The degenerative spondylolisthesis is one of the most common causes of the prominent central and recess stenosis which are produced by the hypertrophy of the facet joints and anterior slipping of the posterior arch. The resulting neurogenic symptoms in the legs are the major causes of the surgical treatment in the degenerative spondylolisthesis and the complete decompression is indicated for these types of spinal stenosis. The decompression procedures performed in the degenerative spondylolisthesis makes more unstable and induce the late instability and the post
Clinical Study ; Constriction, Pathologic ; Daegu ; Decompression ; Decompression, Surgical ; Hypertrophy ; Korea ; Leg ; Lumbar Vertebrae ; Nerve Compression Syndromes ; Spinal Stenosis ; Spine ; Spondylolisthesis ; Zygapophyseal Joint

The idiopathic osteonecrosis of femoral head is one of the orthopaedic dilemma in regarding the treatment and various trials to preserve the femoral head were known to be effective in the early stage of the disease process. The conventional methods of core decompression and bone graft were not usually indicated in the progressed cases that disclose the subchondral fracture or collapse of the femoral head. Authors reviewed 15 cases of the free fibular strut grafts performed for the progressed idopathic osteonecrosis of femoral head since 1983 at the Department of Orthopaedic Surgery, Daegu Fatima Hospital with follow-up periods from 2 years and 2 months to 4 years and 6 months except for 2 cases who had secondary procedures because of progressive collapse of the femoral head after the bone grafting and the following results were obtained; 1. The cases were 14 males and a female aging from 28 years to 56 years and revealed crescent signs in 9 cases and early collapses in 6 cases on the pre-operative x-rays with involvement in the other sides in 10 cases. 2. The successful results in clinical and roentgenological evaluations were obtained in 8 cases(53%) and progressive collapse was prevented in 10 cases(67%). 3. The exact insertion of the graft up to the subchondral level through the necrotic bone was essential and no weight bearing for 1 year was neccessary for success. 4. The free fibular strut grafts were effective to prevent the progressive collapse in progressed idiopathic osteonecrosis of the femoral head.
Aging ; Bone Transplantation ; Clinical Study ; Daegu ; Decompression ; Female ; Follow-Up Studies ; Head ; Humans ; Male ; Osteonecrosis ; Transplants ; Weight-Bearing

A retrospective study was undertaken to define the factors that cause the neurogenic symptoms in 18 cases of spondylolytic spondylolisthesis who were operated for leg pain and neurologic deficits of motor functions documented by neurologic examination or electromyographic findings in the Department of Orthopaedic Surgery, Fatima Hospital, Daegu for three years since June, 1986. The cases having other combined pathology to cause neurogenic symptoms were excluded. The causes were predetermined by preoperative x-rays, myelograms, electromyograms, and computerized tomograms and the causes were explored at surgery regarding the preoperative findings. The findings were compared with the avilable findings of 13 cases who were operated for low back pain only without any neurogenic pain in the leg during the same period. The cases were quite older and had narrower disc spaces than the back pain group but there were no significant differences in the degree of slipping and stability of slipped level between the two groups. The foraminal stenosis was found in all of the cases and a central stenosis was combined in a case. The intervertebral foramens were narrowed up-down in most of the cases between the bony prominence of proximal pars interarticularis above and the disc and vertebral body below but three cases had soft tissue mass only at the isthmic defect encroaching the foramen. There were hypertrophy of bone and/or soft tissue at the pars interarticularis in all cases. The nerve roots were mainly compressed up-down below pars interarticularis in the foramen in 8 cases and impinged at the anterior foramen in front of the pars interarticularis in 10 cases. The central stenosis was due to marked bony hypertrophy of pars interarticularis and osteophyte of vertebral body. The causes of neurogenic symptoms in spondylolytic spondylolisthesis were foraminal stenosis due to hypertrophy of bone and/or soft tissue at the pars interarticularis combined with narrowing of disc and seemed to be a process of degenerative changes occurring at the motion segment of slipped level.
Back Pain ; Constriction, Pathologic ; Daegu ; Hypertrophy ; Leg ; Low Back Pain ; Neurologic Examination ; Neurologic Manifestations ; Osteophyte ; Pathology ; Pheniramine ; Retrospective Studies ; Spondylolisthesis

The most common form of joint dislocation is anterior shoulder dislocation. There are a number of available techniques to reduce, but which have a possibility to be happened many kinds of complications like brachial plexus injury, axillary nerve injury and fracture of the humerus. In addition, the drugs we use for the reduction have potential side effects such as cardiovascular complications and respiratory arrest. We are trying to introduce new reduction technique aimed at minimizing the complications and increasing the success rate, which was used in 23 cases and all of them were successfully reduced without complications.
Acromion* ; Brachial Plexus ; Dislocations ; Humerus ; Joints ; Shoulder Dislocation* ; Shoulder*

No Abstract Available.
Lower Extremity* ; Varicose Veins*

As an alphs-2 adrenergic agonist, clonidine, which is an antihypertensive drug, can reduce central sympathetic outflow. By regulation of presynaptic transmitter release, it also lowers blood pressure and amounts of anesthetic drugs used during anesthesia, causes sedation, and attenuates postoperative shivering. The authors studied the effects of transdermal clonidine as a premedicant, which is easy and simple to use and maintains constant plasma level. Sixty patients undergoing elective orthopedic surgery, with preoperative normal blood preesure, were seleeted and randomly divided into 2 groups, 30 subjects each. Placebo patch was placed on the shoulder of patients belonging to the placebo group, and clonidine patch for the clonidine group just 48 hours before operation. Cardiovascular effects such as changes in perioperative blood pressure and heart rate, the degree of sedation before to induction, amounts of anesthetic drugs during anesthesia, postoperative analgesic requirements, ratio of patients who experienced postoperative shivering were observed and compared between the two groups. Patients in the clonidine group showed more stable cardiovascular response perioperatively and amounts of anesthetic drugs required during operation were reduced as compared to the placebo group(p<0.05). Preinduction sedation score of clonidine group was definitely higher than that of placebo group. (p <0.05) All 30 patients in the placebo group required analgesics for 48 hours after operation(100%) and only 19 patients of the clonidine group required analgesics(63%). The amounts of postoperative analgesics were definetely reduced in the clonidine group(p<0.05). Postoperative shivering occurred in 12 patients of the placebo group(40%) and 5 patients of the clonidine group(16.6%). We concluded that transdermal clonidine can be used effectively as a premedicant privided close regulation of anesthetic drugs used during anesthesia is possible.
Adrenergic Agonists ; Analgesics ; Anesthesia ; Anesthetics ; Blood Pressure ; Clonidine* ; Heart Rate ; Humans ; Orthopedics ; Plasma ; Shivering ; Shoulder

High doses of corticosteroids have been found to have beneficial effects in various shock states. It has been well recognized that ischemia is one of the important factors in shock states. This prompted us to investigate the effect of high dose methylprednisolone on tourniquet induced ischemia. The results were as follows: 1) The heart rate did not change significantly after tourniquet release in both group. 2) The mean arterial pressure decreased ignificantly at 1 minute after tourniquet release in both group. 3) The PaO2,PaCO2 and HCO-(3) did not change significantly after tourniquet release in both group. 4) The pH decreased significantly at l minute and 5 minutes after tourniquet release in control group and did not change in methylprednisolone group. 5) Base excess increased significantly at 1 minute and 5 munutes after tourniquet release in control group and did not change significantly in methylprednisolone group. In conclusion, the results of this study indicate that methylprednisolone provides a beneficial effect during tourniquet ischemia.
Adrenal Cortex Hormones ; Arterial Pressure ; Heart Rate ; Hydrogen-Ion Concentration ; Ischemia* ; Methylprednisolone* ; Shock ; Tourniquets*

We are reporting anesthetic management of a case of successful separation of pygopagus twins. Conjoined twins are the result of an abnormality in fission of the primitive streak occurring during the first two weeks of development, and they are always of the same sex. These absormalities usually have multiple common organa, and surgical separation with survival is extremely rare. We are reporting our experience concerning the anesthetic management of this case along with the precautions and give some references.
Anesthesia* ; Humans ; Primitive Streak ; Twins ; Twins, Conjoined*

BACKGROUND: Introduction of a pneumoperitoneum using CO2 is accompanied by significant alterations in respiratory function and pulmonary gas exchange during laparoscopic cholecystectomy. Previous studies have shown differing results concerning pulmonary gas exchange: a significant decrease of PaO2 was induced with isoflurane. In contrast, no significant changes were observed with propofol. The purpose of the present study was to compare the effects of propofol vs isoflurane on pulmonary gas exchange during general anesthesia for laparoscopic cholecystectomy. METHODS: Forty patients were divided randomly between isoflurane and propofol groups. After induction of anesthesia, ventilation was controlled and intra-abdominal pressure was maintained automatically at 12 mmHg by a CO2 insufflator. After the measuring of baseline values of blood pressure, heart rate, PaO2, PaCO2 and PetCO2 before CO2 insufflation, measurements were also made immediately, 30min after CO2 insufflation and 5 min after CO2 exsufflation. RESULTS: In the isoflurane group, PaCO2, PetCO2, PaO2, and P(a-et)CO2 changed significantly 30 min after CO2 insufflation and 5 min after CO2 exsufflation (P < 0.05). In the propofol group, PaCO2 and PetCO2 increased significantly 30 min after CO2 insufflation and 5 min after CO2 exsufflation (P < 0.05), but PaO2 and P(a-et)CO2 remained constant. When the two groups were compared, there were significant differences in PaO2, PaCO2, PetCO2 and P(a-et)CO2 at 30min after CO2 insufflation and 5 min after CO2 exsufflation (P < 0.05). CONCLUSIONS: These results indicate that during laparoscopic cholecystectomy the PaO2 was significantly lower and PaCO2 and P(a-et)CO2 were significantly higher in the isoflurane group compared with the propofol group.
Anesthesia* ; Anesthesia, General ; Blood Pressure ; Cholecystectomy, Laparoscopic* ; Heart Rate ; Humans ; Insufflation ; Isoflurane* ; Pneumoperitoneum ; Propofol* ; Pulmonary Gas Exchange ; Ventilation

PURPOSE: This study investigated the anatomy of infraorbital fat and the relationship between surrounding structures and infraorbital fat. METHODS: Forty-one orbits from adult Korean cadavers were dissected. Among them 20 orbits were male and 21 orbits were female. The cadavers were perfused and embalmed in formalin solution. The skin and orbicularis oculi muscle were dissected to expose the arrangement and compartments of infraorbital fat. A punctal probe was used to find a deeper fat compartment lying under the another compartment. The width of each compartment and the distances from the inferior orbital rim and from the lower lid margin to the topmost point of each compartment were measured using a digital caliper. The distance from the top of the medial compartment and lower lid margin to the first appearance of the inferior oblique muscle, located between the medial and the central fat compartments, were measured, respectively. RESULTS: The width of the medial compartment was 11.49+/-2.54 mm, the central compartment was 21.78+/-5.69 mm, and the lateral compartment was 17.94+/-4.99 mm. The distance from the inferior orbital rim to the medial compartment was 8.13+/-2.72 mm, to the central compartment was 9.91+/-3.44 mm, to the lateral compartment was 9.58+/-3.76 mm. The distance from the lower lid margin to the medial compartment was 5.55+/-1.22 mm, to the central compartment was 7.09+/-3.22 mm, and to the lateral compartment was 5.41+/-3.07 mm. The distance from the inferior oblique muscle to the medial compartment was 9.09+/-2.63 mm, and to the lower lid margin was 13.60+/-2.27 mm. CONCLUSIONS: Our study evaluates the normal anatomy of the infraorbital fat compartments in Korean patients and suggests a useful index for lower blepharoplasty and lower orbital surgery.
Adult* ; Blepharoplasty ; Cadaver* ; Deception ; Female ; Formaldehyde ; Humans ; Male ; Orbit ; Skin