BACKGROUND: To report the radiological and clinical outcomes of internal fixation using distal clavicle hook plates for distal clavicle fractures. METHODS: From April 2008 to December 2012, 32 patients with distal clavicle fractures underwent surgery using an AO hook plate. The reduction was qualified and evaluated according to the radiological findings. The evaluation of the clinical outcomes was performed with the University of California at Los Angeles (UCLA) score, the Korean Shoulder score, and the visual analogue scale (VAS) pain score. RESULTS: By radiological evaluation, we found that 31 of 32 patients showed anatomical reduction and solid bone union. Although we obtained satisfactory UCLA scores, Korean Shoulder Scale scores, and VAS pain scores, 12 cases of complications were present. We found 4 cases of osteolysis of the acromion, 1 case of nonunion, 3 cases of periprosthetic fractures, 3 cases of subacromial pain, and 1 case of skin irritation. We performed re-operations in 2 patients. CONCLUSIONS: To avoid complications associated with clavicle hook plates, choosing the appropriate hook size and bending of the hook according to the slope of the acromion undersurface is critical. Also, we believe that early removal of clavicle plates may help reduce complications.
Acromion ; California ; Clavicle* ; Humans ; Osteolysis ; Periprosthetic Fractures ; Shoulder ; Skin

No abstract available.
Fracture Fixation, Intramedullary*

OBJECTIVES: In Korea, pharmacists can dispense medicines without doctor's prescription. This causes the high proportion of pharmaceutical expenditures. The study shows the prescribing behaviors of practicing pharmacists with the simulated patient of arthritis. We select the arthritis as a subject of simulation, because the arthritis is one of the major health problems and the abuse of cortico-steroids is usual in treatment of arthritis patients. METHODS: Twenty drug stores among the 320 drug stores in a district, Seoul, Korea were randomly selected. One of the researchers visited the drug stores and received the medicines from the pharmacists after explaining standardized scenario of arthritis. The simulated patient recorded the practice behaviors of pharmacists. RESULTS: The mean number of prescribed drugs are four and half. Among the twenty pharmacists, the nineteen prescribed non-steroidal anti-inflammatory drugs and the seven(35%) prescribed the cortico-steroids. The antacids were prescribed by the fourteen(70%) pharmacists. The five(25%) pharmacists only recommended the simulated patients to visit the medical doctors, and the three(15%) performed physical examination to the simulated patients. The three pharmacists(15%) asked the past history of the drug adverse effects and no pharmacist explained the adverse effects of prescribed medicines. CONCLUSIONS: The research shows that the cortico-steroids are frequently prescribed and the pharmacists commonly do not give the explanations of the prescribed medicines to the arthritis patients.
Antacids ; Arthritis* ; Health Expenditures ; Humans ; Korea ; Patient Simulation ; Pharmacists* ; Physical Examination ; Prescriptions* ; Seoul

BACKGROUND: Hypertension and tachycardia usually accompany laryngoscopy and tracheal intubation. Topical and intravenous lidocaine are used in an attempt to blunt these potentially adverse hemodynamic responses, but these effects of lidocaine are controversial. The purpose of this study is to evaluate whether intratracheal nebulized lidocaine and/or intravenous lidocaine attenuate circulatory stimulating response to tracheal intubation. METHODS: Sixty patients, ASA physical status I, scheduled elective surgery, were randomly assigned to receive a preintubation dose of either 5 mL of normal saline intravenously, 4 mL of 4% lidocaine by intratracheal nebulizer, 1.5 mg/kg of 2% lidocaine intravenously, or 4 mL of 4% lidocaine intratracheal nebulizer and 2% lidocaine of 1.5 mg/kg intravenouly. Induction of anesthesia was accomplished with 5 mg/kg of thiopental IV, and 1 mg/kg of succinylcholine was given. Laryngoscopy and intubation was performed, and anesthesia maintained with 2% enflurane in 50% nitrous oxide in oxygen. Blood pressure and heart rate were recorded at preinduction, after induction, and every minute until 5 min after intubation. RESULTS: Intratracheal nebulized lidocaine and/or intravenous lidocaine were effective in attenuating increases in systolic pressure with no detectable difference between them, and failed to attenuate increases in diastolic pressure and heart rate. And significant decrease in systolic pressure 3 min after intubation was detected in intratracheal and intravenous lidocaine group. CONCLUSIONS: These data suggest that intratracheal nebulized lidocaine or intravenous lidocaine is effective in attenuating increase in systolic pressure to tracheal intubation, but intratracheal and intravenous lidocaine has not synergistic effect.
Anesthesia ; Blood Pressure ; Carbon Dioxide ; Enflurane ; Heart Rate ; Hemodynamics ; Humans ; Hypertension ; Intubation* ; Laryngoscopy ; Lidocaine* ; Nebulizers and Vaporizers ; Nitrous Oxide ; Oxygen ; Succinylcholine ; Tachycardia ; Thiopental

No abstract available.
Leukemia*

Transient synovitis of the hip is non-specific inflammation and self limited condition, which is most common cause of painful limping in children under 10 years of age. Ultrasonography presents some merits, simple, rapid, non-invasive, low cost, repetitive to assess soft structures in and around the hip joint compared to other diagnostic methods. We prospectively studied 32 cases of unilateral transient synovitis at OPD from Jan. 1988 to Oct. 1989 using 5-7.5 MH, probe ultrasonography. 2-times serial check up in symptomatic and asymptomatic stage about capsule thickness and bone-capsule distance in 3 different positions of the both hips were performed for comparision. The following results were obtained; 1. Boys were 25 cases (78%) and 26 cases (83%) were between 3 and 7 years old of age. 2. Bone-capsule distance in ultrasonography revealed abnormal increase in 72%. 3. External rotation position showed wider bone-capsule distance than other position. 4. Capsule thickness was 3.3mm in diseased and 3.0mm in sound, 0.3mm decrease after treatment. 5. Bone-capsule distance was 4.5mm in symptomatic stage, 2.7mm in asymptomatic stage, 1.8mm decrease after treatment in averge.
Child ; Hip Joint ; Hip ; Humans ; Inflammation ; Prospective Studies ; Synovitis ; Ultrasonography

The corpus callosum is the main interhemispheric connection in human brain. Agenesis of corpus callosum may partial or complete, and it may have not functional abnormalities. Its prenatal sonographic diagnosis is difficult because of fetal head position, especially in a cephalic presentation. We experienced a case of complete agenesis of corpus callosum. The prenatal sonographic findings was disproportionate dilatation of lateral ventricle, which were suggestive finding of agenesis of corpus callosum or hydrocephalus. We could confirm the diagnosis of complete agenesis of corpus callosum by postnatal MRI.
Agenesis of Corpus Callosum* ; Brain ; Corpus Callosum ; Diagnosis ; Dilatation ; Head ; Humans ; Hydrocephalus ; Lateral Ventricles ; Magnetic Resonance Imaging ; Ultrasonography

Aplastic anemia in pregnancy is an extremely rare condition with high maternal morbidity and mortality rates. Prognosis is poorer when aplastic anemia is complicated during pregnancy and many such patients have an unsuccessful pregnancy outcome. The relationship between aplastic anemia and pregnancy remains uncertain. Intensive hematological support remains the mainstay of therapy and a successful obstetric outcome can be best accomplished with the close clinical collaboration of the hematologist and the obstetrician. We report here a case of a 24-year-old woman with aplastic anemia, she experienced two consecutive vaginal deliveries. We present it with brief review of literature.
Anemia, Aplastic* ; Cooperative Behavior ; Female ; Humans ; Mortality ; Pancytopenia ; Pregnancy Outcome ; Pregnancy* ; Prognosis ; Young Adult

The area overlying the ischium is a frequent site for the development and recurrence of pressure sores because they directly overlie the points of maximum pressure on the sitting surface. Furthermore, they are frequently complicated by abnormal lesional bursae, or by extension, fistula toward the perineum or peritoneal cavity. In all cases of the ischial pressure sores, total en bloc excision of the ulceration, underlying bony prominence with immediate closure, and healthy, well-vascularized soft tissue is required to obtain the satisfactory result. It is well known that the choice of the treatment of the ischial pressure sore is the gluteal or posterior thigh flap. There have been many reports on the reconstruction of the ischial pressure sores such as cases involving the fasciocutaneous flap, muscle and musculocutaneous flaps, V-Y advancement flaps, rotation flaps, and long random flaps. In spite of these varieties, the recurrence of the ischial pressure sore after treatment still remains about seventy-five percent according to Conway and Griffith.9 Consequently, any surgical plane for ischial pressure sores must provide a stable, durable soft tissue cover that can be reused in the event of recurrence. From February to December 2002, we have performed the reconstruction of the ischial pressure sores on the posterior thigh's transposition flap in order to get following advantages: simplicity of the operation, sufficiency of padding with skin flap, preservation of the adjacent normal tissues and the capability of recycling this same flap in case of recurrences. Its design is somewhat different from and more extended widely than that of the gluteal or posterior thigh flap. This flap was elevated above the deep fascia to be cutaneous with appropriate backcut incision; some perforators from the inferior gluteal artery were also preserved. We present some cases of ischial pressure sores treated with a laterally based posterior thigh transposition flap herein. Therefore, the need to perform repetitive surgery in the future must be considered so that the maximum number of reconstructive options can be preserved. Although the follow-up period has not always been satisfactory, we have not had any serious complications in these patients until recently.
Arteries ; Fascia ; Fistula ; Follow-Up Studies ; Humans ; Ischium ; Myocutaneous Flap ; Perineum ; Peritoneal Cavity ; Pressure Ulcer* ; Recurrence ; Recycling ; Skin ; Thigh* ; Ulcer

BACKGROUND: Surgical correction of the full spectrum of esophageal atresia with tracheoesophageal fistula has improved over the years, but the mortality and morbidity assoiated with repair of these anomalies still remains high. MATERIAL AND METHOD: We retrospectively analyzes 27 surgically treated patients with esophageal atresia and tracheoesophageal fistula at Dong-A University Hospital between January 1992 and March 1997. RESULT: There were 21 male and 6 female patients. Mean birth weight was 2.62+/-.385 kg(2.0~3.4 kg). Twenty- four(88.9%) had esophageal atresia with distal tracheoesophageal fistula, and 3(11.1%) had pure esophageal atresia. Four(14.8%) infants were allocated to Waterston risk group A, 18(66.7%) to group B, and 5(18.5%) to group C. In eighteen(66.7%) infants with associated anomalies, cardiovascular anomalies were the most common. Three had a gap length of 3.5 cm or greater(ultra-long gap) between esophageal segments, 7 had 2.0 to 3.5 cm(long gap), 8 had 1.0 to 2.0 cm(medium gap), and 9 had 1 cm or less(short gap) gap length. Among 27 neonates, 3 cases underwent staged operation, late colon interposition was done in 2, and all other 24 cases underwent primary esophageal anastomosis. Oerative mortality was 2/27(7.4%). Causes of death included acute renal failure(n=1), empyema from anastomotic leak(n=1), necrotizing enterocolitis(n=1), sepsis(n=1), insulin-dependent diabetus mellitus(n=1 . There were 4 anastomosis- related complications including stricture in 3, leakage in 1. Mortality was related to the gap length(p<.05). CONCLUSION: Although the complication rate associated with surgical repair of these anomalies is high, this does not always implicate the operative mortality. The overall survival can be improved by effective treatment for combined anomalies and intensive postoperatve care.
Birth Weight ; Cause of Death ; Colon ; Constriction, Pathologic ; Empyema ; Esophageal Atresia* ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Mortality ; Retrospective Studies ; Tracheoesophageal Fistula