Bradycardia is recognized as an acute complication of cervical cord injury. The etiology of such a phenomenon is believed to be due to an imbalance in the autonomic nervous system imposed on the heart by a cervical cord injury. The majority of the episodes of bradycardia degrees Ccurred either with tracheal suctioning or with changes in position. We experienced a case of severe bradycardia and hypotension when turning the patient with acute cervical spinal cord injury to the prone position, which was reversed by administration of intravenous atropine and ephedrine.
Anesthesia, General* ; Atropine ; Autonomic Nervous System ; Bradycardia* ; Ephedrine ; Heart ; Humans ; Hypotension* ; Prone Position ; Spinal Cord Injuries* ; Spinal Cord* ; Suction

A 61-year-old man was admitted to the emergency room complaining of a severe left exophthalmos caused by frontal and ethmoid sinus mucoceles that were visualized on a brain computerized tomogram. In addition, he had coexisting ankylosing spondylitis with a 20 year duration that resulted in total fixation of the cervical spine and progressive thoracic kyphosis. An unruptured anterior communicating artery aneurysm was found incidentally on the cerebral angiogram. We report that the anesthetic management for endoscopic sinus surgery of a frontal sinus mucocele in a patient with coexisting severe cervical spine ankylosing spondylitis and an unruptured cerebral aneurysm requires a detailed preoperative assessment of the airway, cardiac, pulmonary, and neurologic system. This case highlights the need for careful measures to avoid rupturing the cerebral aneurysm by the increased blood pressure induced by endotracheal intubation and the infiltration of an epinephrine-containing local anesthetic.
Blood Pressure ; Brain ; Emergencies ; Ethmoid Sinus ; Exophthalmos ; Frontal Sinus ; Humans ; Intracranial Aneurysm ; Intubation, Intratracheal ; Kyphosis ; Middle Aged ; Mucocele ; Spine ; Spondylitis, Ankylosing

PURPOSE: To evaluate the usefulness of IM Ender nail in treating femoral intertrochanteric fractures with high risks including cardiovascular disease, pulmonary disease, liver cirrhosis, cerebrovascular disease, metastatic cancer, and skin problem at hip joint region. MATERIALS AND METHODS: Thirty-five patients of pre-existing diseases and femoral intertrochanteric fractures treated with Ender nailing, January 1990 to November 1997. Under the c-arm guided, closed reduction and internal fixation were performed using Ender nails, We analized operation time, blood loss, bone union, ambulation time and complications RESULTS: Mean operation time was 55 minutes, mean blood loss was 120 ml, mean radiological bone union was 12 weeks and average of partial weight bearing was 6.9 days. Postoperative complications were gastrointestinal discomfort in 3 cases, superficial wound infection in 1 case, knee pain in 7 cases, inguinal pains in 5 cases, distal migration of nails in 3 cases, varus deformity in 2 cases, proximal migration of nail with nonunion in 1 case. CONCLUSION: The intramedullary ender nail is useful method in treating femoral intertrochanteric fractures in high risk patients of anesthesia and blood loss or skin problem at hip joint region.
Aged* ; Anesthesia* ; Cardiovascular Diseases ; Congenital Abnormalities ; Femur* ; Hip Fractures ; Hip Joint ; Humans ; Knee ; Liver Cirrhosis ; Lung Diseases ; Postoperative Complications ; Preexisting Condition Coverage ; Skin ; Walking ; Weight-Bearing ; Wound Infection

PURPOSE: To compare the results of a total knee arthroplasty (TKA) between the degenerative osteoarthritic patients and the posttraumatic arthritic patients. MATERIALS AND METHODS: 38 cases with posttraumatic arthritis (group A) and 40 cases with degnerative osteoarthritis (group B) had a total knee arthroplasty between April 1995 and May 2002. The knee score, functional score, activity level and radiologic analyses were performed. RESULTS: There were no significant difference in the knee score, functional score, activity level and radiological findings between the two groups. The range of motion arcs were reduced in the posttraumatic arthritic patients. There is a higher complication rate in the post-traumatic arthritic patients (36%) when compared with the degenerative osteoarthritic patients (15%) after TKA . CONCLUSION: In group A showed a higher complication rate and reduced range of motion arcs. However, in terms of our results, we considered that a total knee arthroplasty is an useful treatment for the posttraumatic arthritis in spite of the technical difficulties.
Arthritis* ; Arthroplasty* ; Humans ; Knee* ; Osteoarthritis ; Range of Motion, Articular

PURPOSE: We evaluated the polyethylene wear rate between patients from farming and non-farming communities to determine whether active life styles, knee scores, and occupations could affect outcomes. MATERIALS AND METHODS: 201 knee replacements were performed in 105 patients who were an average of 68.7 years old. 30 non-farming patients(59 cases) and 75 farming patients(142 cases) who had operation between 1989 and 1996 were reviewed retrospectively. Mean follow-up period was 12.1 years(range 10~16 years). The difference of clinical, radiographic, and functional results of total knee replacement were assessed by Knee Society scores and activity levels. RESULTS: The non-farming group had lesser activity levels(non-farming group 82.5, farming group 89.7), higher knee scores(non-farming group 88.4, farming group 81.1) and functional scores(non-farming group 87.9, farming group 80.4) than the farming group(p<0.05). Farming patients showed 33 cases(23%) of polyethylene wear and non-farming patients showed 7 cases(12%) which is statistically significant(p<0.001). CONCLUSION: Primary osteoarthritic patients from farming communities had higher activity levels and polyethylene wear rate with lower Knee Society scores which were expected to participate in more activities involving impact on knee joint. We assume that the increase rate of complication is due to the overuse of the prosthesis. Therefore, working condition and life style modification will be needed.
Arthroplasty* ; Arthroplasty, Replacement, Knee ; Follow-Up Studies ; Humans ; Knee Joint ; Knee* ; Life Style ; Occupations ; Polyethylene* ; Prostheses and Implants ; Retrospective Studies

PURPOSE: To compare the performance of a total knee arthroplasty with either a PFC Sigma fixed bearing or a rotating platform in the same patient. MATERIALS AND METHODS: 48 cases (24 patients) that received a PFC Sigma fixed bearing and a rotating platform in both knees, one in each knee. The knee score, functional score, activity level, radiologic analyses through fluoroscope , varus/valgus stress, and subjective satisfaction evaluation were performed at the last follow up in the same patient. RESULTS: There were no significant differences in the knee score, functional score, activity level, radiological findings through fluoroscope, and subjective satisfaction. In the varus/valgus stress views, 3 cases of lateral femoral condylar lift-off were observed in the fixed bearing type and 6 cases of lateral femoral condylar lift-off were observed in the rotating platform type. CONCLUSION: In cases of total knee arthroplasty with PFC Sigma fixed bearing and with rotating platform performed in the same patient, there were no significant differences in the clinical, radiological and subjective satisfaction. However, it is considered that the fixed bearing is more stable in terms of medial and lateral femoral condylar lift-off with varus and valgus stress than rotating platform. Therefore long term follow-up would be necessary.
Arthroplasty* ; Follow-Up Studies ; Humans ; Knee*

PURPOSE: To evaluate the short-term results of PFC Sigma Rotating-Platform in total knee arthroplasty. MATERIALS AND METHODS: From November 2001 to April 2002, 41 knees in 25 patients who had been followed up over 2 year after TKA with PFC Sigma Rotating-Platform were evaluated retrospectively. RESULTS: The average range of motion increased from 96.9 degree preoperatively to 122.3 degree at the last follow-up. The average preoperative knee score (44.2) and functional score (51.3) improved to 90.8 and 92.1 respectively. The average score of activity level by authors 'improved from 42 preoperatively to 87 post-operatively. The radiolucent lines around prosthesis were found in 12% at femur and in 24% at tibia. But, none showed any clinical significance. Complications were superficial infections in 3 knees. CONCLUSION: The short-term results of PFC Sigma Rotating-Platform TKA were satisfactory. Therefore, long term follow-up evaluation is necessary.
Arthroplasty* ; Femur ; Follow-Up Studies ; Humans ; Knee* ; Prostheses and Implants ; Range of Motion, Articular ; Retrospective Studies ; Tibia

Left atrial dissection is an uncommon entity, and is generally associated with mitral valve surgery, blunt chest trauma, intramyocardial dissecting hematoma after AMI, Behcet's disease, and infective endocarditis. Moreover, debridement of very calcified valves or inadvertent incision of the annulus may occur during the surgical procedure, and hemodynamic influence of a paraprosthetic leak may extend the dissection into the left atrial wall. We report a case with a mobile intimal flap of the left atrial wall detected by intraoperative transesophageal echocardiography after aortic valve replacement. An intraoperative transesophageal echocardiographic examination is needed for aortic valve replacement, especially when aortic stenosis is combined with severe annulus calcification.
Aortic Valve Stenosis ; Aortic Valve* ; Debridement ; Echocardiography ; Echocardiography, Transesophageal ; Endocarditis ; Fistula* ; Hematoma ; Hemodynamics ; Mitral Valve ; Thorax

PURPOSE: To evaluate the incidence rate and risk factors for periprosthetic fracture after total knee replacement (TKR). MATERIALS AND METHODS: We carried out a retrospective case-control study of 596 patients (951 knees) who underwent TKR between 1999 and 2006 and who were followed up over 36 months. We classified patients into group I (study group) and group II (control group). We subdivided risk factors as pre-operative, intra-operative, and post-operative factors. Age, osteoporosis, revision arthroplasty, CVA, and alcohol dependence were categorized as pre-operative factors; anterior femoral notching and prosthetic types (mobile, fixed, and load-bearing) were considered intra-operative factors; and post-operative activity level was classified as a post-operative factor. We obtained information from the patients' charts, X-ray film, and telephone interviews. RESULTS: The overall incidence rate was 2.25%; 3 patients were male, and 18 were female (14.28% and 85.72%, respectively). Old age (p<0.01, odds ratio=1.14), osteoporosis (p=0.01, odds ratio=4.74), revision arthroplasty (p=0.01, odds ratio=7.46), CVA (p=0.02, odds ratio=8.55), and alcohol dependence (p=0.03, odds ratio=44.54) were statistically significant among the pre-operative factors. Among the intra-operative factors, anterior femoral notching (p<0.01, odds ratio=11.74) was significant, and continued heavy labor (p<0.01, odds ratio=8.14) was significant among the post-operative factors. CONCLUSION: We concluded that old age, osteoporosis, revision arthroplasty, comorbidity related with falling down, anterior femoral notching, and continued heavy labor were associated with periprosthetic fracture after TKR.
Alcoholism ; Arthroplasty ; Arthroplasty, Replacement, Knee ; Case-Control Studies ; Comorbidity ; Female ; Humans ; Incidence ; Knee ; Male ; Osteoporosis ; Periprosthetic Fractures ; Retrospective Studies ; Risk Factors ; Telephone ; X-Ray Film

A 35-year-old man presented with progressive dyspnea and hemoptysis. His blood pressure was 230/140 mmHg and serum creatinine level was 20.13 mg/dL. Chest radiography and computed tomography revealed pulmonary hemorrhage. His renal function was low, thus emergent renal replacement therapy was required. Malignant hypertension and acute kidney injury were diagnosed, and antihypertensive therapy and hemodialysis started immediately. Renal biopsy was performed to examine the underlying disease. Typical pathological changes of malignant hypertension, fibrinoid necrosis of the afferent arterioles, and proliferative endoarteritis at the interlobular arteries were observed. His renal function improved gradually and pulmonary hemorrhage completely disappeared with administration of antihypertensive agents. Here, we report this rare case of malignant hypertension with pulmonary alveolar hemorrhage and speculate that the hemorrhage may be related to vascular injuries at the alveolar capillary level caused by malignant hypertension.
Acute Kidney Injury ; Adult ; Antihypertensive Agents ; Arteries ; Arterioles ; Biopsy ; Blood Pressure ; Capillaries ; Creatinine ; Dialysis* ; Dyspnea ; Hemoptysis ; Hemorrhage* ; Humans ; Hypertension, Malignant* ; Necrosis ; Pulmonary Alveoli ; Radiography ; Renal Dialysis ; Renal Replacement Therapy ; Thorax ; Vascular System Injuries