From May, 1971 to June, 1984, we performed extensive saucerization on the chronic osteomyelitis of long bones eradicating all pathologic foci; not only sequestra but sclerotic involocurum and necrotic original cortex embeded by new bone, which was different from the conventional methods such as sequestrectomy or guttering in its extensiveness. Clinical analysis on the base of radiologic evaluation after saucerization was done on the 16 patients; for average 5 years of follow-up. The results obtained were as follows; 1. The angulatory deformity of the long bones after pathologic fracture complicated by the chronic osteomyelitis was not corrected satisfactorily due to the bony sclerosis or hyperostosis at the fracture site, especially in cases of posterior or medial angulation. 2. The recurrence was closely related to the persisting non-sequestered original cortical lesion after incomplete saucerization, which was embeded by the new bone. So to prevent the recurrence the non-sequestered original cortical lesion must be removed completely. 3. The cortical defect after saucerization was restored completely in patients under the age of 14, but which was not the way in patients over the age of 16.
Congenital Abnormalities ; Follow-Up Studies ; Fractures, Spontaneous ; Humans ; Hyperostosis ; Osteomyelitis ; Recurrence ; Sclerosis

No abstract available.
Pressure Ulcer*

In evaluation of head trauma, simple skull examinations have been almost routinely requested in emergency room, regardless of historical, physical or neurologic findings, for fear of an unexpected fracture and medicolegal problem. Considering the low yield rate of positive radiologic findings for skull fracture and poor correlation of skull fracture with intracranial sequelae, simple skull examinations in head trauma patients, especially in those with minor trauma, is overutilized without reasonable clinical criteria of application. A retrospective review of 1,101 patients was performed to evaluate the efficacy of simple skull examination at the point of diagnosis and treatment, and to predict the risk for skull fracture and significant intracranial sequelae by clinical findings. Eighty-six patients(7.8%) had skull fractures including two basilar fractures and 12 depressed fractures. 116 patients(10.5%) had significant intracranial sequelae and 62 of these had skull fractures. Of 1,101 patients, 237 had the clinical findings of "high-yield" features and 70 of these had skull fractures and 99 had intracranial sequelae, so high-yield fractures are very indicative for the skull fracture and intracramal sequelae. Only in nine patients(0.08%0 the managements were altered after simple skull examination in that two with basilar fractures were treated with antibiotics and seven with depressed fractures were undergone neurosurgical precedures. Patients who were not admitted nor required further study or treatment because of minor head traumadidn't have any skull fractures or intracranial sequelae in our series, and 62 of 116 patients with intracranial sequelae showed normal skull findings indicating that normal findings can create false sense of security.
Anti-Bacterial Agents ; Craniocerebral Trauma* ; Diagnosis ; Emergency Service, Hospital ; Head* ; Humans ; Neurologic Manifestations ; Retrospective Studies ; Skull Fractures ; Skull*

Insulin autoimmune syndrome (IAS) includes fasting or reactive hypoglycemia, hyperinsulinemia and the presence of insulin-binding antibodies in patients who have never been exposed to exogenous insulin. This report concems a 29-year-old male patient with Graves disease who had history of having taken methimazole for two months, without any consequence, 6 months previously. However, when methimazole was administered again for three weeks, the patient suffered hypoglycemia during the next fourth week. He denied history of diabetes mellitus (DM), of taking any oral hypoglycemic agent or of having received insulin injection. Laboratory data showed total serum insulin level > 300 pu/mL, C-peptide reactivity (CPR) 8.0ng/mL and insulin antibody 89%. After stopping methimazole, he was treated with radioiodine (131I). There was no episode of hypoglycemic attack during 8 months of follow-up.
Adult ; Antibodies ; C-Peptide ; Diabetes Mellitus ; Fasting ; Follow-Up Studies ; Graves Disease* ; Humans ; Hyperinsulinism ; Hypoglycemia ; Insulin ; Male ; Methimazole

The effects of sodium hypochlorite for the destruction of P. aeruginosa, E. coli, K. pneumonias and S. anreas and for the prevention of contamination of irrigation fluid, which is either exposed to ICU environment or used for cleansing oral or trachea catheter tips, were tested and the following results were obtained. 1) The sodium hypochlorite solution 1: 800 destroyed P. aeraginosa, E. coli, K. pneomoniue and S. aweas in 5 minutes. This bactericidal effect was observed to be retained after the solution had stood 24 hours. 2) Viable P. aeraginosa was not detected immediately, 5 minutes and 10 minutes after exposure to 1: 500, 1: 800 and 1: 1000 sodium hypochloride solutions respectively. 3) The sodium hypochlorite solution 1: 800 prevented contamination of the irrigation fluids during a 24 hour exposure to the ICU environment. 4) P. aeraginosa and other gram-negative bacilli were frequently isolated from the plain fluid used for irrigating and holding the suction tips which had been used for patients. However, no organisms were isolated from fluid containing sodium hypochlorite 1: 800 even after 24 hour usage. It is concluded that the use of fluid containing sodium hypochlorite for the irrigation of catheter tips can reduce development of infections in the ICU patients.
Catheters ; Humans ; Infection Control* ; Pneumonia ; Sodium Hypochlorite* ; Sodium* ; Suction ; Trachea

Anesthesia for the patients with mediastinal mass may be associated with significant respiratory and cardiovaacular complications due to compression of traeheobronchial trees, the pulmonary artery, heart and superior vena cava The authors present a case of a 6-year-old girl with a large mediastinal tumor located in anterior and superior mediaetinum. Preoperatively, the patient was asymptomatic and anesthesia was induced and maintained uneventfully. Operative finding was that 8 X 14 cm sized hemangioma was extended superiorly over thoracic outlet, posteriorly aorta and SVC, medially pericardium and right hilum and inferiorly right upper lung and pleura. Because difficulties in removal of the hemangioma were expected, exploratory thoracotomy was discontinued. On emergence, as soon as the patient was extubated due to irritability, the patient became cyanotic and was noticed bulging mass on right supraclavicular area, Intubation was attempted and during direct laryngoscopy, anesthesiologist also noticed a bulging mass in right oral cavity. Postoperatively, the patients airway was kept with endotracheal tube, but cyanosis appeared on the face and skin over the chest, but not below the abdomen. Bulging mass on right supraclavicular area, distension of neck vein and conjunctival edema were noticed only when the patient was crying or suctioned. Symptoms improved by deep sedation. We assumed that enlargement of hemangioma due to increased central blood volume occasionally compressed tracheobronchial tree and sup. vena cava when patient was irritable, crying and coughing. On 11th postoperative day, patient was transferred to the another hospital for the better treatment with endotracheal intubation.
Abdomen ; Airway Obstruction* ; Anesthesia ; Aorta ; Blood Volume ; Child ; Cough ; Crying ; Cyanosis ; Deep Sedation ; Edema ; Female ; Heart ; Hemangioma ; Humans ; Intubation ; Intubation, Intratracheal ; Laryngoscopy ; Lung ; Mouth ; Neck ; Pericardium ; Pleura ; Pulmonary Artery ; Skin ; Suction ; Thoracotomy ; Thorax ; Veins ; Vena Cava, Superior

Elective operation should be postponed in patient with acute hepatitis because of the increased risk of morbidity and mortality. Especially, surgery carried out in the presence of acute viral hepatitis is associated with high incidence of major complications The authors have recently experienced a patient who was performed emergency craniotomy for epidural hematoma. At that time, the patient was in midst of acute viral hepatitis B. Major in- halational anesthetic was isoflurane and muscle relaxant was atracurium. Fortunately, the preoperative hepatic dysfunction was not exacerbated and recovered uneventfully. The choice of anesthetics and the proper pre-and intraoperative anesthetic managements are reviewed.
Anesthesia* ; Anesthetics ; Atracurium ; Craniotomy ; Emergencies ; Hematoma ; Hepatitis B* ; Hepatitis* ; Humans ; Incidence ; Isoflurane* ; Mortality

No abstract available.
Colon* ; Gastrointestinal Hemorrhage* ; Varicose Veins*

Among the environmental pollutants, cadmium and lead compounds may impair human health. These compounds may inhibit the biological metabolic function of bum.an body and may furthermore cause the disease directly or indirectly. This study was undertaken to investigate the effects of the immune response by intoxication of cadmium chloride and chloride acetate. Cadmium chloride (8.8 mg/kg, in saline 10 ml) and lead acetate (15 mg/kg, in saline 10 ml) were administered by lntraperitoneal injection. After 3 weeks, the rats were intoxicated with the above chemicals and immunized with sheep RBC. After 4 weeks, the immune response of rat spleen cells was measured by the Jerne's technique. The results were obtained as follows; 1. There was no change in leukocyte counts by the intoxication of cadmium chloride or lead acetate. 2. Cadmium chloride or lead acetate reduced hemoglobin contents for most intoxicated and immunized groups. 3. Hematocrits were decreased by the intoxication of cadmium chloride or lead acetate significantly. 4. It was determined that total protein, A/G (Albumin/Globulin), alpha-, beta- and gamma-globulins in rat serum were not changed. 5. Intoxication by cadmium chloride or lead acetate reduced the number of hemolytic plaque to the sheep RBC in rat spleen cells. Therefore, antibody producing of rat spleen cells was suppressed by the intoxication of cadmium chloride and lead acetate.
Animals ; Cadmium Chloride* ; Cadmium* ; Environmental Pollutants ; gamma-Globulins ; Hematocrit ; Humans ; Leukocyte Count ; Rats* ; Sheep ; Spleen

Deepening of the nasolabial crease is an esthetically unpleasing aging phenomenon occurring in the midface. Various treatment modalities have been introduced to improve the appearance of prominent nasolabial folds, all of which have pros and cons. Currently, a minimally invasive technique using synthetic dermal fillers is most commonly used. A simple and easy subcision procedure using a wire scalpel has also been used and reported to be effective for prominent nasolabial fold correction, with minimal complications. As an alternative to the wire scalpel, we used a 20-gauge metal type spinal needle cannula (Hakko Co.) and 4-0 Vicryl suture (Ethicon Inc.) for subcision of nasolabial folds. This technique is less expensive than the use of a wire scalpel and easily available when needed. Therefore, on the basis of favorable results, our modified subcision technique may be considered effective for prominent nasolabial fold correction.
Aging ; Catheters ; Nasolabial Fold ; Needles ; Polyglactin 910 ; Sutures