Postoperative negative pressure pulmonary edema following repetitive laryngospasm even after reversal of neuromuscular blockade by sugammadex: a case report / 대한마취과학회지

Laryngospasm, an occlusion of the glottis, can occur at any time during anesthesia, and is associated with serious perioperative complications such as hypoxia, hypercabia, aspiration, bronchospasm, arrhythmia, prolonged recovery, cardiac collapse, and eventually catastrophic death. Importantly, postoperative negative pressure pulmonary edema (NPPE) is a rare, but well described life-threatening complication related to acute and chronic upper airway obstruction. Sugammadex well known for affirmatively reducing the postoperative pulmonary complications associated with residual neuromuscular blockade may have an indirect role in triggering the negative intrathoracic pressure by raising a rapid and efficacious respiratory muscle strength in acute upper airway obstruction. Herein, we report a case of postoperative NPPE following repetitive laryngospasm even after reversal of rocuronium-induced neuromuscular blockade using sugammadex.

Epinephrine-induced lactic acidosis in orthognathic surgery: a report of two cases

Submucosal infiltration and the topical application of epinephrine as a vasoconstrictor produce excellent hemostasis during surgery. The hemodynamic effects of epinephrine have been documented in numerous studies. However, its metabolic effects (especially during surgery) have been seldom recognized clinically. We report two cases of significant metabolic effects (including lactic acidosis and hyperglycemia) as well as hemodynamic effects in healthy patients undergoing orthognathic surgery with general anesthesia. Epinephrine can induce glycolysis and pyruvate generation, which result in lactic acidosis, via β2-adrenergic receptors. Therefore, careful perioperative observation for changes in plasma lactate and glucose levels along with intensive monitoring of vital signs should be carried out when epinephrine is excessively used as a vasoconstrictor during surgery.

Fibrodysplasia Ossificans Progressiva / 대한정형외과학회잡지

Fibrodysplasia ossificans progressive (FOP) is an extremely rare disabling disorder characterized by progressive heterotopic ossification associated with congenital digital malformations. The purpose of this study is to delineate the problems in diagnosis and treatment of this rare disease, and to present their solutions. Nine Korean FOP patients have been followed up for average 7.2 years. Their medical records and radiographs were reviewed, and they were reexamined directly or interviewed by telephone. There were 6 female and 3 male patients. The age at the time of this study averaged 13.3 years (range, 4 to 23). In 5 cases, the first clinical manifestation was migrating scalp and neck mass at the age of 1-2 years. The diagnosis was delayed for 3 year and 5 months at average although all the patients had pathognomonic big toe anomaly. Surgical excision of heterotopic ossification in an attempt to increase the joint motion was performed in 4 cases but in vain. Posterior spinal fusion in 1 case failed to prevent progression of scoliosis and trunk decompensation. Disodium etidronate, tried in 3 patients, brought no effective symptom relief. All the patients in their 20's were household ambulators. Understanding the clinical manifestation of this disease enables early diagnosis, by which unnecessary and harmful procedures such as surgical biopsy or excision can be avoided, although no effective treatment has been developed.

Segmental Spinal Instrumentation in the Management of Fracture and Fracture-Dislocation of the Thoraco-Lumbar Spine / 대한정형외과학회잡지

Segmental Spinal Instrumentation(S.S.I.) is more effective means of managing unstable thoraco-lumbar spine fractures than traditional Harrington Rod Instrumentation as an operative procedure which afforded rigid internal fixation with stability and needed minimal external immobilization. Early return to normal activity and successful rehabilitation are facilitated by efficient stabilization with S.S.I. Fifty-nine patients with fractures and fracture-dislocations of thoraco-lumbar spine were treated by Harrington Rod Instrumentation (29 patients) and S.S.I. (30 patients) at this hospital from June 1979 to July 1984. We have analysed the results of these treatment and obtained following conclusions: 1. S.S.I. is more rigid internal fixation than Harrington Rod Instrumentation. a) no or minimal external immobilization b) early ambulation and rehabilitation c) lowered complications 2. There was no significant difference in correction rate, loss of correction, and neurologic recovery between Harrington Rod Instrumentation and S.S.I.

Distal Femoral Fracture / 대한정형외과학회잡지

Fractures involving joints and about the joints provide complex problems with small comminuted fractures, surrounding soft tissue injuries and articular cartilage damage. Various problems are also encountered on the weight bearing surface, especially on the convex side of the distal Femur. Even though many auther had recommended kinds of management upto now, operative methods are more suggested in order to get good results regarding with the accurate anatomical reduction, rigid internal fixation and early joint motion. The clinical analysis of rnanagements of 20 cases of distai femoral fracture demonstrate that seperate dual incision-bilateral or right angle plane-to originate fracture site, and anatomical reduction & rigid internal fixation, early non-weight bearing ROM exercise of joint were sometimes mandatory to treat the displaced, comminuted fracture.

In Vitro Biomechanical Evaluation of Proper Position of Acetabular Cup and Femoral Stem for T.H.R.A.: by Using Mueller Apparatus / 대한정형외과학회잡지

The Primary objectives of total hip replacement arthroplasty are not only to relieve pain, but to improve motion and function. The range of motion following total hip replacement arthroplasty depends on several factors, especially the position of acetabular cup and femoral stem. Also the oriental need more flexion and abduction in hip motion for squarting position as compared with the European who have different living activity. We studied in vitro biomechanical evaluation of proper position of acetabular cup and femoral stem for T.H.R.A. The following results were obtained: l. Effect of component orientation on R.O.M. 2. Acceptable position of prosthesis was as follows: Acetabular cup: inclination 40–50 degree, anteversion 20–30 degree, Femoral stem: anteversion 0–10 degree. 3. The sum of ideal anteversion of the two components was 30–35 degree 4. Oriental sitting position was performed normally in the ideal position of the prosthesis 5. Acetabular cup is likely insert in the position as far as post sup rim of acetabulum mightbe feasible to be full recovered.

The Treatment of Femoral Head Fractures Associated with Posterior Hip Dislocations / 대한정형외과학회잡지

Femoral Head fracture associated with posterior dislocation of the hip was once considered a rare industrial injury. However, the advant of high-speed travel has contributed to its increased incidence. Ten cases of fractured femoral head with posterior dislocation of the hip were treated at the Busan Paik Hospital between June 1979 and June 1982. During the same period, a total of 38 posterior hip dislocations were treated. The patients were followed for the average of 19.3 months, the range being 6 months to 3 years. There were 9 men and 1 woman the age ranged from 25 to 56 years. The fractures were classified according to Pipkin and the results were evaluated by Epsteins criteria. 1. The incidence of femoral head fracture was 26.3%, 10 cases of 38 posterior hip dislocations. 2. The better result was noted in open method than in closed method. 3. The absolute surgical indications were considered as followings. a. inadequate closed reduction of head fragment especially the large one. b. the involvement of weight bearing portion of femoral head. c. the hip joint pain caused by impingement of small fragment between joint space. 4. Arthrogram was helpful to find the concealed small fragment when the hip joint pain persisted with negative findings in ordinary x-ray.

The Clinical Study of Autotransfusion in the Orthopedic Surgical Field / 대한정형외과학회잡지

Requirement of blood transfusion has been progressively increased and supplements by volunteer donor are not sufficient to their requirements. Moreover homologous blood transfusion are not supplied without risks, espcially the transmission of the serum hepatitis. Twenty procedures, including two total hip replacement arthroplasty, were carried out with acute hemodilutional autotransfusion. The results of this study show that autotransfusion is a safe method without difficulty of blood replacement in elective orthopedic procedures.

Apert Syndrome: A Report of One Case / 대한정형외과학회잡지

Apert described acrocephalosyndactyly as a clinical entity in 1906. At first he included a patient with craniofacial deformities combined with syndactyly of both the upper and lower extremities. This is a rare congenital disturbance in the growth of bone and soft tissue affecting principally the head, the hands and the feet. More than 200 cases have been reported in the world literature, and three cases in Korea. Authors experienced one case of the classic pattern of Apert's syndrome and treated surgically for syndsctyly.

SPINAL STENOSIS: Review of 60 Cases / 대한정형외과학회잡지

Spinal stenosis is a localized narrowing of the spinal canal due to structural abnormalities. It may be caused by diminution of the sagittal diameter, volume changes of the lateral recesses and the intervertebral foramena. Its symptoms are somewhat different from those of classical herniated intervertebral disc and are characterised by a chronic, less localized and usually bilateral nerve root compression syndrome. During the period of 5 years and 8 months, from January 1973 when the concept of spinal stenosis was adopted to August 1978, we saw at Seoul National University Hospital 65 cases of spinal stenosis and operated on 58. 60 of the cases were reviewed and following observations were made: 1. There were 30 males and 30 females. The youngest age was 9 years and the oldest 62 years, the average being 41.5 years. 80% of the patients were between 30 and 60 years of age. 2. The etiology of spinal stenosis was as follows: Congenital/developmental 5, Degenerative 11, Combined 19, Spondylolitic/spondylolisthetic 19, Iatrogenic 1, Miscellaneous 5. 3. Chief complaints on admission were as follows: Back pain only 17, back pain and sciatica 22. intermittent claudication 11, numbness 5, weakness 4, and bladder incontinence 1. 4. Lasegue test was positive in only 11 cases, 7 of which being bilateral. 5. Myelogram was performed on 44 patients, yielding following findings: Hourglass bilateral defects 13, complete block 12, unilateral focal defect 7, multiple defects 6, almost complete block 2, uniformly narrow canal 2, and negative 2. 6. Decompressive surgery was carred out on 58 patients as in the following One level 21. two levels 21, and more than three levels 16. The longest follow-up was 4 years and the shortest 1 month, the average being one year and six months. Results were as follows: excellent 31.4%. good: 53%. fair 13.7% and poor 1.9%.