Diabetes mellitus is one of troublesome disorder for the orthopaedic patient who should be operated on some other problems. Internist will advice and take care of them as far as diabetic problem is concern. However, orthopaedic surgeon should fully understand and follow every details about the condition of his own patient. Gamerin-Davalos hadclassified the diabetes mellitus into four types of potentiate, chemical and clinical diabetes. Potentiate form is not detectable at present method. The chemical and latent chemical forms are subclinical types and will be detected by the special examinations. In the orthopaedic practice, surgeon should keep in mind and perform proper tests for any suspecious symptomes or histories related to diabetes mellitus. Administration of insulin for the diabetes should be full doses but nerve be over-dosed. Neuropathy, vascular changes and infections are the common complications to diabetic patient and closely influence to the prognosis of major surgery. Ellenbery et al. had emphasized that the neuropathy is not a complication but rather a concomitant feature of diabetes mellitus. It may appear nerve root symptome to confuse with the herniated intervertebral disc. Vascualr change of the thickening of capillary basement membrane will causes gangrene of extremities and unexpected massive bleeding during surgery. Susceptibility of infection on diabetic patient is well known fact and in case of chronic osteomyelitis or tuberculosis of bone persist for long time without specific reason, surgeon should check once for the posibility of diabetes mellitus. Administration of any general anesthetic agents will elevate blood sugar level especially the ether, however, fluothane is a selective one at present. In case of surgery on diabetic patient, aceton uria and CO2 combining power should be checked closely for four to five days post-operatively. Blood sugar level should be kept slightly elevated during and post-operative period for diabetic patient. Surgeon should check his patient for any complications in case of increased dose of insulin is required post-operatively.
Anesthetics ; Basement Membrane ; Blood Glucose ; Capillaries ; Diabetes Mellitus ; Ether ; Extremities ; Gangrene ; Halothane ; Hemorrhage ; Humans ; Insulin ; Intervertebral Disc ; Methods ; Osteomyelitis ; Prognosis ; Tuberculosis

No abstract available.
Extraembryonic Membranes* ; Placenta*

The analysis of 48 infants of congenital torticollis and the result of their conservative treatment are reported. The abnormalities of their neck were noticed by mothers within three months of infant life but mostly at three to four weeks. The ratio of male to female was 9:7 and incidence of right and left was 30 to 18. The mass located mostly(50%) at middle third of the sternocleidomastoid muscle belly. The prominence of incidence were noticed on the abnormality of fetal position in the uterus, mode of delivery and also on the baby of elderly primipara. About 67% of cases were breech(46%) and transverse(21%) position prenatally and 67% were delivered by forceps(41.7%), vacum and induction(12.5%each). The age of mother at delivery has close relationship between congenital torticollis with about two third of them are born of 29–34 year old mother and primipara infants were 61%. For the treatment, daily stretch exercises of affected sternocleidomastoid muscle was done by physical therapist for 20–30 times in two separate session. The effect can be noticed by the gradual correction of rotation deformity first and then the mass become soften and smaller. The next change is the correction of deviation deformity but the mass remain last. However, the mass remaining one fourth of original size was absorbed spontaneously without further treatment. The result of complete cure in ten weeks of treatment were 43(90%) out of 48 patients and the remianing five cases required for 15 weeks of treatment. In conclusion the congenital torticollis can be treated effectively by stretch exercises when it began within three months of age of the patient. A hundred per cent effect of cure may be obtained in ten weeks of treatment in case of initial treatment is begin within four weeks of age and required for 15 weeks of treatment on 4–12 weeks old infants.
Aged ; Congenital Abnormalities ; Exercise ; Female ; Humans ; Incidence ; Infant ; Male ; Mothers ; Neck ; Physical Therapists ; Torticollis ; Uterus

A case of osteochondritis dissecans of both knee joints is developed in 15 year old boy. Since the original articles of Paget, Koning and others were reported, many theories as to etiology and pathogenesis have been proposed but exact cause has been unknown. Many Joint may show evidence of osteochondritis dissecans but lateral aspect of medial femoral condyle of knee is by far the most frequent site. Under the diagnosis of osteochondritis dissecans of both knees with clinical symptoms and X-ray finding, the one was treated with excision of framents and curettage, and the other treated with drilling of fragments. In follow up study for one year, the result was good without any complaints.
Curettage ; Diagnosis ; Follow-Up Studies ; Humans ; Joints ; Knee Joint ; Knee ; Male ; Osteochondritis Dissecans ; Osteochondritis

Two cases report on osteogenesis imperfecta tarda and review of literature has been made. The rare genetic disorder, osteogenesis imperfecta tarda is familiar to most orthopedic surgeons because of management of fracture and skeletal deformities, espicially bowing of long bone. Its clinical manifestations are known as bony fragility, blue sclera and deafness less frequently ligamentous laxity but its etiological factor is obscure; The basic defect is thought to involvement some abnormality of collagen. Recently the bony weakness caused by increased bony turnover rate. One case of osteogenesis imberrfecta tarda in 8 year old male was belonged to tarda type 1. (Falvo-classification), who could not walk due to marked anterolateral bowing of right tibia and the another to tarda type II. in 13 year old male with fresh fracture of right femoral shaft. The former was performed corrective multible osteotomy, realignment and intramedullary rod fixation for correction of bowing deformity of right tibia, and the later was managed the fracture of right femoral shaft with Russels traction and hip spica cast. The result of reported therapeutic mesure was good.
Collagen ; Congenital Abnormalities ; Deafness ; Fibrinogen ; Hip ; Humans ; Ligaments ; Male ; Orthopedics ; Osteogenesis Imperfecta ; Osteogenesis ; Osteotomy ; Sclera ; Surgeons ; Tibia ; Traction

No abstract available.
Anesthesia, Local* ; Arthroscopy* ; Knee*

It is generally accepted that the integrity of posterior cruciate ligament plays a major role in knee stability. The rotatory movement is around a point to the back of center of joint where the posterior cruciate ligament lies, and it is a structure which is just as important as the other ligaments. Methods of reconstruction have been described, using semitendinosus tendon, gracilis tendon, popliteus tendon, patellar tendon, iliotibial band, and medial meniscus. We have successfully used the semitendinosus tendon in two patients who sustained neglected rupture of posterior cruciate ligament.
Humans ; Joints ; Knee ; Ligaments ; Menisci, Tibial ; Patellar Ligament ; Posterior Cruciate Ligament ; Rupture ; Tendons

PURPOSE: This study was conducted to compare the PET and CT findings for patients with a pulmonary lymphangitic metastasis. MATERIALS AND METHODS: We retrospectively reviewed the PET and CT findings of seven patients diagnosed with a pulmonary lymphangitic metastasis between May 2005 and May 2007. RESULTS: All patients had interstitial thickening, as seen on a CT scan, while the PET scans showed abnormal findings in only three patients. In these three patients, one patient had interlobular septal thickening of more than 10, another patient had interlobular septal thickening of more than 5 but less than 10, and another patient had interlobular septal thickening of less than 5. All of the patients had bronchovascular bundle thickening. However, among the four patients that had normal FDG uptake, no patient had interlobular septal thickening of more than 10, two of the patients had interlobular septal thickening of more than 5 but less than 10, and the remaining patients had interlobular septal thickening of less than 5. Only two of the patients had bronchovascular bundle thickening. CONCLUSION: All patients with pulmonary lymphangitic metastasis have typical CT findings, but some of the patients had FDG uptake, as seen in the PET scans. Thus, CT is a more useful modality for diagnosis for pulmonary lymphangitic metastases.
Diagnosis ; Humans ; Lung Neoplasms ; Lymphatic Metastasis ; Neoplasm Metastasis* ; Positron-Emission Tomography ; Retrospective Studies ; Tomography, X-Ray Computed

Among multple injured patients, the incidence of head injuries combined with long bone fracture is high. In adults who present with long bone fracture and concomitant head injury, the exuberant callus at fracture site was formed. The authors analyzed 26 cases of lower extremity fracure with severe head injury from January 1987 to December 1988. For the control group, we analyzed each 20 patients of only femur and tibia fractures. The results of this study are as follows:1. The mean age of experimental and control group were 38.4 yrs old and 40.1 yrs old, respectively. The sex ratio between male and female of experimental and control group were 2.3:1 and 2.7:1, respectively. 2. The initial level of consciousness by Glasgow coma scale was mild impairement 12%, moderate impairement 65% and severe impairement 23%. 3. Serum calium and phosphate level were no specific difference between the head injury with lower extremity fractured patients and only lower extremity fractured patients, but there was increment of serum alkaline phosphatase level on post-trauma 1 month in head injury cases. 4. The pattern of callus formation in experimental group was different compared with control group. 5. The formation of callus was exuberant in the severe head iniury with femur fracture. 6. In experimental group, there was evidence of early bony union time compared with control group, but there was no statistical significance (p<0.05). In conclusion, the callus formation was exuberant in the head injury with femur fractured patient, there was different healing response compared with control group.
Adult ; Alkaline Phosphatase ; Bony Callus ; Consciousness ; Craniocerebral Trauma ; Extremities ; Female ; Femur ; Fractures, Bone ; Glasgow Coma Scale ; Head ; Humans ; Incidence ; Lower Extremity ; Male ; Sex Ratio ; Tibia

A case report on the ABO-type imcompatible transfusion has been made. The case was O-type, 51 year old male who has been transfused 1,000ml of A-type whole blood during and after the intramedullary nailing of the left femur. He had fall in acute hemoglobinuric renal failure immediately after the transfusion. He has been received peritoneal dialysis (P.D.) at eighth day after mismatched transfusion, to correct the uremic condition. His pre-P.D. labaratory findings were Hb. 4.5gm%, BUN 85mg%, creatinine 12. 2mg% and K 7.0mEq/1. He was well recovering after the P.D. but worse again in 16th day after mismatched transfusion with BUN 114mg%, creatinine 12.4mg% and pulmonary edema. An-other P.D. was performed at 16th day and recovered gradually since then. He had marked maximum amount of urine was 9, 100ml at 36 th day after mismatch transfusion. Following the second P.D. his conditions improved gradually and electrolyte imbalance was controlled caused from polyuric state properly. His renal condition was recovered completely at the ten weeks after the mismatch transfusion.
Acute Kidney Injury ; Blood Transfusion ; Creatinine ; Femur ; Fracture Fixation, Intramedullary ; Humans ; Male ; Peritoneal Dialysis ; Pulmonary Edema ; Renal Insufficiency