Complete fractures of radial neck or proximal radial epiphysis with 90° displacement are very rare, and only several cases were reported in the literatures. We have experienced 2 cases of radial neck fracture with 90° posterior displacement and one case with anterior displacement. All of them were treated operatively. We followed up these 3 cases more than 15 months and report the results with review of literatures.
Child ; Epiphyses ; Humans ; Neck

BACKGROUND: Bupivacaine is a amide type local anesthetic agent, widely used for its excellent quality of analgesia and long duration of action. But unintended intravenous injection causes severe complication such as convulsion and cardiovascular collapse, which is known for its difficulty in resuscitation. With all the study, the exact mechanism is still unclear and there are much debate on the method of resuscitation. METHOD: We studied the effect of clonidine pretreatment on bupivacaine-induced cardiac toxicity and resuscitation in anesthetized dog. Twelve dogs were divided into two groups. : saline pretreatment group (control, N=6) and clonidine pretreatment group (clonidine group, N=6). The dogs were anesthetized with N2O-O2-enflurane and vecuronium. Thoracotomy was done in 4th or 5th intercostal space for open cardiac massage. After confirming stability of vital signs, we administered clonidine (10 mcg/kg) or saline, and then administered bupivacaine with the rate of 2 mg/kg/min. When the electeocardiogram showed asystole, 20 mcg/kg of epinephrine was administered via central venous line and open cardiac massage with the rate of 120 beat/min. was performed. We observed electrocardiogram (lead II), arterial blood pressure, heart rate, dose of infused bupivacaine to be required for QRS widening and arrest, required time and administered dose of epinephrine for resuscitation. RESULTS: Clonidine group showed significant decrease of heart rate after pretreatment (p<0.05). There was no significant difference in required dose for QRS widening between two groups. The dose administered for inducing arrest was less in clonidine group than control group (p<0.05). The time required for resuscitation was shorter in clonidine group than control group (p<0.05). The total dose of epinephrine required for resuscitation was less in clonidine group than control group (p<0.05). The blood concentration of catecholamine did not showed significant difference during the whole course of experiment. CONCLUSIONS: Above results demonstrated that clonidine, a central nervous system-mediated sympatholytic agent, facilitated cardiac arrest when bupivacaine was infused intravenously and cardiac rescucitation.
Analgesia ; Animals ; Arterial Pressure ; Bupivacaine ; Clonidine* ; Dogs* ; Electrocardiography ; Epinephrine ; Heart Arrest ; Heart Massage ; Heart Rate ; Injections, Intravenous ; Resuscitation* ; Seizures ; Thoracotomy ; Vecuronium Bromide ; Vital Signs

Anesthesia, General ; Cleft Palate ; Congenital Abnormalities ; Electrocoagulation ; Emergencies ; Fistula ; Hemorrhage ; Humans ; Infant ; Critical Care ; Palate, Soft ; Shock ; Uvula ; Wounds and Injuries

BACKGROUNDS: Though they are considered as reliable devices, titanium plates and screws have limitations due to some potential problems. To overcome these problems, researches on bioabsorbable materials for internal fixation have been continuing. Recently, there are many clinical trials to apply biodegradable internal fixation devices in oral and maxillofacial surgery. The purpose of this study was to evaluate the clinical results of application of bioabsorbable plates and screws in orthognathic surgery. METHODS: Fifty-four patients with dentofacial deformity (17 male patients and 37 female patients) were selected in this study. The patients were treated by internal fixation using bioabsorbable plates and 2.4-mm, 2.0-mm pretapped screws (Biosorb FX, Bionix Implants, Inc., Finland). The patients were evaluated for complications during the follow-up period. RESULTS: Five patients (9.3%) experienced complications. All complications in these cases were infection. No other complications related with physical or mechanical properties of bioabsorbable plates were found such as malunion or nonunion, fractures of plates and loosening of screws. All complications were minor and adequately managed with drainage and supportive care with antibiotics coverage. CONCLUSIONS: From the results, the use of these fixation systems in orthognathic surgery will provide a promising alternative titanium fixation in appropriate cases.
Anti-Bacterial Agents ; Dentofacial Deformities ; Drainage ; Female ; Follow-Up Studies ; Humans ; Internal Fixators ; Male ; Orthognathic Surgery* ; Surgery, Oral ; Titanium

Ankylosis ; Arthritis ; Arthroplasty ; Diagnosis ; Follow-Up Studies ; Humans ; Male ; Mouth ; Temporomandibular Joint Disorders ; Temporomandibular Joint

OBJECTIVE: Spasticity has been reported to be one of the common complications in patients with spinal cord injury. The purposes of this study were to investigate the proper dosage, the therapeutic and undesirable effects of clonidine with combined used of baclofen for the management of spasticity. METHOD: A prospective study was performed for 17 patients with spinal cord injury who did not improve spasticity with 80 mg baclofen administration. The degree of spasticity was assessed in the more-affected knee by modified Ashworth scale, pendulum test at pre-treatment and at 7 days after receiving clonidine. We also investigated the complications and subjective satisfaction. RESULTS: Seven of 13 patients with spinal cord injury showed subjective improvement in spasticity. We found significant improvement in the relaxation index by pendulum test after administration of more than 0.3 mg of clonidine. There was no significant difference between the subgroups depending on the extent of spinal cord injury. We didn't find any serious complication in adjuvant clonidine therapy. CONCLUSION: Adjuvant clonidine therapy can be effective in spasticity of spinal cord injured patients without serious complication.
Baclofen ; Clonidine* ; Humans ; Knee ; Muscle Spasticity* ; Prospective Studies ; Relaxation ; Spinal Cord Injuries* ; Spinal Cord*

Arthroplasty ; Diagnosis ; Ear Canal ; Hearing Disorders ; Hearing ; Humans ; Male ; Mouth ; Noise ; Temporomandibular Joint

BACKGROUND: In intravenous administration of a depolarizing neuromuscular blocker, succinylcholine is reported to produce activation of the electroencephalogram and increase cerebral blood flow and intracranial pressure. In this point, rocuronium was recently introduced as a non-depolarizing relaxant, and recommended as a safe alternative to succinylcholine. The purpose of this study was to evaluate the effects of rocuronium and succinylcholine on cerebral blood flow velocities during anesthetic induction. METHODS: Forty patients were randomly assigned into two groups. Group 1 was administrated rocuronium 0.6 mg/kg and group 2 was administrated succinylcholine 1 mg/kg for tracheal intubation after each group had intravenous administration of thiopental 5 mg/kg. The author observed changes of mean arterial pressure, arterial carbon dioxide tension, and middle cerebral arterial blood flow velocities at 5 times: before induction (control), 30 sec after thiopental administration, 30 sec, 60 sec and 90 sec after muscle relaxant administration. RESULTS: Mean arterial pressure decreased more at 30 sec after thiopental administration compared with the control (P<0.05). Middle cerebral arterial blood flow velocities were reduced at 30 sec after thiopental administration and 60 sec after rocuronium administration compared with the control (P<0.05). Middle cerebral arterial blood flow velocities were reduced at 30, 60, 90 sec after rocuronium administration compared with succinylcholine administration (P<0.05). CONCLUSIONS: We conclude that rocuronium has little effects on increasing cerebral blood flow. These result suggest that rocuronium have a less effect on increase in cerebral blood flow during neurosurgical anesthesia.
Administration, Intravenous ; Anesthesia ; Arterial Pressure ; Blood Flow Velocity* ; Carbon Dioxide ; Electroencephalography ; Humans ; Intracranial Pressure ; Intubation ; Neuromuscular Blockade ; Succinylcholine* ; Thiopental

Since 1920, when Harvey Cushing first used radiofrequency in electrosurgery, the procedural technique has developed rapidly. Even though this procedure is minimally invasive and safer than other neurodestructive procedures, it is still not free of complications. A 72-year-old female patient had constant facial pain, despite several operations and radiotherapies for her maxillary cancer. The region innervated ophthalmic branch and maxillary branch of the trigeminal nerve was involved, with radiofrequency procedure of the gasserian ganglion for pain control also performed at the area. After the procedure, her blood pressure became elevated and she complained of a headache, and six hours later, she became irritable and distracted. Bacterial meningitis was diagnosed by a spinal tap, with third-generation cephalosporin administered as the treatment. The following day, her symptoms had improved and the pain was also reduced. She was discharged from hospital after 14 days, without any sequelae.
Aged ; Blood Pressure ; Electrosurgery ; Facial Pain ; Female ; Headache ; Humans ; Meningitis ; Meningitis, Bacterial* ; Radiotherapy ; Spinal Puncture ; Trigeminal Ganglion ; Trigeminal Nerve

Acute fatty liver of pregnancy is a uncommon complication of late pregnancy which may progress to hepatic failure, encephalopathy, disseminated intravascular coagulopathy, and death. A 65 kg 29-yr-old female at 35 weeks gestation complained of epigastric discomfort and jaundice 5 days before adimission. She had icteric sclera but other physical findings were non-specific. Anesthetic induction was achieved with thiopental, succinylcholine and vecuronium and the trachea was easily intubated. Maintenance of anesthesia was accomplished with oxygen : nitrous oxide (3 : 2) and 0.8% isoflurane. The Apgar scores were 8 and 10 at 1 min and 5 min, respectively. After the end of surgery, the patient was awakened and she was extubated after she followed verbal commands. She remained stable during her immediate postoperative course, but her vital signs were worse suddenly on postoperative day 3. On postoperative day 5, she was supported by artificial ventilation. The prothrombin time and the partial thromboplastin time were prolonged. Dopamine, dobutamine and norepinephrine were administered for maintaining her cardiovascular function. After that she was managed with artificial ventilation, cardiovascular drugs, fluid and blood products due to multi-organ failure. On postoperative day 25, she expired due to an acute cardiac arrest which was suspected to be due to multi-organ failure.
Anesthesia ; Anesthesia, General ; Cardiovascular Agents ; Cesarean Section ; Dobutamine ; Dopamine ; Fatty Liver* ; Female ; Heart Arrest ; Humans ; Isoflurane ; Jaundice ; Liver Failure ; Nitrous Oxide ; Norepinephrine ; Oxygen ; Partial Thromboplastin Time ; Pregnancy* ; Prothrombin Time ; Sclera ; Succinylcholine ; Thiopental ; Trachea ; Vecuronium Bromide ; Ventilation ; Vital Signs