Eighty four patients with 104 calcaneal fractures which were treated at the dept. of orthopaedic surgery, Inchon Christian Hospital from October, 1979 to September, 1983 were clinically analysed and the results were as follows; 1. 72 patients were male and 12 patients were female. The male were more injuried in the ratio of 6:l. 2. Their ages were ranged from 6 yrs. to 66 yrs. (average; 35.4 yrs.) and the half of the patients were occured at the 3rd and 4th decade. They admitted for average 7.6/7 weeks. 3. The main cause was a fall from a height in 62 patients (73.8%) and its average height was 4.5m. 4. The open fractures were occured in 13 feet (12.5%) and the spine fracture was associated in 16 patient (19%). 5. The 104 cases were classified according to the Rowe and Essex-Lopresti classification. Fractures involving subtalar joint were 74 feet (71.2%) and the Rowes type V were 58 feet(55.8%). 6. The 22 cases were treated by elosed reduction and axial pin fixation, 10 cases were treated by open reduction and the subtalar fusion was done at 2 cases. Others were treated by cast immobilization with or without closed reduction. The satisfactory result was obtained in 64 cases(61.5%). 7. The most common problem after any treatment was persistent foot pain, especially beneath the lateral malleolus.
Calcaneus ; Classification ; Clinical Study ; Female ; Foot ; Fractures, Open ; Humans ; Immobilization ; Incheon ; Male ; Spine ; Subtalar Joint

Skeletal Class III malocclusions are growth-related discrepancies, and the problems are more severe until growth is complete. Causes of skeletal Class III malocclusion are classified into mandibular overgrowth, maxillary deficiency, and combination of the two. Face mask has been recommended for treatment of Class M malocclusion with maxillary deficiency in the early time of growth. Numerous experiments were performed and clinical studies have been reported on face mask ; nevertheless, studies on profile changes and stability after treatment of face mask are considered to be somewhat insufficient. The author selected 50 patients who can be checked for follow-up. They had been diagnosed as skeletal Class III malocclusion with maxillary deficiency and then treated with face mask ; the sample group was divided according to sex, treatment beginning age, palatal suture opening(intraoral appliance). For each group, changing pattern of facial profile and stability of treatment observed, and comparison with 20 Korean normal children(Angle's Class I ). The following results were obtained. 1. Skeletal, dental, and soft tissue measurements indicated more changes in the amounts of maxillary forward movement during face mask treatment. 2. R.P.E. group showed more significant maxillofacial changes and La-Li group showed more dental changes. 3. Growth changes of maxilla induced in the treatment group during wearing face mask were much more than those of normal group. 4. Growth changes of maxilla in the treatment group after treatment of face mask were less than those of normal group. From the obtained data, it can be concluded that. there was a stimulative effect on forward growth of maxilla during the use of face mask however, on removal of face mask, the stimulative effect was eliminated and undergrowth tendency of maxilla resumed.
Follow-Up Studies ; Humans ; Malocclusion ; Masks* ; Maxilla ; Sutures

The aim of this study was to assess the adaptive changes in plasma level of atrial natriuretic peptide(ANP) and its atrial mRNA expression in experimental rat model of chronic renal failure(CRF). Male Sprague-Dawley rats weighing 250-300g were divided into control rats, sham operated rats and 5/6 nephrectomized rats. CRF was induced by 5/6 nephrectomy, in that two thirds of the left kidney was ligated and the contralateral kidney was removed 1 week later. In the rats with 2/3 pole ligation, there were no significant changes in mean arterial pressure(MAP), heart rate, BUN and serum creatinine compared to sham operated rats. Expression of atrial ANP mRNA showed initially higher values and plasma renin activity(PRA) was lower than the sham operated rats. After 5/6 nephrectomy, MAP, heart rate, BUN and serum creatinine increased, and PRA showed the sustained lower values than the control rats. The changing pattern of plasma ANP level was similar to the that of ANP mRNA expression that showed biphasic peaks with the first increase at 1 to 3 days and the second increase at 28 days after nephrectomy. There were a significant positive correlation between plasma ANP level and MAP, and a negative correlation between plasma ANP and PRA. These results suggest that the secretion and the synthesis of ANP respond rapidly to the reduced renal mass, and ANP may play an important regulatory role during the renal adapting process in rats with experimental CRF.
Animals ; Atrial Natriuretic Factor* ; Creatinine ; Heart Rate ; Humans ; Kidney ; Kidney Failure, Chronic* ; Ligation ; Male ; Models, Animal ; Nephrectomy ; Plasma* ; Rats* ; Rats, Sprague-Dawley ; Renin ; RNA, Messenger*

PURPOSE: Acute aortic diseases, such as aortic dissection and aortic aneurysm, can be life-threatening vascular conditions. In this study, we compared outcomes before and after the implementation of a critical pathway (CP) for patients with acute aortic disease at the emergency department (ED). MATERIALS AND METHODS: This was a retrospective observational cohort study. The CP was composed of two phases: PRE-AORTA for early diagnosis and AORTA for prompt treatment. We compared patients who were diagnosed with acute aortic disease between pre-period (January 2010 to December 2011) and post-period (July 2012 to June 2014). RESULTS: Ninety-four and 104 patients were diagnosed with acute aortic disease in the pre- and post-periods, respectively. After the implementation of the CP, 38.7% of acute aortic disease cases were diagnosed via PRE-AORTA. The door-to-CT time was reduced more in PRE-AORTA-activated patients [71.0 (61.0, 115.0) min vs. 113.0 (56.0, 170.5) min; p=0.026]. During the post-period, more patients received emergency intervention than during the pre-period (22.3% vs. 36.5%; p=0.029). Time until emergency intervention was reduced in patients, who visited the ED directly, from 378.0 (302.0, 489.0) min in the pre-period to 200.0 (170.0, 299.0) min in the post-period (p=0.001). The number of patients who died in the ED declined from 11 to 4 from the pre-period to the post-period. Hospital mortality decreased from 26.6% to 14.4% in the post-period (p=0.033). CONCLUSION: After the implementation of a CP for patients with acute aortic disease, more patients received emergency intervention within a shorter time, resulting in improved hospital mortality.
Acute Disease ; Adult ; Aged ; Aneurysm, Dissecting/diagnosis/mortality/*surgery ; Aorta ; Aortic Aneurysm/diagnosis/mortality/*surgery ; Aortic Diseases/diagnosis/mortality/*surgery ; *Critical Pathways ; Emergency Service, Hospital/*organization & administration ; Female ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Outcome and Process Assessment (Health Care) ; Postoperative Complications/mortality ; Republic of Korea/epidemiology ; Retrospective Studies ; Time Factors ; Treatment Outcome ; Vascular Surgical Procedures/*methods

BACKGROUND: Redo coronary artery bypass grafting (CABG) is still associated with increased morbidity and mortality as compared to the first-time operation. Further, the application of the off-pump technique to redo CABG is limited due to technical difficulties. The aim of this retrospective study was to analyze early and midterm results after redo CABG and compare the outcome of redo on-pump and off-pump CABG. METHODS: From June 1996 to October 2011, elective redo CABG was performed in 32 patients. Mean age was 64.8 years (on pump 64.3 years vs. off pump 65.5 years; p=0.658), and 21 patients were male. Among these patients, 14 (43.8%) underwent on-pump CABG, and 18 (56.2%) underwent off-pump CABG. RESULTS: Internal thoracic artery was used in 22 patients (68.8%), and total arterial revascularization was achieved in 17 patients (53.1%). The average number of distal anastomoses was 2.13, and the rate of incomplete revascularization was 43.8%. The rate of total arterial revascularization was higher in the off-pump group (14.3% vs. 83.3%, p<0.001), and the use of saphenous vein graft was more in the on-pump group (78.6% vs. 16.7%, p<0.001). Overall hospital mortality was 3.1% (n=1) and was comparable in both groups (on pump 7.1% vs. off pump 0%; p=0.249). Postoperative complications occurred in 9 patients (64.2%), and the rate of complications was high in the on-pump group without statistical significance (64.2% vs. 33.3%, p=0.082). The mean follow-up duration was 5.4 years, and overall survival at 10 years was 86.0%+/-10.5%. There was no significant difference in the 10-year survival rate between the two groups (79.6% vs. 100%, p=0.225). CONCLUSION: Redo CABG can be safely performed with acceptable mortality. Redo off-pump coronary artery bypass is feasible with low mortality and morbidity, comparable target vessel bypass grafting, and long-term survival. The off-pump technique might be considered a safe option for redo CABG in high-risk patients.
Coronary Artery Bypass* ; Coronary Artery Bypass, Off-Pump ; Follow-Up Studies ; Hospital Mortality ; Humans ; Male ; Mammary Arteries ; Mortality ; Postoperative Complications ; Reoperation ; Retrospective Studies ; Saphenous Vein ; Survival Rate ; Transplants

OBJECTIVE: The purpose of this study is to investigate the prognostic role of pretreatment anemia in patients with early cervical cancer who underwent radical hysterectomy. METHODS: In this study, we retrospectively enrolled patients with early cervical cancer (International Federation of Obstetrics and Gynecology stage IB to IIA) who were treated at Samsung Medical Center, Seoul, Korea, from 1996 to 2007. RESULTS: We retrospectively enrolled 805 patients. Median pretreatment hemoglobin (Hb) level was 12.8 g/dL (4.0-16.9) in all patients. Ninety-ninth out of 805 patients had pretreatment anemia (12.3%). Pretreatment anemia was significantly associated with large tumor size, advanced clinical stage, and parametrial invasion. In multivariate analysis, higher pretreatment Hb entailed better prognostic significance in disease free survival (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.078-0.99) but not in overall survival (HR, 0.94; 95% CI, 0.80-1.10). CONCLUSION: In conclusion, we found that the negative association between pretreatment Hb level and tumor size and the impact of anemia before treatment on disease free survival adjusted for other factors including clinical stage and pathological findings in early stage cervical cancer.
Anemia ; Disease-Free Survival ; Gynecology ; Humans ; Hysterectomy ; Korea ; Multivariate Analysis ; Obstetrics ; Prognosis ; Retrospective Studies ; Seoul ; Uterine Cervical Neoplasms*

OBJECTIVE: Adhesion barrier has been commonly used in gynecologic surgery. The objective of this study is to evaluate the outcome of applying adhesion barrier in preventing adhesion formation after laparoscopic surgery. METHODS: Between March 2000 and March 2010, we retrospectively reviewed the medical records of patients who performed laparoscopic surgery twice at Samsung Medical Center. The patients to whom adhesion barrier was applied at the end of the first laparoscopic surgery and had imaging files of pelvic cavity at second laparoscopic surgery were included. The patients with recurrent endometriosis and pelvic inflammatory disease which can make postoperative adhesion by itself due to the nature of the disease were excluded. RESULTS: Ten patients were eligible to be analyzed. Only 3 among 10 showed adhesion free and we could find de novo adhesion formation in 7 patients at second laparoscopic surgery. Eight patients used Intercede(R) (oxidized regenerated cellulose mesh; Johnson & Johnson, New Brunswick, NJ, USA) and two patients used Guardix(R) (sodium hyaluronic acid solution and carboxymethylcellulose: Hanmi, Seoul, Korea). In six patients, adhesion formation was found at the operation site and one patient showed postoperative adhesion distant from operation site between omentum and anterior peritoneum of pelvic wall. CONCLUSION: We observed adhesion formation despite of prior use of adhesion barrier after laparoscopic gynecological surgery. These results suggest that the use of adhesion barrier alone after gynecologic laparoscopic surgery may not guarantee adhesion prevention.
Cellulose ; Endometriosis ; Female ; Gynecologic Surgical Procedures ; Humans ; Hyaluronic Acid ; Laparoscopy ; Medical Records ; New Brunswick ; Omentum ; Pelvic Inflammatory Disease ; Peritoneum ; Retrospective Studies

Unilateral pulmonary artery hypoplasia (UPAH) is a rare disease in adults and is frequently accompanied by a congenital cardiac anomaly at a young age. The diagnosis is usually based on computed tomography (CT), angiography, and magnetic resonance imaging (MRI). However, no reports are available on retrograde flow in patients with UPAH. We describe a 68-year-old man with isolated UPAH and retrograde blood flow. He was admitted for dyspnea on exertion for the past 23 years. His diagnosis was delayed, as his symptoms and signs mimicked his underlying pulmonary diseases, such as emphysema and previous tuberculous pleurisy sequelae. A discrepancy was detected between the results of a ventilation-perfusion scan and the CT image. This was resolved by MRI, which showed retrograde blood flow from the right to the left pulmonary artery. Using MRI, we diagnosed this patient with isolated pulmonary artery hypoplasia and retrograde flow.
Adult ; Aged ; Angiography ; Dyspnea ; Emphysema ; Humans ; Lung Diseases ; Magnetic Resonance Imaging ; Pulmonary Artery ; Rare Diseases ; Regional Blood Flow ; Tuberculosis, Pleural

To present a case of successful robotic assisted radical trachelectomy. A nulliparous woman with early cervical cancer underwent a laparoscopic radical trachelectomy and pelvic lymphadenectomy with the da Vinci robot (Intuitive Surgical Inc., Sunnyvale, CA). After the pelvic lymph nodes were found negative on frozen section, the parametria, paracolpia and uterosacral ligaments were dissected transabdominally sparing the ascending branches of the uterine arteries. Cervical transection and vaginal closure were performed transvaginally. Surgical time was 450 min. No perioperative complications were noted. Robotic laparoscopic radical trachelectomy may bridge the gap between laparotomy and laparoscopy for radical trachelectomy.
Female ; Frozen Sections ; Humans ; Laparoscopy ; Laparotomy ; Ligaments ; Lymph Node Excision ; Lymph Nodes ; Operative Time ; Uterine Artery ; Uterine Cervical Neoplasms

OBJECTIVES: To determine the effectiveness and toxicity when levamisole was added to the adjuvant combination chemotherapy in patients with operable gastric cancer. METHODS: After en bloc resection of gastric cancer without gross or microscopic evidence of residual disease from April 1991 to December 1992, 100 patients were randomized to 6 months of 5-fluorouracil 1,000 mg/m2/day administered as continuous infusion for 5 days, cisplatin 60 mg/m2/day as intravenous infusion for 1 day with or without levamisole (50 mg every eight hours P.O for a period of three days every 2 weeks for 6 months). This chemotherapy treatment was begun within 2 to 4 weeks after the surgery. The chemotherapy consisted of discrete 5-day courses administered at 4-weeks intervals. All 100 patients are assessable. RESULTS: The fifty patients were assigned to each treatment group. There was no statistical difference and no bias in the distribution of characteristics of the 100 evaluable patients between the two groups. A total of 274 courses of treatment were given in the levamisole group and 260 courses of treatment in non-levamisole group. Eleven patients in each group did not finish planned 6 courses of treatment mainly due to non-compliance. At median follow up of 39 months, 32 patients relapsed 19 in the levamisole group and 13 in the non-levamisole group (p = 0.284). Twenty five patients died of relapsed diseases, 15 in the levamisole group and 10 in the non-levamisole group. The levamisole group tended to show more risk of overall death rate and recurrence than the non-levamisole group. However, this result was not statistically significant at 3 years. The treatment was well tolerated in both treatment groups. The grade 2-3 toxicities were nausea/ vomiting (levamisole, non-levamisole group; 31.7%, 29.3% of treatment courses respectively), diarrhea (7.6%, 8.4%), mucositis (11.6%, 12.3%), and leukopenia (9.8%, 9.6%). CONCLUSION: Levamisole had negative effects on disease-free survival and overall survival when added to adjuvant combination chemotherapy of cisplatin and 5-fluorouracil in patients with operable gastric cancer. Both treatment arms were generally well tolerated and the toxicity profile was similar with or without levamisole.
Adjuvants, Immunologic/administration & dosage* ; Adult ; Aged ; Antineoplastic Agents, Combined/therapeutic use* ; Antineoplastic Agents, Combined/adverse effects ; Cisplatin/administration & dosage ; Comparative Study ; Female ; Fluorouracil/administration & dosage ; Human ; Levamisole/administration & dosage* ; Male ; Middle Age ; Stomach Neoplasms/mortality ; Stomach Neoplasms/drug therapy*