This purpose of this study was to evaluate the possible prognostic factors of physeal bar resection in the treatment of partial physeal growth arrest. From January 1979 to October 1993, 23 skeletally immature patients (16 males, 7 females) underwent physeal bar resection and fat graft interposition. The age was ranged from 1 year 8 months to 16 years 9 months (average 8 years 9 months). The follow-up period was ranged from 12 months to 10 years 6 months (average 3 years 4 months). The results of the surgery were categorized into 4 groups on the basis of relative growth ratio (RGR), spontaneous angular correction after physeal bar resection, disappearance of converging growth arrest lines, and the viability & proximal migration of the interposed fat verified by follow-up MRI. The RGR was assessed as a percentage of the contralateral limb segment: change in length of operated limb segment divided by change in length of unoperated limb segment multiplied by 100. The angular correction was calculated as the difference of the degrees of angular deformity between the preoperative and the latest follow-up visit. In the sixteen cases which required concomitant operations (osteotomy, Ilizarov method of for lengthening or deformity correction), their contribution to the angular correction was excluded in the calculation. The etiology of partial physeal arrest consisted of fracture (17), infection (5), and leukemia (1). In 10 of 17 fracture cases in which initial radiographs were available, the Salter-Harris types were assessed. There were type II (2), type III (2) and type IV (6) fractures. Distal femur was the most common site of physeal arrest (13), followed by distal tibia (7), proximal tibia (2), and distal radius (1). There were peripheral (9), combined (6), central (5) and linear (3) types of physeal bar. The nine variables including preoperative limb length discrepancy and degree of angulation, age, onset, etioloty of physeal arrest, Salter-Harris type of epiphyseal injury, site of the arrested physis, type and size.
Congenital Abnormalities ; Extremities ; Femur ; Follow-Up Studies ; Humans ; Ilizarov Technique ; Leukemia ; Magnetic Resonance Imaging ; Male ; Radius ; Tibia ; Transplants

We have observed that the companion shadow of the upper rib may be misinterpreted as a small pnemothorax or pleural plaque associated with asbestosis. To observe the radiographic characteristics of the normal companion shadow, we analyzed, on the posteroanterior(PA) chest radiographs, the companion shadow of 50 normal cases. Factors such as occurrence on each rib, the sharpness of the margin, the relative position to the rib, the shape and the thickness were observed. Also, we analyzed the displaced pleura of 4 pneumothorax cases to differentiate their frndings from the findings of normal companion shadows. On 50 normal chest radiographs, 192 compaion shadows were observed on the first to fourth ribs. In 173 of those shadows, the visceral margin of the companion shadow on the second rib simulated pneumothorax more closely than those on any othe rivs due to its apical location and thinness. In six of 50 normal cases, the companion shadow on the first or second rib showed an inw rdly convex lower margin, mimicking pleural plaque. The compaion shadow was suggested on the plain chest radiograph by the following characteristics imultiplicity(47/50), thicker than normal pleura(3/4), persistent on serial filma with the same shape and specific location(4/4).
Asbestosis ; Friends* ; Humans ; Pleura ; Pneumothorax ; Radiography, Thoracic ; Ribs* ; Thinness

BACKGROUND: We conducted this study to verify whether a mechanical ventilator is adequate for cardiopulmonary resuscitation (CPR). METHODS: A self-inflating bag resuscitator and a mechanical ventilator were used to test two experimental models: Model 1 (CPR manikin without chest compression) and Model 2 (CPR manikin with chest compression). Model 2 was divided into three subgroups according to ventilator pressure limits (P(limit)). The self-inflating bag resuscitator was set with a ventilation rate of 10 breaths/min with the volume-marked bag-valve procedure. The mode of the mechanical ventilator was set as follows: volume-controlled mandatory ventilation of tidal volume (Vt) 600 mL, an inspiration time of 1.2 seconds, a constant flow pattern, a ventilation rate of 10 breaths/minute, a positive end expiratory pressure of 3 cmH2O and a maximum trigger limit. Peak airway pressure (P(peak)) and Vt were measured by a flow analyzer. Ventilation adequacy was determined at a Vt range of 400-600 mL with a P(peak) of < or = 50 cmH2O. RESULTS: In Model 1, Vt and P(peak) were in the appropriate range in the ventilation equipments. In Model 2, for the self-inflating bag resuscitator, the adequate Vt and P(peak) levels were 17%, and the P(peak) adequacy was 20% and the Vt was 65%. For the mechanical ventilator, the adequate Vt and P(peak) levels were 85%; the P(peak) adequacy was 85%; and the Vt adequacy was 100% at 60 cmH2O of P(limit). CONCLUSIONS: In a manikin model, a mechanical ventilator was superior to self-inflating bag resuscitator for maintaining adequate ventilation during chest compression.
Cardiopulmonary Resuscitation* ; Manikins* ; Models, Theoretical ; Positive-Pressure Respiration ; Thorax ; Tidal Volume ; Ventilation* ; Ventilators, Mechanical*

No abstract available.
Alcoholism* ; Memory*

The purpose of this study are to delineate the temporal and spatial changes of bone mineralization at the distraction gap and adjacent parent bone, and to investigate the effect of microaxial dynamization on regenerate bone healing and on development of regional osteopenia at the adjacent parent bone, during callotasis. Sixteen Korean adult mongrel dogs underwent bilateral tibial lengthening by callotasis. To the right hindlimbs, no dynamization was applied and served as control group (group I, and axial elastic dynamization was conffered to the left hindlimbs (group II). Bone mineral density(BMD) was measured by dual X-ray absorptionmetry(DXA) at immediate post-operative day, post-operative 12 day, 22 day, 36 day, 50 day, 65 day, and 85 day. Quantitative computed tomogram(Q-CT) was also taken after sacrifice to analyze temporal changes of mineralization pattern in the distraction gap. The following results were obtained; 1. In both group I and II, the BMD was lowest at the interzone in the distraction gap and increased linearly toward the corticotomy surface. This pattern did not change with time until the consolidation of the distraction gap, but the difference of BMD between the interzone and adjacent parent bone decreased with progress of consolidation. 2. During the distraction period, BMD increased progressively at the distraction gap and adjacent parent bone in both group I and II. During consolidation period, although BMD of the distraction gap still increased progressively, that of the adjacent parent bone decreased progressively in group I; the more distant from the corticotomy surface, the more decreased the relative BMD. in group II, the decrease in BMD of the adjacent parent bone was less than that in group I which was statistically significant in mid-consolidation period. In conclusion, the new bone in the distraction gap during callotasis appeared to form in bilateral direction with linear gradient from interzone toward corticotomy surface. Dynamization during callotasis not only stimulated regenerate bone healing in the distraction gap, but also prevented the occurrence of transient regional osteopenia at the distant part of the adjacent bone during midconsolidation period.
Adult ; Animals ; Bone Density ; Bone Diseases, Metabolic ; Calcification, Physiologic ; Dogs ; Hindlimb ; Humans ; Miners ; Osteogenesis, Distraction ; Parents ; Tibia

The appendiceal mucocele is very rare disease of 0.2% incidence. About 24% of patients are asymptomatic and symptomatic patients present with pain in the right lower quadrant of abdomen in 64%, plapable maas in the right lower quadrant of abdomen in 50%, and rarely, melena, hematochezia, anemia, diarrhea, malaise, and abdominal distension. The gastrointestinal bleeding may be presented in the patient with intussusception, but the massive bleeding is generally absent. We report a case of appendiceal mucocele accompanying with gastrointestinal bleeding and review of literature.
Abdomen ; Anemia ; Diarrhea ; Gastrointestinal Hemorrhage ; Hemorrhage* ; Humans ; Incidence ; Intussusception ; Melena ; Mucocele* ; Rare Diseases

Primary gastrointestinal lymphoma primarily confined to gastrointestinal tract is relatively rare diaease. Although the lymphoma primarily involved colorectum or small bowel was commonly reported than primary gastric lymphoma in Korea, the concurrent primary lymphoma of colon and small bowel is very rare in reported cases. We report a case of combined primary malignant lymphoma of the jejunum and cecum, who was admitted due to melena and anemia. She had right hemicolectomy and end-to-side ileotransverse colostomy at 2 months ago, due to primary colon lymphoma. The laparotomy was performed and identified hard, 2 x 3 cm sized masses on distal 25 cm, 80 cm and 150 cm from the Treitz ligament. The histology of these small ma showed histiocytic lymphoma as same as cecal specimen. In general, the small bowel lymphoma shaws poor prognosis than gastric or colorectal lymphoma due to diffieulty in diagnosis and late symptoms, but this problem could be resolved through the knowledge about primary gastrointestinal lymphoma and the development of diagnostic methods.
Anemia ; Cecum ; Colon* ; Colostomy ; Diagnosis ; Gastrointestinal Tract ; Jejunum ; Korea ; Laparotomy ; Ligaments ; Lymphoma* ; Lymphoma, Large B-Cell, Diffuse ; Melena ; Prognosis

No abstract available.
Cleft Lip* ; Diagnosis* ; Ultrasonography*

BACKGROUND: With increase of antibiotics use and invasive procedures, infections caused by multi-resistant Acinetobacter baumannii (MRAB) are increasing. Recently, we experienced the outbreak of- nosocomial infections caused by MRAB resistant to imipenem and cefoperazone/sulbactam in intensive care units (ICU) and general ward. We analyzed the clinical characteristics of the infected patients and antibiotic susceptibility of the organisms. And surveillance cultures and IRS-PCR were performed to find out the transmission route. METHODS: We collected data from physical examination and clinical records. We performed surveillance cultures of environment, patients not infected with MRAB in ICU, and hands of health care workers. RESULTS: Between November 1996 and June 1997, 49 strains of MRAB were isolated from the 26 patients hospitalized in Kangnam St. Mary' s Hospital. The lower respiratory infection (13 cases) was the most common infection and sputum was the most common sources (47.1%). All strains of MRAB showed the same genotype. In disk diffusion test, all strains were resistant to piperacillin, gentamicin, amikacin, ceftazidime, cefoperazone/sulbactam, aztreonam, imipencm, ciprofloxacin. From the surveillance cultures, the genotypically identical strains were isolated from ventilator Y-piece, the floor of ICU, and hands of health care workers. It suggested that this strain was transmitted through ventilatory device or hands of health care workers. We instructed all the health care workers to wash hands, to disinfect hospital environment completely. Since July 1997, no further case has occurred. CONCLUSIONS: Since A. baumannii could be transmitted through ventilatory devices and the hands of health care workers, it is important to wash hands and to disinfect hospital environment completely.
Acinetobacter baumannii* ; Acinetobacter* ; Amikacin ; Anti-Bacterial Agents ; Aztreonam ; Ceftazidime ; Ciprofloxacin ; Cross Infection* ; Delivery of Health Care ; Diffusion ; Genotype ; Gentamicins ; Hand ; Humans ; Imipenem* ; Critical Care Units ; Patients' Rooms ; Physical Examination ; Piperacillin ; Sputum ; Ventilators, Mechanical

The purpose of this study was to evaluate the results of various types of opponensplasties which have been performed for the last 15 years. For the patients who had median nerve injury with or without ulnar nerve injury, we usually transferred the ECRL or ECRB to restore thumb opposition and Huber s procedure were usually done for thumb hypoplasia. With the criteria outlined by Sundararaj and Mani, postoperative function of 27 hands from 23 patients who underwent the opponensplasty from March 1981 to March 1995 were evaluated. The results from each etiology group were analyzed by the same criteria. Also subjective opinion of the patients about the scar were investigated by our own criteria. The analysis from overall 27 hands yielded 19 excellent (70.4%), 4 good (14.8%), 3 fair (11.1%), and 1 poor (3.7%) results with Sundararaj and Mani s criteria and 1 excellent (3.7%), 14 good (81.5%), 3 fair (11.1%), and 1 poor (3.7%) results about the scar. In 11 patients with nerve injury (median nerve with or without ulnar nerve injury), 7 excellent and 2 fair results were yielded by the ECRL or ECRB transfer, 1 excellent by Phalen-Miller's procedure, and 1 excellent by Burkhalter's procedure. In 8 patients with congenital hypoplastic thumb, 7 excellent results were yielded by Huber's procedure and 1 excellent by the ECRB transfer. In 8 patients with residual poliomyelitis or brachial plexus injury, the ECRB transfer yielded 3 excellent results. However, 2 good and 1 fair results were obtained by Bunnell's procedure; and l good, l poor by Camitz's procedure. In summary, the ECRL or ECRB transfer in the patients who had neuropathy, such as median with or without ulnar nerve injury, brachial plexus injury or residual poliomyelitis; and Huber's procedure in congenital hypoplastic thumb were thought to be one of the useful methods for the restoration of the thumb opposition.
Brachial Plexus ; Cicatrix ; Hand ; Humans ; Median Nerve ; Poliomyelitis ; Thumb* ; Ulnar Nerve