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Objective@#The study compared the first-attempt success and complication rates of endotracheal intubation (ETI) using video laryngoscopy (VL; GlideScope) with those of direct laryngoscopy (DL) in the emergency department (ED). @*Methods@#This was a retrospectively clinical study of adult patients who underwent intubation using from 2010 to 2014 in the ED. All data were collected from the electronic medical records. The primary outcome was the first-attempt intubation success of ETI. The secondary outcomes were occurrences of desaturation, hypotension, oesophageal intubation, dental injuries, and cardiac arrest. The between-device differences in outcome risks were examined. @*Results@#A total of 431 emergency ETIs were included. The first-attempt intubation success rate was higher in the VL than DL (93.8% vs. 74.8%, P<0.001). The non-expert emergency physicians (first and second-year residents) showed a higher first-attempt intubation success rate in VL than DL, but there was no difference in the first-attempt intubation success rate between the two devices between experts (third and fourth-year residents). The use of VL was associated with a lower rate of desaturation (0.0% vs. 5.0%) and tooth injuries (0.0% vs. 2.7%) compared to the DL. @*Conclusion@#The use of VL was associated with a higher first-attempt success rate compared to DL, particularly in inexperienced intubators. For complications related to ETI, VL showed a lower rate of desaturation and dental injuries in the ED than the DL.
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BACKGROUND AND OBJECTIVES: Cancer of the oral cavity is a disease of the head and neck that is difficult to treat. Periodic observation and biopsy are important for its early diagnosis once a premalignant lesion in the oral cavity is confirmed. The purpose of this study was to determine the importance of early excisional biopsy by investigating the histological features of oral leukoplakia and the rate of malignant change in the oral cavity. SUBJECTS AND METHOD: A total of 327 patients who underwent punch biopsy of oral cavity from January 2011 to December 2017 were reviewed retrospectively for the presence of initial gross lesions and for their biopsy results. The histological findings of 6 initial gross lesion groups were compared. Additional excisional biopsies were performed in the seven oral cavity subsites. RESULTS: There were 33 cases of oral leukoplakia. The punch biopsies of 3 of these cases (9.1%) showed malignancy. Additional excisional biopsies were performed in 6 cases, 4 of which were malignant (66.7%). Additional excisional biopsies of the tongue were performed in 14 cases (9.0%), 5 of which (35.7%) were malignant. The rate of atypia in leukoplakia (9.1%) was higher than in other atypia groups. Additional excisional biopsies were performed in 3 cases (100%) of atypia of leukoplakia, all of which were assessed to be malignant. CONCLUSION: For tongue leukoplakia, performing an early excisional biopsy rather than an incisional biopsy is recommendable. Moreover, additional excisional biopsies are needed when the initial biopsy is suggestive of hyperkeratosis, parakeratosis, or atypia.
Subject(s)
Humans , Biopsy , Early Diagnosis , Head , Leukoplakia , Leukoplakia, Oral , Methods , Mouth , Neck , Parakeratosis , Retrospective Studies , TongueABSTRACT
BACKGROUND AND OBJECTIVES@#Cancer of the oral cavity is a disease of the head and neck that is difficult to treat. Periodic observation and biopsy are important for its early diagnosis once a premalignant lesion in the oral cavity is confirmed. The purpose of this study was to determine the importance of early excisional biopsy by investigating the histological features of oral leukoplakia and the rate of malignant change in the oral cavity.SUBJECTS AND METHOD: A total of 327 patients who underwent punch biopsy of oral cavity from January 2011 to December 2017 were reviewed retrospectively for the presence of initial gross lesions and for their biopsy results. The histological findings of 6 initial gross lesion groups were compared. Additional excisional biopsies were performed in the seven oral cavity subsites.@*RESULTS@#There were 33 cases of oral leukoplakia. The punch biopsies of 3 of these cases (9.1%) showed malignancy. Additional excisional biopsies were performed in 6 cases, 4 of which were malignant (66.7%). Additional excisional biopsies of the tongue were performed in 14 cases (9.0%), 5 of which (35.7%) were malignant. The rate of atypia in leukoplakia (9.1%) was higher than in other atypia groups. Additional excisional biopsies were performed in 3 cases (100%) of atypia of leukoplakia, all of which were assessed to be malignant.@*CONCLUSION@#For tongue leukoplakia, performing an early excisional biopsy rather than an incisional biopsy is recommendable. Moreover, additional excisional biopsies are needed when the initial biopsy is suggestive of hyperkeratosis, parakeratosis, or atypia.
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BACKGROUND AND OBJECTIVES: Foreign bodies in the external auditory canal (EAC) are frequently encountered by otolaryngologists, emergency care physicians and pediatricians. The purpose of this study was to assess clinical characteristics, complications, as well as to investigate the proper management of foreign bodies in the EAC. SUBJECTS AND METHOD: We retrospectively reviewed and analyzed clinical records of patients who presented with foreign bodies in the EAC at the otolaryngologic department of Keimyung University Dongsan Hospital from January, 2011 to October, 2016. RESULTS: One-hundred seventy patients with aural foreign bodies were identified. The age of patients ranged from 12 months to 83 years, with 34.1% of the patients being under 10 years of age. Thirteen different types of foreign bodies were found, where insects, cottons and beads were the most common. Approximately 98% of the foreign bodies were removed without general anesthesia by using proper instruments under direct vision. Complications were observed in 5.8% of the patients: these included laceration and bleeding from the EAC (80%) and traumatic perforation of the tympanic membrane (20%). CONCLUSION: Various methods are available for foreign body removal from the EAC. In order to remove foreign bodies successfully and reduce complications, patients should be given precautions, such as, regarding adequate immobilization, prior to removing foreign bodies using proper instruments with a surgical microscope under appropriate anesthesia.
Subject(s)
Child , Humans , Anesthesia , Anesthesia, General , Ear Canal , Emergency Medical Services , Foreign Bodies , Hemorrhage , Immobilization , Insecta , Lacerations , Methods , Retrospective Studies , Tympanic MembraneABSTRACT
BACKGROUND AND OBJECTIVES: This study was to done to determine the value of PROPELLER diffusion-weighted imaging in detecting cholesteatoma. SUBJECTS AND METHOD: Sixty-five patients were evaluated by preoperative magnetic resonance imaging (MRI) with PROPELLER diffusion-weighted imaging. Of 65 patients, 16 patients had chronic otitis media without cholesteatoma and 49 patients with cholesteatoma. Surgical and pathologic findings were compared with the preoperative findings by PROPELLER diffusion-weighted imaging to assess the sensitivity, specificity, positive and negative predictive values. RESULTS: In 49 patients with cholesteatoma, high signal intensity compatible with cholesteatoma was found in 46 patients, whereas in 16 patients without cholesteatoma, high signal intensity was not detected in any of them. The sensitivity, specificity, positive and negative predictive values for PROPELLER diffusion-weighted imaging were 94.1%, 100%, 100%, and 84.2%, respectively. CONCLUSION: PROPELLER diffusion-weighted imaging can be a useful tool in detecting cholesteatoma.
Subject(s)
Humans , Cholesteatoma , Diffusion Magnetic Resonance Imaging , Magnetic Resonance Imaging , Methods , Otitis Media , Sensitivity and SpecificityABSTRACT
BACKGROUND: A preponderance of small low-density lipoproteins (LDL subclass phenotype B) has been closely associated with a high-risk for coronary artery disease. Lipoprotein lipase (LPL) gene polymorphisms have been found to be associated with coronary artery disease and lipid levels; but their impact on LDL particle size is less clearly established. METHODS: The LDL subclass phenotype was analyzed in 114 normal controls and 131 patients with coronary artery disease using the LipoPrint LDL system (Quantimetrix Co., Redondo Beach, CA, USA). HindIII and PvuII polymorphisms of LPL genes were analyzed using PCR-RFLP. Ser447 -Ter polymorphisms of LPL gene were analyzed using the PCR-based method and using mismatched primer and restriction digestion. The analysis of their associations with the LDL subclass phenotype and the LDL score was investigated. RESULTS: No statistical differences in the allelic frequencies of HindIII, PvuII and Ser447 -Ter poly-morphisms were observed between the control and patient groups. The G allelic frequency of Ser447 -Ter polymorphism was significantly higher in phenotype B than in the phenotype AandI group (P=0.043). HindIII, PvuII and Ser447 -Ter sites were in strong linkage disequilibrium. CONCLUSIONS: HindIII, PvuII and Ser447 -Ter polymorphisms were not directly linked with coronary artery disease. However, the Ser447 -Ter polymorphism is associated with the small LDL particle, which results in a change in lipid metabolism and might have an effect on the development of coronary artery disease.
Subject(s)
Humans , Coronary Artery Disease , Coronary Vessels , Digestion , Linkage Disequilibrium , Lipid Metabolism , Lipoprotein Lipase , Lipoproteins , Lipoproteins, LDL , Particle Size , PhenotypeABSTRACT
Methicillin-resistant Staphylococcus aureus colony variants (SCVs) are frequently auxotrophic for hemin, menadione, thiamine, and CO2 involved in biosynthesis of the electron transport chain element. This phenotype grows slowly, and forms very small, nonhemolytic colonies in routine culture, so it may be led to the misidentification of this organism. We isolated an organism with catalase-positive, gram-positive cocci in cluster from the urine of a 55-years-old woman with persistent and relapsing bladder stone, who had undergone the antibiotic treatment with cefotaxime, ceftizoxime, amikacin, and/or micronomicin, intermittently for three years. The possibility of SCVs should have been ruled out because this organism didn't grow on Mueller-Hinton agar (MHA) for the susceptibility test. It formed small colonies on blood agar plate overnight, and grew only on MHA with supplement of hemin, or with 5% CO2. This organism was coagulase-positive, DNase-positive, manitol-salt positive, and identified as S. aureus with VITEK GPI card. The susceptibility test could be performed after adding hemin(1mg/mL) into bacterial suspension and showed susceptibility against vancomycin, teicoplanin, and rifampin. Because these phenotypes can be misidentifide as other non-pathogenic organisms due to their atypical characteristics, we should consider SCVs in case of small, nonhemolytic colonies with catalase-positive, gram-positive cocci in cluster, showing no growth on MHA. In addition, infections caused by SCVs are recently recognized in relation to persistent and relapsing infection, so they could be isolated from the patients with long-term antibiotic therapy.