The Analysis of Polymethylmethacrylate Leakage after Vertebroplasty for Vertebral Body Compression Fractures

OBJECTIVE: To assess causative factors that may induce the leakage of the PMMA after the vertebroplasty performed on osteoporotic compression fracture patients. METHODS: Percutaneous vertebroplasty was done on 80 vertebral compression fractures in 54 patients from June.2001 to Nov.2002. Leakage of PMMA was divided into paravertebral, venous, epidural, and intradiscal leakage. The relationship between leakage of PMMA and various factors were analyzed such as clinical features, bone mineral density, existence of bone sclerosis, interval from injury to operation, amount of PMMA, tip location, operation method, compression pattern, compression ratio etc. RESULTS: Leakage was found in 39 vertebral bodies out of a total of 80 operated vertebral bodies. A large amount of PMMA, which was injected into compressed vertebra, induced a high incidence of leakage(P=0.042). Preoperative high bone mineral density in Compressed Vertebra induced a high incidence of leakage(P=0.014). The existence of sclerosis caused a high incidence of leakage.(P=0.014). Other factors, which were examined, did not induce the leakage of PMMA. CONCLUSION: Percutaneous vertebroplasty must be done carefully after a detailed examination of factors that might cause leakage of PMMA.

Primary Small Cell Carcinoma of the Parotid Gland / 대한이비인후과학회지

Small cell neuroendocrine carcinomas mainly occur in the lung. Four percent of small cell carcinomas arise in extrapulmonary sites. In the head and neck region, small cell carcinomas arise most commonly in the larynx and very rarely in the parotid gland. Although the prognosis for patients with small cell carcinoma of the salivary glands is better than for those with small cell carcinoma of the lung or larynx, it is a high grade malignancy that is treated aggressively. We have recently experienced a case of primary small cell neuroendocrine carcinoma of parotid gland with extensive neck metastases. The histopathologic findings showed undifferentiated small cells with hyperchromatic nuclei, numerous mitoses, ductal differentiations and squamous changes. The positive findings for CD56 and neuron specific enolase staining determined this carcinoma to be a neuroendocrine subtype, and the patient received chemoradiation after surgery. We present this case with a review of literatures.

Guglielmi Detachable Coil Embolization of Incompletely Surgically Clipped Anterior Communicating Artery Aneurysm: Case Report

Residual intracranial aneurysm represents a continued risk of rupture and hemorrhage after incompletely surgically aneurysmal clipping. The authors describe a case of residual anterior communicating artery aneurysm after incomplete clipping, which was successfully managed by Guglielmi detachable coil(GDC) embolization. The endovascular treatment using GDC may be a good therapy for those patients in whom microsurgical clipping results in incomplete occlusion of the aneurysm and in whom reoperation is considered contraindicated or is unacceptable to patients.

The Effect of Thiopental Sodium, Etomidate and Propofol on Systemic Vascular Resistance and Venous Capacitance during Cardiopulmonary Bypass / 대한마취과학회지

BACKGROUND: The focus of this study is the effects of thiopental sodium, etomidate and propofol on systemic vascular resistance and venous capacitance during cardiopulmonary bypass with constant pump flow. METHODS: Thirty patients (ASA III) scheduled for open heart surgery were randomly divided into three groups. Anesthesia was induced with thiopental sodium 5 mg/kg, fentanyl 5 microgram/kg and vecuronium 1 mg/kg. CPB was conduced with a membrane oxygenator using non-pulsatile flow and moderate hypothermia. When rectal temperature and pump flow had been stable for 5 min, patients randomly received thiopental sodium 4 mg/kg, etomidate 0.3 mg/kg and propofol 2 mg/kg. Perfusion pressure and pump flow were measured 0, 1, 3, 5, 10, 15, 20 and 30 min after administration. RESULTS: The systemic vascular resistance index (SVRI) decreased to 84.3% of the control values after thiopental sodium 4 mg/kg, to 74.7% of the control after etomidate 0.3 mg/kg and to 79.8% of the control after propofol 2 mg/kg. SVRI returned to control value levels 3 min after the administration of thiopental sodium, 20 min after etomidate, and 5 min after propofol. Thiopental sodium, etomidate and propofol reduced venous reservoir volume 1 min after injection and the reduction was sustained throughout the all period of the cardiopulmonary bypass. CONCLUSIONS: The results indicate that thiopental sodium, etomidate and propofol dilate both resistance and capacitance vessels, but there was no correlation between the two vessels.

The Effect of General Anesthesia on Hemodynamics during Laparoscopic Hysterectomy / 대한마취과학회지

BACKGROUND: Laparoscopy with peritoneal carbon dioxide insufflation is a standard procedure in many gynecological departments. And more prolonged gynecological laparoscopic operations are being performed in recent years, and a steeper head-down position is required. Despite laparoscopic operations have many advantages, peritoneal insufflation of CO2 to create the pneumoperitoneum necessary for laparoscopy induces intraoperative hemodynamic changes that complicate anesthetic management of laparoscopy.The purpose of this study is to evaluate the effect of general anesthesia on hemodynamics during loparoscopic hysterectomy. METHODS: Twenty six women undergoing laparoscopic hysterectomy were randomly allocated to either a propofol (Group 1, n=13) intravenous anesthesia or a enflurane (Group 2, n=13) anesthesia with fentanyl-N2O/O2-vecuronium. Hemodynamic parameters were measured before induction (T1), 5 min after induction (T2), 5 min after head-down (T3), 5, 10, 15, 20 min after pneumoperitoneum (T4, T5, T6, T7), 5, 10 min after deflation (T8, T9). The MAP, HR, CI, SVRI, SI were measured by transthoracic electrical bioimpedence method and automated blood pressure device. RESULTS: The mean arterial pressure were increased during pneumoperitonem in both groups and heart rate were increased in Group 2. The cardic index were decreased in both groups after induction by 27.4 % in Group 1 and 25.7% in Group 2. The systemic vascular resistanace index were increased in both groups from head-down to after deflation by 68.3% in Group 1, 73.1% in Group 2 maximally. No significant changes of stroke index were observed during surgery in Group 1. CONCLUSIONS: Laproscopy with CO2 insufflation induces significant hemodynamic changes includig increases of MAP, SVR and a reduction of CI. And usual intraoperative hemodynamic monitoring; the blood pressure and heart rate give no information on the reduction in cardic output.

A Scalding Burn Resulting from Sitz Bath Long Enough after Epidural Block for Vaginal Delivery: A case report / 대한마취과학회지

Epidural block is one of the most effective methods of intrapartum pain relief in current practice. This is a case of a scalding burn resulting from a sitz bath long enough after epidural block for vaginal delivery. The patient received 7 ml of 0.25% bupivacaine mixed with 1 : 300,000 epinephrine and fentanyl 50 microgram for epidural block. Following delivery, the patient started complaining of voiding difficulty without any motor weakness 6 hours after the epidural block occured. At that time, the patient did not feel any hot or pain sensations during the 15 minutes of unintentional hot water application for sitz bath. Consequently, an approximately 5~10% superficial second degree burn developed on her perineal and inner thigh region.

Endoscopic Surgery for Intraorbital Abscess: A Report of One Case / 대한이비인후과학회지

Intraorbital abscess is one of the serious complications of the paranasal sinusitis and an inadequate treatment for this condition may result in irreversible damages of the optic nerve and retina. Conventionally, surgical treatment of intraorbital abscess has been performed by external ethmoidectomy approach. More recenty, the endoscopic drainage technique has been reported. The authors experienced a case of intraorbital abscess in a 16 year-old male patient for whom we applied the endoscopic drainage technique under the general anesthesia. After the partial removal of the lamina papyracea, we incised the periorbita and then induced drainage of intraorbital abscess by applying external pressure to the eye ball. The surgery was satisfactory and there was no evidence of complications.

Comparison Study for Mucosal Malignant Melanoma ofHead and Neck according to Primary Sites / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Mucosal melanomas of head and neck are rare and show poor prognosis. Present study was undertaken to compare clinical features, treatment, recurrence and survival rates in the primary sites of head and neck mucosal melanoma. MATERIALS AND METHODS: From 1983 to 1992, 19 patients with malignant melanoma of the mucosal membrane of the head and neck were presented and treated at Kyungpook National University hospital. RESULTS: There were 12 males and 7 females with an average age of 50.7 years. Ten patients presented tumors in the oral cavity, six patients in nasal cavity and paranasal sinus, and three patients in laryngopharynx. The average duration of symptoms was 20.0 months in nasal sites and 3.7 months in oral sites. Seventeen patients were treated by surgery or combined surgery and radiotherapy (5 nasal melanomas, 9 oral melanomas, 3 laryngopharyngeal melanomas). Fifteen patients developed tumor recurrence, except for two patients with oral melanoma who were alive without disease. There were local recurrences in all five patients with nasal melanoma, and in two of seven patients with oral melanoma. However, there were regional recurrences or distant metastases without local recurrence in five of seven patients with oral melanoma, and in all three patients with laryngopharyngeal melanoma. 3YSR was 40.3%, with 50.0% in nasal melanomas and 24.0% in oral melanomas. 5-YSR was 17.2, with 16.7% in nasal melanomas and 12.0% in oral melanomas. CONCLUSION: The major factors in the failure of treatment were regional recurrence and distant metastasis in oral melanoma, but local recurrence in nasal melanoma. Patients with nasal melanoma showed higher survival rates than those with oral melanom, although there was no statistical difference in the survival rates.

A Clinical Study on the Surgical Treatment of Inverted Papilloma / 대한이비인후과학회지

BACKGROUND: Inverted papilloma is an uncommon benign tumor which is characterized by local aggressiveness, high recurrence rate, associated malignancy and tendency to multicentricity. Most authors advocate radical surgical removal of these tumors; however, conservative endoscopic surgery has been reported to be effective in selected cases. OBJECTIVES: To compare with operative methods of the inverted papilloma. MATERIAL AND METHODS: This study comprised 14 cases of inverted papilloma, which were divided into 3 groups. The first was lateral rhinotomy and traditional medial maxillectomy treated group with 7 cases. The second group was treated with conservative endoscopic intranasal resection of 4 cases and the third group was treated by endoscopic medial maxillectomy of 3 cases. RESULTS: The follow-up periods in average were 23 months, 19 months and 11 months in first, second and third groups respectively. All cases showed no recurrence. CONCLUSION: Although follow-up periods are insufficient, the endoscopic approaches are meaningful methods to treat inverted papilloma.