Rotational ankle fractures are one of the most common injuries of lower limbs treated by orthopedic surgeons. Open reduction and internal fixation (ORIF) is considered a gold standard treatment for unstable ankle fractures, though adjunct ankle arthroscopy is being increasingly used in cases of ankle trauma. Although the role and use of ankle arthroscopy are expanding, the clinical outcomes and cost-effectiveness of arthroscopy remain undefined. Furthermore, despite the number of clinical research studies performed on arthroscopically assisted surgery for ankle fractures, no definite guidelines have been agreed, and no consensus has been reached regarding indications. This article reviews the role, indications, operative techniques, and complications of ankle arthroscopy and compares the clinical outcomes of conventional ORIF and arthroscopically assisted ORIF.

Premature infants with respiratory distress syndrome may have clinically significant shunting through a patent ductus arteriosus (PDA). Left-to-right shunting through the PDA may lead to left ventricular volume overload and pulmonary edema. We present a case of perioperative management for severe respiratory distress syndrome in a premature infant who underwent surgical closure of PDA. Under general anesthesia, the infant was successfully managed by inhaled nitric oxide, high frequency oscillation ventilation with intermittent mandatory ventilation despite intermittent hypoxia. The operation was performed safely in the neonatal intensive care unit.
Anesthesia, General ; Anoxia ; Ductus Arteriosus, Patent* ; High-Frequency Ventilation ; Humans ; Infant ; Infant, Newborn ; Infant, Premature* ; Intensive Care, Neonatal ; Nitric Oxide ; Pulmonary Edema ; Ventilation

BACKGROUND: The elastic properties of skin may be useful indicators of cutaneous diseases and skin aging. OBJECTIVE: The purpose of this study is to obtain the normal range of skin elastic properties according to anatomical sites in normal Korean individuals and to show the differences among them. METHODS: Eleven different anatomical sites were measured in 41 healthy volunteers (20 males and 21 females) with a measuring device, Dermaflex-A . Tensile distensibility(TD), elasticity(E), and hysteresis(H) were recorded. RESULTS: TD was decreased in the distal portions (e.g. 2.30 +/- 0.35 in the arm vs 1.62 +/- 0.30 in the palm in males) and in the sites where the subcutaneous tissue was thin (e.g. 3.08 +/- 0.60 in the abdomen vs 1.20 +/- 0.44 in the medial malleolus in males). E was also decreased in the distal portions (e.g. 82.3 +/- 8.5 in arm vs 51.2 +/- 11.1 in the palm in males) and in the sites where the subcutaneous tissue was thin (e.g. 89.3 +/- 8.3 in the abdomen vs 58.8 +/- 13.8 in the medial melleolus in males). In contrast, H had greater individual variations and it showed no definite tendency according to sites. TD and E were generally greater in males than in females, and there were some significant differences between sexes according to sites. CONCLUSION: Cutaneous elastic properties varied according to anatomical sites and sexes. This feature must be considered in future studies measuring elastic properties, such as aging experiments.
Abdomen ; Aging ; Arm ; Elasticity ; Female ; Healthy Volunteers ; Humans ; Male ; Reference Values ; Skin Aging ; Skin* ; Subcutaneous Tissue

BACKGROUND: Psoriatic lesions have reduced water-holding capacity and show increased transepidermal water loss (TEWL). The effect of D-PUVA therapy, which combines topical calcipotriol and PUVA therapy, on epidermal barrier function has not yet been evaluated. OBJECTIVE: The purpose of this study was to verify the change of TEWL in lesional and normal skin according to D-PUVA therapy in psoriasis patients. METHODS: TEWL was measured consecutively by TEWAMETER TM210®, in 13 psoriasis patients who received D-PUVA therapy. Clinical grading was done according to psoriasis severity index (PSI). RESULTS: TEWL of psoriatic lesion decreased as D-PUVA continued. TEWL of normal-looking skin gradually increased, although the increase was trivial. Clinical grading of scale and in-filtration followed the pattern of PSI in the decrease of TEWL, while that of erythema did not. CONCLUSION: In psoriatic plaques, TEWL was decreased according to the improvement. In normal-looking skin, D-PUVA therapy caused only a little effect on TEWL.
Erythema ; Humans ; Psoriasis ; PUVA Therapy ; Skin ; Water*

A 33-year-old male visited the emergency room with abdominal pain which developed after a vomiting episode. Based on the pneumomediastinum findings from a chest radiograph and a contrast-enhanced chest and abdominal computed tomography scan, the patient was diagnosed with Boerhaave's syndrome. Preoperative radiologic findings showed no pneumothorax or pleural effusion. Once anesthesia was administered, the patient developed near complete cardiopulmonary collapse due to a bilateral tension pneumothorax, which was treated by bilateral thoracentesis, followed by chest tube insertion. Despite a left side rupture, the damaged right lung was unable to overcome single right ventilation, so the surgery was completed via right thoracotomy. The ruptured site was treated, and the patient was transferred to the intensive care unit. We discuss the anesthetic implications of this disease and how to prevent fatal complications.
Abdominal Pain ; Adult ; Anesthesia* ; Anesthesia, General ; Chest Tubes ; Emergency Service, Hospital ; Humans ; Intensive Care Units ; Lung ; Male ; Mediastinal Emphysema ; Pleural Effusion ; Pneumothorax* ; Positive-Pressure Respiration ; Radiography, Thoracic ; Rupture ; Thoracotomy ; Thorax ; Ventilation ; Vomiting

No abstract available.
Humans ; Laparoscopy* ; Pleural Effusion*

BACKGROUND: Because difficult airways are not commonly encountered, simulation of a difficult airway using a cervical collar has become a well-established technique of for modeling difficult laryngoscopic views and evaluating interventions for use in difficult airway scenarios. In this study, we have determined the optimal remifentanil concentrations (EC50 and EC95) required for i-gel insertion in anesthetized patients fitted with cervical collars at propofol effect-site concentrations of 4.0 and 6.0 microg/ml (group 4.0 and group 6.0). METHODS: The remifentanil dosage for each propofol effect-site concentration group was determined by the modified Dixon's up-and-down method using previous results. The experiment was started using a 4.0 ng/ml effect-site remifentanil concentration, and the dose was reduced by 0.5 ng/ml for the next attempt when tube insertion was successful; if tube insertion failed, the dose for the next attempt was increased by 0.5 ng/ml. RESULTS: EC50 and EC95 were respectively 2.11 ng/ml (95% CI, 1.78-2.26 ng/ml) and 2.44 ng/ml (95% CI, 2.28-3.67 ng/ml) for the 4.0 group, and 0.42 ng/ml (95% CI, -1.30 to 0.77 ng/ml) and 0.75 ng/ml (0.56-14.3 ng/ml) for the 6.0 group. CONCLUSIONS: In this study, a cervical collar was attached and head fixation was performed to induce a difficult airway. The optimal concentration of remifentanil at a propofol effect-site concentration of 4.0 microg/ml was greater than 2.44 ng/ml (95% CI, 2.28-3.67 ng/ml), and that at the propofol effect-site concentration of 6.0 microg/ml was greater than 0.75 ng/ml (0.56-14.3 ng/ml).
Head ; Humans ; Propofol

This study was aimed to furnish the data of facial bone fracture which was related regional and social environment and to aid diagnosis and treatment of the fracture. This is the retrospective and clinicostatical study on 625 patients with facial bone fracture. The patients were treated in the Dept. of Oral and Maxillofacial Surgery of Wonkwang University Hospital from Jan. 1, 1993 to Dec. 31, 1997. The result were as follows : The facial bone fractures occured most frequently in the twenties(32.3%) and male were predominent(77.4%) than female. The most frequent etiologic factor of facial bone fracture was fall down(42.8%) and midface fracture was traffic accident(63.4%). The most common site of fracture was symphysis(51.1%) and angle(29.7%), condyle(27.5%), ZMC(13.4%) were next in order of frequency. Of the 626 patients, 590 patients(89.5%) were treated with open reduction and only 36 patients(10.5%) were treated with closed reduction. In the blow, the ratio of angle fracture(50%) is especially high(the overall ratio 29.7%) and in the Out car TA, the ratio of ZMC fracture(34.6%) is especially high(the overall ratio 13.4%). In the fall-down, the ratio of symphysis(58.4%) and condyle fracture(33.6%) is especially high(the overall ratio 51.1%, 27.5%). Postoperatives complication were found in 35(5.6%) of 626 patients, in which mouth opening limitation(3%) was the most common. Above results suggest that early diagnosis and treatment of fracture site, systemic condition and associated injuries are nessary, and cooperative treatment with medical department should be performed.
Diagnosis ; Early Diagnosis ; Facial Bones* ; Female ; Humans ; Male ; Mouth ; Retrospective Studies ; Social Environment ; Surgery, Oral

BACKGROUND: Age-based formulae have been widely used to predict appropriate size of the endotracheal tube (ETT) in children. The objective of this study was to evaluate the effectiveness of formula (internal diameter (ID) (mm) = [age in years + 16]/4) in Korean children. METHODS: Ninety children under 8 years who required intubation with the regular uncuffed ETT were included in the study. Appropriate sizes were to permit a gas leak at 10-25 cmH2O with positive pressure ventilation. Initial intubation was tried with predetermined size and ETT was adjusted to meet this guideline. RESULTS: A range of three tubes around the predicted tube size covered 79 cases (88%), whereas one size predicted by the formula applied to only 29 cases (32%). The selection of ETT which is 0.5 mm larger than the predicted size could allow appropriate intubation in 41 (45.6%) patients. CONCLUSIONS: The age-based formula (ID (mm) = [age in years + 16]/4) could predict the appropriate tube size in less than one third our patients. Therefore, we recommend three sizes be available before endotracheal intubation.
Child* ; Humans ; Intubation ; Intubation, Intratracheal ; Positive-Pressure Respiration

No abstract available.
Alagille Syndrome* ; Cholestasis ; Xanthomatosis*