OBJECTIVE: With improvement in endoscopic visualization and surgical tools, several minimally invasive procedures such as transpedicular fixation, interbody fusion, or decompression have advocated their respective advantages. But all these procedures are developed separately and are not related to other techniques. The authors utilize these procedures as organized procedure like comprehensive conventional procedure. This study is designed to study early results of minimally invasive decompression, interbody fusion, and endoscopic pedicle screw fixation. METHODS: We utilized minimally invasive decompression, interbody fusion, and endoscopic pedicle screw fixation on 12 consecutive patients(9 female, 3 male, mean age 54.8 years). For decompression, unilateral laminectomy and controlateral laminar undercutting was performed through tubular retractor, and interbody fusion(PLIF or TLIF) was done with one cage and bone packing. Pedicle screw fixation was done using expandable tubular retractor under endoscopic visualization and fluoroscopic guidance. Contralateral screw fixation was done with the same manner. RESULTS: There were five spinal stenosis and seven degenerative spondylolisthesis. All patients received one level (L4-5) decompression, interbody fusion, and fixation. Mean operating time was 245.8 minutes. There was dural tear in one patient. All patients were excellent or good with average follow up of 7.2 months. Bone fusion was not evident due to short-term follow-up, but there were no instability or screw loosening. CONCLUSION: Although it is small series and has short-term follow-up, this study demonstrates that minimally invasive decompression, interbody fusion, and pedicle screw fixation are feasible and effective.
Decompression* ; Female ; Follow-Up Studies ; Humans ; Laminectomy ; Male ; Spinal Fusion ; Spinal Stenosis ; Spondylolisthesis

BACKGROUND: Propofol can produce a dose-dependent reduction in blood pressure by providing titratable sedation and rapid recovery. It has been reported that a combination of midazolam and propofol resulted in the significant reduction in the total dose of propofol needed. It was hypothesized that the addition of low-dose midazolam to propofol may provide sufficient sedation without compromising the hemodynamic stability. METHODS: A total of 40 consecutive patients were randomly assigned to one of two groups (n = 20 each). Group M-P received a bolus of 0.02 mg/kg of midazolam, followed by a propofol infusion with a fixed target concentration of 1.0microgram/ml. Group P received only a propofol infusion with an initial target plasma concentration of 2.5microgram/ml. Subsequent titration of the infusion rates in Group P or the additional midazolam boluses in Group M-P were made in order to maintain a predetermined sedation level. RESULTS: In Group P, a mean dose of 5.4 +/- 0.7 mg/kg/h propofol was used compared with 2.7 +/- 0.5 mg/kg/h in Group M-P (P<0.0001, plus additional 2.96 +/- 1.8 mg of midazolam). Ephedrine was administered to 15 patients in Group M-P and 17 patients in Group P. Recovery was significantly fast (Group P, 6.8 +/- 2.9 min vs. Group M-P, 9.8 +/- 4.4 min, P<0.05). CONCLUSIONS: Sedation with propofol plus midazolam requires a lower total dose of propofol compared with propofol alone but has no superior hemodynamic stability. A further study using younger patients and combinations of different doses of each drug will be needed.
Anesthesia, Spinal* ; Blood Pressure ; Ephedrine ; Hemodynamics ; Humans ; Hypotension ; Midazolam ; Plasma ; Propofol* ; Prospective Studies*

BACKGROUND: The image and status of anesthesiology as a medical specialty in the eyes of the general public has been a problem. This study assessed the patients' thoughts on anesthesiologists and their preoperative concerns and examined the influence of any previous anesthetic experience on their apprehension. METHODS: One hundred thirty-nine patients undergoing elective surgical procedures were surveyed with a questionnaire regarding their thoughts on anesthesiologists and their preoperative concerns at preoperative visits. The results were analyzed in terms of a previous experience with anesthesia. RESULTS: Sixty-five patients had previous experience with anesthesia (Group 1), and 74 patients had none (Group 2). Seventy-one percent of patients in Group 1 and 80% in Group 2 reported that a physician-anesthesiologist was in charge of their anesthesia. Regarding the responsibility for the patients' safety during the surgical procedures, 83% of patients in Group 1 and 82% in Group 2 reported that the anesthesiologists were responsible for the patients' well-being. Fifty-seven percent of patients in Group 1 and 58% in Group 2 reported that the anesthesiologists were responsible for their safe recovery from the anesthesia. The most frequent preoperative apprehensions were postoperative pain (57% in Group 1 and 62% in Group 2) and the risk of not waking up from the anesthesia (60% in Group 1 and 57% in Group 2). There were no significant differences between the two groups. CONCLUSIONS: Passive learning from previous anesthetic experience does not affect the patients' thoughts on the anesthesiologists and their preoperative concerns.
Anesthesia* ; Anesthesiology ; Humans ; Learning ; Pain, Postoperative ; Surveys and Questionnaires ; Surgical Procedures, Elective

PURPOSE: To determine the value of magnetic resonance imaging (MRI) using HASTE (half- Fourier single-shot turbo spin-echo) and true FISP (fast imaging with steady-state precession and heavy T2-weighting) sequences in diagnosing bowel obstruction. MATERIALS AND METHODS: Thirty-one consecutive patients in whom suspected bowel obstruction was revealed at plain abdominal radiography, barium study, and computed tomography (CT) were admitted during an eight-month period. Eighteen of 27 in whom bowel obstruction was confirmed underwent MRI using HASTE and true FISP sequences. RESULTS: At MRI, bowel obstruction was diagnosed in all patients. Using the HASTE sequence, the site of obstruction was correctly identified in 16 patients(89%) and the cause of obstruction was correctly diagnosed in 15(83%). Using the true FISP sequence, the corresponding figures were 16(89%) and 16(89%). Of the 18 patients with confirmed bowel obstruction, 33%(6/18) showed better lesion conspicuity at true FISP, for 39%(7/18), conspicuity was equal at both sequences, 28%(5/18) showed better conspicuity at HASTE. CONCLUSION: MRI can be useful for evaluation the presence, site and cause of bowel obstruction. On comparing the findings of HASTE and true FISP sequences, no significant differences were observed.
Barium ; Humans ; Magnetic Resonance Imaging* ; Radiography, Abdominal

PURPOSE: the purposes of this study were: to contribute to maintaining and promoting health for female college students by identifying their body weight control behaviors and the Affecting factors; and, to serve as a basis for the development of weight control programs to orient their weight management to a desirable direction specifically for those who have low or normal body weight but still practice body weight control in a way that is neither useful nor desirable. METHOD: The data were analyzed by the SPSS/PC 10.0 statistical program using frequency, percentage, mean, standard deviation, t-test, ANOVA, Pearson's correlation coefficient, and the Stepwise multiple regression. RESULT: The main predictive factors affecting body weight control was 'between - meal snack', 'family support', 'satisfaction with their diet', 'possession of secret method for weight loss', 'body image', 'satisfaction with university life', and 'interest in weight control'. CONCLUSION: It may be necessary to develope educational programs on weight control for female collegians in consideration of affecting body weight control behavior.
Body Weight* ; Female* ; Humans ; Ideal Body Weight ; Meals

Intraoperative three-dimensional (3D) transesophageal echocardiography (TEE) facilitates an understanding of the complex cardiac pathology that is not fully delineated in a two-dimensional (2D) echocardiographic evaluation, and it suggests earlier and more precise surgical planning and intraoperative decision making. In the present case, the intraoperative 2D-TEE midesophageal long-axis view indicated a significant narrowing of the left ventricular outflow tract (LVOT) area by a band-like structure that vertically traversed the middle of the LVOT and connected to the anterior mitral leaflet base and the interventricular septum. However, additional 3D-TEE images of the LVOT and their cropped and rendered 2D images showed that web-like tissue, which presumably had grown around the patch closure from a previous atrioventricular septal defect, was obstructing the LVOT partially.
Decision Making ; Echocardiography ; Echocardiography, Three-Dimensional ; Echocardiography, Transesophageal* ; Pathology

We describe a patient with infective endocarditis (IE) complicated by mycotic cerebral aneurysms (MCAs). Transarterial embolization of a larger MCA was attempted but failed. Aneurysmal clipping through craniotomy was followed by mitral valvuloplasty. During mitral valvuloplasty for IE, the low values of cerebral oxygen saturation after aneurysmal clipping were improved by continuous nimodipine infusion. We also review anesthetic management of patients with IE complicated by MCAs.
Aneurysm ; Craniotomy ; Endocarditis ; Humans ; Intracranial Aneurysm ; Nimodipine ; Oxygen

This study was conducted in order to compare the biological activities of leaf and root water extracts of Smilax china L. (SC) by measuring the total polyphenol and flavonoid contents, anti-oxidant activity, inhibitory effect on alpha-glucosidase, and anti-inflammatory gene expression. The total polyphenol and flavonoid contents of SC leaf (SCLE) and root (SCRE) water extracts were 127.93 mg GAE/g and 39.50 mg GAE/g and 41.99 mg QE/g and 1.25 mg QE/g, respectively. The anti-oxidative activities of SCLE and SCRE were measured using the 1,1-diphenyl-2-picrylhydrazyl (DPPH) and 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) diammonium salt (ABTS) radical scavenging activity assay and reducing power assay. Both SCLE and SCRE scavenged radicals in a concentration-dependent manner, and SCLE showed stronger radical scavenging activity and reducing power than SCRE; however, both SCLE and SCRE exhibited lower activities than ascorbic acid. Compared to the anti-diabetic drug acarbose, which was used as a positive control, SCLE and SCRE exhibited low alpha-glucosidase inhibition activities; nevertheless, the activity of SCLE was 3.7 fold higher than that of SCRE. Finally, SCLE caused significantly decreased expression of the LPS-induced cytokines, iNOS, and COX-2 mRNA in RAW264.7 cells, indicating anti-inflammatory activity. These results indicate that SCLE might be a potential candidate as an anti-oxidant, anti-diabetic, and anti-inflammatory agent.
Acarbose ; alpha-Glucosidases ; Ascorbic Acid ; Biphenyl Compounds ; China ; Cytokines ; Gene Expression ; Picrates ; RNA, Messenger ; Smilax ; Water

The purpose of this study was to investigate the effect of 3-month nutrition education (First Time Intervention, FI) + additional 3-month nutrition education (Repeated Intervention, RI) which was performed after the 8-month follow-up. FI was conducted during 0-3 months and RI for 11-14 months. Ninety-two subjects completed FI program, and 38 out of 92 subjects who received FI finished the RI. Anthropometric data, dietary assessment (24hr recall) and fasting blood analysis were measured at 0 month, 3 months, 11 months and 14 months time points. After FI (3 mo), waist circumference, triglycerides, total cholesterol were significantly decreased. At 11 month follow-up, body weight, BMI, hip circumference, SBP, DBP were significantly rebounced and HDL cholesterol was significantly decreased. Therefore, the effect of short-term nutrition education was not being sustained. After the secondary nutrition intervention (14 mo), waist circumference and hip circumference were again significantly decreased. Total diet quality index-international (DQI-I) score was significantly increased in both FI group and RI group. The changes in DQI-I scores were significantly correlated with the changes in body weight (r = -0.129, p < 0.05) and counts of nutrition education (r = 0.159, p < 0.05), indicating that effective nutrition education helps improve the diet quality leading to a possible role in CVD prevention among male workers. Although a short-term intervention seems to be a success, the effect was not retained in this study. Therefore, we suggest incorporating nutrition education as a routine program for male worker at worksite.
Body Weight ; Cholesterol ; Cholesterol, HDL ; Diet ; Fasting ; Follow-Up Studies ; Hip ; Humans ; Male ; Triglycerides ; Waist Circumference ; Workplace

Rhabdomyoma has been reported to be the most common type of cardiac tumors in fetuses and children, and multiple cardiac rhabdomyomas almost certainly signify the association with tuberous sclerosis. We report here on a case of Tetralogy of Fallot (ToF) that was associated with multiple rhabdomyomas and tuberous sclerosis. A two-year-old boy, who had undergone systemic-pulmonary shunt during the neonatal period, received total correction of his ToF after the complete regression of the cardiac tumor. The postoperative course was uneventful, and he has been follow-up for 2 months. The boy is currently in an excellent condition.
Child ; Fetus ; Follow-Up Studies ; Heart Neoplasms ; Humans ; Rhabdomyoma ; Tetralogy of Fallot ; Tuberous Sclerosis