No abstract available.

No abstract available.
Mesenteric Artery, Superior

OBJECTIVE: To determine the level of conus medullaris in normal subjects by the magnetic resonance imaging (MRI). METHODS: The corresponding vertebral level of tip of conus medullaris was evaluated in MRIs (sagittal T1 and T2-weighted imaging) of 226 subjects composed of Koreans (138 males, 88 females) with no spine fracture or significant spinal deformity. The termination of the spinal cord was determined by locating the corresponding vertebral point of the lowest end of the conus medullaris to the three-points (upper, middle, and lower) of the nearest vertebral body and intervertebral discs between the T11 and S3 vertebral bodies. RESULTS: If the male and female groups were combined, the most frequent level of cord termination was the mid-portion of L1 (24.5%) which was followed by the lower portion of L1 (22.1%) and the L1-L2 intervertebral disc level (20.8%). In a female group, the tip of conus was one third of vertebra lower than in a male group with a statistical significance (Mann- Whitney test, p=0.025). CONCLUSION: The spinal cord terminates at the mid-portion of L1 most frequently and the termination level distributes from the mid-portion of T12 to the intervertebral disc level of L1-L2. In a clinical setting, variable levels of the spinal cord termination should be considered in a diagnosis for the determination of the neurological level of the spinal cord associated with a vertebral injury and an unexpected neurological complication after a spinal anesthesia or injection.
Anesthesia, Spinal ; Congenital Abnormalities ; Conus Snail ; Diagnosis ; Female ; Humans ; Intervertebral Disc ; Magnetic Resonance Imaging ; Male ; Spinal Cord* ; Spine

BACKGROUND: We intended to investigate the relationship between red cell size observed through a light microscope and mean corpuscular volume (MCV) measured by an automatic hematology analyzer. METHODS: 164 samples which were referred for complete blood count analysis and peripheral blood cell morphology were selected. MCV was measured by Gen-S (Coulter Co., USA). Smear slides of the same samples were examined on a microscope with a CCD camera connected to it. The image observed through the microscope emerged on an IBM-compatible computer system through the CCD camera. Mean red cell size-mean corpuscular area (MCA) of the captured image was calculated by Image-Pro Plus, the image capture and analyzing software. RESULTS: The coefficient of variation (CV) of MCA measurement, which was done 5 times on 10 slides, was 1.5-3.6%. Compared to the measurements performed in the ideal zone, MCA was measured lower in the thickly smeared zone (medial zone) and higher in the thinly smeared zone (lateral zone) on smear slide observation. The correlation between MCA and MCV values was poor (R=0.641, P<0.01). The normal reference range of MCA measurement was 37.40-50.22 m2. CONCLUSIONS: As the red cell size observed on the light microscope does not correlate well with the MCV measured by automatic analyzer, the determination of red cell size by microscopic peripheral blood smear requires profound caution.
Blood Cell Count ; Blood Cells ; Cell Size* ; Computer Systems ; Erythrocyte Indices* ; Hematology ; Reference Values

Liver has a dual blood supply from portal vein and hepatic artery. Hepatocellular carcinoma receive their blood supply almost exclusively from hepatic artery. Thus, the concept of treating hepatocellular carcinoma by chemoembolization through these arteries is very effective. However, there may be several collateral or parasitic vessels feeding them in case of huge tumor or previous chemoembolization. We experierced a case of huge tumor involving right upper posterior portion of liver fed by 9th, 10th, 11th right posterior intercostal arteries and an anomalous hepatic artery. We tried chemoembolization with Adriamycin-Lipiodol suspension and Gelfoam material through the right posterior intercostal arteries to treat the lesion. After the procedure, the patient(55 years old female) became paraplegic with voiding and defecation difficulty which could be due to spinal cord infarction .by anterior spinal arteri. al occlusion caused by embolic material through the artery of Adamkiewicz from a posterior intercostal artery. She recovered completely after 20 days of treatment.
Arteries* ; Carcinoma, Hepatocellular ; Defecation ; Gelatin Sponge, Absorbable ; Hepatic Artery ; Infarction ; Liver ; Portal Vein ; Spinal Cord Injuries* ; Spinal Cord*

OBJECTIVE: To determine the normal variations of end level of the dural sac in Korean subjects by magnetic resonance imaging (MRI). METHOD: The corresponding vertebral level of termination of the dural sac was evaluated by MRIs in two hundred adult Koreans (118 males, 82 females). We excluded the subjects with spine fracture, significant spinal deformity or spinal stenosis. End level of the dural sac was described in terms of their corresponding vertebral level. The vertebral levels were further divided into upper, middle, lower level, and intervertebral disc levels from the L5 to S3 vertebra. RESULTS: The most frequent end level of the dural sac was at the S1-S2 intervertebral disc level (22.5%) which was followed by the upper portion of S2 (21.5%) and the middle portion of S2 (17.0%). There was no significant difference in end level of the dural sac between male and female subjects. CONCLUSION: The dural sac most frequently ended at the S1-S2 intervertebral level and the end level of dural sac were located from the L5-S1 intervertebral level to the mid-point of S3. In a clinical setting, variable levels of the dural sac termination should be considered in an unexpected dural puncture during a caudal anesthesia or injection.
Adult ; Anesthesia, Caudal ; Congenital Abnormalities ; Female ; Humans ; Intervertebral Disc ; Magnetic Resonance Imaging ; Male ; Punctures ; Spinal Stenosis ; Spine

Vertebral hemangioma is a slow-growg, benign tumor which is often discovered incidentally during evaluation of neck or back pain.1,2 It is easily demonstrated by spine MRI, but in some cases did not show typical radiological appearance. In that case, Tc-99m RBC SPECT may be another confirmatory diagnostic tool. We report a case of vertebral hemangioma diagnosed with the assistance of Tc-99m RBC SPECT.
Hemangioma* ; Magnetic Resonance Imaging ; Neck ; Spine ; Tomography, Emission-Computed, Single-Photon*

Case reports after accidental subdural injection during attempted epidural block have usually described extensive neuraxial blocks with a characteristic radiographic appearance on contrast injection. We experienced a case of cervical subdural injection with unusual clinical findings and radiographic appearance. A 51-year-old female patient with central herniated nucleus pulposus at cervical (C5/6) and lumbar level (L4/5, L5/S1) was referred to the pain clinic. During attempted cervical epidural block at the C6/7 interspace with fluoroscopy, injection of the 4 ml contrast showed posterior spread at cervical level. After cervical epidural steroid injection, the contrast was also confined to the posterior aspect of the spinal canal at lumbar level with fluoroscopy. In order to discriminate subdural space from epidural space, we performed transforaminal epidural injection of the 2 ml contrast at the L5/S1 interspace and we could confirm cervical epidural injection was made into the subdural space. We discuss the clinical characteristics of a subdural injection and the appearance of the cervical and lumbar subdurogram.
Epidural Space ; Female ; Fluoroscopy ; Humans ; Injections, Epidural ; Middle Aged ; Pain Clinics ; Spinal Canal ; Subdural Space

BACKGROUND: The aim of this randomized double-blinded study was to determine the optimal concentration of alfentanil with 0.15% ropivacaine for postoperative patient-controlled epidural analgesia. METHODS: Forty five patients undergoing major abdominal surgery under general anesthesia were assigned to groups receiving patient-controlled thoracic epidural analgesia with 0.15% ropivacaine + 45 microgram/ml alfentanil (Group I), 75microgram/ml alfentanil (Group II), 150 microgram/ml alfentanil (Group III). The incidence of side effects and additional analgesic use, VAS (visual analog pain scale) on resting and coughing, and patient's satisfaction were checked for 24 hours after a loading dose injection. RESULTS: The VAS on coughing and resting 1 hour after the loading dose injection were significantly lower in Groups II and III than in Group I. The patients in group II were more satisfied with the result than those in Group I. CONCLUSIONS: A combination of 0.15% ropivacaine and 75microgram/ml alfentanil for thoracic epidural analgesia after major abdominal surgery provides the best analgesia with minimal side effects and a higher level of patient's satisfaction.
Alfentanil* ; Analgesia ; Analgesia, Epidural* ; Anesthesia, General ; Cough ; Humans ; Incidence

PURPOSE: We investigated the long-term survival and patient satisfaction with an inflatable penile prosthesis as a treatment for refractory erectile dysfunction (ED). MATERIALS AND METHODS: Between July 1997 and September 2014, a total of 74 patients underwent implantation of an inflatable penile prosthesis. The present mechanical status of the prosthesis was ascertained by telephone interview and review of medical records, and related clinical factors were analyzed by using Cox proportional hazard regression model. To investigate current status and satisfaction with the devices, novel questionnaires consisting of eight items were administered. RESULTS: The mean (+/-standard deviation) age and follow-up period were 57.0+/-12.2 years and 105.5+/-64.0 months, respectively. Sixteen patients (21.6%) experienced a mechanical failure and 4 patients (5.4%) experienced a nonmechanical failure at a median follow-up of 98.0 months. Mechanical and overall survival rates of the inflatable penile prosthesis at 5, 10, and 15 years were 93.3%, 76.5%, and 64.8% and 89.1%, 71.4%, and 60.5%, respectively, without a statistically significant correlation with host factors including age, cause of ED, and presence of obesity, hypertension, and diabetes mellitus. Overall, 53 patients (71.6%) completed the questionnaires. The overall patient satisfaction rate was 86.8%, and 83.0% of the patients replied that they intended to repeat the same procedure. Among the 8 items asked, satisfaction with the rigidity of the device received the highest score (90.6%). In contrast, only 60.4% of subjects experienced orgasm. CONCLUSIONS: The results of our study suggest that excellent long-term reliability and high patient satisfaction rates make the implantation of an inflatable penile prosthesis a recommendable surgical treatment for refractory ED.
Adult ; Aged ; Aged, 80 and over ; Erectile Dysfunction/physiopathology/*surgery ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Orgasm ; *Patient Satisfaction ; *Penile Prosthesis ; Prosthesis Failure ; Prosthesis Implantation/methods ; Treatment Outcome