Leiomyomas of the vagina is a rare tumor, with 300 cases reported in the world literature. We experienced a case of leiomyoma of the vagina, and present it with a brief review of the literatures.
Leiomyoma* ; Vagina*

Two cases of old unreduced radial head dislocation in children were experienced in this hospital. These were the results of neglected Monteggia fracture. Dislocated radial heads were reduced under direct vision and the anular ligaments were reconstructed. Follow up study taken 9 months and 6 years respectively after operation revealed excellent elbow motion including pronation and supination. The radial nerve palsy which had been developed in one of the two patients after injury was recovered spontaneously after reduction of the radial head without opening of the Arcade of Frohse. Then we are reporting these cases with a review of the literature.
Child ; Dislocations ; Elbow ; Follow-Up Studies ; Head ; Humans ; Ligaments ; Monteggia's Fracture ; Paralysis ; Pronation ; Radial Nerve ; Supination

An induced hypotension is employed as a useful technique for operations on intracranial aneurysms, brain tumors and other intracranial lesions to diminish operative bleeding and to decrease brain tension. In aneurysm surgery under induced hypotension, the sac becomes softer and thus diminishes the risk of rupture when clips are applid. In 1946 Gardner used arteriotomy to lower blood pressure by decreasing the blood volume during brain tumor surgery, then gradually improved. Pharmacologically-induced hypotension soon became the cominant method of producing hypotension. Halothane and trimethaphan are the most popular drugs for this purpose. On the other hand, the risks of hypotension are obvious. These include decreased cardiac output, decreased cerebral blood flow, and low perfusion pressure exposing brain tissue to the risk of hypoxia thereby aggravating the effects of the circulatory disturbance present in the brain lesion. In this situation the blood oxygen tension in jugular-bulb and lactate content in brain tissue have been found to be reliable indices of degrees of cerebral oxygenation. Consequently, several investigators have studied the critical level of arterial blood pressure during hypotensive anesthesia and have accepted 60 mmHg of systolic pressure(40~50 mmHg of mean arterial pressure) as a clinically applicable level free from the danger of cerebral hypoxia. Furthermore, Griffiths and Gillies(1948) postulated that systolic pressure over 30 mmHg would provide adequate tissue oxygenation. However, there are only a few reports concerning the adequacy of cerebral oxygenation under such low levels of arterial blood pressure. The purpose of this study is to investigate cereral hemodynamics and metabolism during halothane-induced hypotensive anesthesia and to find any evidence of cerebral hypoxia at the levels of 60 mmHg and 30 mmHg, of systolic blood pressure. 15 adult mongrel dogs, weighing 10~13kg, were anesthetized with intravenous pentobarbital sodium. Endotracheal intubation was performed. One femoral artery was cannulated with a polyethylene tube for arterial blood sampling. The tube was connected to a Statham pressure transducer for continuous arterial blood pressure recording. The common carotid artery was exposed and a probe of square-wave electromagnetic flowmeter was placed on the vessel to record the carotid blood flow. An electrocardiogram and above two parameters were recorded simultaneously on a 4-channel polygraph. The internal jugular vein was cannulated and a catheter threaded up to the jugular-bulb for sampling of venous blood draining from the brain. The cisterna magna was punctured with an 18 gauge spinal needle to sample the cerebrospinal fluid. The experiments were divided into control phase, induction phase, hypotensive phase I, hypotensive phase II, and recovery phase. Each phase was maintained for 30 minutes. Cerebrospinal fluid, arterial venous blood were sampled at the end of each phase for analysis of gas tension and lactate content. 100% oxygen was inhaled during the induction phase. During the hypotensive phases, halothane/O2 was administered to lower the arterial blood pressure. In the hypotensive phase I and hypotensive phase II systolic pressure was maintained at 60 mmHg and 30 mmHg, respectively. In the recovery phase, halothane was discontinued and 100% oxygen only was inhaled. The results obtained are summarized as follows; 1. The carotid artery blood flow, which represents the cerebral blood flow, decreased linearly during the decline of the arterial blood pressure. At the end of each phase there was no difference in the carotid blood flow between hypotensive phase I and phase II. Cerebral vascular resistance was markedly reduced in the hypotensive phase II, which suggests cereral vasodilation. 2. Cerebral venous pO2 decreased significantly in the hypotensive phases, but the values till remained within normal limits. A marked reduction of arterial pCO2 was noted in the hypotensive phases. The values approach the lower limits of safety. 3. The most outstanding difference between hypotensive phase I and II is in the lactate content of cerebral venous blood and cerebrospinal fluid. There was a moderate increase of lactate content, and a slight reduction of cereral venous pH in hypotensive phase II, however, a significant degree of cerebral hypoxia and metabolic acidosis could be excluded. 4. Most of the changes in the cerebral metabolism and hemodynamics including arterial blood pressure, tent to return to return to normal at the end of the recovery phase. From the result of this study, it is concluded; Halothane-induced hypotensive anesthesia at 60 mmHg of systolic blood pressure(45 mmHg of possibility of mild metabolic acidosis 30 mmHg of systolic blood pressure(23 mmHg of mean arterial pressure), adequate cerebral oxygenation is maintained without difficulty.
Acidosis ; Adult ; Anesthesia* ; Aneurysm ; Animals ; Anoxia ; Arterial Pressure ; Blood Pressure ; Blood Volume ; Brain ; Brain Neoplasms ; Cardiac Output ; Carotid Arteries ; Carotid Artery, Common ; Catheters ; Cerebrospinal Fluid ; Cisterna Magna ; Dogs ; Electrocardiography ; Femoral Artery ; Flowmeters ; Halothane ; Hand ; Hemodynamics ; Hemorrhage ; Humans ; Hydrogen-Ion Concentration ; Hypotension ; Hypoxia, Brain ; Intracranial Aneurysm ; Intubation, Intratracheal ; Jugular Veins ; Lactic Acid ; Magnets ; Metabolism ; Needles ; Oxygen ; Pentobarbital ; Perfusion ; Polyethylene ; Research Personnel ; Rupture ; Transducers, Pressure ; Trimethaphan ; Vascular Resistance ; Vasodilation

No abstract available.
Pregnancy*

The use of artificial skins for full thickness wounds is an accepted technique, but unfortunately the take rate is low and the aesthetical result is not acceptable. The freeze-drying treatment of allogenic tissues can destroy cells with preserving the structural organization of extracellular matrices, permitting allogenic transplantation. In this study we investigated a new method to process the allogenic skin for transplantable allogenic dermis and this dermis was evaluated in a full thickness wound model. The results are as followings; 1. After treatment with NaCl and SDS solution and then with freeze-drying method, the allogenic dermis shows acellular dermal matrix with preserved normal extracellular matrix. 2. This allogenic dermis became completely incorporated into the wound without evidence of rejection or replacement by scar tissue. 3. The take rate of thin autografts overlying the allogenic dermis that were applied simultaneously was comparable to take rate of autograft alone. 4. The reduction in secondary contraction by allogenic dermis treated wounds was significant. 5. After grafting with cultured keratinocytes, the degree of epithelial coverage was 70% at 2 weeks. In conclusion, the allogenic dermis processed with our method displayed lack of antigenicity, and rapid revascularization. This allogenic dermis can permit simultaneous engraftment of an overlying STSG or cultured kerationocytes, reduce secondary contraction and improve cosmesis of full thickness wounds.
Acellular Dermis ; Autografts ; Cicatrix ; Dermis* ; Extracellular Matrix ; Keratinocytes ; Skin ; Skin, Artificial ; Transplants ; Wounds and Injuries*

Balanced anesthesia is being equilibrated with the maintenance of light planes of anesthesia and the relatively free utilization of muscle relaxants to prevent untoward movement of the patient in response to surgical stimuli. However, muscle relaxants per se do not contributes to the state of hypnosis or analgesia. Therfore, awareness during modern anesthesia must be seriously taken. We have given anesthesia in 175 cases for cesarean section in order to investigate intraoperative awareness. Among the 175 anesthetic cases, 13 cases had awareness of pain and 19 cases had auditor awareness. Accordingly the total incidence of awareness in our investigation was 16% which was significantly high and should be considered in clinical anesthesia practice.
Analgesia ; Anesthesia* ; Balanced Anesthesia ; Cesarean Section* ; Female ; Humans ; Hypnosis ; Incidence ; Intraoperative Awareness ; Pregnancy

No abstract available.
Teratoma*

A total of 132 cases of structural scoliosis have been followed since Jan. 1963 up to Dec. 1976 at the Hanyang University Hospital. The present paper classified scoliosis according to the etiology and analyzed curve patterns and spinal deformties such as rotation and wedging. Various kinds of treatment were done and these included Milwaukee brace, posterior spinal fusion with or without Harrington instrumentation. The end results of these treatment were also analyzed. The results concluded from the present studies were as follows: 1. Poliomyelitis was the most common cause of structural scoliosis. Of 132 cases of scoliosis, paralytic scoliosis was 48.5% while idiopathic scoliosis was 31.1% and congenital scoliosis 9.8%. 2. In paralytic scoliosis lumbar curves were the most common pattern and thoracic and thoracolumbar curves were the next. 3. In idiopathic scoliosis, the most common pattern was the right thoracic. 4. Very severe curves over 80° were more frequent in paralytic than in idiopathic scoliosis, showing the percentage of 20.3% in paralytic scoliosis and 10.3% in idiopathic scoliosis respectively. 5. The number of vertebrae involved in primary curve was approximately the same in both paralytic and idiopathic scoliosis. 6. In paralytic scoliosis, as the curves progressed, rotation of vertebrae became more marked in lumbar curve than in thoracic curve, while wedging deformity was more severe in thoracic curve than in Jumbar curve. 7. The tendency of the rotation and wedging in thoracic and lumbar curve was the same in both idiopathic scoliosis and paralytic scoliosis. When the degree of curves was the same, rotation and wedging were slightly more severe in idiopathic than in paralytic scoliosis. 8. In congenital scoliosis hemivertebrae were the most common anomaly and the majority of congenital anomalies were located at lumbar region. 9. Treated with Milwaukee brace, 22.1% of original curve angle was corrected in idiopathic coliosis, 9.8% in paralytic scoliosis, and 7.3% in congenital scoliosis, respectively. The Milwaukee brace was effective in thoracic and thoracolumbar curves but not in lumbar curves. 10. In paralytic scoliosis treated with posterior spinal fusion without Harrington instrumentation, the final degree was 43.2 and the correction loss was 12.6% but with both posterior fusion and Harrington instrumentation, the final degree was 50.2 and the correction loss was 6.8%. 11. There were 2 cases of complication after posterior spinal fusion without Harrington instrumentation. One was pseudarthrosis and the other was bending of graft with some loss of correction. One case of complication occured after posterior spinal fusion with Harrington instrumentation. It was a case of displacement of distraction hook on the rod.
Braces ; Clinical Study ; Congenital Abnormalities ; Lumbosacral Region ; Poliomyelitis ; Pseudarthrosis ; Scoliosis ; Spinal Fusion ; Spine ; Transplants

Most proximal humeral fractures respond satisfactorily to conservative treatment. It is only the occasional displaced fracture or fracture-dislocation that demaads special treatment. The purpose of this study is to analysis the results of closed and open reduction of displaced proximal humeral fractures according to Neers classification. Fifty-two cases of these fractures, followed up more than five months, are presented. 1. The average age of patients was 40. I years. 2. The fractures were classified according to Neers method. Nearly half (48.1%) of the cases were one-part fractures. Next, two-part fractures rated 42.3%, while three-part fractures, only one (l.9%). 3. Among the total 52 patients, 42 cases(80.8%) were treated conservatively and 10 were operated. We performed surgical operations in seven cases among 22 two-part fractures, aix were reduced with Kirschner wires and one treated with Kirschner wire and staple. The average age of these seven cases was 26. 6 years and the resulta were good except one. 4. The results of these patients were evaluated by the Neers criteria. Of 52 caaes, 40 had good results, five, fair, and the remaining seven poor results. Twenty-three cases (92%) in 25(100%) one-part fractures were good and 17 cases (77.3%) in 22 (100%) two-part fractures were also good. In three-part and four-part fractures the results were all poor.
Bone Wires ; Classification ; Humans ; Methods ; Shoulder Fractures

Dislocation of the hemate bone is very rare. There is no reported case in Korea. The mechanism of injury may be attributed to direct trauma. We have experiened a case of dislocation of the hamate bone, treated it by open reduction and internal fixation using two Kirschner wires. The result was satisfactory. A case of dislocation of the hamte bone is reported with brief review of literature.
Bone Wires ; Dislocations ; Hamate Bone ; Korea