Anesthetic management of obese and morbidly obese parturients

The prevalence of obese parturients is increasing worldwide. This review describes safe analgesic techniques for labor and anesthetic management during cesarean sections in obese parturients. The epidural analgesic technique is the best way to provide good pain relief during the labor phase and can be easily converted to a surgical anesthetic condition. However, the insertion of the epidural catheter in obese parturients is technically more difficult compared to that in non-obese parturients. The distance from the skin to the epidural space increases in proportion to the body mass index (BMI): 4.4 cm in mothers of normal weight and 7.5 cm in mothers with BMI 50 and above. Neuraxial blocks are the ideal anesthetic methods and gold standard techniques for cesarean section in pregnant women with obesity. Single-shot spinal anesthesia is the most common type of anesthesia used for cesarean sections. The advantage of single-shot spinal anesthesia is a dense-sufficient block of rapid onset. A combined spinal-epidural (CSE) anesthetic technique is also recommended as an attractive alternative method. In obese parturients, the operation time can be longer than expected, and therefore, the CSE technique provides the advantage of rapid onset and intense block for prolonged operation with postoperative pain control. The risk of postoperative complications is very high in obese parturients. Therefore, detailed communication of the parturient's medical condition and the details of surgery and anesthesia between the anesthesiologist and obstetrician is important prior to cesarean section in obese pregnant women.

Evaluation of changes in anesthetic methods for cesarean delivery: an analysis for 5 years using the big data of the Korean Health Insurance Review and Assessment Service

Background@#As an anesthesia induced during cesarean section, spinal anesthesia is preferred over general and epidural anesthesia. This study aimed to review the trend of anesthetic methods for cesarean section based on data obtained from the Korean Health Insurance Review and Assessment Service from 2013 to 2018. @*Methods@#The anesthetic methods were analyzed in 753,285 parturients who underwent a cesarean section in Korea from 2013 to 2018. We determined the association between each anesthetic method and hospital type and maternal and fetal factors. We also evaluated whether the anesthetic method was associated with the parturients’ length of hospital stay. @*Results@#General anesthesia, spinal anesthesia, and epidural anesthesia were induced in 28.8%, 47.7%, and 23.6% of parturients from 2013 to 2018, respectively. Trend analyses showed that spinal anesthesia increased from 40.0% in 2013 to 53.7% in 2018. The opposite trend applied to general anesthesia, decreasing from 37.1% in 2013 to 22.2% in 2018. The factors that were significantly associated with the anesthetic method were parturient’s parity, emergency condition, gestational age, and fetal weight. The type of hospital, parturient’s age, and multiple birth were also associated with the anesthetic methods. There was a strong association between general anesthesia and hospital stay longer than 7 days. @*Conclusions@#Spinal anesthesia is currently the main anesthetic method used for cesarean delivery, and the rate of spinal anesthesia is gradually increasing in Korea.

Effects of benzydamine hydrochloride spray on postoperative sore throat associated with double-lumen endobronchial intubation: a double-blind, randomized controlled clinical trial

BACKGROUND: Postoperative sore throat is a common complication of endotracheal intubation; the thicker the endotracheal tube, the higher the frequency of postoperative sore throat. So, we evaluated the effect of benzydamine hydrochloride spray on postoperative sore throat, associated with double-lumen endobronchial intubation. METHODS: Sixty patients undergoing thoracic surgery were scheduled and enrolled for intubation, with a double-lumen endobronchial tube. Of these patients, 30 were sprayed with benzydamine hydrochloride (group B), and 30 with normal saline (group N), 10 minutes before intubation was performed. Patients were randomly assigned to the two groups. Blood pressure and heart rate were recorded before, and after endotracheal intubation. Symptoms of sore throat, hoarseness, and dysphagia were examined one hour, as well as 24 hours, after surgery. RESULTS: Incidence of sore throat was 73.3% and 23.3% (P < 0.001) in groups N and B, respectively, at one hour after surgery. In addition, incidence of sore throat at 24 hours after the operation, was also statistically significant (66.6% and 20.0%, P = 0.001). Frequency of dysphagia at one hour, and 24 hours after surgery, was lower in group B. There were no significant differences in heart rate, blood pressure, and hoarseness at 24 hours after surgery between the two groups. CONCLUSIONS: In cases wherein a double-lumen endobronchial tube was used, an oropharyngeal spray of benzydamine hydrochloride before tracheal intubation, reduced incidence of postoperative sore throat.

Radiofrequency Coil Design for in vivo Sodium Magnetic Resonance Imaging of Mouse Kidney at 9.4T

The objective of this study was to describe a radiofrequency (RF) coil design for in vivo sodium magnetic resonance imaging (MRI) for use in small animals. Accumulating evidence has indicated the importance and potential of sodium imaging with improved magnet strength (> 7T), faster gradient, better hardware, multi-nucleus imaging methods, and optimal coil design for patient and animal studies. Thus, we developed a saddle-shaped sodium volume coil with a diameter/length of 30/30 mm. To evaluate the efficiency of this coil, bench-level measurement was performed. Unloaded Q value, loaded Q value, and ratio of these two values were estimated to be 352.8, 211.18, and 1.67, respectively. Thereafter, in vivo acquisition of sodium images was performed using normal mice (12 weeks old; n = 5) with a two-dimensional gradient echo sequence and minimized echo time to increase spatial resolution of images. Sodium signal-to-noise ratio in mouse kidneys (renal cortex, medulla, and pelvis) was measured. We successfully acquired sodium MR images of the mouse kidney with high spatial resolution (approximately 0.625 mm) through a combination of sodium-proton coils.

Usefulness of Dermoscopy in the Differential Diagnosis of Ruptured and Unruptured Epidermal Cysts

BACKGROUND: An epidermal cyst is a common keratin-filled epithelial-lined cyst. The treatment of choice for epidermal cysts is surgical excision. If the cyst becomes ruptured, incision and drainage with oral antibiotic therapy or intralesional steroid injection are required. OBJECTIVE: To analyze the dermoscopic features that can differentiate between ruptured and unruptured epidermal cysts. METHODS: The clinical and dermoscopic features of the pathologically confirmed epidermal cysts of two subgroups of 38 patients, 20 with unruptured cysts and 18 with ruptured cysts, were reviewed. RESULTS: With regard to the dermoscopic features, an ivory- white background color and punctum were commonly found in both groups (p>0.05). The unruptured-cyst group showed higher frequencies of pore sign (p0.05), no vascular structure, and arborizing telangiectasia (p0.05) and peripheral linear branched vessels (with an erythematous rim) (p<0.05). CONCLUSION: Dermoscopy is helpful in differentiating between ruptured and unruptured epidermal cysts.

Usefulness of Dermoscopy in the Differential Diagnosis of Ruptured and Unruptured Epidermal Cysts

BACKGROUND: An epidermal cyst is a common keratin-filled epithelial-lined cyst. The treatment of choice for epidermal cysts is surgical excision. If the cyst becomes ruptured, incision and drainage with oral antibiotic therapy or intralesional steroid injection are required. OBJECTIVE: To analyze the dermoscopic features that can differentiate between ruptured and unruptured epidermal cysts. METHODS: The clinical and dermoscopic features of the pathologically confirmed epidermal cysts of two subgroups of 38 patients, 20 with unruptured cysts and 18 with ruptured cysts, were reviewed. RESULTS: With regard to the dermoscopic features, an ivory- white background color and punctum were commonly found in both groups (p>0.05). The unruptured-cyst group showed higher frequencies of pore sign (p0.05), no vascular structure, and arborizing telangiectasia (p0.05) and peripheral linear branched vessels (with an erythematous rim) (p<0.05). CONCLUSION: Dermoscopy is helpful in differentiating between ruptured and unruptured epidermal cysts.

Erratum: Increased Expression of Herpes Virus-Encoded hsv1-miR-H18 and hsv2-miR-H9-5p in Cancer-Containing Prostate Tissue Compared to That in Benign Prostate Hyperplasia Tissue / 대한배뇨장애요실금학회지

In this article, a part of fund and grant supports was omitted unintentionally.

Porphyria Cutanea Tarda in a Hemodialysis Patient / 대한피부과학회지

No abstract available.

Increased Expression of Herpes Virus-Encoded hsv1-miR-H18 and hsv2-miR-H9-5p in Cancer-Containing Prostate Tissue Compared to That in Benign Prostate Hyperplasia Tissue / 대한배뇨장애요실금학회지

PURPOSE: Previously, we reported the presence of virus-encoded microRNAs (miRNAs) in the urine of prostate cancer (CaP) patients. In this study, we investigated the expression of two herpes virus-encoded miRNAs in prostate tissue. METHODS: A total of 175 tissue samples from noncancerous benign prostatic hyperplasia (BPH), 248 tissue samples from patients with CaP and BPH, and 50 samples from noncancerous surrounding tissues from these same patients were analyzed for the expression of two herpes virus-encoded miRNAs by real-time polymerase chain reaction (PCR) and immunocytochemistry using nanoparticles as molecular beacons. RESULTS: Real-time reverse transcription-PCR results revealed significantly higher expression of hsv1-miR-H18 and hsv2-miRH9- 5p in surrounding noncancerous and CaP tissues than that in BPH tissue (each comparison, P<0.001). Of note, these miRNA were expressed equivalently in the CaP tissues and surrounding noncancerous tissues. Moreover, immunocytochemistry clearly demonstrated a significant enrichment of both hsv1-miR-H18 and hsv2-miR-H9 beacon-labeled cells in CaP and surrounding noncancerous tissue compared to that in BPH tissue (each comparison, P<0.05 for hsv1-miR-H18 and hsv2- miR-H9). CONCLUSIONS: These results suggest that increased expression of hsv1-miR-H18 and hsv2-miR-H95p might be associated with tumorigenesis in the prostate. Further studies will be required to elucidate the role of these miRNAs with respect to CaP and herpes viral infections.

Urticarial Vasculitis Associated with Mycoplasma pneumoniae / 대한피부과학회지

No abstract available.

Pigmentary Changes Following Photodynamic Therapy with 5-aminolevulinic Acid or Methyl Aminolevulinate Cream / 대한피부과학회지

BACKGROUND: Several side effects such as pain, erythema, and hyperpigmentation have been reported following photodynamic therapy (PDT). OBJECTIVE: We sought to compare the pigmentary changes induced by PDT with 5-aminolevulinic acid (ALA) and those induced by PDT with methyl aminolevulinate (MAL) in people with skin phototypes III-IV over a 6 month period. METHODS: In ten healthy volunteers, six skin areas on the upper arm of each subject were treated with (A) ALA 20% in base cream without irradiation, (A1) MAL 16.8% without irradiation, (B), (B1) control vehicles, (C) ALA 20% in base cream, and (C1) MAL 16.8%. Areas (B), (B1), (C), and (C1) were irradiated at four hours after photosensitizer or vehicle application. Irradiation was administered twice with a 1 week interval. The effects on the skin were assessed by visual and colorimetric evaluations. RESULTS: On (C) and (C1) areas, erythema and pigmentation were most pronounced at 30 minutes after the second irradiation. Erythema rapidly diminished but pigmentation persisted throughout the study. Erythema and pigmentation on (C)-treated areas were more prominent and prolonged than those on (C1)-treated areas. CONCLUSION: In subjects with skin phototypes III-IV, pigmentation tends to last for more than 6 months after PDT. The ALA-treated skin areas developed more severe and prolonged erythema and pigmentation than the MAL-treated skin areas.

Epidermotropic Metastatic Malignant Melanoma / 대한피부과학회지

Cutaneous metastases of malignant melanoma are usually confined to the dermis or subcutaneous fat. In some instances, however, they may involve the epidermis. A 68-year-old woman with a malignant melanoma on the subungual area of the right great toe presented with multiple blackish pinhead-sized macules surrounding an ulcerative lesion on the right great toe. Histopathological study of the macules showed atypical melanocytes and melanocytic nests in the papillary dermis and the dermoepidermal junction. A thinning of the epidermis, widening of the dermal papillae by aggregated atypical melanocytes, epidermal collarette formation, and angiotropism were also seen. A diagnosis of epidermotropic metastatic malignant melanoma (EMMM) was made. EMMM is a specific form of metastatic malignant melanoma that is associated with epidermotropism of melanoma cells and several histopathological features. The differential diagnosis between primary malignant melanoma and EMMM can be difficult because of their similar clinical and histological features. Here, we report a case demonstrating EMMM.

Usefulness of Ultrasonography in Differential Diagnosis between Ruptured and Unruptured Epidermal Cysts / 대한피부과학회지

BACKGROUND: An epidermal cyst is a common keratin-filled epithelial-lined cyst. The treatment of choice for epidermal cysts is surgical excision. If the cyst becomes ruptured, inflamed, or infected, then incision and drainage together with oral antibiotic therapy or intralesional steroid injection treatment is required. Identification of ruptured and unruptured cysts is important for treatment decisions. OBJECTIVE: The purpose of this study was to evaluate the usefulness of ultrasonography in the diagnosis of epidermal cysts, and to analyze distinctive features that can differentiate between ruptured and unruptured epidermal cysts. METHODS: We reviewed the clinical and sonographic features of pathologically confirmed epidermal cysts from 2 subgroups of 66 patients: 30 with unruptured cysts and 36 with ruptured cysts. The sonographic features used in the analysis included tumor size, margin, shape, tumor texture, posterior echo, internal debris, and lesion vascularity on color Doppler sonography. RESULTS: The mean long diameter of the cysts was 10.95 mm in the unruptured cyst group and 12 mm in the ruptured cyst group. Some sonographic features, including heterogenous and hypoechoic echo texture, posterior echo enhancement, and internal hyperechoic and hypoechoic debris, showed no significant differences between the groups (p>0.05). The unruptured cyst group showed cysts with significantly higher frequencies of a well-circumscribed margin, an ovoid shape, and no vascular flow (p<0.05). In contrast, the ruptured cyst group usually had cysts with a poorly defined or slightly poorly defined margin, an irregular shape, peripheral vascular flow, and mild or moderate flow vascularity. CONCLUSION: The results of this study indicate that ultrasonography is helpful in differentiating between ruptured and unruptured epidermal cysts.

Usefulness of Ultrasonography in Differential Diagnosis between Ruptured and Unruptured Epidermal Cysts / 대한피부과학회지

BACKGROUND: An epidermal cyst is a common keratin-filled epithelial-lined cyst. The treatment of choice for epidermal cysts is surgical excision. If the cyst becomes ruptured, inflamed, or infected, then incision and drainage together with oral antibiotic therapy or intralesional steroid injection treatment is required. Identification of ruptured and unruptured cysts is important for treatment decisions. OBJECTIVE: The purpose of this study was to evaluate the usefulness of ultrasonography in the diagnosis of epidermal cysts, and to analyze distinctive features that can differentiate between ruptured and unruptured epidermal cysts. METHODS: We reviewed the clinical and sonographic features of pathologically confirmed epidermal cysts from 2 subgroups of 66 patients: 30 with unruptured cysts and 36 with ruptured cysts. The sonographic features used in the analysis included tumor size, margin, shape, tumor texture, posterior echo, internal debris, and lesion vascularity on color Doppler sonography. RESULTS: The mean long diameter of the cysts was 10.95 mm in the unruptured cyst group and 12 mm in the ruptured cyst group. Some sonographic features, including heterogenous and hypoechoic echo texture, posterior echo enhancement, and internal hyperechoic and hypoechoic debris, showed no significant differences between the groups (p>0.05). The unruptured cyst group showed cysts with significantly higher frequencies of a well-circumscribed margin, an ovoid shape, and no vascular flow (p<0.05). In contrast, the ruptured cyst group usually had cysts with a poorly defined or slightly poorly defined margin, an irregular shape, peripheral vascular flow, and mild or moderate flow vascularity. CONCLUSION: The results of this study indicate that ultrasonography is helpful in differentiating between ruptured and unruptured epidermal cysts.

Eosinophilic Pustular Folliculitis with Palmoplantar Involvement / 대한피부과학회지

Eosinophilic pustular folliculitis (EPF) is an inflammatory disease characterized by pruritic follicular papulopustules of unknown etiology. EPF is clinically characterized by annular configurations on the face, trunk, and extremities. EPF rarely affects the palms and soles where hair follicles are absent. Histopathologically, a number of eosinophils infiltrate around and into hair follicles. A 44-year-old man visited us with pruritic plaques on the face, crusted patches and pustules on the both palms and soles. Histopathologic findings of the pustule on the palms and soles showed spongiosis and intraepidermal vesicular formations containing numerous eosinophils, with dermal perivascular infiltrates consisting of eosinophils and lymphocytes. Histopathologic findings of facial lesion showed dense eosinophils and lymphocytes around hair follicles. Another patient who 28-year-old man visited us with pruritic papules and pustules on the face, trunk, and soles. Histopathologic findings of the pustules on the sole and face were similar with those of the preceding patient. The diagnosis of EPF with palmoplantar involvement was made. The patients were treated with oral dapsone, resulting in a significant improvement in skin lesions. Herein we report two cases of EPF manifested on the face and palmoplantar areas.

Urinary MicroRNAs of Prostate Cancer: Virus-Encoded hsv1-miRH18 and hsv2-miR-H9-5p Could Be Valuable Diagnostic Markers / 대한배뇨장애요실금학회지

PURPOSE: MicroRNAs (miRNAs) in biological fluids are potential biomarkers for the diagnosis and assessment of urological diseases such as benign prostatic hyperplasia (BPH) and prostate cancer (PCa). The aim of the study was to identify and validate urinary cell-free miRNAs that can segregate patients with PCa from those with BPH. METHODS: In total, 1,052 urine, 150 serum, and 150 prostate tissue samples from patients with PCa or BPH were used in the study. A urine-based miRNA microarray analysis suggested the presence of differentially expressed urinary miRNAs in patients with PCa, and these were further validated in three independent PCa cohorts, using a quantitative reverse transcriptionpolymerase chain reaction analysis. RESULTS: The expression levels of hsa-miR-615-3p, hsv1-miR-H18, hsv2-miR-H9-5p, and hsa-miR-4316 were significantly higher in urine samples of patients with PCa than in those of BPH controls. In particular, herpes simplex virus (hsv)-derived hsv1-miR-H18 and hsv2-miR-H9-5p showed better diagnostic performance than did the serum prostate-specific antigen (PSA) test for patients in the PSA gray zone. Furthermore, a combination of urinary hsv2-miR-H9-5p with serum PSA showed high sensitivity and specificity, providing a potential clinical benefit by reducing unnecessary biopsies. CONCLUSIONS: Our findings showed that hsv-encoded hsv1-miR-H18 and hsv2-miR-H9-5p are significantly associated with PCa and can facilitate early diagnosis of PCa for patients within the serum PSA gray zone.

A Clinical, Microbiological, and Pathological Study of Cutaneous Nontuberculous Mycobacterial Infection / 대한피부과학회지

BACKGROUND: As the immunocompromised population has increased in recent years, the number of cutaneous nontuberculous mycobacterial (NTM) infections has also risen. However, since this affliction has no pathognomonic clinical or histological features, the diagnosis and treatment of cutaneous NTM infections are often delayed. OBJECTIVE: The aim of this study was to investigate the microbiological, clinical, and histological findings of cutaneous NTM infections. METHODS: We reviewed medical records and histologic slides of 10 patients diagnosed with cutaneous NTM infections confirmed by culture or polymerase chain reaction. RESULTS: All patients except one were immunocompetent, and 5 of 10 patients had preceding factors including trauma, liposuction, and intralesional triamcinolone injection. Microbiologically, of the 10 infections, 5 were caused by Mycobacterium marinum, 3 by Mycobacterium fortuitum, and 1 each by Mycobacterium chelonae and Mycobacterium ulcerans, respectively. Of the 5 patients with M. marinum, 2 had a fish-related job and 1 reared fish at a home aquarium. The most common clinical presentation was erythematous nodules (7/10). Histologically, irregular acanthosis (4/10), mixed cell infiltrate of lymphocytes, histiocytes, neutrophils (9/10), suppurative granuloma (7/10), microcysts lined by neutrophils (5/10), fibrosis (4/10), and panniculitis (7/10) were identified. CONCLUSION: We found microcysts lined by neutrophils in 50% of the samples and considered this finding to be a diagnostic marker of NTM infection. These clinicopathologic features will assist clinicians in diagnosing NTM infection more rapidly and accurately.

The effects of different loading doses of dexmedetomidine on sedation / 대한마취과학회지

BACKGROUND: Dexmedetomidine is a useful sedative drug with various uses. We designed this study to investigate the clinical effects and complications of different loading doses, 0.5 and 1.0 microg/kg. METHODS: Forty six patients, of American Society of Anesthesiologists physical status I and II, who required elective and emergency operation under spinal anesthesia were randomly assigned to group L or group H. Group L received a loading dose of 0.5 microg/kg for 10 minutes while group H received 1.0 microg/kg. Bispectral index (BIS), systolic blood pressure, heart rate, and Ramsay score were recorded at T0 (before loading), TL (just after loading) and T10, 20, 30 (10, 20, 30 minutes after TL). Complications, drug use, lowest BIS and time to reach BIS 80 after termination of dexmedetomidine were recorded during this study. RESULTS: In group H, BIS value decreased significantly after TL compared to the baseline (T0), while in group L after T10. Between two groups, BIS values showed a significant differences only at T10, BIS of group H was lower than that of group L. Ramsay score showed no significant differences except in TL; the score of group L was significantly lower than that of group H. Other vital signs and complications showed a minimal differences between two groups. CONCLUSIONS: Higher loading dose (1.0 microg/kg) of dexmedetomidine can lead to faster sedation without any severe complications.

Iododerma Following Radioactive Iodine Ablation of the Thyroid for Thyroid Cancer / 대한피부과학회지

Iododerma is a rare cutaneous eruption that occurs after oral, parenteral or topical administration of iodides. Acneiform papulopustular lesions are the most common skin reactions of iododerma and erythematous, vesiculobullous, vegetative, and pustular psoriasis-like lesions appear less commonly. A 40-year-old woman with post-thyroidectomy presented with pustular and crusted patches with erythematous and indurated bases on the face and well-defined purplish crusted desquamative plaques on the lower legs at 10 days after radioactive iodine-131 ablation. Based on clinicopathological findings and history, she was diagnosed with iododerma following radioactive iodine ablation. Hypersensitivity to iodine is more uncommon in iodine-131 therapy compared with other iodine-containing substances since the quantity of sodium iodide is infinitely small. As iododerma following radioactive iodine ablation is a rare entity, so clinicians need to know about the possibilities of developing the skin lesion along with other early side effects before administering iodine-131 therapy.

Cutaneous Epithelioid Hemangioendothelioma That Enlarged in Size during Pregnancy: Dermoscopic Features / 대한피부과학회지

Epithelioid hemangioendothelioma (EHE) is a rare vascular tumor that has been reported in systemic organs and in the skin as a biologically "borderline" neoplasm with intermediate malignant potentials. Skin involvement in EHE is rare, but when present, it occurs most commonly in the upper and lower extremities, presenting as a solitary, slightly painful, soft tissue mass. Skin involvement is often associated with underlying soft tissues or bone tumors. Histopathological study reveals cords and nests of epithelioid endothelial cells in a myxoid or hyalinized background and small intracytoplasmic vacuoles containing red blood cells. There have been no reported cases yet describing the dermoscopic features of EHE. Herein, we describe a young woman who developed cutaneous EHE that enlarged during pregnancy, we provided the dermoscopic findings and a review of the relevant literature.