• Journal of Dental Anesthesia and Pain Medicine
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• 제24권1호
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• pp.1-17
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• 2024

The video laryngoscope is a novel instrument for intubation that enables indirect visualization of the upper airway. It is recognized for its ability to enhance Cormack-Lehane grades in the management of difficult airways. Notably, video laryngoscopy is associated with equal or higher rates of intubation success within a shorter time frame than direct laryngoscopy. Video laryngoscopy facilitates faster and easier visualization of the glottis and reduces the need for Magill forceps, thereby shortening the intubation time. Despite the advanced glottic visualization afforded by video laryngoscopy, nasotracheal tube insertion and advancement occasionally fail. This is particularly evident during nasotracheal intubation, where oropharyngeal blood or secretions may obstruct the visual field on the monitor, thereby complicating video laryngoscopy. Moreover, the use of Magill forceps is markedly challenging or nearly unfeasible in this context, especially in pediatric cases. Furthermore, the substantial blade size of video laryngoscopes may restrict their applicability in individuals with limited oral apertures. This study aimed to review the literature on video laryngoscopy, discuss its clinical role in nasotracheal intubation, and address the challenges that anesthesiologists may encounter during the intubation process.

• Journal of Korean Neurosurgical Society
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• 제62권1호
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• pp.96-105
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• 2019

Objective : The aims in the management of thoracolumbar spinal fractures are not only to restore vertebral column stability, but also to obtain acceptable alignment of the thoracolumbar junction (T-L junction) to prevent complications. However, insufficient surgical correction of the thoracolumbar spine would be likely to cause late progression of abnormal kyphosis. Therefore, we identified the surgical factors that affected unfavorable radiologic outcomes of the thoracolumbar spine after surgery. Methods : This study was conducted in a single institution from January 2007 to December 2013. A total of 98 patients with unstable thoracolumbar spine fracture were included. In these patients, fixation was done through transpedicular screws with rods by three surgical patterns. We reviewed digital radiographs and analyzed the images preoperatively and postoperatively during follow-up visits to compare the change of the thoracolumbar Cobb angle with radiologic parameters and clinical outcomes. The unfavorable radiologic group was defined as the patients who were measured as having greater than 20 degrees of thoracolumbar Cobb angle on the last follow-up, or who underwent kyphotic progression of thoracolumbar Cobb angle greater than 10 degrees from the immediate postoperative state to final follow-up, or who had overt instrument failure with/without additional surgery. We assessed the risk factors that affected the unfavorable radiologic outcomes. Results : We had 43 patients with unfavorable radiologic outcomes, including 35 abnormal thoracolumbar alignments and 14 instrumental failures with/without additional surgery. The multivariate logistic regression test showed that immediate postoperative T-L junction Cobb angle less than 10.5 degrees was a statistically significant risk factor, as well as the presence of osteoporosis (p=0.017 and 0.049, respectively). Conclusion : Insufficient correction of thoracolumbar kyphosis was considered to be a major factor of an unfavorable radiological outcome. The spinal surgeon should consider that having a T-L junction Cobb angle larger than 10.5 degrees immediately after surgery could result in an unfavorable radiological outcome, which is related to a poor clinical outcome.

• 대한기계학회논문집B
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• 제35권12호
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• pp.1301-1307
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• 2011

슬관절 소작용 완드(Electrosurgical Knee Wand, EKW)는 고주파 소작법으로 슬관절 인대, 조직 등의 응고, 삭마, 절제, 등에 적용된다. EKW와 radiofrequency를 이용한 조직응고, 삭마 등의 슬관절 수술에서 수술안전성, 편의성 및 성공률을 극대화하기 위해서는 병변에 매우 정확하고 안전하게 EKW가 선택적 접근을 할 수 있도록 유도하는 탁월한 방향조종제어능이 핵심기술이다. 따라서 본 연구에서는 대퇴경골부 제한적인 공간에서 가장 적합한 수술용 의료기기 액추에이터로 판단되는 형상기억합금(SMA) 와이어를 이용하여 형상기억효과를 극대화 할 수 있는 SMA 인장스프링 모델을 제작하여 실험을 수행하였다. 또한 SMA의 열전기적 특성 및 전류변화에 따른 온도특성에 대한 연구를 수행하고 SMA 인장스프링의 설계조건에 따른 회복력 및 행정거리의 관계를 평가하였다. 그 결과, SMA 인장스프링의 직경이 작아질수록 최대온도는 증가하였다. 전류인가 15초의 경우는 전류량 증가와 힘의 증가가 비례한 반면, 전류인가 30초는 매우 불안정한 결과가 나타났다. 반면, 전류량 증가와 행정거리(TS) 증가 관계는 전류인가 15초일 때가 전류인가 30초일 때보다 더 안정적인 결과가 나타났다.

• Journal of Korean Neurosurgical Society
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• 제62권4호
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• pp.450-457
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• 2019

Objective : Anterior cervical discectomy and fusion (ACDF) is commonly used surgical procedure for cervical degenerative disease. Among the various intervertebral spacers, the use of allografts is increasing due to its advantages such as no harvest site complications and low rate of subsidence. Although subsidence is a rare complication, graft collapse is often observed in the follow-up period. Graft collapse is defined as a significant graft height loss without subsidence, which can lead to clinical deterioration due to foraminal re-stenosis or segmental kyphosis. However, studies about the collapse of allografts are very limited. In this study, we evaluated risk factors associated with graft collapse. Methods : We retrospectively reviewed 33 patients who underwent two level ACDF with anterior plating using allogenous bone graft from January 2013 to June 2017. Various factors related to cervical sagittal alignment were measured preoperatively (PRE), postoperatively (POST), and last follow-up. The collapse was defined as the ratio of decrement from POST disc height to follow-up disc height. We also defined significant collapses as disc heights that were decreased by 30% or more after surgery. The intraoperative distraction was defined as the ratio of increment from PRE disc height to POST disc height. Results : The subsidence rate was 4.5% and graft collapse rate was 28.8%. The pseudarthrosis rate was 16.7% and there was no association between pseudarthrosis and graft collapse. Among the collapse-related risk factors, pre-operative segmental angle (p=0.047) and intra-operative distraction (p=0.003) were significantly related to allograft collapse. The cut-off value of intraoperative distraction ${\geq}37.3%$ was significantly associated with collapse (p=0.009; odds ratio, 4.622; 95% confidence interval, 1.470-14.531). The average time of events were as follows: collapse, $5.8{\pm}5.7months$; subsidence, $0.99{\pm}0.50months$; and instrument failure, $9.13{\pm}0.50months$. Conclusion : We experienced a higher frequency rate of collapse than subsidence in ACDF using an allograft. Of the various preoperative factors, intra-operative distraction was the most predictable factor of the allograft collapse. This was especially true when the intraoperative distraction was more than 37%, in which case the occurrence of graft collapse increased 4.6 times. We also found that instrument failure occurs only after the allograft collapse.

• 한국동물위생학회지
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• 제45권4호
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• pp.325-330
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• 2022

Distichiasis is one of the diseases commonly encountered in companion animals, and these abnormal eyelashes cause corneal ulcers, continuous eye irritation, eye pain, glare, epiphora, foreign body sensation and can cause corneal opacity and vision loss in severe cases. In this study, an eyelash epilation needle for animals was developed and applied to a real case, and the results were observed. In a case of corneal ulcer caused by distichiasis of a 2-year-old Shih Tzu, a high-frequency surgical instrument for animals was converted into an electric epilation needle to attempt a procedure to destroy the eyelash hair follicles on the upper eyelid. A epilation needle was developed to have a diameter of 0.1 mm and a length of 4 mm at the end of the handle of DOCTANZ 400, an electrosurgical instrument for animals only. In the procedure, 2~3 mm of an epilation needle was inserted into the hair follicle, and 1 watt of electric power was applied to the hair follicle for about 5 sec. to carry out electrolysis until white bubbles were generated around the meibomian glands thereby destroying the hair follicle. As a result, no eyelashes grew any longer in the treated area indicating that the treatment was successful. It is hoped that the method developed in this study will be applied so that it will be widely used as a treatment method for distichiasis in companion animals that can be frequently seen hereafter.

• Journal of Korean Neurosurgical Society
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• 제30권11호
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• pp.1314-1319
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• 2001

Objects : Because of the nonspecific nature of symptoms in tuberculous spondylitis, a delay in the diagnosis can result in progressive neurologic deficits. The authors evaluate the clinical and the radiological results of the 10 cases of surgically treated tuberculous spondylitis. Clinical materials & Methods : We retrospectively analyzed the medical records of 10 patients with tuberculous spondylitis who were treated between February 1996 and March 2000. Six patients were female, and four were male. Mean age was 43 years old, and mean follow-up period was 20.5 months. All patients were treated with 12 months of antituberculous medication postoperatively, and were followed by complete blood count, ESR, spine X-ray and MRI. Results : The lumbar spine was involved in 5 patients, the thoracic in 4, and the thoracolumbar in one. The infected vertebral bodies were 2.8 in average. The associated lesions were pulmonary tuberculosis in 3 cases, and renal tuberculosis in one. Five patients were treated by anterior debridement and fusion with bone graft using anterior instrumentation, 2 with anterior debridement and fusion with bone graft(Hong Kong procedure only), 1 with Hong Kong procedure with posterior spinal instrumentation, and 2 were managed with posterior debridement and posterior spinal instrumentation. All patients improved after operation, and the average kyphotic angle decreased postoperatively. Postoperatively, one patient had a fistula at the operative site. Conclusion : The debridement and minimal level fusion of motion segment with instrument fixation is one of surgical option for tuberculous spondyltis to preserve the spine motion segment as much as possible. Spine instability and kyphosis were prevented by anterior and posterior spinal instrumentation. But, large number of cases and longer period follow-up study in future will be needed to confirm the long term results.

• Journal of Korean Neurosurgical Society
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• 제63권2호
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• pp.237-247
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• 2020

Objective : Fixation of the C1-2 segment is challenging because of the complex anatomy in the region and the need for a high degree of accuracy to avoid complications. Preoperative 3D-computed tomography (CT) scans can help reduce the risk of complications in the vertebral artery, spinal cord, and nerve roots. However, the patient may be susceptible to injury if the patient's anatomy does not match the preoperative CT scans. The intraoperative 3D image-based navigation systems have reduced complications in instrument-assisted techniques due to greater accuracy. This study aimed to compare the radiologic outcomes of C1-2 fusion surgery between intraoperative CT image-guided operation and fluoroscopy-guided operation. Methods : We retrospectively reviewed the radiologic images of 34 patients who underwent C1-2 fusion spine surgery from January 2009 to November 2018 at our hospital. We assessed 17 cases each of degenerative cervical disease and trauma in a study population of 18 males and 16 females. The mean age was 54.8 years. A total of 139 screws were used and the surgical procedures included 68 screws in the C1 lateral mass, 58 screws in C2 pedicle, nine screws in C2 lamina and C2 pars screws, four lateral mass screws in sub-axial level. Of the 34 patients, 19 patients underwent screw insertion using intraoperative mobile CT. Other patients underwent atlantoaxial fusion with a standard fluoroscopy-guided device. Results : A total of 139 screws were correctly positioned. We analyzed the positions of 135 screws except for the four screws that performed the lateral mass screws in C3 vertebra. Minor screw penetration was observed in seven cases (5.2%), and major pedicle screw penetration was observed in three cases (2.2%). In one case, the malposition of a C2 pedicle screw was confirmed, which was subsequently corrected. There were no complications regarding vertebral artery injury or onset of new neurologic deficits. The screw malposition rate was lower (5.3%) in patients who underwent intraoperative CT-based navigation than that for fluoroscopy-guided cases (10.2%). And we confirmed that the operation time can be significantly reduced by surgery using intraoperative O-arm device. Conclusion : Spinal navigation using intraoperative cone-beam CT scans is reliable for posterior fixation in unstable C1-2 pathologies and can be reduced the operative time.

• 대한치과보철학회지
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• 제37권4호
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• pp.433-453
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• 1999

There are a lot of elements affecting the success of implant prosthesis. The quality of surgical procedure is considered as one of the key factors. To avoid the excess heat generation is an important element of successful osseointegration and it can be achieved by using a gentle surgical technique with a sharp instrument in bone drilling. This study was performed to measure and analyze comparatively the heat transmitted to sur-rounding bone at a distance of 0.5mm from the periphery of the drill hole in each drilling stage. The results were as follows. In standard system, the temperature of surrounding bone tissue ranged from $29.2^{\circ}C\;to\;48.3^{\circ}C$ with irrigation and from $34.6^{\circ}C\;to\;84.3^{\circ}C$ without irrigation. And in wide system, the temperature of surrounding bone tissue ranged from $29.5^{\circ}C\;to\;52.5^{\circ}C$ with irrigation and from $34.8^{\circ}C\;to\;87.8^{\circ}C$ without irrigation. And the temperature ranges exceeded the threshold without irrigation, while showing less than the threshold by the cooling effect of irrigation. In comparing standard system with wide system, although there was no significant difference, ${\phi}4.3mm$ pilot and ${\phi}4.3mm$ twist drill of wide system showed high value and wide system showed slightly high elevation of temperature in all depth in fixture installation. In the finite element analysis, the calculated value by the Fourier's cooling law were applied to the bone drilling surface. And through analysis using different irrigation temperatures at $28^{\circ}C,\;15^{\circ}C\;and\;5^{\circ}C$, and according to the time. The result was that the cooling water at least below $15^{\circ}C$ was required to maintain the temperature of surrounding bone less than threshold in bone drilling, the cooling water below $5^{\circ}C$ was required to gain more sufficient cooling effect, and cooling over 5 seconds was needed after bone drilling for sufficient effect.

• Journal of Korean Neurosurgical Society
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• 제30권2호
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• pp.201-206
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• 2001

Objective : The purpose of this study was to assess the complications, duration of admission, cost effectiveness, radiologic stabilization of the anterior cervical bone fusion in the treatment of cervical disc disease with and without plating. Materials and Methods : Fifty-two surgically treated patients for cervical disc disease were reviewed. Group I consisted of consecutive treated patients with iliac auto-bone graft without instrumentation after anterior cervical discectomy. Group II consisted of consecutive treated patients with iliac autologous-bone graft with CASPER cervical plate fixations. Radiologic fusion was decided when loss of end plate boundary between graft bone and vertebral body and immobile, maintenance of the disc space were evident on simple dynamic plain films. The patients were discharged after the stabilization of cervical motion by films was of tained. These groups were analysed multiple variably with Mann-Whitney U-test. Results : Group I consisted of 18 patients, group II consisted of 34 patients. Mean age was $49.0{\pm}8.1years$, mean duration of admission was $17.27{\pm}10.51days$, mean costs for treatment was $1,970,000{\pm}475,000won$. In group I, mean age was 47.7(34-60) years, 16 patients had undergo on one-level operation, 2-patients had undergo on two-level operation, mean duration of admission was $28.7{\pm}10.4days$, mean costs for treatment was $2,194,473{\pm}561,639won$. The periods of stabilization was $6.6{\pm}3.36weeks$ on radiologic study. Mean periods of out patient follow up was 16.8(6-64) weeks after discharge. Mean period of radiologic follow up was 17.3(4-6) weeks after surgical operation. In group II, mean age was 49.7(37-62) years and 18 patients one-level operation, 14- patients had undergo on two-level operation and 2-patients three-level operation. Mean duration of admission was $11.24{\pm}3.29days$, mean costs for treatment was $1,850,823{\pm}389,372won$. The periods of stabilization was $5.88{\pm}7.07weeks$ on radiologic study. Mean period of out patients follow up was 16.7(4-60) weeks after discharge. Mean period of radiologic follow up was 12.4(3-52) weeks after surgical operation. The duration of admission showed statistical significance in Group II but other items showed no significant difference between two groups. Conclusions : The more economic, early life return and effective method of cervical disc disease in our series were evident in patients who had undergone, iliac bone graft and plate fixations after anterior discectomy.

• 간호행정학회지
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• 제6권1호
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• pp.19-29
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• 2000

The purpose of this study was to analyze the relationship and the importance of relevant variables among structure, process, and outcome dimensions of nursing department in hospitals. The subject for this study was the registered nurses(N=400) working in medical, intensive care, and surgical units at 5 general hospitals with more than 500beds in Chungnam and Chungbuk. The research design was cross-sectional correlation among the variables based on their self description. The survey instrument was based on eleven structured questionnaires. The data were collected from April 26 to May 26, 1999. The SPSS/PC+ program and LISREL 8.12a program were used to analyze the data. Based on the data collected, the following results were obtained. The relationship among structural, procedural, and outcome dimensions 1. Structural dimension had a relationship with procedural dimension relating to decision-making of caregiving and working conditions, in particular, participation of the problem identification. 2. The extent of participation in decision-making had a relationship with organizational commitment and group effectiveness through the selection process among the total decision-making processes. 3. The structural dimension had a large direct effect rather than indirect effect through decision making processes on organizational commitment and group effectiveness. The relationship of structure, process, outcome dimensions was partially supported by this study. The information obtained from surveys in the field form the basis for the following recommendations for improving organizational effectiveness with in the nursing department in an hospitals. 1) Establishment of decentralized structure, environment, and culture in organizational settings would be desirable so that their members may actively participate in decision-making process. 2) Continuous education and training of nurses with theoretical Knowledge and skill of decision making, practical knowledge, and upright role perception should be highly emphasized for persons in nursing schools and in on-the-job training.