Aspiration pneumonia rarely occurs during general anesthesia; however, it can result in fatal pulmonary complications. To reduce aspiration pneumonia, a preoperative fasting time of 8 hours is recommended. A 4-year-old boy with ankyloglossia was scheduled for frenotomy. He completed preoperative fasting time and had no digestive symptoms. Pulmonary aspiration due to unexpected massive vomiting occurred during anesthesia induction. The patient's airway was immediately secured by endotracheal tube. The vomitus in the airway tract was removed by fiberoptic bronchoscopy. Abdomen radiograph taken after this event showed paralytic ileus which can cause aspiration of gastric contents. We describe a case of pneumonia caused by aspiration of gastric contents in a pediatric patient who followed fasting instructions and who was scheduled for outpatient surgery.
Abdomen ; Ambulatory Surgical Procedures ; Anesthesia ; Anesthesia, General* ; Bronchoscopy ; Child, Preschool ; Fasting* ; Humans ; Intestinal Pseudo-Obstruction ; Male ; Pneumonia ; Pneumonia, Aspiration* ; Vomiting

Twenty-seven patients with congenital constriction band syndrome were treated at department of orthopedic surgery, college of medicine, Seoul National University between 1981 and 1989. In order to obtain basic and fundamental information about this syndrome, we have analyzed the clinical records of those patients who were treated at our hospital with above syndrome. Analysis was based on the age at operation, sex distribution, familial history and past-medical history, prevalent sites of constricition bands, associated anomalies and methods of surgical treatments. The results were summarized as follows: l. Average age at operation was 9.3 months and the ratio of sex was 3:2 as male predominant. 2. There was no case with familial history of this syndrome, and serious medical problems of patient's mothers during pregnancy were not experienced except 4 cases who took some medication for URI. 3. The frequency of constriction band was greater distally than proximally, and 91% of these bands were noted distal to knee and elbow joint. 4. About 85% of cases were associated with other anomalies, and among them syndactylism and acral absence were most frequent. 5. For the simple constriction ring, staged excision of the ring and z-plasty of the defects seemed to be a most agreeable recommendation. And other associated anomalies of digits could be treated with combined procedures such as seperation of digits, web construction, transposition of ray, lengthening of digit, skin graft, corrective osteotomy, etc.
Clinical Study ; Constriction ; Elbow Joint ; Humans ; Knee ; Male ; Mothers ; Orthopedics ; Osteotomy ; Pregnancy ; Seoul ; Sex Distribution ; Skin ; Transplants

No abstract available.
Humans ; Temporomandibular Joint Disorders* ; Temporomandibular Joint*

No abstract available.
Urinary Retention*

Inactivation of tumor suppressor genes may play an important role in many human cancers including breast. This study was done to determine the relationship between the expression of p53 and Rb protein and prognostic factors such as histopathologic differentiation, tumor size, and lymph node metastasis. In 57 cases of breast invasive ductal carcinomas, the immunohistochemical staining with p53 and Rb protein gave the following results: p53 protein was detected in 45.6% (26/57) of cases. Tumors with large size, poor differentiation or lymph node metastases tended to show increased expression of p53 protein. However, p53 protein expression did not show any significant correlation with prognostic factors such as tumor size (p value 0.25), histologic grade (p value 0.75), and positive lymph node status (p value 0.26). Rb protein was detected in 57.9% (33/57) of cases. Rb protein also did not show any significant correlation with prognostic factors such as tumor size (p value 0.56), histologic grade (p value 0.71), and positive lymph node status (p value 0.98). There was no significant correlation between p53 expression and Rb protein expression (p value 0.80).
Breast* ; Carcinoma, Ductal* ; Genes, Tumor Suppressor ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Retinoblastoma Protein*

No abstract available.
Tendons*

Since Palmer's introduction of the torn medial collateral ligament, many clinical and anatomical studies were performed. But any reconstructive procedure of the medial collateral ligament of the knee known to us, has not solved the problem completely yet. The purpose of present study is to describe a technique of reconstruction, socalled Tatsuzawa's tenodesis surgery of transposed semitendinosus tendon, and is to report the clinical results of 45 cases treated by his procedure between April 1976 and June 1981. In addition, significance of the procerdure was compared with the result of primary closure group of the torn ligament. Tatsuzawa's procedure consists of reinforcement surgery of the repaired or unrepaired torn medial collateral ligament with forwardly transposed semitendinosus. The semitendinosus tendon was brought forward to lie adjacent to deep layer of the medial collateral ligament. The transposed part of the tendon was sutured throughout its length to the medial collateral ligament and to the medial aspect of the tibia and femoral condyle. Because the direction of transposed tendon as similar to the direction of fibers of medial collateral ligament, the procedure was very simple and anatomical one, and had some functional advantages. In this series some old cases are treated only with tendon reinforcement operation without repairing the laxed torn ligament. The results of the surgery were evaluated by the Asais modification of the Feltons evaluation criteria. Results obtained were as follows: 1. In semitendinosus tenodesis with or without primary repair of the torn ligament, satisfactory results were obtained (excellent and good) in 33 cases (73.3%). But in 20 cases of the primary repair group, the satisfactory results were obtained in 11 cases (55%). More satisfactory results were obtained with the semitendinosus tendon reinforcement operation of the torn ligament than only with primary repair. 2. In 29 cases with fresh injury of the medial collateral ligament in which the primary repair together with the tendon reinforcement procedure was performed, satisfactory (excellent and good) results were obtained in 72.4% (21 cases), and in 16 untreated old cases in which only the tendon reinforcement procedure were done, satisfactory results were obtained in 75%. 3. In 5 cases having medial collateral and anterior cruciate ligaments tear, excellent results were obtained in 3. This explains that semitendinosus tendon reinforcement procedure is the key one of the reconstructive operative procedures. It is thought that the procedure is also effective for the anterior cruciate tear to provide the anterior instability.
Anterior Cruciate Ligament ; Clinical Study ; Collateral Ligaments ; Knee ; Ligaments ; Surgical Procedures, Operative ; Tears ; Tendons ; Tenodesis ; Tibia

The reconstruction of soft tissue defects with open fracture around the knee joint is limited by its unique location. Free tissue transfer is hindered by the selection of the recipient vessel and problems of microsurgery. The arc of rotation, defect size, and location must be taken into consideration in the use of regional muscle transfer such as gastrocnemius. According to Mathes et al, the flap survival can be enhanced by selective division of the dominant segmental pedicles, only a part of which can normally be transposed safely on its minor segmental pedicle. Neovascularization, vascular proliferation, and dilatation have also been produced by the delay procedure using silicone sheets. The authors have used the delay procedures with wrapping of the gracilis or sartorius muscle which enabled distally-based transposition of these muscles. The method showed satisfactory outcome in resurfacing the wound around the knee joint. The indictions for this procedure were defects of moderate size and those difficult to reach with conventional muscle flaps. The flap could reach the upper one-third of the lower leg. Other merits are relative simplicity and reliability without significant extension of hospital stay. The drawbacks are the two operative procedures necessary and the risk of infection due to silicone sheets.
Dilatation ; Fractures, Open ; Knee Joint* ; Knee* ; Leg ; Length of Stay ; Microsurgery ; Muscles ; Silicones ; Surgical Procedures, Operative ; Wounds and Injuries*

Fixation failure is a major complication of intertrochanteric fracture. The causes of fixation failure were assessed in a series of 80 patients with intertrochanteric fractures, which had been internally fixed with either a sliding hip screw or a Gamma interlocking nail. The overall rate of fixation failure was 16.3%, in which the cutting-out of the implant from the femoral head was the only cause of the instance. The cutting-out rate was influenced by the accuracy of fracture reduction, the position of implant placement within the femoral head, and the bone mineral density. Anatomical reduction and the central placement of implant within the femoral head showed the most excellent results compared to other treatment modalities. Age, gender, fracture type and a kind of fixation implant had no significant effect. Our results showed that the intertrochanteric fractures should be reduced as anatomically as possible and it is essential that the central placement of the implant within the femoral head be obtained.
Bone Density ; Head ; Hip ; Hip Fractures* ; Humans

No abstract available in English.
Dislocations ; Knee Joint ; Knee