The Revision Operation Rate for Adjacent Segmental Degeneration by Survival Analysis in Mono-segment Lumbar Fusion / 대한정형외과학회잡지

PURPOSE: To analyze survival rates of patients after mono-segmental lumbar or lumbosacral fusion and to evaluate factors affecting the revision operation due to adjacent segmental degeneration. MATERIALS AND METHODS: This study enrolled 1,206 patients who had mono-segmental lumbar or lumbosacral fusion between March 1997 and December 2006 at the Seoul Spine Institute. The survival rates for the revision operation due to adjacent segmental degeneration were analyzed retrospectively. The age at index operation, sex, etiologic diagnosis, fusion method, fusion level, substance of bone graft, operator, body mass index (BMI), and smoking were considered as risk factors for the revision operation. RESULTS: There were 27 patients with a revision operation for adjacent segmental degeneration (2.24%). The average follow-up period was 39.0 months (6 months to 12 years 6 months) and the average age at operation was 47.0 years (13 to 85 years). The survival rate at 5 years was 97.3%, and at 10 years it was 89.4%. Patients less than 50 years old had a significantly lower revision operation rate than those aged 50 or more (p=0.002). When fusion between the 4th lumbar and the 5th lumbar spinal vertebrae was done, the revision operation rate was significantly higher than for other levels (p=0.003). Obese patients with BMI> or =25 had a significantly higher revision rate than did patients with BMI0.05). In multivariate analysis, age alone was a significant risk factor (p=0.048, Hazard ratio=2.50). CONCLUSION: The most important factor for survival without revision surgery for adjacent segmental degeneration following instrumented mono-segment lumbar or lumbosacral fusion is the age at index operation. Patients 50 year-old or older should be informed of the possibility of adjacent segmental disease after instrumented mono-segment lumbar or lumbosacral fusion.

Central Vein Catheterization for Prematurity / 대한마취과학회지

BACKGROUND: The establishment of safe and functional intravenous lines is of fundamental importance in premature sick neonates. Due to technical difficulties and various potential complications, central venous catheterization(CVC) has become an important part of long term care for prematurity. In terms of safety, it is believed by some that the central vein catheter tip should not be in the right atrium to avoid fatal complications. However, catheter performance and durability can be improved by positioning the catheter tip within the right atrium. Here, we evaluated the effectiveness of intraatrial catheter tip positioning for prematurities, to resolve this controversy between patient safety and catheter performance. METHODS: Premature neonates in whom CVC had been attempted at a nursery and pediatric intensive care unit were enrolled in this study. We successfully performed eighteen CVCs in twenty patients from September 2003 to December 2004. CVC tips were in positioned within the right atrium, and central venous route, central venous catheter depth, duration of catheterization, and any complications during or after catheterization were evaluated. RESULTS: Eighteen CVC were successful among twenty attempted in premature neonates. Two attempts failed due to guidewire insertion failure. A left supraclavicular venous approach was selected for 16 patients and a right approach for two. For intraatrial tip positioning, distances from skin to catheter tip were adjusted to an average depth of 5 cm in 11 patients and 6 cm in three patients. Two arterial punctures were the only minor complications. Mean duration of catheterization was 19 days without any long term complicaions. CONCLUSIONS: To prematue long term CVC performance, left supraclavicular subclavian vein catheterization and intraatrial catheter tip positioning should be considered a first option in premature neonates.

Effects of Aprotinin during Off-Pump Coronary Artery Bypass Grafting in Patients on Hemostasis Taking Aspirin / 대한마취과학회지

BACKGROUND: Patients with ischemic heart disease are frequently maintained on a regimen of aspirin because of its ability to reduce variable thrombotic complications. However, aspirin has been recognized as a causative factor of increased perioperative bleeding. This study was aimed to determine whether aprotinin maintain its efficacy at reducing blood loss in patients on aspirin undergoing off-pump coronary artery bypass grafting (OPCAB). METHODS: In the prospective, double blind, randomized study, we investigated 30 patients on preoperative aspirin medication undergoing OPCAB surgery. Patients received aprotinin (1 x 106 KIU bolus for loading plus 0.5 x 106 KIU/hr, n = 15, the aprotinin group) or saline solution (n = 15, the control group). Operation time, total transfusion amount during operation, and plasma D-dimer levels immediately after the induction of anesthesia and immediately after operation were investigated and compared between and within groups where possible. RESULTS: Both group showed no comparable demographic and operation data such as operation time and number of grafts. The aprotinin group showed significantly less transfusion amount than the control group (packed RBC 352.7 +/- 89.2 ml vs 478.0 +/- 132.1 ml). Compared with that immediately after anesthetic induction value, postoperative D-dimer significantly increased in the control group but not in the aprotinin group. CONCLUSIONS: The above results suggest that aprotinin significantly reduces transfusion amount and probably inhibits fibrinolysis in patients with aspirin undergoing OPCAB.