Vólvulo gástrico agudo: cuadro clínico infrecuente / Acute gastric volvulus: an uncommon presentation

RESUMEN El vólvulo gástrico agudo (VGA) es una entidad infrecuente, con elevada mortalidad de hasta 50%, y su diagnóstico se basa en un alto nivel de sospecha clínica. En el paciente estable se puede plantear manejo no operatorio, pero en el inestable se impone el tratamiento quirúrgico. Presentamos el caso de un paciente con VGA e inestabilidad hemodinámica, en el cual se realizó laparotomía y devolvulación gástrica, pero falleció en el posoperatorio inmediato por shock refractario.

ABSTRACT Acute gastric volvulus (AGV) is an uncommon condition with high mortality (up to 50%) and its diagnosis is based on high level of suspicion. Conservative management can be attempted in stable patients, but the surgical approach is indicated in unstable cases. We report the case of a patient with AGV and hemodynamic instability who underwent laparotomy with reduction of the volvulus but who died in the immediate postoperative period due to refractory shock.

Intestinal derotation maneuver for resection of intestinal neoplasm near the ligament of Treitz / 中华普通外科杂志

Objective To study the the feasibility of intestinal derotation maneuver in the resection of gastrointestinal neoplam localized in the vicinity of the ligament of Treitz.Method Intestinal derotation maneuver was applied in all the 9 case of gastrointestinal neoplasms near the ligament of Treitz,from January 2014 to January 2016,at the Second Hospital of Jilin University.The clinical date were retrospectively analyzed.Results Intestinal derotation maneuver were applied without failure in all the nine patients,the mean operation time were (195 ± 50) min,and the mean intestinal derotation maneuver time were (19 ±5) min;No derotation procedure-related injury occured,and the mean estimated blood loss were (132 ±94) ml.Early postoperative ileus developed in one case and gastroparesis in two cases.All were recovered by conservative treatment.The follow-up period were 3-24 month,tumor recurrence occurred in two cases and one case died.One case lossed to follow-up after postoperative 3 month.Conclusion The present data suggest that clinical use of intestinal derotation maneuver was feasible for surgical management of gastrointestinal neoplasms near the ligament of Treitz.

Maxillary molar derotation and distalization by using a nickel-titanium wire fabricated on a setup model / 대한치과교정학회지

The purpose of this article is to introduce a simple appliance that uses a setup model and a nickel-titanium (Ni-Ti) wire for correcting the mesial rotation and drift of the permanent maxillary first molar. The technique involves bonding a Ni-Ti wire to the proper position of the target tooth on a setup model, followed by the fabrication of the transfer cap for indirect bonding and its transfer to the patient's teeth. This appliance causes less discomfort and provides better oral hygiene for the patients than do conventional appliances such as the bracket, pendulum, and distal jet. The treatment time is also shorter with the new appliance than with full-fixed appliances. Moreover, the applicability of the new appliance can be expanded to many cases by using screws or splinting with adjacent teeth to improve anchorage.

Usefulness of Simple Rod Rotation to Correct Curve of Adolescent Idiopathic Scoliosis

OBJECTIVE: To correct apical vertebral rotation for adolescent idiopathic scoliosis (AIS), direct vertebral derotation (DVD) or simple rod rotation (SRR) might be considered. The aim of the present study is to introduce the surgical experiences of AIS by a Korean neurosurgeon and to evaluate the effectiveness of SRR for apical vertebral rotation. METHODS: A total of 9 patients (1 male and 8 females) underwent scoliosis surgery by a neurosurgeon of our hospital. The Lenke classifications of the patients were 1 of 1B, 2 of 1C, 1 of 2A, 1 of 2C, 3 of 5C and 1 of 6C. Surgery was done by manner of simple rod rotation on the concave side and in situ coronal bending. Coronal Cobb's angles, vertebral rotation angles and SRS-22 were measured on a plain standing X-ray and CT before and after surgery. RESULTS: The mean follow up period was 25.7 months (range : 5-52). The mean number of screw positioning level was nine (6-12). The mean age was 16.4 years (range : 13-25) at surgery. The mean Risser grade was 3.7+/-0.9. The apical vertebral rotation measured from the CT scans was 25.8+/-8.5degrees vs. 9.3+/-6.7degrees (p<0.001) and the Coronal Cobb's angle was 53.7+/-10.4degrees vs. 15.4+/-6.5degrees (p<0.001) preoperatively and postoperative, respectively. The SRS-22 improved from 71.9 preoperatively to 90.3 postoperatively. There were no complications related with the operations. CONCLUSION: SRR with pedicle screw instrumentation could be corrected successfully by axial rotation without complications. SRR might serve as a good option to correct AIS deformed curves of AIS.

Comparison of Apical Axial Derotation between Adolescent Idiopathic and Neuromuscular Scoliosis with Pedicle Screw Instrumentation

STUDY DESIGN: A retrospective study. PURPOSE: To compare outcomes of apical derotation with pedicle screws in idiopathic and neuromuscular scoliosis (NMS). OVERVIEW OF LITERATURE: No information about apical derotation in NMS with pedicle screws is available. METHODS: We performed deformity correcting surgery using pedicle screw constructs on 12 adolescent idiopathic scoliosis (AIS) patients (mean age 14.1 years) and 16 NMS patients (mean age 16.5 years). Preoperative, postoperative, and final follow-up radiographs were analyzed for Cobb's angle and pelvic obliquity, while apical rotation was measured on CT scans using the Aaro-Dahlborn method. RESULTS: For AIS, the mean preoperative Cobb's angle, pelvic obliquity, and apical rotation values were 57.3degrees, 2.8degrees, and 20.4degrees, respectively, and postoperatively they were 16.8degrees, 1.1degrees and 14.7degrees, respectively, showing significant correction. For NMS, the mean preoperative Cobb's angle, pelvic obliquity, and apical rotation values were 75.6degrees, 13.7degrees, and 42.9degrees, respectively, and postoperatively they were 27.1degrees, 5.8degrees, and 34.1degrees, respectively, also showing significant correction. There were no significant differences between AIS and NMS patients Cobb's angle p=0.306, pelvic obliquity p=0.887 and apical derotation p=0.113degrees. There were no differences in curve severity in the three groups (AIS, NMS >80degreesand NMS 80 NMS group (p=0.04). CONCLUSIONS: Apical axial derotation can be achieved with posterior only pedicle screw fixation in NMS without anterior release, with comparable results in idiopathic scoliosis.

Axial Plane Lumbar Responses after Anterior Selective Thoracic Fusion for Main Thoracic Adolescent Idiopathic Scoliosis

STUDY DESIGN: A retrospective radiographic study. PURPOSE: To evaluate the axial plane lumbar responses after anterior selective thoracic fusion (STF) in patients with main thoracic adolescent idiopathic scoliosis (MT-AIS). OVERVIEW OF LITERATURE: Anterior scoliosis surgery induces more MT derotation through disc preparation than posterior surgery. METHODS: Twenty-eight MT-AIS patients treated with STF were evaluated after a minimum follow-up (FU) of 2 years. The MT and lumbar coronal angles, as well as the MT and lumbar rotational angles at the most rotated vertebrae were measured. RESULTS: At the last FU, the MT coronal correction and derotation rates were 65% and 41%, respectively. The lumbar coronal correction rate was 61% but there was minimal lumbar derotation (2%). Nine cases were decompensated (coronal balance >10 mm). After surgery, the compensated and decompensated groups showed similar MT coronal and axial correction rates. During the FU, the MT and lumbar apecies rotated in the same direction (r=0.443). In addition, significant MT derotation occurred in the decompensated group with increasing lumbar rotational correction loss. At the last FU, while the MT coronal correction was similar between the two groups, there was more MT derotation in the decompensated group. Furthermore, the MT rotational change was strongly associated with the coronal C7 plumb line position (r=0.728). CONCLUSIONS: After anterior STF in patients with MT-AIS, the final MT derotation is strongly associated with the coronal C7 plumb line position. During the FU, the excessive MT derotation in the decompensated group was attributed to excessive lumbar rotational correction loss.

Correction of Double Thoracic Adolescent Idiopathic Scoliosis Using PedicleScrew Instrumentation: Comparison with Translation and Rod Derotation / 대한정형외과학회잡지

PURPOSE: To compare the results of two different surgical methods (translation vs rod derotation) in a correction of double thoracic adolescent idiopathic scoliosis (AIS) using pedicle screw instrumentation. MATERIALS AND METHODS: Forty-seven patients with double thoracic AIS treated by pedicle screw instrumentation were reviewed retrospectively after a minimum follow-up of 2 years. The patients were divided into two groups; TR group (translation method, n=14) and RD group (rod derotation, n=33). There were no significant differences in the preoperative curve characteristics between the two groups. RESULTS: In the TR group, the preoperative upper thoracic curve of 37+/-4 degrees improved to 24+/-4 degrees (35% correction), and the lower thoracic curve of 52+/-9 degrees improved to 18+/-5 degrees (65% correction). In the RD group, the preoperative upper thoracic curve of 40+/-7 degrees improved to 19+/-7 degrees (51% correction), and the lower thoracic curve of 56+/-12 degrees was improved to 16+/-6 degrees (72% correction). The correction of the upper and lower thoracic curves was significantly better in the RD group (p<0.05). Thoracic sagittal kyphosis was corrected from 21 degrees to 24 degrees in the TR group and from 18 degrees to 26 degrees in the RD group. There was no significant difference in the spinal balance, shoulder height difference, T1 tilt and fusion extent. The operating time and the amount of blood loss was 231 minutes and 2050ml in the TR group and 263 minutes and 3217ml in the RD group, respectively (p<0.05). CONCLUSION: In correcting double thoracic AIS using pedicle screw instrumentation, the rod derotation method showed better correction for the upper and lower thoracic curves. The translation method showed the advantages of easier application, a shorter operation time and less blood loss.

Spatial changes of the maxillary molar following unilateral derotation with the precision TPA / 대한치과교정학회지

The purpose of this study was to evaluate the spatial changes of mesial-in rotated maxillary molar and opposite anchor tooth during derotation by the precision transpalatal arch (TPA) with the use of a new typodont simulation system, the Calorific machine system, which was designed to observe the whole process of tooth movement. The maxillary right first molar was used for the anchor tooth and the maxillary left first molar was used for the mesial-in rotated tooth, and the angle of rotation was increased to 20, 40, and 60. A passive precision TPA was fabricated and then activated by bending the left arm to 20, 40, and 60. Each experiment was repeated five times under the same conditions and analyzed by ANOVA and Tucky's Studentized Range (HSD) test. In the occlusal plane, when the bending angle of precision TPA was increased, the mesiobuccal cusp of the rotated molar moved more buccally (p<0.001) and less distally (p<0.001) while the distolingual cusp moved in the mesiopalatal direction. In the sagittal plane, the palatal roots of the derotated molar moved mesially (p<0.001). In the traverse plane, the derotated molar showed slight extrusion (p<0.001). The upper right first molar, which was used as an anchor tooth, showed clinically insignificant movement across all three planes.

The Explanation of Postoperative Change of Vertebral Rotation and Rib Hump Using 3 Dimensional Finite Element Scoliosis Model / 대한척추외과학회지

STUDY DESIGN: An analytical study using a mathematical 3-D finite element model for thoracic scoliosis. OBJECTIVE: To find the important kinematics and post-operative changes of the spine and rib cage, in the corrective surgery for scoliosis, using the rod derotation method. SUMMARY OF LITERATURE REVIEW: A conventional corrective surgery for scoliosis was performed, based on empirical knowledge, and an increase in the secondary postoperative change in the rib hump, and a shoulder level imbalance, were reported. However, no analytical data exists for the kinematics and optimal correction method. MATERIALS AND METHODS: A mathematical finite element model of a normal spine, including the rib cage, sternum, both clavicles and pelvis, was developed. Using geometric mapping, with standing radiographs and CT images, a 3-D FEM of scoliosis was reconstructed, after translating and rotating the 3-D FEM of a normal spine, with the amounts analyzed from 12 built-in digitized coordinate axes for each vertebral image. With this model, three elements; distraction, translation and derotation, in operative kinematics, were investigated by analyzing the Cobb angle, apical vertebrae axial rotation (AVAR) and thoracic kyphosis. A simulation of a segmental pedicle screw fixation, with rod derotation for scoliosis, was performed. The changes in the Cobb angle, kyphotic angle, AVAR and rib hump were compared after 0 degrees, 15 degrees, 30 degrees, 45 degrees, 60 degrees and 90 degrees rod derotations. RESULTS: In kinematics, the vertebral rod derotation of a major curve, without rod deformation, is less influential in the correction of scoliosis, simply causing an increase in the rib hump. During the simulation, the co-action of distraction and translation, during rod insertion, has a major impact on the decrease in the Cobb angle and in the maintenance of the kyphotic angle. However, after a 30 degrees rod derotation, a decrease in the kyphosis, and increases in the rib hump and AVAR were observed. CONCLUSIONS: The distraction and translation factors were more important in operative kinematics than the rod derotation. With excessive rod derotation, the Cobb angle progressively decreased, but increases in the secondary change in the rib hump and rotation of the apical vertebrae were found.

Comparison of Apical Z-axis Derotation between Rod Derotation(RD) and Vertebrae to Rod(VTR) Methods in Idiopathic Thoracic Scoliosis / 대한척추외과학회지

STUDY DESIGN: A prospective study. OBJECTIVE: To compare the derotational effect of the two methods and to determine the effect of the position of axis of the rotation on derotation of the apical vertebrae. SUMMARY OF BACKGROUND DATA: Vertebral derotation about z-axis following a posterior instrumentation and its relation to the position of the rotational axis is still controversial. Rod derotation(RD) method rotates the vertebrae about the axis of the rod curvature located relatively anterior position whereas the vertebrae to rod(VTR) method, reducing the vertebrae to the contoured rod, rotates the vertebrae about the posteriorly located axis. MATERIALS AND METHODS: Eleven consecutive thoracic idiopathic scoliosis subjected to segmental pedicle screw instrumentation were analysed. Six were treated by RD and five by VTR. Average preoperative curve was 46.6 delta in RD and 51 delta in VTR with flexibility of 69% and 71% respectively (p>0.05). Mean preoperative relative apical vertebral rotation(RAVR) measured by computerized tomography were 11.2 delta in RD and 13.8 delta in VTR(p>0.05). RESULTS: Average postoperative curve magnitudes were 11.5 delta in RD and 12 delta in VTR with correction rates of 77% and 74% respectively (p>0.05). Postoperative relative apical vertebral rotation(RAVR) were 3.6 delta in RD and 6.1delta in VTR with correction rates of 68% and 56% respectively (p>0.05). The mean instrumentation time per vertebral segment instrumented was 4.7 minutes in RD and 8.5 minutes in VTR (p<0.05). Screw pullout during operative procedure in 8/51 screws(15%) in VTR and none(0/60) in RD. CONCLUSION: RD and VTR methods were not significantly different, both enabling a significant apical z-axis derotation and frontal curve correction. However, RD was more efficient than VTR with less operative time and intraoperative screw loosening. The position of the axis of rotation did not significantly influence the apical derotation effect of segmental pedicle screw instrumentation.

Technique of Pedicle Screw Fixation and Derotation for the Improvement of Rotational Deformity in Scoliosis Surgery:Derotation:Screw Rotation / 대한척추외과학회지

STUDY DESIGN: This is a prospective design. SUMMARY AND BACKGROUND DATA: Derotation makes powerful coronal and satisfactory sagittal correction, however, making rotational correction is still controversy. OBJECTIVES: To introduce a new technique to improve the vertebral rotation. METHODS: 1. Fix the pedicle screws of concave side of thoracic spine with nut driver or derotator before derotation maneuver. 2. During the derotation (counter-clockwise), rotate the nut driver/derotator to the opposite direction (clockwise). RESULTS: A King type II AIS girl with the magnitude of right thoracic and left lumbar curve was 54 degrees and 40degress respectively was reviewed. Thoracic apical rotation was checked 32 degrees. When derotation maneuver was done, the Cobbs angle of thoracic verteba was corrected to 14 degrees (74.1%), however the apical angle was aggravated to 34 degrees . When derotation-screw rotation(DSR) was done, thoracic angle was corrected to 3 degrees with 94.4% of curve correction. The apical rotation was improved to 25 degrees. Preoperative 19.6 degrees of RAsac was corrected to 10.4 degrees showing 46.9% of correction. Postooperatively she was balanced inspite of overcorrection. CONCLUSION: Derotation itself did not improve or slightly aggravate the rotation of apical vertebra. Apical rotation was dramatically improved by derotation combined by screw rotation technique. Maximal curve correction was obtained without trunk decompensation. This new technique may replace the advantages of anterior instrumentation in better rotational correction and saving fusion levels.

Femoral Varus Derotation Osteotomy in the Treatment of Acetabular Cysplasia in Deveolpinetal Dysplasia of the Hip / 대한정형외과학회잡지

We have attempted to define the acetabular remodelling after varus derotation osteotomy and limitations of pelvic osteotomy in the treatment of DDH. We studied the case of thirty eight patients (42 hips) who were divided into three groups according to age at operation and into two groups, subluxation with acetabular dyaplasia and complete dislocation. The cases were evaluated the influence of femoral remodeling, age, acetabular response and instability and requirement of other additional surgery. The length of follow up ranged from two to fourteen years. A return to a valgus femoral neck shaft angle by remodeling was observed in case without avascular necrosis of femoral head. Acetabular correction by remodeling occurred in case of well reduced the femoral head in the socket. Acetabular remodeling was observed even in age of 8. Twenty eight of 42 hips which were complete dislocation required no pelvic osteotomy. A varus derotation osteotomy is a necessary procedure for hip stability and open reduction in treatment of DDH. Good results should be anticipated in patient whose femoral head was well seated in the acetablum.

Experience of Lenox Hill Derotation Brace Application in Knee Instability Cases: Lenox Hill Derotation Brace / 대한정형외과학회잡지

Injuries to the ligament and other supporting structures of the knee joint are becoming very frequent because of the increasing popularity of sports and the complexity of traffic & industrial accidents in the modern society. There have been much development in undtrstanding the anatomy, function and biomechanics of the knee in recent years. Accurate surgical technique, energetic physiotherapy and appropriate use of brace are essential to obtain the maximum rehabilitation of the injured knees. It is long realized that some sort of knee brace is necessary as a means of stabilizing the injured knee either as a conservative treatment or as a adjuvant treatment treatment pre-or postoperatively before full rehabilitation is attained. We have introuced Lenox Hill Derotation Brace for the first time in Korea, employed in 24 case(26 knees) and found the following advantages. 1. It is light and easy to apply. 2. It is possible to control all kind of the knee instability. 3. It is possible to engage in any activity with the Brace in place without limitation of the knee motion. therefore, we recommend the Brace as a very usefull adjuvant for the proper treatment of the injured knee.