Validation of the Korean Version of the Neck Dissection Impairment Index in Patients Who Underwent Neck Dissection / 대한두경부종양학회지

Background/Objectives@#Shoulder function is an important aspect of health related quality of life (QOL). Neck dissection impairment index (NDII) is a simple shoulder-specific questionnaire. This study aimed to evaluate the association between QOL and NDII in patients who underwent neck dissection to validate the Korean version of NDII.Materials & Methods: This study enrolled 74 patients with head and neck cancer who underwent neck dissection from December 2013 to April 2014. Patients completed questionnaires on QOL including the European Organization of Research and Treatment of Cancer 30-item Core QOL questionnaire (EORTC QLQ-C30) and NDII which was translated into Korean. Validity was evaluated by calculating the Pearson correlation coefficient between NDII and EORTC QLQ-C30. @*Results@#We compared preoperative, postoperative within a week, 1st and 3rd months NDII scores. The total NDII scores were 14.7, 47.4, 33.7 and 34.3 each. Clinical variables including gender, site of primary tumor, performing revision neck dissection, radiotherapy and flap reconstruction were not significantly associated with NDII. However NDII mean score of patients who underwent unilateral neck dissection over 3 levels is most increased after operation. During all periods NDII scores were significantly associated with functioning score. Although other scores are lower correlation than function scores, global health status scores and symptom scores are also correlation with NDII. @*Conclusion@#NDII was valid instrument and can be used not only in the clinical practice to assess shoulder dysfunction but also in the simple instrument to evaluate global QOL in Korea patients with having neck dissection.

Anesthesia-Related Neurally Mediated Syncope in the Perioperative Period: Two Case Reports

The following report describes the occurrence of severe hypotension and bradycardia in a healthy 50-year-old man following placement from supine to the beach chair position during general anesthesia for injured rotator cuff tendon repair, as well as the occurrence of micturition syncope in a 71-year-old man following postobstructive diuresis after combined spinal–epidural anesthesia for total knee replacement. Rapid decompression of the urinary bladder is associated with severe hypotension, bradycardia, and syncope. Neurally mediated syncope includes true vasovagal and situational syncope that can occur in association with various situations such as cough, micturition, postprandial state, and interscalene block. We report two cases of neurally mediated syncope (true vasovagal and situational) that occurred in different conditions and were controlled well with prompt and proper management without serious complications.

Increased Effect-Site Concentration of Propofol Reduces ECâ‚…â‚€ of Remifentanil for Successful Intubation Using the Shikani Optical Stylet without Neuromuscular Blockade

OBJECTIVE@#For short-duration surgery, propofol and remifentanil are the drugs of choice for intubation without neuromuscular blockade. The Shikani Optical Stylet (SOS) is a novel semi-rigid type fiberoptic laryngoscope. In this study, we determined the clinically required effect-site concentration of remifentanil for intubation using SOS without neuromuscular blockade depending on propofol effect-site concentration.@*METHODS@#We enrolled patients scheduled for elective surgery with general anesthesia, and assigned them into two groups by a randomized, double-blind method: concentration of propofol 3.5 µg/mL (group PRO 3.5) and 7.0 µg/mL (group PRO 7.0). Anesthesia was conducted with target-controlled infusion in predetermined target effect-site concentrations of propofol. The concentration of remifentanil for successful intubation using SOS in 50% of patients (EC₅₀) was determined using a modified Dixon's up-and-down method.@*RESULTS@#The mean±standard deviation EC₅₀ of remifentanil was 5.07±0.40 ng/mL in group PRO 3.5 and 1.79±0.44 ng/mL in group PRO 7.0. From probit analysis, EC₅₀ and EC₉₅ of remifentanil in group PRO 3.5 were 4.85 ng/mL (95% confidence interval [CI], 4.44–5.16 ng/mL) and 5.42 ng/mL (95% CI, 5.13–7.47 ng/mL) respectively, and EC₅₀ and EC₉₅ of remifentanil in group PRO 7.0 were 1.68 ng/mL (95% CI, 1.22–2.01 ng/mL) and 2.29 ng/mL (95% CI, 1.98–4.05 ng/mL), respectively.@*CONCLUSION@#Increased concentration of propofol reduced EC₅₀ of remifentanil for successful intubation using SOS without neuromuscular blockade.

Anesthetic Management for an Eye Surgery in a Patient with Stevens-Johnson Syndrome

The Stevens-Johnson syndrome is a severe manifestation of erythema multiforme associated with multisystem involvement. It is extremely unusual for patients with this syndrome to present with indications for eye surgery. Respiratory tract involvement can make the management of the airway and tracheal intubation difficult. We describe herein the perioperative management of a patient with this disease who underwent surgery for amniotic membrane transplantation.

Results of High-Frequency and High-Acceleration Rotary Chair Test in Patients with Acute Unilateral Vestibular Neuritis / 대한평형의학회지

BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate the results of high-frequency and high-acceleration rotary chair test in patients with acute unilateral vestibular neuritis. MATERIALS AND METHODS: Twenty-four patients who were diagnosed as acute vestibular neuritis and underwent rotational chair and caloric tests during March 2012 to March 2013 were included. Slow harmonic acceleration (SHA) test was performed at 0.01, 0.04, 0.16, 0.64, 1.28, and 2.00 Hz. Step velocity tests at the peak velocity of 100degrees/sec (low-acceleration) and 240degrees/sec (high-acceleration) were performed. Gains and phases in SHA test and gains and time constants (Tc) in step velocity test were analyzed. RESULTS: In SHA test, decreased gain and phase lead was observed mostly in low frequencies. Gains (phases) at 0.01, 0.04, 0.16, 0.64, 1.28, and 2.00 Hz were 0.2+/-0.1 (62.2+/-15.4), 0.3+/-0.2 (24.5+/-13.0), 0.4+/-0.2 (7.2+/-18.8), 0.5+/-0.1 (7.2+/-11.3), 0.7+/-0.2 (11.0+/-7.5), and 0.8+/-0.3 (4.4+/-14.4), respectively. In step velocity (SV) test, gains stimulating the lesion side were significantly lower than those stimulating the intact side in both low- and high-acceleration SV test (p<0.05) and per-rotatory gain stimulating the lesion side in high-acceleration SV test was significantly lower than that in low-acceleration SV test. Tc stimulating the lesion side were significantly shorter than those stimulating the intact side in low- acceleration SV test (p<0.05) but not in high-acceleration SV test. Per- and post-rotatory Tc in high-acceleration SV test stimulating the intact side was significantly lower than those in low-acceleration SV test (p<0.05). CONCLUSION: At high-frequency SHA test, gain was pretty normal and phase lead was observed in some patients. High-acceleration SV test showed shortened Tc regardless of the sides, suggesting that high-acceleration SV test can reveal the impaired velocity storage system in patients with vestibular neuritis more frequently than low-acceleration SV test.

Anti-Inflammatory Effect of Mangostenone F in Lipopolysaccharide-Stimulated RAW264.7 Macrophages by Suppressing NF-kappaB and MAPK Activation

Mangostenone F (MF) is a natural xanthone isolated from Garcinia mangostana. However, little is known about the biological activities of MF. This study was designed to investigate the anti-inflammatory effect and underlying molecular mechanisms of MF in lipopolysaccharide (LPS)-stimulated RAW264.7 macrophages. MF dose-dependently inhibited the production of NO, iNOS, and pro-inflammatory cytokines (TNF-alpha, IL-6, and IL-1beta) in LPS-stimulated RAW264.7 macrophages. Moreover, MF decreased the NF-kappaB luciferase activity and NF-kappaB DNA binding capacity in LPS-stimulated RAW264.7 macrophages. Furthermore, MF suppressed the NF-kappaB activation by inhibiting the degradation of IkappaBalpha and nuclear translocation of p65 subunit of NF-kappaB. In addition, MF attenuated the AP-1 luciferase activity and phosphorylation of ERK, JNK, and p38 MAP kinases. Taken together, these results suggest that the anti-inflammatory effect of MF is associated with the suppression of NO production and iNOS expression through the down-regulation of NF-kappaB activation and MAPK signaling pathway in LPS-stimulated RAW264.7 macrophages.

Neurochemical Profile Quantification of Regional Adult Mice Brain Using: ex vivo 1H High-Resolution Magic Angle Spinning NMR Spectroscopy / 의학물리

The purpose of this study is to quantitate regional neurochemical profile of regional normal adult mice brain and assess regional metabolic differences by using ex vivo 1H high-resolution magic angle spinning nuclear magnetic resonance spectroscopy (1H HR-MAS NMRS). The animals were matched in sex and age. The collected brain tissue included frontal cortex, temporal cortex, thalamus, and hippocampus. Quantitative 1D spectra were acquired on 40 samples with the CPMG pulse sequence (8 kHz spectral window, TR/TE = 5500/2.2 ms, NEX = 128, scan time: 17 min 20 sec). The mass of brain tissue and D2O+TSP solvent were 8~14 mg and 7~13 mg. A total of 16 metabolites were quantified as follow: Acet, NAA, NAAG, tCr, Cr, tCho, Cho, GPC + PC, mIns, Lac, GABA, Glu, Gln, Tau and Ala. As a results, Acet, Cho, NAA, NAAG and mIns were showed significantly different aspects on frontal cortex, hippocampus, temporal cortex and thalamus respectively. The present study demonstrated that absolute metabolite concentrations were significantly different among four brain regions of adult mice. Our finding might be helpful to investigate brain metabolism of neuro-disease in animal model.

The Effect of Lateral Retinacular Peeling in Total Knee Arthroplasty

PURPOSE: The aim of the present study was to investigate if a lateral retinacular peeling helped decrease the amount of lateral patellar tilt in total knee arthroplasty (TKA). MATERIALS AND METHODS: The lateral tilt angles were measured in tangential radiographs made preoperatively and postoperatively, with the knee in 100 degrees of flexion, in an earlier series of 38 TKAs(Group 1) and a series of 53 TKAs (Group 2) that included lateral retinacular peel and partial facetectomy. RESULTS: The mean preoperative patellar tilt angle was 9.1+/-4.5 degrees in the group 1 and 9.5+/-5.2 degrees in the group 2. The mean postoperative patellar tilt angle was 12.8 +/-6.2 and 11.0+/-7.1 degrees, respectively. The implant tilt angle was 6.3+/-7.3 and 5.5+/-6.1 degrees, respectively. The differences between two groups were not statistically significant. CONCLUSION: The patella would tilt laterally following total knee arthroplasty. A lateral retinacular peeling had no discernible effect on the postoperative lateral tilt of the resurfaced patella.

Wall-Suction Assisted Vacuum Sealing for Treatment of Infected Diabetic Foot Ulcer / 대한족부족관절학회지

PURPOSE: The infected diabetic foot patients were reviewed to analyze the result of new dressing methods using a wall-suction instruments. MATERIALS AND METHODS: Eighteen patients treated with wall-suction assisted vacuum dressing were included. After debridement under local anesthesia, a sponge pad, a drain, and a surgical drape were used to seal the wound. Negative pressure applied by the wall-suction at around 200 mmHg and dressing were repeated in every two to three days. The results of repeated wound cultures, growth of granulation tissues, and CRP level were closely observed on the regular basis. RESULTS: Rapid growth of granulation tissues was noticed around the wound in 16 cases. No organism was obtained in an average 5 days and wound coverage was possible in an average 18 days. The CRP level returned to normal in an average 4 weeks. Two patients with end stage renal disease, who were regularly hemodialised, underwent major amputation. CONCLUSION: New dressing method has the following advantages: a rapid wound improvement in the patients with infected diabetic foot, less expensive, less painful, impediment of bacterial contamination in the hospital room. However, further study will be needed for the end stage renal disease patients.

Septooptic Dysplasia: A Case Report

Septooptic dysplasia is a rare anterior midline anomaly considered to be a mild form of lobar holoprosencephaly. We describe a case with unilateral optic nerve hypoplasia and the absence of a septum pellucidum.

Neuronal Dysfunction in Patients with Chronic Alcoholism Evaluated by In Vivo 1H Magnetic Resonance Spectroscopy

PURPOSE: With the use of localized, water-suppressed in vivo 1H magnetic resonance spectroscopy (MRS), we evaluated the proton metabolic alterations in patients with chronic alcoholism and healthy normal controls. MATERIALS AND METHODS: Patients with chronic alcoholism (N=10) and normal control subjects (N=10) underwent MRS examinations using a stimulated echo acquisition mode (STEAM) pulse sequence with 2X2X2 cm3 volume of interest (VOI) in the left cerebellum and basal ganglia. Proton metabolite ratios relative to creatine (Cr) were obtained using a Marquart algorithm. RESULTS: The specific feature in patients with chronic alcoholism was a significant decrease of N-acetylaspartate (NAA)/Cr ratio in the left cerebellum, compared with normal controls. No clear correlation of other metabolite ratios such as choline (Cho)/Cr and inositols (Ins)/Cr was established. CONCLUSION: Our preliminary study suggests that the reduction of NAA/Cr ratio may indicate neuronal loss in patients with chronic alcoholism. Thus, in vivo 1H MRS may be a useful modality in the clinical evaluation of patients with chronic alcoholism based on the proton metabolite ratios.

Age-related Changes of Mac1-positive Cell Distribution in the Thymus, Spleen and Popliteal Lymph Node in C57BL/6 Mice / 체질인류학회지

The following experiment was performed to clarify distributional change of the Mac1-positive cells at 1, 4, 8 ,12 and 40 weeks after birth. Thymuses, spleens and lymph nodes were removed and immunocytochemical staining using the specific Mac1 antibody was performed The results obtained from the present experiment were as follows : 1. Mac1-positive cell was absent at 1 week, they were increased by 4 weeks and decreased at 40 weeks in the thymus after birth. 2. There was no Mac1-positive cell in the marginal zone of the spleen at 4, 40 weeks, but they were shown at 8 weeks. 3. Mac1-positive cells were increased at 4 weeks in the subfollicular area of lymph nodes. There was no change of distribution in the lymph nodes. From the above results, we suggest that the age-related decrease of the immunity might be caused by decrease of Mac1-positive cells in the antigen-presenting area.

Peripheral Cholangiocarcinoma: Three-Phase Helical CT Appearance

PURPOSE: To analyze the enhancement patterns and morphology of peripheral cholangiocarcinomas (CCs), as seen on three-phase helical CT. MATERIALS AND METHODS: Three-phase helical CT scans of 25 cases of 24 patients with pathologically-proven CCs were retrospectively reviewed. After intravenous administration of contrast media, scans of the hepatic arterial phase (HAP) were obtained at 30 seconds, of the portal venous phase (PVP) at 70 seconds, and of the delayed phase (DP) at 3 minutes. RESULTS: Linear, dense, marginal enhancement was seen in 17 CCs (68%), mainly on HAP images (64%) while thick, band-like, peripheral enhancement was seen in 18 (72%), on either PVP (52%) or DP (44%). Internal enhancement was observed in 23 CCs (92%) on PVP (68%) and/or DP (88%), and 19 CCs (76%) among them showed incomplete enhancement of stippled and/or septated patterns. Most (76%) were seen throughout all three phases to be hypoattenuating, as compared to the surrounding parenchyma. On HAP, wedge-shaped parenchymal enhancement was demonstrated at the periphery of 19 CCs (76%) suggesting impaired portal flow. Associated morphologic findings were satellate nodules (n=15, 60%), lymphadenopathy (n=14, 56%), focal dilatation of intrahepatic ducts around the tumor (44%), umbilication of the liver surface (50%), and clonorchiasis (44%). CONCLUSION: On three-phase helical CT, peripheral cholangiocarcinoma showed linear marginal enhancement on HAP, thick peripheral enhancement on PVP and/or DP, stippled and septated enhancing foci on DP, and peritumoral wedge enhancement on HAP. Associcated findings such as satellite nodules, focal dilatation of the intrahepatic ducts, umbilication of the tumor, and clonorchiasis were helpful.

Injury of Anterior Cruciate Ligament with Associated Bony Lesions: MR Image

PURPOSE: To evaluate the characteristic MR findings in injury of the anterior cruciate ligament (ACL) with associated bony lesions. MATERIALS AND METHODS: We reviewed MR findings and the corresponding arthroscopic or operative results of 48 patients with ACL injuries, and evaluated ACL signal intensity and contour. In associated bony lesions, we determined the location of avulsion fracture and bony bruise. RESULTS: Cmplete ACL tears were seen in 27 cases, partial tears in 13, and avulsion injury in eight. Complete tears showed heterogeneously increased signal intensity with contour bulging in ten cases (37 %), and combined bony lesion in 14 (52 %). ACL with a thin continous low signal intensity band surrounding heterogeneously-increased signal intensity suggested partial tears, and was seen in three of 13 proven cases (23 %) of partial ACL tears ; combined bony lesion was seen in four such cases (31 %). There were eight cases of avulsion fracture ; the most frequent site was the anterolateral portion of the tibial spine (n=6). The most frequent sites of bony lesion were at the midportion of the lateral femoral condyle (n=6), and the posterior portion of the lateral tibial plateau (n=6) ; the next most frequent site was the anterior portion of the lateral tibial plateau (n=5). CONCLUSION: Tearing of the ACL was seen on MRI as ligament discontinuity, and heterogeneously increased signal intensity with ACL contour bulging. The most frequent sites of associated bony lesions were the midportion of the lateral femoral condyle, and the posterior portion of the lateral tibial plateau. In associated bony lesions, bony contusion suggested ACL tearing, but avulsion fracture suggested ligament avulsion injury without tear.

The relationship among insight, psychopathology and drug compliance in the schizophrenic patient / 신경정신의학

No abstract available.

Surgical treatment on Graves'disease

No abstract available.