L1 Slope as an Indicator of Thoracolumbar Sagittal Balance in Osteoporotic Vertebral Fractures

Objectives@#To evaluate the association between L1 slope and thoracolumbar spinal parameters of sagittal balance in cases of osteoporotic vertebral fracture.Summary of Literature Review: Recently, interest has emerged in the sagittal parameters of the thoracolumbar spine in cases of osteoporotic vertebral fracture. @*Materials and Methods@#Eighty-five patients were enrolled in this study, including 36 patients with recent osteoporotic vertebral fractures (group 1) and 49 patients who did not have vertebral fractures (group 2). Radiographic parameters including L1 slope, C7 plumb line (C7 PL), sagittal imbalance (C7 PL >50 mm), lumbar lordosis, thoracic kyphosis, pelvic tilt, S1 slope, local kyphotic angle were evaluated on standing lateral radiographs of the whole spine. We analyzed correlations between L1 slope and these parameters. @*Results@#Of the sagittal parameters of the spine, the mean L1 slope, C7 PL, thoracic kyphosis, lumbar lordosis, S1 slope, pelvic tilt, and local kyphotic angle were 10.43°, 92.43 mm, 29.30°, 30.31°, 25.27°, 27.27°, 9.90° in group 1 and 9.41°, 68.50 mm, 20.09°, 23.25°, 22.03°, 31.43°, 8.21° in group 2, respectively. There were significant differences in thoracic kyphosis (p=0.01) and lumbar lordosis (p=0.04) between the two groups. L1 slope was positively correlated with thoracic kyphosis (r=0.46, p=0.01), lumbar lordosis (r=0.51, p=0.01), and local kyphotic angle (r=0.29, p=0.04) in group 1. @*Conclusions@#These results suggest that L1 slope is a central indicator for the evaluation of thoracolumbar sagittal balance in osteoporotic vertebral fractures.

L1 Slope as an Indicator of Thoracolumbar Sagittal Balance in Osteoporotic Vertebral Fractures

Objectives@#To evaluate the association between L1 slope and thoracolumbar spinal parameters of sagittal balance in cases of osteoporotic vertebral fracture.Summary of Literature Review: Recently, interest has emerged in the sagittal parameters of the thoracolumbar spine in cases of osteoporotic vertebral fracture. @*Materials and Methods@#Eighty-five patients were enrolled in this study, including 36 patients with recent osteoporotic vertebral fractures (group 1) and 49 patients who did not have vertebral fractures (group 2). Radiographic parameters including L1 slope, C7 plumb line (C7 PL), sagittal imbalance (C7 PL >50 mm), lumbar lordosis, thoracic kyphosis, pelvic tilt, S1 slope, local kyphotic angle were evaluated on standing lateral radiographs of the whole spine. We analyzed correlations between L1 slope and these parameters. @*Results@#Of the sagittal parameters of the spine, the mean L1 slope, C7 PL, thoracic kyphosis, lumbar lordosis, S1 slope, pelvic tilt, and local kyphotic angle were 10.43°, 92.43 mm, 29.30°, 30.31°, 25.27°, 27.27°, 9.90° in group 1 and 9.41°, 68.50 mm, 20.09°, 23.25°, 22.03°, 31.43°, 8.21° in group 2, respectively. There were significant differences in thoracic kyphosis (p=0.01) and lumbar lordosis (p=0.04) between the two groups. L1 slope was positively correlated with thoracic kyphosis (r=0.46, p=0.01), lumbar lordosis (r=0.51, p=0.01), and local kyphotic angle (r=0.29, p=0.04) in group 1. @*Conclusions@#These results suggest that L1 slope is a central indicator for the evaluation of thoracolumbar sagittal balance in osteoporotic vertebral fractures.

How Effective Are Radiation Reducing Gloves in C-arm Fluoroscopy-guided Pain Interventions?

BACKGROUND: The physician's hands are close to the X-ray field in C-arm fluoroscopy-guided pain interventions. We prospectively investigated the radiation attenuation of Proguard RR-2 gloves. METHODS: In 100 cases, the effective doses (EDs) of two dosimeters without a radiation-reducing glove were collected. EDs from the two dosimeters-one dosimeter wrapped with a glove and the other dosimeter without a glove- were also measured at the side of the table (Group 1, 140 cases) and at a location 20 cm away from the side of the table (Group 2, 120 cases). Mean differences such as age, height, weight, radiation absorbed dose (RAD), exposure time, ED, and ratio of EDs were analyzed. RESULTS: In the EDs of two dosimeters without gloves, there were no significant differences (39.0 +/- 36.3 microSv vs. 38.8 +/- 36.4 microSv) (P = 0.578). The RAD (192.0 +/- 182.0 radcm2) in Group 2 was higher than that (132.3 +/- 103.5 radcm2) in Group 1 (P = 0.002). The ED (33.3 +/- 30.9 microSv) of the dosimeter without a glove in Group 1 was higher than that (12.3 +/- 8.8 microSv) in Group 2 (P < 0.001). The ED (24.4 +/- 22.4 microSv) of the dosimeter wrapped with a glove in Group 1 was higher than that (9.2 +/- 6.8 microSv) in Group 2 (P < 0.001). No significant differences were noted in the ratio of EDs (73.5 +/- 6.7% vs. 74.2 +/- 9.3%, P = 0.469) between Group 1 and Group 2. CONCLUSIONS: Proguard RR-2 gloves have a radiation attenuation effect of 25.8-26.5%. The radiation attenuation is not significantly different by intensity of scatter radiation or the different RADs of C-arm fluoroscopy.

The Radiation Exposure of Radiographer Related to the Location in C-arm Fluoroscopy-guided Pain Interventions

BACKGROUND: Although a physician may be the nearest to the radiation source during C-arm fluoroscope-guided interventions, the radiographer is also near the fluoroscope. We prospectively investigated the radiation exposure of radiographers relative to their location. METHODS: The effective dose (ED) was measured with a digital dosimeter on the radiographers' left chest and the side of the table. We observed the location of the radiographers in each procedure related to the mobile support structure of the fluoroscope (Groups A, M and P). Data about age, height, weight, sex, exposure time, radiation absorbed dose (RAD), and the ED at the radiographer's chest and the side of the table was collected. RESULTS: There were 51 cases for Group A, 116 cases for Group M and 144 cases for Group P. No significant differences were noted in the demographic data such as age, height, weight, and male to female ratio, and exposure time, RAD and ED at the side of the table. Group P had the lowest ED (0.5 +/- 0.8 microSv) of all the groups (Group A, 1.6 +/- 2.3 microSv; Group M, 1.3 +/- 1.9 microSv; P < 0.001). The ED ratio (ED on the radiographer's chest/ED at the side of the table) of Group A was the highest, and the ED radio of Group P was the lowest of all the groups (Group A, 12.2 +/- 21.5%; Group M, 5.7 +/- 6.5%; Group P, 2.5 +/- 6.7%; P < 0.001). CONCLUSIONS: Radiographers can easily reduce their radiation exposure by changing their position. Two steps behind the mobile support structure can effectively decrease the exposure of radiographers by about 80%.

Spectral entropy for assessing the depth of propofol sedation / 대한마취과학회지

BACKGROUND: For patients in the intensive care unit (ICU) or under monitored anesthetic care (MAC), the precise monitoring of sedation depth facilitates the optimization of dosage and prevents adverse complications from underor over-sedation. For this purpose, conventional subjective sedation scales, such as the Observer's Assessment of Alertness/Sedation (OAA/S) or the Ramsay scale, have been widely utilized. Current procedures frequently disturb the patient's comfort and compromise the already well-established sedation. Therefore, reliable objective sedation scales that do not cause disturbances would be beneficial. We aimed to determine whether spectral entropy can be used as a sedation monitor as well as determine its ability to discriminate all levels of propofol-induced sedation during gradual increments of propofol dosage. METHODS: In 25 healthy volunteers undergoing general anesthesia, the values of response entropy (RE) and state entropy (SE) corresponding to each OAA/S (5 to 1) were determined. The scores were then analyzed during each 0.5 mcg/ml- incremental increase of a propofol dose. RESULTS: We observed a reduction of both RE and SE values that correlated with the OAA/S (correlation coefficient of 0.819 in RE-OAA/S and 0.753 in SE-OAA/S). The RE and SE values corresponding to awake (OAA/S score 5), light sedation (OAA/S 3-4) and deep sedation (OAA/S 1-2) displayed differences (P < 0.05). CONCLUSIONS: The results indicate that spectral entropy can be utilized as a reliable objective monitor to determine the depth of propofol-induced sedation.

A case of life-threatening post-operative diffuse alveolar hemorrhage in patient with recent chemotherapy: A case report / 대한마취과학회지

A 53-year-old woman who had undergone total gastrectomy and received adjuvant chemotherapy two months ago underwent adhesiolysis of the small bowel. She presented with sudden desaturation and dyspnea of unknown etiology at postanesthetic care unit. Following ET intubation, the endotracheal tube suction revealed massive hemoptysis. Bilateral lung infiltrated on her chest radiograph and bronchofibroscopic examination disclosed a diffuse hemorrhage on both lung fields without bleeding focus. These findings were consistent with diffuse alveolar hemorrhage (DAH) syndrome. As per our knowledge and search, this is the first reported case of DAH that occurred during the recovery period immediately after general anesthesia. DAH is known to have a high mortality rate and an early detection followed by adequate treatment is essential.