The surgical technique for removal of ruptured lumbar intervertebral disc has changed very little since it was introduced by Mixter and Barr in 1934. The technique of the interlaminar operation used by most neurosurgeons was used successfully in early cases to relieve the sciatica, but many patients were unable to return to heavy work because of low back pain. Cloward described a different surgical technique for removal of a ruptured lumbar intervertebral disc. The operation utilizes a transverse skin incision and a wide bilateral stlipping and retraction of fascia and muscles. The ligamentum flavum is not removed but detached and reflected medially in a flap. Only the bone margins of the adjacent facets are removed. A complete laminectomy is never done except for spondylolisthesis when the separate neural arch is disarticulated and removed. Using a "Vertebral Spreader", and interlaminar exposure is developed two to three times larger than that obtained y the "standard" technique. The advantages are obvious: 1. Both operations were done through a single transverse incision. A wider lateral exposure for the skin wound, being made parallel to the lumbar operation was possible and the normal skin lines, heals better with less scar. 2. The entire ligament is preserved, by separating its attachments from the lamina and reflecting in a flap, a larger opening into the spinal canal is obtained and the replaced flap protects the dura and prevents scarring. 3. Cloward recommends the use of a narrow, sharp chisel and hammer, but we used the spinal rongeurs including the Kerrison punch to remove part of the laminal edge. We leave the articular facets of the lumbar disc surgery because the articular facets are considered important major elements in the articulation of the vertebral joints, and as an essential bony surface to be used in posterior spinal fusion operation. 4. The routine use of intrathecal cortisone after lumbar disc operation has not been used in our cases because of increased pressure of the cerebrospinal fluid in modified prone position of the patient.
Cerebrospinal Fluid ; Cicatrix ; Cortisone ; Fascia ; Humans ; Intervertebral Disc ; Joints ; Laminectomy ; Ligaments ; Ligamentum Flavum ; Low Back Pain ; Muscles ; Prone Position ; Sciatica ; Skin ; Spinal Canal ; Spinal Fusion ; Spondylolisthesis ; Wounds and Injuries

BACKGROUND: Lidocaine is a useful intravenous and topical adjunct to facilitate tracheal intubation. We evaluated the effect of tracheal lidocaine on tracheal intubating conditions without neuromuscular blocking agent and hemodynamics during anesthesia induction with propofol and remifentanil target-controlled infusion (TCI). METHODS: Fifty patients, aged 18-60 years, scheduled for closed reduction of fractured nasal bone were randomly assigned to the control group (n = 25) or lidocaine group (n = 25). Anesthesia was induced with propofol-remifentanil TCI with the effect-site concentration of 5 microg/ml and 5 ng/ml. Four minutes after the start of propofol-remifentanil TCI, 4% lidocaine or saline 3 ml was instilled to larynx and trachea, and intubation was performed 1 min later. Acceptable intubation was defined as excellent or good intubating conditions. Hemodynamic data, induction and recovery profiles were recorded. RESULTS: Intubating condition was clinically acceptable in 13 out of 25 (52%) patients in the control group and in 22 out of 25 (88%) in the lidocaine group, and there was a significant difference between the two groups in regard to acceptable intubating conditions (P = 0.005). Mean arterial pressure change over time was significantly different between the two groups. There were no significant differences in the heart rate between the two groups. CONCLUSIONS: This study demonstrated that laryngotracheal administration of 4% lidocaine could increase the percentage of acceptable conditions for tracheal intubation during propofol and remifentanil anesthesia without neuromuscular blockade.
Anesthesia* ; Anesthesia, Intravenous ; Arterial Pressure ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Larynx ; Lidocaine* ; Nasal Bone ; Neuromuscular Blockade* ; Piperidines ; Propofol ; Trachea

PURPOSE: The purpose of this study is to compare the diagnostic accuracy and usefelness of three dimensional CT, plain radiography and two-dimensional axial CT in cases of maxillofacial fracture. MATERIALS AND METHODS: Plain radiography, two dimensional axial CT, and three dimensional helical CT images of eighty-two maxillofacial fractures in 45 patients were retrospectively analyzed according to detectability of fracture and displacement. The diagnostic accuracy of each modality was analysed using the Ridit method. RESULTS: Two- and three-dimensional CT were superior to plain radiography in evaluating fracture and displacement (p=0.001, 0.039), though the type of CT used did not cause significantly variation in the accuracy with which fracture and diferrent were diagnosed. CONCLUSION: Three dimensional helical CT is useful not only in the detection of fracture but in the evaluation of displaced maxillofacial fractures, especially if these are multiple and the complex.
Humans ; Imaging, Three-Dimensional* ; Radiography ; Retrospective Studies ; Tomography, Spiral Computed*

Retrograde jejunogastric intussusception defined as a segmental invagination of jejunal loop into stomach through stoma is a rare complication following partial gastric resection. Endoscopy and UGI series is very helpful in the diagnosis of this disease. Although the management of this disease is usually surgical, an endoscopic reduction can alternatively be attempted. If endoscopic reduction was failed, operation should be immediately per-formed in the acute type because of its high mortality. When anatomical reduction is done on due time, the prognosis is fairly good. We report a case of retrograde jejunogastric intussusception with a brief review of the literature. There was a 56 year old male patient who visited the hospital with chief complaints of severe epigastric pain and vomiting. He had subtotal gastrectomy for gastric carcinoma 6 years ago. On emergency endoscopy the type IIa jejunogastric intussusception was found. As the patient was suspected to be incar-cerated, surgical reduction was performed without delay. He was discharged on the 8th admission day.
Diagnosis ; Emergencies ; Endoscopy* ; Gastrectomy ; Humans ; Intussusception* ; Male ; Middle Aged ; Mortality ; Prognosis ; Stomach ; Vomiting

Tamoxifen, which is often used in breast cancer therapy, has also been used in the treatment of patients with advanced and recurrent endometrial carcinoma. Tamoxifen has been shown to have significant benificial effects in the treatment of breast cancer patients as hormonal therapy. However, there is evidence that tamoxifen may affect other hormone sensitive organs, including the uterus and ovaries. An increased risk of endometrial polyps, endometrial hyperplasia and endometrial cancer has been reported in tamoxifen treated women. We are able to make this report because we have experienced uterine endometrial carcinosarcoma which is developed in a patient treated with tamoxifen for five years following a modified radical mastectomy due to breast cancer in our hospital.
Breast Neoplasms* ; Breast* ; Carcinosarcoma* ; Endometrial Hyperplasia ; Endometrial Neoplasms ; Endometrium* ; Female ; Humans ; Mastectomy, Modified Radical ; Ovary ; Polyps ; Tamoxifen* ; Uterus

OBJECTIVE: To explore whether the growth hormone is effective in the treatment of degenerative cartilage of knee in rabbits. METHOD: Thirty New Zealand white rabbits were administered intra-articular injection with monosodium iodoacetate (Sigma, St. Louis, USA) 2.5 mg and divided into 3 groups. Each group was administered with hyaluronic acid (Hyruan plus(R), LG life science, Seoul, Korea)(group A) 0.6 ml, growth hormone (Declage(R), LG life science, Seoul, Korea) (group B) or saline (group C) 0.6 ml intra-articulary once a week for 4 weeks, beginning 4 weeks after the degeneration induction. All rabbits were killed 9 weeks after degeneration induction. The histologic morphology was observed by optical microscope with knee cartilage. RESULTS: Mankin score was 2.4+/-1.3 in group A, 3.9+/-1.7 in group B, 7.4+/-0.8 in group C. Yoshimi score was 1.5+/-0.7 in group A, 2.2+/-0.9 in group B, 4.4+/-0.6 in group C. Gross and microscopic morphologic findings showed that group C represented the more severe than group A & B (p<0.01), also group A was better than group B (p<0.05). CONCLUSION: Growth hormone is effective on degenerative knee cartilage in rabbit model, but less than the hyaluronic acid.
Biological Science Disciplines ; Cartilage ; Growth Hormone ; Hyaluronic Acid ; Injections, Intra-Articular ; Knee ; Rabbits

Tuberculosis is a multi-organ disease. The incidence of pulmonary tuberculosis is declining due to improvement in public health, vaccination and the development of anti-tuberculosis medication, but extrapulmonary tuberculosis has become more common, especially in immuno-compromised individuals, AIDS patients and immigrants to western worlds. Gastrointestinal tuberculosis continues to give rise to diagnostic and therapeutic challenges. The jejunal tuberculosis is uncommon and presents a difficult diagnostic problem. Bleeding jejunal tuberculosis is a very rare source of lower gastrointestinal bleeding. We have recently experienced a case of a jejunal tuberculosis which was proven to be a source of gastrointestinal bleeding by intraoperative endoscopy and was confirmed by surgical exploration. This report summarized our experience and review of literature.
Emigrants and Immigrants ; Endoscopy* ; Hemorrhage* ; Humans ; Incidence ; Public Health ; Tuberculosis* ; Tuberculosis, Gastrointestinal ; Tuberculosis, Pulmonary ; Vaccination ; Western World

Panniculitis generally indicates a group of diseases whose hallmark is fibrous thickening and chronic inflammation of subcutaneous fat. Various factors seem to induce a similar pathological histology, and morphological differences can be found among the patients diagnosed with the same disease. Paraneoplastic causes account for 3~10% of the cases of panniculitis. The commonest causes of cancer associated panniculitis are hematological malignancies and mostly lymphomas. In this case, we confirmed acute myeloid leukemia by a blood test and bone marrow examination, and with considering the clinical aspects and pathological findings of the skin lesion, and we finally diagnosed the patient as having panniculitis, which seems to be related with acute myeloid leukemia. The obvious clinical symptoms or pathophysiological features of this rare type of panniculitis are not yet fully known, and so making the differential diagnosis is needed to distinguish this malady from erythema nodosum, erythema induratum and various connective tissue disorders with accompanying erythematous subcutaneous nodules. We diagnosed this very rare and interesting case of paraneoplastic panniculitis that seemed to be generated from acute myeloid leukemia. We report here on this case and we review the relevant literature.
Bone Marrow Examination ; Connective Tissue ; Diagnosis, Differential ; Erythema Induratum ; Erythema Nodosum ; Hematologic Neoplasms ; Hematologic Tests ; Humans ; Inflammation ; Leukemia, Myeloid, Acute ; Lymphoma ; Panniculitis ; Skin ; Subcutaneous Fat

BACKGROUND: During beating heart surgery, the accuracy of cardiac output (CO) measurement techniques may be influenced by several factors. This study was conducted to analyze the clinical agreement among stat CO mode (SCO), continuous CO mode (CCO), arterial pressure waveform-based CO estimation (APCO), and transesophageal Doppler ultrasound technique (UCCO) according to the vessel anastomosis sites. METHODS: This study was prospectively performed in 25 patients who would be undergoing elective OPCAB. Hemodynamic variables were recorded at the following time points: during left anterior descending (LAD) anastomosis at 1 min and 5 min; during obtuse marginal (OM) anastomosis at 1 min and 5 min: and during right coronary artery (RCA) anastomosis at 1 min and 5 min. The variables measured including the SCO, CCO, APCO, and UCCO. RESULTS: CO measurement techniques showed different correlations according to vessel anastomosis site. However, the percent error observed was higher than the value of 30% postulated by the criteria of Critchley and Critchley during all study periods for all CO measurement techniques. CONCLUSIONS: In the beating heart procedure, SCO, CCO and APCO showed different correlations according to the vessel anastomosis sites and did not agree with UCCO. CO values from the various measurement techniques should be interpreted with caution during OPCAB.
Arterial Pressure ; Cardiac Output ; Coronary Artery Bypass, Off-Pump ; Coronary Vessels ; Glycosaminoglycans ; Heart ; Hemodynamics ; Humans ; Prospective Studies ; Thoracic Surgery

The diagnosis of pyomyositis in the pelvic region is difficult, as its incidence is relatively, with symptoms that mimic those of discogenic pain. Sciatica is a common presentation of a prolapsed lumbar disc. Less common causes, such as spinal stenosis, pelvic tumors or even primary nerve tumors can also cause these symptoms. Magnetic resonance imaging (MRI) is a useful diagnostic tool. Herein, the case of a patient with an acute pyogenic infection in the iliopsoas muscle, presenting with sciatica, is reported. This is a rare infective disease, which if promptly treated with intravenous antibiotics, can be completely resolved; otherwise, it can result in deep abscess formation, sepsis and death.
Abscess ; Anti-Bacterial Agents ; Diagnosis ; Humans ; Incidence ; Magnetic Resonance Imaging ; Pelvis ; Pyomyositis* ; Sciatica ; Sepsis ; Spinal Stenosis