Anesthetic considerations for a patient with situs inversus totalis undergoing cardiac surgery: A case report

A 58-year-old male patient with situs inversus totalis, a rare congenital malformation characterized by all asymmetric organs being formed as the mirror images of their normal morphologies, underwent mitral valve repair due to mitral valve prolapse. This case was reported to suggest that anesthesiologists should thoroughly understand the anatomy of these types of patients before providing cardiac anesthesia that often requires advanced monitoring and rely on their accurate interpretation. Accordingly, a few key points will be discussed with emphasis on reversing lead placement during electrocardiogram monitoring, using the left internal jugular vein for pulmonary artery catheterization, and firmly comprehending mirror image heart morphology to better conduct transesophageal echocardiography.

Effect of Device Rigidity and Physiological Loading on Spinal Kinematics after Dynamic Stabilization : An In-Vitro Biomechanical Study

OBJECTIVE: To investigate the effects of posterior implant rigidity on spinal kinematics at adjacent levels by utilizing a cadaveric spine model with simulated physiological loading. METHODS: Five human lumbar spinal specimens (L3 to S1) were obtained and checked for abnormalities. The fresh specimens were stripped of muscle tissue, with care taken to preserve the spinal ligaments and facet joints. Pedicle screws were implanted in the L4 and L5 vertebrae of each specimen. Specimens were tested under 0 N and 400 N axial loading. Five different posterior rods of various elastic moduli (intact, rubber, low-density polyethylene, aluminum, and titanium) were tested. Segmental range of motion (ROM), center of rotation (COR) and intervertebral disc pressure were investigated. RESULTS: As the rigidity of the posterior rods increased, both the segmental ROM and disc pressure at L4-5 decreased, while those values increased at adjacent levels. Implant stiffness saturation was evident, as the ROM and disc pressure were only marginally increased beyond an implant stiffness of aluminum. Since the disc pressures of adjacent levels were increased by the axial loading, it was shown that the rigidity of the implants influenced the load sharing between the implant and the spinal column. The segmental CORs at the adjacent disc levels translated anteriorly and inferiorly as rigidity of the device increased. CONCLUSION: These biomechanical findings indicate that the rigidity of the dynamic stabilization implant and physiological loading play significant roles on spinal kinematics at adjacent disc levels, and will aid in further device development.

Application Status and Its Affecting Factors of Double Standard for Multinational Corporations in Korea / 예방의학회지

OBJECTIVE: We intended to evaluate the double standard status and to identify factors of determining double standard criteria in multinational corporations of Korea, and specifically those in the occupational health and safety area. METHODS: A postal questionnaire had been sent, between August 2002 and September 2002, to multinational corporations in Korea. A double standard company was defined as those who answered in more than one item as adopting a different standard among the five items regarding double standard identification. By comparing double standard companies with equivalent standard companies, determinants for double standards were then identified using logistic regression analysis. RESULTS: Of multinational corporations, 45.1% had adopted a double standard. Based on the question naire's scale level, the factor of 'characteristic and size of multinational corporation' was found to have the most potent impact on increasing double standard risk. On the variable level, factors of 'number of affiliated companies' and 'existence of an auditing system with the parent company' showed a strong negative impact on double standard risk. CONCLUSION: : Our study suggests that a distinctive approach is needed to manage the occupational safety and health for multinational corporations. This approach should be focused on the specific level of a corporation, not on a country level.