Comparison of Ulnar Collateral Ligament Reconstruction Techniques in the Elbow of Sports Players

Ulnar collateral ligament injuries have been increasingly common in overhead throwing athletes. Ulnar collateral ligament reconstruction is the current gold standard for managing ulnar collateral ligament insufficiency, and numerous reconstruction techniques have been described. Although good clinical outcomes have been reported regarding return to sports, there are still several technical issues including exposure, graft selection and fixation, and ulnar nerve management. This review article summarizes a variety of surgical techniques of ulnar collateral ligament reconstructions and compares clinical outcomes and biomechanics.

Management of Periprosthetic Hip Joint Infection / 대한고관절학회지

Total hip joint replacement offers dramatic improvement in the quality of life but periprosthetic joint infection (PJI) is the most devastating complication of this procedure. The infection threatens the function of the joint, the preservation of the limb, and occasionally even the life of the patient due to long term hospitalization and high cost. For the surgeon it is a disastrous burden, which requires repeated, complicated procedures to eradicate infection and to provide a mobile joint without pain. Yet in the absence of a true gold standard, the diagnosis of PJI can be elusive. Synovial fluid aspiration, diagnostic imaging, traditional culture, peripheral serum inflammatory markers, and intraoperative frozen sections each have their limitations but continue to be the mainstay for diagnosis of PJI. Treatment options mainly include thorough irrigation and debridement with prosthesis retention, or a two-stage prosthesis exchange with intervening placement of an antibiotic-loaded spacer. Success in treating PJI depends on extensive surgical debridement and adequate and effective antibiotic therapy. Treatment in two stages using a spacer is recommended for most chronic PJI. Debridement, antibiotics and implant retention is the obvious choice for treatment of acute PJI, with good success rates in selected patients. This article presents an overview of recent management concepts for PJI of the hip emphasizing diagnosis and the clinical approach, and also share own experience at our institution.

The effect of heating insufflation gas on acid-base alterations and core temperature during laparoscopic major abdominal surgery / 대한마취과학회지

BACKGROUND: Carbon dioxide (CO2) has different biophysical properties under different thermal conditions, which may affect its rate of absorption in the blood and the related adverse events. The present study was aimed to investigate the effects of heating of CO2 on acid-base balance using Stewart's physiochemical approach, and body temperature during laparoscopy. METHODS: Thirty adult patients undergoing laparoscopic major abdominal surgery were randomized to receive either room temperature CO2 (control group, n = 15) or heated CO2 (heated group, n = 15). The acid-base parameters were measured 10 min after the induction of anesthesia (T1), 40 min after pneumoperitoneum (T2), at the end of surgery (T3) and 1 h after surgery (T4). Body temperature was measured at 15-min intervals until the end of the surgery. RESULTS: There were no significant differences in pH, PaCO2, the apparent strong ion difference, the strong ion gap, bicarbonate ion, or lactate between two groups throughout the whole investigation period. At T2, pH was decreased whereas PaCO2 was increased in both groups compared with T1 but these changes were not significantly different. Body temperatures in the heated group were significantly higher than those in the control group from 30 to 90 min after pneumoperitoneum. CONCLUSIONS: The heating of insufflating CO2 did not affect changes in the acid-base status and PaCO2 in patients undergoing laparoscopic abdominal surgery when the ventilator was set to maintain constant end-tidal CO2. However, the heated CO2 reduced the decrease in the core body temperature 30 min after the pneumoperitoneum.

Anesthetic management for a patient with Eisenmenger syndrome undergoing dacryocystorhinostomy: A case report

Eisenmenger syndrome is defined as pulmonary hypertension at or close to systemic values, with an intracardiac or aortopulmonary communication resulting a bidirectional or right-to-left shunt.Patients with Eisenmenger syndrome require a close monitoring while undergoing non-cardiac surgery because these patients are very vulnerable to alteration in hemodynamics induced by anesthetics or surgery.Therefore we report the successful management of a patient with Eisenmenger syndrome undergoing a dacryocystorhinostomy under desflurane and ketamine based general anesthesia.

Anesthetic management of a patient with pulmonary arteriovenous malformation under total intravenous anesthesia : A case report / 대한마취과학회지

A 23-year-old woman with pulmonary arteriovenous malformation was scheduled for open reduction and internal fixation due to her mandible fracture. Total intravenous anesthesia using propofol and remifentanil was selected as the anesthetic method in order to avoid the inhibition of hypoxic pulmonary vasoconstriction and the exacerbation of intrapulmonary shunting. After the standard monitoring devices were applied, anesthesia was then induced and maintained with a target controlled infusion of propofol and remifentanil in the range of 2.5-3.0 microg/ml and 2-3 ng/ml, respectively. Anesthesia was performed uneventfully and the patient was discharged without complication.