Calcaneus was the most commonly involved bone among the tarsal bone fracture. Many different methods have been tried for the treatment of fractures of the calcaneus in order to search for better results. But there is no general agreement on the treatment of the fracture of the calcaneus, especially involving the subtalar joint. From Jan. 1986 to Jan. 1990, 25 feet in 20 patients of calcaneal fractures involving the subtalar joint were treated by closed reduction & percutaneous pinning at the Dept. of Orthopedic Surgery, Chosun University Hospital and the results were as follows; 1. Of these intra-articular fractures, 15 fractures were tongue type and 10 fractures were joint depression type by Essex-Lopresti classification. 2. According to the Salama unit system, the results of treatment were excellent or good in 11 cases of 15 tongue types and 6 cases of 10 joint depression types. 3. The results were excellent in which reduction is achieved near anatomical reduction. 4. Even if the joint depression type fracture which is not severely comminuted, the treatment with closed reduction & percutaneous pinning is thought to be good method.
Calcaneus ; Classification ; Depression ; Foot ; Humans ; Intra-Articular Fractures ; Joints ; Methods ; Orthopedics ; Subtalar Joint ; Tarsal Bones ; Tongue

Since Klemm introduced the concept of antibiotic-containing bone cement for the treatment of chronic osteomyelitis, a number of studies have demonstrated the positive results of this therapy. It has been proved that antibiotic-containing bone cement continuously releases high levels of atibiotics locally into the infected and avascular wound environment. Antibiotic-containing bone cement provides several distinct advantages over irrigation-suction drainage. The major objective of this study is to analyze the results of therapy using antibiotic-containing bone cement beads for chronic osteomyelitis. The authors analyzed 21 cases of chronic osteomyelitis in patients who had been treated by saucerization and antibiotic-containing bone cement beads at Chosun University Hospital, between February 1990 and January 1993. Each patient's case was followed for at least thirteen months after operation. The results are as follows: 1. The causes of osteomyelitis were postoperative complications(10 patients), open fracture(8 patients), and hematogenous osteomyelitis(3 patients). 2. Staphylococcus aureus was the most common organism causing osteomyelitis, followed by Pseudomonas. 3. The femur was the most common location of lesion(11 patients) followed by the tibia(7 patients), the humerus(2 patients) and the ulna (1 patients). 4. Pus drainage was stopped in 13 cases with one insertion of the beads, in 2 cases with two insertions and in 2 cases with three insertions. 5. Therapy using antibiotic-containing bone cement beads can be regraded as an effective method of increasing local antibacterial activity by releasing the antibiotic into surrounding tissue over a continuous period in the treatment of chronic osteomyelitis. Antibiotic-containing bone cement beads are useful in the treatment of chronic osteomyelitis.
Drainage ; Femur ; Humans ; Methods ; Osteomyelitis ; Pseudomonas ; Staphylococcus aureus ; Suppuration ; Ulna ; Wounds and Injuries

A 46 year-old female patient underwent cholecystectomy under general anesthesia. During the preoperative preparation, pulmonary edema developed from fluid overloading in the early septic condition. Pulmonary edema contributed significantly to the acute respiratory failure, which played a major role in the pathogenesis of multiple organ failure. For this condition, early surgical intervention is most important. After preoperative evaluaion, the authors anesthetized the patient with Morphine, used Enfluane intermitently, along with pancronium and oxygen and used endotracheal semiclosed circle absorption techniques with CMV incorporated PEEP. PEEP level was 5cm H2O. Inspired oxygen fraction was 1.0. Arterial oxygen tension increased from 62 torr to 183 torr despite the overt pulmonary edema. A-aDO2 was greater than 480 mmHg during the anesthesia of 2 hrs 40 minutes. For further treatment of pulmonary edema and postoperative respiratory care, synchronized IMV with PEEP, along with conventional methods for pulmonary edema and sepsis, were used in the ICU. After 6 days of intensive care, the patient was transferred to the general ward in good cardiovascular and respiratory function.
Absorption ; Anesthesia* ; Anesthesia, General ; Cholecystectomy ; Cholecystitis* ; Female ; Humans ; Critical Care ; Middle Aged ; Morphine ; Multiple Organ Failure ; Oxygen ; Patients' Rooms ; Pulmonary Edema* ; Respiratory Insufficiency ; Sepsis

Beta-lapachone (beta-Lap; 3,4-dihydro-2, 2-dimethyl-2H-naphthol[1, 2-b]pyran-5,6-dione) is a novel anti-cancer drug under phase I/II clinical trials. beta-Lap has been demonstrated to cause apoptotic and necrotic death in a variety of human cancer cells in vitro and in vivo. The mechanisms underlying the beta-Lap toxicity against cancer cells has been controversial. The most recent view is that beta-Lap, which is a quinone compound, undergoes two-electron reduction to hydroquinone form utilizing NAD(P)H or NADH as electron source. This two-electron reduction of beta-Lap is mediated by NAD(P)H:quinone oxidoreductase (NQO1), which is known to mediate the reduction of many quinone compounds. The hydroquinone forms of beta-Lap then spontaneously oxidizes back to the original oxidized beta-Lap, creating futile cycling between the oxidized and reduced forms of beta-Lap. It is proposed that the futile recycling between oxidized and reduced forms of beta-Lap leads to two distinct cell death pathways. First one is that the two-electron reduced beta-Lap is converted first to one-electron reduced beta-Lap, i.e., semiquinone beta-Lap (SQ).- causing production of reactive oxygen species (ROS), which then causes apoptotic cell death. The second mechanism is that severe depletion of NAD(P)H and NADH as a result of futile cycling between the quinone and hydroquinone forms of beta-Lap causes severe disturbance in cellular metabolism leading to apoptosis and necrosis. The relative importance of the aforementioned two mechanisms, i.e., generation of ROS or depletion of NAD(P)H/NADH, may vary depending on cell type and environment. Importantly, the NQO1 level in cancer cells has been found to be higher than that in normal cells indicating that beta-Lap may be preferentially toxic to cancer cells relative to non-cancer cells. The cellular level of NQO1 has been found to be significantly increased by divergent physical and chemical stresses including ionizing radiation. Recent reports clearly demonstrated that beta-Lap and ionizing radiation kill cancer cells in a synergistic manner. Indications are that irradiation of cancer cells causes long-lasting elevation of NQO1, thereby sensitizing the cells to beta-Lap. In addition, beta-Lap has been shown to inhibit the repair of sublethal radiation damage. Treating experimental tumors growing in the legs of mice with irradiation and intraperitoneal injection of beta-Lap suppressed the growth of the tumors in a manner more than additive. Collectively, beta-Lap is a potentially useful anti-cancer drug, particularly in combination with radiotherapy.
Animals ; Apoptosis ; Benzoquinones ; Cell Death ; Electrons ; Humans ; Hydroquinones ; Injections, Intraperitoneal ; Leg ; Mice ; NAD ; Naphthoquinones ; Necrosis ; Radiation Tolerance ; Radiation, Ionizing ; Reactive Oxygen Species ; Recycling ; Substrate Cycling

The authors have experienced three cases of pulmonary edema during anesthesia and after operation: 3 cases in urgent condition with toxemia and ectopic gestation underwent general anesthesia. One patient had no specific past history and the other two had cardiac or pulmonary problems before operation. In these cases, we believe that relative overloading of fluids in an undetected valular heart disease, preexisting pulmonary disease, severs preeclamptic condition, and myocardial depressant were the causative factors. High Fio2, with IPPB, diuretics, digitalis, dopamine and albumine were given immediately and so full recovery was observed in 4 hours to 3 days. There are many causes, prevention, and treatment for acute pulmonary edema. But believe that preoperative evaluation, intraoperative monitoring, prompt recognition and attention by the anesthetists are the most important preventive and therapeutic measures.
Anesthesia ; Anesthesia, General* ; Digitalis ; Diuretics ; Dopamine ; Heart Diseases ; Humans ; Intermittent Positive-Pressure Breathing ; Lung Diseases ; Monitoring, Intraoperative ; Pregnancy ; Pulmonary Edema* ; Toxemia

No abstract available.
Female ; Humans ; Insulin* ; Intercellular Signaling Peptides and Proteins*

This is a case report of accidental total spinal block during epidural anesthesia with 1.5% lidocaine 20 ml for hemorrhoidectomy in a 25 year old male. It could have been avoided by; a) careful technical application. b) aspiration of spinal fluid and c) use of a test dose. Management consists of the administration of a vasopressor usually with assistance of respiration until dissipation of anesthesia. He was discharged in good condition without complications on the 7th postop, day.
Anesthesia ; Anesthesia, Epidural* ; Hemorrhoidectomy ; Humans ; Lidocaine ; Male ; Respiration

No abstract available.
Rectal Neoplasms* ; Recurrence*

Transhiatal gastric transpositions were performed in two case of long gap esophageal atresia without tracheoesophageal fistula. The patients were a 12 months old female and an 18 months old male. Stamm type gastrostomies were performed at other hospitals in both cases. The stomach was mobilized preserving the right gastric artery, the right gastroepiploic artery and spleen. The proximal and distal esophageal pouches were excised by transcervical and transhiatal route, respectively. The mobilized stomach was pulled up to the neck through esophageal hiatus and posterior mediastinal route. The esophagogastrostomy, the only one anastomosis of this procedure, was performed in the neck. There was no clinical evidence of anastomotic leakage, stricture, regurgitation, difficulty of gastric emptying, hoarseness or respiratory problem. Transhiatal gastric transposition seems to be a safe and easy alternative surgical procedure for esophageal replacement in long gap esophageal atresia.
Anastomotic Leak ; Arteries ; Constriction, Pathologic ; Esophageal Atresia* ; Female ; Gastric Emptying ; Gastroepiploic Artery ; Gastrostomy ; Hoarseness ; Humans ; Infant ; Male ; Neck ; Spleen ; Stomach ; Tracheoesophageal Fistula

Objective To compare the response and adverse reactions of NP time-chemotherapy with that of routine NP for advanced breast cancer.Methods 52 patients with advanced breast cancer were ran- domly assigned to groupA which received NP time-chemotherapy,or group B which received routine NP.Re- suits The overall response rate is 69.2 % in Group A compare to 30.8 % in group B,there was significant difference(P