Comparison of Short Fusion versus Long Fusion for Degenerative Lumbar Scoliosis / 대한정형외과학회잡지

PURPOSE: To compare the results of short fusion versus long fusion for degenerative lumbar scoliosis. MATERIALS AND METHODS: Forty-seven patients undergoing short fusion (n=28) and long fusion and instrumentation (n=19) were evaluated. Short fusion was defined as fusion within the deformity, not exceeding the upper end vertebra. Long fusion was defined as fusion extended above the upper end vertebra. The number of levels fused in the short and long fusion groups was 3.14 and 6.89 segments, respectively. RESULTS: Before surgery, the Cobb angle was 16.3 degrees in the short fusion group and 22 degrees in the long fusion group, which changed to 10.1 degrees and 8.47 degrees, respectively, at the last visit. The correction of coronal imbalance was better in the long fusion group. In contrast, the correction of sagittal imbalance was similar in both groups. The mean estimated blood loss in the short and long fusion groups was 1,671 ml and 2,742 ml, respectively. Early perioperative complications developed frequently in the long fusion group. Adjacent segment disease occurred more frequently in the short fusion group. CONCLUSION: Long fusion and instrumentation for degenerative lumbar scoliosis was better at correcting the coronal deformity and imbalance than short fusion but was ineffective in correcting the sagittal imbalance.

Short Segment Fixation of Flexion-Distraction Injuries in Thoracolumbar Spines

PURPOSE: To evaluate the efficacy of short segment fixation in flexion-distraction injuries of thoracolumbar junction. MATERIALS AND METHODS: Twenty-five patients with a flexion-distraction injury in thoracolumbar junction confirmed by radiogram or MRI and stabilized with a short construct spanning short segment were included in this study. We investigated the location of fractures, type of fractures, anterior or posterior vertebral body height, and preoperative and postoperative kyphotic angle of injuried motion-segments on radiologic examinations and clinical outcome on the Oswestry score. RESULTS: A significant correction of deformity was achieved, from a mean preoperative kyphosis of 17.3 degrees to a mean postoperative kyphosis of 8.4 degrees. The loss of correction were minimal. The mean Oswestry score was 6.9, with 84% of patients having minimal disability (<20%) and no correlation with age, sex, the location of fractures, type of fractures, change of kyphotic angle. CONCLUSION: This study demonstrates the efficacy of posterior open reduction and short segment fixation of flexion-distraction injuries.

Selective Thoracic Fusion with Segmental Pedicle Screw Fixation for the Treatment of Thoracic Idiopathic Scoliosis: More than Five Year's Follow-Up / 대한척추외과학회지

STUDY DESIGN: This is a retrospective study. OBJECTIVES: We wanted to evaluate the outcomes of selective thoracic fusion with segmental pedicle screw fixation for treating thoracic idiopathic scoliosis with a minimum 5-year follow-up. SUMMARY OF THE LITERATURE REVIEW: Segmental pedicle screw fixation has been proven to achieve true segmental control and greater correction of scoliosis in both the coronal and sagittal planes. However, there is no long-term study of selective thoracic fusion with segmental pedicle screw fixation for treating thoracic idiopathic scoliosis. MATERIALS AND METHODS: We analyzed 203 thoracic idiopathic scoliosis patients (236 thoracic curves) who underwent selective thoracic fusion with segmental pedicle screw fixation. The mean patient age at the time of operation was 13.8 years (range: 8.9~18 years). RESULTS: The preoperative thoracic curve of 51+/-12 degrees was corrected to 16+/-7 degrees(69% correction with 3% loss of correction) at the most recent follow-up. The non-instrumented lumbar curve of 30+/-10 degrees was corrected to 10+/-8 degrees(66% correction with 5% loss of correction) at the most recent follow-up. The preoperative thoracic kyphosis of 18+/-11 degrees and the lumbar lordosis of 43+/-10 degrees were improved to 23+/-8 degrees and 46+/-9 degrees, respectively, at the most recent follow-up. There was no junctional kyphosis at the most recent follow-up. Coronal decompensation at the most recent follow-up occurred in 10 patients. Postoperative adding-on occurred in 17 patients who were fused two levels short of the neutral vertebra. Of the 2867 thoracic pedicle screws inserted at the thoracic level, 43 screws were found to be malpositioned (1.5%), but they did not cause neurologic complications or adversely affect the long-term results. CONCLUSIONS: Selective thoracic fusion with segmental pedicle screw fixation for treating thoracic idiopathic scoliosis had satisfactory radiographic and clinical outcomes after surgery, and the outcomes were well-maintained for a minimum of 5 years follow-up. It is a safe and effective method for preserving segments of lumbar motion as well as for the restoration and maintenance of both the coronal and sagittal alignments.

Mucociliary Differentiation according to Time in Human Nasal Epithelial Cell Culture / 대한이비인후과학회지

In cell culture studies using human nasal epithelial cells, information regarding the state of differentiation, cell phenotype, and gene expression for mucus production would be important to have in relations to different culture time as these factors may vary according to the length of culture period. The primary purpose of this research was to determine whether the number of the ciliated cells increases as a function of differentiation in normal human nasal epithelial (NHNE) cells. When an increase was observed in the number of ciliated cells, we determined the composition ratio of ciliated cells and secretory cells according to the culture duration. At the same time, we also examined the levels of mucin and lysozyme secretion at the same time. The presence of ciliated cells was not evident up to 2 days after confluence. However, 3.1+/-0.2%, 7.4+/-0.5%, and 14.5+/-0.6% of the cells were ciliated 7, 14, and 28 days after confluence, respectively. Meanwhile, the percentage of secretory cells were 35.6+/-2.8%, 32.8+/-2.5%, 32.8+/-2.5%, and 49.4+/-1.4% on the 2, 7, 14 and 28 days after confluence, respectively. The amount of secreted mucin showed an abruptly increasing pattern by the 14th day of confluence, but showed no significant changes thereafter. The amount of secreted lysozyme increased as a function of differentiation. We concluded that in in vitro studies with NHNE cells, the time point of treatment should vary according to the purpose of the study.

The Complicated Changes of External Nose after Corrective Rhinoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Rhinoplasty is not a simple technique but a series of interrelated, interdependent surgical maneuvers performed consequently. Each maneuver should be calculated to correct the total nasal deformity by creating a series of small defects or repositioning various anatomic components that must ultimately fit together. The purpose of this study is to review undesirable complicated changes that occur in the external nose following corrective rhinoplasty and to provide useful reference for better practice in rhinoplasty. MATERIALS AND METHODS: We have carried out 42 cases of corrective rhinoplasty from January, 1994 to December, 1998. We have observed complicated changes of the external nose after corrective rhinoplasty by conducting serial photogaphic documentation and analyses, questionnaires which were answered by the patients and the surgeons. RESULTS: We analyzed the various undesirable complicated changes and found out that the most common changes were widening of the nasal dorsum. The major causes of this nasal widening were the failure of perfect osteotomy, inadequate postoperative contouring, aging process of patients' nose, and the lack of ability of surgeon to predict the healing dynamics. CONCLUSION: To prevent and to minimize such undesirable changes following corrective rhinoplasty, surgeons need to gain skillful surgical techniques and adequate postoperative contouring skills. Most importantly, a thorough appreciation and understanding of the healing dynamics of rhinoplasty should be recognized.

Clinical Significance of Saccade Abnormalities / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The saccadic eye movement means rapid eye movement in order to fixate an intended target with fovea. Frontal lobe, brain stem and paramedian pontine reticular formation operate the saccade movement in the central nervous system. Although saccadic abnormalities were usually seen in the CNS lesion(most commonly in the cerebellar lesion) some normal individuals consistently undershoot or overshoot the target(corrective saccade). Because there are several possibilities for serious error when interpreting the saccade test, clinical usefulness of saccade test may be uncertain. We study the saccade movement in out dizzy patients to find out the definite usefulness of saccadic abnormality and cause of dizziness according to the saccadic abnormalities. MATERIAL AND METHOD: For 4 years, 1994.1.-1997.12, 53 patients showed saccade abnormalities and they were classified into 5 categories-undershoot, overshoot, slow velocity of saccade, impaired saccade and fail of saccade. Spontaneous nystagmus, gaze nystagmus, pursuit test and optokinetic test were also performed. We analyzed the cause of saccade abnormality and other associated eye movement disorders. RESULTS: Almost all saccade abnormalities were seen in central disease(71%), but some could be seen in specific cases of peripheral disease(11%) and in other conditions(18%). In peripheral lesion, only saccade undershoot was seen without other abnormal eye movement. In central lesion, all kinds of saccade movement were seen with or without other abnormal eye movement disorders, but there was no correlation between the sites of lesion and types of saccade. Spontaneous nystagmus was seen in 6 patients, but there was no correlation between the causes of vertigo and the types of saccade abnormality. CONCLUSION: Saccade test must be clinically useful for differentiating between the central and peripheral lesion using the types of saccade abnormality and other abnormal eye movement. But many factors that affect saccade movement should be considered when interpreting the test results.

Clinical Implication of Magnetic Resonance Imaging in Bell's Palsy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Magnetic resonance imaging(MRI) with gadolimiun, an intravenous paramagnetic agent, shows non-enhancement of the cranial nerves in normal subjects. In the presence of inflammation or edema, gadolinium is absorbed into these tissues, resulting in enhancement on T1-weighted images. The purpose of this study was to evaluate the clinical implication of gadolinium-enhanced MRI in Bell's palsy. MATERIALS AND METHODS: From 1994 to 1998, 19 patients with Bell's palsy were evaluated to assess the efficacy of gadolinium-enhanced MRI in determining the frequency, the site of facial nerve enhancement, and the relationship between electroneuronography(ENoG) findings and gadolinium-enhanced MRI. The data was compared to 40 patients with sudden sensorineural hearing loss who had temporal bone MRI. RESULTS: On gadolinium-enhanced MRI, 16 of 19 patients had abnormal contrast enhancement of the facial nerve, but nobody had abnormal contrast enhancement of the facial nerve in the control group. In particular, facial nerve enhancement was identified in the distal portion of the internal auditory canal, geniculate ganglion, labyrinthine segment (n=10), tympanic segment (n=10), and mastoid segment (n=7) of the facial nerve. The facial nerve was enhanced more frequently in patients in whom the degeneration of ENoG was more than 50%. The facial nerve was more frequently enhanced in patients who had a higher House-Blackmann grade. CONCLUSION: Gadolinium-enhanced MRI plays a important role in diagnosing Bell's palsy and in predicting the location of pathology of the facial nerve.

Plasticity of Vestibulo-ocular Reflex in Slow Harmonic Acceleration Test / 대한이비인후과학회지

The results of rotation chair test were known to variable by many parameters such as eye opening and alertness, etc. The situational change in rotation chair test must be considered to interpretation of its result. But in Korea, there were no reports or articles about parameters which influence the result of rotation chair test. So, we assumed that eye opening and alertness were main parameters and took rotation chair test in neurotologically normal subjects. For evaluation of the effect of eye-open or eye-closure and alertness on the rotational vestibular stimulation, we have taken sinusoidal harmonic acceleration test in 30 otoneurologically normal subjects. The maximal slow phase eye velocity, gain and asymmetry were obtained and compared with each other in four different conditions with properly fixed conditions such as in darkness and 0.05Hz frequency. At least five minutes interval was given between the tests and recalibrations were done before each tests. The results of this test were as follows. 1) Vestibular-ocular reflex(VOR) changes according to eye open or closure. In cases of examinees which were given alerting tasks, larger gain was obtained with eyes opened than with eyes closed, and that was statistically significant(p0.05). 2) VOR changes according to alertness. In cases of examinees which opened their eyes, larger gain was obtained with alerting tasks than without alerting tasks, and that was statistically significant(p<0.05). In cases of examinees which closed their eyes, larger gain was obtained with alerting tasks than without alerting tasks, and that was statistically significant(p<0.05). 3) There was no significant changes of asymmetry according to the conditions. Therefore, from above results, we recommend the condition in which examinees open their eyes and be given alerting tasks as one of the optimal condition in sinusoidal harmonic acceleration test.

Dramatic Control of Tachycardia during Enflurane Anesthesia in a Patient with Hyperthyroidism by Verapamil - A case report / 대한마취과학회지

Though clinical use of verapamil, a calcium channel blocker, is increasingly presenting and hemodynamic change due to verapamil alone and in combination with beta b1ockerg or inhalation aneathetics are in active investgation now, there is scare Korean literature about the use of verapamil for the treatment of tachycardia during aneatheeia. Here, we report our clinical enflurance of dramatic, even dangerous, control of tachy-cardia during enflurane anesthesia in a patient with hyperthyroidism after trial of verapamil. There are two episodes of tachycardia in a 52-year old female with hyperthyroidism of 3-rearg duration and atrial fibrillation, each developed during enflurane anesthesia for 2 operations performed one moath apart. After slow intravenous injection of verapamil(0.1mg/kg for the first and 0.05 mg/kg for the second episode), the heart rates were reduced from 130 and 132 to 80 and 75. The effect was much sustained and the reduction of BP were slight in both instances. We feel that the dramatic reduction of heart rate is probably related to drug interaction between verapamil, propranolol given preoperatively, and enflurane. Literatures concerning the use of, and the heinodynamic changes induced by verapamil in various situations are reviewed briefly.

Esophageal Lead for Intraoperative Electrocardiographic Monitoring in Major Burned Patients / 대한마취과학회지

The use and safety of the esophageal electrocardiogram for detection and diagnosis of using lead ll in major burn patient, especially burn of chest and face Compared with lead ll , 100% of cardiac rhythm was properly detected with the esopha-geal electrcardiogram. Large distinct P waves, resulting from the proximity of the esophageal lead to the left atrium, clearly established the temporal relationship between atrial and ventricular depo- larization Ne complications were encountered during the atudy. The esophageal lead is safe, simple to use, and provides valuable information fur dele- ction or diagnosis of cardiac rhythm during major burn anesthesia.