The recovery process of brain damage caused by an acute severe cerebral hypoxia has been reported in various literatures. And the possibility of complete recovery of such case was said to be good in younger age group than in adult's group. We experienced a case of cardiac arrest of a 12 year old girl during halothane anesthesia induction and the cardiac and pulmonary resuscitation was succeeded promptly. But the hypotensive period persted for few minutes before the diagnosis was made. The condition of the patient after the resuscitation was good except that her unconsciousness state persisted unusually. The proposed appendectomy performed uneventfully and the anesthesia recovery of the patient was carefully observed in our I.C.U. The uncoscious state lasted for 2 days with agitated movements of legs, EEG showed abnormal, irregular patterns but showed no signs of damage of gobus pallidum and putamen. During the first month, the order of recovery of cerebral function was comatous state, swallowing, eating, and urination. The cerebellar dysunction was prominent. Then recovery of amnesia and defection followed. Speech and gate started to regain in the 26 and 36 post-operative day respectively. Writing function started recover quickly with the recovery of speech function, which occurred in 4 to 6 post-operative months. Recovery of intelligence was slowest and gradually reached to the intelligent level of 11 year old child in one year. It was found the primitive function recovered first and the highly cultivated function recovered last.
Amnesia ; Anesthesia* ; Appendectomy ; Brain* ; Child ; Deglutition ; Diagnosis ; Dihydroergotamine ; Eating ; Electroencephalography ; Female ; Halothane ; Heart Arrest* ; Humans ; Hypoxia, Brain ; Intelligence ; Leg ; Putamen ; Resuscitation ; Unconsciousness ; Urination ; Writing

A new fluorinated benzodiazepine compound Ro 5-4200 was used for induction in 58 surgical patients to evaluate the possibility of an intravenous anesthetic induction agent (Table 2 and 3). The hypnotic properties as well as respiratory, cardiovascular, muscle relaxant and local effects were observed. 1. Ro 5-4200 in doses of 2mg was slowly injected intravenously to adult patients (body weight ; 54.2+/-10.3 kg) and 1 mg to a child (body weight; 22 kg, 5 yr.) (Table 2). The tim between the start of injection and the loss of consciousness was 110.3"+/-68.6", taken from the beginning of the injection until the patient was asleep and eyelash and corneal reflexes abolished. Sleep did not occur in 2 patients (Table 4). 2. But the time to sleep after the injection varied remarkebly according to the dilution of the drug. When the dose of 2 mg of the drug was injected, undiluted directly to the small vein, the time to sleep was 83.2"+/-31.4" and 69.1"+/-31.4"; in the former case the patients complained of pain along the injected vein and the latter did not. 3. The hypnotic time with the diluted solution of the drug was 144.5" +/-4.6" and 117.3"+/-77.8", in which the former complained of pain during injection, and the latter did not. 4. Blood pressure, pulse rate and respiratory rate were measured immediately prior to induction and again 2 and 5 minutes after induction. A slight but insignificant rise in blood pressure with a mean of 3.4% in systolic and 6.7% in diastolic pressure above control value was observed in 2 minutes after injection. And at 5 minutes there was a significant fall in blood pressure, 11.3% and 4.3% respectively (p<0.05) (Table 5). 5. Pulse rate increased significantly by 12.7 beats (14.2%) a minute in 2 minutes after injection and 15.7 beat (17.5%) a minute in 5 minutes after injection from a control level of 89.6 (p<0.01) ,(Table 6). 6 Respiration became shallower and the rate decreased as the patients fell asleep. Apnea occurred in 4 patients (6.9%). In the apnea cases, respiration was controlled by mask and positive pressure ventilation. It needed that the facilities for positive pressure ventilation be available in case apnea develops. 7. During induction, tremors, abnormal muscle movements, and laryngospasm were not observed. Hiccough was observed in 4 cases (6.9%). Hiccugh had the tendency to recur during intra-abdominal procedure. 32 patients (55.0%) had an antegrade amnesia, that is shortly before the injection of the drug. They did not remember being moved to the operating table or the insertion of the injection needle. 8. Ro 5-4200 caused pain on injection when given undiluted directly into a small vein on the dorsum of the hand, and the pain was also complained of even when the drug was diluted to 5 times with normal saline or intravenous drip infusion. A localized thrombophlebitis was not seen. 9. Laryngeal reflexes were retained on induction but endotracheal intubation was tried successfully without muscle relaxant in three cases. In this procedure the patients tended to be awake and showed some resistance. The help of muscle relaxants in intubation is recommended. As to degree of everity and nature of muscle fasciculation after succinylcholine, there was somewhat delayed appearance but degree was not altered by Ro 5-4200 10. Recovery from anesthesia and reversal of muscle relaxation was unaltered. The induction was satisfactory, but slow, and characterized by minimal change in blood pressure, pulse rate and respiration. Because of this delayed induction time and the varied degree of depth of sleep, the agent seemed to be improper as an intravenous induction agent. Acknowledgements: Samples of Ro 5-4200 have been kindly supplied by Hoffmann La Roche, Hong Kong. The authors wish to thank Dr. S.S.Lo and Dr. P.A. Bulhr of Roche Products Ltd., for their assistance and advice.
Adult ; Amnesia ; Anesthesia ; Apnea ; Benzodiazepines* ; Blinking ; Blood Pressure ; Child ; Fasciculation ; Flunitrazepam* ; Hand ; Heart Rate ; Hiccup ; Hong Kong ; Humans ; Infusions, Intravenous ; Intubation ; Intubation, Intratracheal ; Laryngismus ; Masks ; Muscle Relaxation ; Needles ; Operating Tables ; Positive-Pressure Respiration ; Reflex ; Respiration ; Respiratory Rate ; Succinylcholine ; Thrombophlebitis ; Tremor ; Unconsciousness ; Veins

STUDY DESIGN: This is a retrospective study evaluating the efficacy of new surgical technique for treatment of fixed lumbosacral kyphosis. OBJECTIVES: To report a new method of vertebral column resection and to determine its efficacy in the treatment of fixed lumbosacral kyphosis. SUMMARY OF BACKGROUND DATA: The treatment of fixed severe spinal deformity is very difficult and only a few surgical methods are reported. The vertebral column resection from anterior and posterior is a radical method to treat the severe deformity but it has many problems with anterior and posterior approachs. MATERIALS AND METHODS: A new surgical method of vertebral column resection from posterior approach only(PVCR) was carried out in 5 patients of fixed lumbosacral Tb kyphosis from October 1997 to March 1998. The mean age was 43.4 years(range 35-61 years), and four were female and one male. The average postoperative follow-up period was 5.5 months(ranged from 2 months to 12 months). An average of 2.6 vertebrae was resected. The degree of sagittal curves was measured using the Cobb technique preoperatively and postoperatively. the rejional lumbosacral kyphotic angle and compensatory thoracic curvature from 74 to 712. The sagittal imbalance was measured by distance from C7 plumb line to postero-superior corner of 51 using 14 x 36 inch standing lateral radiograph. RESULTS: The sagittal deformities were corrected from an average of kyphosis 37.4 to lodosis 8.4 at lumbosacral level and from an average of lodosis 31.6 to lodosis 8.2 at thoracic level. The sagittal imbalance was improved from an average of +11.7cm to +2.2cm, for a posterior immigration of 9.5cm. The mean operating time was 334 minutes and with an average blood loss of 4338m1. Complication comprised of motor weakness with deep wound infection in one case and superficial wound infection in another case. The transient hip flexor weakness was seen in all the patients. The hip flexor power recovered in 3-4 weeks. The patient of motor weakness and deep infection showed partial motor improvement and complete wound healing at last 2 month follow-up. CONCLUSION: one-stage posterior vertebral column resection is a promising technique for treatment of the severe fixed lumbosacral kyphosis.
Congenital Abnormalities ; Emigration and Immigration ; Female ; Follow-Up Studies ; Hip ; Humans ; Kyphosis* ; Male ; Retrospective Studies ; Spine* ; Wound Healing ; Wound Infection

No abstract available.
Disseminated Intravascular Coagulation* ; Plasma* ; Scrub Typhus*

STUDY DESIGN: This study analyzes the influence of segmental pedicle screw fixation on distal fusion extent of King type I adolescent Idiopathic scoliosis(AIS). OBJECTIVES: To verify the efficacy of segmental pedicle screw fixation in preservation of distal lumbar motion segments. SUMMARY OF BACKGROUND DATA: King type I AIS has usually been treated by fusion to L4. However, segmental pedicle screw fixation may shorten the distal fusion extent by reducing the hopi-Bontal tiIt of the lower end vertebra. MATERIALS AND METHODS: Eighteen King type I AIS subjected to segmental pedicle screw fixation of both curves were analyzed after a minimum follow-up of 2 years. Fourteen were fused to L3(short fusion group, SF) and 4 were fused to L4(long fusion group, LF). They were compared for correction of deformity, spinal balance and L4 tiIt. RESULTS: In SF group, the thoracic currie showed 71.6% correction. Lumbar curve and L4 tiIt corrections were 76.8% and 75.2% respectiveIY. In LF group, the thoracic currie showed 65.2% correction. Lumbar currie and L4 tilt corrections were 76.8% and 78.4% respectively. There was no significant difference between two groups. Spinal balance was maintained in all patients(SF 14/14; LF 4/4). CONCLUSIONS: Segmental pedicle screw fixation may shorten the distal fusion extent of King type IAIS to L3, preserving a distal motion segment with a correction of deformity and spinal balance comparable to fusion down to L4. It is attributed to enhanced segmental control of the system enabling horizontalization of L4.
Adolescent* ; Congenital Abnormalities ; Follow-Up Studies ; Humans ; Spine

STUDY DESIGN: This study analyzes the results of selective thoracic fusion by segmental pedicle screw fixation in King type II adolescent idiopathic scoliosis(AIS). OBJECTIVES: To verify the efficacy of selective thoracic fusion by segmental pedicle screw fixation in King type II adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: Decompensations following selective thoracic fusion in King type II adolescent idipathic scoliosis have been attributed to relative inability of the lumbar curves to accommodate correction of the thoracic curves. However, with segmental pedicle screw fixation, selective thoracic fusions yielded satisfactory results in most of the patients regardless of the lumbar curve characteristics. MATERIALS AND METHODS: Eighty patients subjected to selective thoracic fusion by segmental pedicle screw fixation were analyzed after a minimum follow-up of 2 years for deformity correction and spinal balance. Deformity correction was performed by derotation of rod contoured to the normal sagittal curve without additional compression or distraction. RESULTS: Mean preoperative thoracic curve of 53.3 was corrected to 20.3 showing a correction of 63.2%. The mean preoperative lumbar curve was 34.4 with a flexibility of 97.2% and mean lumboapical distance(LAD)of 18.0mm, L4 tilt of 8.0, and lumbar apical rotation (LAR) of 10.9. It was corrected to 16.5 showing a correction of 55.5%. All the patients were balanced clinically and radiologically. CONCLUSIONS: Selective thoracic fusion with segmental pedicle screw fixation and rod rotation offers a satisfactory correction of the deformity and maintenance of spinal balance in King type g AIS regardless of lumbar curve magnitude, LAD, L4 tilt or LAR.
Adolescent* ; Congenital Abnormalities ; Follow-Up Studies ; Humans ; Pliability ; Scoliosis*

The employment of segmental pedicle screw instrumentation has greatly enhanced the correction of scoliotic deformity. However there is still much controversy on the ability of the system to correct the rotational deformity. This prospective study with 12 idiopathic throacic scoliosis patients subjected to segmental pedicle screw instrumentation was performed to determine the effect of the system on the rotational deformity of idiopathic throacic scoliosis. In addition to the standing films to measure the magnitude of scoliotic curvatures, preand postoperative CT were utilized for the measurement and comparison of angle of rotation relative to the sagittal plane(RAsag.), relative rotation with reference to the upper and lower end vertebrae(RAend), relative rotation with reference to the sacrum(RAsac.), frontal translation(TF) and sagittal translation(TS) for the apical vertebrae. Despite the high correction rate obtained in the frontal plane(average 71.1%) and normalization of sagittal contour, the rotational corrections were statistically insignificant in all parameters and showed no significant correlation to the correction of the curvatures nor horizontal plane displacement as represented by the frontal and sagittal displacement. In conclusions, the segmental pedicle screw instrumentation with rod derotation does not produce significant derotation by itself.
Congenital Abnormalities ; Employment ; Humans ; Prospective Studies ; Scoliosis* ; Spine

PURPOSE: The purpose of this study is to find out the normal angles of the talus-1st metatarsal angle, the talo-horizontal angle and calcaneal pitch angle for diagnosis of foot deformity in Korea. This would be helpful as it would provide a basic angular measurement of flat and cavus foot that indicates the need for operation. MATERIALS AND METHODS: Within a period of four months from January 2007 to April 2007, We have established 600 feet of 300 males without trauma history of foot. The source to image distance is 40 inches and erect weight bearing radiographs are obtained in anteroposterior and lateral projections. The significant angular measurements that define flat or cavus foot are the talus-1st metatarsal angle, the talo-horizontal angle and calcaneal pitch angle. RESULTS: The mean age was 21 years (19-22 years) old. The mean talus-1st metatarsal angle was 0+/-6.9degrees, the mean talo-horizontal angle was 25.8+/-4.5degrees and the mean calcaneal pitch angle was 23.9+/-5.1degrees. CONCLUSION: We can consider that mean talus-1st metatarsal angle, talo-horizontal angle and calcaneal pitch angle are 0+/-6.9degrees, 25.8+/-4.5degrees and 23.9+/-5.1degrees as an normal angle limit of young age in Korea.
Foot ; Foot Deformities ; Humans ; Korea ; Male ; Metatarsal Bones ; Weight-Bearing

Calcific tendinitis on gluteus medius tendon of the amateur athletes were reviewed, and a study on the therapeutic effect of conservative treatment methods. From January 2003 to December 2010, among the patients who had been treated with calcific tendinitis on gluteus medius tendon, there were nine patients available to monitor more than a year as outpatients. ten cases were observed from them and were retrospectively analyzed and magnetic resonance examinations were performed in every case. All of the ten cases were initially treated with non-steroid anti-inflammatory oral doses. If a non-steroid anti-inflammatory treatment could not relieve pain or caused an aggravation of a condition, a local steroid injection was enforced. There were responses to non-steroid antiinflammatory oral doses of therapeutic methods in four cases and the time required for the symptoms to be improved was approximately 3 weeks (range: 1-3 weeks). In the remainder of six cases, conditions got worsened or did not improve even after 3 weeks. In these cases, the condition was altered for better in 3 days (range: 1-3 days) by using local steroid injections. There was no recurrence in all cases. The amateur athlete with a severe pain around his or her hip joint should be questioned with calcific tendinitis on gluteus medius tendon and differential diagnosis of hip around diseases. After calcific tendinitis was diagnosed, initial treatment was considered conserevative treatment. Although it is invasive, the initial treatment with a local steroid injection is considered to be helpful in treating amateur athletes with calcific tendinitis.
Athletes ; Diagnosis, Differential ; Hip ; Hip Joint ; Humans ; Magnetic Resonance Spectroscopy ; Organothiophosphorus Compounds ; Outpatients ; Recurrence ; Retrospective Studies ; Tendinopathy ; Tendons

This is a report of anesthesia for five cases of renal transplantation which was performed between February 1969 and August 1969 at St. Mary's Hospital, Catholic Medical College, Seoul, Korea. General of renal insufficiency of the operated cases were described. Operative technique were unilateral nephrectomy for three cases and bilateral nechprectomy with splenectomy for 2 cases ; Anesthesia was induced with epontol (propanidid) 250mgs i.v. and 4% halothane-oxygen and maintained with 1% halotbane-oxygen which was supplemented by nitrous oxide occasionally. 6% dextrose and lactated-Ringer's solution were infused. For transfusion, whole blood was given to replace the operative blood loss. Dextran was also used to maintain adequate blood volume. Shortly before anastomosis of renal and femoral vessels, patients were haparinized. Fluids and electrolytes balance were studied pre-and post-operatively. Preoperatively, uremia and hyperpotassemia was corrected by several hemodyalysis. Urinary output after surgery showed a marked degree of diuresis up to 1800 ml/hr until second post-operative day. The special concern of anesthesia for kidney transplantation were: 1. Patients were suffering from severe uremia and metabolic disterbances. 2. Acidosis and hyperpotassemia should be corrected before surgery by hemo-or peritoneal dialysis. 3. Immunosuppressive agents made the patient less resistant to infection. 4. Anemia and hydrops was difficult to be corrected before surgery. 5. Muscle relaxants of choice were depolarizing agents, because of impaired renal excretion.
Acidosis ; Anemia ; Anesthesia* ; Blood Volume ; Dextrans ; Diuresis ; Edema ; Electrolytes ; Glucose ; Humans ; Hyperkalemia ; Immunosuppressive Agents ; Kidney Transplantation* ; Kidney* ; Korea ; Nephrectomy ; Nitrous Oxide ; Peritoneal Dialysis ; Propanidid ; Renal Insufficiency ; Seoul ; Splenectomy ; Uremia