Transient right hemidiaphragmatic paralysis following subclavian venous catheterization: possible implications of anatomical variation of the phrenic nerve: a case report / 대한마취과학회지

Phrenic nerve paralysis is an unusual complication associated with central venous catheterization. Various mechanisms have been proposed. We present a case of transient right hemidiaphragmatic paralysis after subclavian venous catheterization. We hypothesize that anatomical variation of the phrenic nerve was responsible for this complication.

Hemodynamic comparison of propofol-remifentanil and sevoflurane based anesthesia for total knee arthroplasty using tourniquet / 대한마취과학회지

BACKGROUND: Use of pneumatic tourniquet is commonly accepted in total knee arthroplasty (TKA) to reduce perioperative blood loss. However, hemodynamic changes and cardiovascular collapse, which is caused by tourniquet, might be fatal to elderly patient. It is important to maintain the hemodynamic stability. We evaluated the effect of general anesthesia using propofol-remifentanil or sevoflurane on hemodynamic changes by using tourniquet during TKA. METHODS: Thirty patients underwent TKA were randomly divided into two groups; propofol-remifentanil (n = 15) and sevoflurane (n = 15). Mean arterial blood pressure (MBP), heart rate (HR), central venous pressure (CVP), stroke volume (SV), cardiac index (CI) and systemic vascular resistance (SVR) were recorded throughout the operation. Statistical analysis was done using nonparametric test and repeated measures of ANOVA. RESULTS: There are no differences in MBP, HR, CVP and SV between both groups during the tourniquet inflation but there are differences of CI at the 6, 9, 12 minute after the tourniquet inflation. During the tourniquet deflation, there are differences of MBP, HR between the two groups at just after, 3, 30, 45 minutes after the tourniquet deflation. But the changes of both groups are within 20% of baseline. There are no differences of CVP, SVR between the two groups during the tourniquet deflation. CONCLUSIONS: Propofol-remifentanil based anesthesia provided more stable hemodynamic conditions than sevoflurane based anesthesia, although both may be useful techniques for maintaining the hemodynamic changes within 20% of the baseline values, according to the tourniquet application in TKA.

Effect of Recruiting Maneuvers in a Patient with Acute Lung Injury after Femoral Nailing: A case report / 대한마취과학회지

Recruitment maneuvers have been increasingly used to reverse the alveolar derecruitment associated with low tidal volume ventilation in patients with acute lung injury and acute respiratory distress syndrome. We report a case of improved oxygenation without hypotension or lung rupture, due to an early application of recruitment maneuvers (40 cmH2O of continuous positive airway pressure for 40 s, three times [at 4.5 h, 5 h, 7 h], guided by pulse oximetry) followed by a mechanical pressure controlled ventilation with 20 cmH2O of positive end-expiratory pressure in acute lung injury after femoral intramedullary nailing.

Rupture of Thoracic Empyema for Femur Neck Fracture Surgery under Combined Spinal-Epidural Anesthesia: A case report / 대한마취과학회지

Thoracic empyema can result from the pleural accumulation of infected fluid or the infection of accumulated pleural fluid. The causes of empyema are pneumonia, surgery of lung, mediastinum, diaphragm, trauma, and so on. The impact of anesthetic technique (regional versus general versus combination of both) on the respiratory complication rate has not been established. A 86-yr-old male patient, who had COPD about 15 years and chronic empyema for several months, scheduled to operation for a femur neck fracture. We report a case that this patient with COPD and empyema operated under combined spinal-epidural anesthesia and converted to general anesthesia because of the rupture of the chronic empyema.

The Korean Memory Test (KMT) for Elderly: Estimating Validity and Reliability

Background: Verbal learning test is useful and significant test to evaluating memory function. There were many memory tests but few for elderly and dementia patients. Although there have been a variety of Korean memory tests developed, these tests were difficult to administer to dementia patients and elderly individuals with low educational levels. Therefore, we developed the Korean Memory Test (KMT). Methods: The KMT task consists of three trials of free recall of 10 simplified line drawing figures of familiar materials. Three immediate recall trials and one 20 minutes delayed recall and one recognition trial were administered. Sixty-five of probable Alzheimer's patients received the Korean version of Mini-Mental State Examination (K-MMSE), Korean version of expanded Clinical Dementia Rating Scale (CDR) and KMT. Also sixty-seven of normal controls were enrolled. We tested reliability and validity of the KMT and also evaluated scores of the KMT with progression of dementia. Results: The parameters of the KMT correlated with CDR -0.74~-0.77 (p<0.01), K-MMSE 0.66~0.68 (p<0.01). The internal consis- tency was 0.78 (Cronbach's alpha). Most of the KMT's parameters decreased with CDR significantly (p<0.01). Conclusions: The KMT is a good test for evaluating memory function of elderly with low educational level. Also it is a sensitive and specific test to detection of dementia in early stage and has excellent reliability and validity.

Development of the Korean Stroop Test and Study of the Validity and the Reliability

BACKGROUND: The Stroop color word test is useful to examines the frontal lobe function of selective attention and inhibition. The Korean Color Word Stroop Test(K-CWST) was widely used in Korea. But, it was difficult in elderly individual with low educational level and visual problem and in patients with more progressed dementia. So we developed the Korean Stroop Test(KST). METHODS: The KST consist of word reading(WR), color naming(CN), interference word reading(IWR) and interference color naming (ICN). The interference tasks are naming the ink color of color words which were mismatched with word meaning. We measured reaction time and number of error. This study used the K-CWST to assess and compare the KST in eighteen probable alcohol related dementia patients and nineteen normal control. All subjects received the Korean version of Mini-Mental State Examination (K-MMSE) and the K-CWST and the KST. We tested reliability and validity of the KST. Also we enrolled normal adult from 41 to 80 year old for evaluating the change of the KST test with age. RESULTS: The KST tasks were correlated with K-MMSE -0.33(p<0.05) to -0.63(p<0.001) and K-CWST correlated with K-MMSE 0.37 (p<0.05) to 0.55(p<0.01). The interference color naming of KST was correlated the most to K-MMSE -0.78(p<0.001). The interference color naming of KST and interference color naming of K-CWST was correlated by 0.81(p<0.001). The internal consistency were 0.78 (Cronbach's alpha). The KST score was statistically different between alcohol related dementia patients and normal subjects in CN, ICN and ICN error. The KST was not differ in old age group except some tasks. CONCLUSION: The KST has a excellent reliability and validity. It takes less time and easy than the K-CWST. So the KST is a good test for evaluating frontal lobe function in elderly with low educational level of older people.

The Neurops ychologic Features of Alcohol-Related Dementia

BACKGROUND: Recent studies indicate that heavy alcohol drinking is a significant factor for dementia. There are little studies for the neupsychology of alcohol-related persistent dementia patients in Korea. The main purpose of our study is investigate the results of neuropsychological test and neuroimaging of alcoholic dementia. METHODS: Eleven inpatients meeting DSM-IVcriteria for alcohol-related persistent dementia were examined with careful history taking, Seoul neuropsychological screening battery and brain CT. RESULTS: The mean K-MMSE, CDR scores were 18.4+/-3.8, 1.4+/-0.5, respectively. Language functions including spontaneous speech, comprehension, repetition, reading, writing were almost normal, except K-BNT. Attention, visuospatial function, calculation, orientation, memory, frontal executive function were severely impaired. Diffuse brain atrophy was the main finding on the brain CT. Personality changes including impulsivity, apathy, lack of motivation were observed most of the patients. CONCLUSION: Alcohol-induced persistent dementia subjects were impaired on the test of attention, visuospatial function, calculation, orientation, memory, frontal related function, but language function was relatively preserved.

The Effect of Nitric Oxide Donor on the Endogenous Endothelin-1 Expression in Renal Ischemia-Reperfusion Injury

PURPOSE: The balance between nitric oxide (NO) and endothelin-1 (ET-1) production is essential to vascular function in controlling organ perfusion, and an elevated ET-1 in the peritubular capillary network, following renal transplantation, can be associated with renal allograft rejection. The administration of a nitric oxide donor during the preischemic period has been shown to protect the kidneys against an ischemia-reperfusion injury, but the mechanism underlying this therapeutic benefit remains to be completely understood. Our hypothesis is that the early administration of the NO donor, sodium nitroprusside (SNP), may suppress ET-1, and thereby improve the renal function in an ischemia-reperfusion injury. METHODS: Sprague Dawley rats were subjected to 60 minutes of renal warm ischemia, followed by a contralateral nephrectomy. Renal biopsies were performed prior to ischemia and reperfusion, and at 1 and 48 hours after the reperfusion. The animals were divided into 4 groups: a sham group, without warm ischemia, an early SNP group (SNP given before ischemia), a late SNP group (SNP given before reperfusion) and an ischemic control group. The ET-1 expression was assessed by a semiquantitative analysis by immunohistochemical staining with the ET-1 monoclonal antibody and Hematoxylin-Eosin stain. The serum creatinine was measured at 48 hours after the reperfusion. RESULTS: There were significant improvements in all parameters of the early SNP group compared with those in the late SNP and ischemic control groups, but there was no difference between the late SNP and ischemic control groups. CONCLUSION: These data suggest that the early administration of SNP in renal ischemia-reperfusion improves the renal function by suppressing the expression of ET-1.

CT Findings of Pleural Dissemination from Lung Cancer

PURPOSE: The purpose of our study was to identify the CT findings that help detect pleural dissemination from lung cancer and to evaluate the usefulness of selected diagnostic criteria. MATERIALS AND METHODS: After a computerized database search of 606 patients who had undergone thoracotomy for primary lung cancer, 23 patients were identified as h aving surgically documented pleural dissemination. From the same database, 50 patients without pleural dissemination during thoracotomy were randomly selected as controls. Preoperative CT scans and medical records were rev i ewed retrospectively, and findings were compared between the two groups. RESULT: One or more of three types of pleural thickening (plaque-like, nodular, and fissural) were identified on CT as the most discriminating finding (sensitivity, 74 % ; specificity, 60 %; p = 0.007). The following findings were also significantly discriminating (p<0.05): contiguity of primary tumor with the pleural surface as seen on CT; adenocarcinoma in cell type; and a peripheral tumor defined as one in which bronchoscopy revealed no endobronchial lesion. The use of combinations of these findings in addition to pleural thickening rendered diagnostic criteria more specific at the cost of the sensitivity. CONCLUSION: During preoperative CT evaluation of lung cancer, the recognition of subtle pleural thickening helps detect pleural dissemination. The likelihood that subtle pleural thickening represents pleural dissemination is increased when a primary tumor is contiguous with the pleural surface, is an adenocarcinoma, or is peripherally located.

Effect of Intraarterial and Systemic Chemotherapy for Stage IIb Cervical Carcinoma: Assessment of TherapeuticResponse Using MR Imaging

PURPOSE: To evaluate the effectiveness of intraarterial chemotherapy(IAC) and systemic chemotherapy(SC) incases of locally advanced cervical carcinoma, and to assess the accuracy of magnetic resonance(MR) imaging fordetermining parametrial invasion after IAC or SC. MATERIALS AND METHODS: Among 44 patients with stage IIbcervical carcinoma, IAC was performed in 25 and SC in 19. MR images obtained before and after IAC or SC wereprospectively analyzed with regard to tumor volume and parametrial invasion, and tumor response to chemotherapywas classified as complete, partial, or progressive. Forty-one patients underwent radical hysterectomy within twoweeks of the second MR examination, and postoperative pathologic findings were correlated with radiologicfindings. RESULTS: The average reduction rate of tumor volume in the IAC and SC group was 89.2% and 66.3%,respectively. Between the two groups, there was no statistically significant difference(P>0.05). In the IAC group,13 patients showed a complete response and 11 a partial response, and in one there was progression. In the SCgroup, eight patients showed a complete response and nine a partial response, and in two there was progression.The accuracy of MR imaging for determining parametrial invasion after chemotherapy was 87.8%. In each patientthere was close correlation between MR imaging and pathologic findings. CONCLUSION: There was no statisticallysignificant difference in tumor reduction between the IAC and SC group. After chemotherapy for stage IIb cervicalcarcinoma, MR imaging is a valuable modality for determining surgical candidates.