For many years, healing membranous bone fractures have been known to show a persistent lucency at the fracture interface. Radiographic follow-up has proven to be of little value as a guideline for healing of mandibular fractures. Recently, a fracture has been treated by rigid internal fixation by metallic plate and screws rather than closed reduction and wire fixation, we expected that some difference in the radiographic features of fracture healing. To investigate these questions we undertook a retrospective radiographic and clinical analysis of 33 followed patients with fractures of the body and angle of the mandible from 1993 to 1997. There were 26 male and 7 female patients ranging in age between 5 and 74 years, with an average of 29.7 years. All patients were managed by open reduction with metallic plates and screws. The length of follow-up ranged from 9 to 187 weeks. Total 81 radiographic follow-up films were obtained and divided into 3 grades according to the degree of radiolucency of fracture lines; grade 0 radiolucent fracture line and no evidence of fracture interface calcification, grade 1 decreased radiolucent area and evidence of fracture interface calcification, and grade 2 disappearance of fracture line.Until follow-up of 8 weeks, all of the radiographs showed grade 0. From 8 weeks to 16 weeks, 62.5 percent showed grade 0 and 37.5 percent showed grade 1. From 16 weeks to 48 weeks, 38.5 percent showed grade 1 and 61.5 percent showed grade 2. After follow-up of 48 weeks, all showed grade 2.In this study we have shown that the radiographic disappearance of mandibular fracture lines was usually accomplished by 48 weeks. We feel that radiographic union of the mandible is lagging well behind clinical union, but disapperance of the fracture line in rigidly fixated mandibular fracture was occurred earlier than healed by fibrous union. We propose that radiographic union of the mandible by approximately 1 year can be a guideline for the normal mandibular bone healing.
Female ; Follow-Up Studies* ; Fracture Healing ; Fractures, Bone ; Humans ; Male ; Mandible ; Mandibular Fractures* ; Retrospective Studies

Complications after a median sternotomy incision, which is used currently in most open heart surgery, are serious, although it is infrequent. Reconstruction of the sternal defect resulting from dehiscence of median sternotomy is still big challenge to the most plastic surgeons. Since vascularized greater omentum was transposed to eliminate mediastinal wound problems, many vascularized regional muscle flaps became mainstay in reconstruction of median sternotomy wound. We treated 13 patients with median sternotomy dehiscence between October of 1993 and March of 1998. In two patients, the wound problems were so confined to superficial tissue that debrided and closed primarily. Eleven patients with deep wound infection were managed with vigorous debridement of all necrotic tissues and resultant defects were covered with regional muscle flaps: rectus myocutaneous flap(3) and bilateral pectoralis advancement flap(8). We used the pectoralis major advancement flaps without counter incision at humeral insertion site and the dissections were limited only medial to the anterior axillary line to preserve the axillary fold. In five patients with larger defects, we elevated muscle and cutaneous flaps separately to make these flaps more mobile. Large portion of two rectus abdominis flaps could not survive, whereas pectoralis advancement flaps had mo special wound problems. Only one patient developed fistula due to remained wire, regardless to flap surgery.
Debridement ; Fistula ; Humans ; Omentum ; Rectus Abdominis ; Sternotomy* ; Thoracic Surgery ; Wound Infection ; Wounds and Injuries

Ulcerative colitis, one of the inflammatory bowel disease, is primarily managed medically with combinations of 5-ASA and steroids. However, this chronic disease requires surgical management if symptoms persist or complications develop despite medical management. The clinical course, the indications and outcome for surgical management of pediatric ulcerative colitis patients were studied from medical records retrospectively. Twenty-one patients under the age of 15 who were endoscopically diagnosed with ulcerative colitis at the Seoul National University Children's Hospital between January, 1988 and January, 2003 were subjected to the study. Mean follow up period was 3 years and 10 months. The mean age was 10.3 years old. All patients received medical management primarily after diagnosis and 8 patients (38%) eventually required surgical management. Of 13 patients who received medical management only, 7 patients (53%) showed remission, 4 patients are still on medical management, and 2 patients expired due to congenital immune deficiency and hepatic failure owing to sclerosing cholangitis respectively. In 8 patients who received surgical management, 1 patient underwent surgery due to sigmoid colon perforation and 7 patients due to intractability of medical management. The perforated case received colon segmental resection and the other 7 patients recieved total protocolectomy with ileal pouch-anal anastomosis. One patient expired postoperatively due to pneumonia and sepsis. One patient is still on medical management because of mild persistent hematochezia after surgery. The other operated patients are showing good prognosis without any management. Pediatric ulcerative colitis patients can be surgically managed if the patient is intractable to medical management or if complications such as perforation is present. Total protocolectomy & ileal pouch-anal anastomosis is thought to be the adequate surgical method.
Child* ; Cholangitis, Sclerosing ; Chronic Disease ; Colitis, Ulcerative* ; Colon ; Colon, Sigmoid ; Diagnosis ; Follow-Up Studies ; Gastrointestinal Hemorrhage ; Humans ; Inflammatory Bowel Diseases ; Liver Failure ; Medical Records ; Pneumonia ; Prognosis ; Retrospective Studies ; Seoul ; Sepsis ; Steroids ; Ulcer*

Twenty five patients (twenty seven hips) who had Chiari osteotomy at Kang Nam St. Marys Hospital between 1980 and 1995 were reviewed to evaluate the factors in the operative technique that contribute to successful outcome and assess the clinical results in various conditions. The length of follow-up ranged from one to fourteen years and the age of at operation ranged from four to twentythree years. Eighteen patients had developmental dysplasia of the hip: four, septic hip: three had another disorders, Prior to the Chiari osteotomy, fourteen hips had an femoral osteotomy and four, trochanteric arthroplasty. We used to the standard osteotomy as described by Chiari with certain modification. A pneumatic saw and osteotome are used instead of Gigli saw. This technique is simple procedure to make the correct level and angle. Bone graft was not performed in all cases even the osteotomy was displaced more than 50 percent of the iliac width. The overall results were 12 excellent, eight good, five fair, and two poor. In eleven patients, the osteotomy had to be displaced more than 50 percent to provide good coverage of the femoral head. Their results were good or excellent. A good result will be obtained if enough attention is paid to displacing the osteotomy. The osteotomy using the pneumatic saw provides accurate level and direction of osteotomy and it is an simple procedure also.
Adolescent* ; Arthroplasty ; Child* ; Femur ; Follow-Up Studies ; Head ; Hip ; Humans ; Osteotomy* ; Transplants

An important error in the result of Table 3 was confirmed in the article.

PURPOSE: To evaluate the efficacy of intravitreal tissue plasminogen activator (tPA) with C3F8 injection for branch retinal vein occlusion (BRVO) involving fovea. METHODS: Seven patients (7 eyes) presenting with subfoveal hemorrhage caused by BRVO were treated with an intravitreal tPA and C3F8 injection. We assessed the visual acuity (VA) and foveal thickness measured with optical coherence tomography. RESULTS: The mean duration of symptoms before surgery was 5.42+/-1.90 weeks. The mean logMAR VA improved from 1.14+/-0.19 at baseline to 0.87+/-0.34 at one week and 0.30+/-0.32 at six months. The mean foveal thickness decreased from 564.421+/-186.88 micrometer at baseline to 483.14+/-275.06 micrometer at one week and 353.28+/-152.99 micrometer at six months. There was no adverse effect related to the treatment. CONCLUSIONS: Intravitreal tPA with C3F8 injection may be an effective treatment for resolving macular edema with subfoveal hemorrhage and improving the VA in recently developed BRVO.
Hemorrhage ; Humans ; Intravitreal Injections ; Macular Edema ; Retinal Vein ; Retinal Vein Occlusion ; Retinaldehyde ; Tissue Plasminogen Activator ; Tomography, Optical Coherence ; Visual Acuity

When pericardial tamponade occurs to the left ventricular assist device (LVAD) implanted patients, typical hemodynamic signs of tamponade such as tachycardia and pulsus paradoxus may be masked by LVAD action. For those with normal heart, anesthetic management during pericardial tamponade operation before drainage is to restrict fluid administration and maintain perfusion pressure with vasopressor are recommended. But the things to concern are different in cases of patient with LVAD. Here, we describe a case of performing anesthesia with LVAD implanted patient for pericardial tamponade operation. A 58-year-old male with HeartWare™ (Medtronic, Framingham, MA, USA) LVAD implant was referred for cardiac tamponade surgery. After the induction of general anesthesia, his mean arterial pressure (MAP) decreased to 38 mmHg with device flow 1.8 L/min and device power 2.4 Watts at pump speed 2,400 RPM. Norepinephrine and Epinephrine infusion were initiated. MAP recovered to 70mmHg with device flow 3.7 L/min and power 3.0 Watts after the drainage of 1,200 cc of pericardial fluid. Cardiac tamponade with LVAD implanted patient present with decreased peak flow, mean flow and decreased pulsatility. LVAD flow depends on pump rotation, preload and afterload. In order to maintain flow in these patients, prevention of preload reduction is important. Since LVAD implantation becoming more popular as Bridge to transplantation and destination therapy, it is important for anesthesiologist to understand the LVAD parameters and factors that affect.
Anesthesia ; Anesthesia, General ; Arterial Pressure ; Cardiac Tamponade ; Drainage ; Epinephrine ; Heart ; Heart-Assist Devices ; Hemodynamics ; Humans ; Male ; Masks ; Middle Aged ; Norepinephrine ; Perfusion ; Pericardial Fluid ; Tachycardia

When pericardial tamponade occurs to the left ventricular assist device (LVAD) implanted patients, typical hemodynamic signs of tamponade such as tachycardia and pulsus paradoxus may be masked by LVAD action. For those with normal heart, anesthetic management during pericardial tamponade operation before drainage is to restrict fluid administration and maintain perfusion pressure with vasopressor are recommended. But the things to concern are different in cases of patient with LVAD. Here, we describe a case of performing anesthesia with LVAD implanted patient for pericardial tamponade operation. A 58-year-old male with HeartWareâ„¢ (Medtronic, Framingham, MA, USA) LVAD implant was referred for cardiac tamponade surgery. After the induction of general anesthesia, his mean arterial pressure (MAP) decreased to 38 mmHg with device flow 1.8 L/min and device power 2.4 Watts at pump speed 2,400 RPM. Norepinephrine and Epinephrine infusion were initiated. MAP recovered to 70mmHg with device flow 3.7 L/min and power 3.0 Watts after the drainage of 1,200 cc of pericardial fluid. Cardiac tamponade with LVAD implanted patient present with decreased peak flow, mean flow and decreased pulsatility. LVAD flow depends on pump rotation, preload and afterload. In order to maintain flow in these patients, prevention of preload reduction is important. Since LVAD implantation becoming more popular as Bridge to transplantation and destination therapy, it is important for anesthesiologist to understand the LVAD parameters and factors that affect.

When pericardial tamponade occurs to the left ventricular assist device (LVAD) implanted patients, typical hemodynamic signs of tamponade such as tachycardia and pulsus paradoxus may be masked by LVAD action. For those with normal heart, anesthetic management during pericardial tamponade operation before drainage is to restrict fluid administration and maintain perfusion pressure with vasopressor are recommended. But the things to concern are different in cases of patient with LVAD. Here, we describe a case of performing anesthesia with LVAD implanted patient for pericardial tamponade operation. A 58-year-old male with HeartWareâ„¢ (Medtronic, Framingham, MA, USA) LVAD implant was referred for cardiac tamponade surgery. After the induction of general anesthesia, his mean arterial pressure (MAP) decreased to 38 mmHg with device flow 1.8 L/min and device power 2.4 Watts at pump speed 2,400 RPM. Norepinephrine and Epinephrine infusion were initiated. MAP recovered to 70mmHg with device flow 3.7 L/min and power 3.0 Watts after the drainage of 1,200 cc of pericardial fluid. Cardiac tamponade with LVAD implanted patient present with decreased peak flow, mean flow and decreased pulsatility. LVAD flow depends on pump rotation, preload and afterload. In order to maintain flow in these patients, prevention of preload reduction is important. Since LVAD implantation becoming more popular as Bridge to transplantation and destination therapy, it is important for anesthesiologist to understand the LVAD parameters and factors that affect.

Backgound: The placement of stents in coronary arteries has been shown to reduce acute closure and restenosis in comparison to balloon angioplasty. However, clinical use of intracoronary stents is impeded by the subacute stent thrombosis and hemorrhagic complications associated with the anticoagulant regimen. It's known that the complete stent deployment with high pressure inflation and new antiplatelet agents are effective in reduction of subacute thrombosis and hemorrhage. So we evaluated initial results (success and complication rate) after high pressure-stent deployment with new anticoagulation protocol. METHODS: One hundred and ninety one patients with 201 lesions were treated with 231 stents of various types. The high pressure balloon inflation and antiplatelets agents were used in all cases. Final high pressure balloon inflation guided by IVUS were performed in 23 consecutive cases with incomplete stent deployment according to angiographic findings. RESULTS: 1) The indications of stenting (n=210) were De novo in 124 (59%), bailout procedure in 57 (27%), suboptimal result after PTCA in 19 (8%), and restenosis after PTCA in 14 (6%). The location of lesions were LAD in 101, RCA in 67, circumflex in 28, ramus intermedius in 3, and LMT artery in 2 lesions. Angiographic morphologic characteristics were type A in 2, type B in 158 (B1: 57, B2: 101), and type C in 22 lesions. 2) The angiographic and clinical success rate was 96% (192/201) and 92% (186/201) respectively. 3) In angiographic analysis, the baseline average reference vessel dirmeter was 3.33+/-0.35 mm. Baseline minimum lumen diameter (MLD) was 0.58+/-0.29 mm, with baseline percent diameter stenosis of 82.86+/-8.64%. The final stent diameter was 3.37+/-0.29 mm, with mean final percent stenosis of 0.63+/-8.25. The mean MLD after stenting was significantly increased (p<0.001). The mean MLD within stent increased 14%, from 2.91+/-0.39 mm at the nominal balloon inflation (inflation pressure=7 atm) to 3.37+/-0.29 mm at high pressure balloon inflation (inflation pressure <0A65B>12atm) (p<0.001). The length of lesions in GR I (cook), GR II, and Micro II stents were significantly longer than ones in PS, Cordis, Wiktor, Nir (p<0.001). 4) In intravascular ultrasound analysis, the mean lumen CSA at the tightest point within stent increased 11%, from 8.4+/-2.4 mm2 at the intial intravascular ultrasound to 9.4+/-2.1 mm2 at the final intravascular ultrasound (p<0.001). 5) The procedural and postprocedural complications were 2 acute closures associated with AMI and emergent CABG, 1 subacute closure which was revascularized by bail out stenting, 5 major hemorrhage requiring transfusion associated with 1 CVA and 2 metabolic acidosis induced by acute renal failure, and 5 death. CONCLUSION: The high pressure stent deployment procedure and new anticoagulation protocol associating tidopidine and aspirin without coumadin or prolonged heparin infusion allow us to obtain an acceptably low subacute thrombosis or bleeding complication rate. These results are encouraging and allow a wide use of coronary stenting.
Acidosis ; Acute Kidney Injury ; Angioplasty, Balloon ; Arteries ; Aspirin ; Constriction, Pathologic ; Coronary Vessels* ; Hemorrhage ; Heparin ; Humans ; Inflation, Economic ; Platelet Aggregation Inhibitors* ; Stents* ; Thrombosis ; Ultrasonography ; Warfarin