BACKGROUND: The purpose of this study is to compare the clinical effects of isobaric 0.5% bupivacaine 8 mg and hyperbaric 0.5% bupivacaine 8 mg on sensory and motor block in aged patients undergoing spinal anesthesia. METHODS: Thirty patients, aged 65 years or more, undergoing orthopedic surgical operation of the lower extremities were randomly assigned to two groups for spinal anesthesia. In the isobaric group (n = 15), isobaric 0.5% bupivacaine 8 mg was administered and in the hyperbaric group (n = 15), hyperbaric 0.5% bupivacaine 8 mg was administered. We measured the maximal sensory level, the time to maximal sensory block, the duration of sensory block, the time to complete motor block, degree of motor block and hemodynamic variables every 2 minutes for 10 minutes in lateral decubitus position and then every 5 minutes for 20 minutes in supine position after spinal anesthesia. RESULTS: The maximal sensory block level and the duration of sensory block were not significantly different between the two groups. The time to maximal sensory block was significantly shorter in the hyperbaric group than in the isobaric group in both lower extremities. The time to complete motor block was significantly longer in the hyperbaric group than in the isobaric group in the nondependent extremity. CONCLUSIONS: These results suggest that isobaric 0.5% bupivacaine 8 mg for spinal anestheisa is more suitable for orthopedic operations requiring rapid and complete motor block than hyperbaric 0.5% bupivacaine 8 mg and that it can be performed in lateral decubitus position with the operating site up.
Anesthesia, Spinal* ; Bupivacaine* ; Extremities ; Hemodynamics ; Humans ; Lower Extremity* ; Orthopedics ; Supine Position

OBJECTIVE: To compare the clinical usefulness of the posterior superior iliac spine (PSIS) with that of iliac crest (IC) for identifying the lumbar vertebral level. METHOD: Lumbar spine level was identified by the line connecting bilateral upper margin of iliac crests in the antero-posterior lumbar X-rays of 120 patients. Assumed IC level and assumed PSIS level were compared by 3 examiners' palpation in 60 patients. A marker was taped on assumed IC level and assumed PSIS level by 4 examiners and the postero-anterior lumbar X-rays was taken in randomly distributed 50 patients. RESULTS: IC intersection line was ranged from the L4 spinous process to the L5-S1 interspinous process in all patients. Inter- examiner agreement of palpation was significantly greater in PSIS than IC level (p<0.05). The marker indicating assumed IC level was higher than true IC level in all patients and was higher than L3-4 interspinous process in 8%. CONCLUSION: We may use PSIS level for assumption of the lumbar vertebral level to compensate for the limitation of iliac crest palpation, but at the same time keep in the mind the variarity of the PSIS level.
Humans ; Palpation* ; Spine*

Verruciform xanthoma (VX) is a rare, benign lesion that presents in the oral cavity, skin, or genital organs as a verrucous, papillomatous, or flat papule with varying colors. VX has indistinct clinical features, making histopathological examination necessary for a definitive diagnosis. Histologically, VX is characterized by parakeratosis, rete ridges with uniform depth, and an accumulation of the foam cells, which are also known as the "xanthoma cells". These foam cells test positive for antibodies, such as CD-68 and vimentin; it is thought that VX foam cells are derived from the monocyte-macrophage lineage, and that VX's pathogenic mechanism is partly related to an immune mechanism. Nevertheless, the pathogenesis of VX remains unclear. VX can be treated by surgical excision; other medical, chemical, and radiological treatments are not required postoperatively. Recurrence and malignant transformation of VX are rare. Two patients, each with a mass of unknown origin on the palatal gingiva, were presented at our clinic. Excisional biopsies of the masses were performed for a histological diagnosis after clinical and radiological examinations. Histological examination confirmed a diagnosis of VX in both cases.
Antibodies ; Biopsy ; Diagnosis ; Foam Cells ; Genitalia ; Gingiva* ; Humans ; Mouth ; Parakeratosis ; Recurrence ; Skin ; Vimentin ; Xanthomatosis*