Brachial plexus injury following median sternotomy / 대한마취과학회지

No abstract available.

Ceramic-on-Ceramic Bearing Total Hip Arthroplasty in Young Patients with Osteonecrosis of Femoral Head / 대한정형외과학회잡지

PURPOSE: To evaluate the short-term clinical and radiographic results associated with use of the ceramicon-ceramic articulation uncemented total hip arthroplasty (THA) in patients less than fifty years old with osteonecrosis of femoral head. MATERIALS AND METHODS: Sixty-eight THAs with use of the ceramic-on-ceramic articulation were performed in fifty-nine patients who were younger than fifty years old with the implantation of an uncemented plasma coated Plasma cup and Bicontact stem. All patients were available for complete clinical and radiographic analysis after a mean duration of a follow-up of 31.6 months (range; 24-50 months). The average age of the patients at the index operation was 39.4 years (range; 16-49 years). Preoperative diagnosis was osteonecrosis of femoral head in all hips. The causative factors were idiopathic in twenty-one hips; alcohol abuse in twenty-eight hips, steroid in eleven hips, and posttraumatic in eight hips. Clinical evaluation was done by Harris Hip score (HHS). Radiographic evaluation was done in terms of stability of components and prevalence of osteolysis. RESULTS: The mean preoperative HHS of 61 points improved to 95 points at the time of the final follow-up. Excellent results were found in 57 hips (84%), good results were 11 hips (16%). No acetabular or femoral components were loosened radiographically. There was no evidence of osteolysis. There were two postoperative dislocation, one intraoperative femoral fissuring, and one transient sciatic nerve palsy. CONCLUSION: Short-term clinical and radiographic results associated with use of the ceramic-on-ceramic articulation uncemented THA in patients less than fifty years old with osteonecrosis of femoral head were excellent. However, longer-term follow up is needed.

Grade III Tibia Open Fractures Treated with Unreamed Tibial Nailing

PURPOSE: This is a retrospective study to analyze the results of unreamed intramedullary nailing in grade III tibial open fracture. MATERIALS AND METHODS: Twenty-nine Gustilo-Anderson grade III tibial open fractures fixed with unreamed tibial nail were followed more than one year. Primary union rate, union time, infection, conversion to external fixation, ankle and knee function according to different grade of open, fracture level, AO classification, and muscle flap were evaluated. RESULTS: Primary union was achieved at sixteen fractures. There were three delayed union that achieved union twenty week after primary operation. And eight undergone secondary bone grafts which were done after inflammation sign subcided. Complications about infection were in five cases. Two cases were unable to maintain internal fixation due to deep infection, and three of superficial infection were treated with repeated debridement and antibiotics use. CONCLUSION: In grade III tibial open fracture, unreamed nailing with early soft tissue reconstruction and early prophylactic bone graft can be a good treatment.

Transcavernous Approach for Invasive Pituitary Adenoma

OBJECTIVE: Surgical management of invasive pituitary tumor is challengeable with conventional transsphenoidal approach(TSA) or pterional intradural approach alone. Gross total resection of pituitary adenoma influences its prognosis favorably, so transcavernous approach(TCA) is essential in invasive pituitary tumor. This study is performed to evaluate and analyze the surgical results of TCA in cases of invasive pituitary adenoma. METHODS: From November 1995 to May 2002, nine cases of invasive pituitary adenoma were treated. The authors reviewed medical records and radiological findings. Pterional transzygomatic or orbitozygomatic transcavernous approach was selected for tumors extended below or above the third ventricle floor respectively and intradural removal of tumor with suprasellar extension was combined. Surgical results including hormonal function, recurrence, completeness of tumor resection, and postoperative complications were evaluated and analyzed. RESULTS: Eight patients were treated with TSA followed by TCA and one with TCA alone. Total resection was achieved in seven cases, subtotal resection in one, and partial resection in one. Postoperative complications included temporary third nerve palsy in four cases and facial paresthesia in two. There was no recurrence during follow-up period. CONCLUSION: Transcavernous approach alone or combined with TSA is essential surgical procedure for total removal of invasive pituitary adenomas with acceptable morbidities.

the Effectiveness of Core Decompression for the Treatment of Early Osteonecrosis of the Femoral Head / 대한정형외과학회잡지

PURPOSE: To evaluate the effectiveness of core decompression according to anatomic location and extent of necrotic portion. MATERIALS AND METHODS: The authors reviewed 28 hips with a mean follow-up of 36 months. Cases were classified according to Steinberg, Ficat, Ohzono, Kerboul index, Koo's index, and lateral head index. Failure was defined radiographically as depression of the femoral head compared with the previous one , and clinically HHS lesser than 80. RESULTS: Radiographically, success rates were 15.8% (3/19) in Steinberg IIC, 15.8% (3/19) in Ficat IIA, 26.3% (5/19) in Ohzono 1C, 28.6% (6/21) in Kerboul index greater than 250, 30.4% (7/23) in Koo's index greater than 40, and 15% (3/20) in lateral head index smaller than 12%. Clinically, success rates were 26.3% (5/19) in Steinberg IIC, 26.3% (5/19) in Ficat IIA, 36.8% (7/19) in Ohzono 1C, 38.1% (8/21) in Kerboul index greater than 250, 39.1% (9/14) in Koo's index greater than 40, and 25% (5/20) in lateral head index smaller than 12%. CONCLUSION: Core decompression was ineffective in preventing the collapse of the femoral head for the lesions with diffuse involvement and located laterally at weight- bearing portion, even though in the early stage of osteonecrosis, there was no collapse of the femoral head.

A Case of Crescentic Glomerulonephritis Associated with Bacterial Endocarditis / 대한신장학회잡지

A 25-year-old male presented with mitral insufficiency, perimembranous type of ventricular septal defect, pulmonary edema and renal insufficiency. The initial serum creatinine level was 16.2mg/dl. Blood cultures were positive for Streptococcus viridans and appropriate antibiotic therapy was initiated. Renal biopsy revealed diffuse proliferative glomerulonephritis with crescents involving all of the glomeruli. Even after adequate duration of treatment with antibiotics, surgical therapy, and high dose steroid therapy, renal function did not recover and the patient ended up with continuous ambulatory peritoneal dialysis. We present a case of crescentic glomerulonephritis associated with bacterial endocarditis with a review of the literature.

One - staged Saucerization and Cancellous Chip Allograft for Treatment of Chronic Localized Osteomyelitis / 대한정형외과학회잡지

Treatment of chronic localized osteomyelitis is the same as the other osteomyelitis, that is, curettage and debridement of all dead tissue which is called saucerization. After saucerization there leaves empty cavity and autogenous bone graft has been used for filling the cavity in lower extremity hecause of weight bearing and avoiding fracture. We treated seven cases of chronic localized osteomyelitis with one-staged saucerization and cancellous chip allograft and retrospective analysis was done. All healed without complication and no recurrence was ohserved. Most orthopaedic surgeons are not willing to use allograft on the site of osteomyelitis because of the fear of recurrence. But. we think that as far as complete removal of infected and dead tissue, allograft could he a good solution in terms of rapid remodelling and early weight hearing. Another advantages of allograft are to get a large amount of bone and no damage of iliac apophysis. In summary, one-staged saucerization and cancellous chip allograft would he very useful treatment for chronic localized osteomyelitis.

Biomechanical Study about Strength and Strain of Pretwist on Properties of Canine Central 1/3 Patellar Tendon / 대한정형외과학회잡지

Pretwisting the patellar tendon graft has been advocated hy many authors. Lambert has described a 90 degrees pretwist to benifit the fat pad vascular supply as well as to "" simulate the helicoid course of the ACL "". This technique has also been recommended to fascilitate fixation. Jackson has recommended a 90 pretwist to decrease the possibility of abrasive wear on the tunnel edge, and also to fascilitate fixation as much as a 180 degrees pretwist has heen recommended. However, in spite of all these recommendations, little work has been done on the effect of such pretwisting on the biomechanical behavior of patellar tendon grafts. The purpose of this study is to discover, by experiment, the effects of a 360 degrees external rotation pretwist on the following tensile mechanical properties of canine central 1/3 patellapatellar tendon-tibia complex : (a) ultimate stress, (b) ultimate strain, (c) average elastic modulus, and (d) strain energy density. Five groups of each S specimens were divided as group 1 (0 degrees external rotation), group 2 (90 degrees external rotation). group 3 (180 degrees external rotation), group 4 (270 degreesexternal rotation), and group 5 (360 degrees external rotation). The direction of pretwist meant the twist of tibia around patella. The effects of pretwist were analyzed using parameter one-way analysis of variance (ANOVA)(P1) and nonparameter Kruskal-Wallis one-way analysis of variance (ANOVA)(P2) with repeated measures followed by Scheff multiple comparison test. A p values of < 0.05 was considered statistically significant. Among each groups ultimate stress (P1=0.059, P2=0.095), ultimate strain(P1=0.154, P2=0. l65), and average elastic modulus(P1=0.814, P2=0.818) were not statistically significant. Only strain energy density was the statistically significant difference between group 2 and group 5(P1=0.008, P2=0.022). As a result, there were observed that the ultimate stress and strain energy density were decreased and ultimate strain was decreased but there were not statistically significant differences hetween groups because of the small number of samples, and there will be advantages for graft to avoid ahrasive wear on the tunnel edge and lateral femoral condyle. But, more studies are needed for human being in the future.

The Use of Calcium Sulfate as a Bone Substitute / 대한정형외과학회잡지

Bone defect occurs due to various causes, such as neoplasms, cysts, trauma, infection, congenital disease and surgical intervention. Autograft is generally considered to be the gold standard in bone graft surgery. But, allograft, xenograft and bone substitutes have been used because of complication and limited quantity of autograft. Calcium sulfate is one of the bone substitutes. We reviewed and analyzed 18 cases with bone defects that were treated with calcium sulfate from January 1997 to April 1997. We used the Osteoset' pellets that contained calcium sulfate 98%, produced by Wright Medical Technology Inc. in U.S.A., to fill defects in all cases. Except in 2 cases, autogenous cancellous bone from patients own iliac crest was mixed with calcium sulfate from 30% to 50%. Follow-up time averaged 13.7 months(range, from 12 to 15 months). The degree of absorption of calcium sulfate and new bone growth at conventional roentgenography was represented by percentage at each follow-up. The results were as follows. First, 8 weeks after operation, 93% of calcium sulfate was absorbed. Second, 6 months after operation, nearly 90% of new bone growth was observed. Third, until last follow-up, there was no noticeable complication, such as infection or foreign body reaction. We concluded that calcium sulfate might be on effective material for bone defects because of rapid absorption rate and easy recognition of new bone growth.

Clinical Analysis of the Factors Affecting the Growth or Rebleeding of Spontaneous Intracerebral Hemorrhages

The growth or rebleeding of the spontaneous ICH is catastrophic so that prevention of them is critical in management. We reviewed 233 cases of spontaneous ICH from Jan. 1990 to Dec. 1994 to evaluate the factors associated with the hematoma enlargement. The relationship among the admission time from hematoma onset, the systolic BP at admission, hemostatic parameter, liver dysfunction with rebleeding incidence were assessed. Also, hematoma shape, density, site, volume, and operation tiem from hematoma onset were evaluated. Hematoma growth was oserved at 26 patients(11.6%). Incidence of rebleeding was significantly associated in patients with shorter admission time from hematoma onset, high systoic BP at admission, inhomogenous, irregular-shaped hematoma at CT and liver dysfunction. The incidence of hematoma growth was higher in the early operation group but there was no significant relationship in statistic analysis. Patients admitted within 6 hours of hematoma onset, with irregular-shaped, inhomogenous hematoma on CT, and liver dysfunction should be observed closely for the enlargement of hematoma. The operation time might be delayed at least 6 hours after hematoma onset.

Exophthalmos in Chronic Epidural Hematoma: Case Report

A case of chronic epidural hematoma in the left frontal region is presented. The patient presented with a unique neurologic sign, exophthalmos, which was not a result of the injury but of in-growth of granulation tissue of the hematoma capsule into the orbit through the orbital roof defect. The time interval between head injury and the operation was about 25 years. Our case represent the second most longest time interval among the reviewed literatures.