Comparison of fiberoptic bronchoscopic intubation using silicone and polyvinyl chloride double-lumen tubes / 대한마취과학회지

Background@#Direct insertion of a double-lumen tube (DLT) using a flexible fiberoptic bronchoscope (FOB) is an option for DLT intubation. The difficult process of fiberoptic intubation is that the different properties of polyvinyl chloride and silicone DLTs may affect railroading differently. Therefore, we aimed to compare intubation using polyvinyl chloride and silicone DLTs over an FOB. @*Methods@#Patients aged 19–75 years who required one-lung ventilation under general anesthesia were enrolled in this study. After induction of anesthesia, the anesthesiologist intubated the DLT using FOB. The primary outcome was the difficulty of railroading over the flexible FOB scaled into five grades (I, II-1, II-2, III, and IV). Additionally, the intubation time and mucosal damage were recorded. @*Results@#A total of 46 patients participated in this study, 23 each in the silicone and polyvinyl groups. The difficulty of railroading over the FOB was significantly different between the two groups (P < 0.001). In the silicone group, the grades of difficulty in railroading were limited to I and II-1; 20 patients (87%) presented no difficulty in advancing the tube. In contrast, in the polyvinyl group, 13 patients (57%) had scores of II-2 and III. Both the intubation time and mucosal damage were significantly better in the silicone group than in the polyvinyl group. @*Conclusions@#Intubation using a silicone DLT over an FOB was easier and faster than that with a polyvinyl chloride DLT with lesser trauma around the glottis.

Osteosarcomatous Transformation in Mazabraud Syndrome: A Case Report

Mazabraud syndrome is a rare benign disease that is accompanied by polyostotic fibrous dysplasia and intramuscular myxoma. Malignant transformation of fibrous dysplasia occurs in approximately 1% of cases. To date, only eight cases of malignant transformation, of fibrous dysplasia to osteosarcoma, in Mazabraud syndrome have been reported worldwide. The authors report the first case of osteosarcomatous transformation in a patient with Mazabraud syndrome in the Republic of Korea, focusing on imaging findings.

Osteosarcomatous Transformation in Mazabraud Syndrome: A Case Report

Mazabraud syndrome is a rare benign disease that is accompanied by polyostotic fibrous dysplasia and intramuscular myxoma. Malignant transformation of fibrous dysplasia occurs in approximately 1% of cases. To date, only eight cases of malignant transformation, of fibrous dysplasia to osteosarcoma, in Mazabraud syndrome have been reported worldwide. The authors report the first case of osteosarcomatous transformation in a patient with Mazabraud syndrome in the Republic of Korea, focusing on imaging findings.

Neuregulin-1 Protects Neuronal Cells Against Damage due to CoCl2-Induced Hypoxia by Suppressing Hypoxia-Inducible Factor-1α and P53 in SH-SY5Y Cells / 대한배뇨장애요실금학회지

PURPOSE@#Hypoxia-mediated neurotoxicity contributes to various neurodegenerative disorders, including Alzheimer disease. Neuregulin-1 (NRG1) plays an important role in the development and plasticity of the brain. The aim of the present study was to investigate the neuroprotective effect and the regulating hypoxic inducible factor of NRG1 in cobalt chloride (CoCl₂) induced hypoxia.@*METHODS@#Hypoxia was induced in SH-SY5Y cells by CoCl₂ treatment. SH-SY5Y cells were pretreated with NRG1 and then treated with CoCl₂. Western blotting, immunocytochemistry, and lactate dehydrogenase (LDH) release assays were performed to examine neuroprotective properties of NRG1 in SH-SY5Y cells.@*RESULTS@#Our data showed that CoCl₂ induced cytotoxicity and changes of hypoxia-inducible factor-1α (HIF-1α) and p53 expression in SH-SY5Y cells. However, pretreatment with NRG1 inhibited CoCl₂-induced accumulation of HIF-1α and p53 stability. In addition, NRG1 significantly attenuated cell death of SH-SY5Y induced by CoCl₂.@*CONCLUSIONS@#NRG1 can regulate HIF-1α and p53 to protect neurons against hypoxic damage.

Neuregulin 1/ErbB4 signaling attenuates neuronal cell damage under oxygen-glucose deprivation in primary hippocampal neurons / 대한해부학회지

Influence of electrocautery-induced electromagnetic interference on quantitative electroencephalographic monitoring of hypnosis during general anesthesia: comparison between the ADMS® and the BIS VISTATM / 대한마취과학회지

BACKGROUND: Hypnosis monitors analyze small-amplitude electrical signals transmitted from the brain that could be exposed to the electromagnetic field that occurs around the body during electrocautery (ECT). We investigated the influence of ECT on hypnosis monitoring during anesthesia. METHODS: We simultaneously monitored BIS and uCON during 50 gynecologic oncology surgeries. During the episodes of ECT, we compared the absolute difference (a-Diff) between the baseline index and the most deviated index after ECT over either 30–60 s (ECT30–60) or more than 60 s (ECT > 60) between the monitors. We also investigated the bias and the limits of agreement between the monitors. RESULTS: Between the two monitors, the a-Diff of ECT30–60 was 1.4 ± 1.1 for the BIS, which was significantly greater than 0.6 ± 0.9 for the uCON (P = 0.003), and the a-Diff of ECT > 60 was 16.5 ± 8.2 for the BIS, which was also significantly greater than 1.4 ± 1.3 for uCON (P 60 was significantly greater than that during ECT30–60 (P 60 (P = 0.056). The estimated bias between the monitors was 6.3 ± 9.8 and 95% limits agreement was –12.3 to 25.0. CONCLUSIONS: Prolonged ECT intervention might lead to spurious estimations of quantitative EEG indexes. Therefore, hypnosis should be clinically assessed in combination with scrutinized judgment of relevant clinical symptoms and signs for hypnosis.

Primary Sclerosing Mucoepidermoid Carcinoma with Eosinophilia of the Thyroid: Description of a Case and Review of the Literature

Primary sclerosing mucoepidermoid carcinoma with eosinophilia (SMECE) of the thyroid gland is a very rare disease. We present the clinical and histopathologic findings of a 37-year-old woman recently diagnosed with SMECE of the thyroid gland. The patient, clinically euthyroid, who presented with a neck swelling since last 2 years along. Fine needle aspiration cytology suggested thyroid papillary carcinoma. Total thyroidectomy, central neck dissection and right selective neck dissection were performed. Although SMECE is considered to be a relatively slow growing and non-aggressive tumor, occasional metastasis does occur. We report an additional case of SMECE, with metastasis to regional lymph nodes. Physicians should be aware of extended operation, including total thyroidectomy and/or neck node dissection for metastatic lesion of the neck node. More standardized treatment is likely to evolve in the future.

Effects of pulse pressure alterations on cardiac output measurements derived from analysis of arterial pressure waveform

BACKGROUND: Changes in pulse pressure (PP) may alter the morphology of arterial pressure waveforms, thereby affecting the accuracy of cardiac output (CO) measurements derived from such waveforms. This study evaluated the influence of PP on the accuracy of FloTrac/Vigileo™ system-measured CO (APCO). Pulmonary artery catheter (PAC) measured stat mode CO (SCO) is used as a reference standard. METHODS: Hemodynamic variables were measured at various time points in 24 patients. APCO and SCO were compared using Bland-Altman analysis of the overall data pairs. The data pairs were divided into a low PP group and a high PP group, and subgroup analysis was conducted. RESULTS: The mean APCO (5.3 ± 1.7 L/min) was higher than the mean SCO (5.1 ± 1.6 L/min) for all data pairs (P < 0.001). The Bland-Altman analysis revealed an overall percentage error of 41.7% between the APCO and SCO, which exceeds a 30% limit of agreement. There was a significant relationship between PP and the difference between APCO and SCO (P = 0.031, R = 0.151). In subgroup analysis, APCO and SCO showed reasonable agreement in the low PP group, with a percentage error of 28.2%, but decreased agreement in the high PP group, with a percentage error of 43.2%. CONCLUSIONS: Changes in PP affect the accuracy of APCO measurements. An acceptable level of agreement between APCO and SCO was observed only in a low range of PP.

Flexible bronchoscopic foreign body removal through the I-gel supraglottic airway: A case report

The daily insertion of endotracheal tubes, laryngeal mask airways, oral/nasal airways, gastric tubes, transesophageal echocardiogram probes, esophageal dilators and emergency airways all involve the risk of airway structure damage. In the closed claims analysis of the American Society of Anesthesiologists, 6% of all claims concerned airway injury. Among the airway injury clams, the most common cause was difficult intubation. Among many other causes, esophageal stethoscope is a relatively noninvasive monitor that provides extremely useful information. Relatively not many side effects that hardly is ratable. Some of that was from tracheal insertion, bronchial insertion resulting in hypoxia, hoarseness due to post cricoids inflammation, misguided surgical dissection of esophagus. Also oropharyngeal bleeding and subsequent anemia probably are possible and rarely pharyngeal/esophageal perforations are also possible because of this device. Careful and gentle procedure is necessary when inserting esophageal stethoscope and observations for injury and bleeding are needed after insertion.

Predicted EC50 and EC95 of Remifentanil for Smooth Removal of a Laryngeal Mask Airway Under Propofol Anesthesia

PURPOSE: The purpose of this study was to determine the effect-site concentration (Ce) of remifentanil in 50% of patients (EC50) and 95% of patients (EC95) for smooth laryngeal mask airway (LMA) removal in adults under propofol and remifentanil anesthesia. MATERIALS AND METHODS: Twenty-five patients of ASA physical status I-II and ages 18-60 years who were to undergo minor gynecological or orthopedic surgery were assessed in this study. Anesthesia was induced and maintained with propofol and remifentanil target-controlled infusion (TCI). Remifentanil was maintained at a predetermined Ce during the emergence period. The modified Dixon's up-and-down method was used to determine the remifentanil concentration, starting from 1.0 ng/mL (step size of 0.2 ng/mL). Successful removal of the LMA was regarded as absence of coughing/gagging, clenched teeth, gross purposeful movements, breath holding, laryngospasm, or desaturation to SpO2<90%. RESULTS: The mean+/-SD Ce of remifentanil for smooth LMA removal after propofol anesthesia was 0.83+/-0.16 ng/mL. Using isotonic regression with a bootstrapping approach, the estimated EC50 and EC95 of remifentanil Ce were 0.91 ng/mL [95% confidence interval (CI), 0.77-1.07 ng/mL] and 1.35 ng/mL (95% CI, 1.16-1.38 ng/mL), respectively. CONCLUSION: Our results showed that remifentanil TCI at an established Ce is a reliable technique for achieving safe and smooth emergence without coughing, laryngospasm, or other airway reflexes.

Cutaneous Infection Due to Mycobacterium abscessus / 대한피부과학회지

No abstract available.

Unilateral Abdominal Distention Followed by Herpes Zoster Infection / 대한피부과학회지

No abstract available.

Porcelain repair - Influence of different systems and surface treatments on resin bond strength

PURPOSE: The purpose of this study was to evaluate the bond strength of composite resin on the fracture surface of metal-ceramic depending on the repair systems and surface roughening methods. MATERIALS AND METHODS: A total of 30 disk specimens were fabricated, 15 of each were made from feldspathic porcelain and nickel-chromium base metal alloy. Each substrate was divided into three groups according to the repair method: a) application of repair system I (Intraoral Repair Kit) with diamond bur roughening (Group DP and DM), b) application of repair system I with airborne-particle abrasion (Group SP and SM), and c) application of repair system II (CoJet Intraoral Repair System, Group CP and CM). All specimens were thermocycled, and the shear bond strength was measured. The data were analyzed using the Kruskal-Wallis analysis and the Mann-Whitney test with a significance level of 0.05. RESULTS: For the porcelain specimens, group SP showed the highest shear bond strength (25.85 +/- 3.51 MPa) and group DP and CP were not significantly different. In metal specimens, group CM showed superior values of bond strength (13.81 +/- 3.45 MPa) compared to groups DM or SM. CONCLUSION: Airborne-particle abrasion and application of repair system I can be recommended in the case of a fracture localized to the porcelain. If the fracture extends to metal surface, the repair system II is worthy of consideration.

The effect of injection speed on remifentanil-induced cough in children / 대한마취과학회지

BACKGROUND: Remifentanil sometimes elicits cough during induction of anesthesia, as with the use of other fentanyl congeners. We designed this study to investigate the incidence of remifentanil-induced cough (RIC) in children and to evaluate the effect of injection speed on RIC. METHODS: One hundred twenty ASA physical status I-II patients, aged 3-12 yr, undergoing general anesthesia were enrolled in the study. Patients were randomly assigned to one of the three groups. Patients in Group R30 received remifentanil 1.5 microg/kg at a constant rate over 30 s. Patients in Group R45 received remifentanil 1.5 microg/kg over 45 s, and patients in Group R60 received remifentanil 1.5 microg/kg over 60 s, respectively. Episodes of cough were recorded and graded as mild (1-2), moderate (3-4), or severe (5 or more). Mean arterial pressure (MAP), heart rate (HR), and SpO2 were recorded on arrival in the operating room (baseline) and 1 min after remifentanil infusion. RESULTS: The incidence of RIC was 33.3% in Group R30 (13 of 39 patients), 17.9% in Group R45 (7 of 39 patients), and 5.0% in Group R60 (2 of 40 patients). Patients in Group R60 had a significantly lower incidence of RIC than those in Group R30 (P = 0.001). The MAP, HR, and SpO2 values were not significantly different between groups. CONCLUSIONS: When intravenous remifentanil 1.5 microg/kg was administered in pediatric patients, the incidence of RIC decreased from 33 to 5% by increasing the injection time from 30 to 60 s. Remifentanil should be administered slowly over 60 s in children to suppress cough during anesthesia induction.

Penile Herpes Zoster / 대한피부과학회지

No abstract available.

Dexmedetomidine Preconditioning Attenuates Cisplatin-Induced Ototoxicity in Zebrafish

OBJECTIVES: Utilisation of high-frequency drills is known to increase noise induced hearing loss due to increasing the damages of inner ear cells. This study aimed to investigate whether preconditioning by using dexmedetomidine (DEX) decreased the occurrence of ischemia in inner cells of the ear. METHODS: We utilised a transgenic zebrafish line Brn3C, and the embryos were collected from breeding adult zebrafish. Five-day-old larvae were cultured at the density of 50 embryos, and the larvae were classified into 4 groups: control, cisplatin group, DEX group, and DEX+yohimbine; adrenoreceptor blocker group. The DEX group was categorised into 3 subgroups by dosage; 0.1, 1, and 10 microM. Preconditioning was performed for 150 minutes and then exposed to cisplatin for 6 hours. The experiment was performed in 7 replicates for each group and the number of hair cells in 3 parts of the neuromasts of each fish was determined. RESULTS: Hair cell apoptosis by cisplatin was attenuated more significantly in the DEX preconditioning group than in the control group. However, the preconditioning effects were not blocked by yohimbine. CONCLUSION: The results of this study suggest that hearing loss caused by vibration-induced noise could be reduced by using DEX and may occur through other mechanisms rather than adreno-receptors.

Tinea Barbae Caused by Trichophyton mentagrophytes / 대한의진균학회지

Tinea barbae is a dermatophyte infection of the bearded areas of the face and neck. The incidence of tinea barbae has decreased as improved sanitation. We report a case of tinea barbae in a 49-year-old-man, who presented with relatively well-defined erythematous patch with pustules on the upper lip. A fungal culture from tissue of the lesions was grown on Sabouraud's dextrose agar and showed typical Trichophyton mentagrophytes. The nucleotide sequence of internal transcribed spacer for clinical isolate was identical to that of Arthroderma vanbreuseghemii IHEM 4411. The patient was treated with oral itraconazole for 3 months. The skin lesions improved 3 months after treatment, and recurrence has not been observed.

A Clinical and Mycological Study of Onychomycosis in the Elderly Over 10 Years (2001-2010) / 대한의진균학회지

BACKGROUND: As the life expectancy has risen globally because of the advance of medicine, onychomycosis in the elderly has been increasing with higher concerns over nails. Onychomycosis has been studied quite extensively, however, few reports on onychomycosis in a geriatric Korean population have been available. OBJECTIVE: The purpose of this study was to investigate the clinical features of onychomycosis in the elderly compared with other age groups and to identify the etiological agents during 10-year period. METHODS: A total of 629 patients over 65 years of age had been diagnosed with onychomycosis during a 10-year period (2001-2010). The etiological agents were identified by cultures on Sabouraud's dextrose agar with and without cycloheximide. Nondermatophytic molds and yeasts were considered as pathogens, if the identical fungal elements were observed at the initial direct microscopy and repeatedly in specimen-yielding cultures at a follow-up visit. RESULTS: The 629 elderly patients represented 22.1% of all onychomycosis patients. Toenails were involved in 567 (90.1%) patients; fingernails in 39 (6.2%); both toenails and fingernails in 23 (3.7%). The ratio of male to female was 1.01:1. Associated systemic diseases were found in 327 (52.0%) cases. Distal and lateral subungual onychomycosis (80.2%) was the most common clinical type of onychomycosis, followed by TDO (10.7%), SWO (6.2%) and PSO (2.9%). TDO was increasing significantly in the elderly. Organisms causing onychomycosis were dermatophytes (76.5%), yeasts (14.3%) and nondermatophytic molds (9.2%). The most common cause of onychomycosis in the elderly was Trichophyton rubrum. Nondermatophytic molds were more frequently responsible for onychomycosis in the elderly. CONCLUSION: Onychomycosis has been increased in the elderly and there are many differences from other age groups in aspects of clinical features, associated diseases and etiologic agents. Therefore, we suggest the need of a careful mycological examination in the elderly patients with onychomycosis.

Tinea Barbae Caused by Trichophyton verrucosum / 대한의진균학회지

Tinea barbae is a dermatophyte infection of the bearded areas of the face and neck. The incidence of tinea barbae has decreased as improved sanitation. We report a case of tinea barbae in a 58-year-old-man, who presented with relatively well-defined erythematous pustular plaque on the upper lip. A fungal culture from tissue of the lesions was grown on Sabouraud dextrose agar and showed typical Trichophyton verrucosum. The nucleotide sequence of internal transcribed spacer for clinical isolate was identical to that of Trichophyton verrucosum strain ATCC 10695. The patient was treated with oral itraconazole for 3 months. The skin lesions improved 3 months after treatment, and recurrence has not been observed.

A Case of Localized Skin Infection Due to Scedosporium apiospermum Diagnosed by DNA Sequencing of the Internal Transcribed Spacer Region / 대한의진균학회지

Scedosporium apiospermum is an asexual state of Pseudallescheria boydii which has been isolated from soil, sewage, and decaying vegetation. It can cause cutaneous infections by traumatic implantation of the contaminant due to penetrating injury. This ubiquitous fungus cause not only mycetoma, but also infections of variety of body sites including the skin. The localized skin infection due to this organism is much rare than mycetoma. We report a case of cutaneous S. apiospermum infection occurred in 80-year-old male. The skin lesion was manifested by a 8.0 x 4.0 cm-sized erythematous plaque with pustules and crusts on the dorsum of right hand. The fungal culture from the biopsy specimen on Sabouraud's dextrose agar showed white to gray colored cottony colonies of S. apiospermum. The nucleotide sequence of internal transcribed spacer for clinical isolate was identical to that of S. apiospermum strain IHEM 23829. The patient was treated with oral fluconazole for 3 months.