A comparative discussion of incisional methods in total capsulectomy of the breast

Background@#Capsular contracture is a frequent complication of breast augmentation that constitutes one of the most common reasons for secondary operations. Capsular contracture is treated surgically, often with total capsulectomy. Therefore, in this study, we aimed to study correlations among intraoperative observations, physical examination findings, and characteristics of the previous operation in patients with capsular contracture who underwent total capsulectomy. @*Methods@#A retrospective chart review was conducted for patients treated from May 2017 to April 2019, analyzing 24 breasts in 12 female patients. The patients were classified in terms of the Baker grade, incision type, implant type, and implant plane. During the operation, we evaluated the ease of dissection based on intraoperative features such as anterior and posterior wall dissection, bleeding tendency, and scar length. Statistical analysis was performed to identify association between variables @*Results@#The implant was changed in eight patients, while only explantation was performed in the remaining four patients. The ease of capsule dissection had a proportional correlation with the Baker grade (P=0.005). Intraoperative dissection was significantly easier in the inframammary fold (IMF) group than in the periareolar group (P=0.035). @*Conclusions@#An IMF incision is preferable for planning en bloc capsulectomy. However, for aesthetic concerns, a periareolar incision would be preferable. In addition, a lower Baker grade (grade I or II) was associated with easier dissection. Therefore, surgeons should choose the incision type depending on the necessity of performing en bloc capsulectomy, Baker grade, and scar length.

The Characteristics and Safety of Previous Fillers in Secondary Rhinoplasty

BACKGROUND: Filler injection into the soft tissue of the nose is a useful technique for rhinoplasty. The individual characteristics of fillers determine which is best suited for a patient's specific circumstances. The objective of this study was to identify the characteristics of various fillers and to determine which fillers should be used for primary rhinoplasty in order to yield optimal long-term results. METHODS: Excluding patients treated with hyaluronic acid fillers, we reviewed 17 patients who underwent surgical rhinoplasty due to dissatisfaction with an injection using a different filler. After removing the previously injected filler, rhinoplasty was performed as part of the same procedure using a silicone or Surgiform® prosthesis. RESULTS: Various previous fillers were used in the cohort. During the process of filler removal, skin perforation occurred in 2 cases and infection was observed in 1 case. In the other cases, rhinoplasty using a prosthesis was performed at the time of filler removal and no complications were observed. CONCLUSIONS: We found that if surrounding tissue had been maintained stably, a simultaneous secondary operation using implants produced ideal results in most cases without any complications, despite the presence of residual remnant filler material.

Alar Rim Composite Graft: A Safe and Simple Way to Correct Alar Retraction

BACKGROUND: The alar rim is a complex structure that ensures the competence of the external valves and the patency of inlets to the nasal airways. Retraction of the alar rim is caused by congenital malpositioning, hypoplasia, or surgical weakening of the lateral crura, with the potential for both functional and aesthetic ramifications. Most previously introduced procedures involved a relatively long operation time and relatively high risks of surgical complications. The purpose of this study is to introduce a novel surgical technique for alar rim connection and to present its results. METHODS: After marking the extent of the correction, the recipient alar bed was created by making an incision through the vestibular skin 2-mm cephalad to the rim. Then, the composite graft was harvested from the cymba concha by removing the cartilage with its adherent anterior skin. According to the degree of retraction, the harvested composite graft was divided into 2 pieces considering the symmetry of both alar rims. The composite grafts were inserted into the defects and primary closure was done at the donor site. RESULTS: Our surgical technique was used to correct 12 retracted alar rims in 6 patients. Caudal advancement of the alar rims was observed and the contour of the ala was corrected in all 6 patients. The mean length of follow-up was 1-year, and there were no postoperative complications, such as graft loss or disruption. CONCLUSIONS: The alar rim composite graft is a safe and simple technique for correction of short nostril and caudal transposition of the retracted alar rim.

Four Limb Shaped Auricular Chondrocutaneous Composite Graft for the Alar and the Columellar Defects

BACKGROUND: Composite grafts have advantages for small nasal defect coverage. However, if the the outer skin defect and the inner skin defect have a different location, conventional composite grafts encounter considerable limitations. Therefore, we devised a 4-limbed graft to overcome this limitation by use of soft tissue transposition. METHODS: Over the course of 5 years, this auricular composite graft was used in 10 cases of reconstruction. We harvested skin and cartilage from the helix. The composite graft had 2 limbs of soft tissue to cover the nasal defect and another 2 limbs of cartilage to support nasal framework. The cartilage limbs extended 3 to 5 mm beyond the margin of the skin. The direction of each limb was modified according to defect position. RESULTS: All 10 composite grafts survived completely. All composite grafts shrank by a small percentage of their bulk. Nonetheless, the nasal framework was maintained to an acceptable extent because of the cartilage limbs. CONCLUSIONS: This technique was capable not only of covering defects in the alar and columellar area, but also of maintaining a satisfactory external appearance, because the 2 limbs of cartilage included in the graft strengthened the nasal framework and provided modest support to the nostril margin. The 2 limbs of soft tissue covered the defect area. Our 4-limbed auricular chondrocutaneous composite graft is reliable option for the reconstruction of alar and columellar defects in a single-stage procedure.

The Effects of Social Skills Training as a Preventive Approach for Children in the Community Setting

OBJECTIVES: The purpose of this study was to evaluate the effect of social skills training (SST) for children in two different community settings, an elementary school and a child community center. METHODS: Two separate groups of 15 children (10 boys and 5 girls) and 13 children (4 boys and 9 girls) participated in a SST program twice per week at an elementary school and a child community center, respectively. Age range of participants was from 8 to 10 years. Sixty-minute-long sessions of SST were continued twice per week for 4 weeks. Korean-Child Behavior Checklist (K-CBCL), Conner's Rating Scales, Korean-Attention-Deficit Hyperactivity Disorder Rating Scale (K-ARS), Social Skills Rating System (SSRS), and Matson's Evaluation of Social Skills with Youngsters (MESSY) were evaluated by their parents before and after the SST program. RESULTS: Pre-and-post analysis of SST indicated no significant statistical differences in the elementary school group. However, the child community center group showed significantly increased scores for total social ability (p<.05) and decreased scores for attention problem (p<.05) on the K-CBCL. In addition, scores of MESSY were significantly increased (p<.05). These differences between the two groups were still significant after controlling pre-SST scores ; and difference of SST scores between the two groups disappeared after SST. CONCLUSION: Results suggest that SST in the community setting is an effective tool for prevention of social deficits and problems in attention by promoting social function and attention.

The Effects of Remifentanil on the LMA Insertion with the Administration of Propofol

BACKGROUND: Laryngeal mask airway (LMA) can be inserted without muscle relaxant in patients who have received propofol. Remifentanil that is recently used opioid effectively attenuates the hemodynamic responses to laryngoscopy. This study was to investigate the effects of remifentanil on the quality and hemodynamic response of LMA insertion after intravenous propofol induction without muscle relaxant. METHODS: Forty patients (ASA I or II, 20-65 years) were randomly allocated to control and remifentanil group. Control group received propofol 4microg/ml alone, remifentanil group received propofol 4microg/ml and remifetanil 2 ng/ml by target controlled infusion. LMA insertion condition was assessed by Muzi's score (jaw mobility, coughing, movement). The time interval to loss of eyelash reflex, to BIS < 60 and to insertion of LMA were recorded. The BIS and hemodynamic changes were measured at preinduction (baseline), preinsertion and postinsertion. RESULTS: Loss of consciousness and LMA insertion were more rapid with remifentanil group than control group (P < 0.05). Clinically acceptable insertion of LMA were observed in 35% and 70% of patients in the control and remifentanil group, respectively. There were significant elevations in heart rate, mean blood pressure after insertion of LMA in control group, but no elevations in remifentanil group. And there were no significant differences in BIS in both groups. CONCLUSIONS: The LMA insertion with propofol-remifentanil can provide more favorable condition and stable hemodynamic status compared with propofol alone.

The Effects of Stellate Ganglion Block on the Level of Blood Glucose, Uric Acid, and Catecholamines in the Induced Diabetic Rat / 대한마취과학회지

BACKGROUND: Stellate ganglion block (SGB) has been used to treat over 150 diseases which include diabetes mellitus and gout. This study was planned to investigate whether stellate ganglion block (SGB) could lower the levels of blood glucose, uric acid, epinephrine, and norepinephrine. METHODS: Sixty Sprague-Dawley rats within the weight of 250-350 gm were randomly devided into four groups. CS group was normal group with sham SGB with normal saline, CL group was normal group with SGB with lidocaine, DS group was diabetic group with SGB with normal saline, DL group was diabetic group with SGB with lidocaine. The diabetes was induced by intraperitoneal injection of 40 mg/kg of streptozotocin in citrate buffer (0.01 M, pH 4.5). Nondiabetic groups were given same amount of the citrate buffer. Seven days after the last injection of the streptozotocin blood glucose level was checked and more than 300 mg/dl was considered diabetic. The SGB was performed three times at right superior cervical ganglion two days apart from two days after the conformation of diabetes. Successful SGB was conformed by the ipsilateral ptosis or conjunctival congestion. Blood samplings from tail vein for the check of glucose, uric acid, and catecholamines were done before the injection of streptozotocin, seven days after the last injection of streptozotocin, and two days after the last SGB. RESULTS: The SGB with lidocaine reduced the blood glucose level only in the diabetic rats while SGB with the saline did not. The epinephrine levels were increased in the diabetics and decreased by the SGB with lidocaine without any statistical significance. Norepinephrine and uric acid levels had not been effected by the SGB and both of them had no correlationship with the glucose level. CONCLUSIONS: SGB in the diabetic rats decreases the blood glucose level. But for the effects of the SGB on the level of epinephrine further study would be needed.

Rocuronium Pretreatment for Prevention of Myalgia Following Succinylcholine Administration / 대한마취과학회지

BACKGROUND: The purpose of this study was to assess the effect of rocuronium pretreatment on the succinylcholine induced biochemical changes and fasciculations, myalgia and to compare it with vecuronium pretreatment. METHODS: We have studied 60 patients undergoing minor elective surgery, in a prospective double blinded method. Three groups of 20 patients each were pretreated with saline 0.01 ml/kg (group C), rocuronium 0.05 mg/kg (group R), or vecuronium 0.007 mg/kg (group V). Three minutes after the pretreatment, 1.5 mg/kg succinylcholine was injected. Serum potassium five minutes after succinylcholine and creatine kinase 24 hr after operation were measured. Fasciculations and postoperative myalgia at 24 and 48 h were evaluated. RESULTS: The increase in creatine kinase and incidence of fasciculations were lowest in the rocuronium group (33 IU/L; 15%) and followed by vecuronium group (58 IU/L; 50%) and highest in the control group (101 IU/L; 100%). The increase in serum potassium concentration (0.3 mEq/L) was not attenuated by any regimen. The incidence of postoperative myalgia on day 1 and day 2 was lower in the rocuronium (40%, 30%) and the vecuronium (50%; 35%) group than control group (85%; 75%). CONCLUSIONS: Rocuronium pretreatment is more effective in reducing creatine kinase rise and fasciculations after succinylcholine than vecuronium. However rocuronium and vecuronium are also effective in preventing postoperative myalgia.

Ejaculatory Failure after Chemical Lumbar Sympathectomy / 대한마취과학회지

Neurolytic or surgical lumbar sympathectomy are commonly used for the treatment of intractable pain, peripheral vascular insufficiency and hyperhydrosis. For the procedure, the patient sometimes has to suffer from complications such as major vascular perforation, subarachnoid injection, genitofemoral neuralgia, somatic neuralgia, disc perforation, ureteral stricture, inflammation, ejaculatory failure, chronic lumbago. The authors came across with a case of ejaculatory failure a week after both lumbar sympathetic block with 6 ml of 100% alcohol at L3 level under the control of fluoroscopy. Three months after the block the patient recovered without any treatment.

Development of a Integrated Healthcare Information System in Standardized Environment / 대한의료정보학회지

A number of application systems for medical information services were developed. However, each of those application systems was developed independently out of consideration for other applications. Therefore, there are many problems in operation of the systems. Users(hospitals) have to prepare communication lines and equipments for using each service redundantly, and facilities for operation of those systems are also furnished individually. Thus, it is necessary to integrate the medical information systems in standardized environment in order to reduce operating costs and upgrade the services. This paper analyzes the methodology for development of an integrated medical information system in common environment and summarizes the result of the integration and standardization. Finally, we studies the directions for expanding the integrated system and activating the services.

A Study on the Predictors of Hypertension in the Immediate Postoperative Period / 대한마취과학회지

BACKGROUND: Hypertension in the immediate postoperative period, if sufficiently high, can cause left heart failure, arrhythmia, myocardial infarction, and cerebral hemorrhage. The causes of postoperative hypertension are hypertension history, pain, hypoxia, emergence excitement, reaction to endotracheal tube, hypothermia, excess fluid administration, hypercarbia, etc. To know the predictable factors for the postoperative hypertension the authors tried to investigate perioperative patient care of the postoperative hypertensive cases. METHODS: One hundred twenty surgical patients in both sexes between the age of 40~60 were sampled randomly and devided into two groups. The normotensive (N) group included the patients with postoperative blood pressure below 140/90 mmHg and the hypertensive (H) group, above 140/90 mmHg. The incidence of hypertension history, hypertension on admission, hypertension on ward, change of systolic blood pressure above 20% during surgery, intra or postoperative use of antihypertensives or inotropic agents were compared between the groups. RESULTS: The incidence of history of hypertension was higher in H group (20%) than N group (6.7%). Hypertension on admission was higher in H group (43.3%) than N group (23.3%). Systolic blood pressure change above 20% was only in H group (6.7%). Use of antihypertensive was more frequent in H group (33.3%) than N group (3.3%) and use of inotropic agents was only in N group (8.3%). The blood pressure at ward, preinduction, and after induction were higher in H group. Within the group the blood pressure between preinduction and after induction has no difference. CONCLUSION: Immediate postoperative hypertension can be expected in case of history of hypertenion, hypertension on admission (above 140/90 mmHg), change of systolic blood pressure above 20%, use of antihypertensive during operation, and hypertension just before induction.

The Effect of Propofol on Pruritus induced by Epidural Morphine / 대한마취과학회지

BACKGROUND: Epidural morphine is used commonly for postoperative pain control. But, pruritus, although trivial, is a common side effect. It is reported that subhypnotic doses of propofol are effective against pruritus induced by epidural or subarachnoid morphine. METHODS: Sixty five patients received epidural morphine 4 mg bolus and 4 mg/day with continuous infusion for 2 days via Baxter infusor. The patients who have pruritus with scratching were allocated randomly to receive either 1 ml propofol(10 mg) or 1 ml placebo(Intralipos ) intravenously. Pruritus was assessed 5 min later using a pruritus rating scale with double-blind, placebo-controlled study. RESULTS: Forty patients showed pruritus with scratching. The overall success rate in treating pruritus was 75% in propofol group and 25% in placebo group. Compared with placebo, propofol was effective significantly(P<.05). CONCLUSIONS: These results suggest that propofol in a subhypnotic dose is an efficient drug treatment for epidural morphine induced pruritus.

A report of hypercarbia during general anesthesia / 대한구급학회지

No abstract available.

Improvement of titration methods for porcine rotavirus, its serum neutralizing antibody and of virus isolation from feces

No abstract available.

The Effect of Neostigmine Pretreatment on Vecuronium Induced Neuromuscular Blockade / 대한마취과학회지

Prolonged neuromuscular blockade following succinylcholine may be seen when anticho- linesterase had been administered prior to reverse nondepolarizing muscle relaxant-induced paralysis, possibly anticholinesterase has been reported to inhibit serum cholinesterase activity. Our study was undertaken in order to understand the effect of a nondepolarizing muscle relaxant (vecuronium) following neostigmine pretreatment. In this study, we assessed the effect of vecuronium induced neuromuscular blockade using a train of four, 2 Hz stimulations on ulnar nerve. Patients admitted to our hospital for elective operations were divided into two groups, each group consisting of 16 patients. In group I, vecuronium 0.1 mg/kg was .administered according to the priming principle following normal saline, in group II, vecuronium 1.0mg/kg was administered according to the priming principle following neostigmine 0.05 mg/kg and glycopyrrolate 0.003 mg/kg pretreatment. Then the time for Tl to reach 5% or less(second), and the time for Tl to reach from 25% to 75%(recovery index) were measured in both groups. The time for Tl to reach 5% or less in group I(92.8+/-14.72 second) and group II(97.5+/-16.43 seconds) were not siginificant. However the recovery indexof group I(10.2 5+/-1.93 minute) and group II(8.5+/-1.80 minute) showed significant shortening in group II(p<0. 05)

Incidence of Postoperative Sore Throat with the Laryngeal Mask / 대한마취과학회지

The laryngeal mask as an new form of airway has recently been described. This mask is introduced blindly into the hypopharynx to form a seal around the larynx, so permitting spontaneous or positive pressure ventilation without passing the larynx, therefore associated with much reduced incidence of laryngeal damage. But endotracheal intubation is associated with a significant rate of layngeal damage and subsequent vocal cord pathology. This study was designed to investigate the effects of postoperative sore throat related to insertion of laryngeal mask airway and to compare with these effects after endotracheal intubation. One hundred randomly selected female patients who had gynecological procedures under general anesthesia were surveyed to ascertain the incidence of sore throats. The results were as follows; l) The incidence of sore throat after endotracheal intubation with the Portex tube was 48% but 12% after insertion of laryngeal mask. 2) The average volume of air required to inflate the cuff of laryngeal mask sufficiently to form air-tight seal around larynx was 11.4+/-2.8ml and cuff pressure was 25.6+/-13.2cmH2O when the laryngeal mask 3 was used for Korean adult female.

Incidence of Postoperative Sore Throat with the Laryngeal Mask / 대한마취과학회지

The laryngeal mask as an new form of airway has recently been described. This mask is introduced blindly into the hypopharynx to form a seal around the larynx, so permitting spontaneous or positive pressure ventilation without passing the larynx, therefore associated with much reduced incidence of laryngeal damage. But endotracheal intubation is associated with a significant rate of layngeal damage and subsequent vocal cord pathology. This study was designed to investigate the effects of postoperative sore throat related to insertion of laryngeal mask airway and to compare with these effects after endotracheal intubation. One hundred randomly selected female patients who had gynecological procedures under general anesthesia were surveyed to ascertain the incidence of sore throats. The results were as follows; l) The incidence of sore throat after endotracheal intubation with the Portex tube was 48% but 12% after insertion of laryngeal mask. 2) The average volume of air required to inflate the cuff of laryngeal mask sufficiently to form air-tight seal around larynx was 11.4+/-2.8ml and cuff pressure was 25.6+/-13.2cmH2O when the laryngeal mask 3 was used for Korean adult female.