An Animal Model of Tracheal Stenosis Induced by an Endotracheal Segmented Tube / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Various methods to induce tracheal stenosis in an animal model have been introduced. However, most methods use non-physiologic mechanical or chemical injury to tracheal mucosa or cartilage. In this study, we sought to develop an animal model of tracheal stenosis using a segmented endotracheal tube. MATERIALS AND METHOD: Nine New Zealand White Rabbits were included in this feasibility study. A segmented 1.5 cm LEVIN-Tube (16 French) was inserted into tracheal lumen via tracheotomy site and fixed with a nylon tape circumferentially tied around the trachea. The tube was removed transorally one week later and the tracheal lumen was observed with bronchoscopy every week. Rabbits were sacrificed two weeks after the tube removal and the trachea was evaluated with histologic image. Three rabbits underwent tracheotomy and closure only to evaluate possible impact of tracheotomy procedure to tracheal stenosis (sham surgery). RESULTS: None of the 6 rabbits showed significant complications or death during the study. No significant change of tracheal lumen was identified in 3 sham models. The mean grade of stenosis was 57.2±9.9% (range, 43-70%). Histologic image showed thickening and fibrosis of lamina propria with relatively intact tracheal cartilage framework. CONCLUSION: We developed an animal model of tracheal stenosis using a segmented endotracheal tube fixed with a nylon tape. Since this model has similar pathophysiology to prolonged endotracheal intubation, it may be used in various studies related to tracheal stenosis.

Different Patterns of Emotional Eating and Visuospatial Deficits Whereas Shared Risk Factors Related with Social Support between Anorexia Nervosa and Bulimia Nervosa

OBJECTIVE: Although it is thought that eating disorders result from the interplay of personal and sociocultural factors, a comprehensive model of eating disorders remains to be established. The aim of this study was to determine the extent to which the childhood factors and deficit in visuoperceptual ability contribute to eating disorders. METHODS: A total of 76 participants - 22 women with anorexia nervosa (AN), 28 women with bulimia nervosa (BN), and 26 healthy women of comparable age, IQ, and years of education - were examined. Neuropsychological tasks were applied to measure the visuoperceptual deficits, viz. the Rey-Osterrieth complex figure test and the group embedded figures test (GEFT). A questionnaire designed to obtain retrospective assessments of the childhood risk factors was administered to the participants. RESULTS: The women with both AN and BN were less likely to report having supportive figures in their childhood and poor copy accuracy in the Rey-Osterrieth test. The women with AN were more likely to report premorbid anxiety, childhood emotional undereating and showed poor performances in the GEFT. In the final model, the factors independently contributing to the case status were less social support in childhood as a common factor for both AN and BN, and childhood emotional undereating and poor ability in the low-level visuospatial processing for AN. CONCLUSION: Our results suggest the disturbance in the food-emotion relationship and the deficit in low-level visuospatial processing in people with AN. Lower social support appears to contribute to an increase in vulnerability to both AN and BN.

Assessment of Left Ventricular Function and Volume in Patients Undergoing 128-Slice Coronary CT Angiography with ECG-Based Maximum Tube Current Modulation: a Comparison with Echocardiography

OBJECTIVE: To compare multi-detector CT (MDCT) using 128-slice coronary CT angiography (Definition AS+, Siemens Medical Solution, Forchheim, Germany) with ECG-based maximum tube current modulation with echocardiography for the determination of left ventricular ejection fraction (LVEF), end-diastolic volume (EDV), end-systolic volume (ESV), as well as assessing coronary artery image quality and patient radiation dose. MATERIALS AND METHODS: Thirty consecutive patients (M:F = 20:10; mean age, 57.9 +/- 11.4 years) were referred for MDCT for evaluation of atypical chest pain. EF, EDV and ESV were determined for both MDCT and echocardiography, and the correlation coefficients were assessed. Coronary artery segment subjective image quality (1, excellent; 4, poor) and radiation dose were recorded. RESULTS: Left ventricular EF, EDV, and ESV were calculated by MDCT and echocardiography and the comparison showed a significant correlation with those estimated by echocardiography (p < 0.05). Consistently, the LVEFs calculated by MDCT and echocardiography were not statistically different. However, LV, EDV and ESV from MDCT were statistically higher than those from echocardiography (p < 0.05). The average image quality score of the coronary artery segment was 1.10 and the mean patient radiation dose was 3.99 +/- 1.85 mSv. CONCLUSION: Although LV volume was overestimated by MDCT, MDCT provides comparable results to echocardiography for LVEF and LVV, with a low radiation dose.

Langerhans Cell Histiocytosis in the Skull: Comparison of MR Image and Other Images

PURPOSE: To evaluate the characteristic MR imaging findings of Langerhans cell histiocytosis (LCH) in the skull and to compare them with those of plain radiography and computed tomography. MATERIALS AND METHODS: A total of 10 lesions in 9 patients (Age range; 5-42 years, Mean age; 18, all women) with Langerhans cell histiocytosis in the skull were included in our study. Nine lesions in nine patients were histologically confirmed by surgery or fine needle aspiration biopsy. All patients performed with MRI, and plain radiography and CT scan were done in 7 patients (8 lesions). Two experienced neuroradiologists reviewed the radiological examinations independently with attention to location, size, shape and nature of the lesions in the skull and compared the extent and extension of the lesions to adjacent structures. RESULTS: The lesions were distributed in all of the skulls without predilection site. On MRI, the masses were shown as well-enhancing soft tissue masses (10/10) mainly in diploic spaces (8/10) with extension to scalp (9/10) and dura mater (7/10). Dural enhancement (7/10) and thickening (4/10) were seen. The largest diameter of the soft tissue masses ranged 1.1 cm to 6.8 cm, shaped as round (5/10) or oval (5/10). On CT scans, the lesions were presented as soft tissue masses involving diploic space (6/8) and scalp extension (7/8) were also well visualized. Although bony erosion or destruction was more clearly seen on CT rather than those of MRI, enhancement of soft tissue masses and dura were not well visualized on CT. In contrast, all of the lesions in LCH were seen as punched out (4/8), beveled-edge appearance (4/8) osteolytic masses in plain radiography, but scalp and dural extension could not be seen. CONCLUSION: Characteristic MR findings in patients with LCH are soft tissue mass in diploic space with extension to dura and scalp, and MRI would be better imaging modality than plain radiography or CT .

An Association Study of the A218C Polymorphism of the Tryptophan Hydroxylase 1 Gene with Eating Disorders in a Korean Population: A Pilot Study

OBJECTIVE: We examined the association between the tryptophan hydroxylase 1 (TPH1) gene and eating disorders focusing on obsessionality. METHODS: The sample included 62 women with a lifetime diagnosis of anorexia nervosa (AN) as well as 50 women with a lifetime diagnosis of bulimia nervosa (BN) recruited from specialist clinics for eating disorders and 131 healthy women in Korea. Blood samples were collected from all participants for the TPH1 genotyping. The patients were ad ministered the Korean version of the Eating Disorders Examination and obsessionality was conceptualized using measures of persistence, harm avoidance, and obsessive-compulsive symptoms. RESULTS: In the case-control comparisons, the frequency of the A/A genotype was increased in the patients with BN, but this difference was not significant after correcting for multiple testing. We found no effect of the TPH A218C polymorphism on obsessionality in the patients with AN or BN. CONCLUSION: Although the present findings should be regarded as preliminary because of the small size of our sample, they suggest that the TPH1 gene may contribute to the genetic susceptibility to BN and be associated with the other unexplored traits of bulimic case status.

The effect of music on the effect-site concentration of propofol for loss of consciousness / 대한마취과학회지

BACKGROUND: Music reduces anxiety and the need for sedatives in preoperative patients. Currently, propofol is usually infused using target controlled infusion device. With the use of such a device, we investigated the effects of music on the effect-site concentration of propofol for loss of consciousness. METHODS: Sixty-five ASA 1 or 2 patients aged 35 to 55 years who were scheduled for general anesthesia were randomly allocated to either the control, music or headphone group. The control group patients were exposed to the ambient operating room atmosphere (n = 17), the music group patients listened to music (n = 25), and headphone group wore a headphone alone without listening to music (n = 23). Propofol was infused with a predetermined effect-site concentration and we determined loss of consciousness in patients by a verbal response and eyelash reflex for 3 minutes. Each concentration of propofol was predetermined by the up-and-down method with 0.4microgram/ml as the step size. RESULTS: Loss of consciousness was observed at a concentration of 4.20 +/- 0.25microgram/ml in the control group, 3.60 +/- 0.34microgram/ml in the music group, and 3.73 +/- 0.47microgram/ml in the headphone group. The effect-site concentration for loss of consciousness was significantly lower in the music group as compared to the control group (P < 0.05). The effect-site concentration in the headphone group, however, showed no statistical difference as compared to the control group (P = 0.117). CONCLUSIONS: Listening to music reduced overall propofol effect-site concentration for loss of consciousness that was required by patients.

Clinical Utility of Coronary CT Angiography with Low-dose Chest CT in the Evaluation of Patients with Atypical Chest Pain: A Preliminary Report

PURPOSE: To determine the clinical utility of coronary CT angiography (CCTA) with low-dose chest CT in the evaluation of patients with atypical chest pain. MATERIALS AND METHODS: Ninety-six patients (mean age 60.2 years; age range, 41-68 years; 70 males) were referred for CCTA with low-dose chest CT (16-slice MDCT, Siemens) for an evaluation of atypical chest pain. When significant stenoses (lumen diameter reduction > 50%) were detected on CCTA, invasive coronary angiography (CA) was performed as the standard of reference. In all patients, medical chart review or telephone contact with patients was used to evaluate the contribution of CCTA with low-dose chest CT to the final clinical diagnosis, at least 6 months after performing CCTA. RESULTS: Among 96 patients, seven patients (7%) had significant stenoses as detected on CCTA, whereas two patients (2%) had significant stenoses and five patients had insignificant stenoses or no stenosis, as detected on conventional catheter angiography. In 18 (19%) of the 89 patients without significant stenosis detected on CCTA, this protocol provided additional information that suggested or confirmed an alternate clinical diagnosis. CONCLUSION: In patients with atypical chest pain, CCTA with low-dose chest CT could help to exclude ischemic heart disease and could provide important ancillary information for the final diagnosis.

Frequency of Irritable Bowel Syndrome, Perceived Stress, and Mental Health Among Women / 성인간호학회지

PURPOSE: This study was performed to examine the frequency of irritable bowel syndrome(IBS), perceived stress, and mental health among community-dwelling women. METHODS: This study conducted a survey to collect data on 869 women in Seoul and Gyeonggi-do. The measurements included the Rome III criteria(to diagnose IBS), the Global Assessment Recent Stress(GARS scale to evaluate perceived stress), and symptom check list 90R(SCL-90R to evaluate psychological distress). Data were analyzed using SPSS 15.0 program by frequency, chi-square -tests, t-test, and analysis of variance(ANOVA). RESULTS: The frequency of IBS in women was 15.1%. Eighty-six women(65.6%) had mixed constipation and diarrhea subtype of IBS. Compared to the women without IBS, those with IBS reported significantly higher scores on GARS, all subscales of GARS, SCL-90R, all subscales of SCL-90R, and the global severity index(GSI). No significant differences were observed among stress, mental health, and the IBS subtypes. CONCLUSION: Nursing interventions targeting women with IBS should be developed in order to reduce the associated stress and psychological distress.

Multi-Detector Computed Tomography for Assessing the Left Ventricular Function, Perfusion and Viability

MDCT has recently been used as a diagnostic tool to evaluate coronary artery stenosis and to detect coronary artery anomalies. The accuracy of MDCT has improved the assessment of stenosis as the number of detectors has increased. In addition to its excellent role in evaluating coronary artery stenosis, MDCT can provide information regarding the left ventricular function without having to perform additional scanning, and the myocardial viability of the left ventricle can be assessed on a delayed scan. MDCT has several disadvantages such as the amount of radiation exposure and the use of an iodine contrast medium, which might cause an adverse reaction, when combined with the reconstruction of the systolic and diastolic phases and the delayed scan. Yet MDCT may provide the opportunity to evaluate the coronary anatomy, the left ventricular function and the tissue characterization in one single imaging session that lasts less than 15 minutes.

A Case of Hereditary Factor VII Deficiency Performed Operation without any Replacement Therapy / 대한혈액학회지

Hereditary factor VII deficiency is a rare disorder transmitted by autosomal recessive pattern and its clinical feature is extremely variable. Recently we have experienced a case who was performed herniorrhaphy without any cryoprecipitate or fresh frozen plasma replacement therapy. A 21-year-old patient who had undergone intermittent nasal bleeding was noted for prolonged prothrombin time(INR of 1.5). The level of the factor VII of the patient was decreased at 22% of the normal activity. His parents had normal level of factor VII activity. Both his sister and brother had decreased level of factor VII at 41% and 24% respectively. Herniorrhaphy was performed without factor replacement therapy and there was no visible postoperative bleeding. We report here a case of factor VII deficiency performed an operation successfully without any replacement therapy.

Repair of Orbital Wall Fracture Using Transcaruncular Approach

Transcutaneous and transconjunctival approaches are still the most frequently used techniques in repairing orbital wall fractures. However, medial wall fracture is still a challenging area to the oculoplastic surgeons due to technical difficulties and postroperative scars. Transcaruncular approach is an effective way to repair medial or combined medial and inferior orbital wall fractures without visible scars. Ten cases of orbital wall fractures are repaired using the transcaruncular approach alone or combined with transconjunctival approch. All patients were corrected satisfactorily without leaving any visible scar. We think transcaruncular approach is a useful technique to repair medial orbital wall fracture.

Coniparision of Clinical Results Between Keratomileusis In Situ and Laser Assisted In Situ Keratomileusis for High Myopia from -15 Diopter to -23 Diopter

Photorefractive keratectomy (PRK), Keratomileusis In Situ (KM), Laser Assisted In Situ Keratomileusis (LASIK), and clear lens extraction have been performed for high myopic patients. Among the above surgical procedures KM and LASIK are applied to young patients in general. However, comparison of clinical results of these two procedures was not reported yet in Korea. To evaluate the clinical results of KM (n=16) and LASIK (n=11) for high myopic patients between -15 diopter (D) and -23 diopter (D), spherical equivalent (S.E) and uncorrected visual acuity were studied for more than ten months, retrospectively. The mean S.E. was changed from -17.36 D before operation to -3.70 D ten months after operation in KM, whereas it was from -17.41 D to -0.31 D in LASIK. At ten months after operation, uncorrected visual acuity equal or better than best corrected visual acuity before operation was 43. 8% in KM and 63. 6% in LASIK. This results show that the clinical result of LASIK were superior to that of KM for high myopia.