Since May 1981, the standard method of treatment of the femoral shaft fractures at the Daejeon EuIji Deneral Hospital has been the closed intramedullary nailing technique of Kuntscher. We performed intramedullary nailing on thirty-five fractures of femoral shaft in 35 patients. Closed intramedullary nailing was used in twenty-eight femora and open intramedullary nailing with cerclage wiring in seven fractures, in which large butterfly fragment was present, precluding control of rotation or length, or both. The overall rate of union was 97 percent. The range of motion of the knee at follow up was good in 80%, fair in 14%, poor in 6% (Good Full extension; loss of flexion less than 10 degrees. Fair Any loss of extension;loss of flexion of 10 to 50 degrees, Poor Loss of more than 10 degrees of extension; range of flexion-extension less than 90 degrees). The advantages of this technique include the negligible risk of infection, the rapid stabilization of fracture, thus facilitating management of other associated injuries, the rapid return of function of the knee, and early union of fracture and return to work. It is authors' opinion that when proper equipment and expertise are available, than closed intramedullary nailing is the treatment of choice not only for simple uncomminuted fracture of the femoral shaft but also for open comminuted fractures.
Butterflies ; Follow-Up Studies ; Fracture Fixation, Intramedullary ; Fractures, Comminuted ; Humans ; Knee ; Methods ; Range of Motion, Articular ; Return to Work

Many methods are available for monitoring spinal cord conductian during operation. It is essential for the anesthesiologist to the know potential interactions between the drugs used during the operation and the neurophysiologic response. The purpose of the present study was to experimentally examine the effects of ketamine and fentanyl used in the operating room. Twenty-three patients, 23 to 68 years of age, ASA I-II, free of neurologic disease and scheduled for elective operations were randomly selected for the study. Averaged somatosensory evoked potentials to stimulation of the posterior tibial nerve at the ankle were recorded. After baseline recording of the somatosensory evoked potential, ketamine (1.5 mg/kg) or fentanyl (3u/kg) was administered by bolus injection in each patient. Additional somatosensory evoked potential after the drug injection was recorded. ECG, blood pressure and heart rate were monitored throughout the measuring procedure. 1) The mean values of latency (Pl, Nl, P2) and amplitude (Pl-N1, Nl-P2) were 39.58, 48.36 and 60. 74 msec and 7.88 and 10.30uV respectively. Those values were changed to 38.54, 46.67 and 60.50 msec and 6.55 and 9.85uV in patients in the ketamine injected group. 2) The mean values of latency and amplitude were 37.90, 45.93 and 61.01 msec and 7.35 and 7.21uV respectively in the baseline state. Each value changed to 38.10, 47.06 and 61.88 msec and 6.67 and 8.49uV respectively after fentanyl injection. There was no statistical difference in latencies and amplitudes between the pre-injection state and post-injection state in both the ketamine and fentanyl groups. Therefore, we suggested that the use of ketamine or fentanyl could be administered successfully during intraoperative somatosensory evoked potential monitoring without much influence on tibial nerve stimulation.
Ankle ; Blood Pressure ; Electrocardiography ; Evoked Potentials, Somatosensory* ; Fentanyl* ; Heart Rate ; Humans* ; Ketamine ; Operating Rooms ; Spinal Cord ; Tibial Nerve

Spontaneous rupture of the bile duct is an exceedingly rare and usually recognized fatal cause of peritonitis and intraabdominal sepsis. Several reports of isolated cases have demonstrated its rarity in the absence of operative trauma or severe injury. Perforation of the biliary system occurs most frequently in the gall bladder, which perforation of the hepatic duct is less common, being described mainly in infants, but extremely rarely in adults. The diagnosis of the spontaneous rupture of the bile duct depends on meticulous clinical examination and imaging investigation. The basic principles of treatment are to stop the bile leakage, evacuate the extravasated bile, apply decortication of the encapsulated fluid collection and provide adequate drainage. We report on a patient with spontaneous perforation of the right hepatic duct who presented with abdominal pain, jaundice and fever. Exploratory surgery showed proximal common bile duct obstruction with right hepatic duct perforation.
Abdominal Pain ; Adult ; Bile ; Bile Ducts ; Biliary Tract ; Common Bile Duct ; Diagnosis ; Drainage ; Fever ; Hepatic Duct, Common* ; Humans ; Infant ; Jaundice ; Peritonitis ; Rupture, Spontaneous* ; Sepsis ; Urinary Bladder

No abstract available.
Lambert-Eaton Myasthenic Syndrome*

The authors report a rare case of aggravated myelopathy due to rebleeding of intramedullary cavernous angioma during pregnancy. A 29-year-old woman with a intramedullary cavernous angioma of the lower thoracic spinal cord was initially managed with a conservative treatment. She suffered the progressive paraparesis 16 months later during the 3rd trimester of her pregnancy. The follow-up magnetic resonance imaging revealed rebleeding of the previous cavernous angioma. The entire lesion was resected with a standard microsurgical technique after delivery, and her neurological symptoms subsequently resolved.
Adult ; Female ; Follow-Up Studies ; Hemangioma, Cavernous* ; Humans ; Magnetic Resonance Imaging ; Paraparesis ; Pregnancy* ; Spinal Cord ; Spinal Cord Diseases

The purpose of this article is to review the past history of hand surgery briefly and to overview of a vision of hand surgery over next generations in republic of Korea. There were three characteristics of the past history of digit replantation in Korea. Due to the tremendous use of press machine, the replantation surgery for finger amputation had been developed rapidly from 1980's to 1990's period. Also new microsurgery techniques had been introduced such as toe pulp free flap for digit reconstruction. These techniques had been developed based on the medical health insurance system for the factory employees. Future of hand surgery in Korea can be anticipated as followings: operative microscopy and robotics may help surgeons to anastomosis very tiny micro-vessels; the functional recovery of fingers and hands will be more important; incidence of degenerative disease, musculoskeletal system disorder due to excessive use and injury during sports will increase; new materials such as artificial joint will be used more frequently according to the innovation of tissue engineering and regenerative medicine; specialist system for hand surgeon will be settled. Since there are a lot of hand surgeon who has a mission to alleviate patient's pain and injury, there will be a continuous growth of hand surgery in Korea.
Amputation ; Family Characteristics ; Fingers ; Free Tissue Flaps ; Hand ; Humans ; Incidence ; Insurance, Health ; Joints ; Korea ; Microscopy ; Microsurgery ; Missions and Missionaries ; Musculoskeletal Diseases ; Replantation ; Republic of Korea ; Robotics ; Specialization ; Sports ; Tissue Engineering ; Toes ; Vision, Ocular

A 39-year-old woman has had several episodes of transient right hemiplegia. On neurological examination during the ictal period she had alert consciousness with aphasia, head and eyeball deviation to the right side, and right hemiplegia. Brain MRI was normal. EEG-video monitoring of ictal period showed continuous ictal discharge in the midline frontocentral area coincided with right hemiplegia. After injection of diazepam, the ictal discharge and right hemiplegia disappeared. We report a case of status epilepticus characterized by ictal hemiplegia.
Adult ; Aphasia ; Brain ; Consciousness ; Diazepam ; Female ; Head ; Hemiplegia* ; Humans ; Magnetic Resonance Imaging ; Neurologic Examination ; Status Epilepticus*

Leber's hereditary optic neuropathy (LHON) is an important cause of bilateral optic neuropathy in youth and occasionally associated with other neurological abnormalities (Leber's plus). The authors recently found out one family of LHON and another patient of Leber's plus with mitochondrial DNA (mtDNA) 11778 mutation. The presence of a point mutation of mtDNA was investigated by restriction length fragment polymorphism. Among 14 patients who had mtDNA 11778 mutation in the family, only two men had bilateral optic neuropathy. The other was a man of optic neuropathy with myelopathy. The age at onset of visual loss ranged from 14 to 25 (average 19.7). The time delay between involvement of the two eyes was I to 3 months Central visual field defect was observed in each of all affected eyes and worse in the earlier affected. The brain MRI and CSF studies revealed no abnormality. This study showed that the clinical manifestations and genealogical features of LHON in our patients are similar to those of previously reported cases in other countries.
Adolescent ; Brain ; DNA, Mitochondrial* ; Humans ; Magnetic Resonance Imaging ; Male ; Optic Atrophy, Hereditary, Leber ; Optic Nerve Diseases ; Point Mutation ; Spinal Cord Diseases ; Visual Fields

The purpose of this study was to evaluate the efficiency of Magnetic Resonance Imaging (MRI) in the evaluation of patients with lacunar syndrome, to compare the sensitivity of MRI and that of brain Computed Tomography(CT) in the lacunar lesions. Thirty-nine cases of lacunar syndrome were pure sensory stroke(1 case), pure motor hemiparesis (12 cases), ataxic hemiparesis (5 cases), pure motor hemiparesis sparing face (2 case), pure motor hemiparesis with confusion (1 case), cerebellar ataxia with crossed 3rd nerve palsy (1 case), sensory-motor stroke(4 cases), lower basilar branch syndrome (6 cases), lateral medullary syndrome (3 cases), lateral pontomedullary syndrome (2 cases), locked-in syndrome (1 case), and miscellaneous (1 case). MRI detected small, deep lesions appropriate to lacunar syndrome in 34 cases (medulla, 3 cases; pons, 16 cases; midbrain, 3 cases : thalamus-internal capsule, 2 cases : internal capsule-basal ganglia, 6 cases; periventricular white matter, 3 cases) of the patients (34/39, 87.1%), and was diagnostically superior to CT in those cases (especially in brainstem lacunar lesions), where both studies were obtained concommitantly (MRI : CT=84.3% : 37.5%). MRI, when evailable, should replace CT as the diagnostic imaging procedure of choice in evaluation of lacunar syndrome.
Brain Stem ; Brain* ; Cerebellar Ataxia ; Diagnostic Imaging ; Ganglia ; Humans ; Lateral Medullary Syndrome ; Magnetic Resonance Imaging* ; Mesencephalon ; Paralysis ; Paresis ; Pons ; Quadriplegia ; Stroke, Lacunar*

A sarcomatoid carcinoma of the gastrointestinal tract is a very rare tumor. Only limited cases have been reported in the literature. The tumor is more malignant than the usual adenocarcinoma of the gastrointestinal tract. Typically, when discovered, a sarcomatoid carcinoma of the small intestine is already in a late stage of disease with a rapidly progressive course. The survival rate is markedly lower than for adenocarcinomas. Here, we report the case of a 63-year-old male patient who was referred from the Gastroenterology Department of Chonnam University Hospital. He had been suffering from a sudden onset of painless jaundice, and from weight loss for one month. The operation at our hospital was performed under a diagnosis of periampullary cancer. Whipple's operation was carried out on Dec. 14, 1998. Pathology confirmed the diagnosis of a sarcomatoid carcinoma of the duodenum. This article presents that case of a sarcomatoid carcinoma of the duodenum with a brief review of the literature.
Adenocarcinoma ; Diagnosis ; Duodenum* ; Gastroenterology ; Gastrointestinal Tract ; Humans ; Intestine, Small ; Jaundice ; Jeollanam-do ; Male ; Middle Aged ; Pathology ; Survival Rate ; Weight Loss