A tibial segment in 3cm length with vascular pedicle and periosteum (Living bone graft) and the segment without vascular pedicle and periosteum (Dead bone graft) was obtained from twenty four rabbits, being divided into two group respectively. Then it was replaced with the segmental bone in the initial osteomized defect. The grade of healing and the time factor required to accomplish the repair of resected segmental tibial transplant was determined at one week interval during one to eight weeks, aimed by the,comparative studies of microscopic (gross), radiological as well as histological observation during the healing process. The average time of callus formation in the living bone graft was approximately two weeks, as compared to four weeks of the dead bone graft. Radiographically the average time of bone union in the living bone graft was four weeks, compared with seven weeks for the dead bone graft. The living bone graft was permitted to the healing process of the simple fracture at the graft-recipient bone juncture, in the contrast with the dead bone graft it was united with replacement of the grafted bone by new bone, so called “creeping substitution”.
Bony Callus ; Periosteum ; Rabbits ; Tibia ; Time Factors ; Transplants

BACKGROUND: High-frequency jet ventilaion is considered a reliable technique for anesthesia and critical care including respiratory failure but there are adverse reactions such as carbon dioxide retension and dry of respiratory mucosa. The purpose of this study was to confirm the effects of combined high- frequency jet ventilation (HFJV) and converntional mechanical ventilation (CMV) on the cardiovascular system, arterial blood gases tension and mean airway pressure in 9 Korea mongrel dogs with pulmonary edema induced by oleic acid. METHODS: During CMV with 20 breaths/minute, 10 ml/kg of tidal volume and F1O2 1.0, parameers were evaluated (base line value). When pulmonary edema was developed, HFJV was applied initially with 120 breaths/minute, inspiratory time 30% and driving pressure 40 psi F1O2 1.0 for 60 minutes (control value) and thereafter simultaneous use of CMV was applied with the tidal volume of 10 ml/kg and each respiratory rate 8, 4, 2, 1, 0.5 per minute for 30 minutes. RESULTS: Combined application of HFJV and CMV (above repiratory rate 1 per minute) achieved the improvement of oxygenation and carbon dioxide elimination, and Paw was decreased without undesirable effects on cardiovascular system in case of the induced pulmonary edema. CONCUSIONS: From above results we recommanded that HFJV combined with CMV may be a useful method of treatment for respiratory failure.
Anesthesia ; Animals ; Carbon Dioxide ; Cardiovascular System ; Critical Care ; Dogs* ; Gases ; High-Frequency Jet Ventilation* ; Korea ; Oleic Acid* ; Oxygen ; Pulmonary Edema* ; Respiration, Artificial* ; Respiratory Insufficiency ; Respiratory Mucosa ; Respiratory Rate ; Tidal Volume ; Ventilation

STUDY DESIGN: Authors experienced three cases of malignant schwannoma arising from multiple neurofibromatosis and invading the vertebrae. OBJECTIVE: To report treatment results and preventive idea in three cases of malignant schwannoma transformed from neurofibromatosis within the retroperifoneal area and invading the vertebrae. SUMMARY OF BACKGROUND DATA: The patients with neurofibromatosis are clearly at increased risk to develop the malignant schwannoma. A review of Korean literature revealed no such cases. RESULTS: The first case presented in the L4 body and was treated by surgical excision and chemotherapy, but she expired due to secondary metastasis in six months after diagnosis. The second case was treated by diagnostic biopsy and chemotherapy with adriamycin, ifosfamide, DTIC, mesna. He eventually lived for 14 months. After a diagnostic biopsy, the third case died due to lung metastasis before we could begin the treatment. CONCLUSION: We recommend that neurofibromatsis patients be regularly followed-up and if necessary, CT examination of spine or abdomen should be done. If a malignant schwannoma is detected, then early treatment can be started.
Abdomen ; Biopsy ; Dacarbazine ; Diagnosis ; Doxorubicin ; Drug Therapy ; Humans ; Ifosfamide ; Lung ; Mesna ; Neoplasm Metastasis ; Neurilemmoma* ; Neurofibromatoses ; Spine*

High tibial osteotomy has been widely accepted as a method of treatments for middle-aged varus osteoarthritides with uncompartmental involvements. There have been several reports regarding the managements of fibula and their complications during the valgization procedure of tibia. They are, for example, osteotomy of fibular diaphysis or neck and excision of fibular head. Each level of fibular management is often complicated by nonunison, peroneal nerve palsy and lateral instability respectively. We have reviewed 20 cases of cases of high tibial osteotomy using proximal tibiofibular arthrolysis performed between March 1987 and February 1993. This method has proved excellent exposure of upper lateral tibia for the wedge removal, internal fixation and relief of the tethering effect of fibula. There was no peroneal nerve palsy relate to this degenerative change of the proximal tibiofibular was 3.4mm(range 1-11mm) and there was neither degenerative change of the proximal tibiofibular joint nor varus instability. In conclusion the arthrolysis of proximal tibiofibular joint can be highly recommended in high tibial osteotomy.
Diaphyses ; Fibula ; Head ; Joints ; Methods ; Neck ; Osteoarthritis ; Osteotomy ; Paralysis ; Peroneal Nerve ; Tibia

No abstract available.

BACKGROUNDS: Pancreaticoduodenectomy has been applied to diseases of periampullary region since 1935 by Whipple and associates, but this procedure is so complexed that associated with high morbidity and mortality. In the treatment of periampullary cancer, curative surgical resection only promises the possibilities of cure, because other methods of treatment including chemotherapy and radiation therapy have been of little or no benefit to improve the survival rate. METHODS: We performed the clinical analysis on 123 cases of pancreaticoduodenectomies at the department of Surgery, Chonnam University Hospital, during the past 11 years from June 1986 to May 1997 to assess the associated factors with postoperative complications and the survival rate. RESULTS: Among 123 cases, 104 cases(84.6%) were malignant tumor of periampullary region, 16 cases were benign lesion, and 3 cases were type IV pancreatic injury. Pancreaticoduodenectomy was performed in 115 cases, pylorus-preserving pancreaticoduodenectomy in 4 cases, total pancreatectomy in 2 cases and extended pancreaticoduodenectomy in 2 cases. Postoperative complications were developed in 28 cases(22.8%) and the major cause of postoperative complication was the anastomotic leakage, especially in the pancreatico-jejunostomy site. The overall operative and hospital mortality rate was 7.3%. Preoperative percutaneous transhepatic biliary drainage(PTBD) and the serum level of albumin and bilirubin were not related to the development of postoperative complications. Factors affecting survival after resection of malignant tumor were the size of tumor, presence of lymph node metastasis and tumor infiltration to adjacent tissue, but the level of CEA, alphaFP, and CA 19-9 and tumor differentiation were not related to the survival rate statistically. CONCLUSION: Optimal preoperative preparation of the patient and a meticulous and standarized operative technique are mandatory to minimize the operative morbidity and mortality after pancreaticoduodenectomy. In the treatment of periampullary cancer, radical surgical resection is recommended for long-term survival, as well as the development of other treatment modalities to prevent the postoperative recurrence.
Anastomotic Leak ; Bilirubin ; Drug Therapy ; Hospital Mortality ; Humans ; Jeollanam-do ; Lymph Nodes ; Mortality ; Neoplasm Metastasis ; Pancreatectomy ; Pancreaticoduodenectomy* ; Postoperative Complications ; Recurrence ; Survival Rate

Pulmonary paragonimiasis and tuberculosis are endemic in Asia, South America, and Africa. However, differential diagnosis among the diseases is difficult because they present with similar clinical symptoms and diagnostic features. Here, we report a case of pulmonary paragonimiasis that was identified using Ziehl-Neelsen stain after initially being assessed for pulmonary tuberculosis. Following anti-Paragonimus chemotherapy, the patient's symptoms, laboratory test results, and lung lesions improved. Thus, the identification of Paragonimus westermani using Ziehl-Neelsen stain can be considered in the diagnosis.
Africa ; Asia ; Diagnosis ; Diagnosis, Differential ; Drug Therapy ; Lung ; Paragonimiasis ; Paragonimus westermani ; South America ; Tuberculosis ; Tuberculosis, Pulmonary

Background: The purpose of this study was to introduce a screening system for coronavirus disease 2019 (COVID-19), to evaluate the overall orthopedic management in hip fracture patients during the COVID-19 pandemic in South Korea, and to compare the surgical results in hip fracture patients during the COVID-19 pandemic with those of the previous year. Methods: Hip fracture patients who visited emergency rooms were screened at the screening clinics before admission. The medical management was carried out with the medical staff wearing surgical masks, meticulous hand hygiene observed, and a minimum distance of 2 m between patients maintained. The demographics, operative parameters, and surgical results of patients treated during the pandemic were compared with those from the previous year. Results: From January 2020 to July 21, 2020, 119 patients with hip fractures (33 men and 86 women) were admitted to our institution for surgical treatment. Five patients showed symptoms of pneumonia, but no patient was positive for COVID-19. The mortality rate during the study period was 4.2%, and none of the patients died due to COVID-19. The interval between admission and surgery and the length of hospital stay were significantly shorter (p = 0.008, p = 0.002) and the proportion of spinal anesthesia was greater in hip fracture patients during the COVID-19 pandemic compared to those from the previous year (p = 0.011). Conclusions The COVID-19 screening system for hip fracture patients has proven to be effective in preventing intrahospital spread of the disease. Hip fracture surgery performed during the COVID-19 pandemic has shown comparable results without any COVID-19 infection and COVID-19-related mortality.

BACKGROUND: Subclinical thyroid dysfunction might influence a bone health. We evaluated whether subclinical hypothyroidism adversely affects bone health including bone mineral density (BMD), level of vitamin D, and bone turnover status in patients with hip fracture. METHODS: We evaluated 471 patients aged 50 years or older, who underwent hip fracture surgeries. BMD, level of vitamin D, bone turnover status, and one-year mortality were compared between subclinical hypothyroidism group and control group. RESULTS: BMD of femur and the level of 25-hydroxy-vitamin D (25-[OH]D) were similar in the two groups. There were no significant differences in bone turnover markers according to thyroid function. No significant differences were observed between the groups in utilization of intensive care unit (ICU), length of hospital stay, mobility, and one-year mortality. CONCLUSIONS: Subclinical hypothyroidism was not associated with reduced bone health, including BMD, the level of 25-(OH)D, and bone turnover marker.
Bone Density ; Femur ; Hip Fractures ; Hip* ; Humans ; Hypothyroidism* ; Intensive Care Units ; Length of Stay ; Mortality ; Thyroid Gland ; Vitamin D

BACKGROUND: High frequency jet ventilation (HFJV) which can be replaced conventional mechanical ventilation (CMV) is another method in respiratory care. But, each one has weakness. This study was designed to determine whether combined HFJV with CMV is more prominent than HFJV on cardiopulmonary system. METHOD: Korean mongrel dogs (n=11) were induced with thiopental sodium 10 mg/Kg, intravenously. Tracheal intubation was performed, and CMV (respiratory rate 30/min, VT 10 ml/Kg, FiO2 1.0) was applied. After placement of monitors, arterial blood pressure (BP), heart rate (HR), central venous pressure (CVP), cardiac output (CO), pulmonary capillary wedge pressure (PCWP) were measured for control values on steady state of vital signs. Thereafter, HFJV was done using respiratory rate 120/min, inspiratory time 30 %, driving pressure 40 psi for 60 min (examed at time of 15, 30, 60 min), and then CMV was supplemented to HFJV using VT 10 ml/Kg, respiratory rate 8, 4, 2, 1, 0.5/min for 150 min (examed at time of 30, 60, 90, 120, 150 min). All values were measured and analyzed on suggested times according to the different ventilatory modes. RESULT: Arterial BP, HR, CO, CVP and PCWP were not changed significantly during the 60 minutes of HFJV. PaCO2 was increased significantly from 33+/-9 mmHg to 45+/-12 mmHg (p<0.05) and arterial pH was decreased significantly from 7.39+/-0.10 to 7.29+/-0.11 (p<0.05) after 60 minutes of HFJV. PaO2 was not changed for HFJV. Variables (BP, HR, CO, CVP and PCWP) were not changed significantly after combined HFJV with CMV at each respiratiry rates. Elevated PaCO2 at the 60 minutes of HFJV was normalized after combined HFJV with CMV at respiratory rate of 8, 4, 2, 1, 0.5/min. (p<0.05) and decreased pHa was also normalized (p<0.05) after combined HFJV with CMV at respiratory rate of 8, 4, 2, 1/min. PaO2 was not changed for the time which we combind HFJV with CMV. CONCLUSION: The combinded HFJV with CMV makes expected arterial oxygenation and prevents accumulation of arterial carbon dioxide without depressive effect on cardiovascular system, when tidal volume of CMV is 10 ml/Kg and the respiratory rate is above 1/minute. So, this study suggests that the combined HFJV with CMV may be applied to respiratory failure effectively.
Animals ; Arterial Pressure ; Carbon Dioxide ; Cardiac Output ; Cardiovascular System ; Central Venous Pressure ; Dogs* ; Heart Rate ; High-Frequency Jet Ventilation* ; Hydrogen-Ion Concentration ; Intubation ; Oxygen ; Pulmonary Wedge Pressure ; Respiration, Artificial* ; Respiratory Insufficiency ; Respiratory Rate ; Thiopental ; Tidal Volume ; Vital Signs