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Since the rectangular rod had been used by Eduardo R. Luque in 1979, many authors reported good results by this technique in low back arthrodesis. The advantages of this device are that the technique is relatively easy, the cost is cheaper than the other devices, and no special instruments are needed for application of this device. On the other hand, it has the disadvantage of possible neurologic damage while passing sublaminar wires. The rectangular rod functions fundamentally as a tension band that although it is strong in flexion, it is relatively weak in lateral bending or axial loading on the spine. From June, 1984 to June, 1988, the authors experienced 41 cases of rectangular rod instrumentation with sublaminar wiring in various low back conditions. And 30 cases of spondylolisthesis which could be followed for more than one year were analyzed. And the results obtained were as follows. l. Of 30 patients of spondylolisthesis, 7 cases(23.3%) were male and 23 cases(76.7%) were female. 2. 21 cases(70.0%) were isthmic type and 9 cases(30.0%) degenerative type. 3. 23 cases(76.7%) were in Grade I, 6 cases(20.0%) in Grade II and 1 cases(3.3%) in Grade III, according to Meyerding's classification. 4. At follow up examination, 18 cases(60.0%) were in excellent group, 8 cases(26.6%) in good, 2 cases(6.7%) in fair, according to Gill's criteria. Two cases(6.7%) of pseudoarthrosis were noted and these cases were classified in unsatisfactory group. 5. Rectangular rod with sublaminar wiring was not a good device for reduction of spondylolisthesis
Arthrodesis ; Classification ; Female ; Follow-Up Studies ; Hand ; Humans ; Male ; Pseudarthrosis ; Spine ; Spondylolisthesis

Torsade de pointes is a life-threatening, polymorphic ventricular tachycardia associated with prolongation of the QTc interval. Although torsade de pointes is found in many clinical settings, it is mostly drug induced. Similar problems have been described with nonsedating H1-selective antihistamines like terfenadine and astemizole. The increased risks of both H1-antihistamines were associated with exposure to supratherapeutic doses or concomitant exposure to the cytochrome P-450 inhibitors, ketoconazole, erythromycin and cimetidine. We report a 51-year-old woman with torsade de pointes and a long QTc interval caused by the combined use of terfenadine and itraconazole. After discontinuation of these drugs and treatments with electrical cardioversion and magnesium sulfate, torsade de pointes and prolonged QTc interval were no longer observed and she was discharged in good condition with a normal ECG. In conclusion, physicians should be aware that terfenadine and astemizole can cause torsade de pointes in rare cases.
Astemizole ; Cimetidine ; Cytochrome P-450 Enzyme System ; Electric Countershock ; Electrocardiography ; Erythromycin ; Female ; Histamine Antagonists ; Humans ; Itraconazole* ; Ketoconazole ; Magnesium Sulfate ; Middle Aged ; Tachycardia, Ventricular ; Terfenadine* ; Torsades de Pointes*

A case of survivor who showed alpha coma after an attempted suicide by hanging was reported. A 44 years old women was admitted to the hospital because of respiratory arrest following a hanging attempt on July 3, 1996. She was found pendant completely. On admission she was comatose and the pupils were not reactive to light. The systolic pressure was 100 mmHg, and diastolic pressure was 80mmHg and she had no self respiration and immediately an endotracheal intubation was instituted. After three hours from the onset, the weak spontaneous respiration was restored and the pupils reacted briskly to light. On the 1st day the brain computed tomography (CT) revealed no abnormal findings. An electroencephalogram (EEG) showed widespread alpha activity without occipital dominance a moderate amount of regular, 8 approximately 10 Hz, 10 approximately 30 microvolt potentials. This alpha rhythm had persisted until 24 hours from the onset. At 36 hours later she was still comatose, presenting flaccid quadriplegia with no responses to stimulations. On the 2nd hospital day she was drowsy and on the 3rd day she had become conscious. She showed gradual progress towards complete nerologic recovery. This is the first presentation of a survivor from alpha coma caused by anoxic encephalopathy following a hanging attempt in Korea.
Adult ; Alpha Rhythm ; Anoxia ; Blood Pressure ; Brain ; Coma* ; Electroencephalography ; Female ; Humans ; Hypoxia, Brain ; Intubation, Intratracheal ; Korea ; Pupil ; Quadriplegia ; Respiration ; Suicide ; Suicide, Attempted* ; Survivors*

BACKGROUND: Cardiac tamponade is associated with the expiratory increase and the expira-tory decrease in left ventricular filling flow. With Doppler echocardiography, we analyzed the respiratory variations of mitral and tricuspid inflows, and pulmonary and hepatic venous flows in patients with cardiac tamponade. METHODS: Respiratory hemodynamic changes in mitral and tricuspid inflows and pulmonary and hepatic venous flows were evaluated using Doppler echocardiography in 13 patients (6 men and 7 women; mean age 51+/-13 years) with large pericardial effusion and clinical cardiac tamponade, and compared the results with those of 11 control subjects (3 men and 8 women, mean age 53+/-13 years). Doppler examination was repeated after pericardiocentesis in 6 patients. RESULTS: Peak velocity of early diastolic mitral inflow (E velocity) decreased during inspiration compared with expiratory increase; the mean percentage change was 40%. Peak velocity of late diastolic mitral inflow (A velocity) decreased 13% during inspiration. E/A ratio decreased 31% during inspiration. Deceleration time (DT) and isovolumic relaxation time (IVRT) increased by 26% and 44%, respectively, during inspiration. But respiratory variations of tricuspid inflow were opposite to those of mitral inflow. Tricuspid E velocity increased during inspiration and decre-ased during expiration. The mean percentage change was 123%, which was larger than thte 40% of mitral inflow. The most characteristic findings of pulmonary venous flow during respiration were the expiratory increases of peak diastolic velocity (DV) and diastolic time-velocity integral (D-TVI). The mean percentage changes of peak systolic velocity (SV), DV and D-TVI during respiration were 27%, 45% and 53% respectively. In contrast, the SV and DV of hepatic venous flow increased during inspiration and decreased during expiration. The respiratory variations of peak systolic reverse flow velocity (SR) and peak diastolic reverse flow velocity (DR) were opposite to those of SV and DV. DR notably increased during expiration, and the mean percentage change was 61%. The ratio of RFI (Inspiratory reverse flow integral) to FFI (forward flow integral) of the tamponade group was 270%. The mean percentage changes of each parameters decreased after pericardiocentesis. CONCLUSION: Patients with cardiac tamponade showed inspiratory increases of diastolic tri-cuspid filling flow and hepatic forward flow. Expiratory increases included diastolic mitral filling flow, pulmonary venous systolic and diastolic flow, and hepatic venous reverse flow. Such res-piratory variations decreased after pericardiocentesis.
Cardiac Tamponade* ; Deceleration ; Echocardiography* ; Echocardiography, Doppler ; Female ; Hemodynamics ; Humans ; Male ; Pericardial Effusion ; Pericardiocentesis ; Relaxation ; Respiration

Mivacurium is mainly metabolized by plasma cholinesterase, whereas atracurium is removed by Hofman elimination. The purpose of this study was to compare the infusion rate of atracurium and mivacurium in maintaining surgical relaxation, and to compare their recovery indices between parturients and non-pregnant women. Muscle relaxation was maintained by the continuous infusion of relaxants to retain the first response of train-of-four (TOF) at 5% of control. When mivacurium was used, Bolus-T5 (duration from the end of mivacurium bolus injection to 5% single twitch recovery) was measured. After discontinuing the infusion, the recovery index was measured. The infusion rate of mivacurium, not atracurium, was significantly lower in parturients and Bolus-T5 of parturients was significantly longer than that of non-pregnant women. There was no significant difference in the recovery indices of both relaxants. The authors concluded that the infusion rate of mivacurium in maintaining muscle relaxation in parturients should be reduced compared to the rate in non-pregnant women and measuring Bolus-T5 may be helpful in determining the infusion rate to maintain muscle relaxation.
Adult ; Atracurium/therapeutic use ; Atracurium/administration & dosage* ; Cesarean Section* ; Comparative Study ; Female ; Human ; Injections, Intramuscular ; Isoquinolines/therapeutic use ; Isoquinolines/administration & dosage* ; Neuromuscular Nondepolarizing Agents/therapeutic use ; Neuromuscular Nondepolarizing Agents/administration & dosage* ; Pregnancy

Thromboangiitis obliterans (Buerger's disease) is an inflammatory, thromboccluisive vasclar disease that usually involves small and medium sized arteries and veins of the distal extremities of young male smokers. Involvement of cerebral blood vessels in Buerger's disease is rare, but clinical and Pathological demonstration has ionally been found. We describe three patients with cerebral infarction who had amputated their distal extremities due to thromboangiitis obliterans. - they had . No clinical, laboratory, a,ngiographic evidence of vasculitis, source of emboli, and atherosclerotic risk factors except heavy smoking.
Arteries ; Blood Vessels ; Cerebral Infarction ; Extremities ; Humans ; Male ; Risk Factors ; Smoke ; Smoking ; Thromboangiitis Obliterans* ; Vasculitis ; Veins