Open-Door Laminoplasty Using Lateral Mass Anchoring Screws and Nonabsorbable Sutures in Patients with Multilevel Cervical Myelopathy

Background@#The purpose of this study was to evaluate the clinical usefulness of open-door laminoplasty using lateral mass anchoring screws and nonabsorbable sutures (ODLLM) for multilevel cervical myelopathy. @*Methods@#We retrospectively studied 30 patients who underwent ODLLM. Clinical evaluations were performed using a visual analog scale (VAS), Japanese Orthopaedic Association (JOA) score, and Neck Disability Index (NDI) preoperatively, at 1 year postoperatively, and at the last follow-up. Radiographic evaluation was done using cervical spine radiographs to measure changes in the lordotic angle and range of motion (ROM) preoperatively, at 1 year postoperatively, and at the last follow-up and computed tomography at 1 year postoperatively to measure the opening angle and anteroposterior diameter of the spinal canal. @*Results@#Significant improvement in VAS, JOA, and NDI was seen overall at 1 year after operation. However, there was no significant difference between 1 year after operation and the last follow-up. There were no significant changes in the lordotic angle and neck ROM. The mean opening angle of the opened lamina was measured as 39.04°. The mean anteroposterior diameter was significantly increased from 7.51 ± 1.79 mm before surgery to 13.98 ± 1.80 mm at 1 year of operation. Complications such as laminar reclosure and screw loosening were not observed in all cases. @*Conclusions@#The ODLLM was technically easy to perform and showed good results comparable to those of conventional techniques. It can be suggested that ODLLM is an appropriate treatment option for multilevel cervical myelopathy.

Comparison of Arthroscopically Guided Suprascapular Nerve Block and Blinded Axillary Nerve Block vs. Blinded Suprascapular Nerve Block in Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial

BACKGROUND: The purpose of this study was to compare the results of arthroscopically guided suprascapular nerve block (SSNB) and blinded axillary nerve block with those of blinded SSNB in terms of postoperative pain and satisfaction within the first 48 hours after arthroscopic rotator cuff repair. METHODS: Forty patients who underwent arthroscopic rotator cuff repair for medium-sized full thickness rotator cuff tears were included in this study. Among them, 20 patients were randomly assigned to group 1 and preemptively underwent blinded SSNB and axillary nerve block of 10 mL 0.25% ropivacaine and received arthroscopically guided SSNB with 10 mL of 0.25% ropivacaine. The other 20 patients were assigned to group 2 and received blinded SSNB with 10 mL of 0.25% ropivacaine. Visual analog scale (VAS) score for pain and patient satisfaction score were assessed 4, 8, 12, 24, 36, and 48 hours postoperatively. RESULTS: The mean VAS score for pain was significantly lower 4, 8, 12, 24, 36, and 48 hours postoperatively in group 1 (group 1 vs. group 2; 5.2 vs. 7.4, 4.1 vs. 6.1, 3.0 vs. 5.1, 2.1 vs. 4.2, 0.9 vs. 3.9, and 1.3 vs. 3.3, respectively). The mean patient satisfaction score was significantly higher at postoperative 4, 8, 12, 24, 36, and 48 hours in group 1 (group 1 vs. group 2; 6.7 vs. 3.9, 7.4 vs. 5.1, 8.8 vs. 5.9, 9.2 vs. 6.7, 9.5 vs. 6.9, and 9.0 vs. 7.2, respectively). CONCLUSIONS: Arthroscopically guided SSNB and blinded axillary nerve block in arthroscopic rotator cuff repair for medium-sized rotator cuff tears provided more improvement in VAS for pain and greater patient satisfaction in the first 48 postoperative hours than blinded SSNB.

Ideal Placement for Endotracheal Intubation in Newborn Infants

PURPOSE: A malpositioned endotracheal tube poses a serious threat to the intubated patient. After intubation in newborn infants, the position of the endotracheal tube must be checked by a chest radiograph to ensure a minimum number of complications. The most commonly used reference point for placement is the medial ends of the clavicles, but it is known that the position of clavicles on a chest radiograph can be variable. The purpose of this study was to evaluate whether e body of the first thoracic vertebra (Tl) can be used as the standard reference point for endotracheal intubation instead of the clavicles because its fixed position on the chest radiographs. METHODS: Eighty-one radiographs of newborn who were admitted in NICU during the period from January 1, 1998 to December 31, 1998 at Kangdong Sacred Heart Hospital, Hallym University were reviewed prospectively and the following informations were recorded: ( I ) positions of the clavicles and the carina in relation to the cervical or thoracic vertebra, or intervertebral disc space, and ( ii ) the distances in cm using a ruler on the films, from the carina to the clavicles and Tl. RESULTS: The carina overlay from T2-3 to T5, most commonly at T3 to T4 (74.1%) although the clavicles are placed from C3-4 to T1-2, most commonly at C6 to C7 (62.9%). On 74 (91.4%) examinations the clavicles lay above the Tl. The distance in centimeters from the carina to the clavicles and Tl increases in length as gestational age, birth weight, and height increases. Analysis of variance shows that the position of the clavicles was determined with significantly higher variation than Tl (F=6.92 vs F=3.80, P<0.01). CONCLUSION: Because the clinical sign we describe are unreliable for detecting endotracheal intubation, chest radiographs at the bedside should be obtained routinely immediately after intubation and daily thereafter to determine the position of the tube. In neonatal period, the tip of endotracheal tube should be placed at Tl on chest radiograph, and its use would obviate the need to measure the distance from carina.

A Case of Mucosa-associated Lymphoid Tissue Lymphoma in Small Intestine / 대한소화기내시경학회지

Mucosa-associated lymphoid tissue (MALT) lymphoma is the disease of distinctive clinicopathologic entities most of which are different from current lymph-node based lymphoma classification. According to the circulatory properties of the lymphocytes and specific immunoglobulin isotype distribution, MALT is defined as the central lymphoid tissue and is opposed to peripheral somatic lymphoid tissue. It occurs most often in the gastrointestinal mucosa and the bronchial mucosa and may occur in other organs such as salivary gland, thyroid gland, conjunctiva, skin. The most common site of MALT lymphoma is gastrointestinal tract but non-gastrointestinal MALT lymphoma may present. The characteristics of pathology are reactive follicles surrounded by the diffuse infiltration of centrocyte-like (CCL) cells and lymphoepithelial lesion due to the gland invasion of CCL cells. It is a localized disease and has a long survival, Isaacson et al suggested the classification of primary gastrointestinal MALT lymphoma as low grade, high grade, immunoproliferative small intestinal disease (IPSID). The distribution is more often in the stomach than in the intestine. Intestinal MALT lymphomas have less favorable clinicnl courses than the gastric MALT lymphomas. Recurrences may appear in the same organ or in other extranodal sites. We report clinical, pathologic findings, and clinical course in a case of primary small intestinal MALT lymphoma in terminal ileum with literature review.

A case of Asbestosis, Pleural Effusion and Lung Cancer Caused by Long-Term Occupational Asbestos Exposure / 결핵

Asbestos is widely used in the textile, asbestos cement, construction products, friction material, paper products, insulation products, chemical and plastic products because of its heat resistance, flexibility, tensile strength, and texturability. It is now generally recognized that longterm and excessive inhalation of asbestos dust causes asbestosis, lung cancer, malignant mesothelioma and malignancies in other organs such as cancer of gastrointestinal tract, leukemia, lymphoma. Although eighty thousand tons of asbestos has been annually consumed since 1979 in korea, it has not been reported asbestos and lung cancer by asbestos dust so far, while a case of mesothelioma was officially diagnosis as a occupational disease at 1993. We experienced firstly a case of asbestosis and lung cancer caused simultanously by occupational asbestos exposure 11 years, which was confirmed by chest x-ray, pulmonary function test, chest CT and HRCT, bronchoalveolar lavage, and gallium scan. And so We present a case of asbestosis, pleural effusion and lung cancer with a review literature.