The results of treatment of injuries of the thoracic and thoracolumbar spine with neurological involvement have been reviewed in a retrospective study of 14 patients who received surgical treatment. Seven patients were treated with open reduction and Harrington instrumentation and the others were treated with anterior fusion, laminectomy only, Roger wiring with H-graft and posterior fusion respectively. In the former group, distraction rods were used in all patients. Three patients with incomplete paraplegia and of the 4 patients with complete paraplegia, two patients showed marked neurological improvement. While, in the latter group, only two patients with incomplete paraplegia showed marked neurological improvement. Harrington instrumentation allowed easier postoperative nursing and early mobilization of the patients.
Dislocations ; Early Ambulation ; Humans ; Laminectomy ; Nursing ; Paraplegia ; Retrospective Studies ; Spine

PURPOSE: Cerebral palsy or hearing disability of hyperbilirubinemic complication was reduced by blood exchange transfusion(BET) and phototherapy(PT). But in spite of these treatment, abnormal Auditory Brainstem evoked Response(ABR) finding after BET or PT and neurodevelopmental defect due to chronic bilirubin encephalopathy were observed. So we have studied risk factors and outcome of chronic bilirubin encephalopathy after BET, and treatment of hyperbilirubinemia. METHODS: We have analyzed clinical characteristics, the finding and change of ABR after BET in 17 hyperbilirubinemic neonates, and in 8 hyperbilirubinemic neonates who were treated by phototherapy and 15 normal control neonates. RESULTS: 1) Mean bilirubin concentraion were 27.5+/-4.1mg/dL in BET group and 22.1+/-2.3 mg/dL in PT group. There were no difference of clinical findings between BET and PT group. 2) Change of ABR (1) Wave I loss resulted in 4 neonates, wave III loss in 3 neonates, and wave V loss in 2 neonates in BET group(P<0.05). (2) Wave I peak latency and hearing threshold in BET group were significantly increased more than normal control group(P<0.01). 3) In 10 neonates(58.8%) among 17 BET group, 4 neonates(50%) in 8 PT group were observed abnormal initial ABR finding after jaundice treatment. Age at treatment and duration of jaundice(interval between onset of jaundice and treatment) in abnormal ABR group were significant prolongation compared with normal ABR group(P<0.05). 4) Chronic bilirubin encephalopathy(CBE) was observed in 3 neonates(17.6%) among 17 BET group and showed higher of bilirubin level than normalized group after BET (31.1mg/dL vs 26.6mg/dL), other clinical findings showed no significant differences. CONCLUSION: Bilirubin level was significantly elevated in CBE more than in BET group and duration of jaundice, age at treatment were longer in abnormal ABR group than in normal ABR group. So not only bilirubin level but also duration of jaundice shoud be considered at jaundice treatment, and ABR has a potential utility in detection of acute brain toxicity of bilirubin and follow up evaluation of bilirubin encephalopathy.
Bilirubin ; Brain ; Brain Stem ; Cerebral Palsy ; Follow-Up Studies* ; Hearing ; Humans ; Hyperbilirubinemia ; Infant, Newborn* ; Jaundice ; Kernicterus ; Phototherapy* ; Risk Factors

No abstract available.
Posterior Cruciate Ligament*

In the literature, the scapular neck fracture with ipsilateral acromioclavicluar dislocation(type I), mid-clavicular fracture(type II) or sternoclavicular dislocation(type III) is defined as floating shoulder. Authors managed 4 cases of type II floating shoulder, 3 cases by open reduction and internal fixation for the clavicular fracture only and 1 case by conservative therapy. The final results were excellent in 3 cases of the operative group and good in 1 case of the conservative group, by UCLA shoulder rating scale. There were no complications, including drooping or limited motion in the operative treatment group. However, there was shoulder pain in the case of the conservative treatment. It is thought that internal fixation for the clavicular fracture only may be the simple and sufficient treatment method for type lI floating shoulder.
Neck ; Shoulder Pain ; Shoulder*

From September 1992 to April 1994, we reviewed 7 patients after arthroscopic surgery for anterior impingement in the ankle, who complained ankle pain and limitation of motion. All patients were mem and main symptoms were severe pain at full dorsiflexion of ankle and limitation of motion. Bony spur was located on the anterior aspect of tibia, and it was possible to resect the tibial bony spur arthroscopically without distraction devices. Mean operation time was 55 minutes. Pain, swelling and limitation of motion were much improved. There was no postoperative complication. Arthroscopic resection of the anterior tibial bony spur is an effective treatment for anterior impingement in the ankle.
Ankle ; Arthroscopy ; Humans ; Postoperative Complications ; Tibia

BACKGROUND: Rocuronium, a new nondepolarizing muscle relaxant, has been reported to develop a rapid onset of action and may be suitable as a component of a rapid-sequence induction of anesthesia. Therefore we have compared rocuronium with pancuronium and vecuronium about the onset time, intubation time, and tracheal intubating conditions. METHOD: Thirty patients were divided into three groups, who were receiving intravenously pancuronium 0.14 mg/kg, vecuronium 0.1 mg/kg and rocuronium 0.6 mg/kg respectively for tracheal intubation during induction of anesthesia. The onset time(Time from drug administration to zero count of PTC) and intubation time were checked using train of four responses of the adductor pollicis muscle after ulnar nerve stimulation(2 Hz, 40mA) every 10 seconds. The intubation conditions were recorded by a "blinded" assessor as excellent, good, fair or not possible. RESULT: The onset time of pancuronium, vecuronium and rocuronium was, 125.0+/-10.0, 256.0+/-18.4 and 90.0+/-22.1 sec. respectivly. The time of intubation was 94.0+/-12.6, 95.3+/-7.9, and 77.0+/-10.6sec.(pancuronium,vecuronium & rocuronium respectively). The onset time of rocuronium was significantly faster than the other two nondepolarizing muscle relaxants. The tracheal intubation with rocuronium was possible earlier than pancuronium or vecuronium but no statistical significance was observed and the condition of intubation was excellent compare to others in all ten patients. CONCLUSION: Rocuronium may have advantages over existing non-depolarizing neuromuscular blocking agents with faster rate of development of neuromuscular block with excellent intubation condition after administraction of a dose 0.6 mg/kg(ED 95 x 2).
Anesthesia ; Humans ; Intubation ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Pancuronium ; Ulnar Nerve ; Vecuronium Bromide

BACKGROUND: Rocuronium, a new nondepolarizing muscle relaxant, has been reported to develop a rapid onset of action and may be suitable as a component of a rapid-sequence induction of anesthesia. Therefore we have compared rocuronium with pancuronium and vecuronium about the onset time, intubation time, and tracheal intubating conditions. METHOD: Thirty patients were divided into three groups, who were receiving intravenously pancuronium 0.14 mg/kg, vecuronium 0.1 mg/kg and rocuronium 0.6 mg/kg respectively for tracheal intubation during induction of anesthesia. The onset time(Time from drug administration to zero count of PTC) and intubation time were checked using train of four responses of the adductor pollicis muscle after ulnar nerve stimulation(2 Hz, 40mA) every 10 seconds. The intubation conditions were recorded by a "blinded" assessor as excellent, good, fair or not possible. RESULT: The onset time of pancuronium, vecuronium and rocuronium was, 125.0+/-10.0, 256.0+/-18.4 and 90.0+/-22.1 sec. respectivly. The time of intubation was 94.0+/-12.6, 95.3+/-7.9, and 77.0+/-10.6sec.(pancuronium,vecuronium & rocuronium respectively). The onset time of rocuronium was significantly faster than the other two nondepolarizing muscle relaxants. The tracheal intubation with rocuronium was possible earlier than pancuronium or vecuronium but no statistical significance was observed and the condition of intubation was excellent compare to others in all ten patients. CONCLUSION: Rocuronium may have advantages over existing non-depolarizing neuromuscular blocking agents with faster rate of development of neuromuscular block with excellent intubation condition after administraction of a dose 0.6 mg/kg(ED 95 x 2).
Anesthesia ; Humans ; Intubation ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Pancuronium ; Ulnar Nerve ; Vecuronium Bromide

BACKGROUND: Motor conduction slowing in diabetic distal symmetrical polyneuropathy (DSP) generally exceeds that in distal axonal polyneuropathy. Additional mechanisms secondary to axonal injury may contribute towards this slowing. However, clinical and pathophysiological significances of motor conduction slowing have been rarely discussed. The purpose of this study is to evaluate the clinical and pathophysiological significance of conduction slowing in DSP. METHODS: We analyzed motor conduction studies of 39 patients with symptomatic painful DSP and 24 patients with asymptomatic painless DSP. Motor conduction studies of 39 patients with amyotrophic lateral sclerosis (ALS) were used as controls for the amplitude-dependent slowing of conduction. Percentages of normal limits were calculated for the compound muscle action potential amplitude (CMAP), distal motor latency (DL), and conduction velocity (CV), and converted to a square root (SQRT) form. The changes of SQRT-DL or SQRT-CV according to SQRT-CMAP changes were plotted and analyzed. RESULTS: Regression analysis showed that DL and CV were amplitude-dependent in both painless DSP and ALS. The changes of DL and CV in painful DSP did not show amplitude-dependency except DL in the lower extremities. CONCLUSIONS: This data supports the hypothesis that the mechanism of slowing is similar in both painless DSP and ALS and results from the loss of large, fast-conducting fibers. Lack of amplitude-dependency of conduction slowing in painful DSP may reflect the combined axonal and demyelinating changes, possibly due to inflammation.
Action Potentials ; Amyotrophic Lateral Sclerosis ; Axons ; Diabetic Neuropathies* ; Electrophysiology ; Humans ; Inflammation ; Lower Extremity ; Neural Conduction ; Polyneuropathies

No abstract available.
Hepatocytes* ; Macrophages* ; Muscle, Smooth, Vascular* ; Nitric Oxide* ; Rhodiola*

We performed a primary vitrectimy using scleral depression technique for uncomplicated rhegmetogenous retinal detachment and intended to highlight the importance of scleral depression technique. The indications for the primary vitrectomy were eyes with multiple or posteriorly located retinal breaks, unidentified retinal breaks, vitreous opacities, strong vitreous tractions on the retina tear flap, and aphakic/pseudophakic retinal detachments, Removal of vitreoretinal traction and vitreous base dissection using scleral depression technuque were performed in sixty-eight eyes of rhegmatogenous retinal detachment uncomplicated with proliferative vitreoretinopathy of grade C or worse. Scleral segmental buckle or encircling was also placed in 60 of 68 eyes. The retina was reattached after the primary operation in fifty-seven eyes(80.9%), and after reoperations in remaining eleven eyes(19.1%). Postoperative visual acuity was 0.4 or better in thirty-eight eyes (55.9%), and worse than 0.025 in eight eyes(11.8%). Vitrectomy in conjuction with scleral depression technique would be effective in increasing surgical success rate in selected cases of retinal detachment surgery.
Depression ; Hexamethonium* ; Retina ; Retinal Detachment* ; Retinal Perforations ; Retinaldehyde* ; Traction ; Visual Acuity ; Vitrectomy* ; Vitreoretinopathy, Proliferative