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

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*

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

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

BACKGROUND: Intravenous injection of rocuronium is associated with withdrawal responses which are attributable to the pain from the injection of rocuronium. Several methods have been proposed to abolish and attenuate rocuronium-induced pain. We hypothesized priming dose of rocuronium could reduce withdrawal responses associated with administering a second large dose of rocuronium for tracheal intubation. We compared the efficacy of the priming dose technique of rocuronium with intravenous lidocaine as a pre-treatment for the prevention of withdrawal responses associated with rocuronium injection. METHODS: We recruited 150 patients aged between 18 and 60 years, ASA physical status 1 or 2, who were going to undergo elective surgery requiring general anesthesia. Patients were allocated into three groups. Group C received normal saline, Group L received lidocaine 1 mg/kg, and Group P received rocuronium 0.06 mg/kg 2 minutes before administering a second large dose of rocuronium for tracheal intubation. After the loss of consciousness, rocuronium 0.6 mg/kg was administered intravenously over 10 seconds for tracheal intubation. The withdrawal responses to the injection of rocuronium were evaluated. RESULTS: The incidence of withdrawal responses associated with rocuronium injection for tracheal intubation was 56, 50, 24% in group C, group L, and group P, respectively. The incidence of withdrawal responses was lower in group P than group C and group L, but there was no difference between group L and group C. CONCLUSIONS: Priming dose technique is a useful clinical method to alleviate withdrawal responses associated with rocuronium injection.
Administration, Intravenous ; Aged ; Androstanols ; Anesthesia, General ; Humans ; Incidence ; Injections, Intravenous ; Intubation ; Lidocaine ; Unconsciousness

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

BACKGROUND: Remifentanil combined with propofol is usually used to induce anesthesia. However, remifentanil and propofol depress the cardiovascular system. This study investigated the effects of a continuous infusion of remifentanil on the propofol dose and hemodynamics using the bispectral index (BIS) during anesthetic induction. METHODS: Sixty female ASA physical status class I or II patients, who were scheduled to undergo gynecologic surgery were randomly assigned to one of three groups (n = 20). Normal saline 20 ml/hr (Group S), remifentanil 0.25microgram/kg/min (Group 0.25), or remifentanil 0.5microgram/kg/min (Group 0.5) was infused intravenously. Propofol was administered slowly two minutes after administering remifentanil or normal saline. The heart rate, mean arterial pressure (MAP) and BIS were measured at baseline, preintubation and postintubation. RESULT: There were no significant differences in the changes in the BIS among the groups. The MAP and heart rate decreased at preintubation compared with baseline (P < 0.05). The MAP of Group 0.5 at postintubation was lower than that in the other groups (P < 0.05). The heart rate in all groups increased at postintubation compared with baseline (P < 0.05). The heart rate of Group 0.5 at postintubation was lower than that of Group S (P < 0.05). The propofol requirement for unconsciousness was lower in Groups 0.25 and 0.5 than in Group S. The propofol requirement in Groups S, 0.25 and 0.5 was 1.56+/-0.2 mg/kg, 1.07+/-0.2 mg/kg and 0.9+/-0.1 mg/kg, respectively. CONCLUSIONS: A combined injection of 0.5microgram/kg/min remifantanil with 0.9 mg/kg of propofol decreases the heart rate and MAP at preintubation without adverse effects and appropriately prevents the cardiovascular responses to tracheal intubation, and reduces the propofol dose needed for a loss of consciousness.
Anesthesia ; Arterial Pressure ; Cardiovascular System ; Female ; Gynecologic Surgical Procedures ; Heart Rate ; Hemodynamics* ; Humans ; Intubation ; Propofol* ; Unconsciousness