Comparison of the Macintosh Laryngoscope and the Disposcope Endoscope(R) in Both Normal Airway and Manual In-line Stabilization for Suspected Cervical Spine Injury Patients: A Simulation Study using an Airway Training Manikin

PURPOSE: We conducted a comparative evaluation in the ease of endotracheal intubation when using the Macintosh laryngoscope (ML) versus the new Disposcope endoscope(R) (DE) (Disposcope Taiwan, Hsinchuang city, Taiwan), a video-laryngoscope, during simulated normal airway and manual in-line stabilization of suspected cervical spine injury patients. METHODS: Forty-three medical interns participating in an endotracheal intubation training program used both the DE and the ML as part of their lessons. In each of the two simulated patient scenarios, endotracheal intubation was performed using each endoscope, in random order. The rate of successful intubation, time required for visualizing the glottis, time to complete endotracheal intubation, results of a modified Cormack & Lehane classification (CL grade), and a measure of dental injury were all recorded and analyzed. RESULTS: In the normal airway scenario, there was no difference in the rate of successful completion of intubation (both 100%) between the two endoscopes. Time to complete endotracheal intubation using the DE was shorter than that with the ML (10.7 versus 12.6 sec; p=0 010). In the trauma scenario, despite similar success rates (95.3% in ML versus 100% in DE), the time required to complete endotracheal intubation using the DE was shorter than that with the ML (17.6 versus 24.1 sec; p=0.010). Rate of dental injury using the DE was significantly less than that observed with the ML (0.0% versus 30.2%; p<0.0001). In both scenarios, the DE provided higher achievement of CL grade 1 (93% versus 67.4% in normal airway; p=0.006 and 55.8% versus 0% in trauma airway; p<0.0001). CONCLUSION: Compared to the ML, the DE provided a better view of the glottis, provided decreased dental trauma, and offered faster completion time for endotracheal intubation.

Comparison of Digital Templating with Manual Templating for Total hip Replacement / 대한정형외과학회잡지

PURPOSE: The objectives of this study are to compare digital with manual templating in preoperative planning for total hip arthroplasty and to assess the usability of digital templating. MATERIALS AND METHODS: Conventional and digital radiographs performed prior to hip arthroplasty in forty one patients. Preoperative templating was performed by four independent observers with manual and digital templates on a Picture Archiving and Communication System (PACS) workstation. In all cases, acetabular cup, femoral stem sizes and length of femoral neck were measured. Intra- and interobserver agreement and predictability of real component size were calculated with weighted kappa analysis and Mann-Whitney test. RESULTS: For acetabular cup and femoral stem size, inter- and intraobserver agreement was substantial, nevertheless, for length of femoral neck, it was poor in both methods. Comparing with the real size, digital templating method showed statistically significant predictability for acetabular cup size (p=0.001). However, there was no significant difference in femoral stem size and the length of femoral neck by both methods (p=0.074, p=0.140). CONCLUSION: Both inter- and intraobserver agreement was similar. However, considering advantage of PACS system and superior predictability of digital templating technique, we recommend the preoperative digital templating in hospital with PACS system.

The Effectiveness of Decompressive Craniectomy with Dural Augmentation in Malignant Cerebral Infarction

OBJECTIVES: There is continuing controversy about the benefits of decompressive craniectomy in massive cerebral edema following space occupying hemispheric cerebral infarction. The aims of this study are to determine the effectiveness and to confirm the life-saving nature of decompressive craniectomy with dural augmentation for massive cerebral infarction. PATIENTS AND METHODS: We present twelve patients with medically uncontrollable hemispheric cerebral infarction. All were treated with extensive craniectomy and duroplasty without resection of necrotic tissue. We evaluated various characteristics(size of hemispheric infarction, Glasgow Coma Scale, volume of low density and midline shift in CT) at three different periods(preoperative, immediate postoperative and 3-4weeks after operation) and evaluated effectiveness of hemicraniectomy for massive cerebral edema after large hemispheric infarction. RESULTS: All patients have survived from surgery. Nine patients with nondominant hemispheric infarction showed significant functional recovery with minimal assistance, and remaining two patients with dominant hemispheric infarction and one patient with nondominant hemispheric infarction have functionally dependent. The volume of low density and midline shift in CT were significantly reduced after decompressive craniectomy. CONCLUSIONS: Our results indicate that decompressive craniectomy with dural augmentation without resection of necrotic tissue for massive cerebral hemispheric infarction not only reduce the mortality and infarction size but also significantly improve the outcome, especially for nondominant hemispheric infarction.