The fracture of the upper end of the femur is unique in orthopedics because it is endemic to an elderly population with special problem. In trochanteric fractures open reduction and internal fixation, with a hip nail used to maintain reduction, have become the standard treatment protocol for the elderly. Unlike fractures of the femoral neck, nonunion and avascular necrosis is rare but more frequently complicated by fatal sequele, such as pneumonia, thromboembolic disease, and decubitus ulceration. In order to achieve early ambulation of a patient with a trochanteric hip fracture, two conditions must be met: The implant used for fixation must be strong enough to withstand loadings exerted upon it during fracture healing, and the fracture itself must be rendered stable in a suitably reduced position. The treatment of the fracture of the femoral neck has a long and frustrating history. As recently as 20 years ago McCarroll remarked that this fracture must be considered “unsolved” until the incidence of aseptic necrosis and nonunion could be diminished or abolished. But now with adequate reduction, impaction, accurate internal fixation with newer devices, and carefully supervised postoperative care the fracture of the femoral neck can be expected to heal at least 90 per cent of the patients. A lower incidence of recognizable aseptic necrosis has been reported under these circumstances. X-ray films of 94 cases of hip nailing for hip fractures were collected in the Department of Orthopedic Surgery of Seoul National University Hospital. Twenty seven cases considered to be failed in hip nailing were analysed radiologically, and following results were obtained. 1. The incidence of failed hip nailing was most frequent in the fifties with average age of 54. 6 years, which seemed somewhat younger than that of the hip fracture. There was no sexual difference. 2. Hip nailings were failed in 23 cases of the femoral neck fractures and in 4 cases of the trochanteric fractures, which revealed respectively 52.3% and 8.2% of failure. Among these the technical failure was 22.7% in femoral neck fractures and 6.1% in trochanteric fractures. 3. Among the various fixation devices, Smith-Petersen nail or hip screws which has no side plate to fix the shaft rigidly showed high failure rates. 4. In all cases the etiology of the failed hip nailing was functional, such as failure of reduction, failure of fixation, penetration of the head, avaseular necrosis, infection, and inadequate postoperative management. 5. Most cases of femoral neck fractures which was not achieved near anatomical reduction was failed in fixation. 6. Too long or short nails showed high failure rates. In view point of this, hip nail should fix the lateral cortex, calcar femorale and center of subchondral bone, even in the trochanteric fracture. So devices such as heavy compression sliding nail or multiple pinning were more desirable to achieve complete fixation. 7. When, in the fresh fractures of the femur neck cannot be reduced to an anatomical or slightly overcorrected position, endoprosthesis should be considered seriously. When the joint is abnormal, the total hip arthroplasty can reduce morbidity and mortality, and also shorten the hospitalization.
Aged ; Arthroplasty, Replacement, Hip ; Clinical Protocols ; Early Ambulation ; Femoral Neck Fractures ; Femur ; Femur Neck ; Fracture Healing ; Head ; Hip Fractures ; Hip ; Hospitalization ; Humans ; Incidence ; Joints ; Mortality ; Necrosis ; Orthopedics ; Pneumonia ; Postoperative Care ; Pressure Ulcer ; Seoul ; X-Ray Film

A Clinical study was done on 90 cases of acute myocardial infarction admitted to Busan Wallace Memorial Baptist Hospital from January, 1977 to Febuary, 1983. The following results have been obtained. 1) The ratio of male to female was 2.2:1. The most age group were 5th decades(35.6%) and over 5th decades(5th decades and 6th decades) were two-thirds of all age group. And annual incidency were increasing tendencies, in 1980-1982 than 1977-1979. 2) Between the preceding diseases and the risk factors, the most common cause was the smoking (60%). And other associated diseases and factors were hypertension(54.4%), hypercholesterolemia (43.8%), hyperlipidemia(51.4%) and angina pectoris (34.4%). 3) The most common inducing factor was physical exertion(33.3%). And others were emotional stress(23.3%), alcohol drinking(10%), rest and sleeping(5.6%). 4) The major symptoms of acute myocardial infarction were precordial or epigastric pain(96.7%), dyspnea(53.3%), radiating chest pain (51.7%) and painless infarction(3.3%). 5) On laboratory data, there were leukocytosis in 50.5% increased SGOT in 68.6%, increased serum LDH in 75.9% and cardiomegaly in chest x-ray film were 82 percents. 6) The ratio between the anterior and inferior infarction on EKG was 1.9:1. 7) When admission, normal sinus rhythms on EKG were 59 percents. And the common associated electrocardiographic abnormalities were ventricular premature beat (23.6%), atrial fibrillation(15.7%), first degree A-V block (15.7%), left ventricular hypertrophy(15.7%). The most common abnormality was ventricular premature beat(23.6%). 8) The mortality rate of acute myocardial infarction was 10 percents. The causes of death were heart failure(33.3%), ventricular arrhythmia(33.3%), sudden death (22.2%) and cardiogenic shock(11.1%).
Angina Pectoris ; Aspartate Aminotransferases ; Busan ; Cardiac Complexes, Premature ; Cardiomegaly ; Cause of Death ; Chest Pain ; Death, Sudden ; Electrocardiography ; Female ; Heart ; Humans ; Hypercholesterolemia ; Infarction ; Leukocytosis ; Male ; Mortality ; Myocardial Infarction* ; Protestantism ; Risk Factors ; Smoke ; Smoking ; Thorax ; X-Ray Film

The bleeding duodenal varices ia uncommon and frequeintly present a difficult diagnostic problem While the bleeding duodenal varices is a complication of portal hypertension, the possibility of bleeding duodenal varices in the absence of eaophageal varix bleeding should be kept mind. For the surgeon, the mikin technical problem is that even when identified by frequently impalpable, and invisible to the naked eye unless they are actively bleeding at the time of surgery. We described simple intra-operative endoscopic technique successfully to identify and bleeding varices in the duodenal third portion prior to the partial duodenal resection. This report summarized our experience and review of literature.
Endoscopy* ; Hemorrhage* ; Hypertension, Portal ; Varicose Veins*

BACKGROUND: Acromioclavicular (AC) stability is maintained through a complex combination of soft-tissue restraints that include coracoclavicular (CC), AC ligament and overlying muscles. Among these structures, the role of the CC ligament has continued to be studied because of its importance on shoulder kinematics, especially after AC injury. This study was designed to determine the geometric change of conoid and trapezoid ligaments and resulting stresses on these ligaments according to various scapular motions. METHODS: The scapuloclavicular (SC) complex was isolated from a fresh-frozen cadaver by removing all soft tissues except the AC and CC ligaments. The anatomically aligned SC complex was then scanned with a high-resolution computed tomography scanner into 0.6-mm slices. The Finite element model of the SC complex was obtained and used for calculating the stress on different parts of the CC ligaments with simulated movements of the scapula. RESULTS: Average stress on the conoid ligament during anterior tilt, internal rotation, and scapular protraction was higher, whereas the stress on the trapezoid ligament was more prominent during posterior tilt, external rotation, and retraction. CONCLUSIONS: We conclude that CC ligament plays an integral role in regulating horizontal SC motion as well as complex motions indicated by increased stress over the ligament with an incremental scapular position change. The conoid ligament is the key structure restraining scapular protraction that might occur in high-grade AC dislocation. Hence in CC ligament reconstructions involving only single bundle, every attempt must be made to reconstruct conoid part of CC ligament as anatomically as possible.
Biomechanical Phenomena ; Cadaver* ; Dislocations ; Ligaments* ; Muscles ; Scapula ; Shoulder

Four hundred and fifty patients of cerebrovascular accident who underwent computerized tomographic scanning during the 45 months, from January 1978 to October 1981, at department of internal medicine, Kyung Hee University Hospital, were studied and following results were obtained. 1. In Korea, intracerebral hematoma(48.2%) is more common than cerebral infarction(27.6%). 2. 87.3% of intracerebral hemorrhage were comfirmed while 61.5% of cerebral infarction were identified by brain CT. 3. Cerebrovascular accidents are definitely developing in 6th decade(40.6%) and male is more often affected. 4. hypertension is the most common underlying disease(72.3%) of cerebral hemorrhage, 52.4% of cerebral infarction. 5. hematoma occurs most frequently in basal ganglia(40.6%) and cerebral infarction occurs most frequently in global area(48.4%). 6. Changes of consciousness level were observed in 54.2% of the cases of mild degree hematoma. Mortality was 6.2% in mild degree hematoma and 88.2% in severe degree hematoma. 7. In 26.2% of cerebral hematoma, inital CSF findings were normal in spite of the evidence of cerebral hematoma confirmed by CT scanning.
Brain* ; Cerebral Hemorrhage ; Cerebral Infarction ; Classification* ; Consciousness ; Hematoma ; Humans ; Hypertension ; Internal Medicine ; Korea ; Male ; Mortality ; Stroke* ; Tomography, X-Ray Computed

No abstract available.
Intercellular Adhesion Molecule-1* ; Interleukin-6* ; Keratinocytes*

No abstract available.

Paraneoplastic pemphigus is a distinct and rare autoimmune disease characterized by extensive and painful mucosal ulcerations and polymorphic desquamated skin lesions in the setting of an underlying neoplasm, typically of lymphoreticular origin. Thus difficulties in the management of anesthesia can be expected. A 66-years-old man was scheduled for removal of intraabdominal sarcoma associated with paraneoplastic pemphigus. Physical examination showed multiple erythematous bullae, crusts, plaques and target-like lesions on the whole body and desquamated erythematous skin lesions on the back and extremities. In the operating room, his right femoral artery was cannulated with a 20 G, 12.7 cm CVP catheter and left femoral and subclavian veins with 14 G, 20 cm CVP catheters, respectively. After application of 4 % lidocaine spray, his oropharynx and supraglottic area were evaluated under direct laryngoscopy and revealed multiple ulcerations on oral mucosa, but no distinct lesion on supraglottic area. Anesthesia was induced by rapid-sequence method with fentanyl, thiopental sodium and succinylcholine followed by endotracheal intubation. The endotracheal tube was held by a roll gauze around the neck and its cuff was minimally inflated to avoid overpressure against his tracheal wall. After the end of surgery, his oral cavity was suctioned with no remarkable bleeding, and tracheal wall including cuff-contacted area was evaluated under fiberoptic bronchoscopy, revealed intact wall without any bulla or ulceration. The patient was transferred to intensive care unit for proper postoperative management after extubation of endotracheal tube.
Anesthesia ; Autoimmune Diseases ; Bronchoscopy ; Catheters ; Extremities ; Femoral Artery ; Fentanyl ; Hemorrhage ; Humans ; Intensive Care Units ; Intubation, Intratracheal ; Laryngoscopy ; Lidocaine ; Mouth ; Mouth Mucosa ; Neck ; Operating Rooms ; Oropharynx ; Pemphigus* ; Physical Examination ; Sarcoma ; Skin ; Subclavian Vein ; Succinylcholine ; Suction ; Thiopental ; Ulcer

The highly accurate laser holographic interferemotry method was used to determine in what way low-magnitude forces during maxillary expansion are transmitted to the entire maxillary complex and its surrounding structures. The experiments were carried out on a dryed human skull which had a perfectly preserved, normally aligned maxillary dental arch and intact alveolar process. The skull was fixed within a constructed metal frame which ensured maximal stability of the object. The optical equipment and the object were mounted on antivibration table. Interferograms were taken on the lateral and frontal sides of the maxillary complex, using the 10mW He-Ne laser and the double-exposure method. Analysis of the fringe pattern on the recorded object surface was performed by graphically determining the deformation curves related to the bony surface in selected horizontal and vertical planes. On the basis of this study, the following conclusions can be drawn 1. The density of the interference fringes was gradually increased with the degree of expansion force. 2. Mechanical reactions on the maxillary complex, circummaxillary sutures, and surrounding bones were clearly visible, even with the lowest loading degree. 3. The amount of bone displacement was greater in application of the force after 90degrees turn than in initial application of the same force. 4. The direction of interference fringes on the bony surface was similar at all loading degrees.
Alveolar Process ; Dental Arch ; Humans ; Palatal Expansion Technique* ; Skeleton* ; Skull ; Sutures

Carcinoid tumors arise from enterochromaffin cells that are located predominatly in the gastrointestinal mucosa. The vast majority of rectal carcinoid tumors are benign and can be safely treated by local excision. Lesions larger than 2 cm and invading the museular wall of the rectum should be considered malignancy and treated by more radical surgery such as abominoperined resection. We report 6 cases of rectal carcinoid tumor, three cases of them were less than 1 cm in size without metastasis. Two of these, small carcinoid tumor were treated with endoacopic polypectomy and one was treated with segmental resection. The others were 2.0 cm or larger in size with regional or liver mestasis. They were treated with segmental resection or electrical fugalization for tumor and transcatheter arterial embilization for liver metastasis or none.
Carcinoid Tumor* ; Enterochromaffin Cells ; Liver ; Mucous Membrane ; Neoplasm Metastasis ; Rectum