BACKGROUND: Elderly patients with underlying cardiovascular or respiratory diseases are more susceptible to anesthesiologic risks or serious complications following laparoscopic operations. We evaluated the safety of laparoscopic radical nephrectomy in elderly patients to compensate for the lack of Korean data on the subject in the field of urology. METHODS: From March 2003 and March 2009, 73 patients with localized renal cell cancer underwent laparoscopic radical nephrectomy. They were divided into two groups according to age; 75 years or older (elderly group, n=21) and under 75 years (young group, n=52). Operative parameters as well as oncological outcomes were evaluated. RESULTS: The mean age was 77.7+/-2.5 years for the elderly group and 55.9+/-10.5 years for the young group. No significant differences existed between the groups in terms of mean operative time, intraoperative blood loss, complications, and hospital stay. However, American Society of Anesthesiologists (ASA) score, co-morbidities (p<0.05), and rate of transfusion (p<0.05) were significantly higher in the elderly group. In overall analyses, we conclude that in elderly patients undergoing laparoscopic radical nephrectomy, close monitoring of hemoglobin level as well as intraoperative transfusion for maintenance of hemoglobin level at 10 mg/L or higher is necessary in elderly patients to achieve adequate circulation. CONCLUSION: Laparoscopic radical nephrectomy can be considered a safe and effective procedure for most elderly patients.
Aged ; Carcinoma, Renal Cell ; Hemoglobins ; Humans ; Laparoscopy ; Length of Stay ; Nephrectomy ; Operative Time ; Urology

BACKGROUND: Circadian variations in the absorption, distribution, protein binding, elimination and metabolism of drugs account for many of the administration-time-dependent differences in their pharmacokinetics. The aim of this study is to determine whether the time of intrathecal injection influences spinal anesthesia. METHODS: Ninety patients scheduled for orthopedic surgery were randomly assigned to three groups. Each group received spinal anesthesia with 0.5% bupivacaine 10 mg at different times; group AM (8 am to 12:00), group Noon (12:00 to 4:00 pm) and group PM (4:00 pm to 8:00 pm). Sensory and motor blockade were assessed by pinprick and a four-point modified Bromage scale. Time to first postoperative analgesic requirement and side effects such as hypotension, bradycardia, nausea, and shivering were recorded. RESULTS: No significant differences were found among the three groups in peak sensory blockade, duration of motor block to Bromage 1 or side effects, but time to first postoperative analgesic requirement (P = 0.008), and recovery time of S1 sensation to pinprick were significantly prolonged in group Noon compared with the other groups (P = 0.03). CONCLUSIONS: The tine of administration of spinal local anesthetics influences the duration of local anesthesia.
Absorption ; Anesthesia, Local ; Anesthesia, Spinal ; Anesthetics, Local ; Bradycardia ; Bupivacaine ; Humans ; Hypotension ; Injections, Spinal ; Nausea ; Orthopedics ; Protein Binding ; Sensation ; Shivering

During inflammation of the colon, cells of the gut mucosa express numerous inflammatory mediators including interleukin-8 (IL-8), tumor necrosis factor-alpha (TNF-alpha), and interleukin-1beta(IL-1beta). These cytokines have been implicated as contributing factors in the inflammatory process, which may result in colitis during inflammatory bowel disease (IBD). Gliotoxin is a fungal metabolite of an epipolythiodioxopiperazine analogue with immunosup-pressive properties in vivo and in vitro, but the effects of gliotoxin on IBD have not been largely evaluated. Therefore, this study evaluated the potential of gliotoxin to protect against TNBS-induced colitis. One microgram of gliotoxin in 100microliter of vehicle was intra-rectally administered into mice exhibiting trinitrobenzene sulfonic acid (TNBS)-induced colitis. IL-8 secretion was measured using an enzyme-linked immu-nosorbent assay (ELISA), myeloperoxidase (MPO) activity was evaluated spectrophotometically, and IkappaB degradation was analyzed on Western blots. Gliotoxin treatment of mice bearing TNBS-induced colitis improved macro-and micro-pathological findings and dramatically decreased MPO activity, a marker of leukocyte infiltration. Furthermore, gliotoxin decreased IkappaB degradation and IL-8 induction caused by TNF-alpha or IL-1beta in HT-29 cells. These findings suggest that gliotoxin partially protects against TNBS-induced colitis through the sup-pression of IL-8 induction and IkappaB degradation by inflammatory mediators such as TNF-alpha or IL-1beta.
Animals ; Blotting, Western ; Colitis* ; Colon ; Crohn Disease ; Cytokines ; Down-Regulation* ; Gliotoxin* ; HT29 Cells ; Humans ; Inflammation ; Inflammatory Bowel Diseases ; Interleukin-8 ; Leukocytes ; Mice ; Mucous Membrane ; Peroxidase ; Tumor Necrosis Factor-alpha

OBJECTIVES: The purpose of this study was to determine the association between the bone mineral density (BMD) and severity of spinal osteoarthritis (spondylosis) in osteoporotic spinal compression fracture. METHODS: Fifty six patients were evaluated 66 cases had an osteoporotic thoracolumbar compression fracture between January 2008 and June 2010. The average patient age was 76.2 years (M/F : 8/48). Age and body mass index (BMI, kg/m2) were measured, and the BMD was performed using peripheral quantitative computed tomography (pQCT). Simple thoracolumbar (T-L) spine lateral radiography was evaluated for three criteria: presence of osteophytes, disc space narrowing and vertebral body sclerosis. The findings were graded 0 to 3 and analyzed statistically for a correlation with the BMD and fractured vertebrae. RESULTS: Acute compression fractures comprised of 15 cases and the most common site of acute fractures with old fractures was lumbar spine (L1; 30 cases, 45.4%). The average of BMI was 23.32 and BMD (T-score) was -4.47. Pearson's rho showed a positive association between the weight, height and the BMD (P < 0.01). In terms of the BMD versus spondylosis, there was a positive association with high score in the high order cortical bone. Compression fractures occurrence rate in the absent and present of spondylosis was 74.3% and 22.4%, and 69% occur in the spinal segmental with no bony spur with chi-square test (P < 0.01). CONCLUSION: In the present of spondylosis was high score of cortical BMD and low rate of compression fracture. Spondylosis could be one of a factor of the occurrence in acute and adjacent compression fracture after old fractures.
Body Mass Index ; Bone Density ; Fractures, Compression ; Humans ; Osteoarthritis, Spine ; Osteophyte ; Sclerosis ; Spine ; Spondylosis

The risk of deep vein thrombosis (DVT) is well studied for some orthopedic surgery. However, the incidence of postoperative DVT is less well-defined in patients who have spinal surgery. In addition, there is insufficient evidence to suggest that screening patients before spinal surgery and to use of prophylactic method such as anticoagulants, compression stockings, and pneumatic compression device. We experienced a 78-year-old female patient of DVT after fusion operation with pedicular screws in T12 osteoporotic compression fracture. As risk of DVT after major spinal surgery is fairly low, it seems reasonable to consider prophylactic management after spinal surgery in old aged patients with difficult ambulation.
Aged ; Anticoagulants ; Female ; Fractures, Compression ; Humans ; Incidence ; Mass Screening ; Orthopedics ; Stockings, Compression ; Venous Thrombosis ; Walking

Various types of tumor can occur in the subungual space, including glomus tumors, subungual exostosis, hemangioma, epidermal cysts, and malignant tumors. While fibromatosis can occur at various sites throughout the body, it is very rarely seen in the toe. Here, we are the first to report a case of superficial fibromatosis mimicking a glomus tumor in the subungual space of the second toe. The presentation of this condition shows the possibility of encountering uncommon superficial fibromatosis in the distal phalanx of the toe, and suggests that superficial fibromatosis should be included in the differential diagnosis of a glomus tumor in the toe.
Adult ; *Fibroma ; *Glomus Tumor ; Humans ; Male ; *Osteochondroma ; *Toes/pathology/surgery

We recently encountered an interesting case of acute inferior ST segment elevation myocardial infarction (STEMI). This patient had a rare anatomic variation, single coronary artery. The right coronary artery originate from the left circumflex proper artery, not from aorta, was totally obstructed with thrombi. Though it took more time to figure out the patient's coronary anatomy and the culprit lesion, we successfully performed primary percutaneous coronary intervention within the guideline-recommended time period. We performed left coronary angiography at the beginning. This strategy could be helpful in determining the culprit lesion and preventing unnecessary procedural delay in acute inferior STEMI.
Anatomic Variation ; Aorta ; Arteries ; Coronary Angiography ; Coronary Vessel Anomalies ; Coronary Vessels* ; Humans ; Myocardial Infarction* ; Percutaneous Coronary Intervention

Ankylosing spondylitis (AS) is an inflammatory disease primarily affecting the spine. Osteoporosis can be a complication of AS and associated with low bone mineral density. As well, spinal fractures in the AS are usually unstable and may cause neurologic deficit at the mainly cervical region with low energy trauma. However, reports of lumbar compression fracture in AS are very rare. Thus, we report a 73-year-old male patient with osteoporotic L3 compression fracture with AS treated with kyphoplasty which has no symptom improvement with conservative treatment. Kyphoplasty is a useful procedure option in the treatment of the lumbar compression fracture in AS.
Bone Density ; Fractures, Compression ; Humans ; Kyphoplasty ; Male ; Neurologic Manifestations ; Osteoporosis ; Osteoporotic Fractures ; Spinal Fractures ; Spine ; Spondylitis, Ankylosing

BACKGROUND: To analyze and compare the clinical characteristics including bone mineral density (BMD) in a group who had operation of hip fracture with or without prior osteoporotic spinal compression fractures. METHODS: Two hundred forty patients who had undergone operation of hip fractures were evaluated, 127 patients who had with prior osteoporotic spinal compression fractures were in group I, and 113 patients without prior spinal fractures were in group II. In each group, we measured age, gender, body mass index (BMI, kg/m2), BMD (mg/cm3), type of hip fractures, concomitant diseases, presence of secondary hip fracture and history of percutaneous vertebroplasty. RESULTS: The mean age of group I was 79.4 years (male/female: 28/99) and that of group II was 77.6 years (male/female: 37/76). The mean BMI of group I was 21.3 kg/m2 and that in group II was 22.0 kg/m2. The mean BMD and T-score of group I were 41.1 mg/cm3 and -4.45 and those in group II were 51.0 mg/cm3 and -4.17 (P<0.05). The numbers of patients of neck and intertrochanter fracture of group I were 31 and 96 patients and those in group II were 61 and 52 patients. Sixty in group I and 45 in group II patients had concomitant diseases. Thirteen patients had undergone percutaneous vertebroplasty and 18 patients (7.5%) had second hip fractures. CONCLUSIONS: The hip fracture patients who had with prior osteoporotic spinal compression fractures had lower BMD compared to the hip fracture patients without previous spinal compression fractures.
Body Mass Index ; Bone Density ; Fractures, Compression ; Hip ; Hip Fractures ; Humans ; Neck ; Spinal Fractures ; Vertebroplasty

Small osteophytes are frequently encountered in the foot and ankle, and not to be confused with true osteochondromas, which are relatively uncommon in this region. Osteochondromas are the most common benign osseous neoplasm, occurs in the metaphysis of the long bone. It is rarely found in bones of the foot. Treatment of the osteochondroma is usually conservative, unless symptoms usually pain, are progressive rapid growth, and malignant transformation is suspected. We experienced a rare case of hallux rigidus with osteochondroma of the hallucal proximal phalanx which cause pain and corn of the plantar.
Animals ; Ankle ; Foot ; Hallux ; Hallux Rigidus ; Osteochondroma ; Osteophyte ; Zea mays