Due to its anatomical position and histological characteristics of thin capsule and low abundance of connective tissue, the spleen is a prime target for damage from blunt injury or during operation. Until recently, total splenectomy has been considered as safe operation for splenic injuries. But now, splenic salvage procedure or non operative treatment have become the standard care with knowledge for immunologic function of spleen, development of radiologic examination such as ultrasonography and abdominal CT, and report about high risk of mortality after splenectomy. Authors have experienced 27 patients with splenic injury admitted to the emergency department during 5 years 4 months period from 1991 to 1996. Among them, 10 patients were received total splenectomy, 2 patients partial splenectomy, 8 patients splenorrhaphy, one patients hemostasis, and 6 patients underwent nonoperative management.
Connective Tissue ; Emergency Service, Hospital ; Hemostasis ; Humans ; Mortality ; Spleen ; Splenectomy ; Tomography, X-Ray Computed ; Ultrasonography ; Wounds, Nonpenetrating

The incidence of the bronchial rupture following blunt chest trauma has increased gradually with the increases of traffic accident and mechanization. We have experienced the 3 cases of the bronchial rupture following blunt chest trauma. The first case was a 38 year old man who was compressed into a blank wall by fork-lift. He complained of severe dyspnea with air leak through the chest tube and right pneumothorax with collapsed lung was seen in his chest X-ray film after closed thoracostomy. Emergency bronchoscopy showed disruptions of the right upper lobar bronchus and the membranous portion of the intermediate bronchus. The second was 8 year old boy who was sustained a crushing chest injury by bus. He also complained of severe dyspnea with air leak through the chest tube and right pneumothorax with collapsed lung was seen in his chest X-ray film after closed thoracostomy. We performed the computed tomogram of the chest and found the bronchial rupture at the distal portion of the right main bronchus. The third case was 40 year old male who was sustained a crushing chest injury by in-car accident. He complained of mild dyspnea without air leak through the chest tube and the left lung was well expanded in his chest X-ray film after closed thoracostomy. Bronchoscopy showed disruption of the 6th cartilaginous portion of the left main bronchus. Emergency bronchoplasties were performed with interrupted end-to-end anastomosis in all cases. Postoperative air leak occurred for 7 days in the third case. Others were uneventful.
Accidents, Traffic ; Adult ; Bronchi ; Bronchoscopy ; Chest Tubes ; Child ; Dyspnea ; Emergencies ; Humans ; Incidence ; Lung ; Male ; Pneumothorax ; Rupture* ; Thoracic Injuries ; Thoracostomy ; Thorax* ; X-Ray Film

Lung Volumes and alveolorespiratory function were studied in 30 cases of pure or predominat mitral stenosis in slightly to moderately compromized state, and the results were compared with those in the normal controls. In patients with mitral stenosis, there was a singnificant reduction in the vital capcity and the total lung capacity, whereas the residual volume and its ratio to the total lung capacity were significantly increased. The distribution of inspired gas was uneven as reflected by increase in the lung clearnace index and in the slope of phase III of the single breath nitrogen washout curve. The alvelolar arterial oxygen tension gradient and the physiological dead space were singinificantly increased despite a singinificant decrease in the arterial carbon dioxide tension. The diffusing capacity was also reduced in some cases.
Carbon Dioxide ; Humans ; Lung* ; Mitral Valve Stenosis* ; Nitrogen ; Oxygen ; Residual Volume ; Total Lung Capacity

No abstract available.
Head*

No abstract available.
Femur Neck*

No abstract available.
Femur* ; Hip*

Fractional time intervals during cardiac cycle were determined by means of the analyses of mechanocardiograms in 100 male patients with hypertension and 100 healthy males, which served as controls. The mechanocardiograms anyalyzed in this study were simultaneously recorded electrocardiograms, phoocardiograms, apexcardiograms and carotid pulse tracings. Of various time intervals during systolic in patients with hypertension, the mechanical systole(both C-D and C-A2 intervals), the isovolumic contraction time, the initial phase of ventricular contraction and the ventricular pressure elevation time were significantly prolonged, whereas the protodiastole was significantly shortened. The prolongation of the mechanical systole was caused primarily by the lengthening of the isovolumic contraction time, which resulted from the prolongation of the components of the latter, namely the initial phase of ventricular contraction and the ventricular pressure elevation time. During diastole, there were significant prolongation of the isovolumic relaxation time and the rapid ventricular filling period, and a significant shortening of the slow ventricular filling period. Among these time intervals, the mechanical systole(C-A2 inlerval), the isovolumic contraction time, the ventricular pressure elevation time and the isovolumic relaxation time showed significant positive correlation with blood pressure. On the other hand, the slow ventricular filling period was significantly negatively correlated with blood pressure. These facts suggested that the changes in these time intervals were related to increased afterload and/or resultant myocardial or hemodynamic alterations.
Blood Pressure ; Diastole ; Electrocardiography ; Hand ; Hemodynamics ; Humans ; Hypertension* ; Male ; Relaxation ; Systole ; Ventricular Pressure

Fractional time intervals during cardiac cycle were determined by means of the analyses of mechanocardiograms in 100 male patients with hypertension and 100 healthy males, which served as controls. The mechanocardiograms anyalyzed in this study were simultaneously recorded electrocardiograms, phoocardiograms, apexcardiograms and carotid pulse tracings. Of various time intervals during systolic in patients with hypertension, the mechanical systole(both C-D and C-A2 intervals), the isovolumic contraction time, the initial phase of ventricular contraction and the ventricular pressure elevation time were significantly prolonged, whereas the protodiastole was significantly shortened. The prolongation of the mechanical systole was caused primarily by the lengthening of the isovolumic contraction time, which resulted from the prolongation of the components of the latter, namely the initial phase of ventricular contraction and the ventricular pressure elevation time. During diastole, there were significant prolongation of the isovolumic relaxation time and the rapid ventricular filling period, and a significant shortening of the slow ventricular filling period. Among these time intervals, the mechanical systole(C-A2 inlerval), the isovolumic contraction time, the ventricular pressure elevation time and the isovolumic relaxation time showed significant positive correlation with blood pressure. On the other hand, the slow ventricular filling period was significantly negatively correlated with blood pressure. These facts suggested that the changes in these time intervals were related to increased afterload and/or resultant myocardial or hemodynamic alterations.
Blood Pressure ; Diastole ; Electrocardiography ; Hand ; Hemodynamics ; Humans ; Hypertension* ; Male ; Relaxation ; Systole ; Ventricular Pressure

BACKGROUND: Keloids and hypertrophic scars are benign fibrous growths which usually occur in predisposed individuals after trauma. Numerous modalities have been used to treat keloids and hypertrophic scars, but the final results have been so far unsatisfactory. OBJECTIVE: The purpose of tlis study was to evaluate the effect of the combination of cryosurgery and intralesional corticoster oid for treatment of these scars. METHOD: Thirty patients, aged 17 to 45 years old, with keloids or hypertrophic scars(mean duration, 6.4 years) were treated using solid CO2 followed by intralesional injection of triamcinolone acetonide(13.3 mg/ml). Two freeze-thaw cycles per lesion were employed. Freezing time was chosen arbitrarily from 7 to 20 sec depending on the characteristics of each scar. RESULTS: The results are summarized as follows. 1. Excellent and good results were achieved in 57% of all subjects on average, 77% of those who were treated more than 3 times, and 48% of those treated less than twice. 2. The keloid of less than 2 years duration showed better results than older ones. 3. No recurrence was seen in 63% of patients, but partial recurrence in 21% of patients and complete recurrence in 10% were observed. Lesions on the trunk showed less improvement (p<0.05) and were more recurrent than other lesions. 4. There were complications in 9 patients, such as hyperpigmentation(6), hypopigmentation(1), infection(1) and telangiectasia(1). CONCLUSION: Cryosurgery and intralesional corticosteroid injections produced synergistic advantages. A cornbination of these modalities might be an effective treatment modality in keloids and hypertrophic scars.
Cicatrix ; Cicatrix, Hypertrophic* ; Cryosurgery* ; Freezing ; Humans ; Injections, Intralesional ; Keloid* ; Middle Aged ; Recurrence ; Triamcinolone

Late aseptic loosening of the acetabular component following total hip arthroplasty become increasing frequently after about 10 years and has become a more severe problem both in frequency and severity than femoral component loosening. The complexity of acetabular revision depends largely on the reconstruction required to restore normal anatomy due to acetabular bone loss. The clinical and radiologic results of acetabular revision using a porocoated acetabular component fixed to the pelvis with screws were studied in 36 patients (40 hips) who had moderate or severe acetabular loss. Acetabular revision in patients whose bone stock had already been destroyed provied more formidable problems at revision surgery. The mean Harris hip score was improved 46 to 84. Bone graft union was achieved by 7.4 months and incorporated by 16 months. The graft bone resorption was noted minor degree lateral to the cup. Of 40 cases, 2 cases required re-revision of acetabular cup for identifiable failure of fixation and one was showed probable loosening. The results of the present study suggest that revision of the acetabulum with use of a hemispherical cementless component stabilized with multiple screws and morselized bone grafts filling bone defects appears to be successful in restoring bone stock and providing a stable, pain-free reconstruction.
Acetabulum* ; Arthroplasty, Replacement, Hip ; Bone Resorption ; Hip ; Humans ; Pelvis ; Transplants