New Cervical Laminoplasty Polyethererketone Cage: Two Case Reports

Cervical laminoplasty is a widely used technique to enlarge the spinal canal for spinal cord decompression. The two common methods are an open door laminoplasty and a midline splitting laminoplasty. Several devices and materials have been used as a spacer for maintaining or stabilizing the lamina in the open or split position, however, some are difficult to implant. Moreover, they are not designed to restore the natural dynamics of the cervical spine, and can cause discomfort to the patient. There is a need to develop a device and material that will be effective in maintaining and stabilizing the position of the lamina after laminoplasty, being able to be implanted easily and safely to restore the natural dynamics of the cervical spine, as well as getting the bony union to the host bone. We report two cervical laminoplasty patients who were treated using a new laminoplasty polyetheretherketone cage.

A Clinical Analysis and Referral Rate on Diabetic Retinopathy in Diabetic Patients Referred for Eye Examination at a Tertiary Hospital

PURPOSE: To obtain a recent epidemiological data on diabetics with diabetic retinopathy in a tertiary hospital. METHODS: We reviewed the medical charts of 1041 diabetic patients who visited on eye clinic between 1997 and 2001. We also analyzed the result of first eye examination of 325 patients diagnosed to have diabetic retinopathy. RESULTS: Diabetic retinopathy was diagnosed in 325 patients (31.2%) out of 1041 diabetic patients (41 type I and 1000 Type II patients). Among 325 patients, proliferative retinopathy was diagnosed in 109 patients (10.5%). The longer was the duration of diabetes, the higher was the prevalence of diabetic retinopathy among type II diabetics. Among type I diabetics macular edema was identified in 38.9% (7 eyes/18 eyes) of non-proliferative retinopathy patients, and 90.0% (18 eyes/20 eyes) of proliferative retinopathy patients. Among type II diabetics this prevalence was 35.0% (145 eyes/414eyes) in non-proliferative retinopathy patients, and 73.7% (146 eyes/198 eyes) in proliferative retinopathy patients. Visual acuity tended to be low in diabetics with macular edema. Only 497 patients (47.8%) were those who were referred by their primary doctors. CONCLUSIONS: The prevalence of diabetic retinopathy was 30~40% among diabetics seen in tertiary hospital, and thus the clinical importance of diabetic retinopathy increased. Education of diabetic patients and deep understanding on diabetic retinopathy by primary doctors are needed in the future.

The Results & Affecting Factors of Posterior Lumbar Interbody Fusion with TPM Cages in Spondylolisthesis / 대한척추외과학회지

STUDY DESIGN: This is a retrospective study analyzing the results of posterior lumbar interbody fusion(PLIF) with TPM cages in spondylolisthesis OBJECTIVES: The purpose of this study was to evaluate the clinical, radiologic results & affecting factors of PLIF with TPM cages in spondylolisthesis. SUMMARY OF LITERATURE REVIEW: The ordinary PLIF has 86-98% of radiologic union rate and clinical satisfactory rate. The problems of ordinary PLIF were graft breakage, donor site morbidity, limited bone resources, high failure rate using only transpedicular screw fixation. MATERIALS AND METHODS: From October 1995 to January 1999, 108 consecutive patients with spondylolisthesis were treated by PLIF with TPM cages, in which morcellized bone chips salvaged from posterior neural arch applied, and pedicle screw fixation. RESULTS: Preoperative Low Back Pain score(total 100 points) was improved from 47.4 points to 88.7 points at last follow-up. 10 point visual analogue scale was reduced to 1.5 point at last follow-up. In the end results, Ninty-two percent of patients rated as excellent or good. The preoperative value of slippage, 18.6% was achieved to 5.5% at last follow-up. The anterior intervertebral disc space height was increased from 10.0 to 16.2mm postoperatively. Fusion occurred in all patients except one. Groups below 60-year-old patient at the time of surgery showed better clinical results than those above 60 (p<0.05). No clear correlations were noted between sex, the types of spondylolisthesis, bone mineral density, smoking habits and obesity in clinical, radiologic results. CONCLUSION: PLIF with TPM cages is appeared to be a recommended procedure of choice to treat lumbar spondylolisthesis and this operation should be performed with a caution in aged patients.

The Change of SaO2, PFT and ABGA During the Bronchofiberscopy / 결핵

BACKGROUND: Bronchofiberscopy is a procedure with a chance of airway irritation and it may cause pathophysiologic changes of respiratory system. So we tried to evaluate the influence of bronchofibercopy on O2 saturation, ABGA and PET by patient's basal status and procedure type. METHOD: O2 saturation was measured every 1 minute from the left index finger tip with percutaneous oximetry. ABGA was done before and right after the bronchofiberscopy and PFT was done before and within 10 minutes after the bronchofiberscopy. RESULTS: The mean time for bronehofiberscopy procedure was 14.5mim and SaO2 maximally fall to 89.0 below 8% of the baseline after mean time of 8.4mm, which was recorvered at the end of the procedure. SaO2 change amount was 8.4% on Non-O2 supply group, which was lower compared to 6.4% of the O2-supply group without statistically significance. Biopsy Group and BAL group showed more SaO2 fall than washing only group. The level of PaO2 and FEV1 of the patient didn's influence significantly on SaO2 fall during the procedure. ABGA taken before and after the bronchofiberscopy showed mild fall of Pa02 and mild rise of PaCO2. Whereas PET showed decrease of FEV1(P<0.05) and increase of RV without changes in airway resistance and pulmonary diffusion capacity. Comparing before and after the bronchofiberscopy, the washing group showed no significant changes on PET, while the biopsy group and the BAL group showed increase of RV & decrease of FEV1 after the bronchofiberscopy. BAL group showed more changing tendency rather than biopsy group although not statistically significant. CONCLUSION: Bronchofiberscopy is considered as a relatively safe procedure, but it would be better to be done with O2 supply especially in the patient with low PaO2 and in the case of biopsy and BAL

Aortic Saddle Embolism Caused by Mitral Valve Vegetation

Aortic saddle embolus accounts for approximately 10% of all peripheral arterial emboli. The most common sources of emboli are left atrial thrombi associated with atrial fibrillation and vegetation. A 22-year-old male patient was admitted due to acute onset of orthopnea, tachypea and cough. Transthoracic and transeophageal echocardiography showed huge vegetation (3X2cm) of the posterior mitral valve leaflet which was associated with severe mitral regurgitation. On 14th hospital day, he suffered from sudden onset of weakness, pain, and coldness on both lower extremities. Follow-up echocardiography showed marked size reduction of the original mitral valve vegetation. Angiography showed aortic saddle embolus. The embolectomy of aortic saddle embolus was performed through the transfemoral approach with a Forgarty catheter. At the same time, removal of the infected mitral valve and mitral valve replacement were performed.

Changes in Plasma and Urine Endothelin Levels During Acute Exacerbation of Asthma / 결핵

BACKGROUND: Recent studies have documented increased release of endothelin(ET) during acute attack of asthma. The purpose of this study is to observe the link between plasma level and urinary excretion of each and changes during acute exacerbation. METHOD: Plasma and 24 hour urine were collected from sixteen asthmatics during acute exacerbation, twice ; first day of symptomatic exacerbation and two weeks after treatment. Controls were ten healthy normal subjects. All patients were treated with corticosteroid and beta-2 adrenergic agonist on admission. ET was determined by radioimmmunoassay and had 100% cross reactivity with ET-1, 67% with ET-2, 84% with ET-3, and 8% with Big-ET. RESULTS: Plasma ETs were significantly elevated during acute attack of asthma compared with those in remission and controls. However, there was no significant changes in urine ET concentrations or total ET amounts in 24 hour urine during exacerbation upto two weeks. Those levels of urine ET in asthmatics were still higher than controls. ET concentrations in plasma or urine were not correlated with pulmonary functional parameters and hypoxemia. CONCLUSION: The findings suggests that increased plasma ETs are related with exaggerated release during acute asthma. Urinary ET excretion is increased in asthma. However, urine ET changes during exacerbation should be observed in a larger and longer scale.

A Case of Simple Unilateral Renal Ectopia / 대한비뇨기과학회지

A case of right simple unilateral renal ectopia with left malrotated kidney in 26 years old female is presented with a brief review of literature. Right ectopic kidney was located between 4th and 5th lumber vertebra Numerous aberrant vessels of ectopic kidney disclosed during nephroureterectomy.