Medical Staff of Swedish Methodist Hospital

no abstract available

Surgical Treatment of Pyogenic Spondylitis with the Use of Freeze-Dried Structural Allograft

OBJECTIVE: Radical debridement and reconstruction is necessary for surgical treatment of pyogenic spondylitis to control infection and to provide segmental stability. The authors identified 25 patients who underwent surgery for pyogenic spondylitis using freeze-dried structural allograft for reconstruction. This study aimed to evaluate and demonstrate the effectiveness and safety of a freeze-dried structural allograft during the surgical treatment of pyogenic spondylitis. METHODS: From January 2011 to May 2013, we retrospectively reviewed 25 surgically treated patients of pyogenic spondylitis. Surgical techniques used were anterior radical debridement and reconstruction with a freeze-dried structural allograft and instrumentation. In these 25 patients, we retrospectively examined whether the symptoms had improved and the infection was controlled after surgery by evaluating laboratory data, clinical and radiological outcomes. The average follow-up period was 15.7 months (range, 12.2-37.5 months). RESULTS: The infection resolved in all of the patients and there were no cases of recurrent infection. The mean Visual Analog Scale score was 6.92 (range, 5-10) before surgery and 1.90 (range, 0-5) at the time of the last follow-up. Preoperatively, lower extremity motor deficits related to spinal infection were noted in 10 patients, and they improved in 7 patients after surgery. Follow-up computed tomographic scans were obtained from 10 patients, and osseous union between the vertebral body and the structural allograft was achieved in 2 patients. CONCLUSION: The freeze-dried structural allograft can be a safe and effective alternative for surgical treatment of pyogenic spondylitis, and another option for vertebral reconstruction instead of using the other materials.

Tophaceous Gout of the Spine Causing Neural Compression

Gout is a common metabolic disease in which monosodium urate crystals called tophi develop. Spinal involvement in gout resulting in neural compression is unusual. We describe a case of a 64-year-old man with a history of gouty arthritis of the knee. The patient presented with thoracic myelopathy and radiculopathy. Imaging of the spine revealed an extradural mass lesion with bony erosion of the thoracic spine. A decompressive operation was performed, and a chalky white material was found. Histopathological examination confirmed a gouty tophus. The symptoms of spinal gout vary and its radiological features are not sufficiently specific to provide a definite diagnosis. Therefore, in patients with a history of gouty arthritis who present with neural compressive symptoms of the spine, spinal gout should be strongly suspected.

A Study of the Progression from Acute Subdural Hematoma to Chronic Stage Requiring Surgical Treatment / 대한신경손상학회지

OBJECTIVE: The conscious patients with a small amount of acute subdural hematoma had no neurological deterioration are managed conservatively. Most of them are resolved spontaneously in several weeks without surgery. In our experience, however, some progressed to chronic stage requiring surgical treatment in a few days, unlike chronic subdural hematoma derived from acute hematoma following several weeks or months after head trauma. We aimed to analyse this phenomenon and associated the risk factor comparing with the chronic subdural hematomas. METHODS: Retrospective analysis of 175 alert patients with unilateral acute subdural hematoma identified among 661 patients diagnosed the acute subdural hematoma from October 2009 to September 2012 was performed. Univariate and multivariate analyses were performed to describe the relationships between progression to chronic stage requiring surgery from small amount of acute subdural hematoma and clinical characteristics and radiologic features. RESULTS: Eighteen patients (10.3%) showed neurological deterioration due to progression to chronic stage of acute subdural hematoma and underwent a surgical treatment. The mean time interval between the head trauma and development of neurological symptoms was 12.7 days. Univariate and multivariate analyses found that depth of hematoma and degree of brain swelling were a risk factor for progression to chronic stage requiring surgery from the acute subdural hematoma. CONCLUSION: In spite of the conscious patients with acute subdural hematoma not requiring surgical decompression, the more amount of hematoma and the severer brain swelling, there is higher probability of neurological deterioration caused by the progression to chronic stage in a few days.

A comparative study of emergence agitation between sevoflurane and propofol anesthesia in adults after closed reduction of nasal bone fracture / 대한마취과학회지

BACKGROUND: Emergence agitation is associated with increased morbidity and hospital costs. However, there have been few reports in the medical literature on the occurrence of emergence agitation in adults. The aim of this study was to compare emergence agitation between sevoflurane and propofol anesthesia in adults after closed reduction of nasal bone fracture. METHODS: Forty adults (ASA I-II, 20-60 yr) undergoing closed reduction of nasal bone fracture were randomly assigned to either sevoflurane or propofol group and anesthesia was maintained with sevoflurane or propofol. The bispectral index (BIS) was monitored and maintained within 40-60. At the end of surgery, patients were transported to the post anesthetic care unit (PACU) and agitation state scale was checked by Aono's four-point scale (AFPS). Emergence agitation was defined as and AFPS score of 3 or 4. Pain score were measured by numeric rating scale (NRS) on arrival and peak value at PACU. RESULTS: Nine (45.0%) patients in the sevoflurane group and 2 (10.0%) patients in the propofol group developed emergence agitation in the PACU (P = 0.031). There was no correlation between peak NRS and Aono's four-point scale. CONCLUSIONS: Propofol may decrease incidence of emergence agitation compared to sevoflurane in adults undergoing closed reduction of nasal bone fracture.

A comparison of the recovery characteristics of propofol-remifentanil and desflurane-remifentanil anesthesia under bispectral index (BIS) monitoring following laparoscopic cholecystectomy

BACKGROUND: The aim of this prospective, double-blind randomized study was to compare the recovery characteristics of desflurane-remifentanil and propofol-remifentanil anesthesia in patients undergoing a laparoscopic cholecystectomy under BIS monitoring. METHODS: Eight patients (ASA I-II, 20-65 yr) undergoing laparoscopic cholecystectomy were randomly assigned to receive propofol-remifentanil anaesthesia or desflurane-remifentanil. The BIS was monitored and maintained between 45-55. At the end of surgery all anesthetics were discontinued. Time to eye opening and time to extubation was recorded. Subsequently, the patients were transported to the post-anesthetic care unit (PACU) and the modified aldrete score, visual analogue scale (VAS), blood pressure, heart rate, and postoperative nausea and vomiting (PONV) were recorded upon arrival at the PACU, as well as at 15 min, 30 min, 1 hr, 2 hr, and 24 hr. RESULTS: There were no significant differences in the incidence of PONV between the two groups. Modified aldrete scores were significantly higher in the propofol group at 15 min postoperative period (P = 0.013, Propofol = 9.87, Desflurane = 9.62). Further, VAS scores were significantly higher in the desflurane group at 30 min (P = 0.037, Propofol = 4.26, Desflurane = 5.0), and the number of antiemetic injections were significantly higher in the desflurane group at arrival to the PACU (P = 0.035, Propofol = 0, Desflurane = 0.11 +/- 0.052) and at 24 hr (P = 0.03, Propofol = 0.41 +/- 0.562, Desfluarane = 0.62 +/- 0.157). CONCLUSIONS: In patients undergoing laparoscopic cholecystectomy with BIS monitoring, there is no significant differences in the incidence of PONV. The use of propofol is associated with less postoperative pain.

Evaluation of a New Diagnostic Test for Invasive Fungal Infections Using Prophenoloxydase System to Measure (1->3)-beta-D-glucan Concentration

BACKGROUND: Prognosis of invasive fungal infection is supposed to be better when diagnosed earlier. (1->3)-beta-D-glucan (BDG) test is considered useful in early diagnosis of invasive fungal infections among high-risk patients. A new diagnostic test using prophenoloxydase system to measure BDG level is developed. A study was performed to evaluate clinical usefulness of this new diagnostic test. MATERIALS AND METHODS: 15 patients of confirmed invasive fungal infections and 38 healthy normal volunteers were enrolled. Plasma or serum BDG concentrations were measured using prophenoloxydase system. Assays for intra-run variability and inter-run variability were performed. A cut-off value was determined and sensitivity and specificity of the test were evaluated. RESULTS: A cut-off value of 94.90 pg/mL was determined. Sensitivity and specificity of the test were 86.7% and 52.6%, respectively. Statistical analyses of inter-run variability and intra-run variability revealed the test is reliable (P< or =0.001). CONCLUSION: BDG test using prophenoloxydase system is a sensitive and reliable test in non-invasive detection of invasive fungal infection.

Evaluation of a New Diagnostic Test for Invasive Fungal Infections Using Prophenoloxydase System to Measure (1->3)-beta-D-glucan Concentration

BACKGROUND: Prognosis of invasive fungal infection is supposed to be better when diagnosed earlier. (1->3)-beta-D-glucan (BDG) test is considered useful in early diagnosis of invasive fungal infections among high-risk patients. A new diagnostic test using prophenoloxydase system to measure BDG level is developed. A study was performed to evaluate clinical usefulness of this new diagnostic test. MATERIALS AND METHODS: 15 patients of confirmed invasive fungal infections and 38 healthy normal volunteers were enrolled. Plasma or serum BDG concentrations were measured using prophenoloxydase system. Assays for intra-run variability and inter-run variability were performed. A cut-off value was determined and sensitivity and specificity of the test were evaluated. RESULTS: A cut-off value of 94.90 pg/mL was determined. Sensitivity and specificity of the test were 86.7% and 52.6%, respectively. Statistical analyses of inter-run variability and intra-run variability revealed the test is reliable (P< or =0.001). CONCLUSION: BDG test using prophenoloxydase system is a sensitive and reliable test in non-invasive detection of invasive fungal infection.