• Title/Summary/Keyword: Spine

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The present condition analysis of patients who transferred to the emergency room by 119 Rescue service at night - Focused on the Emergency Center of Chonnam National University Hospital - (119 구급대를 이용하여 야간에 응급실로 내원한 환자 현황 분석 - 전남대학교병원 응급의료센터를 중심으로 -)

  • Yoon, Jonggun;Kim, Gunnam;Kim, Kyungwan;Jeong, Yongtae
    • The Korean Journal of Emergency Medical Services
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    • v.8 no.1
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    • pp.117-126
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    • 2004
  • In general, the patients who transferred to the hospital by 119 rescue service at night go to the emergency room(ER) of general hospital rather than that of their nearby the 1st(clinic) and 2nd(local hospital) hospital. And the hospital is mainly selected not by 119 EMST but by patients or his/her conservators. Therefore we had studied retrospectively with emergency situation diary and medical chart for 697 patients of being transferred to one emergency medical center for 6 months since January 2004, and results are as follows. 1. The 280 patients(42.5%) of being transferred hospital at night by 119 rescue service were not emergency case and their average staying time in hospital was about $7.15{\pm}10.06$ minutes. 2. Transfer time was distributed in each time intervals of 1819, 2021, 2223, and 2401 and patients ratio in each intervals were 15.1%, 17.8%, 16.4%, and 15.2%. 3. In response of ambulance, the average time from the spot to the hospital was $14.53{\pm}9.27min$. and average distance of that was $7.95{\pm}9.21km$. 4. Diseases rather than traffic accidents or traumatic injury were main causes of ambulance calling and its value was 533(76.5%), and accidents were mainly occurred in patients' house and its value was 479(68.7%). 5. In time of transfer by 119 rescue service, hospital was mainly selected by patient/conservator and its value was 648(93.0%). In result. the hospital was selected not by EMST but by patient/conservator. 6. The case that the 1st grade EMT was rode in ambulance was 161(23.1%), and the case that 2nd EMT and emergency team member who educated for emergency were rode in ambulance were 504(72.3%). So the number of the 1st grade EMT was short in fire station of Kwangju metropolitan city than other city. 7. The first aids for patients before reaching hospital were limited to oxygen inhalation, airway control, and BLS for maintaining limbs and spine. So it seems to be a simple patients transfer. Consequently, to establish an efficient emergency medical system, it has been thought that it should be advanced a moderate education and public information about the appropriate use of emergency medical system toward citizen, and also need the hospital selection by the patients categorizing standards for 119 rescue service member, securing the 1st grade EMT, appropriate first-aids education, and securing professional human power in emergency room of the Ist(clinic) and 2nd(local hospital) hospital at night.

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A Comparison between Postmenopausal Osteoporotic Women and Normal Women of Their Nutrient Intakes and the Evaluation of Diet Quality (폐경 후 골다공증 여성과 정상 여성의 영양소 섭취상태와 식사의 질 평가에 관한 비교 연구)

  • Bae Yun-Jung;Sung Chung-Ja
    • Korean Journal of Community Nutrition
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    • v.10 no.2
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    • pp.205-215
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    • 2005
  • The purpose of this study was to compare the nutrient intake and diet quality of postmenopausal osteoporotic women to those of control subjects, and to investigate the relationship among diet quality and bone mineral density in postmenopausal women. In this study, we classified the subjects into the postmenopausal osteoporotic women (n =38) and control (n = 43) according to their lumbar spine bone mineral density and age. Dietary intakes, anthropometric measurements and dietary quality indices were measured and evaluated. The average age of osteoporotic and control group were 60.4 yrs and 58.3 yrs, respectively and there was no significant difference. Body weight, body mass index of osteoporotic group were significantly lower than those of control group. The average energy intake of osteoporotic and control group were 1243.3 kcal and 1475.8 kcal, respectively and there was a significant difference. The osteoporotic group consumed significantly lower quantities of protein, plant protein, vitamin A, vitamin $B_1,\;vitamin\;B_2$, folate, vitamin C, calcium, animal calcium, plant calcium, iron and zinc compared to the control group. The osteoporotic group consumed significantly lower of food, vegetables, mushrooms, fruits intakes compared to the control group. In the diet quality, protein, vitamin A, vitamin $B_1,\;vitamin\;B_2$, folate, vitamin C, calcium, iron, Zinc nutrient adequacy ratio (NAR) of osteoporotic group were significantly lower than that of control group. Mean adequacy ratio (MAR) of osteoporotic and control group were 0.63 and 0.78, respectively and there was significant difference. To evaluate nutrient density, Index of nutritional quality (INQ) was calculated by dividing nutrient content per 1,000 kcal of diet with RDA per 1,000 kcal. The average dietary variety score (DVS) of osteoporotic and control group were 22.4 and 33.2, respectively and there was significant difference. DVSs of pulses (p<0.01), seeds (p<0.01) and vegetables (p<0.05) in osteoporotic group were significantly lower than those of the control. In conclusion, postmenopausal osteoporotic women had lower protein, vitamin A, folate, vitamin C, calcium, iron zinc intake quality and vegetables, mushrooms, fruits DVSs than those of the control. Therefore, to promote skeletal health enough energy and food should be consumed, and the maintenance of vitamin and mineral balance by increasing of vitamin A, folate, vitamin C, calcium, iron of intakes are very important.

Characteristic MRI Findings of Spinal Metastases from Various Primary Cancers: Retrospective Study of Pathologically-Confirmed Cases (다양한 원발성 암의 척추전이 병변의 특징적인 자기공명영상 소견들: 병리학적으로 확인된 병변들의 후향적인 분석)

  • An, Chansik;Lee, Young Han;Kim, Sungjun;Cho, Hee Woo;Suh, Jin-Suck;Song, Ho-Taek
    • Investigative Magnetic Resonance Imaging
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    • v.17 no.1
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    • pp.8-18
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    • 2013
  • Purpose : The purpose of this study was to find and categorize the various magnetic resonance imaging (MRI) findings of spinal metastases that correlate with the type of primary cancer. Materials and Methods: We retrospectively reviewed gadolinium-enhanced magnetic resonance images of 30 patients with 169 spinal metastatic lesions from lung cancer (n = 56), breast cancer (n = 29), colorectal cancer (n = 20), hepatocellular carcinoma (HCC) (n = 17), and stomach cancer (n = 47). The size, location, extent of invasion, signal intensity, margin, enhancement pattern, and osteoblastic or osteolytic characteristics of each metastatic tumor were analyzed. Results: The metastatic lesions from HCC were larger than those from the other primary tumors (P < 0.05) except for colorectal cancer (P = 0.268). Well-defined metastatic tumor margins were more frequently seen in lung cancer and breast cancer (P < 0.01). All but HCC showed a tendency to invade the vertebral body rather than the posterior elements (P < 0.02). Colorectal cancer and HCC showed a tendency toward extraosseous invasion without statistical significance. HCC showed a characteristic enhancement pattern of 'worms-in-a-bag'. Rim enhancement with a sclerotic center was only seen in spinal metastases from stomach cancer. Conclusion: Despite many overlapping imaging features, spinal metastases of various primary tumors display some characteristic MRI findings that can help identify the primary cancer.

Spinal Fusion Based on Ex Vivo Gene Therapy Using Recombinant Human BMP Adenoviruses (사람 골 형성 단백질 Ex vivo 유전자 치료법을 이용한 척추 유합)

  • Kim, Gi-Beom;Kim, Jae-Ryong;Ahn, Myun-Hwan;Seo, Jae-Sung
    • Journal of Yeungnam Medical Science
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    • v.24 no.2
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    • pp.262-274
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    • 2007
  • Purpose : Bone morphogenetic proteins (BMPs) play an important role in the formation of cartilage and bone, as well as regulating the growth of chondroblasts and osteoblasts. In this study, we investigated whether recombinant human BMP adenoviruses are available for ex vivo gene therapy, using human fibroblasts and human bone marrow stromal cells in an animal spinal fusion model. Materials and Methods : Human fibroblasts and human bone marrow stromal cells were transduced with recombinant BMP-2 adenovirus (AdBMP-2) or recombinant BMP-7 adenovirus (AdBMP-7), referred to as AdBMP-7/BMSC, AdBMP-2/BMSC, AdBMP-7/HuFb, and AdBMP-2/HuFb. We showed that each cell secreted active BMPs by alkaline phosphatase staining. Since AdBMP-2 or AdBMP-7 tranducing cells were injected into the paravertebral muscle of athymic nude mice, at 4 weeks and 7 weeks, we confirmed that new bone formation occurred by induction of spinal fusion on radiographs and histochemical staining. Results : In the region where the AdBMP-7/BMSC was injected, new bone formation was observed in all cases and spinal fusion was induced in two of these. AdBMP-2/BMSC induced bone formation and spinal fusion occurred among one of five. However, in the region where AdBMP/HuFb was injected, neither bone formation nor spinal fusion was observed. Conclusion : The osteoinductivity of AdBMP-7 was superior to that of AdBMP-2. In addition, the human bone marrow stromal cells were more efficient than the human fibroblasts for bone formation and spinal fusion. Therefore, the results of this study suggest that AdBMP-7/BMSC would be the most useful approach to ex vivo gene therapy for an animal spinal fusion model.

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Direct Pars Repair Surgery Using Two Different Surgical Methods : Pedicle Screw with Universal Hook System and Direct Pars Screw Fixation in Symptomatic Lumbar Spondylosis Patients

  • Shin, Myung-Hoon;Ryu, Kyeong-Sik;Rathi, Nitesh Kumar;Park, Chun-Kun
    • Journal of Korean Neurosurgical Society
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    • v.51 no.1
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    • pp.14-19
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    • 2012
  • Objective : The authors performed a retrospective study to assess the clinical and radiological outcome in symptomatic lumbar spondylolysis patients who underwent a direct pars repair surgery using two different surgical methods; pedicle screw with universal hook system (PSUH) and direct pars screw fixation (DPSF), and compared the results between two different treated groups. Methods : Forty-seven consecutive patients (PSUH; 23, DPSF; 15) with symptomatic lumbar spondylolysis who underwent a direct pars repair surgery were included. The average follow-up period was 37 months in the PSUH group, and 28 months in the DPSF group. The clinical outcome was measured using visual analogue pain scale (VAS) and Oswestry disability index (ODI). The length of operation time, the amount of blood loss, the duration of hospital stay, surgical complications, and fusion status were also assessed. Results : When compared to the DPSF group, the average preoperative VAS and ODI score of the PSUH group were less decreased at the last follow-up; (the PSUH group; back VAS : 4.9 vs. 3.0, leg VAS : 6.8 vs. 2.2, ODI : 50.6% vs. 24.6%, the DPSF group; back VAS : 5.7 vs. 1.1, leg VAS : 6.1 vs. 1.2, ODI : 57.4% vs. 18.2%). The average operation time was 174.9 minutes in the PSUH group, and 141.7 minutes in the DPSF group. The average blood loss during operation was 468.8 cc in the PSUH group, and 298.8 cc in the DPSF group. The average hospital stay after operation was 8.9 days in the PSUH group, and 7 days in the DPSF group. In the PSUH group, there was one case of a screw misplacement requiring revision surgery. In the DPSF group, one patient suffered from transient leg pain. The successful bone fusion rate was 78.3% in the PSUH group, and 93.3% in the DPSF group. Conclusion : The present study suggests that the technique using direct pars screw would be more effective than the method using pedicle screw with lamina hook system, in terms of decreased operation time, amount of blood loss, hospital stay, and increased fusion success rate, as well as better clinical outcome.

Vertebral Distraction during Anterior Cervical Discectomy and Fusion Causes Postoperative Neck Pain

  • Ha, Seung Man;Kim, Jeong Hoon;Oh, Seung Hun;Song, Ji Hwan;Kim, Hyoung Ihl;Shin, Dong Ah
    • Journal of Korean Neurosurgical Society
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    • v.53 no.5
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    • pp.288-292
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    • 2013
  • Objective : Vertebral distraction is routinely performed during anterior cervical discectomy and fusion (ACDF). Overdistraction can injure the facet joints and may cause postoperative neck pain consequently. The purpose of this study was to investigate the clinical relevance of distraction force during ACDF. Methods : This study included 24 consecutive patients with single level cervical disc disease undergoing single level ACDF. We measure the maximum torque just before the the arm of the Caspar retractor was suspended by the rachet mechanism by turning the lever on the movable arm using a torque meter. In order to turn the lever using the torque driver, we made a linear groove on the top of the lever. We compared the neck disability index (NDI) and visual analogue scale (VAS) scores between the high torque group (distraction force>6 $kgf{\cdot}cm$) and the low torque group (distraction force${\leq}6kgf{\cdot}cm$) at routine postoperative intervals of 1, 3, 5 days and 1, 3, 6 months. Results : The VAS scores for posterior neck pain had a linear correlation with torque at postoperative 1st and 3rd days ($y=0.99{\times}-1.1$, $r^2=0.82$; $y=0.77{\times}-0.63$, $r^2=0.73$, respectively). VAS scores for posterior neck pain were lower in the low torque group than in the high torque group on both 1 and 3 days postoperatively ($3.1{\pm}1.3$, $2.6{\pm}1.0$ compared with $6.0{\pm}0.6$, $4.9{\pm}0.8$, p<0.01). However, the difference in NDI scores was not statistically significant in all postoperative periods. Conclusion : Vertebral distraction may cause posterior neck pain in the immediate postoperative days. We recommend not to distract the intervertebral disc space excessively with a force of more than 6.0 $kgf{\cdot}cm$.

Rutin Improves Bone Histomorphometric Values by Reduction of Osteoclastic Activity in Osteoporosis Mouse Model Induced by Bilateral Ovariectomy

  • Lee, Hye-Hwa;Jang, Jae-Won;Lee, Jung-Kil;Park, Choon-Keun
    • Journal of Korean Neurosurgical Society
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    • v.63 no.4
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    • pp.433-443
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    • 2020
  • Objective : Osteoporosis is a disease of unbalanced bone metabolism that results in low bone mineral density with increased bone fragility and propensity for fractures. The increased rate of bone fracture due to osteoporosis places a significant burden on public health care expenditures. Therefore, numerous studies have been designed and performed to identify the drugs or health foods that can improve the bone quality or quantity. This study was designed to evaluate and analyze the therapeutic effects of rutin on histomorphometric values of the spine and femur in an osteoporotic mouse model induced by bilateral ovariectomy. Methods : Thirty female ICR mice (8 weeks old) underwent either a sham operation (only abdominal incision, sham group, n=10) or bilateral ovariectomy (n=20). The ovariectomized (OVX) animals were randomly divided into two groups : untreated OVX group (OVX-C, n=10), or rutin-administered group (OVX-R, n=10). The OVX-C group received weight-adjusted doses of saline vehicle and the OVX-R group received 50 mg/kg of rutin intraperitoneally, starting 1 day after surgery. At 4 and 8 weeks after surgery, serum estrogen, osteocalcin, alkaline phosphatase (ALP), and the telopeptide fragment of type I collagen C-terminus (CTX-1) were analyzed. Interleukin (IL)-1β, IL-6, IL-10, and tumor necrosis factor (TNF)-α were also analyzed. Bone histomorphometric parameters of the 4th lumbar vertebra and femur were determined by micro-computed tomography. Results : In OVX-C group, ALP, osteocalcin, CTX-1, IL-1β, IL-6, and TNF-α levels were significantly increased at 4 and 8 weeks compared to sham operation group. Rutin administration after OVX statistically significantly reduced ALP, CTX-1, IL-1β, IL-6, and TNF-α levels at 4 and 8 weeks. Rutin administration also improves bone histomorphometric parameters including trabecular bone volume fraction, trabecular thickness, and trabecular number. Trabecular separation was also decreased in OVX-R group compared to OVX-C group. Conclusion : The present study demonstrated that rutin has therapeutic effects on improving bone histomorphometric values in an OVX mouse model. The improvement in histomorphometric values may be associated with the reduction of osteoclastic activity via inhibition of IL-1β, IL-6, and TNF-α. In future studies, the mechanism for the effect of rutin on osteoporosis should be demonstrated more clearly to use rutin in human osteoporosis.

AN EXPERIMENTAL STUDY ON THE EFFECT OF THE MANDIBULAR RETRACTIVE FORCE ON THE MANDIBULAR CONDYLE OF GROWING YOUNG DOG (하악 후방 견인력이 성장기 유견의 하악과두에 미치는 영향에 관한 실험적 연구)

  • Lim, Yong-Kyu;Yang, Won-Sik
    • The korean journal of orthodontics
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    • v.20 no.2
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    • pp.363-379
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    • 1990
  • The purpose of this study was to evaluate the effects of the mandibular retractive force on the mandibular condyle of growing dog. The experimental animals were six mongrel dogs of two-month old. Their deciduous dentition were completed. Two of them was used as control group, and experimental group was composed of remaining four. Head band and chin cup were made of cotton tape, and hooks are fabricated on the chin cup and had band for closed coil. Mandibular retractive force was 100g/side and chin cap appliance was used for 14 hours/day during night. Experimental group were sacrificed at 2, 4, 6, 8 weeks from beginning of the experiment. Right TMJ was prepared for histologic study and left TMJ was examined grossly for disc, fossa, and condyle. The conclusions are: 1. Two-month old control animal showed active cartilaginous growth on the mandibular condyle, therefore showed thick proliferative and hypertrophic zones. Remodeling process in the condyle head was observed in which there were bone resorption on the anterior surface and bone apposition on the posterior surface. 2. Four-month old control animal showed marked reduction of hypertrophic zone but the condylar bone remodeling was more pronounced. 3. In experimental group, there are marked reduction of hypertrophic zone at 4 weeks from beginning of experiment, and hypertrophic zone disappeared at posterior-superior portion of condyle in 6-week experimental animal. 8 week experimental animal showed slight recovery of hypertrophic zone. 4. In experimental group, bone deposition was increased at anterior surface of condyle, and bone resorption was increased at posterior surface of condyle. 5. In control group, the glenoid fossa and surrounding bone showed mainly bone apposition. But experimental group showed bone resorption at anterior surface of articular eminence and increased bone apposition at posterior surface of postglenoid spine. 6. No marked traumatic change was seen but 4 weeks and 8 weeks experimental animal showed flattening of posterior surperior condylar surface. Bone marrow of condyle showed minute focal bleeding in 2 weeks and 4 weeks experimental animal, and congestion and depression of hematopoietic bone marrow during all experimental period.

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An Analysis of Treatment and Economic Evaluation on the Part of Cervical HIVD Inpatients at Korean Medicine Hospital (한방병원에 입원한 경추 추간판 탈출증 환자의 치료 및 경제성 평가 연구)

  • Lee, Hyun-Jae;Jahng, Sun-Jeong;Heo, Dong-Seok
    • Journal of Korean Medicine Rehabilitation
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    • v.23 no.3
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    • pp.159-175
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    • 2013
  • Objectives Herniated Intervertebral Disc of C-spine is one of the most common diseases that causes posterior neck pain. This study was designed to analyze the general distribution and hospital cost by day and case of Korean medical treatment for Cervical Herniated Intervertebral Disc (HIVD). Methods The 132 impatients for treatment of HIVD were analyzed according to the distribution of sex, age, the duration of HIVD, the contributory factors, the Clinical grade at admission, the clinical findings at admission, the duration of hospitalization, the clinical grade at admission and the hospital cost per day and case. Results 1) The total hospital cost per case averaged 1,985,600 Won, which was consisted of room charge 584,044 Won (29.41%), performance fee 511,463 Won (25.76%), herbal medication 381,517 Won (19.21%), Korean medical physiotherapy 296,310 Won (14.92%), food expenses 199,997 Won (10.07%) in order. 2) The total hospital cost per day averaged 137,285 Won, which was consisted of room charge 39,036 Won (28.43%), performance fee 33,594 Won (24.47%), herbal medication 30,642 Won (22.32%), food expenses 12,870 Won (9.37%), and the average duration of hospitalization was 15.1 days. 3) There was statistically significant difference in the consultation fee, room charge, and herbal medication on the part of sex. 4) There was statistically significant difference not only in the performance and consultation on the part of duration of hospitalization but also the in the duration of average duration of hospitalization. 5) There was statistically significant difference in the Korean medical physiotherapy and herbal medication on the part of clinical findings. 6) There was statistically significant difference in the Korean medical physiotherapy and herbal medication on the part of duration of HIVD. 7) There was statistically significant difference in the Korean medical physiotherapy and herbal medication on the part of clinical outcome. 8) There was not only statistically significant difference in the performance, but also in the herbal medication on the part of clinical grade at admission. Conclusions This study provides plenty of information to design out the specific terms of Korean medical expenses of Cervical HIVD inpatients hospitalized at Korean medicine hospital.

Clinical Experience of the Dynamic Stabilization System for the Degenerative Spine Disease

  • Lee, Soo-Eon;Park, Sung-Bae;Jahng, Tae-Ahn;Chung, Chun-Kee;Kim, Hyun-Jib
    • Journal of Korean Neurosurgical Society
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    • v.43 no.5
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    • pp.221-226
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    • 2008
  • Objective : The aim of the present study was to assess the safety and efficacy of the dynamic stabilization system in the treatment of degenerative spinal diseases. Methods : The study population included 20 consecutive patients (13 females, 7 males) with a mean age of $61{\pm}6.98$ years (range 46-70) who underwent decompression and dynamic stabilization with the Dynesys system between January 2005 and August 2006. The diagnoses included spinal stenosis with degenerative spondylolisthesis (9/20, 45%), degenerative spinal stenosis (5/20, 25%), adjacent segmental disease after fusion (3/20, 15%), spinal stenosis with degenerative scoliosis (2/20, 10%) and recurrent intervertebral lumbar disc herniation (1/20, 5%). All of the patients completed the visual analogue scale (VAS) and the Korean version of the Oswestry Disability Index (ODI). The following radiologic parameters were measured in all patients : global lordotic angles and segmental lordotic angles (stabilized segments, above and below adjacent segments). The range of motion (ROM) was then calculated. Results : The mean follow-up period was $27.25{\pm}5.16$ months (range 16-35 months), and 19 patients (95%) were available for follow-up. One patient had to have the implant removed. There were 30 stabilized segments in 19 patients. Monosegmental stabilization was performed in 9 patients (47.3%), 9 patients (47.3%) underwent two segmental stabilizations and one patient (5.3%) underwent three segmental stabilizations. The most frequently treated segment was L4-5 (15/30, 50%), followed by L3-4 (12/30, 40%) and L5-S1 (3/30, 10%). The VAS decreased from $8.55{\pm}1.21$ to $2.20{\pm}1.70$ (p<0.001), and the patients' mean score on the Korean version of the ODI improved from $79.58%{\pm}15.93%$ to $22.17%{\pm}17.24%$ (p<0.001). No statistically significant changes were seen on the ROM at the stabilized segments (p=0.502) and adjacent segments (above segments, p=0.453, below segments, p=0.062). There were no patients with implant failure. Conclusion : The results of this study show that the Dynesys system could preserve the motion of stabilized segments and provide clinical improvement in patients with degenerative spinal stenosis with instability. Thus, dynamic stabilization systems with adequate decompression may be an alternative surgical option to conventional fusion in selected patients.