We had treated 24 patients who had nonunions of the carpal scaphoid from June 1987 to September 1995. 17 of 24 nonunions of carpal scaphoid were treated by K-wires fixation and autogenous iliac bone grafts. Another 7 cases were treated by Herbert screw fixation and autogenous iliac bone graft. 24 patients were followed up average 42.6 months and obtained following results; l. Among 24 cases, 23 cases were men and 19 cases were the third and fourth decade. Most common injury was the falling accidents (11 cases: 45.8%). 2. Most common pattern of fractures was waist type (20cases: 83.3%) in anatomical site and transverse type (15 cases: 75.0%) in pattern of fracture line. 3. Preoperative scapholunate angles (mean 52.9degrees: K-wires, 69.1degrees: Herbert screw) has been improved after open reduction and internal fixation by K-wires or Herbert screw (mean 46.2degrees: K-wires, 51.1degrees: Herbert screw). 6 cases had DISI deformity preoperatively with scapholunate angles over 70degrees (mean 80.0degrees: K-wires, 84.0degrees: Herbert screw) has been corrected after ORIF (mean 48.0: K-wires, 58.0: Herbert screw). 4. Bony unions were obtained in average 13.2 weeks in K-wires group and 9.8 weeks in Herbert screw group. 5. 13 cases (76.5%) in K-wires group and 6 cases (85.7%) in Herbert screw group were excellent and good result by Maudsley method. 6. The complications and sequalaes were present 4 cases in K-wires group with degenerative arthritis on radioscaphoidal and scapholunate joint and collapse of proximal pole and 1 case in Herbert screw group with screw malposition. So, We were thought that ORIF with K-wires and Herbert screw was effective treatment for nonunions of carpal scaphoid, especially Herbert screw fixation and autogenous iliac bone graft. In comparison of bony union and results of treatment, Herbert screw group was more effective than K- wires group.
Congenital Abnormalities ; Humans ; Joints ; Male ; Osteoarthritis ; Transplants

161 patients with tibia fracture were treated by closed intramedullary nailing at the department of Orthopedic Surgery, Eul-Ji General hospital, Dae Jeon, during 5 years from January, 1988 to April, 1993. 134 of these patients were performed with Kiintscher IM nailing and 27 patients with Ender nailing. Rigid IM nailing is the method of choice in tibia shaft fracture with rigid fixation, low complication, wide indication and early weight bearing, but the treatment of segmental fracture of the tibia will have many difficulties because of severe displacement, severe comminution, massive soft tissue damage and lack of blood supply at fracture site. Either antegrade or retrograde Ender nailing was of value for the management of segmental fracture which was too proximally or too dixtally located to insert interlocking screws, open fracture and soft tissue injury around Kiintscher insertion site. The result as fllows; 1. 43 fractures were open and 118 were closed. 69 fractures involved the distal portion, 55 fractures the middle portion, 13 fractures the proximal portion of the tibia and 24 fractures were segmental. 2. Among the 161 eases, 114 cases were male and 47 cases were female, the most common ages were ranged from 21 year to 30 year, involving 44 cases. 3. The most common cause was traffic accident. 4. Average intervals from injury to operation were 6.34 days(closed fracture) and 9.84 days(open fracture). 5. The mean durations of the bone union were 18.90 weeks(closed fracture) and 16.46 weeks(open fracture). 6. Complication included 7 cases delayed union, 3 cases nonunion, 8 cases superficial infection, 4 cases joint stiffness, 3 cases nail migration, 2 cases angular deformity, 2 cases rotational deformity, 1 cases osteomyelitis.
Accidents, Traffic ; Congenital Abnormalities ; Daejeon ; Female ; Fracture Fixation, Intramedullary ; Fractures, Open ; Hospitals, General ; Humans ; Joints ; Male ; Methods ; Orthopedics ; Osteomyelitis ; Soft Tissue Injuries ; Tibia ; Weight-Bearing

BACKGROUND: It is difficult to manage intractable pain from advanced carcinoma of the upper abdomen. One method used to control pain associated with these malignancies is to block the splanchnic nerve. We investigated that VAS (visual analogue scale) difference before and after splanchnic nerve block (SNB) and pain relief day. Also we studied relationship between VAS before SNB and pain relief day. METHODS: A rewiew of 70 patients who took splanchnic nerve block (SNB) from September 1994 to February 1998 was carried out to assess age, sex, primary diseases, pain sites, VAS before and after SNB, date of diagnosis, date of SNB, date of death and pain relief day, etc. RESULTS: Of 70 patients, 44 were males and the remaining 26 were females. The causes of pain were stomach cancer 28 (40%), pancreatic cancer 18 (25%), gall bladder cancer 7 (10%), hepatoma 6 (8.6%) respcectively. Average day from diagnosis to SNB was 272 and average day from diagnosis to death was 341. So, patients died on the average 69 days after they took the splanchnic nerve block in pain clinic. VAS average before SNB was 8.01 and VAS average after SNB was 3.64. Patients felt pain relief during 35 days after SNB. Pain relief day of patients who had lower VAS before SNB was longer than that of patients who had higher VAS before SNB. CONCLUSION: Early application of splanchnic nerve block will make the patients endure the cancer pain more easily.
Abdomen ; Carcinoma, Hepatocellular ; Diagnosis ; Female ; Gallbladder Neoplasms ; Humans ; Male ; Pain Clinics ; Pain, Intractable ; Pancreatic Neoplasms ; Splanchnic Nerves* ; Stomach Neoplasms

Thirty consecutive anesthesia records of transurethral resection (TUR) have been reviewed. Patient's physical status, anesthetic management and complications were also discussed. Operations in this series were classified as follows: 25 cases of TUR for carcinoma of the prostate, 3 cases of bladder tumor. In all the thirty cases of TUR, circulatory diseases, such as hypertension were encountered most frequently. (10 cases) The patients had the highest mean age(66.5 years old) and their physical status was almost all ASA class II or III. Hypotension occurred in 1 patient during TURP. There was no death associated with anesthesia and operation in this study. Pain control after operation with epidural block was satisfactory in nearly all cases. Continuous epidural anesthesia for TUR and pain control after operation was desirable.
Anesthesia ; Anesthesia, Epidural* ; Humans ; Hypertension ; Hypotension ; Pain, Postoperative* ; Prostate ; Transurethral Resection of Prostate ; Urinary Bladder Neoplasms

To investigate the presence of apparent accommodation in monocular pseudopakic eyes and contact lens wearing monocular aphakic eyes, we measured it in 54 monocular pseudophakic eyes (54 patients) and 40 contact lens wearing monocular aphakic eyes (40 patients). The mean apparent accommodation was 1.68+/-1.25 diopters in monocular pseudophakic eyes and 1.74+/-0.73 diopters in contact lens wearing monocular aphakic eyes, and there was no statistically significant difference between them. Apparent accommodation was not related either to type of intraocular lenses or pupil size in pseudophakic eyes and not related to target size in aphakic eyes, but it was influenced by pupil size in aphakic eyes. In the group of patients aged between 45 and 55, accommodation in phakic eyes was significantly greater than apparent accommodation in contralateral contact lens wearing monocular aphakic eyes.
*Accommodation, Ocular ; Adolescent ; Adult ; Aged ; Aphakia, Postcataract/*physiopathology ; Child ; *Contact Lenses ; Humans ; Middle Aged

We studied the healing course and histologic change of ablated rabbit cornea following excimer laser photorefractive keratectomy using three different corneal wound healing methods; pressure patch, T-lens, collagen shield. Nine rabbits(18 eyes) were divided into three different groups according to its treatment method. Corneal status including the corneal haze, conjunctival injection, discharge amount at postoperative 1st day, 2nd day and 3rd day were the same, irrespective to the treatment method and corneal wound healing rate show no significant differentces in all the groups. The histologic feature revealed irregular epithelial hyperplasia and keratacyte infiltration in the superficial stromal layer on postoperative 3rd day and 7th day. These reactions lessened at postoperative 1 month. The cornea treated with pressure patch group revealed more severe tissue reaction when compared with the other groups, T-lens and collagen shield. These results suggest that the corneal wounds produced by excimer laser can be managed by T-lens as an another alternative method of wound treatment.
Collagen* ; Cornea* ; Hyperplasia ; Lasers, Excimer* ; Photorefractive Keratectomy* ; Wound Healing* ; Wounds and Injuries*

The efficacy of high frequency oscillation superimposed on conventional mechanical ventilation (combined ventilation) was evaluated in 11 patients requiring respiratory care. These patients were comatose and in an apneic state. The conventional ventilator was initially set at a tidal volume of 10ml/kg at a rate of 10/min.(control) and half of the tidal volume was delivered throughout superimposing high frequency oscillations. While changing high frequency rates(5,10 and 15 Hz) at an interval of 15 minutes(experimental groups 1,2 and 3), blood pressure, pulse rate, peak and mean airway pressure, and expiratory volume were measured and arterial blood gas analysis was performed. There were no significant differences in cardiovascular and blood gas parameters between each group and the control. But PaCO2 and PaO2 rose and airway pressures(peak and mean airway pressure) were reduced as the high frequency rates increased, especially in the group with the largest samplitude oscillations. These results suggest that combined ventilation can achieve an adequate gas exchange and low airway pressure without cardiovascular embarrassment in respiratory support. This should help to provide an alternative mode for the management of patients with respiratory failure requiring mechanical ventilation.
Blood Gas Analysis ; Blood Pressure ; Coma ; Heart Rate ; High-Frequency Ventilation ; Humans ; Respiration, Artificial* ; Respiratory Insufficiency ; Tidal Volume ; Ventilation* ; Ventilators, Mechanical

We studied the effects of three different treating methods on corneal repithelization after PRK such as pressure patch, therapeutic contact lens and collagen shield. The degree of pain among three different treating groups showed same results without difference. The postoperative corneal wound healing rate in collagen shield group was slower than the other groups at first day. The corneal wound healing duration in therapeutic contact lens was faster than the other groups. Therefore we could obtained the results that therapeutic contact lens treated group is clinically excellent method for accelerating corneal wound healing after excimer laser photorefractive keratectomy.
Collagen ; Epithelium, Corneal ; Lasers, Excimer* ; Photorefractive Keratectomy* ; Wound Healing* ; Wounds and Injuries*

PURPOSE: The authors studied the results of laser in situ keratomileusis for correction of myopic astigmatism with flying spot beam laser. METHODS: The authors studied the results of 179 eyes of 122 patients who had undergone excimer laser in situ keratomileusis for correction of myopic astigmatism with flying spot beam laser and had had preoperative atigmatism greater than 0.5 diopter (D). Patients were divided into group I (0.50D-0.75D), II (1.00D-1.75D), III (2.00D-2.75D), and IV (3.00D-6.00D), Each patient were followed up for over 6 months. Refractive errors and uncorrected visual acuity (UCVA) were measured at 1week, 1, 3, and 6 months after operation, respectively RESULTS: The mean age of the patients was 29 years (19-50 years). In group I, II, III, and IV, preoperative cylindrical power were 0.61+/-0.12D, 1.26+/-0.24D, 2.26+/-0.28D, and 3.34+/-0.33D, respectively. And postoperative astigmatism were 0.11+/-0.25D, 0.16+/-0.31D, 0.63+/-0.55D, 0.45+/-0.67D at postoperative 3 month and 0.08+/-0.24D, 0.17+/-0.31D, 0.29+/-0.47D, 0.16+/-0.32D at postoperative 6month, respectively. At 6 months, there is no statistically significant difference compared with the mean cylindrical power between the two groups. CONCLUSIONS: The astigmatic correction with flying spot beam laser showed effective and stable results regardless of the preoperative cylindrical power.
Astigmatism ; Diptera* ; Humans ; Keratomileusis, Laser In Situ ; Lasers, Excimer ; Refractive Errors ; Visual Acuity

The management of ipsilateral fractures of the femoral neck and shaft has proved to be a challenge to the orthopedist. Most major institutions have treatment protocols that emphasize early rigid stabilization of the femoral neck fracture to minimize the incidence of avascular necrosis of the femoral head and the shaft fractures were fixed prior to definitive neck stabilization. Whenever possible, patients should be followed for a minimum of three years to rule out aseptic necrosis of the femoral head. These dual fractures are usually encountered in the young, associated with high-velocity accidents and usually accompanied by multiple system trauma. At the department of orthopedic surgery, Eul Gi General Hospital, from June, 1986 to August, 1993, 21 cases of the concomitant ipsilateral femoral neck and shaft fractures had been treated. The mean follow-up was 2.8 years(ranging from 1.6 to 5.8 years). The diagnosis of femoral neck fracture was delayed in two patients. Seventeen of the 21 cases underwent surgery had a relatively satisfactory functional outcome without complication of femoral head. In two patient, a symptomatic varus nonunion and varus malunion developed. In two cases, osteonecrosis of femoral head developed and one case of these patients was treated with Meyer techniqe of muscle pedicle graft. Our series emphasize that the recommended treatment consists of a closed intramedullary fixation of the femoral shaft fracture followed by ASNI screw fixation of the femoral neck fracture, with good long term functional results and minimum complication. And approaches to the treatment of concomitant femoral neck and femoral shaft fractures should be selected according to the skill and experience of the surgeon and the availability of equipment.
Clinical Protocols ; Diagnosis ; Femoral Neck Fractures ; Femur ; Femur Neck ; Follow-Up Studies ; Head ; Hospitals, General ; Humans ; Incidence ; Neck ; Necrosis ; Orthopedics ; Osteonecrosis ; Transplants