The treatment of fractures of the dens is controversial and the major controversy has centered on type II fracture of Anderson and D'Alonzo classification because of its high incidence of nonunion when they were treated by external immobilization like halo apparatus. The posterior arthrodesis of atlas and axis which has been recommended by many authors results in the limitation of rotation of neck. In an attempt to promote bone union and to eliminate functional impairment, the authors have treated 7 consecutive cases of type II dens fracture by direct screw fixation with one or two screws. Minimum follow up period was 15 months(Av. 20mos.). Ages were varied between 23 to 68 years. Amounts of displacement on arrival were more than 4mm in all. Ambulation was started from the day after operation with the external support. Bone union was observed in 6 cases within 3 months without limitation of rotation. One nonunion with losening of screw and one transient dysphagia were observed. The authors believe that the procedure has the advantages in bone union and neck motion, but it requires surgeon's experience and the modification of implant for secure fixation.
Arthrodesis ; Classification ; Deglutition Disorders ; Follow-Up Studies ; Immobilization ; Incidence ; Neck ; Walking

PURPOSE: Delirium in the elderly is common in the postoperative period but there are only few reports on detailed studies of this condition. Number of urologic patients with postoperative delirium was increas ed in our hospital for recent 24 months. The clinical characteristics of patients with postoperative delirium was analyzed retrospectively. MATERIALS AND METHODS: We selected the patients with postoperative delirium from 1010 patients who had undergone urological surgery under general or spinal anesthesia in the period from Jan. 1997 to Dec. 1999. Diagnosis of postoperative delirium was established with Diagnostic and Statistical Manual of Mental Disorders(DAM-III-R) by psychiatric clinicians. Onset and recovery of symptoms, risk factors, previous psychiatric clinicians. Onset and recovery of symptoms, risk factors, previous psychiatric disorder, relationship with anesthesia, drugs, and surgical procedures, concomittant medical conditions, and complications were retrospectively reviewed. RESULTS: Postoperative delirium was observed in 13 patients (1.3%). All patients were male and mean age was 70.4 years (46-86 years). Surgical procedures included TURP(8 patients), cystectomy (3 patients), nephroureterectomy (1 patient), and bladder rupture repair (1 patient). Delirium became apparent between one day and two days after the operation (mean 32.2 hours) and lasted for up to 7 days (mean 53 hours). Several factors such as older age (>65 years), male patient, longterm medication, past history of CVA, memory impairment, hearing difficulty, traumatic brain contusion, and obsessive personality were thought to be risk factors of postoperative delirium. Treatment with Haloperidol(R) intramuscular injection (2.5-5mg, every 30 minutes, 2-4 times until symptom resolution was achieved) with or without Ativan(R) intravenous injection (2mg) were effective. Complete symptom recovery was seen in 92.3% (12/13) of patients. One patient (7.7%) with previous history of dementia had persistent memory disturbance and disorientation during follow-up periods. CONCLUSIONS: Generally, postoperative delirium is an acute transient confusional state without considerable sequeles. Treatment is sedation and prevention of inadvertent accident associated with confusional state. Urologic surgeon must be attentive to the development of this illness especially when high risk factors were present.
Aged ; Anesthesia ; Anesthesia, Spinal ; Brain Injuries ; Cystectomy ; Delirium* ; Dementia ; Diagnosis ; Follow-Up Studies ; Hearing ; Humans ; Injections, Intramuscular ; Injections, Intravenous ; Male ; Memory ; Postoperative Period ; Retrospective Studies ; Risk Factors ; Rupture ; Urinary Bladder

No abstract available.
Follow-Up Studies* ; Humans ; Peptic Ulcer*

The bone mineral density (BMD) has been measured for evaluation of the osteoporosis. Of the various methods of measuring the BMD, dual energy X-ray absorptiometry (DEXA) has been known to be an accurate, objective, and easily reproducible method. The authors measured BMD in patients with intertrochanteric fracture of the femur for comparison with results in the normal control. The BMD was measured in thirty-two patients with intertrochanteric fracture by dual energy X-ray absorptiometry from March 1993 to March 1995. And the relationship between the severity of osteoporosis and intertrochanteric fracture of the femur was studied. The comparison of BMD between fracture patients and normal control was done in the population below 79 years old of age (23 fracture patients and 90 normal controls). The average BMD in the intertrochanteric fracture group was 0.558g/cm2 in the neck, 0.425g/cm2 in Ward's triangle and 0.568g/cm2 in the trochanter, while in the normal control group it was 0.870g/cm2 in the neck, 0.681g/cm2 in Ward s triangle and 0.772g/cm2 in the trochanter. In comparison with the normal control group, the BMD in fracture group was about 79% of the normal control group. The BMD in the proximal femur was decreased by about 14% with the age increasing decennially after 50 years. The BMD at Ward s triangle and trochanter was much lower in type III and IV of Tronzo classification than in type I and II .The BMD did not show significant correlation with the height and weight of the patients.
Absorptiometry, Photon ; Aged ; Bone Density* ; Classification ; Femur* ; Humans ; Neck ; Osteoporosis

Fractures about the knee including the distal femur and the proximal tibia not infrequently result in vaseular injuries of the popliteal artery and the distal part of the femoral artery. This is often followed by circulatory disturbance and jeopadizes the viability of the lower extremity. During the three and a half year period, from January 1973 to June 1976, 20 cases of vascular injuries complicated by fractures about the knee were treated at the Orthopedic Department of Busan National University Hospital. Review of the cases resulted in the following observations. 1. The lower extremity escaped amputation in 45% the cases (9 of the 20 cases) 2. Femoral arteriography showed that the site of injury was proximal to the Soleus insertion. in 17 cases. 3. Types of vascular injury were contusion in 9 cases, laceration in 7 and total disruption in 4. 4. 5 of the 6 extremities that were treated within 12 hours after injury survived, while only 2 out of t he 9 extremities treated after 24 hours following injury escaped amputation. 5. 6 of the 13 extermities (46%) tredted by interval fixation survived, while 1 out of 5 extremities (20%) treated by traction escaped amputation.
Amputation ; Angiography ; Busan ; Contusions ; Extremities ; Femoral Artery ; Femur ; Knee ; Lacerations ; Lower Extremity ; Orthopedics ; Popliteal Artery ; Tibia ; Traction ; United Nations ; Vascular System Injuries

To study the relationship between the bone mineral density measured by DEXA and QCT methods and to study the factors influencing on the value, bone mineral density in 208 patients with low back pain were measured by the two methods and compared statistically. Ages were varied between 17 to 79(Av. 46.7) years and male and female were 86 and 122. The results of this are as follows; 1. The values of DEXA and QCT showed statistically significant relationship(γ=0.58) as a whole. And bone mineral density in L2, L3 and L4 showed no difference in both groups. 2. Bone loss by aging(per year) in male and female was 0.99% and 1.06% by DEXA, 0,99% and 1.41% by QCT. 3. Body height and weight showed no significant influence of the value in two methods. 4. In body mass index over 27.5, the value measured by QCT was influenced to be diminished while that of DEXA was not influenced. 5. The value by QCT was influenced to be diminished by the increase of age especially over 50 years old in both sex. While the value by DEXA was influenced to be lowered than expected in female over 50 years old. It is concluded that the methods of measurement of bone mineral density have their limitation depend on the age, sex and mass index.
Body Height ; Body Mass Index ; Bone Density ; Female ; Humans ; Low Back Pain ; Male ; Spine

449 hospital patients with no pathologic brain CT findings, 30 yrs of age or older, were selected for the study of cerebral atrophy during the 30 months, from January 1980 to June 1983, at dept. of internal medicine, Hanyang Univ. hospital & following results were obtained. 1) Thoses in male group, A gradually progressive increase in the degree of cerebral atrophy score in the 3rd, 4th & late 5th decades was followed by a dramatic increase in the late 6th & 7th decades. 2) Those in female group, A gradually progressive increase in the degree of cerebral atrophy.
Atrophy* ; Brain* ; Female ; Humans ; Internal Medicine ; Male

449 hospital patients with no pathologic brain CT findings, 30 yrs of age or older, were selected for the study of cerebral atrophy during the 30 months, from January 1980 to June 1983, at dept. of internal medicine, Hanyang Univ. hospital & following results were obtained. 1) Thoses in male group, A gradually progressive increase in the degree of cerebral atrophy score in the 3rd, 4th & late 5th decades was followed by a dramatic increase in the late 6th & 7th decades. 2) Those in female group, A gradually progressive increase in the degree of cerebral atrophy.
Atrophy* ; Brain* ; Female ; Humans ; Internal Medicine ; Male

Since the introduction of percutaneous mitral valvotomy(PMV) in 1984, PMV was an effecive alternative to surgical commissurotomy in selected patients with severe mitral stenosis. Also PMV was an excellent palliative strategy in such patients who were high risk for operative management or longterm anticoagulation was not feasible. We performed PMV in a patient with very tight mitral stenosis and severe pulmonary hypertension under the general anesthesia because the patient was anticipated to be uncooperative due to mental problem, who was diagnosed as schizophrenia 16 years ago. Robinol was used for premedication and i.v fentanyl was used for maintenance of anesthesia. Inoue balloon was introduced into the LV and gradual ballooning was performed with favorable results. Total anesthesia time and interval from internal jugular vein puncture to the completion of valvuloplasty were 1 hour 45 min and 40 minutes respectively. Hemodynamic variables were improved immediately after intervention and mitral valve area was increased from 0.5cm2 to 1.3cm2.
Anesthesia ; Anesthesia, General* ; Fentanyl ; Hemodynamics ; Humans ; Hypertension, Pulmonary ; Jugular Veins ; Mitral Valve ; Mitral Valve Stenosis* ; Premedication ; Punctures ; Schizophrenia*

BACKGROUNDS: An inhibitory effect of magnesium L-ascorbyl-2-phosphate (VC-PMG, a stable derivative of ascorbic acid) on melanogenesis has been described. Furthermore, glabridin in licorice is known to have inhibitory effects on melanogenesis and widely used for raw materials for depigmenting agents. OBJECTIVE: The purposes of this study are to provide objective data by measuring the visual clinical effects of VC-PMG with the colorimeter and to promote the development of de-pigmenting agents. METHODS: 20 volunteers joined the study. With an artificial UVB irradiation, eight tanned areas were made on the inner side of the forearm. During two months, each tanned area was treated with five whitening cosmetics with 3% VC-PMG and increasing concentration of licorice from 0% to 3%. Darkness degree of each area was measured weekly by the colorimeter and the visual assessment. RESULTS: For all cosmetics, whitening effect was measured by colorimeter and visual as-sessment. The cosmetic containing VC-PMG 3% and licorice 1% had more whitening effect than any other cosmetics of different concentrations. Moreover, VC-PMG 3% alone also had whitening effect in some volunteers. CONCLUSION: VC-PMG was clinically found to have whitening effect.
Ascorbic Acid* ; Darkness ; Forearm ; Glycyrrhiza ; Magnesium* ; Triacetoneamine-N-Oxyl ; Vitamins* ; Volunteers