The biomechanical responses, such as nucleus pulposus pressure, facet contact force, stress distribution among ligaments in the cervical spine under static loading like flexion and extension, were examined with 3-D nonlinear finite element model. Finite element model consisted of whole cervical spines with intact discs and ligaments was developed from 1mm thick CT-cross sections of a 25-year-old healthy young man. Geometrical nonlinearity was considered for the large deformation and ABAQUS package was used for calculation. Results were verified comparing with those of existing in vivo and in vitro experiments. Results indicated that, developed cervical spine FEM was well consistent with other experiments. Nucleus pulposus pressure increased in flexion and extension more in lower cervical region. Facet contact force increased more in lower cervical spine in extension. In addition, capsular ligament was the most important one among 7 cervical ligaments surrounding cervical spine both in flexion and extension. We could better understand the biomechanics of whole cervical spine with developed finite element model and it might be applied to dynamic or postoperative study.
Adult ; Humans ; Ligaments ; Spine*

Solitary fibrous tumor (SFT) is a rare neoplasm, which is usually presented as a pleural based mass, but can also occur in unusual locations based on its mesenchymal origin. However, the radiologic features of SFT occurred in the ischiorectal fossa have been rarely reported. In this case, we describe the MRI findings in a case of a SFT involving the ischiorectal fossa of a 36-year-old man. The tumor appeared as homogeneous iso-signal intensity relative to the adjacent muscle on T1 weighted images, a mixed high signal intensity on the T2 weighted images, and heterogeneous enhancement following the administration of the contrast material.
Adult ; Humans ; Muscles ; Solitary Fibrous Tumors

Cerebral vasospasm is one of most serious complication after subarachnoid hemorrhage due to aneurysmal rupture and a very important cause affecting to prognosis. The most reliable diagnostic assessment of cerebral vasospasm is angiography, but this is limited to perform because of complications such as neurological deficits or death, especially to repeat studdy. It seems likely that assessment of evoked elective, a much simpler and safer than the repeated study of angiography, will be of use in following the condition of patients with clinical vasospasm following SAH. In order to study relationship between clinical vasospasm and electrical activity, we traced SSEP from upper extremity by median nerve stimulation and lower extremity by posterior tibial stimulation which manifest the neurophysiologic function of cerebral ischemia. MN(Me-dian n.) and PTN(Posterior tibial n.)were performed simultaneously. Over 2 years period (1986 through 1988), 41 patients were performed SSEP and evaluated the relationship between SSEP and clinical or angiographic vasospasm in patients of SAH.
Aneurysm ; Angiography ; Brain Ischemia ; Humans ; Lower Extremity ; Median Nerve ; Prognosis ; Rupture ; Subarachnoid Hemorrhage ; Upper Extremity ; Vasospasm, Intracranial

Somatosensory evoked potential(SSEP) has been recorded during 31 operations for intracranial aneurysm. We had monitored the SSEP in each stage of aneurysm surgery(preoperative, anesthetic induction, dura opening, temporary vascular occlusion, aneurysm neck clipping and 30 minute after aneurysm neck clipping). Temporary occlusion of intracranial arteries have performed in 21 cases. In cortical amplitude of more than 50% as compared with induction was considered to be "significant" SSEP change. Eleven out of 21 cases of temporary vascular occlusion showed significant decrease of amplitude. Three out of 4 cases with flat wave had new neurologic deficits postoperatively. We studied the relationship between SSEP changes and postoperative neurologic deficit and concluded as follows: 1) The monitoring of amplitude of SSEP may help control the duration and number of application in temporary clipping during aneurysm surgery. 2) Decreased in amplitude with temporary clipping, especially flat wave, is a strong suggestion of the postoperative neurologic deficit. These results indicate that monitoring of SSEP during aneurysm surgery would be helpful to reduce the incidence of postoperative neurologic deficits.
Aneurysm* ; Arteries ; Incidence ; Intracranial Aneurysm ; Neck ; Neurologic Manifestations

BACKGROUND: Laryngoscopy and tracheal intubation are associated with hemodynamic pressor responses, which can have adverse effects. During anesthesia induction with propofol target-controlled infusion (TCI), we aimed to determine the most appropriate dosage of alfentanil required for intubation, using a steady effect-site concentration of propofol and with the use of vecuronium. METHODS: Eighty ASA class 1 or 2 patients presenting for elective surgery were allocated at random to one of four groups. Anesthesia was induced in all patients with TCI of propofol target concentration 8 microgram /ml, followed by vecuronium (0.12 mg/kg). This was reduced to 5microgram/ml when the effect-site concentration had been 4microgram/ml. After the effect-site concentrations had reached to 5microgram/ml, control group received normal saline, group 1 received alfentanil 10microgram/kg, group 2 received alfentanil 20microgram/kg, and group 3 received alfentanil 30microgram/kg. Laryngoscopy and intubation were performed 90 s later. Heart rate was monitored continuously. Systolic blood pressure, diastolic blood pressure and mean arterial pressure were measured at pre-induction, post-induction (pre-intubation) and post-intubation, respectively. Complications such as hypotention and bradycardia were recorded until 5 minutes had elapsed after tracheal intubation. RESULTS: Control group showed significant increases associated with tracheal intubation in all hemodynamic variables (P < 0.05). Post-intubation values decreased significantly from pre-induction values in groups 1, 2 and 3 (P < 0.05). In groups 2 and 3, hypotension and bradycardia occurred (zero in group 1) but there were no significant differences in their incidences between the three groups. CONCLUSIONS: We suggest that alfentanil 10microgram/kg constitutes the optimal dosage to obtund the hemodynamic responses to tracheal intubation, using propofol TCI (5microgram/ml) and vecuronium for induction of anesthesia.
Alfentanil* ; Anesthesia* ; Arterial Pressure ; Blood Pressure ; Bradycardia ; Heart Rate ; Hemodynamics* ; Humans ; Hypotension ; Incidence ; Intubation ; Intubation, Intratracheal* ; Laryngoscopy ; Propofol* ; Vecuronium Bromide

Aerophagia is a disorder caused by abnormal accumulation of air in the gastrointestinal tract as a result of repetitive and frequent inflow of air through the mouth. For the diagnosis of this condition, it is difficult to objectively measure the air swallowing. However, multichannel intraluminal impedance monitoring facilitates the differential diagnosis between normal air swallowing and pathologic aerophagia, and can aid in the determination of the frequency and amount of air swallowed. In this report, in addition to a literature review, we describe a case of 36-year-old man with abdominal distension who was diagnosed with aerophagia using esophageal impedance monitoring and was treated with clonazepam.
Adult ; Aerophagy/*diagnosis/diagnostic imaging/drug therapy ; Anticonvulsants/therapeutic use ; Clonazepam/therapeutic use ; Diagnosis, Differential ; Electric Impedance ; Humans ; Male ; Mental Disorders/complications ; Tomography, X-Ray Computed

Fulminant gas gangrene is a rare condition, usually associated with contaminated traumatic injuries. It carries a high rate of mortality and morbidity. Also, a number of studies have implicated non-traumatic gas gangrene, associated mostly with underlying diseases that cause immunodeficiency. We report a non-traumatic fatal case of Klebsiella pneumoniae gas gangrene with small air bubbles in the left external and common iliac vein, and inferior vena cava in a previously healthy male. We would like to recommend you do not use nitrous oxide in case of gas gangrene, because it can aggravate pulmonary air embolism.
Embolism, Air ; Gas Gangrene ; Humans ; Iliac Vein ; Klebsiella ; Klebsiella pneumoniae ; Male ; Nitrous Oxide ; Vena Cava, Inferior

Eosinophilic cholecystitis is a rare, poorly understood inflammatory condition of the gall bladder. It is characterized by transmural inflammation of the gallbladder wall in which more than 90% of the white cells are eosinophils. The etiology of eosinophilic cholecystitis remains obscure, although suggested causes include allergies, parasites, eosinophilic enteritis, and local reaction to gall stones. We report the case of a 66-year-old man who had eosinophilic cholecystitis associated with gall stones.
Aged ; Cholecystitis ; Enteritis ; Eosinophilia ; Eosinophils ; Gallbladder ; Gallstones ; Gastritis ; Humans ; Hypersensitivity ; Inflammation ; Parasites ; Urinary Bladder

BACKGROUND: Currently, combined spinal-epidural anesthesia (CSE) is frequently administered, especially in obstetrics and orthopedic surgery. The aim of this study is to determine the appropriate concentration of bupivacaine to use with epidural volume extension that is suitable for total knee replacement during CSE. METHODS: Eighty patients (ASA physical status I and II) scheduled for totalknee replacement were randomly allocated to four groups of 20 patients each: All patients intrathecally received 2 ml of 0.5% hyperbaric bupivacaine. After fixation of spinal anesthesia, the groups received the following treatments. Group S patients received a 10 ml administration of normal saline for 15 min followed by a continuous 10 ml/hr epidural infusion. Group B1 patients received a 10 ml administration of 0.125% bupivacaine for 15 min followed by a continuous 10 ml/hr epidural infusion. Group B2 patients received a 10 ml administration of 0.25% bupivacaine for 15 min followed by a continuous 10 ml/hr epidural infusion. Group B3 patients received a 10 ml administration of 0.5% bupivacaine for 15 min followed by a continuous 10 ml/hr epidural infusion. RESULTS: The incidence of intraoperative movement in group S and group B1 patients were significantly greater than the incidence for group B2 and B3 patients. The incidence of intraoperative pain in group S patients was significantly greater than for patients in any of the other groups. CONCLUSIONS: We conclude that it is necessary to administer more than a 0.25% concentration of epidural bupivacaine load and provide continuous administration after a spinal block during total knee replacement.
Anesthesia* ; Anesthesia, Spinal ; Arthroplasty, Replacement, Knee* ; Bupivacaine* ; Humans ; Incidence ; Obstetrics ; Orthopedics

BACKGROUND: Pulmonary vasoconstriction greatly contributes to the elevated pulmonary vascular resistance in patients with pulmonary hypertension. A rise in cytosolic Ca2+ concentration ([Ca2+]cyt) in pulmonary arterial smooth muscle cells (PASMCs) is a major trigger for pulmonary vasoconstriction. Presently, little is known about the nature of the store-operated channels (SOCs) in PASMCs, even though store depletion-mediated capacitative Ca2+ entry (CCE) is a critical mechanism for refilling the empty sarcoplasmic reticulum (SR) with Ca2+, and for maintaining a sustained increase in [Ca2+]cyt. The goal of this in vitro study was to investigate the effects of nickel and manganese on store-operated channels in canine PASMCs. METHODS: Isolated PASMCs were obtained from an enzymatically treated canine pulmonary artery. Currents were recorded at room temperature using the dialyzed whole cell recording technique. The protocol used to deplete the intracellular Ca2+ stores and to monitor the development of the store-operated Ca2+ currents, involved voltage-clamping cells at 0 mV to inactivate any voltage-dependent calcium currents. Crrents were recorded in response to a 200 ms voltage step from 120 to 40 mV in 20 mV increments every 15 seconds. RESULTS: Simultaneous depletion of intracellular Ca2+ leads to a voltage-independent and linear store-operated Ca2+ current (ISOC) reversal near 0 mV. Nickel and manganese inhibit ISOC. CONCLUSIONS: In canine PASMCs, the depletion of intracellular Ca2+ stores leads to the activation of ISOC, which is inhibited by nickel and manganese. These metals are non-specific inhibitors of non-selective cation channels. Our results indicate that Ni2+- and Mn2+-sensitive pathways may mediate Ca2+ entry, or that a class of non-selective cation channels may contribute to CCE in canine PASMCs.
Calcium ; Cytosol ; Humans ; Hypertension, Pulmonary ; Manganese* ; Metals ; Muscle, Smooth* ; Myocytes, Smooth Muscle* ; Nickel* ; Patch-Clamp Techniques ; Pulmonary Artery ; Sarcoplasmic Reticulum ; Vascular Resistance ; Vasoconstriction