We analysed 26 cases of pyogenic osteomyelitis of the spine who were treaed at Younsei University Hospital during 25 years from January 1952 to August 1977 by operative or conaervative treatment. The diagnosis of pyogenic osteomyelitis of the spine is not easy and very confused. The cause and entry of the offending organism is mainly by venous drainage from the genitourinary and lower extremity circulation and the next is direct spreading from the adjacent focus. The typical clinical symptom is severe pain and tenderness over the lesion accompanied by febril history and the clinical course is relatively rapid than tuberculosis of the spine. In blood examination leukocytosis is uncommon but it showed relative increase of neutrophils in 62%, and erythrocyte sedimentation rate in 89%. Radiological findings are narrowing of joint space, erosion and/or destuctive change of vertebral body, vertebral marginal sclerotic change, and new bone formation and less frequently abscess shadow. The results obtained from this study were as follows, 1) The incidence of pyogenic osteomyelitis of the spine among total cases of the pyogenic osteomyelitis was 2.5% and the ratio of the pyogenic osteomyelitis of the spine to the spine tuberculosis was 2.8%. 2) The sexual incidence was in 11 and 15 each male and female. and the avrage, prevalent age was 34 years of age. 3) The pathogenic organism was isolated in 20 cases from the diseased focus during surgical procedure; stapyhloccus in 16 cases, pseudomonas in two and in a case of E.coli and proteus each. 4) The lumber vertebrae was mostly involved, i.e.lumbar in 11 cases, cervical in four, thoracic in nine, lumbosacral and sacrum in one each. 5) The operative treatment was performed in 23 cases and conservative in 3 cases with the satisfatory result in all cases. 6) We conclude that the focal curettage with anterior interbody fusion through anterior approach was better than the conservative treatment.
Abscess ; Blood Sedimentation ; Curettage ; Diagnosis ; Drainage ; Female ; Humans ; Incidence ; Joints ; Leukocytosis ; Lower Extremity ; Male ; Neutrophils ; Osteogenesis ; Osteomyelitis ; Proteus ; Pseudomonas ; Sacrum ; Spine ; Tuberculosis

Atlanto-axial dislocation with the fracture of the odontoid process has been considered as an uncommon lesion and a high incidence of nonunion of fractures of the odontoid process or high incidence of neurological involvement or death has been reported. With the advent of radiology, this fracture has been diagnosed early with increasing frequency. This paper is presented because very excellent result of union of the odontoid process treated with wiring and posterior atlanto-axial fusion by means of Brooks technic was obtained in our case.
Dislocations ; Incidence ; Odontoid Process

In recent years the rate of the spine frecture tends to be on the increase year by year as the rate of traffic and industrial accidents are increased. Realignment of the displaced vertebral column should be achieved for two reasons. It provedes better neural decompression than a laminectomy in most instances and permits stabilization of the axial skeleton in a position of function. One hundred and nine thoraco-lumbar spine fractures and fracture-dislocations out of 102 patients were evaluated from January, 1972 to December, 1977 in our study. 1. Out of the 102 patients, there were 89 male and 13 female cases. The ratio between male and female was 6.8: 1. The majority(77.1%) of the spine fractures was found in the age group of 20 to 50 years. 54.2% of the cases was caused by industrial accident. 2. The most Common site of the lesion occured between T 12 and L 2 vertebrae (82.6%) and the simple anterior wedge fracture (69.7%) was most common. 3. Thirty one cases of the total were complicated by paraplegia, of which 77.4% was caused by rotational fracture-dislocation and most common site of the lesion was between T 12 and L 2 vertebrae (93.8%). 4. Prognosis for neurological recovery in initially complete lesions was poor, regardless of treatment. About 10% of initially complete lesions showed partial neural recovery compared to 62.5% of initially incomplete lesions. 5. All 6 patients on bladder training with intermittent catheterization became catheter free within 3 months.
Accidents, Occupational ; Catheterization ; Catheters ; Clinical Study ; Decompression ; Female ; Humans ; Laminectomy ; Male ; Paraplegia ; Prognosis ; Skeleton ; Spine ; Urinary Bladder

Cystic hygroma is a rare, endothelial lined cystic lesion of lymphatic origin which is encountered most often in children, usually at birth or early in life. The tumor is usually found in the neck and axilla. It is a soft, nontender, semifluctuant freely movable tumor of varying size filled with lymphatic fluid. The mass is sometimes pedunculated and is uaually multilocular, althouh it may be monolocular. The cystic hygroma of the right axilla and the upper arm, in a 4 month-old female infant, is presented with a review of the literature.
Arm ; Axilla ; Child ; Female ; Humans ; Infant ; Lymphangioma, Cystic ; Neck ; Parturition

During the period from January 1967 to December 1977, 244 cases of tuberculosis of the spine were operated on at the Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea. We followed up 176 cases from 6 months to 10 years and the average period was one year and ten months. (Radical curettage and anterior interbody fusion 129 cases, posterior fusion 20 cases, curettage without bone graft 21 cases, and combined anterior and posterior fusion 6 cases.) The results of those studies are as follows: 1) The incidence of Pott's-parplegia was 25% (61 cases) of the total cases. 2) Almost 41 cases (66%) of the total cases of Pott's parplegia have recovered well enough to return after operation to their previous work. 3) In children (below 15 years of age) 50 cases (87.7%) had satisfactory results with bony fusion and in adults 93 cases (94.9%). 4) In children 44 cases (77%) had healing of radiological activity after operation and in adults 104 cases (87%). 5) The younger the spine, the lower the fusion rate. Combined anterior and posterior fusion is the choice of treatment for tuberculosis of the spine in children. 6) Postoperative complications occured in 38 cases (16%) including wound infection, postoperative pneumonia, postoperative pneoumothorax, postoperative atelectasis, paralytic ileus, meningitis, cystitis, and failure in bone graft.
Adolescent ; Adult ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Human ; Infant ; Korea ; Male ; Middle Age ; Spinal Fusion ; Tuberculosis, Pulmonary/complications ; Tuberculosis, Spinal/complications ; Tuberculosis, Spinal/epidemiology ; Tuberculosis, Spinal/surgery*

BACKGROUND: P300 component of the long latency auditory evoked potentials (LLAEPs) provides information on conscious and cortical funtion. The P300 wave occures only for stimuli that somehow capture the patients attention. Therefore LLAEPs implys a degree of cognitive processing. We studied sedation scale and P300 wave to determine if LLAEPs could be utilized as electrophysiologic predictors of sedation. METHODS: The P300 component of LLAEPs from vertex was recorded from 10 ASA physical status I and II patients undergoing elective surgery while they listened via headphones to a series of clicks which were interrupted unpredictably by a tone burst (2 KHz) before and after diazepam 0.04 mg/kg and 0.08 mg/kg IV. The patients were asked to concentrate on the clicks and to press a button whenever they detected a 2 KHz tone. And sedation scale also was measured. RESULTS: Amplitude of P300 was decreased and latency of P300 was increased in a dose-dependent manner with IV diazepam. Amplitude was greatest and latency was shortest in awake. And sedation scale also was increased according to increased IV diazepam adminstration. CONCLUSIONS: Both amplitude and latency may be highly related to the sedation scale with progressively increasing dose of diazepam. Therefore we conclude that P300 component of LLAEPs can be utilized as an electrophysiologic predictor of awareness and sedation.
Diazepam* ; Event-Related Potentials, P300* ; Evoked Potentials, Auditory* ; Humans

BACKGROUND: Monitoring of PETCO2 in the patients during regional anesthesia may be no less important than under general anesthesia, but will aid in early detection of potentially catastrophic events. However, the utility and accuracy of capnography in non-intubated patients has received little attention. We examined correlation between PETCO2 measured via nasal cannula and PaCO2 values in the sedated spontaneously breathing patients during spinal anesthesia. METHODS: Thirty adult patients who underwent elective surgery were administered optimal doses of tetracaine and epinephrine mixture in their site of operation, length, weight and age. Thereafter, we sampled expired gas by 175ml/min and administered oxygen by 3L/min using oxygen delivery CO2 sampling nasal cannula. End tidal carbon dioxide tension, heart rate, blood pressure and respiratory rate were measured before and 20 min after 0.02 mg/kg midazolam i.v.. And arterial blood gases were once measured 20 min after 0.02 mg/kg midazolam i.v.. RESULTS: The patients, sedation state was asleep or calm in awake. End tidal carbon dioxide tension was significantly increased after midazolam injection (p<0.01), but another values were not different after midazolam injection. Linear regression analysis of arterial carbon dioxide tension and end tidal carbon dioxide tension after midazolam injection yielded y = 0.77x + 4.82 and r2 = 0.76 (p<0.01). CONCLUSIONS: End tidal carbon dioxide tension using oxygen delivery CO2 sampling nasal cannula in the sedated spontaneously breathing patients with midazolam during spinal anesthesia were significantly related with arterial carbon dioxide tension. Therefore, we conclude that monitoring of PETCO2 via nasal cannula is a reliable means during spinal anesthesia.
Adult ; Anesthesia, Conduction ; Anesthesia, General ; Anesthesia, Spinal* ; Blood Pressure ; Capnography ; Carbon Dioxide ; Catheters* ; Epinephrine ; Gases ; Heart Rate ; Humans ; Linear Models ; Midazolam ; Oxygen ; Respiration* ; Respiratory Rate ; Tetracaine

OBJECTIVE: The aim of this study was to compare recycled and unused orthodontic miniscrews to determine the feasibility of reuse. The comparisons included both miniscrews with machined surfaces (MS), and those with etched surfaces (ES). METHODS: Retrieved MS and ES were further divided into three subgroups according to the assigned recycling procedure: group A, air-water spray; group B, mechanical cleaning; and group C, mechanical and chemical cleaning. Unused screws were used as controls. Scanning electron microscopy, energy-dispersive X-ray spectrometry, insertion time and maximum insertion torque measurements in artificial bone, and biological responses in the form of periotest values (PTV), bone–implant contact ratio (BIC), and bone volume ratio (BV) were assessed. RESULTS: Morphological changes after recycling mainly occurred at the screw tip, and the cortical bone penetration success rate of recycled screws was lower than that of unused screws. Retrieved ES needed more thorough cleaning than retrieved MS to produce a surface composition similar to that of unused screws. There were no significant differences in PTV or BIC between recycled and unused screws, while the BV of the former was significantly lower than that of the latter (p < 0.05). CONCLUSIONS: These results indicate that reuse of recycled orthodontic miniscrews may not be feasible from the biomechanical aspect.
Microscopy, Electron, Scanning ; Recycling* ; Spectrum Analysis ; Torque