Changes in Blood Pressure and Heart Rate during Decompressive Craniectomy

Objective@#: Rapid increase in intracranial pressure (ICP) can result in hypertension, bradycardia and apnea, referred to as the Cushing phenomenon. During decompressive craniectomy (DC), rapid ICP decreases can cause changes in mean atrial blood pressure (mABP) and heart rate (HR), which may be an indicator of intact autoregulation and vasomotor reflex. @*Methods@#: A total of 82 patients who underwent DC due to traumatic brain injury (42 cases), hypertensive intracerebral hematoma (19 cases), or major infarction (21 cases) were included in this prospective study. Simultaneous ICP, mABP, and HR changes were monitored in one minute intervals during, prior to and 5–10 minutes following the DC. @*Results@#: After DC, the ICP decreased from 38.1±16.3 mmHg to 9.5±14.2 mmHg (p<0.001) and the mABP decreased from 86.4±14.5 mmHg to 72.5±11.4 mmHg (p<0.001). Conversly, overall HR was no significantly changed in HR, which was 100.1±19.7 rate/min prior to DC and 99.7±18.2 rate/min (p=0.848) after DC. Notably when the HR increased after DC, it correlated with a favorable outcome (p<0.001), however mortality was increased (p=0.032) when the HR decreased or remained unchanged. @*Conclusion@#: In this study, ICP was decreased in all patients after DC. Changes in HR were an indicator of preserved autoregulation and vasomotor reflex. The clinical outcome was improved in patients with increased HR after DC.

Clinical and Hematological Effects of Tocilizumab on Serum Hepcidin, Anemia Response and Disease Activity in Patients with Active Rheumatoid Arthritis

OBJECTIVE: The purpose of this study is to evaluate the clinical and hematological effects of tocilizumab in active rheumatoid arthritis (RA) patients. METHODS: Fourteen patients with active RA were enrolled in this study. The patients received tocilizumab 8 mg/kg intravenously every four weeks for 6 months. Disease activity, anemia-related factors including serum hepcidin-25, and hematological parameters were monitored at baseline and at 1, 3, and 6 months after the initiation of treatment. RESULTS: Significant reductions in tender joint count, swollen joint count, visual analogue scale, erythrocyte sedimentation rate (ESR), and C-reactive (CRP) protein plus reductions in a 28-joint disease activity score were observed within one month after the first tocilizumab treatment. These effects lasted throughout the six-month study period. In addition, significant improvements in anemia-related factors such as hepcidin-25, ferritin, iron, hemoglobin, red blood cell counts and mean corpuscular volume were observed during the treatment period. Hematological parameters were improved with reductions in counts for leukocytes, monocytes, neutrophils, and platelets. The lymphocyte counts and their subset numbers were unchanged. Changes in hepcidin levels showed significant correlation with changes in CRP, ESR, ferritin, hemoglobin and counts for red blood cells, leukocytes, and neutrophils during the treatment period. CONCLUSION: This study demonstrates that tocilizumab significantly and meaningfully reduces disease burden in patients with active RA. In addition, tocilizumab diminishes the levels of inflammatory anemia by inhibiting hepcidin production. These clinical data provide evidence of a favorable outcome from tocilizumab in RA.

The Benefit for Preoperative Coagulation Screening Test in Children / 임상소아혈액종양

BACKGROUND: We evaluated the value of preoperative screening for coagulopathy in children who have undergone elective surgery. METHODS: We retrospectively evaluated laboratory and bleeding histories in 39,884 patients aged greater than 1 year and lesser than 19 years who had undergone elective surgery from January 2003 to March 2015. All of the patients had preoperative coagulation screening with complete blood count, prothrombin time (PT) and activated partial thromboplastin time (aPTT). If PT and/or aPTT were abnormal, further studies, such as mixing test, coagulation factor assay, anti-phospholipid antibody studies were done. RESULTS: The study included 39,884 patients greater than 1 year and lesser than 19 years. Of 924 patients with prolonged PT and/or aPTT values, 63 were subsequently diagnosed with a factor deficiency. CONCLUSION: Our result suggests that preoperative coagulation screening tests have benefit when there are no histories of bleeding tendencies because timely diagnosis allows for proper treatment, as some hereditary factor deficiencies may escape clinical detection in asymptomatic patients. Routine preoperative coagulation screening may serve as a useful adjunct to clinical history.

A Case Report of Solitary Fibrous Tumor in the Axilla of a 4-year-old Girl with Additional Marker Chromosome / 임상소아혈액종양

Solitary fibrous tumor (SFT) is uncommon and known to affect in middle-aged adults, with rare reports of occurrences in children. Although frequently involving the pleura, recent reports show that SFT may also involve extrapleural sites. SFT is known as a benign tumor, but in some cases SFT recurs, invades locally, or shows malignant transformation. We experienced a case of SFT that developed in the axilla of a 4-year-old girl with multiple congenital anomalies with constitutional chromosomal abnormality of 46,XX[44]/47,XX,+mar[11]. Her tumor could not be surgically resected due to the patient's multiple anomalies including congenital heart disease, chronic lung problem and seizure disorder. She died of congestive heart failure with respiratory failure due to tumor growth. This report is meaningful not only because SFT affected a pediatric patient with a constitutional chromosomal abnormality, but also because the tumor originated from the axillary area, a site of origin rarely reported for SFTs.

The Benefit for Preoperative Coagulation Screening Test in Children / 임상소아혈액종양

BACKGROUND: We evaluated the value of preoperative screening for coagulopathy in children who have undergone elective surgery.METHODS: We retrospectively evaluated laboratory and bleeding histories in 39,884 patients aged greater than 1 year and lesser than 19 years who had undergone elective surgery from January 2003 to March 2015. All of the patients had preoperative coagulation screening with complete blood count, prothrombin time (PT) and activated partial thromboplastin time (aPTT). If PT and/or aPTT were abnormal, further studies, such as mixing test, coagulation factor assay, anti-phospholipid antibody studies were done.RESULTS: The study included 39,884 patients greater than 1 year and lesser than 19 years. Of 924 patients with prolonged PT and/or aPTT values, 63 were subsequently diagnosed with a factor deficiency.CONCLUSION: Our result suggests that preoperative coagulation screening tests have benefit when there are no histories of bleeding tendencies because timely diagnosis allows for proper treatment, as some hereditary factor deficiencies may escape clinical detection in asymptomatic patients. Routine preoperative coagulation screening may serve as a useful adjunct to clinical history.

A Case Report of Solitary Fibrous Tumor in the Axilla of a 4-year-old Girl with Additional Marker Chromosome / 임상소아혈액종양

Solitary fibrous tumor (SFT) is uncommon and known to affect in middle-aged adults, with rare reports of occurrences in children. Although frequently involving the pleura, recent reports show that SFT may also involve extrapleural sites. SFT is known as a benign tumor, but in some cases SFT recurs, invades locally, or shows malignant transformation. We experienced a case of SFT that developed in the axilla of a 4-year-old girl with multiple congenital anomalies with constitutional chromosomal abnormality of 46,XX[44]/47,XX,+mar[11]. Her tumor could not be surgically resected due to the patient's multiple anomalies including congenital heart disease, chronic lung problem and seizure disorder. She died of congestive heart failure with respiratory failure due to tumor growth. This report is meaningful not only because SFT affected a pediatric patient with a constitutional chromosomal abnormality, but also because the tumor originated from the axillary area, a site of origin rarely reported for SFTs.

Study on Clinical Effectiveness of the Korean Version of Assessment of SpondyloArthritis International Society-Health Index

OBJECTIVE: To evaluate the validity of the Korean version of ASAS-HI in patients with spondyloarthritis in Korea. METHODS: A total of 91 patients were enrolled. We evaluated the validity by calculating the correlation coefficients between the Korean version of ASAS-HI and other clinical parameters, including patient global assessment (PGA), spinal back pain score, Bath ankylosing spondylitis disease activity index (BASDAI), Bath ankylosing spondylitis functional index (BASFI), ankylosing spondylitis disease activity score (AS-DAS), work productivity and activity impairment (WPAI) number 5 and number 6, hospital Anxiety and Depression Scale (HADS), health Survey Short-Form 36 (SF-36), and EuroQol visual analogue scale (EQ-5D VAS). Using a Pearson correlation coefficient, the validity was assessed by making a comparison between the correlation of the ASAS HI and clinical parameters in all patients. RESULTS: The Korean version of ASAS-HI score was correlated with PGA, spinal back pain score, BASDAI, BASFI, AS-DAS, WPAI number 5, WPAI number 6, HADS, and EQ-5D (r=0.331, 0.403, 0.638, 0.500, 0.595, 0.480, 0.573, 0.626, -0.497, p=0.002, <0.001, <0.001, <0.001, <0.001, <0.001, <0.001, and <0.001, respectively). CONCLUSION: In this study, the clinical effectiveness of the Korean version of ASAS-HI was proved by calculating the correlation with other clinical parameters. The Korean version of ASAS-HI can be used in clinical practice and research to assess the healthy state of spondyloarthritis patients in Korea.

The Reliability and Validity of a Korean Translation of the ASAS Health Index and Environmental Factors in Korean Patients with Axial Spondyloarthritis

The objective of this study was to develop a Korean version of the Assessment of Spondyloarthritis International Society-Health Index/Environmental Factor (ASAS HI/EF) and to evaluate its reliability and validity in Korean patients with axial spondyloarthritis (SpA). A total of 43 patients participated. Translation and cross-cultural adaptation of the ASAS HI/EF was performed according to international standardized guidelines. We also evaluated validity by calculating correlation coefficients between the ASAS-HI/EF score and the clinical parameters. Test-retest reliability was excellent. The correlations among the mean ASAS-HI score and all tools of assessment for SpA were significant. When it came to construct validity, the ASAS HI score was correlated with nocturnal back pain, spinal pain, patients's global assessment score, the Bath ankylosing spondylitis disease activity index (BASDAI), Bath ankylosing spondylitis functional index (BASFI), Bath ankylosing spondylitis metrology index (BASMI) and EuroQoL visual analogue scale (EQ VAS) (r = 0.353, 0.585, 0.598, 0.637, 0.690, 0.430, and -0.534). The ASAS EF score was also correlated with the patient's global assessment's score, BASDAI, BASFI, BASMI, and EQ VAS score (r = 0.375, 0.490, 0.684, 0.485, and -0.554). The Korean version of the ASAS HI/EF can be used in the clinical field to assess and evaluate the state of health of Korean axial SpA patients.

Usefulness of intraoperative real-time three-dimensional transesophageal echocardiography for pre-procedural evaluation of mitral valve cleft: a case report / 대한마취과학회지

A precise pre-procedural evaluation of mitral valve (MV) pathology is essential for planning the surgical strategy for severe mitral regurgitation (MR) and preparing for the intraoperative procedure. In the present case, a 38-year-old woman was scheduled to undergo MV replacement due to severe MR. She had a history of undergoing percutaneous balloon valvuloplasty due to rheumatic mitral stenosis during a previous pregnancy. A preoperative transthoracic echocardiography suggested a tear in the mid tip of the anterior mitral leaflet. However, the "en face" view of the MV in the left atrial perspective using intraoperative real time three-dimensional transesophageal echocardiography (RT 3D-TEE) provided a different diagnosis: a torn cleft in the P2-scallop of the posterior mitral leaflet (PML) with rupture of the chordae. Thus, surgical planning was changed intraoperatively to MV repair (MVRep) consisting of patch closure of the PML, commissurotomy, and lifting annuloplasty. The present case shows that intraoperative RT 3D-TEE provides more precise and reliable spatial information of MV for MVRep and facilitates critical surgical decision-making.

Rotational thromboelastometry for diagnosing sudden hyperfibrinolysis immediately after cardiopulmonary bypass during cardiac surgery / 대한마취과학회지

No abstract available.

Rotational thromboelastometry for diagnosing sudden hyperfibrinolysis immediately after cardiopulmonary bypass during cardiac surgery / 대한마취과학회지

No abstract available.

Postoperative Urinary Retention Following Anterior Cervical Spine Surgery for Degenerative Cervical Disc Diseases

BACKGROUND: Postoperative urinary retention (POUR) may cause bladder dysfunction, urinary tract infection, and catheter-related complications. It is important to be aware and to be able to identify patients at risk of developing POUR. However, there has been no study that has investigated the incidence and risk factors for the development of POUR following anterior cervical spine surgery for degenerative cervical disc disease. METHODS: We included 325 patients (164 male and 161 female), who underwent anterior cervical spine surgery for cervical radiculopathy or myelopathy due to primary cervical disc herniation and/or spondylosis, in the study. We did not perform en bloc catheterization in our patients before the operation. RESULTS: There were 36 patients (27 male and 9 female) that developed POUR with an overall incidence of 11.1%. The mean numbers of postoperative in-and-out catheterizations was 1.6 times and mean urine output was 717.7 mL. Thirteen out of 36 POUR patients (36%) underwent indwelling catheterization for a mean 4.3 days after catheterization for in-and-out surgery, because of persisting POUR. Seven out of 36 POUR patients (19%) were treated for voiding difficulty, urinary tract irritation, or infection. Chi-square test showed that patients who were male, had diabetes mellitus, benign prostate hypertrophy or myelopathy, or used Demerol were at higher risk of developing POUR. The mean age of POUR patients was higher than non-POUR patients (68.5 years vs. 50.8 years, p < 0.01). CONCLUSIONS: To avoid POUR and related complications as a result of anterior cervical spine surgery for degenerative cervical disc disease, we recommend that a catheter be placed selectively before the operation in at-risk patients, the elderly in particular, male gender, diabetes mellitus, benign prostate hypertrophy, and myelopathy. We recommend that Demerol not be used for postoperative pain control.

Cardiopulmonary bypass weaning difficulty due to anomalous origin of coronary artery: A case report / 대한마취과학회지

We report a case of hemodynamic instability after aortic valve replacement, due to the anomalous origin of the right coronary artery. During the cardiopulmonary bypass weaning process, hemodynamic instability occurred. The cause was not identified at first, and compression of the anomalous right coronary artery was thought to be the culprit, thereafter.

Urgent craniectomy for subdural hematoma in the 8-month-old infant with unrecognized hemophilia B / 대한마취과학회지

No abstract available.

Development and Feasibility of a Web-based Program 'Diet Evaluation System (DES)' in Urban and Community Nutrition Survey in Korea

BACKGROUND: Repeated 24 hour recall has been considered as a preferred method for obtaining accurate dietary information while time and cost for coding and data processing have been a major barrier for their use in large studies. This burden can be resolved by automating the interview and data processing. However, there has been no report about a computerized interview system for dietary survey in a free-living population in Korea. METHODS: This study attempts to test the feasibility of a newly-developed web-based dietary assessment program, Diet Evaluation System (DES) for subjects in a mixed region of urban and rural areas via wireless internet. We conducted total of 134 interviews, twice for each of 67 subjects of various age. As another aspect of feasibility, the group discussion among interviewers was done. RESULTS: Success rate of total attempted interviews was about 70%. Major reasons for problem with DES were instability of wireless internet and consequent inefficient booting of laptops in some areas. It took 14 minute 56 seconds on average to complete an interview and data processing conducted automatically. Subjects' age and internet environment influenced the DES interview time. The group discussion revealed that one-stop system with DES is fast and convenient assuming good wireless internet environment. CONCLUSIONS: Web-based dietary assessment was feasible in this community nutrition survey. To confirm the feasibility in large scale, studies with more comprehensive area and subjects are needed with various wireless condition.

How should we monitor pediatric patients with Duchenne muscular dystrophy?: A case report / 대한마취과학회지

Duchenne muscular dystrophy is a hereditary disorder characterized by progressive muscle weakness and contracture, and special care during anesthesia is needed in these patients. Because inhalational anesthetics and succinylcholine can cause fatal results, intravenous anesthetics are commonly used. However, monitorings for the pediatric population are not otherwise specified. We report our experience of a 6 year-old boy that underwent muscle biopsy suspicious of muscle dystrophy under general anesthesia. The patient received midazolam, fentanyl, propofol and a small dose of rocuronium. He was monitored with bispectral index (BIS), acceleromyography (TOF). At the end of surgery, recovery of TOF ratio to 90% was evaluated, followed by injection of pyridostigmine and glycopyrrolate. When reversal of neuromuscular block was confirmed quantitatively and clinically, the patient was extubated and he experienced no complication.

The optimal concentrations of propofol at eye opening and orientation after propofol-remifentanil TCI in Koreans

BACKGROUND: The recovery time in propofol target controlled infusion (TCI) can be determined by the context sensitive decrement time (CSDT) using a Multichannel TCI system. Therefore, it is important to obtain the default CSDT in a Multichannel TCI system. The effect-site concentrations for eye opening and orientation in adults after propofol-remifentanil TCI were evaluated according to the CSDT using a Multichannel TCI system. METHODS: After obtaining informed consent and Institutional Review Board approval, 135 ASA Class I or II patients scheduled to undergo elective surgery were divided into 3 groups according to age. The three groups included the following: group 1 (n = 45), 18-19 years; group 2 (n = 45), 30-39 years; and group 3 (n = 45), 40-54 years. The propofol infusion was started at a propofol target effect-site concentration (CeT) of 6microg/ml. Anesthesia was maintained primarily with a propofol CeT of 2.5microg/ml, a remifentanil CeT of 6ng/ml and with 67% nitrous oxide in oxygen. The average effect-site concentrations of propofol at eye opening and orientation in each group were estimated. RESULTS: The average range of the effect-site concentrations of propofol at eye opening and orientation after surgery were 0.9-1.1microg/ml. The range of times to eye opening and orientation after stopping the nitrous oxide and infusion after surgery were 10.9-12.9 min. CONCLUSIONS: The average range of the effect-site concentrations of propofol at eye opening and orientation after propofol-remifentanil TCI in Koreans are 0.9-1.1microg/ml.

The optimal concentrations of propofol at eye opening and orientation after propofol-remifentanil TCI in Koreans

BACKGROUND: The recovery time in propofol target controlled infusion (TCI) can be determined by the context sensitive decrement time (CSDT) using a Multichannel TCI system. Therefore, it is important to obtain the default CSDT in a Multichannel TCI system. The effect-site concentrations for eye opening and orientation in adults after propofol-remifentanil TCI were evaluated according to the CSDT using a Multichannel TCI system. METHODS: After obtaining informed consent and Institutional Review Board approval, 135 ASA Class I or II patients scheduled to undergo elective surgery were divided into 3 groups according to age. The three groups included the following: group 1 (n = 45), 18-19 years; group 2 (n = 45), 30-39 years; and group 3 (n = 45), 40-54 years. The propofol infusion was started at a propofol target effect-site concentration (CeT) of 6microg/ml. Anesthesia was maintained primarily with a propofol CeT of 2.5microg/ml, a remifentanil CeT of 6ng/ml and with 67% nitrous oxide in oxygen. The average effect-site concentrations of propofol at eye opening and orientation in each group were estimated. RESULTS: The average range of the effect-site concentrations of propofol at eye opening and orientation after surgery were 0.9-1.1microg/ml. The range of times to eye opening and orientation after stopping the nitrous oxide and infusion after surgery were 10.9-12.9 min. CONCLUSIONS: The average range of the effect-site concentrations of propofol at eye opening and orientation after propofol-remifentanil TCI in Koreans are 0.9-1.1microg/ml.

Dietary Characteristics of Macronutrient Intake and the Status of Metabolic Syndrome among Koreans

Metabolic syndrome (MetS), which is heavily dependent on dietary and lifestyle practices, is prevalent in Korean adults. Because dietary practices are unique for each race, nationality, and culture, it is important to identify Korean adult dietary practices that are associated with MetS. Macronutrient intake patterns were analyzed and compared across health status using the 2007-2008 Korean National Health and Nutrition Examination Survey data (8,143 adults who had dietary data and biomarkers related to MetS). Although intake levels were different by age, gender, and health status, carbohydrate intake was high and fat intake was low among Korean adults. The carbohydrate energy ratio was higher and the fat energy ratio was lower for subjects > 60 years old who were diagnosed with diabetes, hypertension, or MetS than those in other age groups. The main source of fat from food differed depending on the group. These results demonstrated that macronutrient intake patterns were different between age, gender, and health status subgroups. Hence, it is recommended that nutritional policy and practices aimed at controlling MetS should be based on the dietary characteristics of the target group.

Clinical Characteristics and Risk Factors of Acute Kidney Injury in Patients with Acute Alcohol Intoxication / 대한신장학회지

PURPOSE: Acute alcohol intoxication (AAI) causes various complications such as electrolyte imbalance, alcoholic ketoacidosis (AKA), rhabdomyolysis, and acute kidney injury (AKI). Although there have been some reports about AKA and rhabdomyolysis, AKI due to acute alcohol intoxication is rarely reported. METHODS: We retrospectively evaluated the medical records of 371 patients with AAI between January 2004 and May 2010 in Uijeongbu St. Mary's Hospital. We compared the clinical findings, morbidity and mortality rate between AKI and normal kidney function (NKF) groups. RESULTS: Of the total 371 patients with AAI, AKI occurred in 107 patients (28.8%). The peak serum creatinine level in AKI patients was 2.9+/-1.9 mg/dL. Thirteen of the 107 patients (12.1%) received renal replacement therapy. AKI group had higher incidence of decreased mentality (29.0% vs 16.3%, p=0.006), dyspnea (11.2% vs 4.9%, p=0.029) and hypotension (66.0% vs 41.7%, p<0.001), and lower incidence of gastrointestinal bleeding (22.4% vs 34.8%, p=0.019), compared to NKF group. The AKI group also had higher incidence of ketoacidosis (78.5% vs 28.8%, p<0.001), rhabdomyolysis (19.6% vs 4.2%, p<0.001), and pneumonia (22.4% vs 8.0%, p<0.001), compared to NKF group. The length of ICU stay was longer (7.4+/-10.8 vs 4.1+/-6.1 days, p=0.003) and the mortality rate was higher (17.8% vs 2.3%, p<0.001) in AKI group. CONCLUSION: This study demonstrated that incidence of AKI in patients with AAI was 28.8% and AKI was associated with high morbidity and mortality. And multivariate analysis demonstrated that independent risk factors of AKI were ketoacidosis and increased serum osmolality.