Chronic compression or ischemia of the spinal cord in the cervical spine causes a clinical syndrome known as cervical myelopathy. Recently, a new term “degenerative cervical myelopathy (DCM)” was introduced. DCM encompasses spondylosis, intervertebral disk herniation, facet arthrosis, ligamentous hypertrophy, calcification, and ossification. The pathophysiology of DCM includes structural and functional abnormalities of the spinal cord caused by static and dynamic factors. In nonoperative patients, cervical myelopathy has a poor prognosis. Surgical treatments, such as anterior or posterior decompression accompanying arthrodesis, arthroplasty, or laminoplasty, should be considered for patients with chronic progressive cervical myelopathy. Surgical decompression can prevent the progression of myelopathy and improve the neurologic status, functional outcomes, and quality of life, irrespective of differences in medical systems and sociocultural determinants of health. The anterior surgical approach to the cervical spine has the advantage of removing or floating the intervertebral disk, osteophytes, and ossification of the posterior longitudinal ligament that compress the spinal cord directly. The posterior surgical approach to the cervical spine is mainly used for multisegment spinal cord compression in patients with cervical lordosis. In this review article, we addressed the pathophysiology, clinical manifestations, differential diagnosis, and treatment options for DCM.

We reviewed 40 cases of femoral shaft fractures in children treated with split Russel traction and initial fracture angulation above 10 degree. The treatment of femoral shaft fractures in children is various according to age. Satisfactory results have been reported with split-Russel traction. At an average follow-up of 33 months, we obtained following results about remodelling of fracture site & physeal site, possible acceptable angulation of fracture. 1. The average time of traction was 18 days, and hip spica cast was applied for 28 days. 2. Malunion within 25degrees in flexion & 23degrees in valgus & 24degrees in varus was well corrected spontaneously. 3. Average correction of initial angular deformity was 86% at last follow up. 4. Anterior angulation was corrected at 83%, varus 87%, valgus 88%. 5. Remodelling according to direction of deformity was no statistical correlation (P>0.05), and then spontaneous correction of angular deformity was same without relation to direction of deformity. 6. Remodelling according to site was statistical correlation (P<0.05), fracture site 26%, physes 74%. And proximal physes 36%, distal physes 38%.
Child* ; Congenital Abnormalities* ; Follow-Up Studies ; Hip ; Humans ; Traction*

The authors studied the effect of insufflation of oxygen at 5 cmH2O into the nonventilated lung on the arterial oxygenation in the thoracotomy patients(n=14) who showed PaO2 below 100 mmHg or oxygen saturation below 95% during one-lung ventilation. When applying CPAP 5 cmH2O to the collapsed lung, we inflated the collapsed lung with reservoir bag that is one of the equipment of self made CPAP device. Hemodynamic parameter(mean arterial pressure and heart rate), arterial blood gas analysis and calculated shunt fraction was collected 10, 20, 30min after applying CPAP. PaO2 was significantly increased from 76+/-20mmHg to 180+/-66 (mean+/-SD) and shunt fraction was significantly decreased from 43.5+/-5.6% to 31.5+/-4.9% at CPAP 10 min. There was no significant difference in the PaO2 and shunt fraction between CPAP 10, 20 and 30 min. Heart rate was also significantly decreased with CPAP compared to pre-CPAP value. Other parameter(mean arterial pressure, PaCO2) was not changed with CPAP. The authors conclude that CPAP 5 cmH2O to the nonventilated lung is effective to improve oxygenation when hypoxemia occurs during one-lung ventilation.
Anoxia ; Arterial Pressure ; Blood Gas Analysis ; Continuous Positive Airway Pressure* ; Heart ; Heart Rate ; Hemodynamics ; Insufflation ; Lung* ; One-Lung Ventilation* ; Oxygen* ; Thoracotomy

BACKGROUND: Tracheal extubation causes hypertension and tachycardia. In susceptable patients, even this short period of hypertension and tachycardia can result in myocardial ischemia. The purpose of this study was to evaluate the effect of esmolol and diltiazem in attenuating cardiovascular responses to tracheal extubation. METHODS: Changes in heart rate, systolic and diastolic blood pressure were measured during extubation and emergence from anesthesia in 60 ASA physical status I patients to assess the effect of esmolol and diltiazem. The patients were randomly assigned to one of three groups (n=20 for each group) : saline 5 ml (as a control), 0.2 mg/kg diltiazem and 1.5 mg/kg esmolol. These medications were given 2 min before tracheal extubation. RESULTS: Both groups of diltiazem and esmolol were greater attenuating effect on changes of heart rate, systolic and diastolic blood pressure than control group. The inhibitory effect on changes of heart rate was greater with esmolol than diltiazem, but the attenuating effect on changes of systolic blood pressure was greater with diltiazem than esmolol. CONCLUSIONS: We concluded that a bolus dose of intravenous diltiazem 0.2 mg/kg or esmolol 1.5 mg/kg given at 2 min before extubation was of value in attenuating the cardiovascular changes occuring in association with tracheal extubation and emergence from anesthesia. Esmolol is more effective than diltiazem in attenuating the heart rate changes. Diltiazem is more effective than esmolol in attenuating the systolic blood pressures changes.
Airway Extubation* ; Anesthesia ; Blood Pressure ; Diltiazem* ; Heart Rate ; Humans ; Hypertension ; Myocardial Ischemia ; Tachycardia

Treatment modalities for herniated lumbar intervertebral disc are the conservative method, chemonucleolysis, percutaneous diskectomy and operation. Conservative treatment is effective in 70–80% of the acute stage and the other 20% requires chemonucleolysis, percutaneous diskectomy or operation. Indications for operation are cases not improved after conservative treatment, recurrent cases and cauda equina syndrome. Mixter and Barr(1934) demonstrated that laminectomy and surgical removal of disc material could relieve symptoms, but spinal segmental instability, incomplete removal of the disc and postoperative adhesion of the nerve root caused low back pain after long-term follow up. Thus, the authors evaluated the plain X-ray and computed tomographic findings in 21 cases of failed laminectomy to determine the cause of failure. The results were as follows ; 1. Among 21 cases, 18 cases complained of low back pain with sciatica and 3 cases complained of low back pain. 2. In all cases, disc space narrowing was detected on plain X-ray. Total laminectomy and diskectomy promote insufficiency and instability of the lumbar and lumbosacral spine. Whenever one attempts to do total laminectomy and diskectomy, it is recommended that spine fusion be performed in same operating field. 3. Several findings were detected on CT scan : 8 disc protrusions in the operation site, 6 disc protrusions in the operation site and spinal stenosis, 4 extradural scars, 1 extradural scar and other site disc protrusion and 2 cases of spinal stenosis and spondyloisthesis. 4. Computed tomography in cases of failed laminectomy offers more information than has been available by any other imaging method.
Cicatrix ; Diskectomy ; Diskectomy, Percutaneous ; Follow-Up Studies ; Intervertebral Disc ; Intervertebral Disc Chemolysis ; Laminectomy ; Low Back Pain ; Methods ; Polyradiculopathy ; Sciatica ; Spinal Stenosis ; Spine ; Tomography, X-Ray Computed

Voice changes developing after endotracheal intubation during right hemicolectomy with endotracheal intubation have been found to be due to a right recurrent laryngeal nerve palsy in 43-years-old male patient. It was likely that the inflated cuffed tube rode up to the level of the cricoid cartilage during the course of surgery as traction was placed on the endotracheal tube because the condenser humidifier and breathing circuit weighed heavy. Cuff overexpansion, in addition to muscle relaxation and decreased tracheal elasticity were considered as contributing factors of vocal cord palsy. We believe that tube traction and cuff overexpansion were the mechanism of vocal cord palsy in our patient. So we recommend the routine use of tube stand so that weigh of the breathing circuit does not transmit traction to the endotracheal tube. Concurrently, filling the cuff with a sample of the inspired mixture of gases, saline and 4% lidocaine in special cases or regular deflation of the cuff must be considered.
Cricoid Cartilage ; Elasticity ; Gases ; Humans ; Intubation, Intratracheal* ; Lidocaine ; Male ; Muscle Relaxation ; Respiration ; Traction ; Vocal Cord Paralysis* ; Vocal Cords* ; Voice

Juvenile xanthogranuloma is a congenital or perinatal tumor, 1 to 2 cm in diameter, usually located on the head. The extracutaneous lesions can occur on the eye, the lung, the epicardium, the oral cavity or the testicles. Subcutaneous form of juvenile xanthogranuloma has been reported very rarely in the literature. We report a unique case of a subcutaneous juvenile xanthogranuloma that showed 4 × 4 cm sized plaque and located on the extremity of 9-year-old girl.
Child ; Extremities ; Female ; Head ; Humans ; Lung ; Mouth ; Pericardium ; Testis ; Xanthogranuloma, Juvenile*

No abstract available in English.
Adult ; Clinical Study ; Fractures, Comminuted ; Humans

STUDY DESIGN: Retrospective study. PURPOSE: This study was conducted to compare vertebral body height restoration rate in rheumatoid arthritis (RA) patients who had undergone percutaneous balloon kyphoplasty (KP) with that of control group who had matched age, sex, body mass index, and bone mineral density. OVERVIEW OF LITERATURE: There is no report on result of KP in RA patients. METHODS: Postoperative height restoration rate of RA group consisting of 15 patients (18 vertebral bodies) who had undergone KP due to osteoporotic vertebral compression fracture with a 30% or higher vertebral compression rate between May 2005 and January 2013 were compared to control group consisting of 38 patients (39 vertebral bodies) who had matched age, sex, body mass index, and bone mineral density. RESULTS: No statically significant difference in age (p=0.846), sex (p=0.366), body mass index (p=0.826), bone mineral density (p=0.349), time to surgery (p=0.528), polymethylmethacrylate injection time (p=0.298), or amount (p=0.830) was found between the RA group and the control group. However, preoperative compression rate in the RA group was significantly (p=0.025) higher compared to that in the control group. In addition, postoperative height restoration rate showed significant correlation with the RA group (p=0.008). Although higher incidence of recollapse occurred in the RA group compared to that in the control group, the difference was not statistically significant (p=0.305). CONCLUSIONS: Compared to the control group, RA patients showed higher compression rate and higher vertebral restoration rate after KP, indirectly indicating weaker bone quality in patients with RA. Higher incidence of recollapse occurred in the RA group compared to that in the control group, although it was not statistically significant.
Arthritis, Rheumatoid ; Body Height ; Body Mass Index ; Bone Density ; Fractures, Compression* ; Humans ; Incidence ; Kyphoplasty* ; Polymethyl Methacrylate ; Retrospective Studies

The incidence of the distal anterior cerebral artery(DACA) aneurysm comprises about 2-6% of all intracerebral aneurysms. Because of the low incidence, unique anatomies of the distal anterior cerebral arteries and some technical difficulties in surgery, these aneurysms present such challenge to neurosurgeons. Presently, early surgery using interhemispheric approach is preferred. The auhtors experienced six patients with DACA aneurysms in 130 consecutive intracerebral aneurysms surgically treated between May. 1994 and Dec. 1997. The patients received operations within five days from the ictus, except one patient because of symptomatic vasospasm. The surgical approaches were all unilateral interhemispheric approaches. During the operations, infusion of large amount of mannitol and CSF volume removal were applied, although there were few difficulties in the interhemispheric dissections, the outcomes of the patients were excellent in three, good in three. The authors suggest that early operative interventions using unilateral interhemispheric approach without generous craniotomy can improve the outcomes of the patients with ruptured DACA aneurysm.
Aneurysm ; Anterior Cerebral Artery* ; Craniotomy ; Humans ; Incidence ; Intracranial Aneurysm* ; Mannitol