The incidence of non-union in the shaft of femur is increasing gradually in spite of considerably improved methods of femoral fracture care. It is necessary that orthopaedic surgeon must draw attention to improve the method of treatment and to prevent the occurance of non-union. This paper presents the follow-up result of 27 cases among 30 established femoral shaft non-union cases, that were treated at the orthopaedic dept. of the National Medical Center from March 1971 to March 1980 by various methods. The study of this series shows the following. l. Amount 27 cases, male was predominant (82%), peak age group was 3rd & 4th decades (52%). 2. The causes of injury were auto-accident (56%), falling down accident (22%), direct blow (11%) & slipping down accident (11%). 3. The most common location was around the mid-shaft of femur (44.4%). 4. The probable causes of non-union were loosening of the implants & metal failure due to improper internal fixation (10 cases), incomplete reduction (7 cases), infection (5 cases) & inadenaute external immobilization (5 cases). 5. Excellent results were obtained by combined method of compression plate, screws & intramedullary nailing with additional autogenous bone graft.
Accidental Falls ; Femoral Fractures ; Femur ; Follow-Up Studies ; Fracture Fixation, Intramedullary ; Humans ; Immobilization ; Incidence ; Male ; Methods ; Transplants

CT scans of 21 patients(intrathoracic goiter=7. Castleman disease=6, pulmonary carcinoid tumor=3, parathyroid adenoma=1, thyroid carcinoma=1, paraganglioma=1, benign pleural mesothelioma=1, sclerosing hemangioma=1) with mediastinal tumors that are known to be enhanced with intravenous injection of contrast media, were studied retrospectively to investigate the enhancing capabilities f those tumors and to describe their CT findings. The degree of enhancement was estimated by visual inspection with a grading system. All but one case of cystic parathyroid adenoma showed enhancement on post-contrast scan. The degree of enhancement was not helpful in differentiating these tumors. Characteristic location and pattern of tumor extension were found in cases of intrathoracic goiter, parathyroid adenoma, thyroid carcinoma and paraganglioma. Calcifications were found in intrathoracic goiter(5/7). Castleman disease(2/6). Pulmonary carcinoid(1/3), thyroid carcinoma. Necrotic low-attenuation areas were in intrathoracic goiter(7/7), parathyroid adenoma, thyroid carcinoma and paraganglioma. In conclusion, mediastinal tumors that are known to be enhanced in the literature were enhanced with rare exception, and if we consider the predilection site of those tumors, the scope of differential diagnosis can reasonably be narrowed.
Carcinoid Tumor ; Contrast Media ; Diagnosis, Differential ; Goiter, Substernal ; Injections, Intravenous ; Paraganglioma ; Parathyroid Neoplasms ; Retrospective Studies ; Thyroid Gland ; Thyroid Neoplasms ; Tomography, X-Ray Computed

BACKGROUND: We evaluated early and late pulmonary hypertension (PH) in preterm infants and its relation with bronchopulmonary dysplasia (BPD). METHODS: Sixty-seven preterm infants < 30 weeks' gestation underwent echocardiography within 14 days after birth for early PH and over 28 days after birth for late PH. We measured tricuspid regurgitation (TR) peak velocity, pulse Doppler-derived myocardial performance index (MPI) of right ventricle (RV) (RV MPI), eccentricity index (EI), and tricuspid annular plane systolic excursion (TAPSE). RESULTS: The median gestation age of patients was 27 weeks (range, 23–30 weeks) and median birth weight was 1030 g (range, 450–1780 g). TR peak velocity was measured only in 19 patients (28.4%). Patients with symptomatic early PH (n = 11) showed a significantly lower systolic EI and a significantly higher incidence of RV MPI > 0.38 and TAPSE < 0.5 cm than patients without PH. The incidence of symptomatic early PH was highest in severe BPD, although this was not statistically significant. Early echocardiographic parameters are not associated with BPD development. Patients with severe BPD showed a significantly higher RV MPI and a significantly higher incidence of RV MPI > 0.38 than patients with mild BPD, and a significantly lower systolic EI and a significantly higher incidence of systolic EI < 0.81 than patients without BPD. CONCLUSION: Systolic EI, RV MPI, and TAPSE were well represented symptomatic early PH, while systolic EI and RV MPI could be useful parameters for identifying late PH in preterm infants with BPD, even if they did not present PH symptoms.
Birth Weight ; Bronchopulmonary Dysplasia* ; Echocardiography* ; Heart Ventricles ; Humans ; Hydrogen-Ion Concentration ; Hypertension, Pulmonary* ; Incidence ; Infant, Newborn ; Infant, Premature* ; Parturition ; Pregnancy ; Premature Birth ; Tricuspid Valve Insufficiency

Norfloxacin is a new broad spectrum of antibacterial activity against both Gram-positive and Gram. negative bacteria. After oral administration of Norfloxacin, it produces high concentrations in the urine, so it has the excellent effect for the treatment of urinary tract infection. Norfloxacin was studied with respect to clinical effect in 115 patients with the urinary tract infection and the following results were obtained. 1. Excellent efficacy was 53% and efficacy rate was 90% in upper urinary tract infection(UTI). Efficacy rate for 20 patients with upper UTI without the underlying disease was 100%, and in 29 patients with underlying disease efficacy rate was 83%. 2. In upper UTI resistant for other antibiotics, efficacy rate was 78%. 3. In lower UTI excellent efficacy rate was 36% and efficacy rate was 71%. In gonococcal urethritis excellent efficacy rate was 76% and efficacy rate was 88%. 4. Eliminated rate of bacteria on culture findings were E. coli 93%, pseudononas 89%, proteus 100%, klebsiella 80%, gonococcus 88% and staphylococcus 80%. 5. Mild side effects such as epigastric pain, nausea, dizziness and itching sensation were seen in 5 cases. We consider Neutam-400 is one of the most effective agents in urinary tract infection.
Administration, Oral ; Anti-Bacterial Agents ; Bacteria ; Dizziness ; Humans ; Klebsiella ; Nausea ; Neisseria gonorrhoeae ; Norfloxacin ; Proteus ; Pruritus ; Sensation ; Staphylococcus ; Urethritis ; Urinary Tract Infections* ; Urinary Tract*

Testicular torsion in neonates is a urologic emergency with an incidence of 6.1 per 100,000 live births. Incarcerated inguinal hernia is also an emergency with an incidence of approximately 6% to 31% in children with inguinal hernia. Functional testicular torsion from an incarcerated inguinal hernia is a rare event in children, often not considered in the initial evaluation. A 19-day-old newborn boy was admitted to our neonatal intensive care unit after visiting a primary clinic. He presented with inconsolable crying and right scrotal swelling. Upon initial physical examination, a hard palpable mass and swelling was found in the inguinoscrotal region, accompanied with redness and warmth of the scrotum. Scrotal ultrasound with color Doppler showed inguinal hernia with strangulation and scanty blood flow to the testis. The patient underwent a right orchiectomy and partial resection of the affected small bowel. Surgical findings confirmed a testicular torsion and incarcerated inguinal hernia with testis with small bowel necrosis. Here, we report a rare case of a newborn with functional testicular torsion as a result of prolonged spermatic cord compression due to incarcerated inguinal hernia.

Intrahepatic stones are frequently associated with recurrent pyogenic cholangiohepatitis and complete surgical removal of the stones is almost always difficult because of the large number of stones and associated bile duct strictures. One hundred and seventy-nine patients with retained intrahepatic stones underwent percuttaneous stone removal utilizing a preshaped angulated catheter and a Dormia basket under fluoroscopy with a combination of techniques including irrigation-suction. crushing of large stones. balloon dilatation of strictures and extracorporenal shock wave lithotripsy. The procedure was performed through a mature T-tube tract (177 patients) and a mature transhepatic tube tract (two patients). Stones were exclusively intrahepatic in 130 patients. whereas 49 patients also had stones in the common bile duct. In 91 (50.8%) of 179 patients. the stones were completely removed and in 36 (20.1%) patients most of the stones were removed. The overall success rate was 70.9% ngulation deformity. stricture of bile ducts and impacted stones were the factor most often responsible for failure, No significant complications were observed. Fluoroscopicalyy-guided percutaneous interventional procedures with a preshaped angulated catheter is an useful complementary procedure to surgery for patients with intrahepatic stones. the major benefits of an individually fitted angulated catheter are its safety and easy access to small peripheral bile ducts.
Bile Ducts ; Catheters* ; Common Bile Duct ; Congenital Abnormalities ; Constriction, Pathologic ; Dilatation ; Fluoroscopy ; Humans ; Lithotripsy ; Shock

This study was designed to evaluate the potential applications of magnetic resonance imaging for the diagnosis of early and sequential changes of acute renal ischemia. Renal isehmia was induced in seventeen rabbits by surgical ligation of the left renal artery. Magnetic resonance imaging(MRI) was performed with a 2.0T super conductive MR system and s pin-echo technique was used with echo times(TE) of 30 and 80 msec and repetition times(TR) or 0.5 and 2.5 seconds. Kidneys were evaluated before and up to 48 hours after left renal artery ligation, and the spin echo images were analyzed for intensity difference and T1, T2 relaxation times between the cortex and the medulla of both kidneys. After one, and one and half hour following ligation of the left renal artery, the kidneys showed a 4-20% decrease in the left cortex compared to the right cortex contrast uptake(CCC) (P<01). There was a 14-29% decrease in left medulla to right medulla contrast uptake(MMC) (P<01). A 29-147% increase in contrast uptake was noted when the left cortex was compared to the left medulla(P<05). There was a 51-68% decrease in CMC of the right kidney (P<05) on three different spin echo images. In the cortex of the left kidney, T2 relaxation time decreased 14% (P<01). CCC and MMC showed more prominent changes than CMC, and sequential changes of CCC and MMC were most prominent on T2 weighted images with TR = 2.5sec and TE=80msec when compared with T1 weighted and proton density weighted images. Twelve hours after renal arterial ligation. T2 relaxation time, CMC, CCC, and MMC returned to normal values and these findings were believed to be due to congestion and collateral blood supply. In renal ischemia, the most useful MRI findings for diagnosis were fund to be changes of CCC and MMC on T2 weighted image, and T2 relaxation time of the cortex in the ischemic kidney.
Diagnosis ; Estrogens, Conjugated (USP) ; Financial Management ; Ischemia* ; Kidney ; Ligation* ; Magnetic Resonance Imaging* ; Protons ; Rabbits ; Reference Values ; Relaxation ; Renal Artery*

This study was designed to evaluate the potential applications of magnetic resonance imaging for the diagnosis of early and sequential changes of acute renal ischemia. Renal isehmia was induced in seventeen rabbits by surgical ligation of the left renal artery. Magnetic resonance imaging(MRI) was performed with a 2.0T super conductive MR system and s pin-echo technique was used with echo times(TE) of 30 and 80 msec and repetition times(TR) or 0.5 and 2.5 seconds. Kidneys were evaluated before and up to 48 hours after left renal artery ligation, and the spin echo images were analyzed for intensity difference and T1, T2 relaxation times between the cortex and the medulla of both kidneys. After one, and one and half hour following ligation of the left renal artery, the kidneys showed a 4-20% decrease in the left cortex compared to the right cortex contrast uptake(CCC) (P<01). There was a 14-29% decrease in left medulla to right medulla contrast uptake(MMC) (P<01). A 29-147% increase in contrast uptake was noted when the left cortex was compared to the left medulla(P<05). There was a 51-68% decrease in CMC of the right kidney (P<05) on three different spin echo images. In the cortex of the left kidney, T2 relaxation time decreased 14% (P<01). CCC and MMC showed more prominent changes than CMC, and sequential changes of CCC and MMC were most prominent on T2 weighted images with TR = 2.5sec and TE=80msec when compared with T1 weighted and proton density weighted images. Twelve hours after renal arterial ligation. T2 relaxation time, CMC, CCC, and MMC returned to normal values and these findings were believed to be due to congestion and collateral blood supply. In renal ischemia, the most useful MRI findings for diagnosis were fund to be changes of CCC and MMC on T2 weighted image, and T2 relaxation time of the cortex in the ischemic kidney.
Diagnosis ; Estrogens, Conjugated (USP) ; Financial Management ; Ischemia* ; Kidney ; Ligation* ; Magnetic Resonance Imaging* ; Protons ; Rabbits ; Reference Values ; Relaxation ; Renal Artery*

BACKGROUND: Cardiogenic shock is the most common cause of in-hospital mortality after acute myocardial infarction. Despite improvement in coronary care, the in-hospital mortality rate of cardiogenic shock is very high in conventional conservative therapy. Recently, it was suggested that coronary angioplasty may reduce the mortality associated with cardiogenic shock. METHOD: Thirteen consecutive patients with cardiogenic shock who underwent coronary angioplasty were studied. Shock was not induced by mechanical complications, arrhythmia, hypovolemia and other reversible cause. We collected and analyzed the clinical, hemodynamic survivor groups. RESULTS: Of 13 patients, 11 had successful reperfusion of the infarct-related coronary artery and 2 had unsuccessful reperfusion. Of 11 patients with successful angioplasty, 8 survived at the time of hospital discharge. All patents with unsuccessful angioplasty died in the hospital. Therefore overall hospital survival rate was 62% and the rate increased to 73% in patients with successful reperfusion. Survivor and non-survivor groups in clinical, hemodynamic and angiographic variables were similar except systolic blood pressure and the presence of successful reperfusion. CONCLUSION: In patients with cardiogenic shock, the patency of infarct-related coronary artery was strongly associated with in-hospital mortality. This findings support aggressive interventional strategy in patient with cardiogenic shock complicating acute myocardial infarction.
Angioplasty ; Angioplasty, Balloon, Coronary* ; Arrhythmias, Cardiac ; Blood Pressure ; Coronary Vessels ; Hemodynamics ; Hospital Mortality ; Humans ; Hypovolemia ; Mortality ; Myocardial Infarction* ; Reperfusion ; Shock ; Shock, Cardiogenic* ; Survival Rate ; Survivors

BACKGROUND: Cardiogenic shock is the most common cause of in-hospital mortality after acute myocardial infarction. Despite improvement in coronary care, the in-hospital mortality rate of cardiogenic shock is very high in conventional conservative therapy. Recently, it was suggested that coronary angioplasty may reduce the mortality associated with cardiogenic shock. METHOD: Thirteen consecutive patients with cardiogenic shock who underwent coronary angioplasty were studied. Shock was not induced by mechanical complications, arrhythmia, hypovolemia and other reversible cause. We collected and analyzed the clinical, hemodynamic survivor groups. RESULTS: Of 13 patients, 11 had successful reperfusion of the infarct-related coronary artery and 2 had unsuccessful reperfusion. Of 11 patients with successful angioplasty, 8 survived at the time of hospital discharge. All patents with unsuccessful angioplasty died in the hospital. Therefore overall hospital survival rate was 62% and the rate increased to 73% in patients with successful reperfusion. Survivor and non-survivor groups in clinical, hemodynamic and angiographic variables were similar except systolic blood pressure and the presence of successful reperfusion. CONCLUSION: In patients with cardiogenic shock, the patency of infarct-related coronary artery was strongly associated with in-hospital mortality. This findings support aggressive interventional strategy in patient with cardiogenic shock complicating acute myocardial infarction.
Angioplasty ; Angioplasty, Balloon, Coronary* ; Arrhythmias, Cardiac ; Blood Pressure ; Coronary Vessels ; Hemodynamics ; Hospital Mortality ; Humans ; Hypovolemia ; Mortality ; Myocardial Infarction* ; Reperfusion ; Shock ; Shock, Cardiogenic* ; Survival Rate ; Survivors