No abstract available.
Gonadotropin-Releasing Hormone* ; Humans ; Hypogonadism* ; Male*

Bone defect of the long bone continues to challenge orthopedic surgeons. It is usually very difficult to obtain union. Ilizarov ext. fixation has recently gained popularity as a multifactorial approach to the management of tibial bone defect because nonunion, bone defects, limb shortening, and deformity can all be addressed simultaneously with the Ilizarov apparatus. From February 1992 to May 1993 at the department of orthopedic surgery, Inje University Pusan Paik Hospital, 9 patients aged from 8 to 37 years were treated for tibial bone defect. The causes were open comminuted fractures with initial bone loss and bone defect after removal of infected necrotic bone. Bony defect size was ranged from 2cm to 14cm, averaging 7.2cm. Bony defects were gradually closed by the Ilizarov's internal bone transport technique, and final equalization of leg length discrepancy was achieved by means of external lengthening technique. Soft tissue defects were treated with secondary closure, split thickness skin graft, and muscle flap. The average healing index was 42.8 days/cm. According to Paley's classification the complications were developed as follows; The problem included pin tract infection(9), knee flexion contracture(4), and intractable pain(1), the obstacles included delayed union(3) and premature consolidation(1), the complication included nonunion(9) and equinus ankle(1). At an average 1 years follow up, according to Paley and Catagnl's classification, body and functional results were either excellent or good in 7 cases. So, we recommend that Ilizarov technique is very useful treatment for open fracture with bone loss, bone defect after removal of infected necrotic bone and limb shortening.
Busan ; Classification ; Congenital Abnormalities ; Extremities ; Follow-Up Studies ; Fractures, Comminuted ; Fractures, Open ; Humans ; Ilizarov Technique ; Knee ; Leg ; Orthopedics ; Skin ; Surgeons ; Tibia ; Transplants

BACKGROUND/AIMS: The ingestion of foreign bodies in the upper gastrointestinal tract usually happens as a result of accidental swallowing, and rarely produces symptoms. Although most foreign bodies are eliminated spontaneously, 10~20% of cases need treatment with endoscopy. We evaluated the role of endoscopy for removing foreign bodies from the upper gastrointestinal tract. METHODS: We analyzed one hundred and thirty-nine cases of foreign bodies in the upper gastrointestinal tract which were endoscopically treated at Chungnam National University Hospital from January 2001 to July 2004. RESULTS: Patients' age ranged from 6 months to 96 years old (mean 36.0 years old). The ratio of males to females was 1.2 : 1. The common foreign bodies included coins (29 cases) and fish bones (23 cases), animal bones (19 cases), and stones (15 cases) follows in order. The most common location was the esophagus (79.9%). In most cases (73.4%), the foreign body was removed using an alligator tooth and a grasping forceps. Twenty-eight among one hundred and thirty-nine patients had a co-morbid condition, such as esophageal disease, diabetes mellitus, hypertension, stomach cancer, or a psychiatric disorder. CONCLUSIONS: Endoscopic removal is a very powerful and useful method for removing foreign bodies from the upper gastrointestinal tract. Nevertheless, a simpler and more efficient endoscopic equipment is required
Alligators and Crocodiles ; Animals ; Chungcheongnam-do ; Deglutition ; Diabetes Mellitus ; Eating ; Endoscopy ; Esophageal Diseases ; Esophagus ; Female ; Foreign Bodies* ; Hand Strength ; Humans ; Hypertension ; Male ; Numismatics ; Stomach Neoplasms ; Surgical Instruments ; Tooth ; Upper Gastrointestinal Tract*

It is a common belief that pancreatic carcinoma has an inherent and unique ability to induce hypercoagulable diathesis that leads to clinically significant thrombosis. The reported incidences of disease range from 17% to 57%. Thromboembolic disease is causally associated with an intrinsic hypercoagulable state. Pancreatic cancer cells activate platelets and these express several procoagulant factors, including tissue factor and thrombin. There are a variety of clinical presentations, include deep vein thrombosis, migratory thrombophlebitis, pulmonary embolism, disseminated intravascular coagulation, portal or superior mesenteric vein thrombosis, and extremity ischemia. Venous gangrene is a very unusual and severe form of venous thrombosis of an extremity, and this hasn't yet been reported in Korea. We report here on a case with repeated deep vein thrombosis that was associated with pancreatic carcinoma. Despite of aggressive treatment with low molecular heparin and oral anticoagulant warfarin, the repeated thrombosis was aggravated to venous gangrene of the lower extremity.
Disease Susceptibility ; Disseminated Intravascular Coagulation ; Extremities ; Gangrene* ; Heparin ; Incidence ; Ischemia ; Korea ; Lower Extremity ; Mesenteric Veins ; Pancreatic Neoplasms ; Pulmonary Embolism ; Thrombin ; Thrombophlebitis* ; Thromboplastin ; Thrombosis ; Venous Thrombosis ; Warfarin

Although antithrombotic drug therapy is not a substitute for precise surgical technique, it has become an important adjunct for the microsurgeon performing replantation and elective free-tissue transfers. Systemic anticoagulant use in 60 free flap procedures performed from January 2001 to February 2004 was reviewed to determine the flap loss rate, associated risk of hematoma formation and heparin-induced thrombocytopenia. Patients were divided into two groups: a single intraoperative bolus of 1250 units of heparin(20 flaps, Group 1), 2500 units(40 flaps, Group 2) respectively. Partial and complete flap loss rate was higher in Group 1(35 percent) than in Group 2(10 percent). Neither the difference in hematoma incidence nor the difference in thrombocytopenia incidence between two groups was significant and there was no case presenting heparin- induced thrombocytopenia. We have encountered unusually high flap loss rate in the group who received a single intraoperative bolus of 1250 units of heparin. Although a cause-and-effect relationship between the use of systemic heparin and flap loss or prevention of thrombosis could not be established, it seems to be beneficial that a single bolus of 2500 units of heparin is given intraoperatively without significantly increasing the risk of hematoma or heparin-induced thrombocytopenia.
Drug Therapy ; Free Tissue Flaps* ; Hematoma ; Heparin* ; Humans ; Incidence ; Replantation ; Thrombocytopenia ; Thrombosis

BACKGROUND: We postulate that a delay in the implementation of hepatic arterial embolization for traumatic liver injury patients will negatively affect patient prognosis. Our work also seeks to identify factors related to the mortality rate among traumatic liver injury patients. METHODS: From January 2008 to April 2014, patients who had been admitted to the emergency room, were subsequently diagnosed with traumatic liver injury, and later underwent hepatic arterial embolization were included in this retrospective study. RESULTS: Of the 149 patients that underwent hepatic arterial embolization, 86 had the procedure due to traumatic liver injury. Excluding the 3 patients that were admitted to the hospital before procedure, the remaining 83 patients were used as subjects for the study. The average time between emergency room arrival and incidence of procedure was 164 min for the survival group and 132 min for the non-survival group; this was not statistically significant (p = 0.170). The average time to intervention was 182 min for the hemodynamically stable group, and 149 min for the hemodynamically unstable group, the latter having a significantly shorter wait time (p = 0.047). Of the factors related to the mortality rate, the odds ratio of the Glasgow Coma Score (GCS) was 18.48 (p < 0.001), and that of albumin level was 0.368 (p = 0.006). CONCLUSIONS: In analyzing the correlation between mortality rate and the time from patient admission to arrival for hepatic arterial embolization, there was no statistical significance observed. Of the factors related to the mortality rate, GCS and albumin level may be used as prognostic factors in traumatic liver injury.
Coma ; Embolization, Therapeutic ; Emergency Service, Hospital ; Humans ; Incidence ; Liver* ; Mortality* ; Odds Ratio ; Patient Admission ; Prognosis ; Retrospective Studies ; Time Factors

BACKGROUND: Inspired concentrations of desflurane > or = 1 minimum alveolar anesthetic concentration (MAC) have been related to sympathetic stimulation such as hypertension and tachycardia. The current study examined whether labetalol, an alpha1 and beta-adrenergic antagonist would blunt these hemodynamic responses. METHODS: Fifty-four ASA physical status I patients, aged 20-60 years, were enrolled in this study. The patients were randomly divided into 2 groups. The breathing circuit was primed with an end-tidal desflurane concentration of 1.2 MAC in 6 L/min O2. Normal saline 5 ml or labetalol 0.3 mg/kg was injected into groups S and L respectively. After 5 minutes, anesthesia was induced with intravenous etomidate 0.2 mg/kg and vecuronium 0.1 mg/kg. Each patient inhaled desflurane through a tight fitting facemask. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and end-tidal concentration of desflurane (et-des) were measured at 5 minutes after saline or labetalol injection (baseline) and every 1 minute for 5 minutes after desflurane inhalation and for 2 minutes after intubation. RESULTS: In the saline injection group (group S), desflurane inhalation increased heart rate and blood pressure, while labetalol 0.3 mg/kg attenuated the heart rate and blood pressure increase in group L. After tracheal intubation, heart rate and blood pressure were significantly lower in group L than in group S. CONCLUSIONS: These results demonstrate that administration of intravenous labetalol is effective in attenuating tracheal intubation and desflurane-induced hemodynamic responses.
Aged ; Anesthesia ; Arterial Pressure ; Blood Pressure ; Etomidate ; Heart Rate ; Hemodynamics ; Humans ; Hypertension ; Inhalation ; Intubation ; Isoflurane ; Labetalol ; Respiration ; Tachycardia ; Vecuronium Bromide

An 8-year-old boy presented with abdominal pain and poor oral intake for two months. Serum amylase and lipase levels were elevated. CT of the abdomen and chest X-ray showed two pseudocysts at the pancreatic uncinate process, pancreatitis with a parenchymal defect, a large amount of ascites, and a right pleural effusion. MR cholangiography and endoscopic retrograde cholangiopanreaticography revealed a pancreatic duct disruption. The patient was successfully treated with a chest tube placement and percutaneous drainage. After surgery, his general condition improved; the serum level of amylase normalized and the pleural effusion resolved. Pancreatic injuries are rare in pediatric blunt trauma; however, diagnostic difficulty is common with isolated blunt trauma. Therefore, a high index of suspicion should follow such an injury. We report the case of an 8-year-old boy with pancreas transection, ductal disruption, ascites, and pleural effusion who was successfully treated.
Abdomen ; Abdominal Pain ; Amylases ; Ascites ; Chest Tubes ; Child* ; Cholangiography ; Drainage ; Humans ; Lipase ; Male ; Pancreas ; Pancreatic Ducts ; Pancreatitis ; Pleural Effusion* ; Thorax

PURPOSE: This study was designed to evaluate the postoperative changes of astigmatism and corneal refractive power after surgical correction of epiblepharon using computerized topography. METHODS: The surgical data were investigated retrospectively before surgery and 1 month, 3 month after surgery in 23 patients who had undergone surgery for epiblepharon. We evaluated 8 points of the corneal refractive index, the corneal center and nasal, temporal, inferior 1.0 and 2.0 mm and superior 1.0 mm respectively. And the incidences and types of astigmatism were evaluated before and after surgery. RESULTS: After surgery, we observed corneal flattening at all points according to corneal topography, but corneal refractive changes were statistically insignificant except for inferior 1.0mm point (P< 0.05). Mean astigmatism was decreased after surgery and statistically significant 3 month after surgery (P< 0.05). Mean corneal refractive change on vetical meridian was prominent compared to horizontal meridia and statistically significant 3 month after surgery (P< 0.05). CONCLUSIONS: In epiblepharon, children corneal topographic changes were observed due to reduction of corneal irritation and pressure by cilia and lower eyelid after surgery. Astigmatic changes were progressed 3 month after surgery and with-the-rule astigmatism was observed mainly before and after surgery. But corneal refractive changes were prominent on vertical meridian, and therefore there was a tendency toward improvement of with-the-rule astigmatism.
Astigmatism ; Child* ; Cilia ; Corneal Topography ; Eyelids ; Humans ; Incidence ; Refractometry ; Retrospective Studies

Cerebral air embolism, the entry of air into the cerebral artery, is an iatrogenic clinical problem in most cases, which may result in seizure, severe neurologic deficits and even death. Although cerebral air embolism may result from almost all procedures that are performed in clinical specialties, occurrence following a gastroscopy is very rare. We report a patient who developed cerebral air embolism following a gastroscopy.
Cerebral Arteries ; Embolism, Air ; Gastroscopy ; Humans ; Neurologic Manifestations ; Seizures