OBJECTIVE: Lumbar lordotic curve on L4 to S1 level is important in maintaining spinal sagittal alignment. Although there has been no definite report in lordotic value, loss of lumbar lordotic curve may lead to pathologic change especially in degenerative lumbar disease. This study examines the changes of lumbar lordotic curve after posterior lumbar interbody fusion with wedge shape cage. METHODS: We studied 45patients who had undergone posterior lumbar interbody fusion with wedge shape cage and screw fixation due to degenerative lumbar disease. Preoperative and postoperative lateral radiographs were taken and one independent observer measured the change of lordotic curve and height of intervertebral space where cages were placed. Segmental lordotic curve angle was measured by Cobb method. Height of intervertebral space was measured by averaging the sum of anterior, posterior, and midpoint interbody distance. Clinical outcome was assessed on Prolo scale at 1month of postoperative period. RESULTS: Nineteen paired wedge shape cages were placed on L4-5 level and 6 paired same cages were inserted on L5-S1 level. Among them, 18patients showed increased segmental lordotic curve angle. Mean increased segmental lordotic curve angle after placing the wedge shape cages was 1.96? Mean increased disc height was 3.21mm. No cases showed retropulsion of cage. The clinical success rate on Prolo's scale was 92.0%. CONCLUSION: Posterior lumbar interbody fusion with wedge shape cage provides increased lordotic curve, increased height of intervertebral space, and satisfactory clinical outcome in a short-term period.
Postoperative Period

In order to study the effect of spinal nareotics on postoperative pulmonary function and ventilatory reserve after upper abdominal surgery, small preoperative doses of morphine were administrated into the subarachnoidal space and the changes in FVC, FEVi.e., MMEF and FEVi.e./FVC with the SC-20 spirometric computer wer evaluated. The results were as follows: 1) On the 1st day postoperatively FVC of the control group was 56% of the preperative value, 2.94+/-0.68(1/sec), and that of the morphine group was 66% of the preoperative value, 2.99+/-0.73(1/sec).(p<0.05) On the 2nd and 3rd day postoperatively the control group was 64% and 65% and that of the morphine group was 82% and 87%. (p<0.05) 2) On the 1st and 2nd postoperative day FEVi.e. of the control group was 52% and 57% of the preoperative value, 2.49+/-0.43(1/sec), and that of the morphine group was 61%, and 65% of the preoperative value, 2.42+/-0.68(1/sec). (p<0.05) On the 3rd postoperative day the FEVi.e. of the control group was 65% and that of the morphine group was 80%. (p<0.05) 3) On the 1st and 2nd postoperative day the MMEF of the control group was 56%, and 61% of the preoperative value, 2.45+/-0.77(1/sec). In the 3rd postoperative day the MMEF on the control group was 63% and that of the morphine group was 78%. (p<0.01) 4) The preoperative FEVi.e./FVC of the control group was 84.3% and that of the morphine group was 78.7%. in the postoperative period, there were no significant differences between the control and morphine group.
Morphine* ; Postoperative Period

Dissociated vertical deviation(DVD) is a clinical entity consisting of an up ward and extorsional drift of a nonfixating eye. This can occur spontaneously or during occlusion of that eye. The cosmetic importance of surgical management of manifest DVD has been agreed upon, but a number of different operative approaches have been cited in the literature. The surgical treatments for DVD are large recession of the superior rectus(10-16mm), resection of the inferior rect-us as much as 8mm, posterior fixation suture of the superior rectus and posterior fixation suture combined with the superior rectus recession. However, in comparing the long-term effect of recession of the superior rectus muscle, reces-sion of the superior rectus muscle combined with posterior fixation, with that of posterior fixation of the superior rectus muscle without recession, Duncan and von Noorden concluded that the best results are obtained by conventional recession of the superior rectus muscle(4 to 5mm) combined with posterior fixation of 12-15mm behind the muscle insertion. 8 eyes of 7 patients received 4mm recession of the superior rectus muscle combined with 12-15mm posterior fixation suture for the treatment of DVD. All patients were followed for postoperative period of 4 weeks to 20 months. The results were as follows: 1. The amount of preoperative DVD has ranged from 20 delta to 38 delta. 2. The amount of postoperative DVD has ranged from 0 delta to 10 delta, and the effect of that surgery has ranged from 10 delta to 33 delta, average 23 delta. 3. After operation 7 of 8 eyes were aligned, within the good to excellent categories (0-10 delta).
Humans ; Postoperative Period ; Sutures*

We investigated the influence of fusional divergence on the surgical results in the intermittent exotropia. Among the 56 patients with intermittent exotropia. the angle of deviation was measured during the preoperative period and the postoperative periods. The amplitude of the fusional divergence was measured with the rotary prism after the correction of the angle of deviation with the prism before the surgery. The subjects were devided into 4 groups; group one which returned to orthophoria after the overcorrection of exodeviation; group two - which did not return to orthophoria after the overcorrection of exodeviation; group three - which remained orthophoria after the correction of exodeviation; group four - which showed orthophoria initially but returned to undercorrection. There was not any significant difference between the four groups. We concluded that the influence of fusional divergence on the surgical results for intermittent exotropia was not significant enough. However, further studies should be done with more subjects for better results.
Exotropia* ; Humans ; Postoperative Period ; Preoperative Period

Humans ; Pancreaticoduodenectomy ; Pathology, Clinical ; Perioperative Period ; Postoperative Period ; Preoperative Period

Dilutional hyponatremia secondary to fluid retention in the postoperative period may be related to a persistent and inappropriate secretion of ADH, possibly orginated from surgical stress, pain, fear and others. It is also serious and over 50% mortality when it should be combined with neurological feature, especially generalized convulsion. But this phenomenon is transitory and complete curable with active management. So Anesthesiologists should be aware of this symptoms by measure of elctrolytes is postanesthetic period. We experienced 2 cases of dilutional hyponatremia with convulsion in postoperative period.
Hyponatremia* ; Mortality ; Postoperative Period ; Seizures*

Malperfusion of a major organ with aortic dissection has various clinical features according to the involved aortic branch. The morbidity and mortality rate can increase without suspicion especially during the intraoperative and postoperative period. Surgical outcomes and prognosis are influenced by early detection and active treatment, and expeditious diagnostic and therapeutic measures are mandatory for successful treatment. The authors report four successful cases of acute aortic dissection with malperfusion of various organs, such as the brain, kidney, and the lower extremities.
Brain ; Kidney ; Postoperative Period ; Prognosis

PURPOSE: The aim of this study was to determine the role of routine manipulation on increasing angle of great flexion(AGF) after total knee arthroplasty (TKA) in early postoperative period. MATERIALS AND METHODS: We analysed the AGF of the both knees 1 year after total knee arthroplasties in 59 patients who had a bilateral procedures and in whom only one knee was manipulated routinely at 2 weeks after TKA. RESULTS: The average AGF was 124.6 degree (85~145) on routine manipulated knee and 125.3 degree (90~145) on non-manipulated side 1 year after TKAs. Therefore, there was no statistical significance in AGFs between both sides(p=0.384). Among 59 patients, the AGF was same on both knees in 32 patients, greater AGF on manipulated knee in 12 patients and greater AGF on non-manipulated TKA side CONCLUSION: The routine manipulation has no positive role on increasing AGF after total knee arthroplasty in early postoperative period.
Arthroplasty* ; Humans ; Knee* ; Postoperative Period

This was a retrospective descriptive study of 105 patients who underwent postoperative endoscopy of the hepatobiliary tract through the T-tube tract. The first 42 consecutive patients (Group A) underwent the procedure from May 1997 to June 1998 wherein a bronchoscope (Pentax 4.9 mm.) was used. The next 63 consecutive patients (Group B) underwent the procedure from July 1998 to August 1999 and a choledoscope (Olympus CHF type P-20) was used. In Group A, 40 patients had retained stones and in Group B, 48 patients had retained stones, for a total of 88 (84%) cases with residual stones diagnosed. The average number of sessions were 5.2 and 2.7 for Group A and Group B, respectively. The clearance rate was 95 percent for Group A and 91.7 per cent for Group B

OBJECTIVES: The goal of surgical management of cerebral arteriovenous malformations (AVMs) is elimination of the lesions without development of new neurological deficits. To improve the surgical management of results of cerebral AVMs in the future, this article discusses about surgical complications of the AVMs and their preventive methods. METHODS: We investigate the methods to avoid the surgical complications of the AVMs based on the our experiences and review of literatures. RESULTS: Accurate anatomical knowledge about location of AVMs, proper reduction of nidus size by preoperative embolization, accurate dissection of peripheral margin of AVMs during surgery, and understanding and proper management of peculiar pathophysiological events of AVMs which occur during surgery and postoperative period are the key points for avoiding surgical complications of the AVMs. CONCLUSION: We conclude that refined skill for endovascular and microsurgical techniques are required to successful surgical treatment of cerebral AVMs.
Arteriovenous Malformations* ; Intracranial Arteriovenous Malformations ; Postoperative Period