Reconstruction of partial ear defect to approximate the opposite normal ear is actually very difficult. Because the patterns of partial ear defect (site, shape and size of defect) are extremely variable, the operative method on each case should be changed. In an effort to overcome these problems, many reconstructive methods have been reported so far. We experienced 11 cases of partial ear defect from September, 1995 to August, 1996 and different reconstructive methods were applied In this study, the most common cause of partial ear defect was trauma (9 cases) and the most common site was middle part of ear helix. The defects were varying from 1x2 cm to 1.5x5 cm in size. The methods that has been used for reconstruction of ear defect include direct closure, helical chondrocutaneous advancement flap, Dieffenbach's method, retroauricular flap, tubed bipedicled flap and so on. We could get to know the merits and demerits of each method through this follow up study. So authors obtained the several basic conclusions about the merits and demerits of each method and standard of method selection in various patterns of ear defects. From analysis of the cases with review of literature, the our conclusions are as follows. 1. If the size of de(tract is small and the patient does not want to have two times of operation, direct closure can be done with good results. 2. If the defect exists on ear auricle confuted to helix and if there are no or small amount of associated cartilage defect, tubued bipedicled flap seems to be proper. 3. With the ear auricle defect confined to helix, especially helix of upper ear auricle, helical chondrocutaneous advancement flap can brought tile best result, though it has disadvantage of being decreased in its size 4. If there are extensive defect on ear auricle extending over scapha and antihelix, retroauricular flap can be done with good results. 5. In the ear auricle defect acompanying considerably large cartilage loss, Dieffenbach's method is thought to be proper.
Cartilage ; Ear Auricle ; Ear* ; Follow-Up Studies ; Humans

The metallic failure is one of the annoying problems after fracture surgery. The seventeen cases of metallic failures after compression plate fixation were treated at the Department of Orthopaedic Surgery. Yonsei University Wonju College of Medicine between January, 1980 and December, 1988. The results were summerized as follows: l. Among 17 cases, 12(70.5%) were under 40 years of age and 14(80%) were male patients. 2. The sites of fracture of the seventeen cases; 12 femurs, 3 tibiae, and 2 radii. Of the cases, there were breakage of plates in 13 cases, bending 1 case and failure of screw in 3 cases. 3. The pattern of fracture: communited fracture
Femur ; Fractures, Bone ; Fractures, Open ; Gangwon-do ; Humans ; Incidence ; Male ; Osteoporosis ; Radius ; Tibia ; Transplants ; Weight-Bearing

The pedicle instrumentation has become a popular way of spinal fixation. Placement of a screw through the pedicle into vertebral body appears to be a very successful way to accomplish spinal fixation. However, the configuration of the pedicle morphometry must be understood. The measurement includes pedicle width, angle of pedicle axis to the transverse plane, ideal screw length, ideal screw entry point and ideal angle. This study was accomplished using computerized axial tomogram(CT) of 704 vertebrae(T10-L5). The results were as follows. 1. Transverse pedicle diameter were narrowest at T10, widest at L5. 2. The pedicle axis is oriented anteromedially at all levels except T11 and T12, then increase from L1 to L5. 3. Screw lengths are fairly constant between all levels, thus the range of screw lengths need is limited. 4. The incidence of pedicle less than 6 mm in the transverse diameter is most common at T10 and followed by levels L1, T12 and L2. Preoperative determination of transpedicular screw diameter and length can be made, by direct measurement from the patient's CT scan.
Incidence ; Thoracic Vertebrae ; Tomography, X-Ray Computed

PURPOSE: Evaluation of clinical and radiologic results of THR using HA-coated femoral stem. MATERIALS AND METHODS: From Jan. 1991 to Dec. 1992, we carried out 177 cases of Total Hip Arthroplasty using hydroxyapatite-coated implants of 167 patients, and among thses, 153 cases in 144 patients were followed up more than 24 months. The implants used were 74 cases of Mallory-Head Hip system, 41 cases of Omnifit system and 38 cases of Profile system. RESULTS: The average Harris Hip Score was 48.3 points preoperatively, 94.7 points at POD 1 year and 95.7 at POD 2 years. Seven patients(5.2%) complained thigh pain at POD 2 years. On the radiologic findings, cancellous condensation was noted around the hydroxyapatite coating region of femoral stem in 84 cases(54.2%), and radiolucent lines were noted at the non-coating region of distal stem in 102 cases(67.7%), but were less than 2mm and not progressive. There was no statistically significant differences among the groups of these three implants(P < 0.05). Comments : This early result of femoral stems with hydroxyapatite-coating was quite satisfactory, however, long-term follow-up studies will be necessary.
Arthroplasty, Replacement, Hip ; Durapatite ; Follow-Up Studies ; Hip ; Humans ; Thigh

The blow-out fracture can be reconstructed by various autogeneous and alloplastic material. Particulate, nonresorbable hydroxyapatite is currently one of the choice of implant material available for reconstruction of blow-out fracture. Hydroxyapatite is radiopaque ceramic, physically and chemically similar to enamel and cortical bone. It is a biomaterial derived from natural corals to use as a bone graft substitute. And we looked into the clinical usefulness of 2 type of hydroxyapatite with their advantages and disadvantages in reconstruction of blow-out fracture. 183 patients with blow-out fracture who underwent surgical reconstruction with two types of hydroxyapatite from March 1933 to July 1977 have been analyzed the results of surgical reconstructions, and have been followed up for more than a year. And the condition of formerly inserted hydroxyapatite was observed in the patients who needed 2nd surgical reconstruction due to the enophthalmos. The disadvantages of hydroxyapatite are fragility, size and contour limitations. In spite of these demerits, hydroxyapatite can be one of the prospective materials to reconstruct orbital floor. Through the clinical experiences for 5 years, we have not found any of complications of exposure, infection, and foreign body reaction. Low rates of diplopia, limitation of ocular movement, and enophtalmos was observed. Hydroxyapatite was well adherent to adjacent orbital bone in most patients who needed secondary reconstruction for enopthalmos. In conclusion, our study shows that the availability of hydroxyapattite in reconstruction of blow-out fracture is recommendable, with low complication rates. Hydroxyapatite important appears to be well tolerated, and provides useful alloplastic prosthesis with few problems in reconstruction of blow-out fracture.
Anthozoa ; Ceramics ; Dental Enamel ; Diplopia ; Durapatite* ; Enophthalmos ; Foreign-Body Reaction ; Humans ; Orbit* ; Orbital Fractures* ; Prostheses and Implants ; Transplants

A 4-year-old boy has had a solitary sclerotic depressed plaque on the right anterior chest since birth. The histopathologic findings are consistent with morphea profunda: thickening, hyalinization, and homogenization of collagen bundles in the dermis and subcutaneous tissues, admixture with a prominent lymphocytic and plasma cell infiltrate, and sweat glands en-trapped between the thickened collagen bundles. We report a case of congenital solitary morphea profunda.
Child, Preschool ; Collagen ; Dermis ; Humans ; Hyalin ; Male ; Parturition ; Plasma Cells ; Scleroderma, Localized* ; Subcutaneous Tissue ; Sweat Glands ; Thorax

BACKGROUND: Methemoglobinemia(MetHb) induced by dapsone overdose is not uncommon in Korea, especially in rural area. For treatment of dapsone-induced methemoglobinemia, methylene blue(MB) and activated charcoal(AC) should be used. To date, no reports have compared the amount of MB used between MB alone with MB & AC combined group(MB+AC). And also between moderate (MetHb<35%) and severe (MetHb>35%) intoxicated group defined by initial MetHb level. Authors hypothesized that less amount of MB can be used if MB and AC was used together and larger amount of MB is necessary to reduce MetHb level to asymptomatic level in severely intoxicated group. METHODS: From Jan 1990 to Dec 1996, a total of 54 patients who received treatment for dapsone intoxication were subject of study, The study was done retrospective chart analysis for initial MetHb level, total amount of MB and AC. Wilcoxon rank sum test and Chi-sqiare test was used to compare the total dosage of MB used for each group. Linear regression analysis was used between initial MetHb and the total amount of MB. Results were considered statistically significant when p<0.05. RESULTS: For MB alone and MB+AC group, the differences in total amount of MB used were statistically significant with mean dosage of 7.14+/-1.1mg/kg and 4.28+/-0.7mg/kg, respectively. And total amount of MB used between moderate and severe intoxicated group, the differences were statistically significant with mean dosage of 5.16+/-1.1mg/kg vs. 10.98+/-1.9mg/kg, respectively. There was significant correlation between initial MetHb level (X) and the amount of methylene blue (Y), Y=0.3X-2.42 (r2=0.41, p=0.0001) in MB alone, Y=0.186X-1.95(r2=0.21, p=0.034) in MB+AC respectively. CONCLUSION: For methemoglobinemia induced by dapsone, total amount of MB can be reduced especially in severe Intoxicated group if AC use was combined in treatment modality. There was significant correlationship between initial MetHb level and total amount of MB used.
Charcoal* ; Dapsone* ; Humans ; Korea ; Linear Models ; Methemoglobinemia ; Methylene Blue* ; Retrospective Studies

Pipecuronium bromide is a new biaquaternary steroid-type neuromuscular bloeking agent that is closely similar to pancuronium and vecuronium in chemical structure. The purpose of this study was to evaluate neuromuscular and cardiovascular effects of pipecuronium bromide in patients under enflurane anesthesia in comparison with those of pan- curonium and vecuronium bromide. 35 ASA class I or II adult patients were assigned to one of the following groups; pipecuro- nium 0.08mg/kg(n=15), vecuronium 0.08mg/kg(n=10), and pancuronium 0.1 mg/kg(n=10) as a bolus dose. To investigate cumulative effect of pipecuronium, an additional incremental doses (1 mg) of pipecuronium were given repeatedly to 5 patients in pipecuronium group at every 25% recovery of first twitch height(Ti) of train-of four(TOF) stimulation after administration of in- itial dose. Anesthesia was induced with iv thiopental 5-6 mg/kg and inhalation of 0 (21/min.)-NO(41/ min.)-enflurane(2%), and maintained with O(11/min.)-NA3(21/min.)-enflurane(1-2%). All pa- tients were intubated at 5 minutes after administration of one of these muscle relaxants fol- lowing T> of TOF was depressed more than 95% of control height. Neuromuscular blocking effect was assessed by electromyographic response of hypothenar muscles in response to TOF stimulation of ulnar nerve every 20 seconds at wrist throughout study. Heart rate, systolic and diastolic blood pressures, and mean arterial pressure were noninvasively measured for 20 minutes after adminisf,ration of muscle relaxant. The results obtained were as follows, 1) The onset times from administration of vecuronium, pipecuronium, and paneuronium to 95% depression of T, were 3.4k0.88, 3.8k0.21, and 4.3+/-0.86min. respectively. The onset time of pipecuronium was similar to that of vecuronium but significantly shorter than that of pancur- onium(p<0.05). 2) The duration of action from administration of pipecuronium to 25% reeovery of T was 92.9 +/-15.3min. which was significantly shorter than that of pancuronium(115.2 +/-17.04min., p< 0.05) and longer than that of vecuronium(27.5 +/-5.89 min., p<0.05). 3) Recovery index of pipecuronium was 39.5+7.53min. which was also shorter than that of pancuronium(46.2+/-3.52 min., p < 0.05) and longer than that of vecuronium(13.3+/-1.77 min., p < 0.05). 4) Durations from 10% to 25% recovery of T1 hy additional incremental doses of pipecuronium were not altered significantly by the repeated administration. 5) There were no significant changes on heart rate and blood pressure by 0.08 mg/kg of pipecuronium or vecuronium while heart rate was increased in 21% to 27% for 20 min. after administration of pancuronium. In conclusion, pipecuronium bromide appears to be a useful alternative to pancuronium or vecuronium in relatively long duration of muscular relaxation in patients in whom hemodynamic changes, especially tachycardia, must be avoided.
Adult ; Anesthesia ; Arterial Pressure ; Blood Pressure ; Cardiovascular System ; Depression ; Enflurane ; Heart Rate ; Hemodynamics ; Humans ; Inhalation ; Muscles ; Neuromuscular Blockade ; Pancuronium ; Pipecuronium* ; Relaxation ; Tachycardia ; Thiopental ; Ulnar Nerve ; Vecuronium Bromide ; Wrist

Plexiform neurofibroma is considered a pathognomic of Von Recklinghousen's disease, which involves the deep and large nerve trunk. These are large irregular nerve fascicles which result from an increase in endoneural matrix within individual nerve facicles, without an increased number of nerve fibers. We experenced a case of Von Recklinghausen's disease in a 24 year-old male who had variable cutaneous skeletal, and CNS lesions. He presented multiple neurofibromas, cafe-au-lait spots, and axillary freckles as common cutaneous lesions of NF-I and giant pigmentation, sacral hypertrichosis, and plexiform neurofibroma as unusual cutaneous lesions. Also he had a scoliosis, bowing deformity of the humerous and wedging deformity of the body of the 5th cervical spine as a skeletal manifestation and cortical calcification in the occipital area as a CNS manifestation.
Cafe-au-Lait Spots ; Congenital Abnormalities ; Humans ; Hypertrichosis ; Male ; Melanosis ; Nerve Fibers ; Neurofibroma, Plexiform* ; Neurofibromatoses ; Neurofibromatosis 1 ; Pigmentation* ; Scoliosis ; Spine ; Young Adult

Transhiatal gastric transpositions were performed in two case of long gap esophageal atresia without tracheoesophageal fistula. The patients were a 12 months old female and an 18 months old male. Stamm type gastrostomies were performed at other hospitals in both cases. The stomach was mobilized preserving the right gastric artery, the right gastroepiploic artery and spleen. The proximal and distal esophageal pouches were excised by transcervical and transhiatal route, respectively. The mobilized stomach was pulled up to the neck through esophageal hiatus and posterior mediastinal route. The esophagogastrostomy, the only one anastomosis of this procedure, was performed in the neck. There was no clinical evidence of anastomotic leakage, stricture, regurgitation, difficulty of gastric emptying, hoarseness or respiratory problem. Transhiatal gastric transposition seems to be a safe and easy alternative surgical procedure for esophageal replacement in long gap esophageal atresia.
Anastomotic Leak ; Arteries ; Constriction, Pathologic ; Esophageal Atresia* ; Female ; Gastric Emptying ; Gastroepiploic Artery ; Gastrostomy ; Hoarseness ; Humans ; Infant ; Male ; Neck ; Spleen ; Stomach ; Tracheoesophageal Fistula