Chronic exposure to dexamethasone may not affect sugammadex reversal of rocuronium-induced neuromuscular blockade: an in vivo study on rats

Background@#Chronic glucocorticoid exposure is associated with resistance to nondepolarizing neuromuscular blocking agents. Therefore, we hypothesized that sugammadex-induced recovery would occur more rapidly in subjects exposed to chronic dexamethasone compared to those who were not exposed. This study evaluated the sugammadex-induced recovery profile after neuromuscular blockade (NMB) in rats exposed to chronic dexamethasone. @*Methods@#Sprague–Dawley rats were allocated to three groups (dexamethasone, control, and pair-fed group) for the in vivo study. The mice received daily intraperitoneal dexamethasone injections (500 μg/kg) or 0.9% saline for 15 days. To achieve complete NMB, 3.5 mg/kg rocuronium was administered on the sixteenth day. The recovery time to a train-of-four ratio ≥ 0.9 was measured to evaluate the complete recovery following the sugammadex injection. @*Results@#Among the groups, no significant differences were observed in the recovery time to a train-of-four ratio ≥ 0.9 following sugammadex administration (P = 0.531). The time to the second twitch of the train-of-four recovery following rocuronium administration indicated that the duration of NMB was significantly shorter in Group D than that in Groups C and P (P = 0.001). @*Conclusions@#Chronic exposure to dexamethasone did not shorten the recovery time of sugammadex-induced NMB reversal. However, the findings of this study indicated that no adjustments to sugammadex dosage or route of administration is required, even in patients undergoing long-term steroid treatment.

Intraocular Hemorrhage After Transoral Endoscopic Thyroidectomy Vestibular Approach / 대한이비인후과학회지

Transoral endoscopic thyroid surgery vestibular approach (TOETVA) is now widely performed globally with good cosmetic outcomes. However, there are complications related to this approach which surgeons should be aware of. We report here a 41-year-old female patient who had an unusual ocular complication after total thyroidectomy via TOETVA. She was diagnosed with papillary thyroid carcinoma and received total thyroidectomy via TOETVA. She complained of floating particles in her right eye immediately after the operation. Fundus examination revealed intraocular hemorrhage in her right eye. At one-month follow-up, all of the intraocular hemorrhage was improved by fundus examination, resolving her chief complaint. Surgeons and anesthesiologists should be aware of increased intracranial pressure during the TOETVA and possible ocular complications after the surgery, although they are rare.

Non-convulsive status epilepticus in the immediate postoperative period following spine surgery -a case report- / 대한마취과학회지

Background@#Non-convulsive status epilepticus (NCSE), in which continuous epileptiform dis-charges occur without seizure-like movement, is rare and unfamiliar to anesthesiologists, both of which make this condition overlooked in patients with decreased levels of consciousness following general anesthesia.Case: We report on an elderly female patient who developed NCSE in the immediate postoperative period after the spine surgery. Initially, delayed emergence from anesthesia was suspected, but the electroencephalogram confirmed NCSE, and anticonvulsant therapy was initiated. @*Conclusions@#Delayed emergence is commonly attributed to cerebrovascular events or residual anes-thetic effects, but NCSE must be included in the differential diagnosis, especially in elderly pa-tients. Anticonvulsant therapy should be initiated as soon as possible for a better prognosis.

Implant-assisted removable partial denture using digital guide surgery in partially edentulous mandible: A case report / 대한치과보철학회지

Fixed implant prostheses or removable partial dentures are common treatment for partially dentulous patients. Recently, an implant-assisted removable partial denture (IARPD) has been introduced and is widely used. In the case of removable partial dentures using implant attachment and surveyed fixed prostheses, the consideration about parallelism of insertion path between implants and surveyed fixed prostheses is an important factor for success of IARPDs. In this case, she complained of discomfort while using the mandibular removable partial denture. Thus, an IARPD using implant surveyed fixed prostheses was fabricated.Thereafter, more implants were placed by a digital guide surgery to have the same insertion path as the existing surveyed fixed prostheses. Locator attachments were installed to the left and right premolar implants, and the left molar was able to obtain support of the removable partial denture with healing abutment. The clinical results were satisfactory on the aspect of aesthetic and masticatory function.

Intracranial Metaplastic Meningioma : Clinical and Radiological Characteristics of 11 Cases

Objective@#: Metaplastic meningioma is an extremely rare subtype of World Health Organization (WHO) grade I meningioma. It has distinctive histological subtypes according to its own mesenchymal components. Owing to its scarcity, clinical or radiological features of a metaplastic meningioma are poorly described. @*Methods@#: Between 2004 and 2018, we analyzed total 1814 cases surgically proven meningioma for 15 years. Among them, metaplastic meningioma was diagnosed in 11 cases. Magnetic resonance images were taken for all patients, and computed tomography scan was taken for 10 patients. @*Results@#: WHO grade I meningiomas were 1376 cases (75.9%), 354 cases (19.5%) in WHO grade II, and 84 cases (4.6%) in WHO grade III meningiomas. Metaplastic meningioma was 11 cases as 0.8% of WHO grade I meningioma and 0.6% of entire meningiomas for 15 years. Among the entire 11 metaplastic meningiomas, five tumors (45%) were diagnosed as a lipomatous subtype with rich fat components, four (36%) as an osseous subtype with extensive bone formation and two (18%) as a xanthomatous subtype. There was no cartilaginous subtype metaplastic meningioma in our study. Lipomatous and osseous metaplastic meningioma have peculiar radiological characteristics according to mesenchymal components. @*Conclusion@#: We investigated a rare metaplastic meningioma subtype based on our 15-year surgical experience with meningiomas.Further investigation will be necessary for the clear clarification of tumor nature of this rare tumor.

Left ventricular response after cardiac resynchronization therapy is related to early leftatrial volume reduction

Background/Aims@#The current study aimed to elucidate a time-course change in left atrial volume after cardiac resynchronization therapy (CRT) and to verify factors associated with left atrial volume reduction (LAVR) and its prognostic implications. @*Methods@#The records of 97 patients were retrospectively reviewed after CRT.Echocardiographic data were analyzed at baseline before CRT, at early follow-up FU) (≤ 1 year, median 6 months), and at late FU (median 30 months). Left ventricular volume response (LVVR) was defined as 15% reduction in left ventricular (LV) end-systolic volume (ESV). LAVR was classified into two groups by the median value at early FU: LAVR (≥ 7.5%) and no LAVR (< 7.5%). @*Results@#LV ESV index continuously decreased from baseline to early FU and from early FU to late FU (106.1 ± 47.4 mL/m2 vs. 87.6 ± 51.6 mL/m2 vs. 72.5 ± 57.1 mL/m2).LA volume index decreased from baseline to early FU, but there were no reductions thereafter (51.8 ± 21.9 mL/m2 vs. 45.1 ± 19.6 mL/m2 vs. 44.9 ± 23.0 mL/m2).The only echocardiographic factor associated with LAVR was change in E velocity(odds ratio [OR], 1.04;p = 0.002). Early LAVR (OR, 10.05;p = 0.002) was an independent predictor for late LVVR. @*Conclusions@#LAVR was related to reduction in E velocity, suggesting its relation with optimization of LV filling pressure. Early LAVR was a predictor for LVVR to CRT in long-term FU.

Choroid Plexus Carcinoma in Adults: Two Case Reports

Choroid plexus tumors are uncommon brain tumors that primarily occur in children. Most of these tumors originate from the intraventricular area, and the most common clinicalpresentation is increased intracranial pressure. Dissemination through the cerebrospinal fluid space is the inevitable natural course of the disease. Here, we present 2 rare cases of adult choroid plexus carcinoma (CPC), each with distinct clinical presentation and progression. The first case was a 40-year-old male who presented with multiple intraventricular masses. After surgical biopsy, radiation and intrathecal chemotherapy failed to elicit any response. The patient progressed with spinal cord dissemination and expired 1 year later. The second case presented with visual disturbance, and brain MRI revealed a large ovoid juxtaventricular mass with peritumoral edema. This 49-year-old female patient underwent craniotomy for what was thought to be a high-grade glioma; however, the mass was connected to the choroid plexus at the operative field. Her pathology specimen was diagnosed as CPC, and adjuvant systemic chemotherapy was administered. She has now been free of recurrence for 10 months. The description of the presentation and progression of these rare adult-onset CPC provides insight for the diagnosis and treatment of other rare instances of choroid plexus tumors.

Acute Phlegmonous Esophagogastritis / 대한소화기학회지

No abstract available.

Prediction of Obstructive Sleep Apnea Based on Respiratory Sounds Recorded Between Sleep Onset and Sleep Offset

OBJECTIVES: To develop a simple algorithm for prescreening of obstructive sleep apnea (OSA) on the basis of respiratorysounds recorded during polysomnography during all sleep stages between sleep onset and offset. METHODS: Patients who underwent attended, in-laboratory, full-night polysomnography were included. For all patients, audiorecordings were performed with an air-conduction microphone during polysomnography. Analyses included allsleep stages (i.e., N1, N2, N3, rapid eye movement, and waking). After noise reduction preprocessing, data were segmentedinto 5-s windows and sound features were extracted. Prediction models were established and validated with10-fold cross-validation by using simple logistic regression. Binary classifications were separately conducted for threedifferent threshold criteria at apnea hypopnea index (AHI) of 5, 15, or 30. Prediction model characteristics, includingaccuracy, sensitivity, specificity, positive predictive value (precision), negative predictive value, and area under thecurve (AUC) of the receiver operating characteristic were computed. RESULTS: A total of 116 subjects were included; their mean age, body mass index, and AHI were 50.4 years, 25.5 kg/m2, and23.0/hr, respectively. A total of 508 sound features were extracted from respiratory sounds recorded throughoutsleep. Accuracies of binary classifiers at AHIs of 5, 15, and 30 were 82.7%, 84.4%, and 85.3%, respectively. Predictionperformances for the classifiers at AHIs of 5, 15, and 30 were AUC, 0.83, 0.901, and 0.91; sensitivity, 87.5%,81.6%, and 60%; and specificity, 67.8%, 87.5%, and 94.1%. Respective precision values of the classifiers were89.5%, 87.5%, and 78.2% for AHIs of 5, 15, and 30. CONCLUSION: This study showed that our binary classifier predicted patients with AHI of ≥15 with sensitivity and specificityof >80% by using respiratory sounds during sleep. Since our prediction model included all sleep stage data, algorithmsbased on respiratory sounds may have a high value for prescreening OSA with mobile devices.

Association Between Hearing Impairment and Albuminuria With or Without Diabetes Mellitus

OBJECTIVES: Few studies have evaluated the accurate association between hearing loss (HL) and albuminuria in patients with or without diabetes mellitus (DM). The aim of our study was to identify the clinical effects of albuminuria on HL with or without DM. METHODS: This study included 9,762 patients from the Korean National Health and Nutrition Examination Survey between 2011 and 2013. Participants were divided into 4 groups based on DM and urine albumin/creatinine ratio levels: group 1 included participants with neither DM nor albuminuria, group 2 included participants without DM and with albuminuria, group 3 included patients with DM and without albuminuria, and group 4 included patients with both DM and albuminuria. The low- or mid-frequency and high-frequency, and average hearing threshold values were obtained. RESULTS: There were 7,508, 545, 1,325, and 384 participants in groups 1, 2, 3, and 4, respectively. Univariate and multivariate analyses showed that the 3 hearing thresholds in group 1 were the lowest and those in group 4 were the highest among the 4 groups. No significant differences were observed in those thresholds between groups 2 and 3. Group 4 was associated with HL compared with the other groups, but moderate to severe HL was not associated with DM or albuminuria. CONCLUSION: The presence of albuminuria was associated with a modest effect on hearing thresholds regardless of presence of DM.

Snowboarder's Fracture in Cable-Wakeboarder / 대한스포츠의학회지

Fractures of the lateral process of the talus (LPT) are considered rare, accounting for less than 1% of all ankle injuries in the general population. These fractures are nearly 15 times more likely to occur in snowboarders. Recently, the number of population who started enjoying cable-wakeboard is increasing and this sport may cause fracture of the LPT by axial loading occur on the LPT while boarding or trick. We report on a case of involving LPT fracture during cable-wakeboard trick with successful screw osteosynthesis.

A Case of Sarcomatoid Carcinoma of the Larynx Mimicking Vocal Polyp

Sarcomatoid carcinomas are biphasic tumors which have surface epithelial changes and an underlying spindle-shaped neoplastic proliferation. A 62-year-old male with hoarseness came to our hospital for evaluation. A single smooth polypoid lesion was detected on his right true vocal fold by larnygoscope. The patient was diagnosed with vocal polyp and treated with surgical excision. Pathology report of the excised specimen was compatible with sarcomatoid carcinoma. Therefore, further surgical resection was performed to secure safety margins. We report a case of a sarcomatoid carcinoma patient who was clinically diagnosed as vocal polyp.

Diagnostic Utility of Ultrasound-Guided Core-Needle Biopsy Performed by a Head and Neck Surgeon for Mass Lesions with Inconclusive Result in Fine-Needle Aspiration Cytology / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To evaluate the diagnostic utility of ultrasound (US)-guided core-needle biopsy (CNB) (US-CNB) performed by a head and neck surgeon for mass lesions with inconclusive result in previous fine-needle aspiration cytology (FNAC). SUBJECTS AND METHOD: Forty six patients who had previously inconclusive results of non-diagnostic specimen, undetermined significance, and malignancy/suspicious malignancy with undetermined subtype were included in the study. They were divided into the repeating FNAC (rFNAC) group and CNB groups. Procedure time, success of targeting, and complications were evaluated in the CNB group. In addition, the diagnostic utility of CNB was compared with that of FNAC. RESULTS: US-CNB was successfully completed by a head and neck surgeon in all 23 cases without any major complications. The US-CNB group showed significantly lower rates of repeated non-diagnostic/undetermined results than in the rFNAC group (0% vs. 40.9%, p=0.001). In addition, CNB provided specific pathological diagnoses that permitted the surgeon to establish an appropriate treatment plan in 95.7% (22/23) of the CNB group, while rFNAC provided specific pathological diagnoses in 56.5% (13/23) of the rFNAC group (p=0.002). CONCLUSION: US-CNB can be performed safely by head and neck surgeons, providing better diagnostic results compared with those of rFNAC for mass lesions with inconclusive results in previous FNAC.

Dislodgement of Two Stents in One Patient during Percutaneous Coronary Intervention

Coronary stent loss is a rare but serious complication during interventional cardiology. This complication occurs not only in the intracoronary area but also in the extracoronary area, such as the aortic root or the left ventricle. An 83-year-old man with stable angina had a stent inserted into a heavy calcific left anterior descending artery. The stent was lost twice during the procedure. The first stent was dislodged from the left main coronary artery to the proximal left anterior descending artery, and the second stent migrated to the aortic root following separation from the balloon. We successfully redeployed the first stent at the dislodged site and retrieved the second stent using a goose-neck snare after moving the stent to the descending aorta. These steps circumvented the need for the patient to undergo emergency cardiovascular surgery.

Onlay Rib Bone Graft in Elevation of Reconstructed Auricle: 17 Years of Experience

BACKGROUND: A cartilage wedge block and covering flap are standard procedures for firm elevation of the ear in microtia correction. However, using costal cartilage for elevation of the reconstructed auricle can be insufficient, and the fixed cartilage wedge block may be absorbed or may slip out. Furthermore, elevating covering flaps is time-consuming and uses up fascia, a potential source of reconstruction material. Therefore, we propose an innovative method using autologous onlay rib bone graft for auricular elevation of microtia. METHODS: From February 1995 to August 2012, 77 patients received a first stage operation with a rib cartilage framework graft. In the second stage operation, a small full thickness of rib bone was harvested through the previous donor scar. The bihalved rib bone was inserted into the subperiosteal pocket beneath the cartilage framework. RESULTS: The follow-up time ranged from 1 month to 17 years, with a mean of 3 years. All of the patients sustained the elevation of their ears very well during the follow-up period. Donor site problems, except for hypertrophic scars, were not observed. Surgery-related complications, specifically skin necrosis, infection, or hematoma, occurred in 4 cases. CONCLUSIONS: Onlay rib bone graft used to elevate the reconstructed auricle is a more anatomically appropriate material than cartilage, due to the bone-to-bone contact between the bone graft and the temporal bone. Postoperative minor correction of the elevation degree is straightforward and the skin graft survives better. Therefore, reconstructed auricle elevation using onlay rib bone graft is a useful and valuable method.

Single Port Laparoscopic Appendectomy in Pediatric Patients: A Preliminary Experience

PURPOSE: The authors retrospectively compared single-port laparoscopic appendectomy (SPLA) with conventional laparoscopic appendectomy (CLA) in terms of the perioperative outcomes in pediatric patients. METHODS: Cases of laparoscopic appendectomy between December 2009 and July 2010 were retrospectively reviewed. The demographic data, operating time, pathology of the appendix, hospital stay and surgical morbidities were compared. RESULTS: Ten patients underwent SPLA and 57 underwent CLA. The mean age of the CLA and SPLA groups were 11.2 and 10.6 years, respectively. The pathology of the appendix showed that relatively more severe cases were included in the CLA group. There were 2 cases of a post operative intra-abdominal abscess and 2 cases of an umbilical wound infection in the SPLA group. Therefore, the SPLA group showed a significantly higher surgical morbidity rate (p=0.003) and hospital stay (p=0.05). The mean operation time of the SPLA and CLA group was 88.1+/-30.1 and 71.6+/-26.3 minutes, respectively; the mean operation time of the SPLA group was slightly longer (p=0.054). On the other hand, surgical morbidity and the mean operation time showed a decreasing tendency in the latter half of 10 cases. CONCLUSION: The initial experience of SPLA in pediatric patients shows a higher complication rate and longer hospital stay than CLA. On the other hand, the complication rates and operation time have been decreasing. The clinical outcomes are expected to improve after going through a learning curve.

Role of Echocardiography in Sinus Venosus Atrial Septal Defect Combined with Systemic and Pulmonary Vascular Disease

We present a case of persistent left superior vena cava, anomalous right pulmonary venous connection to the right-sided superior vena cava and sinus venosus atrial septal defect detected by computed tomography (CT) pulmonary angiography and echocardiography. These defects were surgically corrected using a double-patch technique. In fact, CT can provide anatomical information about a complex anomaly in the systemic and pulmonary vasculatures. Though modern imaging techniques are useful for detecting complex cardiovascular disease, careful echocardiographic examination should be performed to diagnose complex cardiac anomalies.

Role of Echocardiography in Sinus Venosus Atrial Septal Defect Combined with Systemic and Pulmonary Vascular Disease

We present a case of persistent left superior vena cava, anomalous right pulmonary venous connection to the right-sided superior vena cava and sinus venosus atrial septal defect detected by computed tomography (CT) pulmonary angiography and echocardiography. These defects were surgically corrected using a double-patch technique. In fact, CT can provide anatomical information about a complex anomaly in the systemic and pulmonary vasculatures. Though modern imaging techniques are useful for detecting complex cardiovascular disease, careful echocardiographic examination should be performed to diagnose complex cardiac anomalies.

Clinical Experience of Currarino Syndrome

Currarino syndrome is a hereditary syndrome characterized by the triad of a sacral bony defect, presacral mass and anorectal malformation. We retrospectively reviewed 13 Currarino syndrome patients who were treated in our center between 1997 and 2010. Demographic data, initial symptoms, initial diagnosis, pathologic diagnosis of presacral mass, associated anomalies and managements were analyzed. There were 8 boys and 5 girls. Four patients were diagnosed as Currarino syndrome immediately after birth with failure of passage of meconium and abdominal distension. Four patients underwent surgery for imperforate anus immediately after birth and were diagnosed as Currarino syndrome later and underwent reoperation. Three patients were diagnosed during work-up and management with of the tentative diagnosis of Hirschsprung's disease. Diagnosis of the remaining two patients was at the age of 26 months and 9 years and anorectal malformation was not associated. Twelve patients showed hemi-sacrum and one patient showed bilateral sacral subtotal agenesis. Two patients without anorectal malformation underwent presacral mass excision, untethering of spinal cord and repair of myelomeningocele. Six out of 8 patients, excluding 3 that expired or were lost to follow up, with anorectal malformation underwent colostomy, presacral mass excision, untethering of spinal cord, repair of myelomeningocele, posterior sagittal anorectoplasty and colostomy repair. One patient underwent only posterior sagittal anorectoplasty after colostomy. One waits the scheduled operation only with Hegar dilatation. Pathologic examation of presacral masses showed myelomeningoceles in 4 patients, lipomyelomeningoceles in 3 patients and dermoid cyst in one patient. Teratoma was combined in 2 patients. Eight patients needed neurosurgical operation for spinal cord problems. Seven patients had urologic anomalies and two of them underwent operation. Currarino syndrome should be considered as a differential diagnosis in pediatric patients with abdominal distension, constipation and anorectal malformation. For proper evaluation and treatment, a multi-disciplinary approach is recommended.

Extracorporeal Membrane Oxygenation in Neonates with Congenital Diaphragmatic Hernia: a Preliminary Experience

Extracorporeal membrane oxygenation (ECMO) has been utilized in congenital diaphragmatic hernia (CDH) patients with severe respiratory failure unresponsive to conventional medical treatment. We retrospectively reviewed 12 CDH patients who were treated using ECMO in our center between April 2008 and February 2011. The pre ECMO and on ECMO variables analyzed included gestational age, sex, birth weight, age at the time of ECMO cannulation, arterial blood gas analysis results, CDH location, timing of CDH repair operation, complications and survival. There were 9 boys and 3 girls. All patients were prenatally diagnosed. Mean gestational age was 38.8 +/- 1.7 weeks and mean birth weight was 3031 +/- 499 gram. Mean age at the time of ECMO cannulation was 29.9 +/- 28.9 hours. There were 4 patients who survived. Survivors showed higher 5 min Apgar scores (8.25 +/- 0.96 vs. 7.00 +/- 1.20, p=0.109), higher pre ECMO mean pH (7.258 +/- 0.830 vs. 7.159 +/- 0.986, p=0.073) and lower pre ECMO PaCO2 (48.2 +/- 7.9 vs. 64.8 +/- 16.1, p=0.109) without statistical significance. The hernia was located on the left side in 10 patients and the right side in 2 patients. The time interval from ECMO placement to operative repair was about 3~4 days in 5 early cases and around 24 in the remaining cases. There were 3 cases of post operative bleeding requiring re operation and 2 cases of abdominal compartment syndrome requiring abdominal fascia reopening. ECMO catheter reposition was required in 4 cases. Three cases of arterial or venous thrombosis were detected and improved with follow up. Our data suggests that ECMO therapy could save the lives of some neonates with CDH who can not be maintained on other treatment modalities. Protocolized management and accumulation of case experience might be valuable in improving outcomes for neonates with CDH treated with ECMO.