Analysis of Factors Affecting Thoracic Epidural Anesthesia Performance Time / 계명의대학술지

Thoracic epidural anesthesia (TEA) is an efficient procedure for managing intraoperative and postoperative pain caused by liver resection, gastrectomy, or lung surgery. Precise difficulty prediction of TEA has the advantage of reducing the risk of complications. The purpose of this study was to identify factor correlated with TEA performance time under fluoroscopic guidance. From September 2017 to May 2018, 39 patients who were scheduled to receive TEA under fluoroscopic guidance for postoperative pain control were enrolled for this study. All thoracic epidural catheterization was performed by one physician who had more than 5 years of experience in spine intervention. TEA was performed one day before the elective surgery in the outpatient pain clinic. Body mass index (BMI) was found to be a factor associated with TEA procedure time. Correlation coefficients of procedure time with age, height, weight and BMI were 0.099, -0.129, 0.346, and 0.575, respectively. BMI needs to be considered as one factor that affects the difficulty of TEA.

Direct Repair of the Defect in Spondylolysis / 대한척추외과학회지

STUDY DESIGN: This is a retrospective study analysing the results of Buck's operation for spondylolysis. PURPOSE: To analyze the results of Buck`s methods as a treatment for symptomatic spondylolysis clinically and radiographically. MATERIALS AND METHODS: Between March 1992 and March 1999, 12 patients with symptomatic spondylolysis were treated with Buck`s method. Surgical indication was 1)under 30 years of age, 2) patients with intractable low back pain without sciatica who did not response to conservative treatment for over 6 months, 3) without disc degeneration in lumbar MRI, 4) without instability in lateral flexion-extension view. The average age was 23 years and the follow-up periods ranged from 12 months to 54 months, mean 25 months. We confirmed union of defect and loosening or breakage of screws in preoperative, postoperative and the final radiographs, and in bone SPECT. And we analyzed symptomatic improvement by subjective assessment guidelines of Henderson clinically. RESULTS: Radiologically, union of defect by trabeculation was seen in 8 patients, in 2 patients unilaterally. In bone SPECT, union of defect was seen in 5 cases among 7 cases postoperatively. Average periods of union were 3.1 months(2.5-6.2 months). There was no loosening of screws, but in 1 patient breakage of screws and nonunion was seen 8 months postoperatively. Clinically, 10 patients(83.3%) were rated as excellent or good-5 patients excellent, 5 patients good-according to subjective assessment guidelines of Henderson. CONCLUSION: It is suggested that Buck's operation, one of the method of treatment of spondylolysis is simple and has low complication rate. We concluded that it is satisfactory to use Buck's operation in young patients with symptomatic spondylolysis.

Thyroid hormone-induced alterations of Ca2+-ATPase and phospholamban protein expression in cardiac sarcoplasmic reticulum

Alterations of cardiovascular function associated with various thyroid states have been studied. In hyperthyroidism left ventricular contractility and relaxation velocity were increased, whereas these parameters were decreased in hypothyroidism. The mechanisms for these changes have been suggested to include alterations in the expression and/or activity levels of various proteins; alpha-myosin heavy chain, beta-myosin heavy chain, beta-receptors, the guanine nucleotide-binding regulatory protein, and the sarcolemmal Ca2+-ATPase. All these cellular alterations may be associated with changes in the intracellular Ca2+ concentration. The most important regulator of intracellular Ca2+ concentration is the sarcoplasmic reticulum (SR), which serves as a Ca2+ sink during relaxation and as a Ca2+ source during contraction. The Ca2+-ATPase and phospholamban are the most important proteins in the SR membrane for muscle relaxation. The dephosphorylated phospholamban inhibits the SR Ca2+-ATPase through a direct interaction, and phosphorylation of phospholamban relieves the inhibition. In the present study, quantitative changes of Ca2+-ATPase and phospholamban expression and the functional consequences of these changes in various thyroid states were investigated. The effects of thyroid hormones on (1) SR Ca2+ uptake, (2) phosphorylation levels of phospholamban, (3) SR Ca2+-ATPase and phospholamban protein levels, (4) phospholamban mRNA levels were examined. Our findings indicate that hyperthyroidism is associated with increases in Ca2+-ATPase and decreases in phospholamban levels whereas opposite changes in these proteins occur in hypothyroidism.