PURPOSE: This study evaluated the operability for disease of lumbar intervertebral disc (LID) of practitioners and pay doctors of orthopedic surgeons and neurosurgeons by examining their websites. MATERIALS AND METHODS: From March 2006 to April 2006, we searched the internet using the key words orthopedic surgery and neurosurgery, with NAVER as the portal site. There were 68 homepages of orthopedic hospitals and physician's offices (OHP) and 27 homepages of neurosurgical hospitals and physician's offices (NHP). Each homepage was visited in order to survey the operability for disease of an intervertebral disc and the number of board of orthopedists and neurosurgeons. Statistical analysis was carried out using a chi-square test. RESULTS: In 45.6% (31/68) of OHP and 85.2% (23/27) of NHP, the operation for LID was performed and there was significant difference (p<0.001). In 16.2% (11/68) of OHP, neurosurgeons employed by OHP performed the operation for spinal disorders. In 29.4% of OHP, the orthopedic surgeon performed the operation for LID. Orthopedists were employed in 51.9% of NHP. NHP were significantly higher than OHP in the cases in whom the orthopedists and neurosurgeons worked together in a single hospital (p<0.001). CONCLUSION: In 70% of OHP, surgery for LID was not performed. A survey about reasons for not performing operation for LID and improvement of that reasons should be carried out by the medical association.
Internet ; Intervertebral Disc ; Neurosurgery ; Orthopedics ; Physicians' Offices

PURPOSE: To evaluate the radiographic mid-to long-term result of femoral revision hip arthroplasty using impacted cancellous allograft combined with cemented, collarless, polished and tapered stem. MATERIALS AND METHODS: Among 27 patients with impacted cancellous allograft with a cemented stem, 28 hips from 26 consecutive patients were analyzed retrospectively. The average patient age was 59 years. The follow-up period ranged 36 months to 10 years, 3 months (mean, 76.6 months). Radiographic parameters analyzed in this study included subsidence of the stem in the cement, subsidence of the cement mantle in the femur, bone remodeling of the femur, radiolucent line, and osteolysis. RESULTS: Radiographic analysis showed very stable stem initially. 27 stems showed minimal subsidence (less than 5mm) and 1 stem showed moderate subsidence (about 8 mm) in the cement. But there was no mechanical failure and subsidence at the composit-femur interface. Evidence of cortical and trabecular remodeling were observed in all cases. No radiolucent line or osteolysis were found in the follow-up period. There were 4 proximal femoral cracks and 1 distal femoral splitting during operation. CONCLUSION: The result of cemented stem revision with the use of impacted cancellous allograft was good mid-to long-term. and femoral bone stock deficiency may be reconstructed successfully.
Arthroplasty ; Bone Remodeling ; Femur ; Follow-Up Studies ; Hip ; Humans ; Osteolysis ; Retrospective Studies ; Transplantation, Homologous

Thoracic disc herniation is a rare condition in which a posterior approach, extrapleural approach, posterolateral approach, or transthoracic approach is currently used. The posterior approach is not recommended in thoracic disc herniation surgery because of the risk of spinal cord injury. The transthoracic approach makes it possible to remove the intervertebral disc and is considered a standard method. However, due to an extensive transverse skin incision, division of the latissimus dorsi muscles, and rib resection, the conventional open approaches involve a risk of complications, such as infection and post-thoracotomy pain syndrome; and a long period of rehabilitation and recovery is required. Excision of the intervertebral disc under thoracoscopic guidance can reduce the damage to the skin and muscles, but the equipment and surgical materials are expensive and a long learning curve is required. Therefore, we report a case and a new muscle splitting transthoracic approach that can be performed by incising 10 cm of skin longitudinally and preserving the serratus anterior and latissimus dorsi muscles.
Intervertebral Disc ; Learning Curve ; Muscles ; Rehabilitation ; Ribs ; Skin ; Spinal Cord Injuries ; Superficial Back Muscles*

PURPOSE: Traumatic asphyxia is a rare clinical syndrome characterized by cervicofacial cyanosis, edema, and multiple petechiae after a severe chest crush injury, and ophthalmic involvement includes violaceous discoloration of lid, lid edema, bulbar subconjunctival hemorrhage, exophthalmos and retinal hemorrhage. The authors experienced a case of traumatic asphyxia with typical ophthalmic manifestations after a crush chest injury, and we report this case with literature review. METHODS: A-54-year old man was consulted for bilateral proptosis after a crush chest injury. Ophthal-mologice valuation and intervention were performed. RESULT: Right eye was not checked due to previous corneal opacity, but visual acuity was 0.8 and IOP was 45 mmHg in left eye. There were bilateral proptosis and severe bulbar subconjunctival hemorrhage, and orbital computed tomography showed orbit fat interposed between globe and medial orbital wall. IOP was controlled with medications and other clinical signs including proptosis showed progressive improvement.
Asphyxia* ; Corneal Opacity ; Cyanosis ; Edema ; Exophthalmos ; Hemorrhage ; Orbit ; Purpura ; Retinal Hemorrhage ; Thoracic Injuries ; Thorax ; Visual Acuity

BACKGROUND/AIMS: Paradoxical reaction after midazolam administration is relatively uncommon and can obstruct the performance of ERCP. But it can not be predicted before drug administration. We investigate the difference in occurrence of paradoxical reaction according to personal characteristics and clinical status of patients. METHODS: During 155 ERCP procedures, we injected midazolam and meperidine intravenously for conscious sedation until deep sleep occurred. Among 155 patients, 108 patients did not showed paradoxical reaction (group I) and 47 patients (30.3%) showed gross behavioral disturbance and/or agitation (group II). Paradoxical agitation was seen in 9 (7.1%) procedures. RESULTS: Type A-like personality (p=0.002), sleep-talking habit (p=0.026) and presence of pain at the beginning of ERCP (p=0.036) and during ERCP (p=0.021) were seen more frequently in group II. Duration of ERCP was longer (p=0.034) and dosage of midazolam was larger (p=0.009) in group II. In multivariate analysis, having sleep-talking (OR, 5.5), type A-like personality (OR 3.9) and dosage of midazolam (OR 1.3) were risk factors of paradoxical reaction. CONCLUSIONS: Paradoxical agitation after midazolam administration was uncommon and can be managed with flumazenil. Paradoxical reaction can be predicted more often in patients with type A-like personality, sleep-talking habit, complaining pain before ERCP, and in patients injected large dosage of midazolam.
Cholangiopancreatography, Endoscopic Retrograde* ; Conscious Sedation* ; Dihydroergotamine ; Flumazenil ; Humans ; Meperidine ; Midazolam* ; Multivariate Analysis ; Risk Factors

No abstract available.
Jaundice, Obstructive* ; Pancytopenia* ; Ticlopidine*

Annuloaortic ectasia, cystic medial degeneration of the afflicted aortic wall leading to progressive dilatation, is often accompanied by Marfan's syndrome. Some portions of intimal flap is commonly demonstrated along the aorta in the noninvasive diagnosis of aortic dissection. We report the first case of circumscribed aortic dissection developed in a 28 year old obese non-Marfanoid patient. He was transferred after thrombolytic therapy at a community hospital because of severe chest pain and ST segment elevation. Transthoracic echocardiography showed markedly dilated aortic root, moderate amount of pericardial effusion, mild aortic regurgitation in spite of normal regional wall motion of left ventricle. Intimal flap, characteristic of aortic dissection, was not seen with computed tomography. Intimal tear was demonstrated just above aortic valve only by transesophageal echocardiography. Two parallel intimal tear and small circumscribed dissection was demonstrated by autopsy.
Adult ; Aorta ; Aortic Valve ; Aortic Valve Insufficiency ; Autopsy ; Chest Pain ; Diagnosis ; Dilatation ; Dilatation, Pathologic* ; Echocardiography ; Echocardiography, Transesophageal ; Heart Ventricles ; Hospitals, Community ; Humans ; Marfan Syndrome ; Pericardial Effusion ; Thrombolytic Therapy

BACKGROUND: The technique to evaluate left internal mammary artery (LIMA) is not well established during right transradial coronary angiography. MATERIALS AND METHODS: Following coronary angiography via right radial artery, LIMA angiography was performed using 5 French (F) Judkins JL-3.5 catheter in 110 patients (56+/-9 years [range: 46-81], 77 males). Eleven (10%) patients had grafted LIMAs. Subclavian and innominate arteries were moderately tortuous in 14 (13%) patients and aortic arches elongated and more vertically oriented in 16 (15%). The catheter, standing in the ascending aorta with its natural curve, was withdrawn slowly while being rotated clockwise to engage its tip in the proximal left subclavian artery. After the tip portion was adjusted, contrast material was injected while sphyngomanometer cuff inflation applied to the left upper arm. RESULTS: Nonselective LIMA angiography was successfully performed in 108 (98%) patients. The catheter was engaged in the subclavian artery in a mean of 11+/-8 seconds (range: 3-136) from the time when the catheter was withdrawn from the ascending aorta. The image quality of LIMA was satisfactory in 103 (95%) patients and not satisfactory in 5 (5%) in whom the catheter tip was not placed near the origin of LIMA. In ten (91%) of the 11 patients with grafted LIMA, the anastomosis site and distal coronary vessels were well visualized. There were no complications, including arterial dissection and thromboembolism. CONCLUSION: Nonselective technique using 5 F Judkins JL-3.5 catheter is easy, fast, safe and reliable for evaluating LIMA during right transradial coronary angiography.
Angiography ; Aorta ; Aorta, Thoracic ; Arm ; Brachiocephalic Trunk ; Catheters ; Coronary Angiography* ; Coronary Vessels ; Humans ; Inflation, Economic ; Mammary Arteries* ; Radial Artery ; Subclavian Artery ; Thromboembolism ; Transplants

BACKGROUND AND OBJECTIVES: The safety and efficacy of outpatient cardiac catheterization was established. We evaluated our patient population and complications selected for outpatient procedures and our experience with transradial approach. MATERIALS AND METHODS: A total of 346 outpatient cardiac catheterization (31% of all diagnosticprocedures),performed with transradial approach, was compared with 788 in patient diagnostic procedures in terms of patient population, clinical and angiographic features, complications of examinations. RESULTS: 1) Indications of outpatient coronary angiography were as follows: follow-up of coronary interventions or bypass surgery (41.6%), recent-onset or aggravated angina (31.2%), atypical chest pain (19.4%), stable angina (3.8%), recent myocardial infarction (2.9%), variant angina (0.9%), preoperative evaluation of valvular or congenital heart disease (0.3%). 2) Significant coronary lesions were found in 216 (62.5%) patients and left main disease in 1 2 (3.5%). Coronary spasm test, internal mammary artery or saphenous vein graft angiography, aorto-ileofemoral angiography, and bilateral carotid angiography were safely performed as indicated. 3) Success rate of examination by primary approach was 94.5%, similar to 94.9% of inpatients. Alternative brachial or femoral approaches were needed in 19 (5.5%) patients. 4) No death, cerebral thromboembolism or myocardial infarction were observed and one-day admission was required in 13 (3.7%) patients. Initial 254 patients (33%) showed good radial pulse (94%), weak or absent radial pulse (6%), abnormal reverse Allen test (6%) up to 61+/-25 days. However, no claudication was observed. CONCLUSION: Cardiac catheterization and angiography was safely performed in the outpatient population selected using much extended inclusion criteria. Transradial approach is useful to set up outpatient procedures with less facilities and personnels and makes it available in the daytime with low readmission rate.
Angina, Stable ; Angiography* ; Cardiac Catheterization* ; Cardiac Catheters* ; Chest Pain ; Coronary Angiography ; Follow-Up Studies ; Heart Defects, Congenital ; Humans ; Inpatients ; Mammary Arteries ; Myocardial Infarction ; Outpatients* ; Radial Artery ; Saphenous Vein ; Spasm ; Thromboembolism ; Transplants

BACKGROUND: The technique to evaluate left internal mammary artery (LIMA) is not well established during right transradial coronary angiography. MATERIALS AND METHODS: Following coronary angiography via right radial artery, LIMA angiography was performed using 5 French (F) Judkins JL-3.5 catheter in 110 patients (56+/-9 years [range: 46-81], 77 males). Eleven (10%) patients had grafted LIMAs. Subclavian and innominate arteries were moderately tortuous in 14 (13%) patients and aortic arches elongated and more vertically oriented in 16 (15%). The catheter, standing in the ascending aorta with its natural curve, was withdrawn slowly while being rotated clockwise to engage its tip in the proximal left subclavian artery. After the tip portion was adjusted, contrast material was injected while sphyngomanometer cuff inflation applied to the left upper arm. RESULTS: Nonselective LIMA angiography was successfully performed in 108 (98%) patients. The catheter was engaged in the subclavian artery in a mean of 11+/-8 seconds (range: 3-136) from the time when the catheter was withdrawn from the ascending aorta. The image quality of LIMA was satisfactory in 103 (95%) patients and not satisfactory in 5 (5%) in whom the catheter tip was not placed near the origin of LIMA. In ten (91%) of the 11 patients with grafted LIMA, the anastomosis site and distal coronary vessels were well visualized. There were no complications, including arterial dissection and thromboembolism. CONCLUSION: Nonselective technique using 5 F Judkins JL-3.5 catheter is easy, fast, safe and reliable for evaluating LIMA during right transradial coronary angiography.
Angiography ; Aorta ; Aorta, Thoracic ; Arm ; Brachiocephalic Trunk ; Catheters ; Coronary Angiography* ; Coronary Vessels ; Humans ; Inflation, Economic ; Mammary Arteries* ; Radial Artery ; Subclavian Artery ; Thromboembolism ; Transplants