Validation of Ultrasound and Computed Tomography-Based Risk Stratification System and Biopsy Criteria for Cervical Lymph Nodes in Preoperative Patients With Thyroid Cancer

Objective@#This study aimed to validate the risk stratification system (RSS) and biopsy criteria for cervical lymph nodes (LNs) proposed by the Korean Society of Thyroid Radiology (KSThR). @*Materials and Methods@#This retrospective study included a consecutive series of preoperative patients with thyroid cancer who underwent LN biopsy, ultrasound (US), and computed tomography (CT) between December 2006 and June 2015. LNs were categorized as probably benign, indeterminate, or suspicious according to the current US- and CT-based RSS and the size thresholds for cervical LN biopsy as suggested by the KSThR. The diagnostic performance and unnecessary biopsy rates were calculated. @*Results@#A total of 277 LNs (53.1% metastatic) in 228 patients (mean age ± standard deviation, 47.4 years ± 14) were analyzed. In US, the malignancy risks were significantly different among the three categories (all P 5 mm LNs, P ≥ 0.177). The criteria covering only suspicious LNs showed higher specificity and lower unnecessary biopsy rates than the current criteria, while maintaining sensitivity in all imaging modalities. @*Conclusion@#Integrative evaluation of US and CT helps in reducing the proportion of indeterminate LNs and the malignancy risk among them. Nodal size did not affect the malignancy risk of LNs, and the addition of indeterminate LNs to biopsy candidates did not have an advantage in detecting LN metastases in all imaging modalities.

Dilatation of Superior Ophthalmic Vein and Visual Disturbance by Central Venous Stenosis: A Case Mimicking Cavernous Sinus Dural Arteriovenous Fistula

Central venous stenosis is a relatively common complication in hemodialysis patients; however, jugular venous reflux (JVR) and increased intracranial pressure are rare, and associated progressive visual disturbance was reported in only a few cases. Here, we report a case of JVR with visual disturbance and increased intracranial pressure. Notably, the MRI was accompanied by a dilatation of the superior ophthalmic vein, which was mistaken for a cavernous sinus dural arteriovenous fistula (CSdAVF). The patient had JVR on time-of-flight MR angiography (TOF-MRA) and severe stenosis of the left brachiocephalic vein on conventional angiography. After balloon angioplasty for central venous stenosis, he was discharged after improvement of his visual disturbance. Although JVR due to central venous stenosis and CSdAVF might show similar symptoms, treatment plans are different. Therefore, it is important to distinguish radiologically based on a thorough review of MRI and TOF-MRA and confirm the central venous stenosis on cerebral angiography for the accurate diagnosis.

Analysis of Anesthesia-related Medical Disputes in the 2009-2014 Period Using the Korean Society of Anesthesiologists Database

Using the Korean Society of Anesthesiologists database of anesthesia-related medical disputes (July 2009-June 2014), causative mechanisms and injury patterns were analyzed. In total, 105 cases were analyzed. Most patients were aged < 60 yr (82.9%) and were classified as American Society of Anesthesiologists physical status < or = II (90.5%). In 42.9% of all cases, the injuries were determined to be 'avoidable' if the appropriate standard of care had been applied. Sedation was the sec most common type of anesthesia (37.1% of all cases), following by general anesthesia. Most sedation cases (27/39, 69.2%) showed a common lack of vigilance: no pre-procedural testing (82.1%), absence of anesthesia record (89.7%), and non-use of intra-procedural monitoring (15.4%). Most sedation (92.3%) was provided simultaneously by the non-anesthesiologists who performed the procedures. After the resulting injuries were grouped into four categories (temporary, permanent/minor, permanent/major, and death), their causative mechanisms were analyzed in cases with permanent injuries (n=20) and death (n=82). A 'respiratory events' was the leading causative mechanism (56/102, 54.9%). Of these, the most common specific mechanism was hypoxia secondary to airway obstruction or respiratory depression (n=31). The sec most common damaging event was a 'cardiovascular events' (26/102, 25.5%), in which myocardial infarction was the most common specific mechanism (n=12). Our database analysis demonstrated several typical injury profiles (a lack of vigilance in seemingly safe procedures or sedation, non-compliance with the airway management guidelines, and the prevalence of myocardial infarction) and can be helpful to improve patient safety.

Analysis of Anesthesia-related Medical Disputes in the 2009-2014 Period Using the Korean Society of Anesthesiologists Database

Using the Korean Society of Anesthesiologists database of anesthesia-related medical disputes (July 2009-June 2014), causative mechanisms and injury patterns were analyzed. In total, 105 cases were analyzed. Most patients were aged < 60 yr (82.9%) and were classified as American Society of Anesthesiologists physical status < or = II (90.5%). In 42.9% of all cases, the injuries were determined to be 'avoidable' if the appropriate standard of care had been applied. Sedation was the sec most common type of anesthesia (37.1% of all cases), following by general anesthesia. Most sedation cases (27/39, 69.2%) showed a common lack of vigilance: no pre-procedural testing (82.1%), absence of anesthesia record (89.7%), and non-use of intra-procedural monitoring (15.4%). Most sedation (92.3%) was provided simultaneously by the non-anesthesiologists who performed the procedures. After the resulting injuries were grouped into four categories (temporary, permanent/minor, permanent/major, and death), their causative mechanisms were analyzed in cases with permanent injuries (n=20) and death (n=82). A 'respiratory events' was the leading causative mechanism (56/102, 54.9%). Of these, the most common specific mechanism was hypoxia secondary to airway obstruction or respiratory depression (n=31). The sec most common damaging event was a 'cardiovascular events' (26/102, 25.5%), in which myocardial infarction was the most common specific mechanism (n=12). Our database analysis demonstrated several typical injury profiles (a lack of vigilance in seemingly safe procedures or sedation, non-compliance with the airway management guidelines, and the prevalence of myocardial infarction) and can be helpful to improve patient safety.

Zoster Paresis Misconceived as a Radiculopathy due to Herniated Intervertebral Disc

Herpes zoster is a viral disease of the posterior root ganglion and sensory nerve fiber, which presents clinically with vesicular eruption of the skin, radicular pain and sensory changes in the distribution of the affected ganglion. However, involvement of the motor neurons can be seen as well. If classic cutaneous lesions are present, herpes zoster-related motor paresis is easily diagnosed. Otherwise, the diagnosis may be more difficult and suspicious, especially if weakness occurs as a symptom before cutaneous lesions appear, or abnormal findings on the MRI are consistent with the signs. There have been few reports of sciatica with motor loss preceding skin lesions. Here, we report a patient with herpes zoster-related motor paresis preceding skin lesions. In the preliminary diagnosis, the herpes zoster-related motor paresis was confused for some structural disorder.

Effect of Midazolam upon the Prevention of Nausea and Vomiting after Middle Ear Surgery / 대한마취과학회지

BACKGROUND: Midazolam has been reported to decrease postoperative nausea and vomiting (PONV). We studied the antiemetic effect of midazolam after middle ear surgery. METHODS: In this prospective, randomized, double-blind, placebo-controlled study, 90 healthy patients were scheduled for middle ear surgery (tympanomastoidectomy and tympanoplasty). Patients were randomly divided into two groups; Midazolam 0.075 mg/kg (n = 45) or normal saline (n = 45) was administered after induction of anesthesia. The incidence of PONV, metoclopramide and ketorolac usage, pain, sedation, and other side effects were assessed at 6, 24 h after the operation. RESULTS: The incidences of PONV were 15 (33%) in midazolam group and 27 (60%) in placebo group during 24 h postoperatively. The incidence of PONV in midazolam group was significantly lower than that in placebo group (P < 0.05). There were no significant differences between groups in adverse events. CONCLUSIONS: Midazolam 0.075 mg/kg was effective for preventing PONV after middle ear surgery without significant adverse effects.

Antiemetic Effect of Midazolam added to Patient-Controlled Analgesia after Total Abdominal Hysterectomy / 대한마취과학회지

BACKGROUND: Midazolam has been reported to decrease postoperative nausea and vomiting (PONV). We studied the antiemetic effect of midazolam in patients receiving intravenous patient-controlled analgesia (PCA) using morphine after total abdominal hysterectomy. METHODS: Group C (n = 27) received bolus of morphine 5 mg and PCA of morphine 1 mg/ml. Group M1 (n = 27) received bolus of morphine 5 mg and midazolam 1 mg and PCA of midazolam 0.2 mg/ml mixed with morphine 1 mg/ml. Group M2 (n = 27) received bolus of morphine 5 mg and midazolam 1 mg and PCA of midazolam 0.4 mg/ml mixed with morphine 1 mg/ml. The PCA delivery system was programmed to deliver 1 ml of the test solution per demand with a 10 min lockout interval and no background infusion. The incidence of PONV, metoclopramide and ketorolac usage, morphine and midazolam consumption, pain, sedation, and other side effects were assessed at 1, 4, 8, 16, 24, 36 and 48 h after the operation. RESULTS: The incidences of PONV were 19 (70%) in Group C, 14 (52%) in Group M1 and 10 (37%) in Group M2. The incidence of PONV in Group M2 was significantly lower than that in Group C (P < 0.05). Patients in Group M2 experienced more sedation than those in Group C (P < 0.05). No severe sedation was observed in all groups. CONCLUSIONS: Combination of midazolam 0.4 mg per morphine 1 mg in PCA had more effective antiemetic efficacy than control without significant adverse effects.

Intrathecal Alcohol Neurolysis for Intractable Thoracic Postherpetic Neuralgia: A case report / 대한마취과학회지

Postherpetic neuralgia (PHN) is a sequela of acute herpes zoster infection and is defined as pain persisting more than 1 month. The patients with PHN suffer from a persistent neuropathic pain. There are many treatments for PHN but some people occasionally do not respond to the conventional therapies. Neurodestruction using neurolytic agents are beneficial to patients with severe intractable pain because of it's prolonged pain-relief and simplicity, inexpensiveness. We report a case that we managed successfully a patient with intractable thoracic PHN using intrathecal alcohol neurolysis.

Spectral Analysis of EEG During Infusion of Propofol in the Rats / 대한마취과학회지

BACKGROUND: The dose-related effects of intravenous infusion of propofol on the rat EEG were evaluated quantitatively by spectral analysis of EEG recorded from the rat skull. METHODS: Propofol was infused into femoral vein at various concentrations ranging from 0 to 400 g/g body weight, and bipolar EEG was recorded from the rat skull and its spectrum were calculated by power spectrum analysis. The EEG electrodes were fixed at the right and left frontal, parieatal, and occipital bone on rat stereotaxic table. The density of each spectral bands(delta 1 3.25, theta 3.5 7.75, alpha 8 12.75, beta 13 31.75 Hz), total power density, median power frquency, and spectral edge frequency were derived from the spectra. RESULTS: In visual inspection of conventional EEG, low doses of propofol(100, 200 g/100 g) showed no significant changes except appearance of high frequency waves, but higher doses of propofol(300, 400 g/100 g) showed high amplitude with low frequency wave. In quantitative spectral analysis of EEG, low dose of propofol revealed no significant change except appearance of beta-waves in the frontal lobe especially. Significant EEG changes were identified during infusion of higher dose of propofol. 300 and 400 g/g of propofol revealed high amplitude and low frequency waves. Median power frequency and spectral edge frequency were significantly changed at 300 and 400 g/g of propofol in range 4.2Hz and 3.8Hz, and 12.4 Hz and 10.2 Hz respectively. CONCLUSIONS: Taken together, these findings suggest that analysis of EEG parameters derived from EEG power spectrum could be applied to determine the depth of propofol anesthesia in rats.

A Case of 4p-(Wolf-Hirschhorn) Syndrome

No abstract available.