in the two groups decreased significantly over time. CONCLUSION: Hand massage could be effective in decreasing nausea and vomiting, state anxiety, pulse rate and blood pressure in children with acute leukemia receiving high dose chemotherapy.
Academic Medical Centers ; Anxiety* ; Blood Pressure ; Child ; Drug Therapy* ; Hand* ; Heart Rate ; Humans ; Leukemia* ; Leukemia, Lymphoid ; Massage* ; Nausea* ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Seoul ; Vomiting* ; Child Health

BACKGROUND: The external jugular vein (EJV) is a useful intravenous (IV) cannulation site for anesthesiologists, although it has a relatively high failure rate. Unlike other central veins, visualization of the EJV is important during IV cannulation, and the Valsalva maneuver distends the jugular venous system. However, the relationship between the maneuver and EJV visibility remains unknown. This study compared EJV visibility before and after the Valsalva maneuver. METHODS: This was a prospective observational study that included 200 participants. After the induction of anesthesia, EJV visibility grade, depth from the skin to the EJV superficial surface (EJV depth), and EJV cross-sectional area (CSA) before the Valsalva maneuver were measured. The same parameters were measured after the Valsalva maneuver was performed. The EJV visibility grade was defined as grade A: good appearance and good palpation, grade B: poor appearance and good palpation, and grade C: poor appearance and poor palpation. RESULTS: Patient body mass index and EJV depth affected the EJV visibility grade before the Valsalva maneuver (p < 0.05), although EJV CSA did not. The Valsalva maneuver distended EJV CSA and reduced EJV depth, although these changes were not correlated with EJV visibility grade. With regard to EJV visibility, 34.0% of grade B cases and 20.0% of grade C cases were improved by the Valsalva maneuver. CONCLUSIONS: Although the Valsalva maneuver improved EJV CSA and EJV depth, it did not greatly affect EJV visibility grade.
Anesthesia ; Body Mass Index ; Catheterization ; Humans ; Jugular Veins* ; Observational Study ; Palpation ; Prospective Studies ; Skin ; Ultrasonography ; Valsalva Maneuver* ; Veins

BACKGROUND: The purpose of this prospective study is to define the effect of cardiopulmonary bypass (CPB) on the concentration of thyroid hormones and metabolites. METHODS: Blood samples were obtained from 15 patients undergoing open heart surgery at 1) pre-induction, 2) after heparinization, 3) during CPB, 4) 2 hours after CPB, 5) 24 hours after CPB and 6) 48 hours after CPB. Thyroid stimulating hormone, albumin, thyroxine (T4), free thyroxine (FT4), triiodothyronine (T3), free triiodothyronine (FT3) and reverse T3 (T3) were measured. RESULTS: Concentration of T3 significantly decreased after infusion of heparin and maintained at the decreased level until postbypass 24 hours. Concentration of FT3 significantly increased after heparin administration but maintained at a control level during CPB and decreased after postbypass 24 , 48 hours (p<0.05). Reverse T3 increased at 24 and 48 hours after CPB (p<0.05). Thyroxine decreased during CPB and return to control level after CPB. Free thyroxine did not change significantly. Thyroid stimulating hormone was significantly depressed at 24 hours after CPB (p<0.05). CONCLUSIONS: This result suggest that the thyroid function is depressed until 48 hours after CPB and it seems to be associated with abnormal metabolism of thyroid hormones.
Cardiopulmonary Bypass ; Heart* ; Heparin ; Humans ; Metabolism ; Prospective Studies ; Thoracic Surgery* ; Thyroid Gland* ; Thyroid Hormones ; Thyrotropin ; Thyroxine ; Triiodothyronine

PURPOSE: The effects of ball joint location from axis of rotation on postoperative wrist motion in dynamic external fixator for displaced intra-articular fractures in distal radius were evaluated. MATERIALS AND METHODS: 33 patients who had dynamic external fixative surgery after closed reduction within acceptable range and could be followed at least 1 year were reviewed. They were divided into two groups according to distance (5 mm, 10 mm) of ball joint center from axis of wrist rotation which located in proximal cortex of capitate. These groups were compared by clinical results which were evaluated by range of motion of wrist (flexion, extension, radial deviation, ulnar deviation, pronation, supination) and pain evaluation system. They were also divided into two groups according to direction of ball joint migration (proximal, distal) and evaluated by the same methods. RESULTS: No difference in range of motion and pain was observed between distance 0 mm-5 mm group and >5 mm group (p>0.05). Distance 0 mm-10 mm group showed statistically significant more range of motion in extension, supination and pronation than >10mm group (P<0.05). However, there was no significant difference in flexion, radial deviation, ulnar deviation and pain (p>0.05). Also no difference in range of motion and pain was observed between proximal migration group and distal group (p>0.05). DISCUSSION AND CONCLUSION: In retrospective analysis of dynamic external fixator, range of wrist motion should be preserved by decrease of changes of ball joint location within 10mm from center of rotation.
Axis, Cervical Vertebra ; External Fixators ; Humans ; Intra-Articular Fractures ; Joints ; Pronation ; Radius ; Radius Fractures ; Range of Motion, Articular ; Retrospective Studies ; Supination ; Wrist

If orthodontists and restorative dentists establish the interdisciplinary approach to esthetic dentistry, the esthetic and functional outcome of their combined efforts will be greatly enhanced. This article describes satisfying esthetic results obtained by the distribution of space for restoration by orthodontic treatment and porcelain laminate veneers in uneven space between maxillary anterior teeth. It is proposed that the use of orthodontic treatment for re-distribution of the space and the use of porcelain laminate veneers to alter crown anatomy provide maximum esthetic and functional correction for patients with irregular interdental spacing.
Crowns ; Dental Porcelain ; Dentistry ; Dentists ; Humans ; Tooth

If orthodontists and restorative dentists establish the interdisciplinary approach to esthetic dentistry, the esthetic and functional outcome of their combined efforts will be greatly enhanced. This article describes satisfying esthetic results obtained by the distribution of space for restoration by orthodontic treatment and porcelain laminate veneers in uneven space between maxillary anterior teeth. It is proposed that the use of orthodontic treatment for re-distribution of the space and the use of porcelain laminate veneers to alter crown anatomy provide maximum esthetic and functional correction for patients with irregular interdental spacing.
Crowns ; Dental Porcelain ; Dentistry ; Dentists ; Humans ; Tooth

No abstract available.
Cytomegalovirus Infections* ; Cytomegalovirus* ; HIV Infections* ; HIV* ; Humans