The provision of adequate soft tissue cover for a complex hand and forearm wound-dirty, infected and exposed bone can be a challenging problem. Conventionally, a distant flap or free flap have been used, but these have been associated with several problems such as joint stiffness, risk of microsurgical procedures, negligible donor site morbidity, prolonged operation time and economic restriction. As well, fasciocutaneous flap has been the limitation of infection control. In these situations, the ipsilateral muscle flap provides the ideal cover with its rich blood supply and single operative field. Previously described by Lendrum(1980), by Lae et al.(1981), and later by McGeorge(1991), the brachioradilis muscle is the most superficial muscle on the radial side of the forearm. Its flap is based on the radial artery and venae comitantes. From August 1996 to October 1997, we performed branchioradialis muscle flap in seven patients. Despite the sacrifice of the major hand artery, brachioradialis muscle flap has many advantages including the reliability of flap survival, easy dissection, early mobilization and absence of functional and aesthetic problems at the donor site. It is a relatively simple and rapid method for resurfacing soft tissue defect in the hand and forearm. We obtained satisfactory and reliable results.
Arteries ; Early Ambulation ; Forearm* ; Free Tissue Flaps ; Hand* ; Humans ; Infection Control ; Joints ; Radial Artery ; Tissue Donors

No abstract available.

No abstract available.
Oocytes* ; Pregnancy* ; Spermatozoa*

Various kinds of spinal instrumentation have been developed for treatment of spinal disorders which are associated with instability. Recently, newly designed devices using pedicle screw were developed with advantages of short segment fixation and firm internal fixation. This is a retrospective clinical and roentgenographic study to evaluate the effectiveness of Cotrel 1. Of the 27 cases, spinal stenosis were 11, spondylolisthesis were 8, spondylolysis were 4, burst fracture were 2, metastatic bone tumor was 1, and failed back syndrome was 1 case. 2. Result of clinical evaluation by Hanley's criteria at last follow up were excellent in 7(27%), Good in 15(58% ), fair in 4(15%). (1 case of metastatic bone tumor was excluded). 3. In the cases of spondylolisthesis, we tried to reduce the displacement in 2 cases of Meyerding Grade II, and 1 case was reduced and 1 case was not reduced. In the cases of of Meyerding Grade I, no further displacement was developed. 4. The complications were observed in 10(37%)cases. A) Generalized complications were 2 cases of hematoma, 3 cases of superficial infection of wound, and 1 case of nerve root irritation. B) Failure in instrmentation were 1 case of screw breakage, 1 case of complete loss of fixation between screw and rod, and 2 cases of partial loss of fixation. 5. To prevent above mentioned complications in fixation of the instrument, the following factors are recommended: 1) Selection of the adequate length of rod. 2) Fixation of the additional implant such as security bolt when instability between screw and rod is predictable. 3) Selection of the closed head screw in the fixation of proximally sided screw if possible. 6. Cotrel-Dubousset instrument has many advantages such as rigid internal fixation, anatomical reduction, and good maintenance and also effective in reduction and maintenance of spondylolisthesis and in wide posterior decompression of spinal stenosis, but for prevention of some complications, precise use of instrument and good application of surgical technique will be needed.
Decompression ; Follow-Up Studies ; Head ; Hematoma ; Internal Fixators ; Pedicle Screws ; Retrospective Studies ; Spinal Stenosis ; Spine ; Spondylolisthesis ; Spondylolysis ; Wounds and Injuries

Twenty-eight cases of fracture of the femur and tibia on the same leg were treated in Pusan Maryknoll Hospital during the period from April 1981 to Jun 1988. We studied all of these patients, divided by five groups according to the method of treatment, with analysis of treatment and end results. The following results were obtained. 1. The incidence of trauma was high in the young man, and most frequent in the third decade (42.9%). 2. The main cause of injuries was traffic accident; 22 patients (78.6%). 3. The common fracture site was middle one-third in femur and tibia respectively. 4. The most common associsted injury was head trauma (9 case). 5. The average healing time of fracture was 20.7 weeks in femur and 22.7 weeks in tibia of group 3, 4, 5. 6. The best results were obtained in cases both fractures stabilized surgically.
Accidents, Traffic ; Adult ; Busan ; Craniocerebral Trauma ; Femur ; Humans ; Incidence ; Leg ; Methods ; Tibia

No abstract available.
Humans ; Neutropenia* ; Sepsis*

The authors determined the value of performing urine microscopy on biochemically negative urine sepcimens in a pediatric population. The 746 urine specimens of patients who were either visited or admitted to the Department of Pediatrics, National Police Hospital, from March 1991 to July 1992 were reviewed on the basis of comparative evaluation of biochemical and microscopic urine analysis. Eight reactions of Clinitek(r) 200 were used as biochemical indicators, namely, pH, nitrite, albumin, glucose, ketone, urobilinogen, bilirubin, and blood. Out of 746 urine specimens studied, 186 were true positive. Thirty-six specimens reacted biochemically in the absence of positive microscopic findings (false postive), 492 specimens were true negatives. Thirty-two specimens had negative biochemical indicators, in spite of positive microscopy. The sensitivity of the biochemical parameters for predicting significant microscopy of urinary sediment is 85% and the specificity is 99%. The positive predictive value is 69.7% and the negative predictive value is 99.3%. The sensitivity of blood for RBC is 94%. and the specificity is 99%. The predictive value of a positive result is 84.6% and that of a negative result is 99.7%. We therefore conclude that urine microscopy is less necessary in biochemically negative urine specimens from asymptomatic pediatric patients, with hopefully resultant time and cost effectiveness.
Bilirubin ; Cost-Benefit Analysis ; Glucose ; Humans ; Hydrogen-Ion Concentration ; Microscopy ; Pediatrics ; Police ; Sensitivity and Specificity ; Urinalysis* ; Urobilinogen

The efficacy of acetaminophen, sponging plus acetaminophen, and sponging alone as method of lowering body temperature was compared in 108 children aged 8 weeks to 5 years who presented with an axillary temperature of 38.5degrees C or greater during the period from January 1993 to April 1993. The following results were obtained. 1) The male to female ratio was 2.5:1 and clinical diagnosis in the order of frequency were upper respiratory infection, gastroenteritis, pneumonia, urinary tract infection, cellulitis, chickenpox and hand-foot-mouth disease. 2) At thirty minutes after treatment, there was no significant difference on the decrement of temperature among the three groups. 3) At sixty minutes, the temperature decrement was the greatest in the group of sponging plus acetaminophen and that was statistically significant (P<0.01). But there was no significant difference between the group of acetaminophen and that of sponging.
Acetaminophen ; Body Temperature ; Cellulitis ; Chickenpox ; Child* ; Diagnosis ; Female ; Fever* ; Gastroenteritis ; Humans ; Male ; Pneumonia ; Urinary Tract Infections

BACKGROUND: Hypertension is a major and growing public health problem and it calls for life-long management. The antihypertensive agents are still playing major roles in the management of hypertension. We studied the effect of the long-term therapy with a new calcium channel blocker, felodipine in patients with essential hypertension. METHODS: We recruited 31 patients with mild to moderate essential hypertention and gave them 5mg (1 tablet) of felodipine(Munobal(R)) once daily for 12 months. We measured the blood pressure and the heart rate every month and tried to detect any untoward symptoms and signs during the whole observation period. Baseline work-up for the hypertensive patients were done as usual before and after the study. RESULTS: The average systolic and diastolic blood pressures were 162.7+/-9.7/99.6+/-7.4mmHg respectively before the administration and they came down to the level of 139.7+/-15.0/87.3+/-8.6mmHg respectively at the end of the 1st month (p<0.05). This trend was maintained during the whole observation period, so they were 141.2+/-11.0/85.6+/-8.2mmHg respectively at the end of the study (p<0.05). Untoward drug reactions such as gastrointestinal troubles, facial edema, leg edema, chest pain and headache were present in 11 patients (35%) but they were not serious. There was no case in which the drug was withdrawn. There was one case in which the level of the serum triglyceride increased after the administration of the drug. CONCLUSION: Felodipine has good and persistent hypotensive effect and it is safe and easy to use.
Antihypertensive Agents ; Blood Pressure ; Calcium Channels ; Chest Pain ; Edema ; Felodipine ; Headache ; Heart Rate ; Humans ; Hypertension* ; Leg ; Public Health ; Triglycerides