Concomitant ankylosing spondylitis can increase the risk of biologics or small molecule therapies to control inflammatory bowel disease

Background/Aims@#Patients with inflammatory bowel disease (IBD) are diagnosed with ankylosing spondylitis (AS) often. However, the disease course of patients with both IBD and AS is not well understood. This study aims to evaluate the effect of concomitant AS on IBD outcomes. @*Methods@#Among the 4,722 patients with IBD who were treated in 3 academic hospitals from 2004 to 2021, 55 were also diagnosed with AS (IBD-AS group). Based on patients’ electronic medical records, the outcomes of IBD in IBD-AS group and IBD group without AS (IBD-only group) were appraised. @*Results@#The proportion of patients treated with biologics or small molecule therapies was significantly higher in IBD-AS group than the proportion in IBD-only group (27.3% vs. 12.7%, P= 0.036). Patients with both ulcerative colitis and AS had a significantly higher risk of biologics or small molecule therapies than patients with only ulcerative colitis (P< 0.001). For univariable logistic regression, biologics or small molecule therapies were associated with concomitant AS (odds ratio, 4.099; 95% confidence interval, 1.863–9.021; P< 0.001) and Crohn’s disease (odds ratio, 3.552; 95% confidence interval, 1.590–7.934; P= 0.002). @*Conclusions@#Concomitant AS is associated with the high possibility of biologics or small molecule therapies for IBD. IBD patients who also had AS may need more careful examination and active treatment to alleviate the severity of IBD.

Clinical Course of COVID-19 in Patients with Inflammatory Bowel Disease in Korea: a KASID Multicenter Study

In 2020, the novel coronavirus disease 2019 (COVID-19) began to spread worldwide and remains an ongoing medical challenge. This case series reports on the clinical features and characteristics of patients with inflammatory bowel disease (IBD) and confirmed COVID-19 infection. From February 2020 to March 2021, nine patients with IBD had confirmed COVID-19 across four hospitals in Korea. The median age at COVID-19 diagnosis was 42 years. Six patients were male, and seven patients had ulcerative colitis (UC). No patients required oxygen therapy, intensive care unit hospitalizations, or died. The most common symptom was fever, and gastrointestinal (GI) symptoms developed as diarrhea in five patients with UC. Oral steroids were used to combat UC aggravation in two patients. In this case series of nine IBD patients diagnosed with COVID-19 in Korea, the clinical presentation was predominately a mild respiratory tract infection. Most patients with UC developed new GI symptoms including diarrhea.

Risk of Diabetes in Subjects with Positive Fecal Immunochemical Test: A Nationwide Population-Based Study

Background@#Positive fecal immunochemical test (FIT) results have been recently suggested as a risk factor for systemic inflammation. Diabetes induces inflammation in the gastrointestinal tract via several ways. We investigated the association between FIT results and the incidence of diabetes. @*Methods@#A total of 7,946,393 individuals aged ≥50 years from the National Cancer Screening Program database who underwent FIT for colorectal cancer (CRC) screening from 2009 to 2012 were enrolled. The primary outcome was newly diagnosed diabetes based on the International Classification of Disease 10th revision codes and administration of anti-diabetic medication during the follow-up period. @*Results@#During a mean follow-up of 6.5 years, the incidence rates of diabetes were 11.97, 13.60, 14.53, and 16.82 per 1,000 personyears in the FIT negative, one-positive, two-positive, and three-positive groups, respectively. The hazard ratios (HRs) for the incidence of diabetes were 1.14 (95% confidence interval [CI], 1.12 to 1.16; HR, 1.21; 95% CI, 1.16 to 1.27; and HR, 1.40; 95% CI, 1.28 to 1.55) in the one-positive, two-positive, and three-positive FIT groups compared with the FIT negative group, respectively. The effect was consistent in individuals with normal fasting blood glucose (adjusted HR 1.55 vs. 1.14, P for interaction <0.001). @*Conclusion@#Positive FIT results were associated with a significantly higher risk of diabetes, suggesting that the FIT can play a role not only as a CRC screening tool, but also as a surrogate marker of systemic inflammation; thus, increasing the diabetes risk.

Reactive oxygen species and N-methyl-D-aspartate receptor-mediated central sensitization in hindlimb ischemia/reperfusion injury-induced neuropathic pain rats / 대한마취과학회지

BACKGROUND: Reactive oxygen species (ROS) contribute to development of neuropathic pain. A neuropathic pain syndrome was produced in rats following prolonged hindpaw ischemia/reperfusion injury, creating an animal model of complex regional pain syndrome-Type I (CRPS-I). This study was designed to evaluate the validity of this model for ROS and pain research. Herein we show superoxide produces N-methyl-D-aspartate (NMDA) mediated mechanical allodynia. METHODS: Male adult SD rats were used for neuropathic pain model. Plasma superoxide production rates of before ischemia (BI) and 5 min after reperfusion (JR) were measured via cytochrome C reduction in the presence of xanthine (without xanthine oxidase, kinetics, 550 nm). Mechanical allodynia was measured in both hindpaws. Activation of NMDA receptor subunit 1 (P-NR1) of lumbar spinal cord (L4-L6) in accordance with the change of allodynia was analyzed by the Western blot. RESULTS: Allopurinol-inhibitable, xanthine oxidase-mediated plasma superoxide production was increased at AR. Mechanical allodynia was present in both hindpaws as early as 1 hr after reperfusion, and lasted at least 1 week. The expression of P-NR1 was the highest at 3 days after reperfusion when the withdrawal threshold was the lowest point. SOD significantly blocked P-NR1 activation. CONCLUSIONS: This study suggests that ischemia/reperfusion injury induced neuropathic pain model is a good candidate for the research fields of ROS and pain mechanism. The generation of ROS, especially superoxide is partly responsible for NMDA-mediated mechanical allodynia.

Microbiologic Analysis of Severe Childhood Pneumonia by Bronchoalveolar Lavage / 소아알레르기및호흡기학회지

PURPOSE: Pneumonia is rather common and benign disease in children but its course is various. Many clinicians used the empirical antibiotics to treat pneumonia without identification of causative organism. This study was performed to find the pathogenic organism from the fluid culture by bronchoscopy with BAL (bronchoalveolar lavage) in severe pneumonia patients. METHODS: We studied 21 cases (male 15, female 6) who were admitted with severe pneumonia in the Department of Pediatrics, Sunlin Hospital from March to October in 1999. These patients had no underlying disease such as immunologic deficiency. We took laboratory tests including CBC, CRP, ESR, PB smear, mycoplasmal antibody and blood culture at admission day. We performed bronchoscopy with BAL, and wet smear and culture of that fluid. RESULTS: Organisms were cultured in nineteen cases out of 21 cases. Seven cases of Streptococcus mitis, five of Stenotrphomonas maltophilia, five cases of Streptococcus oralis, two of Moraxella species, two of Acinetobacter junii, one of Acinetobacter spesies, one Staphylococcus hominus, one alpha-h-Streptococcus, one Klebsiella pneumoniae, one Pseudomonas aeruginosa, one Enterobacter cloacae. Two organisms were cultured in nine cases. CONCLUSION: The positive rate of BALF culture was very high (90.5%). But, further studies are necessary for the patients with severe pneumonia preceded the use of antibiotics.

Serum Level of G-CSF and GM-CSF and CFU-GM Response to Hematopoietic Growth Factors in a Patient with Cyclic Neutropenia

PURPOSE: Serum levels of G-CSF and GM-CSF were measured and CFU-GM assay using G- CSF, GM-CSF and SCF was conducted to evaluate the influence of hematopoietic growth factor on the precursor cells of cyclic neutropenia. METHODS: A 7-year-old male with cyclic neutropenia was studied. Marrow mononuclear cells were isolated at neutrophil nadir and recovery and cultured in methylcellulose media with or without G-CSF, GM- CSF and SCF. CD34 positive cells were evaluated using flow cytometry. Serum levels of G-CSF and GM-CSF were measured by ELISA. RESULTS: The Numbers of CFU-GM without growth factors were 50 at neutrophil nadir and 33 at the recovery phase in the patient and show increased colony forming capacity. CD34 positive cells were 9.32% at nadir and 14.17% at recovery. Increasement of CFU-GM with G-CSF at nadir and recovery were 46% and 118% and those with GM-CSF were 70% and 78% respectively, compared with 54.4% and 78.2% in control groups. In contrast, the presence of SCF did not enhance CFU-GM number in the patient, but in the control group, increasement with SCF was 28.9 %. There an was inverse relationship between serum G-CSF levels and peripheral neutrophil count whereas those of GM-CSF were constant. CONCLUSION: Serum G-CSF level showed inverse relationship with neutrophil counts. The response of progenitor cells to G-CSF and GM-CSF was not impaired. The presence of SCF did not enhance CFU-GM number in the patient. This result suggests that the abnormality in hematopoiesis in cyclic neutropenia may involve more immature progenitor cells responsive to SCF.

Clinical Applications of Pediatric Bronchoscopy in Pediatric Pulmonary Diseases / 소아알레르기및호흡기학회지

PURPOSE: Pediatric bronchoscopy is becoming an essential tool for diagnosis and treatment of pediatric respiratory tract diseases. But there is no international standard for the indication, procedure and bronchoalveolar lavage. We experienced 110 cases over 1 year for pediatric bronchoscopy and reported datas for them. METHOD: We used Olympus 3C30 pediatric bronchoscope and Wolfs rigid bronchoscopes for the bronchoscopy. Atropine intravenous injections was given as an premedication before 30 minutes of the bronchoscopy procedure. Midazolam was used as a main sedative and fentanyl, and droperidol was used for reduction of pain during procedures. We recorded the findings using videotapes and discussed the findings later. BAL was done if it needed and made a cell count and cultured the BAL fluid for the identifying the causative organisms. RESULTS: 1) Among 110 cases, male were 78 (72%), female were 32 (28%). Age distributions were 42 (37%) in 3-6 year of age, 21 (19%) in 1-3 year of age and the median is 4 year of age. 2) Indications are followings; Chronic cough 42, acute severe pneumonia 26, chronic/recurrent infiltrate 10, pulmonary TB with abnormal radiograph 10, stridor 6, abnormal airway radiograph 6, abnormal voices 5, persistent wheezing 4, foreign body suspected 3, pulmonary toilet with debilitated patient 1, management of artificial airway 1. Primary bronchoscopic findings were as followings; normal findings 21, pus 40, laryngomalacia 19, tracheomalacia 9, mucosa abnormality 5, vocal cord abnormality 5, bronchomalacia, 3, edema 2, obstruction, 2, constriction 1, tracheal bronchus 1 case. 3) Complications of bronchoscopy were fever, hypoxia, laryngospasm and epistaxis. 4) Cell differential analysis of 49 cases, neutrophil predominance 33 (68%), lymphocyte predominance 6 (12%), macrophage predominance 8 (16%), eosinophil predominance 2 (4%). 5) Cultures for bacteriae were included as followings; Stenotrephomonas maltophilia 17, Streptococcus mitis 13, alpha-hemolytic-Streptococcus 6, Klebsiella pneumoniae 6 cases. But it seems to be contaminated. But some organisms, Moraxella species, H. influenza may be causative organisms of pulmonary infections. 6) Ten AFB smear positive cases were discovered. Among them only one case was TB-PCR positive and the other nine cases were TB-PCR negative and two cases were PCR positive for mycobacterium other than tuberculosis (MOTT). It suggests that MOTT infections may be a role for pediatric chronic cough. CONCLUSION: Pediatric bronchoscopy made us far advanced improvement in diagnosis and management of pediatric pulmonary diseases.

A Demonhstration of a Tracheal Bronchus by Bronchoscopy and Computed Tompgraphy

Tracheal bronchus is an aberrant bronchus that arises most often from the right tracheal wall above the carina and is the result of an additional tracheal outgrowth early in embryonic life. It; incidence ranges between 0.1 and 5%. This anomaly is usually diagnosed incidentally during bronchoscopy, bronchography or computed tomography. Occasionally, it represents the underlying etiology for chronic pulmonary disease, especially if it involves the right upper lobe and reflects an abnorrnal pulmonary clearing mechanism. The tracheal bronchus may be associated with other bronchopulmonary anomalies, tracheal stenosis, or Down's syndrome. Asymptornatic tracheal bronchus does not require any treatment. In case of tracheal bronchus associated recurrent right upper lobe diseases, tracheal bronchus therapy should include resection of the aberrant bronchus as well as the lob it supplies. (J Korgan Pediatr Soc 2000;43:1501-1504)

Comparison between Laryngeal Mask Airway and Uncuffed Tracheal Tube for Positive Pressure Ventilation in Paralyzed Pediatric Patients: A Randomized Crossover Study / 대한마취과학회지

BACKGROUND: This randomized cross over study was performed to compare the effect of positive pressure ventilation (PPV) through a laryngeal mask airway (LMA) with that through an uncuffed endotracheal tube (ETT) in paralyzed pediatric patients. Additionally, this study was to determine the protective effect of LMA for the aspiration of oral secretion. METHODS: Pediatric patients (n = 158) weighing less than 30 kg, of ASA physical status 1 or 2 were studied. LMA or ETT was randomly selected and connected to a volume-type ventilator. After measurement and extubation, the other that was not initially used was inserted. Expiratory tidal volume (VT) and airway pressure were measured at the same ventilator setting by a simple pneumo-tachometer, and the expiratory tidal volume ratio (VTR) was calculated as expiratory VT of LMA/expiratory VT of ETT. In randomly selected 39 patients out of 158, methylene blue diluted 1:10 with saline was injected into the oral cavity during PPV through an LMA. At the end of the surgery, fiberoptic bronchoscopy was performed to observe any staining of methylene blue in the trachea. RESULTS: Successful placement of the LMA was achieved in 98% (155/158) of the cases. Expiratory VT through the LMA 1 or 1.5 was decreased if compared with that through the ETT. Leaking pressure of the LMA was lower than that of the ETT except LMA 2.5. VTR of the LMA size 1, 1.5, 2 and 2.5 (mean +/- SD) was respectively 0.94 +/- 0.22, 0.94 +/- 0.14, 1.02 +/- 0.18 and 1.06 +/- 0.19. There was no patient whose trachea was soiled with methylene blue. CONCLUSIONS: Only in older children who are indicated for LMA 2.5, did LMA have the same leakage and the same leaking pressure as ETT during PPV. LMA may not be recommended for the maintenance of PPV in young children less than 10 kg. Inflated LMA seems to have a protective effect against oral secretion.

Two Cases of Congenital Paraesophageal Hiatal Hernia in Infancy

Herniation of the stomach through the esophageal hiatus into the posterior mediastinum is a commom affliction of humans. The incidence of hiatal hernia is difficult to determine because of the absence of symptoms in a large number of patients. Hiatal hernias are classified into two major types; type I sliding hiatal hernia and type II paraesophageal hiatal hernia. Sliding hernia is common, but paraesophageal hernia(PEH) is rare. Most PEH is demonstrated in elderly women. PEH in infancy is really rare. PEH is a true hernia, so it is a potentially life-threatening condition because of the risk of volvulus, incarceration, strangulation, and perforation. PEH is itself the indication for surgery. We experienced congenital PEH in two infants. One case was nearly asymptomatic, found incidentally by plain chest X-ray taken for pneumonia in a 12 month old female infant. She had no vomiting or reflux, but history of frequent feeding of small amount and often gurgling noise in her right chest. She had type IV PEH including herniation of the transverse colon. Another case was presented because of vomiting, and was diagnosed by ultrasonography initially in a 48 day old male infant. He had intrathoracic stomach, type III PEH with idiopathic hypertrophic pyloric stenosis and gastroesophageal reflux.

Hemodynamic Effects of Propofol Anesthesia on Cesarean Section Patients / 대한마취과학회지

BACKGROUND: It is already known that systemic vascular resistance (SVR) is decreased during pregnancy. In addition, one of the large hemodynamic changes when using propofol is also a decrease in SVR, more profoundly than is found with enflurane. It might therefore be suggested that hemodynamic changes are more prominent in cesarean section during propofol anesthesia, compared with enflurane anesthesia. This study was designed to investigate these possible changes by propofol anesthesia. METHODS: One hundred thirty six women for elective cesarean section were involved in this study. They were divided into 2 groups: group E (n = 74), anesthesia with thiopental, enflurane, and N2O, and group P (n = 62), anesthesia with propofol and N2O. All patient were given glycopyrrolate as premedicants. The hemodynamic variables (MAP, HR, CO, CI, SVR, SVRI, SI, and EF) were measured by bioimpedence at the five different time points: at preoperation, after induction, after intubation, during push abdomen, and after delivery. RESULTS: The variables of hemodynamics did not change significantly when both groups were compared, except that MAP, SVR and SVRI at after induction and HR during push and after delivery in group P were lower compared with respective variables in group E. CONCLUSION: From these results, we concluded that there were no significant changes in cardiovascular system (CVS) by propofol anesthesia, compared with enflurane anesthesia in cesarean section patients. It is therefore suggested that propofol anesthesia is safe in considering hemodynamics for cesarean section.

Clinical Application of Pediatric Bronchoscopy / 소아알레르기및호흡기학회지

No Abstracts Available.

A Study of Serum Total and House Dust Mite-Specific IgE, and ECP Levels in Healthy Korean Children Under 7 Years of Age / 소아알레르기및호흡기학회지

PURPUSE: Serum IgE have been shown to be related to allergic disease and used for an initial diagnosis of allergic diseases. House dust mite such as Dermatophagoides pteronyssinus(Dp) and D. farinae(Df) is very important for inhalant allergens, which may be a cause and/or triggering factor of atopic diseases. On the other hand, eosinophil cationic protein (ECP) causes epithelial damages of the airway, and bronchial hyperresponsiveness has been used as a useful indication of allergic inflammation. To date, there are few studies on the longitudinal patterns of total and inhalant allergen-specific IgE, and ECP in normal children in Korea. The present study was performed to determine the reference levels of serum total and Dp- and Df-specific IgE and ECP in healthy children under 7 years of age by the groups of different age and gender. METHODS: Total, and Dp- and Df-specific IgE and ECP concentrations were measured by fluoroimmunoassay(UniCAP, Pharmacia-UpJohn, Sweden) in serum from 449 healthy children under 7 years of age by using a population-based cohort followed from 1996 through 1997. All subjects were enrolled from eight large health organizations in geographically defined area such as Seoul and four local cities. RESULTS: Serum total IgE concentration showed steady increase with age from birth to 4 years, and a plateau. In contrast, Dp- and Df-IgE levels showed apparently continuous increments after 4 years of age. ECP showed variable increase until 4 years of age and slow decrease afterwards. There were no statistically significant differences in those results by gender and/or the living area, but much higher increments of Dp- and Df-IgE of boys from 3 years of age through 6 years were found. CONCLUSION: We found feasible results of total, Dp- and Df-specific IgE, and ECP in serum from healthy children under seven years of age, which may be useful for a reference.

Clinical Comparison of Neonatal Urinary Tract Infection Caused by Klebsiella pneumoniae Versus Non - klebsiella pneumoniae

PURPOSE: The purpose of this study was to describe the clinical characteristics of neonatal urinary tract infection (UTI) caused by Klebsiella pneumoniae and non- Klebsiella pneumoniae UTI. METHODS: We compared clinical characteristics of 84 neonatal patients with UTI caused by Klebsiella pneumoniae who were hospitalized at the Department of Pediatricsat Han Dong University, Sunlin Hospital during the period between May, 1994 and August, 1998. The cases were divided into two groups depending upon causative organisms' Klebsiella pneumoniae UTI vs non-Klebsiella pneumoniae UTI, and the clinical characteristics of these groups were compared. RESULTS: Escherichia coli was the most common bacterial pathogen causing neonatal UTI, followed by Klebsiella pneumoniae. There was no significant difference in the sex distribution of Klebsiella pneumoniae UTI, but non-Klebsiella pneumoniae UTI showed male predominence. There were no significant differences in the incidences of hematologic, urologic, radiologic findings and perinatal complications in between these 2 groups. CONCLUSION: Klebsiella pneumoniae is the second most common pathogen causing neonatal UTI. There were no specific differences in the laboratory, symptomatologic, and radiologic findings in these two groups.

Clinical Manifestations and Ultrasonographic Findings of Neonatal Septic Arthritis and Osteomyelitis

PURPOSE: This study was performed to evaluate clinical manifestations and findings of ultrasonogram of neonatal septic arthritis and osteomyelitis. We tried to determine the value of ultrasonogram as a tool for early diagnosis of septic arthritis and osteomyelitis. METHODS: We reviewed the records of 17 patients, who were diagnosed septic arthritis and/or osteomyelitis in Departments of Pediatrics and Orthopedic Surgery, Han dong University Sunlin Hospital in Pohang between Jan. 1994 and Sep. 1998. Radiologic findings were reviewed retrospectively according to the duration of symptoms at the onset. We compared the sensitivity of ultrasonogram with other radiologic tools done within 7 days of illness. RESULTS: We compared sensitivity of each imaging study done within 7 days of illness. 20%(3/5) had abnormality in plain radiographs, 78.6%(11/14) in ultrasonogram, 28.6%(2/7) in bone scan, and 100,0%(3/3) in MRI. Deep soft-tissue swelling around the bone was the earliest sign of acute osteomyelitis in ultrasonogram. Concurrently early septic arthritis showed deep soft tissue swelling around the joint and increased synovial effusion in ultrasonogram. CONCLUSION: Ultrasonogram is not so expensive, non-invasive, not harmful to patients, and there is no need to sedate patients for examination. Comparing with other imaging studies, the sensitivity of ultrasonogram is relatively high. Ultrasonogram is a useful diagnostic tool of septic arthritis and osteomyelitis in newbom infants.

A Nationwide Clinical Study of Acute Respiratory Distress Syndrome in Children

PURPOSE: Acute respiratory distress syndrome(ARDS) is the final course of acute lung injury. It results from various etiological origins and pathophysiologic mechanisms, and has a mortality rate of approximately 60-70%. Although the confirmative incidence of ARDS in children is yet unknown, the increasing incidence of ARDS has been reported in Korea. In the present study, we report ARDS diagnosed at the Clinic for Pediatric Allergy and Respiratory Disease in eleven medical centers nationwide. METHODS: The study was conducted on 42 patients diagnosed with ARDS in Pediatric Allergy and Respiratory Clinics from January, 1995 to August, 1997. We analyzed the clinical course and treatment modalities of the 42 cases of ARDS retrospectively. RESULTS: The total number of patients recruited was 42, including seventeen(40.4%) below 1-year-old. The mean age was 2.0+/-2.3(mean+/-standard deviation) years with a range of 2 months to 10 years, and there was no sex predominance(male/female : 27/15). Twenty-one cases(50.0%) occured during the spring(March, April and May). The major triggering factors of ARDS were viral pneumonia(59.5%) and bacterial pneumonia (19.1%). Mechanical ventilation was used in 37 cases(88.1%). Major complications included pneumothorax, DIC, and gastrointestinal bleeding. The mortality rate was 61.9% of which 16 case (61.5%) occurred before 2 years of age. CONCLUSION: We conducted this study to make a rapid diagnosis and appropriate treatment of ARDS in children, who have major risk factors, to reduce its mortality rate.

A Nationwide Clinical Study of Acute Respiratory Distress Syndrome in Children

PURPOSE: Acute respiratory distress syndrome(ARDS) is the final course of acute lung injury. It results from various etiological origins and pathophysiologic mechanisms, and has a mortality rate of approximately 60-70%. Although the confirmative incidence of ARDS in children is yet unknown, the increasing incidence of ARDS has been reported in Korea. In the present study, we report ARDS diagnosed at the Clinic for Pediatric Allergy and Respiratory Disease in eleven medical centers nationwide. METHODS: The study was conducted on 42 patients diagnosed with ARDS in Pediatric Allergy and Respiratory Clinics from January, 1995 to August, 1997. We analyzed the clinical course and treatment modalities of the 42 cases of ARDS retrospectively. RESULTS: The total number of patients recruited was 42, including seventeen(40.4%) below 1-year-old. The mean age was 2.0+/-2.3(mean+/-standard deviation) years with a range of 2 months to 10 years, and there was no sex predominance(male/female : 27/15). Twenty-one cases(50.0%) occured during the spring(March, April and May). The major triggering factors of ARDS were viral pneumonia(59.5%) and bacterial pneumonia (19.1%). Mechanical ventilation was used in 37 cases(88.1%). Major complications included pneumothorax, DIC, and gastrointestinal bleeding. The mortality rate was 61.9% of which 16 case (61.5%) occurred before 2 years of age. CONCLUSION: We conducted this study to make a rapid diagnosis and appropriate treatment of ARDS in children, who have major risk factors, to reduce its mortality rate.

Effect of Saline-Filled or Viscous Lidocaine-Filled Cuff on the Laser-Induced Polyvinyl Chloride Endotracheal Tube Fires and Tidal Volume / 대한마취과학회지

BACKGROUND: There have been a lot of methods that prevent catatrophic airway fires during laser surgery, but none of them can protect endotracheal tube cuff exposed directly to laser beam. This study was performed to know the preventive effect of viscous lidocaine-filled cuffs on laser-induced combustion, and to know how long we can maintain positive pressure ventilation if laser beam broke out cuff perforation. METHODS: Transparent acrylic trachea attached to artificaial lung was intubated with 8.0 ID polyvinylchloride endotracheal tube. Cuff was filled with 8ml of saline or saline and viscous lidocaine mixture with 2:1 or 4:1 ratio. Positive pressure ventilation with air in tidal volume of 500 ml was begun. The laser output was set to 10 watt/sec in the continuous mode with beam diameter of 1 mm. Laser beam was directed perpendicularly at the part of the cuff protruding between endotracheal tube shaft and acrylic trachea, and laser emission was continued until the cuff was perforated or combusted. RESULTS: There was no case of laser-induced fires. After the perforation of cuff, the tidal volume was slowly decreased in 2:1 mixture of saline and viscous lidocaine filled cuff compared to others (P<0.05). CONCLUSION: 2:1 mixture of saline and viscous lidocaine may be used as an efficient inflating material of endotracheal tube cuffs on laser airway surgery.

Usefulness of PAR Score and Modified PADSS as Patient Discharge Criteria in Ambulatory Surgery / 대한마취과학회지

Background: Although an ambulatory surgical practice continues to increase, there is a few data exist about patient discharge criteria. This study was undertaken to evaluate the usefulness and safety of Aldrete PAR (postanesthetic recovery) score and modified PADSS (modified postaneathesia discharge scoring system) on ambulatory surgery patients for recovery in Korea. Methods: Demographic, anesthetic data, Aldrete PAR score and modified PADSS on 279 patients were recorded. The time to dicharge, from recovery room and postoperative complications were evaluated, also. Results: PAR score and modified PADSS are correlated to length of stay in ambulatory surgery center. 24hr after discharge, 16% patients complained postoperative complications. Pain was most frequent postoperative complication. The PAR score was correlated with the occurrence of the complication. Conclusion: PAR score and modified PADSS are useful scoring systems to evaluate patients and make a decision to discharge the patients from ambulatory surgery center in safe.

A Case of 13 Ring Chromosome Syndrome

We have experienced a case of 13 ring chromosome in a 40-month-old girl who demonstrated psychomotor retardation with delayed speech, growth retardation, hearing loss(left), microcephaly, trigonocephaly with flat occiput, hypertelorism, epicanthal folds, microophthalmia, broad prominamt nasal bridge, high arched palate, micrognathia, large auricles and other anomalies. Cytogenetic studies of peripheral blood lymphocytes with differential staining of chromosomes revealed 46, XX, r13. Her parents' karyotypes were normal. We reported the case with the review of the associated literatures.