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2.
Article in English | WPRIM | ID: wpr-717582

ABSTRACT

BACKGROUND: Hypnosis monitors analyze small-amplitude electrical signals transmitted from the brain that could be exposed to the electromagnetic field that occurs around the body during electrocautery (ECT). We investigated the influence of ECT on hypnosis monitoring during anesthesia. METHODS: We simultaneously monitored BIS and uCON during 50 gynecologic oncology surgeries. During the episodes of ECT, we compared the absolute difference (a-Diff) between the baseline index and the most deviated index after ECT over either 30–60 s (ECT30–60) or more than 60 s (ECT > 60) between the monitors. We also investigated the bias and the limits of agreement between the monitors. RESULTS: Between the two monitors, the a-Diff of ECT30–60 was 1.4 ± 1.1 for the BIS, which was significantly greater than 0.6 ± 0.9 for the uCON (P = 0.003), and the a-Diff of ECT > 60 was 16.5 ± 8.2 for the BIS, which was also significantly greater than 1.4 ± 1.3 for uCON (P 60 was significantly greater than that during ECT30–60 (P 60 (P = 0.056). The estimated bias between the monitors was 6.3 ± 9.8 and 95% limits agreement was –12.3 to 25.0. CONCLUSIONS: Prolonged ECT intervention might lead to spurious estimations of quantitative EEG indexes. Therefore, hypnosis should be clinically assessed in combination with scrutinized judgment of relevant clinical symptoms and signs for hypnosis.


Subject(s)
Anesthesia , Anesthesia, General , Bias , Brain , Electrocoagulation , Electroencephalography , Electromagnetic Fields , Hypnosis , Judgment , Magnets
3.
Article in English | WPRIM | ID: wpr-155531

ABSTRACT

Primary sclerosing mucoepidermoid carcinoma with eosinophilia (SMECE) of the thyroid gland is a very rare disease. We present the clinical and histopathologic findings of a 37-year-old woman recently diagnosed with SMECE of the thyroid gland. The patient, clinically euthyroid, who presented with a neck swelling since last 2 years along. Fine needle aspiration cytology suggested thyroid papillary carcinoma. Total thyroidectomy, central neck dissection and right selective neck dissection were performed. Although SMECE is considered to be a relatively slow growing and non-aggressive tumor, occasional metastasis does occur. We report an additional case of SMECE, with metastasis to regional lymph nodes. Physicians should be aware of extended operation, including total thyroidectomy and/or neck node dissection for metastatic lesion of the neck node. More standardized treatment is likely to evolve in the future.


Subject(s)
Adult , Biopsy, Fine-Needle , Carcinoma, Mucoepidermoid , Carcinoma, Papillary , Eosinophilia , Female , Humans , Lymph Nodes , Neck , Neck Dissection , Neoplasm Metastasis , Rare Diseases , Thyroid Gland , Thyroidectomy
4.
Article in English | WPRIM | ID: wpr-227116

ABSTRACT

BACKGROUND: Changes in pulse pressure (PP) may alter the morphology of arterial pressure waveforms, thereby affecting the accuracy of cardiac output (CO) measurements derived from such waveforms. This study evaluated the influence of PP on the accuracy of FloTrac/Vigileo™ system-measured CO (APCO). Pulmonary artery catheter (PAC) measured stat mode CO (SCO) is used as a reference standard. METHODS: Hemodynamic variables were measured at various time points in 24 patients. APCO and SCO were compared using Bland-Altman analysis of the overall data pairs. The data pairs were divided into a low PP group and a high PP group, and subgroup analysis was conducted. RESULTS: The mean APCO (5.3 ± 1.7 L/min) was higher than the mean SCO (5.1 ± 1.6 L/min) for all data pairs (P < 0.001). The Bland-Altman analysis revealed an overall percentage error of 41.7% between the APCO and SCO, which exceeds a 30% limit of agreement. There was a significant relationship between PP and the difference between APCO and SCO (P = 0.031, R = 0.151). In subgroup analysis, APCO and SCO showed reasonable agreement in the low PP group, with a percentage error of 28.2%, but decreased agreement in the high PP group, with a percentage error of 43.2%. CONCLUSIONS: Changes in PP affect the accuracy of APCO measurements. An acceptable level of agreement between APCO and SCO was observed only in a low range of PP.


Subject(s)
Arterial Pressure , Blood Pressure , Cardiac Output , Catheters , Hemodynamics , Humans , Pulmonary Artery
5.
Article in English | WPRIM | ID: wpr-32711

ABSTRACT

The daily insertion of endotracheal tubes, laryngeal mask airways, oral/nasal airways, gastric tubes, transesophageal echocardiogram probes, esophageal dilators and emergency airways all involve the risk of airway structure damage. In the closed claims analysis of the American Society of Anesthesiologists, 6% of all claims concerned airway injury. Among the airway injury clams, the most common cause was difficult intubation. Among many other causes, esophageal stethoscope is a relatively noninvasive monitor that provides extremely useful information. Relatively not many side effects that hardly is ratable. Some of that was from tracheal insertion, bronchial insertion resulting in hypoxia, hoarseness due to post cricoids inflammation, misguided surgical dissection of esophagus. Also oropharyngeal bleeding and subsequent anemia probably are possible and rarely pharyngeal/esophageal perforations are also possible because of this device. Careful and gentle procedure is necessary when inserting esophageal stethoscope and observations for injury and bleeding are needed after insertion.


Subject(s)
Anemia , Hypoxia , Bivalvia , Bronchoscopes , Emergencies , Esophagus , Foreign Bodies , Hemorrhage , Hoarseness , Inflammation , Insurance Claim Review , Intubation , Laryngeal Masks , Stethoscopes
6.
Article in English | WPRIM | ID: wpr-188607

ABSTRACT

PURPOSE: The purpose of this study was to evaluate the bond strength of composite resin on the fracture surface of metal-ceramic depending on the repair systems and surface roughening methods. MATERIALS AND METHODS: A total of 30 disk specimens were fabricated, 15 of each were made from feldspathic porcelain and nickel-chromium base metal alloy. Each substrate was divided into three groups according to the repair method: a) application of repair system I (Intraoral Repair Kit) with diamond bur roughening (Group DP and DM), b) application of repair system I with airborne-particle abrasion (Group SP and SM), and c) application of repair system II (CoJet Intraoral Repair System, Group CP and CM). All specimens were thermocycled, and the shear bond strength was measured. The data were analyzed using the Kruskal-Wallis analysis and the Mann-Whitney test with a significance level of 0.05. RESULTS: For the porcelain specimens, group SP showed the highest shear bond strength (25.85 +/- 3.51 MPa) and group DP and CP were not significantly different. In metal specimens, group CM showed superior values of bond strength (13.81 +/- 3.45 MPa) compared to groups DM or SM. CONCLUSION: Airborne-particle abrasion and application of repair system I can be recommended in the case of a fracture localized to the porcelain. If the fracture extends to metal surface, the repair system II is worthy of consideration.


Subject(s)
Alloys , Dental Instruments , Dental Porcelain
8.
Yonsei Medical Journal ; : 1128-1133, 2015.
Article in English | WPRIM | ID: wpr-150469

ABSTRACT

PURPOSE: The purpose of this study was to determine the effect-site concentration (Ce) of remifentanil in 50% of patients (EC50) and 95% of patients (EC95) for smooth laryngeal mask airway (LMA) removal in adults under propofol and remifentanil anesthesia. MATERIALS AND METHODS: Twenty-five patients of ASA physical status I-II and ages 18-60 years who were to undergo minor gynecological or orthopedic surgery were assessed in this study. Anesthesia was induced and maintained with propofol and remifentanil target-controlled infusion (TCI). Remifentanil was maintained at a predetermined Ce during the emergence period. The modified Dixon's up-and-down method was used to determine the remifentanil concentration, starting from 1.0 ng/mL (step size of 0.2 ng/mL). Successful removal of the LMA was regarded as absence of coughing/gagging, clenched teeth, gross purposeful movements, breath holding, laryngospasm, or desaturation to SpO2<90%. RESULTS: The mean+/-SD Ce of remifentanil for smooth LMA removal after propofol anesthesia was 0.83+/-0.16 ng/mL. Using isotonic regression with a bootstrapping approach, the estimated EC50 and EC95 of remifentanil Ce were 0.91 ng/mL [95% confidence interval (CI), 0.77-1.07 ng/mL] and 1.35 ng/mL (95% CI, 1.16-1.38 ng/mL), respectively. CONCLUSION: Our results showed that remifentanil TCI at an established Ce is a reliable technique for achieving safe and smooth emergence without coughing, laryngospasm, or other airway reflexes.


Subject(s)
Adolescent , Adult , Analgesics, Opioid/administration & dosage , Anesthetics, Inhalation/administration & dosage , Cough/prevention & control , Device Removal , Dose-Response Relationship, Drug , Female , Gynecologic Surgical Procedures , Humans , Laryngeal Masks , Male , Middle Aged , Orthopedic Procedures , Piperidines/administration & dosage , Propofol/administration & dosage , Treatment Outcome , Young Adult
10.
Article in Korean | WPRIM | ID: wpr-197844

ABSTRACT

Scedosporium apiospermum is an asexual state of Pseudallescheria boydii which has been isolated from soil, sewage, and decaying vegetation. It can cause cutaneous infections by traumatic implantation of the contaminant due to penetrating injury. This ubiquitous fungus cause not only mycetoma, but also infections of variety of body sites including the skin. The localized skin infection due to this organism is much rare than mycetoma. We report a case of cutaneous S. apiospermum infection occurred in 80-year-old male. The skin lesion was manifested by a 8.0 x 4.0 cm-sized erythematous plaque with pustules and crusts on the dorsum of right hand. The fungal culture from the biopsy specimen on Sabouraud's dextrose agar showed white to gray colored cottony colonies of S. apiospermum. The nucleotide sequence of internal transcribed spacer for clinical isolate was identical to that of S. apiospermum strain IHEM 23829. The patient was treated with oral fluconazole for 3 months.


Subject(s)
Agar , Aged, 80 and over , Base Sequence , Biopsy , Fluconazole , Fungi , Glucose , Hand , Humans , Male , Mycetoma , Pseudallescheria , Scedosporium , Sequence Analysis, DNA , Sewage , Skin , Soil
11.
Article in English | WPRIM | ID: wpr-42151

ABSTRACT

OBJECTIVES: Utilisation of high-frequency drills is known to increase noise induced hearing loss due to increasing the damages of inner ear cells. This study aimed to investigate whether preconditioning by using dexmedetomidine (DEX) decreased the occurrence of ischemia in inner cells of the ear. METHODS: We utilised a transgenic zebrafish line Brn3C, and the embryos were collected from breeding adult zebrafish. Five-day-old larvae were cultured at the density of 50 embryos, and the larvae were classified into 4 groups: control, cisplatin group, DEX group, and DEX+yohimbine; adrenoreceptor blocker group. The DEX group was categorised into 3 subgroups by dosage; 0.1, 1, and 10 microM. Preconditioning was performed for 150 minutes and then exposed to cisplatin for 6 hours. The experiment was performed in 7 replicates for each group and the number of hair cells in 3 parts of the neuromasts of each fish was determined. RESULTS: Hair cell apoptosis by cisplatin was attenuated more significantly in the DEX preconditioning group than in the control group. However, the preconditioning effects were not blocked by yohimbine. CONCLUSION: The results of this study suggest that hearing loss caused by vibration-induced noise could be reduced by using DEX and may occur through other mechanisms rather than adreno-receptors.


Subject(s)
Adult , Apoptosis , Breeding , Cisplatin , Dexmedetomidine , Ear , Ear, Inner , Embryonic Structures , Hair , Hearing Loss , Humans , Ischemia , Larva , Noise , Yohimbine , Zebrafish
12.
Article in Korean | WPRIM | ID: wpr-107237

ABSTRACT

No abstract available.


Subject(s)
Herpes Zoster , Male , Penis
13.
Article in English | WPRIM | ID: wpr-175789

ABSTRACT

BACKGROUND: Remifentanil sometimes elicits cough during induction of anesthesia, as with the use of other fentanyl congeners. We designed this study to investigate the incidence of remifentanil-induced cough (RIC) in children and to evaluate the effect of injection speed on RIC. METHODS: One hundred twenty ASA physical status I-II patients, aged 3-12 yr, undergoing general anesthesia were enrolled in the study. Patients were randomly assigned to one of the three groups. Patients in Group R30 received remifentanil 1.5 microg/kg at a constant rate over 30 s. Patients in Group R45 received remifentanil 1.5 microg/kg over 45 s, and patients in Group R60 received remifentanil 1.5 microg/kg over 60 s, respectively. Episodes of cough were recorded and graded as mild (1-2), moderate (3-4), or severe (5 or more). Mean arterial pressure (MAP), heart rate (HR), and SpO2 were recorded on arrival in the operating room (baseline) and 1 min after remifentanil infusion. RESULTS: The incidence of RIC was 33.3% in Group R30 (13 of 39 patients), 17.9% in Group R45 (7 of 39 patients), and 5.0% in Group R60 (2 of 40 patients). Patients in Group R60 had a significantly lower incidence of RIC than those in Group R30 (P = 0.001). The MAP, HR, and SpO2 values were not significantly different between groups. CONCLUSIONS: When intravenous remifentanil 1.5 microg/kg was administered in pediatric patients, the incidence of RIC decreased from 33 to 5% by increasing the injection time from 30 to 60 s. Remifentanil should be administered slowly over 60 s in children to suppress cough during anesthesia induction.


Subject(s)
Anesthesia , Anesthesia, General , Arterial Pressure , Child , Cough , Fentanyl , Heart Rate , Humans , Incidence , Operating Rooms
14.
Article in Korean | WPRIM | ID: wpr-150367

ABSTRACT

Tinea barbae is a dermatophyte infection of the bearded areas of the face and neck. The incidence of tinea barbae has decreased as improved sanitation. We report a case of tinea barbae in a 58-year-old-man, who presented with relatively well-defined erythematous pustular plaque on the upper lip. A fungal culture from tissue of the lesions was grown on Sabouraud dextrose agar and showed typical Trichophyton verrucosum. The nucleotide sequence of internal transcribed spacer for clinical isolate was identical to that of Trichophyton verrucosum strain ATCC 10695. The patient was treated with oral itraconazole for 3 months. The skin lesions improved 3 months after treatment, and recurrence has not been observed.


Subject(s)
Agar , Arthrodermataceae , Base Sequence , Glucose , Humans , Incidence , Itraconazole , Lip , Neck , Recurrence , Sanitation , Skin , Tinea , Trichophyton
15.
Article in English | WPRIM | ID: wpr-10183

ABSTRACT

BACKGROUND: As the life expectancy has risen globally because of the advance of medicine, onychomycosis in the elderly has been increasing with higher concerns over nails. Onychomycosis has been studied quite extensively, however, few reports on onychomycosis in a geriatric Korean population have been available. OBJECTIVE: The purpose of this study was to investigate the clinical features of onychomycosis in the elderly compared with other age groups and to identify the etiological agents during 10-year period. METHODS: A total of 629 patients over 65 years of age had been diagnosed with onychomycosis during a 10-year period (2001-2010). The etiological agents were identified by cultures on Sabouraud's dextrose agar with and without cycloheximide. Nondermatophytic molds and yeasts were considered as pathogens, if the identical fungal elements were observed at the initial direct microscopy and repeatedly in specimen-yielding cultures at a follow-up visit. RESULTS: The 629 elderly patients represented 22.1% of all onychomycosis patients. Toenails were involved in 567 (90.1%) patients; fingernails in 39 (6.2%); both toenails and fingernails in 23 (3.7%). The ratio of male to female was 1.01:1. Associated systemic diseases were found in 327 (52.0%) cases. Distal and lateral subungual onychomycosis (80.2%) was the most common clinical type of onychomycosis, followed by TDO (10.7%), SWO (6.2%) and PSO (2.9%). TDO was increasing significantly in the elderly. Organisms causing onychomycosis were dermatophytes (76.5%), yeasts (14.3%) and nondermatophytic molds (9.2%). The most common cause of onychomycosis in the elderly was Trichophyton rubrum. Nondermatophytic molds were more frequently responsible for onychomycosis in the elderly. CONCLUSION: Onychomycosis has been increased in the elderly and there are many differences from other age groups in aspects of clinical features, associated diseases and etiologic agents. Therefore, we suggest the need of a careful mycological examination in the elderly patients with onychomycosis.


Subject(s)
Agar , Aged , Arthrodermataceae , Cycloheximide , Female , Follow-Up Studies , Fungi , Glucose , Humans , Life Expectancy , Male , Microscopy , Nails , Onychomycosis , Trichophyton , Yeasts
16.
Article in Korean | WPRIM | ID: wpr-13956

ABSTRACT

Tinea barbae is a dermatophyte infection of the bearded areas of the face and neck. The incidence of tinea barbae has decreased as improved sanitation. We report a case of tinea barbae in a 49-year-old-man, who presented with relatively well-defined erythematous patch with pustules on the upper lip. A fungal culture from tissue of the lesions was grown on Sabouraud's dextrose agar and showed typical Trichophyton mentagrophytes. The nucleotide sequence of internal transcribed spacer for clinical isolate was identical to that of Arthroderma vanbreuseghemii IHEM 4411. The patient was treated with oral itraconazole for 3 months. The skin lesions improved 3 months after treatment, and recurrence has not been observed.


Subject(s)
Agar , Arthrodermataceae , Base Sequence , Glucose , Humans , Incidence , Itraconazole , Lip , Neck , Recurrence , Sanitation , Skin , Tinea , Trichophyton
17.
Article in English | WPRIM | ID: wpr-169064

ABSTRACT

PURPOSE: During the past decade, various endoscopic thyroid surgeries have been conducted, each with its own benefits. The incorporation of robotic systems to endoscopic thyroid surgery has improved the visualization and precision of endoscopic techniques. We previously reported our initial experience with robotic modified radical neck dissection (MRND) of papillary thyroid carcinoma (PTC) with lateral neck node metastasis (LNM). The aim of this study was to compare surgical outcomes of robotic vs. conventional open MRND of PTC with LNM using propensity score matching. METHODS: From January 2008 to February 2011, 515 patients with PTC with LNM were enrolled. One hundred patients underwent robotic MRND, and 415 patients underwent conventional open MRND. These two groups were retrospectively compared with respect to their clinicopathological characteristics, surgical outcomes, and surgical completeness. Furthermore, to avoid selection bias, propensity score matching analysis was used to compare surgical outcomes of each group without any compounding factors. RESULTS: The operative time for the robotic MRND was longer than for the open MRND (297.9±60.2 min vs. 212.1±55.6 min, P=0.089). However, the mean numbers of retrieved lymph nodes and mean hospital stay after surgery were similar in the two groups (36.0±12.9 vs. 40.8±13.3, P=0.235), (6.1±1.6 days vs. 6.1±2.1 days, P=0.577). The complication rates were similar between the two groups, and there was no statistical difference in postoperative thyroglobulin levels between groups (0.51±0.83 ng/ml vs. 0.89±2.46 ng/ml, P=0.593). CONCLUSION: According to our study, robotic MRND shows similar surgical outcomes to conventional open MRND after case-matched analyses. We suggest that robotic MRND is an acceptable alternative as an operative method for PTC with LNM, resulting in excellent cosmesis and patient satisfaction.


Subject(s)
Humans , Length of Stay , Lymph Nodes , Methods , Neck Dissection , Neck , Neoplasm Metastasis , Operative Time , Patient Satisfaction , Propensity Score , Retrospective Studies , Selection Bias , Thyroglobulin , Thyroid Gland , Thyroid Neoplasms
18.
Article in Korean | WPRIM | ID: wpr-121174

ABSTRACT

Fusarium(F.) species are hyalohyphomycetes isolated from plants, soil and air. Fusarium species can cause disseminated infections with involvement of multiple organs and numerous skin lesions in immunocompromised patients. And they can also cause local skin infections of trauma site. We report a case of localized skin infection by F. oxysporum in a 63-year-old immunocompetent woman. She presented with multiple, mild pruritic, 1.5 x 1.5 cm-sized, erythematous maculopapules on the left cheek after cosmetic procedure 4 months ago. Histopathologically, suppurative granulomatous inflammation, fungal elements were observed in dermis. Fungal culture on Sabouraud's dextrose agar showed rapid growing, whitish, cottony colonies at 25degrees C for 1 week. Numerous fusoid macroconidia were observed in slide culture by light microscopy. The nucleotide sequences of the internal transcribed spacer (ITS) region of clinical sample identical to that of F. oxysporum CID 220 strain (GenBank accession number HQ829117.1). The patient had been treated with itraconazole for 6 months. The skin lesion was improved. There was no recurrence 6 months after treatment.


Subject(s)
Agar , Base Sequence , Cheek , Dermis , Female , Fusarium , Glucose , Humans , Immunocompromised Host , Inflammation , Itraconazole , Microscopy , Middle Aged , Recurrence , Skin , Soil , Wounds and Injuries
19.
Article in English | WPRIM | ID: wpr-58730

ABSTRACT

PURPOSE: We performed a pilot study to determine the benefit of high-dose chemotherapy and autologous peripheral blood stem cell transplantation (HDCT/autoPBSCT) for patients with Ewing sarcoma family of tumors. METHODS: We retrospectively analyzed the data of patients who received HDCT/autoPBSCT at Korea Cancer Center Hospital. Patients with relapsed, metastatic, or centrally located tumors were eligible for the study. RESULTS: A total of 9 patients (3 male, 6 female), with a median age at HDCT/autoPBSCT of 13.4 years (range, 7.1 to 28.2 years), were included in this study. Patients underwent conventional chemotherapy and local control either by surgery or radiation therapy, and had achieved complete response (CR, n=7), partial response (n=1), or stable disease (n=1) prior to HDCT/autoPBSCT. There was no transplant-related mortality. However, the median duration of overall survival and event-free survival after HDCT/autoPBSCT were 13.3 months (range, 5.3 to 44.5 months) and 6.2 months (range, 2.1 to 44.5 months), respectively. At present, 4 patients are alive and 5 patients who experienced adverse events (2 metastasis, 2 local recur, and 1 progressive disease) survived for a median time of 2.8 months (range, 0.1 to 10.7 months). The 2-year survival after HDCT/autoPBSCT was 44.4%+/-16.6% and disease status at the time of HDCT/autoPBSCT tended to influence survival (57.1%+/-18.7% of cases with CR vs. 0% of cases with non-CR, P=0.07). CONCLUSION: Disease status at HDCT/autoPBSCT tended to influence survival. Further studies are necessary to define the role of HDCT/autoPBSCT and to identify subgroup of patients who might benefit from this investigational treatment.


Subject(s)
Adolescent , Child , Disease-Free Survival , Humans , Korea , Male , Neoplasm Metastasis , Peripheral Blood Stem Cell Transplantation , Pilot Projects , Retrospective Studies , Sarcoma, Ewing , Stem Cell Transplantation , Therapies, Investigational
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