RESUMO
OBJECTIVE: This study aimed to compare intubation performance between blind intubation through supraglottic airway devices and direct laryngoscopy by novices under manikin simulation. We hypothesized that the intubation time by novices using supraglottic airway devices was superior to that with the Macintosh laryngoscope (MCL). METHODS: A prospective, randomized crossover study was conducted with 95 participants, to evaluate i-gel, air-Q, LMA Fastrach, and MCL devices. Primary outcomes were the intubation time and the success rate for intubation. RESULTS: The i-gel showed the shortest insertion and tube passing time among the four devices; the i-gel and air-Q also showed the shortest total intubation time (all P<0.0083; i-gel vs. air-Q, P=0.03). The i-gel and MCL showed the highest cumulative success rate (all P<0.0083; i-gel vs. MCL, P=0.12). CONCLUSION: Blind intubation through the i-gel showed almost equal intubation performance compared to direct laryngoscopy.
Assuntos
Manuseio das Vias Aéreas , Estudos Cross-Over , Intubação , Máscaras Laríngeas , Laringoscópios , Laringoscopia , Manequins , Estudos ProspectivosRESUMO
BACKGROUND: Recently the incidence of cardiac arrest in the elderly has been on the rise due to aging and the rapid increase in cardiovascular disease. Nevertheless, there has been only a few studies done regarding the factors affecting return of spontaneous circulation (ROSC) and survival in this population within Korea. We investigated the prognostic factors for ROSC and survival in cardiac arrest patients over 65 years visiting a single local emergency center. METHODS: We conducted a single center retrospective observational study, and 87 elderly patients with cardiac arrest were enrolled. They visited the emergency medical care center via ambulance from November 2013 to October 2014. Primary outcomes were ROSC and survival and the secondary outcome was 100 days cumulative survival rate. RESULTS: The level of potassium was the only significant factor for ROSC. The increase in potassium level reduced the rate of ROSC (odds ratio, 0.64; 95% confidence interval [CI], 0.44-0.92; p=0.01). However, higher potassium level was not related to survival (p=1.00). For the 100 days cumulative survival rate, neither hypokalemia (hazard ratio [HR], 1.1; 95% CI, 0.57-2.38; p=0.66) nor hyperkalemia (HR, 1.5; 95% CI, 0.89-2.59; p=0.11) was related to survival compared to normokalemia. CONCLUSION: The potassium level may be considered a valid prognostic factor for ROSC in elderly patients with cardiac arrest. However, it was unrelated to survival.
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Idoso , Humanos , Envelhecimento , Ambulâncias , Reanimação Cardiopulmonar , Doenças Cardiovasculares , Emergências , Parada Cardíaca , Hiperpotassemia , Hipopotassemia , Incidência , Coreia (Geográfico) , Estudo Observacional , Potássio , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
PURPOSE: In an effort to determine the characteristics of foreign suicides who visit an emergency center, this study analyzed suicidal attempt between natives and foreigners. METHODS: We conducted a retrospective analysis of 1,218 Korean and 149 foreign suicidal attempters who visited a regional emergency center from January 1, 2009 to December 31, 2013. We compared two groups according to age, sex, selected suicidal methods, past psychiatric history, medical examination and treatment acceptance, elapsed time to visit an emergency center after suicidal attempt, emergency center residence time, and hospitalization period. RESULTS: No difference in medical exam acceptance and tetanus vaccination was observed between the two groups. However, we found a difference in hospitalization acceptance. The prevalence rate of psychiatric disorders was lower in foreign suicides, and the refusal rate of psychiatric treatment was higher in foreign patients. CONCLUSION: In foreign suicides, social support including finance is required for easy access to health care service. In addition, more active interdisciplinary cooperation with the department of psychiatry and close observation is needed.
Assuntos
Humanos , Dissulfiram , Emergências , Emigrantes e Imigrantes , Acessibilidade aos Serviços de Saúde , Hospitalização , Grupos Populacionais , Prevalência , Estudos Retrospectivos , Suicídio , Tétano , VacinaçãoRESUMO
PURPOSE: To confirm the effect of the frog leg lateral radiographs for determining the clinical indication of total hip arthroplasty for high riding dislocation and to discuss its theoretical background. MATERIALS AND METHODS: A consequent series of reconstructive THA were studied in 28 recent tuberculous hips. Twenty-three hips (17patients) with developmental dysplastic hip were compared. Preoperatively, frog-leg lateral radiographs were performed in all the patients, which were enhanced using a 2-dimensional computer model to predict the reattachment of the greater trochanter. RESULTS: The modified scores of Merle d'aubigne and Postel improved from a mean of 2.6 points preoperatively to a mean of 5.1 points. Sciatic nerve palsies occurred in three cases. In two cases, they fully recovered, but in one case, it did not. We confirmed that old high dislocation of the hip could be adopted in type 1 and 2 categories of frog leg lateral position. The reconstruction of hip was relatively simple in type 3, however, further study is necessary in type 5 due to unsuitable abduction contracture. CONCLUSION: We confirm that frog leg lateral radiography is effective for determining the operative indication of high riding dislocation. However irreducible frog leg lateral position is absolutely contraindirated for total hip arthroplasty.
Assuntos
Humanos , Artroplastia , Artroplastia de Quadril , Simulação por Computador , Contratura , Luxações Articulares , Fêmur , Quadril , Perna (Membro) , Radiografia , Neuropatia CiáticaRESUMO
Catastrophic failure of a zirconia head with Hylamer acetabular component and early failure due to the phase transformation of zirconia ceramic head after total hip arthroplasty have been indebted issues. We report two cases who had failure of the zirconia ceramic head with polyethylene articulations shortly after total hip arthroplasty. Revision retrieval studies were performed subsequently.
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Acetábulo , Artroplastia de Quadril , Cerâmica , Cabeça , PolietilenoRESUMO
PURPOSE: To propose a method providing an accurate femoral shaping for cementless total hip arthroplasty to maximize bone contact without femoral bone breakage and make secure correct position of the implant by eliminating the manual broach process MATERIALS AND METHODS: 5-cadaver specimens were tested with this system. A reamer-shaped registration gauge is inserted into the femoral canal. This gauge defines the position of the implant to be inserted. Then, the base frame is attached to the femur and the position of the gauge with respect to the base frame is measured. After removing the gauge, a mini robot is mounted on the frame and shapes the femoral canal. After the milling operation, model implant is inserted and its position and gap are measured. RESULTS: Anteversion angle error was 0.9degrees(S.D.1.7) and Varus/Valgus alignment error was 1.1degrees(S.D.1.5). 95%(S.D. 3.2) of contact surface had less than 0.3mm gap error. CONCLUSIONS: Proposed THA surgery system increased the accuracy of stem position and fitness compared with manual operation. Our mini robot THA surgery provides most of the benefits RobodocR does while operating procedure is much more simplified and economic.
Assuntos
Artroplastia de Quadril , Cadáver , FêmurRESUMO
Sixty-eight revisions of total hip arthroplasties from sixty-one patients were performed using allogenic cancellous chip bone and fine granules of HA for bone deficiencies of the acetabulum at two hospitals in Seoul since September 1992. In our practice, acetabular deficiencies were classified into two broad categories, which were based on our provisional treatment protocol. For the segmental deficiencies of the acetabulum, we employed the method of using the cemented acetabular component. In the mean time, Ling technique of impaction graft with PMMA cement were also employed. For the cavitary deficiencies of the acetabulum, we used several types of uncemented ingrowth cups with HA granules and Tutoplast was used to further ameliorate the bony integration. In addition, we obtained good results in cavitary deficiencies of the acetabulum with C.L.S. Expansion Cup and Ringloc fin Cups which seem that initial stability during the cup installation were remarkable. Unfortunately, we had 5 cases of clinical failure, which consist of bone graft incorporation, where eventual resorption of the graft and implant migration were resulted. Nevertheless electromicroscopic finding of interface taken from failure showed partial new trabecular formation and physicochemical bonding near the host bone bed in some cases. Although primary stability of reconstructive surgery was acceptable, Tutoplast - HA granule composites have similar effect of incorporation to host bone compared with other method of allogenic bonegraft storage, which remodeled after 5 years. Thus, this phenomenon requires further investigation of molecular biological role of tissue substance known as cytokine, as well as microscopic histology.
Assuntos
Humanos , Acetábulo , Artroplastia , Protocolos Clínicos , Quadril , Polimetil Metacrilato , Seul , TransplantesRESUMO
The purpose of this study was to analyze the minimum two year clinical and radiological results of revision total hip arthroplasties using allogenic chip bone graft and cement in acetabular bone deficiencies. Thirty six revision total hip arthroplasties that had been performed in thirty four patients between Sep. 1992 and May. 1994 at Seoul Paik Hospital and had followed more than two years were included in this study. The clinical result was evaluated by Harris hip score. The mean Harris hip score was 48 points preoperatively, 88 points at final follow-up, a mean of 3 years after revision. In radiological evaluation, osseous union between grafted bone and host bone was seen within 4 months in thirty two hips (89%), a complete grafted bone-cement radiolucent line of two millimeter or more in at least one zone was seen in seven hips (19%) and acetabular component migration was seen in six hips (17%) at postoperative 3 year follow-up radiograph. At the time of follow-up, five hips (14%) had been revised a second time: three for aseptic acetabular loosening, two for infection. In conclusion, we recommend the technique using allogenic chip bone graft and cement to reconstruct the acetabular bone deficiencies in revision total hip arthroplasties, though other technique will be recommend in severe segmental acetabular deficiencies or previous infection.
Assuntos
Humanos , Acetábulo , Artroplastia , Artroplastia de Quadril , Seguimentos , Quadril , Seul , TransplantesRESUMO
35 cases of Mallory-Weiss syndrome among 277 cases of upper gastrointestinal bleeding were ascertained by endoscopy at department of internal medicine St. Columban's hospital. The mean age was 41.6 years. All of 35 cases were found in male. Combined disease were gastritis(15 cases), peptic ulcer(7 cases) and esophageal varix(3 cases). The most common precipitating factor was vomiting, 22 cases among the 28 cases of vomiting(80%) developed after drinking. Endoscopic finding revealed active bleeding in 5 cases, blood clot without active bleeding in 22 cases, and scar change without bleeding evidence in 8 cases. Most cases had had hematemesis after active bleeding but 5 cases had had only melena without hematemesis. The Mallory-Weiss lacerations were located at stomach in 16 cases(46%), at esophagogastric junction in 11 cases(31%) and at esophagus in 8 cases. On the view of gastric direction, 14 cases were on anterior wall side, 9 cases were on posterior wall side, 11 cases were on lesser curvature side and one case was on great curvature side. Single lacerations were more common than multiple lacerations.
Assuntos
Humanos , Masculino , Cicatriz , Ingestão de Líquidos , Endoscopia , Junção Esofagogástrica , Esôfago , Hematemese , Hemorragia , Medicina Interna , Lacerações , Síndrome de Mallory-Weiss , Melena , Fatores Desencadeantes , Estômago , VômitoRESUMO
The proximal tibial osteotomy is a procedure that usually corrects abnormal tibiofemoral angle in osteoarthritis of the knee. In general, we could corrects tibiofemoral angle in ratio of 1mm wedge significantly by the level of osteostomy and size of tiba in patients. The radiologic measurement of proximal tibia and fibula has not been reported. So we analyzed the knee standing AP and lateral films taaken from the 491 patients during the period from January 1988 to December 1989. The results were as follows. 1. The width of tibial plateau was average 82.24mm. 2. The distance between tibial plateau to fibular head was average 11.41mm. 3. The width of proximal tibia at the level of fibular head was average 78.63mm. 4. The width proximal tibia at distal 5mm, 10mm and 15mm along the lateral margin of tibia from fibular head was average 75.78mm, 72.69mm and 65.10mm each other. 5. The length of second osteotomy line with 10mm wedge thickness from fibular head was average 75.06mm. The length of second osteotomy line with 10mm wedge thickness 5mm below fibular head was average 71.48mm. 6. Authors compared radiologic size of proximal tibia which was checked from 1m distance with true bone size of cadaver and patient, and the ratio was 1.13:1. 7. It was suggested that the radiologic measurment of proximal tibia is advised basic study for development of implant because the conventional implant developed other people was not adapted proximal tibia to Korean.
Assuntos
Adulto , Humanos , Cadáver , Fíbula , Cabeça , Joelho , Osteoartrite , Osteotomia , TíbiaRESUMO
The proximal tibial osteotomy is a procedure usually employed for osteoarthritis of the knee with a predominant single compartment involvement accompanied by pain and angular deformity. It has as its objective the shift of the gravitational line of weight from an involved to a relatively uninvolved side of knee. We studied the results of proximal tibial osteotomy in 30 patients (33knees). The mean age was 55.7 years, degenerative osteoarthritis was 31 cases (93.9%) and posttraumatic osteoarthritis was 2 cases (6.1%). The results were as follows; The average distance of osteotomy between the proximal plane and distal plane was 10.3mm. The average preoperative tibiofemoral angle was varus 3.8degrees and average postoperative tibiofemoral angle was valgus 7.6 degrees. The amount of upward displacement of fibular head after proximal tibial osteotomy was from 3mm to 16mm (mean 7.5mm). The preoperative knee rating scale was 52.9 and the postoperative knee rating scale was 78. The complications of proximal tibial osteotomy were 3 cases of transient peroneal nerve palsy and 2cases of Coventry staple loosening, but the nerve palsy was completely recovered and there were no need of staple removal.
Assuntos
Humanos , Anormalidades Congênitas , Cabeça , Joelho , Osteoartrite , Osteotomia , Paralisia , Nervo FibularRESUMO
The purpose of this study is to investigate the effect of the ball-cone contact interface variation on the ceramic ball stress which is the dominant factor of the design of the moldular artificial hip joint. A contact stress analysis problem is formulated using the optimization principle and finite element analysis technique on the ball-cone system of three dimensional axi-symmetrical model, Numerical procedure is employed to get the solution for varying angles of cones and angular mismatches between the ball and cone interfaces. There is a fair amount of friction in the interface and included in the analysis model.
Assuntos
Cerâmica , Análise de Elementos Finitos , Fricção , Articulação do Quadril , QuadrilRESUMO
Between January 1982 and September 1986, at the Department of Orthopaedic Surgery of Kyung Hee University Hospital, 82 total knee arthroplasties were performed in 57 patients. We studied 25 patients (50 Knees) who had been operated by bilateral total knee arthroplasties to compare one stage and two stage operations. The follow-up ranged from 10 months to 5 years and 7 months (average 1 year and 8 months). All operations were performed by one of the authors (D.K.B.), but the follow-up study and the entire medical record were independently evaluated by another authors. The clinical results of preoperative and postoperative assessments and rehabilitation processes are as follows; 1. Group I (10 patients) had both kness replaced by one stage simultaneous operation under same anesthesia, and Group II(15 patients) had replaced by two stage operation at the intervals of 2 weeks. 2. The periods required to do bilateral weight bearing were 10.3 days for Group I, 23.6 days for Group II. 3. Complications in one stage operation was no more than the in two stage operation. 4. The postoperative pain and ROM were not significantly different in both groups. 5. Using the hospital for special surgery rating system, we found the clinical results to be similar in both groups. 6. Comparing to two stage operation, the advantages of one stage operation were shorter operative and tourniquet time, lesser use of antibiotics, reduced medical cost and hospital stay. In conclusion, if patient conditions do not prevent prolonged anesthetic time and surgeons have good surgical techniques, we recommend one stage simultaneous operation in bilateral total knee replacement.
Assuntos
Humanos , Anestesia , Antibacterianos , Artroplastia , Artroplastia do Joelho , Seguimentos , Joelho , Tempo de Internação , Prontuários Médicos , Dor Pós-Operatória , Reabilitação , Cirurgiões , Torniquetes , Suporte de CargaRESUMO
Historically, cerclage has gained a bad reputation because of the early unfavorable results with the Parham band and subsequent further poor results with wire cerclage. The treatment and management of elderly patients with fractures through osteoporotic bone is fraught with difficulties. The standard methods of internal fixation are not always satisfactory as metal plates and screws and intramedullary nailing do not hold well in osteoporotic bone. To overcome this problem, a system of straps and plates has been devised. We experienced 3 cases of femoral fractures using nylon cerclage system, such as the segmental fracture, oblique fracture in osteoporotic patient and the fracture below a hip prostesis. The end-result was satisfactory.
Assuntos
Idoso , Humanos , Fraturas do Fêmur , Fêmur , Fixação Intramedular de Fraturas , Quadril , NylonsRESUMO
The authors treated 4 cases of the congenital dislocation of the hip in aged patients using Klisic procedure (1976) which implies open reduction, femoral shortening and pelvic osteotomy in one stage. The results at 1 year to 16 months after operation follow-up were found very much satisfactory in general on terms of pain, leg length and range of motion. Analysis of the cases with representation of surgical procedure is to be reported.
Assuntos
Criança , Humanos , Luxações Articulares , Seguimentos , Quadril , Perna (Membro) , Osteotomia , Amplitude de Movimento ArticularRESUMO
The reported clinical results following revision of failed cemented hip arthroplasties have varied. The most improtaint aspect of revision surgery, especially in case of removal of well injected femoral cement need not be daunting if certain essential principles are understanding. The prohlem is hasically that of a tuhe (cement) fixed within another tube (femur). Otherwise, any attempt to work between the two will cause the instruments to skid off the cement and penetrate the femoral cortex. Therefore, on the first step to deal with the problem and theoretical ground, we have investigated the mode of fracture in bone cement. Prior to this study, a comparision of various cement strength been published by A.J.C. Lee, University of Exetcr, UK is rviewed for our reference. As far as cement crack is concerned, the re are three modes of fracture, namely, mode I, mode II and mode III. As seen in the Fig. 5, mode I fracture is defined to be the fracture under symmetic loading, which is perpendicular to the crack surface. Mode II fracture is the fracture under anti-symmetric loading, which is parallel to the crack surface. In mode III, the loading is perpendicular to both crack surface and the plan of the paper. On the left is the situation shown when using osteotome to crush the cement Fig. 6. The prohlem here is of dynamical nature, however, this kind of prohlem has not been solved yet. Prediction of the direction of propagation is possible by assuming the static nature when the osteotome just gets inside the cement. Small element with distance and angle from the osteotome tip under stress is also,shown on the left, Here, th mode of fracture is mode I. ∂θθ is obstained from fracture mechanics as this, and the direction of crack propagation is given by solving ∂θθ = o,i.e, the direction of maximum ∂θθwhich turns out to be 0=0. When chisel is used, the mode of fracture is th combined mode, i. e. Mode I + Mode II (Fig. 7). In an angiogous approach to the previous one, aθθis obtained, thus, the direction of propagation is given by solving ∂θθ/∂θ = 0. which results in θ=(−)α, the half of the included angle of the chisel, Note, however, that the direction of propagation given here is the initial direction of crack propagation. In practiee, the crack often gets curves, however, this phenomena is governed by other factors neglected in this presentation, such as inhomogenity, state of stress of bone, cement and stem, etc, Thus, quantitative study is required in addition to so've these phenomenon.