The Effect of Cuff Pressure of Laryngeal Tube on Postoperative Sore Throat after General Anesthesia Using N2O / 대한마취과학회지

BACKGROUND: The cuff pressure (CP) of the laryngeal tube airway (LTA) increases during general anesthesia using nitrous oxide. However, there have been few studies on the relationship between CP and postoperative sore throat (POST). This study evaluated the efficacy of the CP on a POST on the recovery time and postoperative day. METHODS: Forty patients were divided into two groups, group M (n = 20) and group I (n = 20). In all patients, the CP was set to 65 cmH2O at the induction of anesthesia. In group M, the CP was maintained at 60-70 cmH2O during general anesthesia using N2O. However, in group I, the CP was allowed to increase. The CP was measured every 10 minutes during surgery in the two groups. The frequency and intensity (numerical rating scale of 0-100, NRS-101) of the sore throat was measured at recovery room (RR) and on postoperative day 1 (POD1). RESULTS: There was a significant increase in the CP in group I during general anesthesia and the CP was higher in group I than in group M (P < 0.05). The frequency of POST was higher in group I at RR (10% vs 70%) and POD1 (0% vs 35%) than in group M. In addition, the NRS-101 was higher in group I at RR and POD1 than in group M (P < 0.05). CONCLUSIONS: The CP of the LTA needs to be monitored and controlled during surgery in order to reduce POST.

Hypoglossal Nerve Palsy following General Anesthesia: A case report / 대한마취과학회지

The hypoglossal nerve is a motor supply of the tongue. Hypoglossal nerve palsy after general anesthesia is rare but there have been several reports showing an association with oropharyngeal manipulation such as intubation, bronchoscopy, and laryngeal mask airway. The main mechanism considered has been a temporary compression of the nerve along its superficial course at the lateral root of the tongue during oropharyngeal manipulation. We encountered a patient who complained speaking and swallowing difficulties after general surgery. A deviation to the affected side, atrophy, and fasciculation of tongue were observed. Almost all palsies recovered spontaneously. We present a patient with a transient unilateral hypoglossal nerve palsy after an uncomplicated intubation and anesthesia for surgery for humerus fracture in the beach-chair position.

Airway Obstruction in Rheumatoid Arthritis: CT Manifestations, Correlated with Pulmonary Function Testing

In the present study, the signs of airflow obstruction on inspiratory and expiratory CT scans in 45 patients with rheumatoid arthritis were investigated. Radiologic findings were evaluated and correlated with the clinical data, which included rheumatoid factors and pulmonary function tests results. A lung biopsy was performed in five patients. The pattern of CT findings was as follows: infiltrative (n=15), obstructive (n=12), mixed (infiltrative and obstructive; n=10), other complicating diseases (n=7), and normal (n=1). The rheumatologic factor between patients with bronchial wall thickenings and patients without thickenings was significantly different (p=0.009). The forced expiratory flow rate between 25% and 75% of the vital capacity (FEF25-75%) was significantly more reduced in patients with interlobular septal thickenings than in patients without these thickenings. The patients with mosaic attenuation had significantly lower mean values of FEF25-75% (p=0.001) and a lower peak expiratory flow (p=0.003) than patients without mosaic attenuation. On expiratory scans, the mean air-trapping score was 21%. These air-trapping scores were found to be well correlated with FEV1/FVC (r=0.230, p=0.0452), and FEF25-75% (r=-0.63, p= 0.05). It is widely known that a relatively higher percentage of mosaic attenuation with air-trapping and a good correlation between these and functional values contribute to the detection of early airway obstruction in patients with rheumatoid arthritis, and even in patients with infiltrative lung disease only.

Anterior Lumbar Interbody Fusion Using BAK Cage for Treatment of Failed Back Surgery Syndrome

OBJECTIVE: To evaluate the role of anterior lumbar interbody fusion in treatment of failed back surgery syndrome, the authors present a retrospectively analysis of the clinical & radiological results of anterior lumbar interbody fusion. METHODS: Between September 2000 and September 2001, twenty two patients underwent anterior lumbar interbody fusion for treatment of failed back surgery syndrome. We analyzed clinical & radiological changes. The mean follow-up period was 19 months. RESULTS: Overall satisfactory outcome was 90%. The mean VAS was changed from 8.3 to 3.7. The mean Oswestry Disability Index(%) was changed from 70 to 33. The fusion rate was 86%. There were 2 complications; wound infection, sympathetic dysfunction. CONCLUSION: We conclude that the anterior lumbar interbody fusion seems to be a safe and favorable method in treating selective patients with failed back surgery syndrome.

A Case of Pleomorphic Lipoma in the Scalp / 대한피부과학회지

Pleomorphic lipoma is a asymptomatic, slowly growing, solitary, well-circumscribed dermal or subcutaneous benign tumor. The neck, shoulder region and back are the sites of predilection. On gross examination, the lesion resembles an ordinary lipoma. However microscopically, a misdiagnosis of liposarcoma is often made, on occasion leading to excessive and unnecessary surgical procedures. Smookler and Enzinger described 48 cases of lipomatous tumors having bizarre histologic features, but a benign clinical course. The term "pleomorphic lipoma" was selected to refer to these tumors. To date, there have been only three case reports of pleomorphic lipoma in the dermatologic literature. We describe a case of pleomorphic lipoma that developed as a subcutaneous nodule on the scalp of 72-year-old man, and showed a typical histopathologic findings of pleomorphic lipoma.

Differences in Antigen-presenting Cells in Dermatitis Due to Skin Contact and Ingestion of Lacquer Tree / 대한피부과학회지

Cutaneous hypersensitivity reaction due to Rhus can develop against antigens delivered through the epidermis(allergic contact dermatitis: ACD) or through the blood vessels(systemic contact dermatitis: SCD). Although the role of Langerhans cells(LC) in sensitization and elicitation of ACD(external antigen) has been extensively investigated, there are few studies in cases of SCD(internal antigen). Immunohistochemical differences of Langerhans cells were investigated in cases of two different routes(external antigen vs. internal antigen) of the same antigens. The 7 cases of ACD due to Rhus and the 14 cases of SCD due to ingestion of Rhus were involved in this study. Immunohistochemical staining with anti-CD1a, S-100 protein, HLA-DR, factor XIIIa antibodies were performed. Numbers of CD1a, S-100 protein, and HLA-DR positive cells per linear millimeter of epidermis were counted. The ratio between HLA-DR positive cells and CD1a positive cells(HLA-DR/CD1a) was considered as a possible index of activation of LC. The number of factor XIIIa positive dermal dendritic cells(DDC) per mm2 was evaluated. CD1a positive LC were more significantly numerous in ACD than in SCD(19.6+/-1.95 vs. 9.0+/-0.91 p<0.05). Also, HLA-DR/CD1a in ACD were higher than SCD. Factor XIIIa positive DDC were more numerous in SCD than in ACD(21.6+/-1.57 vs. 16.9+/-2.48), but the differences were not significant statistically. Therefore, the epidermal LC appear to be involved in antigen presentation in ACD (external antigens) as to be well-known. On the other hand, it seems possible that DDC plays some role in immune reactions in SCD (internal antigens).

Lumbar Interbody Metal Cages with Pedicle Screw Fixation in Spondylolisthesis

OBJECTIVE: For lumbar spondylolisthesis, various spinal operation methods have been used to relieve clinical symptoms and to stabilize the spine. To determine the effectiveness of the lumbar interbody metal cages and pedicle screw fixation in patients with spondylolisthesis, the authors retrospectively reviewed 70 patients under-going surgery, and also analyzed the relationship between post-operative clinical improvement and bony fusion, postoperative reduction, as well as transitional vertebrae. METHODS: The authors performed the lumbar interbody metal cages and pedicle screw fixation in 70 consecutive patients suffering from spondylolisthesis between November 1994 and December 1997. Follow-up averaged 18 months(range, 3 to 39 months). The post-operative clinical outcome was expressed as good, fair, or poor. The bony fusion was determined by post-operative simple X-ray films. RESULTS: Of 70 patients with clinical, radiologically unstable spondylolisthesis, the clinical results were good and fair in 92% of the patients, and radiological bony fusion were occurred in 86%. There was the significant relationship between clinical improvement and bony fusion. But there was no significant relationship between clinical improvement and post-operative reduction as well as transitional vertebrae. The post-operative complications occurred in 4% of patients and reoperation was required in 1 patient. CONCLUSION: This study demonstrates that the lumbar interbody cage with pedicle screw fixation is the effective operation method in the treatment of spondylolisthesis, though it demands more difficulties technically.

Spinal Epidural Meningioma of the Thoracic Spine: Case Report

Spinal meningiomas account for approximately 25% of all primary neoplasms of the spinal cord and spinal canal. Most spinal meningiomas are located in the intradural extramedullary space. Meningiomas which are primarily and solely epidural have been reported very infrequently. With the locational difference, the solely epidural meningiomas are more likely to be invasive, to be more vascular and probably have more rapid course than other spinal meningiomas. They may also be more likely to recur. Because of this, every effort should be made to be sure all the tumor is removed. Recently, we experienced a case of the meningioma lying solely epidural within the thoracic spinal canal, and we report it with a brief review of the literature.

Induction of Hepatic Microsomal Cytochrome P450 by N,N-dimethylformamide in Sprague-Dawley Rats / 예방의학회지

OBJECTIVES: In order to gain a better understanding of the mechanism of DMF toxicity, recent studies have focused on hepatic drug metabolizing enzymes. In this study, we investigated the effects of DMF on the induction of P450 and the activities of other related enzymes in rat liver microsomes. METHODS: DMF was administered to male Sprague Daweley rats by intraperitoneal injection at 0(control), 450(D1), 900(D2), 1,800(D3) mg DMF/kg body weight in olive oil once a day for three days. Hepatic P450 was measured by method of Omura and Sato. We evaluated selective assays for the three drug metabolizing cytochrome P450 isoenzymes 1A1, 2B1 and 2E1. RESULTS: The content of microsomal protein, P450 and b5 were tended to be decreased in DMF treated group, but they were not statistically significant. The activity of NADPH-cytochrome P450 reductase was significantly increased dose dependently(p<0.01), but the activity of NADH-b5 reductase was decreased in the treated group(p<0.01). The activities of PROD and EROD were not significant between control and treated group. The activities of pNPH in the DMF treated groups were higher than that of the control group(p<0.01). When Western immunoblottings were carried out utilizing three monoclonal antibodies which were specific against P4501A1/1, P4502B1/2 and P4502E1, the strong density band corresponding to P4502E1 was observed with the microsomes obtained from the rats treated with DMF. But there were no significant increased in the P4501A1/2 and P4502B1/2 band densities in immunoblotting. CONCLUSIONS: These result suggested that P4502E1 was inducible by DMF and P4502E1 isozyme might be responsible for the hydroxylation of DMF to HMMF.

Coil Embolization of Intracranial Aneurysms: The Effectiveness and Limitation

This study was designed for the investigation of the effectiveness and limitation of the endovascular coil embolization of intracranial aneurysms. From July 1995 to October 1997, the authors treated 25 patients of intracranial aneurysm with endovascular coil embolization. There were 15 cases of ruptured aneurysms and 10 cases of unruptured aneurysms. The main reasons for the coil embolization were difficult anatomical location and poor neurological condition. Total 28 aneurysms were tried to embolize with coil. Among these, 12 aneurysms were occluded completely, 12 aneurysms partially, and 1 vertebral artery fusiform aneurysm was treated by coil occlusion of the proximal vertebral artery. The complete occlusion was possible in 10 cases of 15 small aneurysms(66.7%), and in 2 cases of 6 large aneurysms(33.3%). Only partial occlusion was achieved in all 3 giant aneurysms. Of 18 small neck aneurysms(4mm) could be occluded completely. There were 3 cases of failure, 2 cases being catherizatioin failure because of the tortuous vessel and 1 case due to local vasospasm. The complications related to the coil embolization were the perforation of the aneurysm caused by the catheterization in 2 cases, rebleeding after partial embolization of the aneurysm in 2 patients of Hunt-Hess grade 4 and 5, and infarction caused by parent vessel occlusion by coil protrusion in 2 cases. In conclusion, the coil embolization can be an alternative modality in the treatment of intracranial aneurysms. But the complete occlusion is not always possible in all cases, and the risk of the rebleeding is still remained in the partially occluded aneurysms. The long-term study is needed to confirm the definite effectiveness of the coil embolization in the treatment of intracranial aneurysms.

Metabolic Ratio of FDG-PET and Histologic Grading in Cerebral Gliomas

To assess the degree of malignancy in cerebral gliomas at the time of diagnosis, we compared the metabolic ratio using 18F-fluorodeoxyglucose(FDG)-Positron Emission Tomography(PET) with histologic grading and proliferative index(Ki-67) of cerebral gliomas. Materials for this study were histologically-examined 21 gliomas and they were divided into glioblastomas as group 1, anaplastic gliomas as group 2, and low-grade gliomas as group 3. The visual analysis of FDG-PET images showed hypermetabolic lesions in 14(87.5%) out of 16 high-grade gliomas (glioblastomas and anaplastic gliomas), and hypometabolic lesions in 4(80%) out of 5 low-grade gliomas. Tumor to cerebellum ratio(T/Cbll) in FDG-PET was used as metabolic ratio and the values of T/Cbll in each group were 1.30+/-0.10, 0.73+/-0.07, 0.70+/-0.07, respectively. In comparision of T/Cbll between group 1 with remaining two groups, differences were statistically significant(p=0.0002, p=0.0002, respectively), however, there was no statistical difference between group 2 and group 3. The values of Ki-67 were 24.16+/-5.66 in group 1, 8.10+/-2.70 in group 2, 5.46+/-1.23 in group 3, and differences were statistically significant between group 1 and group 2, 3(p=0.015, p=0.015, respectively), but there was no statistical difference between group 2 and group 3. The correlation between T/Cbll and Ki-67 was good and statistically significant(p=0.0047). In conclusion, the visual and semiquantitative analysis of FDG-PET would be helpful in determining the degree of malignancy in cerebral gliomas.

Comparison of Positron Emission Tomography(PET) and CT/MRI Findings and Correlation with Histopathology in a Case of Glioblastoma: Case Report

Computed tomography(CT) and magnetic resonance imaging(MRI) facilitated detection and accurate localization of brain tumors, however, have limitation in predicting the physiologic nature of tumors or the extent of tumor cell infiltration. The PET with [18 F] fluorodeoxyglucose(FDG) can give complementary information by measuring glucose consumption. It was reported that PET was useful for differentiation between recurrent tumor and necrosis, detection of early recurrence, and prediction of the degree of malignancy. Also it can evaluate the metabolic status to dfferent areas in a lesion with heterogeneous components, and be useful for optimal targeting in stereotactic biopsy. We performed stereotactic biopsy of a glioblastoma, obtained multiple specimens from different sites, and investigated correlation between histopathological findings and the findings in CT, MRI, and PET. The histopathological findings such as cell density and presence of microscopic necrosis were well correlated with the metabolic status measured by PET. The extent of the area involved by infiltrating tumor cells was estimated more approximately by PET they by CT or MRI. These findings suggest that PET may give additional information which may be useful for diagnosis and evaluation of the disease.