Many difficult problems are encountered in the treatrnent of infected nonunion of long bone. To solve these difficult fractures, authors adopted an active approach-thorough debridement of the infected and necrotic soft tissue and bone, rigid internal fixation with autogenous cancellous bone graft and opening of the wound to ensure continuous drainage until union of the fracture. Authors treated 28 cases of infected nonunions with this method from Mar. 1980 to Feb. 1989, and the results are as follows ;1. Femur(54%) and tibia(43%) were most frequently involved sites. 2. Most of the cases(86%) were treated by rigid internal fixation and cancellous bone graft. 3. In most cases(64%), infection was controlled spontaneously by the time of bony union, but in 5 cases which showed persistent drainage, implant removal controlled the problem, and residual soft tissue and bony defect were solved by Papineau's technique or musculocutaneous flap. 4. Revision was required in 5 cases(18%) because of insercure fixation. 5. Union could be obtained in average 4.8 months, and infection could be controlled in all except 1 case.
Debridement ; Drainage ; Methods ; Myocutaneous Flap ; Transplants ; Wounds and Injuries

No abstract available.
Bone Plates* ; Spine*

BACKGROUND: Because there is difficulty in the addition of known preservatives to oil in water emulsion such as propofol, ethylenediaminetetraacetic acid (EDTA) added to this may formulate for the antimicrobial activity; however, this formulation has side effects such as hyperlipidemia and pain on injection. We have developed a newly formulated poloxamer-solutol propofol which is considered to be free from hyperlipidemia. The aim of this study was to evaluate the possibility of bacterial growth in poloxamer-solutol formulated propofol compared to original propofol and EDTA added propofol. METHODS: Broth cultures (100nl) of four standard preservative efficacy test organisms (Staphylococcus Aureus, Pseudomonas Aeruginosa, Escherichia Coli, Candida Albicans) were added to 9.9 ml of four test formulations. Subjected formulations were original propofol (AstraZeneca Co, 1% solution, UK), EDTA added propofol (0.0055% EDTA added propofol), Poloxamer-Solutol formulated propofol (poloxamer 188/407 and solutol mixture), and normal saline at approximately 200 colony forming units/ml. The test formulations were incubated at 25degreesC and 32.5degreesC (Tryptic soy agar medium for bacteria and Sabrouraud dextrose agar medium for fungus) and tested for viable counts after 24 and 48 hours. RESULTS: Original propofol supported the growth of all microorganisms at both temperature and time. EDTA added propofol inhibited the growth of microorganisms more than the original propofol, but not so much as the poloxamer-solutol formulated propofol. Saline showed a similar pattern as EDTA added propofol. CONCLUSIONS: Poloxamer-solutol formulated propofol possesses more bacteriostatic activity against all four microorganisms than the original and EDTA added propofol.
Agar ; Bacteria ; Candida ; Edetic Acid* ; Escherichia coli ; Glucose ; Hyperlipidemias ; Propofol* ; Pseudomonas aeruginosa ; Thiram

The slipped capital femoral epiphysis is the condition in which the femoral head slips downward and backward on the femoral neck at the epiphyseal plate. The underlying cause of this disease is unknown. In general, it is believed that endocrine factors may play a part as shown in experimental work. But few endocrine abnormalities have been proved. It is rare in Korea and eight cases have been reported and only one case was associated with diabetes insipidus in hypogonadal Turner mosaicism. Authors report a case of mild, acute on chronic slipped capital femoral epiphysis in a 19 year old male with hypogonadism and diabetes insipidus. It was treated by internal fixation with three Steinmann pins and the result was good.
Diabetes Insipidus ; Femur Neck ; Growth Plate ; Head ; Humans ; Hypogonadism ; Korea ; Male ; Mosaicism ; Slipped Capital Femoral Epiphyses

No abstract available.

Hyperbaric oxygen therapy (HBO), which in Korea is used chiefly for CO poisoning, can be used in many disorders in orthopaedic field through the action of increasing oxygen tension of peripheral tissue, Since June 1986, when the multiplace hyperbaric chamber was built in our hospital, we have experienced 197 cases of HBO in orthopaedic field and we are to analyze the result of treatment and suggest reasonable indications. The outline of results are as follows ;1. Crushing injuries and wounds caused or accompanied by circulatory disturbance were most frequent among the 197 cases we've experienced, and received 17.5 times of HBO on average. 2. Discernible effectiveness was found in split thickness skin graft, diabetic ulcer and Buerger's disease as compared to the control group. 3. Otalgia was the most common side effect, but not severe. 4. From the above results, it is thought that HBO has fair range of indications in orthopaedic field and is worth using as an adjuvant means to surgery.
Earache ; Hyperbaric Oxygenation ; Korea ; Oxygen ; Poisoning ; Skin ; Thromboangiitis Obliterans ; Transplants ; Ulcer ; Wounds and Injuries

BACKGROUND: When using a target controlled infusion (TCI) of propofol, combination with N2O or fentanyl as an analgesic adjuvant is common in clinical practice. In a previous study, a minimal steady state plasma concentration necessary to prevent a response in 50% of the patients following a skin incision (Cp50i) for propofol was reduced from 6ng/ml to 4.5ng/ml with 67% nitrous oxide/oxygen compared to air/oxygen. The goal of this study was to quantify the effect site concentration of fentanyl required to replace 67% N2O at a propofol effect site target concentration of 4.5ng/ml. METHODS: Forty six ASA class I or II adult patients scheduled for lower extremity surgery were randomly allocated to one of three groups according to assigned effect site concentration of fentanyl. Group 1, n = 15; 0.5 ng/ml, Group 2, n = 15; 1.0 ng/ml, Group 3, n = 15; 1.5 ng/ml. Patients received propofol with target concentration 4.5ng/ml and predetermined target concentration of fentanyl in three groups. A laryngeal mask airway was placed after anesthesia induction and all patients were controlled ventilation with 67% air/33% oxygen. The response to the skin incision was observed and the patients categorized as movers or non-movers according to Eger's criteria. Cp50i for fentanyl was evaluated using nonlinear regression analysis. RESULTS: Non-movers to skin incision was 20%, 43.7%, 73.7% in groups 1 3 respectively. Cp50i for fentanyl combined with propofol 4.5ng/ml was 1.08 ng/ml. CONCLUSIONS: We concluded that the MAC for 67% N2O is equivalent to an effect site target fentanyl concentration of 1.08 ng/ml in terms of no movement to skin incision.
Adult ; Anesthesia ; Anesthesia, General* ; Fentanyl* ; Humans ; Laryngeal Masks ; Lower Extremity ; Oxygen ; Plasma ; Propofol* ; Skin ; Ventilation

OBJECTIVE: To investigate the association between bone mineral density (BMD) and osteoporotic compression fractures in radiographic spinal osteoarthritis (OA) patients. METHODS: Subjects were 382 female patients (ages 45 to 85) from outpatient clinic for osteoporosis and rheumatic diseases. BMD was measured at lumbar spine and hip by dual X-ray absorptiometry (Hologic QDR 2000). The standard anteroposterior and lateral plain radiographs of thoracic and lumbar spine were taken to define spinal OA and vertebral compression fractures. Radiographic spinal OA was defined by grade of disc degeneration and facet joint degeneration. Frequency of vertebral fractures was compared between spinal OA and control patients in relation to their BMD, age, weight, body mass index (BMI) and years post menopause. RESULTS: Higher proportion of fracture cases were observed in spinal OA patients than non-spinal OA patients (34.1%, 44/129 vs. 18.2%, 46/253, p<0.001) despite comparable mean BMD (0.836+/-0.152 vs. 0.834+/-0.185, p=0.89) and older mean age (65.8+/-8.5 vs. 57.8+/-10.3, p<0.001). In subjects of ages from 65 to 74, spinal OA patients showed significantly higher BMD than non-spinal OA patients (0.784+/-0.125 vs. 0.719+/-0.119, p=0.007), but the frequency of fractures seems to be higher than that of non-spinal OA patients (44.9%, 22/50 patients vs. 34%,19/55 patients, p=0.58). When all study subjects were stratified according to their spine BMD (normal, osteopenia, and osteoporosis), significantly higher proportion of vertebral compression fractures was noted in spinal OA than non-spinal OA patients in osteopenia group (38.5% vs. 13.5%, p<0.001). CONCLUSION: Higher BMD does not seem to be translated directly into decreased risk of osteoporotic compression fractures in spinal OA patients. Careful assessment of risk factors for osteoporotic fractures and newer methods for assessing bone strength in this group of patients are needed.
Absorptiometry, Photon ; Ambulatory Care Facilities ; Body Weight ; Bone Density* ; Bone Diseases, Metabolic ; Female ; Fractures, Compression* ; Hip ; Humans ; Intervertebral Disc Degeneration ; Osteoarthritis, Spine* ; Osteoporosis ; Osteoporotic Fractures ; Postmenopause ; Rheumatic Diseases ; Risk Factors ; Spine ; Zygapophyseal Joint

BACKGROUND: To reduce side effects such as hyperlipidemia, pain on injection, and bacterial growth of the present formation of propofol, many attempts to change its formulation have been tried. We have developed a newly formulated poloxamer-solutol propofol, which is includes soy bean oil and egg phosphatide as sufactants. The aim of this study was to evaluate the poloxamer-solutol propofol regarding its pharmacokinetic and pharmacodynamic characteristics and bacterial growth compared to original propofol. METHODS: Thirty Beagle dogs weighing around 10-15 kg were randomly assigned to one of two groups. Group 1 received Diprivan propofol 1% (AstraZeneca Co. UK), Group 2 received poloxamer-solutol formulated propofol by continuous intravenous infusion at 35 mg/kg/h for 3 hours. Three, 6, 9 and 12 hours after the discontinuation of the propofol infusion, venous samples from the anterior tibial vein were analysed for liver and renal function test. Also, blood lipid levels were checked after 3 hours of infusion and blood propofol concentrations were checked every hour during infusion. Eye opening time and orientation time, represented by walking on four legs, were evaluated. Also, broth cultures (100microliter) of four standard preservative efficacy test organisms (Staphylococcus Aureus, Pseudomonas Aeruginosa, Escherichia Coli, Candida Albicans) were added to 9.9 ml of four test formulations at approximately 200 colony forming units/ml. The subjected formulations were; original propofol (AstraZeneca Co, 1% solution, UK), EDTA added propofol (0.0055% EDTA added propofol), Poloxamer-Solutol formulated propofol (poloxamer 188/407 and solutol mixture), and normal saline. The test formulations were incubated at 25degrees C and 32.5degrees C (Tryptic soy agar medium for bacteria and Sabrouraud dextrose agar medium for fungus) and tested for viable counts after 24 and 48 hours. RESULTS: Poloxamer-solutol propofol showed no increase of triglyceride and the propofol concentrations showed no difference between the two groups. Also the original propofol supported the growth of all microorganisms at both temperatures and times. EDTA added propofol inhibited the growth of microorganisms more than the original propofol, but not as much as the poloxamer-solutol formulated propofol. Saline showed a similar pattern as the propofol with added EDTA. CONCLUSIONS: The poloxamer-solutol formulated propofol has advantages by pharmacokinetic-pharmacodynamic studies in terms of the initial TG level during propofol infusion, and shows more bacteriostatic activity against all four microorganisms than the original propofol and the propofol with added EDTA.
Agar ; Animals ; Bacteria ; Candida ; Dogs* ; Edetic Acid ; Escherichia coli ; Glucose ; Hyperlipidemias ; Infusions, Intravenous ; Leg ; Liver ; Ovum ; Propofol* ; Pseudomonas aeruginosa ; Soybean Oil ; Thiram ; Triglycerides ; Veins ; Walking