• The Korean Journal of Pain
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• v.9 no.1
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• pp.126-129
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• 1996

Background: Advantages of paramedian approach over midline approach include less tissue trauma and less dependence on patient's ability to assume a fetal position. When midline approach fails in patients who are difficult to take a position with lumbar spine flexed, paramedian approach to interlaminar space may succeed. Methods: Success rates of spinal anesthesia were measured for 47 flexed patients by midline approach, 48 flexed patients by paramedian approach, 23 straightened patients receiving spinal anesthesia by midline approach, and 23 straightened patients by paramedian approach. Results: Success rates in flexed patients were 100% by midline approach and 100% by paramedian approach. Success rates for straightened patients were 13.0% by midline approach and 78.3% by paramedian approach. For straightened patients there were no correlations between success fate and age, weight, Ponderal Index but there were correlations between height and midline approach of spinal anesthesia. Conclusion: Pertaining to adult Koreans, success rates of spinal anesthesia for strainghtened patients were less than those for flexed patients. Success rate of paramedian approach of spinal anesthesia among strainghtened patients were better than those of midline approach.

• Journal of Veterinary Clinics
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• v.30 no.1
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• pp.66-70
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• 2013

This report compared paramedian and flank approaches for the effective removal of abdominal unilateral cryptorchidism in calves. Two Korean native calves of approximately 300 kg in body weight, which had undergone the removal of a testis from the scrotum, were diagnosed as having abdominal unilateral (left) cryptorchidism by rectal palpation. One calf was administered with xylazine (0.2 mg/kg, IV) and was restrained in the dorsal recumbency position on the ground of barn for the paramedian approach, while the other calf was sedated with xylazine (0.03 mg/kg, IV) and restrained in the standing position for a flank approach. For the two calves, 2% lidocaine was administered by local infiltration, along the proposed incision line. Following incisions of the skin, muscle and peritoneum, the testis, which was located between the left kidney and inguinal canal, was grasped, exteriorized out of the abdominal cavity and detached from the gubernaculum testis. Then spermatic cord was ligated and cut. Finally, the testis was removed. An assistant was required to restraint a calf in dorsal recumbency for paramedian approach, and cryptorchidectomy was carried out with operator in a rather uncomfortable squatting posture, while restraint was rather simple and cryptorchidectomy was proceeded with operator in a standing posture where the flank approach was taken. During surgery, the gubernaculum testis was more strained during pulling the testis in the flank approach than in the paramedian approach, as the distance between incision site and the gubernaculum testis was greater in the flank approach than that in the paramedian approach. On the other hand, intra-abdominal pressure was greater in the paramedian approach than in the flank approach during surgery. The elapsed time between restraint and the end of surgery was 10 min shorter where the flank approach (35 min) was taken, than where the paramedian approach (45 min) was taken. In conclusion, this case study demonstrated that the flank approach might be more convenient than the paramedian approach for abdominal unilateral cryptorchidectomy in calves.

• Journal of Korean Neurosurgical Society
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• v.39 no.5
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• pp.366-369
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• 2006

Objective : There are various surgical approaches to far-lateral lesions in the L5-S1 intervertebral space. Of these is the validity of a paramedian tangential approach is being investigated in this study. Methods : A retrospective study was conducted on 25 patients who had been diagnosed as having a far-lateral L5-S1 disc herniations, osteophyte, costal process hypertrophy, and had undergone a paramedian tangential approach from November 1999 through December 2003. The degree of symptoms and improvement were compared via the visual analog pain scale, before and after surgery. Results : This study included 4 males and 21 females with a mean age of $62{\pm}11.8$ years old. The average follow-up period after surgery was $8.2{\pm}2.7$ months. The visual analog pain scale taken before surgery was $6.7{\pm}1.1$ points, while the post-surgical scale was $2.4{\pm}0.9$ points showing a significant degrease [p < 005]. There were no complications that developed during surgery. Conclusion : A paramedian tangential approach is less invasive in the soft tissue than that of the median approach. This approach may effectively reduce nerve root compression and expand intervertebral foramens, and is devoid of the risk of spinal instability after surgery. The authors suppose that a paramedian tangential approach is quite an effective technique to relive compression in the far-lateral L5-S1 intervertebral space.

• Journal of Veterinary Clinics
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• v.26 no.3
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• pp.282-285
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• 2009

A 10-year-old Paint horse was presented with gradual changes in behavior, characterized as stallion-like including aggressiveness towards people and other horse. The abnormal right ovary was detected via transrectal ultrasonography and rectal palpation. A complete blood count and biochemical panel values were within reference ranges. The hormone analysis revealed increased testosterone 46.00 pg/mL and inhibin 0.856 ng/mL, and progesterone concentration consistent with absence of luteal tissue 1.2 ng/mL more than normal values. The purpose of the study reported was to describe a ovariectomy of enlarged ovary by using the diagonal paramedian approach. This method is useful to minimize surgical exposure and hemorrhage. This ovary was confirmed fibroma by histological examination post operation. Behavior problems and the hormone values were alleviated after surgery, and clinical signs of complication were not showed.

• The Korean Journal of Pain
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• v.9 no.2
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• pp.349-353
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• 1996

Background: Although the paramedian approach for epidural blockade is useful in some clinical situation, the parameters which are correlated with the distance from skin to the epidural space has not been established. Methods: We studied in 143 patients having elective continuous epidural blocks for relief of postoperative pain. All blocks were performed using paramedian approach with Tuohy needle in the lumbar (group 1, n=100) and thoracic (group 2, n=45) area. We measured the distance from skin to the epidural space, body weight, height, and the angle between the shaft of the needle and the skin. Data were analyzed by linear regression. The relationships between parameters identified by the F-test with a P value of less than 0.05 were considered statistically significant. Results: The mean distance from skin to the lumbar epidural space was $4.4{\pm}0.7$ cm. significant correlation between the body weight and the depth of lumbar epidural space ($\gamma$ value : 0.492) was noted with regression equation of depth(cm)=2.293+0.034${\times}$body weight (kg). Also the significant correlation between the ponderal index (PI) and the depth of lumbar epidural space ($\gamma$ value : 0.539) was noted with regression equation of depth(cm)=1.703+0.07${\times}$PI, The mean distance from skin to the thoracic epidural space was $5.2{\pm}0.7cm$ which did not correlated with other anatomic measurements. Conclusion: We found that PI and body weight are the suitable predictors of the depth of the lumbar epidural space, but not the thoracic epidural space.

• Journal of Chest Surgery
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• v.16 no.2
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• pp.221-225
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• 1983

Morgagni, in 1760, 1st. described the findings of substernal herniation of abdominal contents into the thoracic cavity, based upon 25 postmortem dissections. Herniation through the foramen of Morgagni is the rarest occurrence of the congenital diaphragmatic hernias and is usually a few symptoms. With the increasing use of routine chest roentgenogram & the need to exclude the possibility of a mediastinal neoplasm, most such cases are brought to the attention of a surgeon. We had experienced 2 cases of Morgagni hernia, which one caused a simple mechanical intestinal obstruction & diagnosed as acute appendicitis with perforation & another one was diagnosed as mediastinal lipoma on routine chest X-ray film at arrival due to traffic accident. We had performed left paramedian abdominal incision as misdiagnosis of acute appendicitis with perforation and repair of the defect and returned transverse colon & stomach into abdominal cavity in one patient. And in another patient, we preferred to approach through right thoracotomy incision and then left upper paramedian abdominal incision and returned the omentum into the abdominal cavity. The post-operative courses were in uneventful and we report these cases and review and discuss the literatures.

• Journal of Veterinary Clinics
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• v.16 no.1
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• pp.95-99
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• 1999

돼지 심장의 해부학적 구조에 대해서는 많은 연구가 보고되어 있으나 흉골 정중선 절개와 방정중선 절개 후 절개선에 나타나는 돼지 심장 대혈관들의 외과적 해부구조에 대한 보고는 아직 없고 심장적출 및 수술에 외과적 해부구조의 숙지가 필수적이므로, 체중 15kg - 25kg의 돼지 12마리를 4마리씩 3군, 즉 정중선절개군, 우측방정중선절개군, 좌측방정중선절개군으로 나누어 흉골열개 후 나타난 심장 대혈관들의 육안적 외과구조를 보고하고 심장적출술을 시도해 각 수술절개 접근법에 따른 수술의 용이성을 관찰하여 더 나은 수술접근법을 선택하는데 필요한 정보를 제공하고자 본 실험을 실시하였다. 그 결과, 우측과 좌측 방정중선절개법에 의해 흉골을 완전 열개시에는 제 1흉골과 갑상연골 부위에서 정중선으로 접근하는 초승달형 절개를 통해 internal mammary artery의 절개 위험성을 피할 수 있음을 발견하였고 흉골정중선절개에서는 상행대동맥의 정 중앙부에 aortic cannula를 쉽게 장착할 수 있었고 특히 비숙련자에게 더 적절한 수술 방법임을 알 수 있었다. 한편 숙련자가 심장적출이 아닌 동맥관개존증등과 같은 심장수술의 경우에는 방 정중선절개로써 환축의 수술 후 통증을 감소시키고 조기치유가 가능하다면, 초승달형 절개법을 응용한 방정중선 절개를 권할 수 있고 이에 따른 임상적 관찰이 요구되는 바이다.

• Journal of Korean Neurosurgical Society
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• v.59 no.2
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• pp.143-148
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• 2016

Objective : We evaluated postoperative outcomes in patients who have lumbar foraminal or extraforaminal disc herniation (FELDH) and suggested the risk factors for poor outcomes. Methods : A total of 234 patients were selected for this study. Pre- and post-operative Visual Analogue Scale (VAS) and Korean version Oswestry Disability Index (KODI) were evaluated and the changes of both score were calculated. Outcome was defined as excellent, good, fair, and poor based on Mcnab classification. The percentage of superior facetectomy was calculated by using the Maro-view 5.4 Picture Archiving Communication System (PACS). Results : Paramedian lumbar discectomy was performed in 180 patients and combined lumbar discectomy was performed in 54 patients. Paramedian lumbar discectomy group showed better outcome compared with combined discectomy group. p value of VAS change was 0.009 and KODI was 0.013. The average percentage of superior facetectomy was 33% (range, 0-79%) and it showed negative correlation with VAS and KODI changes (Pearson coefficient : -0.446 and -0.498, respectively). Excellent or good outcome cases (Group I) were 136 (58.1%) and fair or poor outcome cases (Group II) were 98 (41.9%). The percentage of superior facetectomy was 26.5% at Group I and 42.5% at Group II. There was significant difference in superior facetectomy percentage between Group I and II (p=0.000). Conclusion : This study demonstrated that paramedian lumbar discectomy with preservation of facet joints is an effective and good procedure for FELDH. At least 60% of facet should be preserved for excellent or good outcomes.

• Journal of Chest Surgery
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• v.20 no.4
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• pp.851-854
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• 1987

Congenital diaphragmatic hernia remains a disease with high neonatal mortality rate despite recent advance in neonatal intensive care. We experienced one case of the congenital diaphragmatic hernia with acute respiratory distress and left pulmonary hypoplasia in the neonate. The simple closure was performed through left paramedian approach after diagnosis. The postoperative course was uneventful except wound disruption. The patient was follow-up with good general condition.

• The Korean Journal of Pain
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• v.27 no.4
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• pp.353-359
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• 2014

Background: Epidural steroid injections are an accepted procedure for the conservative management of chronic backache caused by lumbar disc pathology. The purpose of this study was to evaluate the epidurographic findings for the midline, transforaminal and parasagittal approaches in lumbar epidural steroid injections, and correlating them with the clinical improvement. Methods: Sixty chronic lower back pain patients with unilateral radiculitis from a herniated/degenerated disc were enrolled. After screening the patients according to the exclusion criteria and randomly allocating them to 3 groups of 20 patients, fluoroscopic contrast enhanced epidural steroids were injected via midline (group 1), transforaminal (group 2) and parasagittal interlaminar (group 3) approaches at the level of the pathology. The fluoroscopic patterns of the three groups were studied and correlated with the clinical improvement measured by the VAS over the next 3 months; any incidences of complications were recorded. Results: The transforaminal group presented better results in terms of VAS reduction than the midline and parasagittal approach groups (P < 0.05). The epidurography showed a better ventral spread for both the transforaminal (P < 0.001) and the paramedian approaches (P < 0.05), as compared to the midline approach. The nerve root filling was greater in the transforaminal group (P < 0.001) than in the other two groups. The ventral spread of the contrast agent was associated with improvement in the VAS score and this difference was statistically significant in group 1 (P < 0.05), and highly significant in groups 2 and 3 (P < 0.001). In all the groups, any complications observed were transient and minor. Conclusions: The midline and paramedian approaches are technically easier and statistically comparable, but clinically less efficacious than the transforaminal approach. The incidence of ventral spread and nerve root delineation show a definite correlation with clinical improvement. However, an longer follow-up period is advisable for a better evaluation of the actual outcom.