Alternative Method of Retrocrural Approach during Celiac Plexus Block Using a Bent Tip Needle

BACKGROUND: This study sought to determine safe ranges of oblique angle, skin entry point and needle length by reviewing computed tomography (CT) scans and to evaluate the usefulness of a bent tip needle during celiac plexus block (CPB). METHODS: CT scans of 60 CPB patients were reviewed. Image of the uppermost margin of L2 vertebral body was used to measure the minimal and maximal oblique angles and the distances from the midline to skin puncture point. The imaginary needle trajectory distance was calculated by three-dimensional measurement. When the procedure was performed by using a 10degrees bent tip needle under a 20degrees oblique X-ray fluoroscopic view, the distance (GF/G'F) from the midline to the actual puncture site was measured. RESULTS: The imaginary safe oblique angle range was 26.4-34.2degrees and 27.7-36.0degrees on the right and left, respectively. The distance from the midline to skin puncture point was 6.1-7.6 cm on the right and 6.3-7.6 cm on the left. The needle trajectory distance at minimal angle was 9.6-11.6 cm on the right and 9.5-11.5 cm on the left. The distance of GF/G'F was 5.1-6.5 cm and 5.0-6.4 cm on the right and left, respectively. All imaginary parameters were correlated with BMI except for GF/G'F. All complications were mild and transient. CONCLUSIONS: We identified safe values of angles and distances using a straight needle. Furthermore, using a bent tip needle under a 20degrees oblique fluoroscopic view, we could safely perform CPB with smaller parameter values.

The usefulness of ankle-brachial index as a screening test on peripheral artery occlusive disease in patients with low back and leg pain / 대한마취과학회지

No abstract available.

Usefulness of Preoperative Serum Testosterone as a Predictor of Extraprostatic Extension and Biochemical Recurrence

PURPOSE: A great variety of studies on preoperative serum testosterone as a predictor of progression of prostate cancer have been reported recently. The purpose of this study was to investigate the relationship of preoperative serum testosterone levels in patients who underwent radical prostatectomy with prognostic factors. MATERIALS AND METHODS: Clinical data were collected from 60 patients who underwent radical prostatectomy. The 60 cases were divided into 2 groups according to their preoperative serum testosterone levels: group 1 (n=21), or =3 ng/ml. The groups were compared according to prog-ression factors. Multivariate logistic regression analysis was performed to determine the correlation between biochemical recurrence and each variable. RESULTS: The incidence of extraprostatic invasions was significantly higher in group 1 with 13 cases in group 1 (61.9%) and 11 cases in group 2 (28.2%) (p=0.011). The incidence of biochemical recurrence was also significantly higher in group 1 with 5 cases in group 1 (23.8%) and 2 cases in group 2 (5.1%) (p=0.032). A low serum testosterone level (< or =3 ng/ml) was associated with an increased risk of biochemical recurrence (odds ratio [OR], 13.64; 95% confidence interval [CI], 1.66 to 2.43; p=0.015) and an increased risk of extraprostatic invasions (OR, 4.96; 95% CI, 1.41 to 17.38; p=0.012). CONCLUSIONS: The incidence rates of extraprostatic invasions and biochemical recurrence were significantly higher in the group with preoperative average serum testosterone of less than 3 ng/ml. Therefore, these results suggest that preoperative average serum testosterone will be useful in predicting postoperative prostate cancer progression.

The Effect of Intraprostatic Chronic Inflammation on Benign Prostatic Hyperplasia Treatment

PURPOSE: Asymptomatic chronic inflammation of the prostate is a common finding in benign prostatic hyperplasia (BPH). We investigated how the chronic inflammation affects medical treatment for BPH. MATERIALS AND METHODS: One pathologist reviewed the chronic inflammation of 82 BPH patients who underwent transrectal ultrasonography (TRUS)-guided needle biopsy. The extent of chronic inflammation was classified into 4 grades, categorized into two groups: the low-grade group and the high-grade group. We compared total, voiding, and storage International Prostate Symptom Score (IPSS) and quality of life (QoL) between the groups at baseline and 1, 3, 6, and 12 months after medical treatment for BPH. RESULTS: There were no significant differences in total IPSS or QoL between the groups during the follow-up period. The low-grade group showed continuous improvement of storage symptoms until 12 months; however, the high-grade group showed improvement until 3 months. Maximal improvements of QoL were observed at 6 months in the high-grade group and at 3 months in the low-grade group. There was no episode of surgery in the low-grade group, but four patients in the high-grade group (9.1%) underwent surgical treatment due to acute urinary retention or insufficient therapeutic response. CONCLUSIONS: Although there was no statistical significance, improvements in IPSS were higher and lasted longer in the low-grade group. We might suggest medical treatment for intraprostatic chronic inflammation in BPH patients.

Analyses of the Frequency and the Indications of Succinylcholine in General Inhalation Anesthesia / 대한마취과학회지

BACKGROUND: Succinylcholine (Sch) has been considered to be the neuromuscular blockade (NMB) of choice in clinical anesthesia due to its rapid onset and short duration of action. Despite these clinical advantages, the use of Sch has decreased recently on account of its potentially fatal adverse effects such as cardiac arrest and malignant hyperthermia. The aim of this report was to analyze the frequency and the indications of Sch as well as to discover an alternative to decreasing the frequency of Sch use. METHODS: The medical records of a total of 33,972 cases under general anesthesia were collected retrospectively, and the frequency of Sch use and the reason for choosing Sch was analyzed. The side effects and other complications of Sch were also analyzed. RESULTS: A muscle relaxant was administered in 32,724 cases (96.3%) out of 33,972 cases, and Sch was used in 647 of these cases (1.9%). The reasons for choosing Sch were the rapid sequence induction (291 cases), short operation time (220 cases), recent food intake (51 cases), habitual use (78 cases) and reintubation (7 cases). There were 211 cases of the single administration of Sch and 13 cases in whom Sch was injected repeatedly. A non-depolarizing muscle relaxant (NDMR) was used after Sch administration in 423 cases. Precurarization was carried out in 434 cases (67%) and no severe complications were observed. CONCLUSIONS: The frequency of using Sch use can be decreased by reducing the habitual use and choosing the intubating dose of the intermediate acting NDMR as an alternative.

A Comparison of the Effects of Histidine-tryptophan-ketoglutarate Solution versus Cold Blood Cardioplegic Solution on Myocardial Protection in Mitral Valve Surgery / 대한흉부외과학회지

BACKGROUND: Ischemia-reperfusion injury related to unsuccessful myocardial protection affects postoperative ventricular function and mortality during open-heart surgery. We prospectively compared the effects of administration of histidine-tryptophan-ketoglutarate (HTK) solution and cold blood cardioplegia (CBC) on myocardial protection and clinical outcome in patients undergoing mitral valve surgery. MATERIAL AND METHOD: Seventy patients with mitral regurgitation (MR) undergoing mitral valve surgery were randomly divided into the HTK group (n=31) and the CBC group (n=31); eight patients were excluded. Perioperative hemodynamics, cardiac medications, pacing, postoperative outcomes and complications were recorded during the hospital stay. All patients received follow-up for at least 6 months postoperatively for morbidity and mortality. RESULT: There were no significant differences in the hemodynamics between the groups during the study period, except for the mean pulmonary artery pressure (MPAP), PCWP and CVP that were lower in the HTK group at 15 min after weaning of CBP. There were no differences for inotropic support and pacing during the 12 hrs postoperatively between the groups. CK-MB values on day 1 and day 2 were 77+/-54 and 41+/-23 for the HTK group and 70+/-69 and 44+/-34 for the CBC group, respectively (p=NS). Postoperative clinical outcomes were similar in both groups for at least 6 months during the follow-up period. CONCLUSION: These results suggest that the use of HTK solution is as safe as cold blood cardioplegia in terms of myocardial protection.