No abstract available.
Fractures, Spontaneous* ; Prostheses and Implants*

No abstract available.
Spine*

No abstract available.

Recently posterior stabilization with various instrumentation and fusion has been used for fractures of the thoracolumbar spine involving anterior and middle columns. However, these methods are sometimes inadequate to gain anatomical reduction and complete decompression especially in burst fractures. So anterior decompression and interbody fusion were frequently added as a second operation. Biomechanically a rigid anterior spinal instrument such as kaneda device can provide enough anterior decompression through partial or total corpectomy and adequate correction of kyphosis as an one stage operation. We have experienced 27 cases of Kaneda instrumentation via anterior approach for thoracolumbar fracture, most of them were burst fractures, from Jan. 1989 to June 1990. Of there 27 cases, 12 were followed up at least 1 year and reviewed. The results were as followed: l. Anterior spinal approach using Kaneda instrumentation provided sufficient anterior neural decompression and adequate correction of kyphotic deformity. It eliminates the second posterior procedure in most cases and enhances early solid union. Simultaneously, it allows early mobilization of patient with an application of brace. 2. Post-operative courses were eventful in most cases except a case of pathological fracture. 3. This procedure seemed to be one of the most suitable method for the treatment of burst fractures of the thoracolumber region. 4. Complications by Kaneda device itself were not developed in the early evaluation stage. However, on longer follow-up study over 1 year revealed some complications including 2 cases of screw breakage and one lateral wedging deformity.
Braces ; Congenital Abnormalities ; Decompression ; Early Ambulation ; Follow-Up Studies ; Fractures, Spontaneous ; Humans ; Kyphosis ; Methods ; Spine

The temporary effects of muscle atrophy, followed by chemodenervation due to acetylcholine blockade at the neuromuscular junction by botulinum toxin type A(BTX-A) were mainly used for the treatment of hypertrophied muscle. In the treatment of masseter hypertrophy or cosmetic contouring of the lower face with injection of botulinum toxin type A, these muscle atrophy causes the change of the bite-force inevitably. Although several reports about the histological change of muscle, ultrasound and computerized tomography measurement studies of the change of muscle thickness in the treatment of masseter hypertrophy with injection of BTX-A have become available recently, it is necessary to study further the change of the bite-force and the relationship between the bite-force and clinical effects after the botulinum toxin A injection. The aim of this study was to evaluate the change of maximal bite-forces after botulinum toxin type A injections for treating the contouring of the lower face. Botulinum toxin type A(BTXA(R), Lanzhou, China) of 25U per side was carried out in 7 subjects. The change of maximal bite-forces was evaluated at pre-injection and 2 week, 4 week, 8 week, 12 week post-injections using bite- force measuring machine(MPM-3000, Japan). There were statistically significant differences between pre-injection and 2 week, 4 week, 8 week post-injections(p<0.05). However, there was no significant difference between pre-injection and 12 week post-injection. In conclusion, the change of maximal bite-forces after BTX-A injections according to the period was similar to the histological change of the muscle. The clinical effects last more longer than maximal bite force. Therefore, it is necessary to evaluate further these difference with more larger samples and the relationship between the change of maximal bite force and clinical effects.
Acetylcholine ; Bite Force ; Botulinum Toxins* ; Botulinum Toxins, Type A ; Hypertrophy ; Muscular Atrophy ; Nerve Block ; Neuromuscular Junction ; Ultrasonography

Diffuse refractory vascular spasms associated with coronary bypass artery grafting (CABG) are rare but devastating. A 42-year-old male patient with a past history of stent insertion was referred for the surgical treatment of a recurrent left main coronary artery disease. A hemodynamic derangement developed during graft harvesting, necessitating a hurried initiation of cardiopulmonary bypass (CPB). Although CABG was carried out as planned, the patient could not be weaned from the bypass. An emergency coronary angiography demonstrated a diffuse spasm of both native coronary arteries and grafts. CPB was switched to the femorofemoral extracorporeal membrane oxygenator (ECMO). Although he managed to recover from heart failure, his discharge was delayed due to the ischemic injury of the lower limb secondary to cannulation for ECMO. We reviewed the case and literature, placing emphasis on the predisposing factors and appropriate management.
Adult ; Arteries ; Cardiopulmonary Bypass ; Catheterization ; Causality ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Vasospasm ; Coronary Vessels ; Emergencies ; Extracorporeal Membrane Oxygenation ; Heart Failure ; Hemodynamics ; Humans ; Lower Extremity ; Male ; Oxygenators, Membrane ; Spasm* ; Stents ; Transplants*

The cause of cyclic strabismus is not clear but is assumed to be an abnormality of the biological clock mechanism. Secondary factors, combined with surgery or trauma as well as unknown causes stimulate its occurrence and may be followed by the periodicity of strabismus. We report postoperative follow-up results of 4 cases of cyclic esotropia following surgery. Two cases (case 1 and 2), who developed cyclic esotropia after surgery for intermittent exotropia, show good postoperative alignment without periodicity. But in case 3, originally treated for intermittent exotropia after receiving treatment for consecutive esotropia, the patient reverted to original condition. In case 4, originally treated for congenital glaucoma and receiving secondary treatment for cyclic esotropia, the cyclic esotropia was recurred. After surgery for consecutive cyclic strabismus, it is necessary to follow up for a long time.
Biological Clocks ; Esotropia* ; Exotropia ; Follow-Up Studies ; Glaucoma ; Humans ; Periodicity ; Strabismus

This is a case report of the accidental insertion of an entire catheter into the right femoral vein during central venous catheterization through the right femoral vein. The risks of accidental guide wire or catheter breakage and migration of resulting fragments to the heart or intravascular or extravascular space has been increased with the frequent diagnostic and therapeutic use of central venous catheters. We used a single lumen polyurethane central venous catheter (SECALON UNIVERSAL, Viggo-Spectramed, UK). During central venous catheterization under general anesthesia, the catheter was disconnected from its hub and accidentally inserted into the right femoral vein. The catheter was retrieved by using a snare under fluoroscopic guidance without any complications.
Anesthesia, General ; Catheterization, Central Venous* ; Catheters* ; Central Venous Catheters* ; Femoral Vein* ; Heart ; Polyurethanes ; SNARE Proteins

BACKGROUND: Conventional visual assessment of coronary arteriogram is fraught with large interobserver variance and disagreement with pathologic findings. Thus quantitative coronary angiography had been recently developed to meet the requirement of more reproducible measurement of severity of coronary artery disease. This study was designed to evaluate the interobserver variability of quantitative coronary angiography and its usefulness in clinical application. METHODS: Three independent observers analysed coronary angiogram of 31 consecutive patients by visual assessment and quantitative measurement using computer based algorithm. RESULTS: 1) There was considerable disagreement between 3 observers in the identification of significant coronary stenosis. Complete agreement was achieved in only 29/61 (47%) coronary lesion and agreement of more than 2 observers in 41/61(67%) lesion. 2) In visual assessment, the largest interobserver variance was found in acute marginal artery and distal circumflex artery, whereas the least variance was observed in proximal right coronary artery. 3) The average interobserver variance was 13.1% in visual assessment, 14.9% in geometric analysis, and 10.5% in video densitometric analysis. There was no significant difference between these values. 4) Visual assessment was noted to overestimate the severity of stenotic lesion, by 5.6% compared to geometric analysis and by 11.8% compared to video-densitometric analysis. CONCLUSION: These findings suggest that identifying significant lesion is major source of interobserve variability in both visual and quantitative analysis of coronary arteriogram. In addition, suboptimal image quality was responsible for the inability of quantitative analysis to reduce the variance. These factors seem to be major limitation of quantitative coronary arterirogam.
Arteries ; Coronary Angiography ; Coronary Artery Disease ; Coronary Stenosis ; Coronary Vessels ; Humans ; Observer Variation*

PURPOSE: To observe sequential changes of acute and subacute hypersensitivity pneumonitis in high resolution CT and to correlate the findings with pulmonary function test and bronchoalveolar lavage. MATERIALS AND METHODS: This study includes 11 patients with pathologically (n=10) and clinically(n=1) proved acute and subacute hypersensitivity pneumonitis. The extent of ground glass attenuation and nodules on high resolution CT scan was correlated with pulmonary function test and bronchoalveolar lavage. We also evaluated serial changes of the lesion in high resolution CT scans. RESULTS: The extent of parenchymal abnormalities on high-resolution CT scans were significantly correlated with diffusing capacity (GGA & DLco:r=0.95, p<0.003, Nodule & DLco:r=-0.94, P<.005) and FEV1 (GGA & FEV1: r=-0.57, p<.05, Nodule & FEV1: r=-0.56, P<.05) on pulmonary function test and relatively correlated with total count of cells (GGA & total count of cells: r=0.86, P<.03, Nodule & total count of cells: r=0.71, p<0. 11) on bronchoalveolar lavage. The order in disappearance of abnormal findings were poorly defined centrilobular nodule, ground glass attenuation, and well defined small centrilobular nodule on sequential CT scans. CONCLUSION: The authors conclude that HRCT is useful for diagnosis and follow up evaluation of the acute and subacute hypersensitivity pneumonitis. Quantitative analysis of extent of disease on HRCT is useful for evaluation of clinical status.
Alveolitis, Extrinsic Allergic* ; Bronchoalveolar Lavage* ; Diagnosis ; Follow-Up Studies ; Glass ; Humans ; Hypersensitivity* ; Respiratory Function Tests* ; Tomography, X-Ray Computed