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 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

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

The clinical trial was carried out with carteolol in 30 patients with essential hypertension. The results were as follows : 1) Before medication and after 2,4,6 and 8 weeks of medications, the overall average systolic and diastolic blood pressure were 175+/-17.7/105+/-9.3, 144+/-8.9/92+/-6.9, 143+/-11.2/90+/-6.6, 141+/-8.4/88+/-6.9, and 142+/-9.0/88+/-7.1 mmHg. As a result, blood pressure significantly fell with carteolol treatment. 2) In 80+/- of all cases, marked or moderate degree of hypotnesive effect was observed within 2 weeks of treatment. 3) Before medication and after 2, 4, 6 and 8 weeks of medication, the overall average heart rates were 75+/-11.8, 73+/-9.0, 71+/-8.7, 71+/-8.2 and 71+/-8.6 beats/minute. There was no significant changes in heart rates before and after treatment. 4) Dizziness or fatigability were complained in 4 patients (13+/-) each while receiving carteolol. These side effects were mild in 3 patients, but one patient discontinued treatment due to dizziness. On the basis of these results, carteolol was evaluated to be promising hypotensive drug.
Blood Pressure ; Carteolol* ; Dizziness ; Heart Rate ; Humans ; Hypertension

It has been well known that dilated cardiomyopathy (D-CMP) has characterized by systolic dysfunction of left ventricle (LV). But there are few studies about LV diastolic and right ventricular (RV) dysfunction in D-CMP. The purpose of this study is to assess the LV and RV systolic function as well as diastolic function in D-CMP. The purpose of this tudy is to assess the LV and RV systolic function as well as diastolic function in D-CMP. The gated blood pool scan (GBPS) was undertaken in 14 patients with D-CMP and 14 normal controls. The results are as follows : 1) Compared to normal controls, the global and regional ejection fraction of LV were significantly reduced (P<0.001) in D-CMP. But, there was no significant difference in LV ejection time between the two groups. 2) Peak filling rate and peak filling time were significantly reduced (P<0.001, P<0.05) in D-CMP 3) Global ejection fraction of RV was also significantly reduced in D-CMP compared to normal controls (P<0.001) But there was no significant difference in ejection rate of right ventricle between the two groups. 4) There was close correlation (R=0.802) between ejection fraction and filling rate of LV : filling rate was also reduced as ejection fraction decreased. And LV filling rate was also reduced with reduction of ejection rate. It is concluded that D-CMP shows diastolic impairment as well as systolic pumping failure and this systolic dysfunction is accounted for the diastolic impairment in D-CMP. And D-CMP shows also right ventricular dysfunction in almost all cases, as well as left ventricular dysfunction.
Cardiomyopathy, Dilated* ; Heart Ventricles ; Humans ; Ventricular Dysfunction, Left ; Ventricular Dysfunction, Right

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