Staged Repair of Truncus Arteriosus Associated with Complete Atrioventricular Septal Defect

We report a case of successful repair of truncus arteriosus (TA) associated with complete atrioventricular septal defect (c-AVSD) using a staged approach. TA associated with c-AVSD is a very rare congenital cardiac anomaly. No report of successful staged repair in South Korea has yet been published. We performed bilateral pulmonary artery banding when the patient was 33 days old, and total correction using an extracardiac conduit was performed at the age of 18 months. The patient recovered uneventfully and is doing well.

State of education regarding ultrasound-guided interventions during pain fellowships in Korea: a survey of recent fellows

BACKGROUND: Recently, the use of ultrasound (US) techniques in regional anesthesia and pain medicine has increased significantly. However, the current extent of training in the use of US-guided pain management procedures in Korea remains unknown. The purpose of the present study was to assess the current state of US training provided during Korean Pain Society (KPS) pain fellowship programs through the comparative analysis between training hospitals. METHODS: We conducted an anonymous survey of 51 pain physicians who had completed KPS fellowships in 2017. Items pertained to current US practices and education, as well as the types of techniques and amount of experience with US-guided pain management procedures. Responses were compared based on the tier of the training hospital. RESULTS: Among the 51 respondents, 14 received training at first- and second-tier hospitals (Group A), while 37 received training at third-tier hospitals (Group B). The mean total duration of pain training during the 1-year fellowship was 7.4 months in Group A and 8.4 months in Group B. Our analysis revealed that 36% and 40% of respondents in Groups A and B received dedicated US training, respectively. Most respondents underwent US training in patient-care settings under the supervision of attending physicians. Cervical root, stellate ganglion, piriformis, and lumbar plexus blocks were more commonly performed by Group B than by Group A (P < 0.05). CONCLUSIONS: Instruction regarding US-guided pain management interventions varied among fellowship training hospitals, highlighting the need for the development of educational standards that mandate a minimum number of US-guided nerve blocks or injections during fellowships in interventional pain management.

Clinical features and short-term outcomes of pediatric acute fulminant myocarditis in a single center / 소아과

PURPOSE: The aims of this study were to document our single-center experience with pediatric acute fulminant myocarditis (AFM) and to investigate its clinical features and short-term outcomes. METHODS: We performed a retrospective chart review of all children 24 hours after admission in 4 of the 13 patients (30.7%), and 3 of those 4 patients (75%) died. CONCLUSION: AFM outcomes may be associated with complete atrioventricular block upon hospital admission, left ventricular fractional shortening at admission, time from admission to the initiation of ECMO support, initial brain natriuretic peptide level, and peak blood urea nitrogen level.

Bilateral Repetitive Transcranial Magnetic Stimulation for Auditory Hallucinations in Patients with Schizophrenia: A Randomized Controlled, Cross-over Study

OBJECTIVE: A randomized double-blind cross-over trial was conducted in patients with persistent auditory hallucinations (AHs) to investigate whether bilateral repetitive transcranial magnetic stimulation (rTMS) at the temporoparietal area or Broca's area is more effective at high- or low-frequencies compared to a sham condition. METHODS: Twenty three patients with persistent AHs who remained stable on the same medication for 2 months were enrolled. They were randomized to one of four conditions: low-frequency (1 Hz)-rTMS to the temporoparietal area (L-TP), high-frequency (20 Hz)-rTMS to the temporoparietal area (H-TP), high-frequency (20 Hz)-rTMS to Broca's area (H-B), or sham. RESULTS: All the four rTMS conditions resulted in significant decrease in the scores under the auditory hallucination rating scale and hallucination change scale over time. However, there were no significant treatment effects or interaction between time and treatment, suggesting no superior effects of the new paradigms over the sham condition. CONCLUSION: Our findings suggest that bilateral rTMS at the temporoparietal area or Broca's area with high- or low-frequency does not produce superior effects in reducing AHs compared to sham stimulation.

Nutrient Intake Status of Korean Drinkers: Analysis of Data from Korea National Health and Nutrition Examination Survey (KNHANES), 2011

This study analyzed the dietary habits and nutrient intake status of adult drinkers in Korea. Alcohol drinking patterns were obtained from the Korea National Health and Nutrition Examination Survey (KNHANES). Among 4,968 persons, 91.5% were drinkers. Classification of their drinking patterns by the Alcohol Use Disorders Identification Test (AUDIT) score showed 64.5% of the drinkers were normal drinkers, 22.4% problem drinkers and 13.2% alcohol-dependent drinkers. Overall, 47% of the drinkers were considered alcohol-dependent in the Rapid Alcohol Problems Screen (RAPS4). Significant differences were found between those who abstained from alcohol (86.8%) and alcohol-dependent drinkers (68.9%); when asked about breakfast habits 73.4% of non-drinkers often had family meals, while only 55.4% of the alcohol-dependent drinkers had family meals. Dietary energy, alcohol energy, and total energy intake significantly increased for the alcohol-dependents (P<0.001). In addition, the intake of eight nutrients (protein, vitamin A, vitamin B1, vitamin B2, niacin, calcium, phosphorous and iron), significantly increased in the following order (least to highest): abstainers, normal drinkers, drinkers with a moderate addiction to alcohol and alcohol-dependent drinkers (P<0.05). Nutrient Adequacy Ratios (NAR) of all nutrients, except vitamin C, and the Mean nutrient Adequacy Ratio (MAR) significantly increased in the following order (least to highest): abstainers, normal drinkers, drinkers with a moderate addiction to alcohol and alcohol-dependent drinkers (P<0.05). The intake of vitamin B1, vitamin B2, and niacin per 1,000 kcal, according to drinking pattern, decreased in the order of abstainers, normal drinkers, drinkers with a moderate addiction to alcohol, and alcohol-dependent drinkers (P<0.001). The above results show that the nutrient intake of normal drinkers, drinkers with a moderate addiction to alcohol, and alcohol-dependent drinkers are higher than abstainers. However, overall intake of vitamin B1, vitamin B2, and niacin per 1,000 kcal was low. Therefore it is necessary to increase vitamin B1, vitamin B2, and niacin intake for drinkers.

Satisfaction in patients with chronic renal failure during the surgical creation of an arteriovenous fistula under monitored anesthesia care using remifentanil

BACKGROUND: Remifentanil is a rapid and short-acting drug that can be used for analgesia and sedation during monitored anesthesia care. This study was designed to evaluate the effect of remifentanil on pain and satisfaction of patients during creation of an arterio-venous fistula (AVF). METHODS: Forty chronic renal failure (CRF) patients, undergoing creation of an AVF, were assigned to receive remifentanil (0.05 microg/kg/min) (group R) or saline infusion (group S). Systolic blood pressure, diastolic blood pressure, heart rate, SpO2, Observer's Assessment Alertness/Sedation scale score, respiratory depression, dizziness, nausea and vomiting, pain intensity and frequency, satisfaction score, and operating time were measured. RESULTS: Pain frequency in group R was lower than group S (P < 0.01). The median (interquartile ranges) of pain frequency was 0 (0, 1) in group R and 1 (0.5, 4.0) in group S. In group R, 6 patients experienced respiratory depression, but responded readily to calling of the name in normal tone and recovered well. Satisfaction scores in group R were higher than that of group S (P < 0.05). The median (interquartile ranges) satisfaction score was 4.5 (4, 5) in group R and 4 (3.0, 4.5) in group S. There were no differences in others between the two groups. CONCLUSIONS: Remifentanil infusion at the rate of 0.05 microg/kg/min effectively reduces pain and increases satisfaction of CRF patients during the creation of an AVF.

Unidirectional valve malfunction by the breakage or malposition of disc: two cases report / 대한마취과학회지

Malfunction of the unidirectional valve in a breathing circuit system may cause hypercapnia from the rebreathing of expired gas, ventilation failure, and barotrauma. Capnography is a useful method for monitoring the integrity of the unidirectional valve. We experienced two cases of malfunction of a unidirectional valve which caused leakage and reverse flow, diagnosed early as a change of the capnographic waveform. One case was caused by expiratory unidirectional valve breakage. The other was caused by an incorrectly-assembled inspiratory unidirectional valve.

Subluxation of the Extensor Carpi Ulnaris Tendon Associated with the Extensor Digitorum Tendon Subluxation of the Long Finger

A twenty-year-old male visited our clinic with wrist and long finger metacarpophalangeal (MP) joint pain. Dynamic ultrasonography revealed sagittal band (SB) ulnar subluxation and extensor carpi ulnaris (ECU) volar subluxation. Magnetic resonance imaging showed longitudinal splitting and dislocation of the volar half slip of the ECU tendon. The redundant radial SB was augmented and ECU sheath was advanced to the periosteum using suture anchors. He was able to perform his previous activities at the last follow-up. We encountered a case of "simulateous" ECU dislocation with extensor tendon subluxation of the long finger at the MP joint. Therefore, we report this case with a review of the relevant literature.

Acute orbital myositis before Herpes zoster ophthalmicus / 대한마취과학회지

No abstract available.

Airway management using O2 flush via Cook airway exchange catheter(R) for microlaryngeal surgery / 대한마취과학회지

No abstract available.

Posterior Lumbar Interbody Fusion Outcomes in Degenerative Lumbar Disease: Comparison of Results between Patients Over 70 and 50-65 Years of Age

STUDY DESIGN: A retrospective study. OBJECTIVES: This study analyzed the clinical and radiographic results of the posterior lumbar interbody fusion performed on patients 50-65 and >7-years-of-age suffering from degenerative lumbar disease. LITERATURE REVIEW SUMMARY: Several studies on posterior lumbar interbody fusion performed on patients aged about 65 years reported insignificant age-related differences in the spinal-fusion results. MATERIALS AND METHODS: The records of 121 patients with degenerative lumbar disease treated with posterior lumbar interbody fusion between 2004 and 2010 were assessed. The patients' clinical results, visual analogue scale (VAS) scores, Oswestry disability index (ODI) values, and complications before and after the surgery were compared. The radiographic results and changes in the fusion segmental angle before and after the surgery as well as in the height of the posterior intervertebral disc were also compared. RESULTS: In group A, comprising 44 patients >70-years-of-age, follow-up duration and number of comorbidities were 73.3 years and 17.8 months, respectively. In group B, comprising 77 patients 50-65-years-of-age, follow-up duration and number of comorbidities were 58.8 years and 31.8 months, respectively. In both groups, the average VAS scores and ODI values decreased. The incidence rate of vertebra-related postoperative complications was 13.6% in group A and 9.0% in group B. The incidence rate of general complications unrelated to the vertebra, was 18.1% in group A and 9.0% in group B. CONCLUSIONS: Posterior lumbar interbody fusion is considered effective even in patients over 70 years with a degenerative lumbar disease.

Arthroscopic Assisted Treatment of Intraosseous Ganglion of the Scaphoid Associated with Occult Ganglion: A Case Report

Intraosseous ganglion of the scaphoid associated with occult ganglion is rare. A 27-year-old man who presented with a 4-month history of progressive left wrist pain visited our institution. The patient was diagnosed intrasosseous ganglion of the carpal scaphoid assosiated with occult ganglion. We obtained satisfactory result by arthroscopic procedure and report this case focusing on surgical technique with literature review.

Intraductal Papillary Mucinous Neoplasm of the Bile Ducts Accompanied by a Choledochoduodenal Fistula / 대한내과학회지

An intraductal papillary mucinous neoplasm of the bile ducts (IPMN-B) is an uncommon tumor characterized by the secretion of large amounts of mucin and intraductal growth. The characteristic clinical symptoms and radiologic findings are due to bile-duct obstruction caused by mucin. A parapapillary choledochoduodenal fistula is a rare disorder. This fistula has no clinical symptoms and is diagnosed by chance. We report a case of parapapillary choledochoduodenal fistula associated with IPMN-B. A 63-year-old woman was admitted to Hanyang University Hospital because of jaundice. Computed tomography (CT) showed diffuse intra- and extrahepatic bile duct dilatation. The ducts were filled with heterogenous material. Duodenoscopy revealed a large choledochoduodenal fistula. Endoscopic retrograde cholangiography through the fistula showed a papillary mass in the common hepatic duct. IPMN-B with choledochoduodenal fistula was diagnosed. The patient underwent a left hepatectomy. Her postoperative course was uneventful, and she was observed regularly in the outpatient department.

Intraductal Papillary Mucinous Neoplasm of the Bile Ducts Accompanied by a Choledochoduodenal Fistula / 대한내과학회지

An intraductal papillary mucinous neoplasm of the bile ducts (IPMN-B) is an uncommon tumor characterized by the secretion of large amounts of mucin and intraductal growth. The characteristic clinical symptoms and radiologic findings are due to bile-duct obstruction caused by mucin. A parapapillary choledochoduodenal fistula is a rare disorder. This fistula has no clinical symptoms and is diagnosed by chance. We report a case of parapapillary choledochoduodenal fistula associated with IPMN-B. A 63-year-old woman was admitted to Hanyang University Hospital because of jaundice. Computed tomography (CT) showed diffuse intra- and extrahepatic bile duct dilatation. The ducts were filled with heterogenous material. Duodenoscopy revealed a large choledochoduodenal fistula. Endoscopic retrograde cholangiography through the fistula showed a papillary mass in the common hepatic duct. IPMN-B with choledochoduodenal fistula was diagnosed. The patient underwent a left hepatectomy. Her postoperative course was uneventful, and she was observed regularly in the outpatient department.

Pancreatic Carcinosarcoma Presenting as Pancreatic Cystic Neoplasm / 대한내과학회지

A 66-year-old woman presented with severe abdominal pain. Abdominal computed tomography revealed a large multicystic mass with a solid component at the tail portion of the pancreas. Distal pancreatectomy was performed with a preoperative diagnosis of mucinous cystic neoplasm. The solid component of the lesion showed both adenomatous and sarcomatous characteristics on histological examination. Immunohistochemical studies showed epithelial cells positive for cytokeratin and an immunoreactive sarcomatous component positive for vimentin. We present here a case of carcinosarcoma of the pancreas with a review of the literature.

Transient cauda equina syndrome related to a sacral schwannoma with cauda equine compression after a lumbar epidural block: A case report / 대한마취과학회지

A 53-year-old man had chronic low back and leg pain for four years without any history of trauma or neurological manifestations. There was a reduction in symptoms after a lumbar epidural block. Two hours later after the procedure, the patient complained of perineal numbness and lower extremity weakness. The neurological evaluation revealed loss of sensation in the saddle area and the posterior aspect of the leg. The deep-tendon reflexes were decreased in the leg. The patient was unable to urinate. The MRI revealed a schwannoma at the S3 level of the sacral spine with cauda equina compression. The patient's symptoms improved slightly over the next few hours. The patient had a gradual return of motor function and could feel the Foley catheter. All of the symptoms completely resolved over the next nine hours and the patient was discharged to home once completely recovered. This case illustrates the importance of clinical examination and continued vigilance for evaluation of neurological deterioration after epidural injections.

Pulsed radiofrequency lesioning for treatment of chronic breast neuropathic pain after breast reduction: A case report / 대한마취과학회지

Breast surgery is a common procedure performed in women. Many women who undergo breast surgery suffer from ill-defined pain syndromes. A nerve block is used in the treatment of the acute and chronic pain, but the effectiveness of the treatment has been limited because of its short duration. Recently, the advent of pulsed radiofrequency lesioning (PRF) has proved a successful treatment for chronic refractory pain involving the peripheral nerves. We experienced a case of a 52-year-old female patient complaining of chronic breast neuropathic pain after breast reduction, which was relieved after PRF lesioning of the 4th thoracic spinal nerve and its root.

Air embolism during anesthesia in the beach chair position for shoulder surgery: A case report

A 60-year-old man was scheduled for elective right shoulder surgery. The patient was placed in the beach chair position. A venous air embolism was suspected because of a sudden decrease in the end-tidal carbon dioxide concentration, hypoxemia, tachycardia, and hypotension 5 mins after a stab incision in the surgical site. We inserted a central venous access catheter and provided hemodynamic support and cardiopulmonary resuscitation, but the patient died. We present this case to make surgeons and anesthesiologists aware of the possibility of air embolism during shoulder surgery in the beach chair position.

Arthroscopic Resection of the Chondroma in the Supraspinatus of the Shoulder / 대한정형외과학회잡지

Soft-tissue chondroma is rare a benign soft-tissue tumor that occurs mainly in hands and feet. There have been no reports of a chondroma in the supraspinatus tendon. We describe the clinical, histological and radiological features of the intratendinous chondroma of the supraspinatus occurring in a 30-year-old man who was managed arthroscopically and a review of the relevant literature review.

Effect of remifentanil on consumption of sevoflurane in entropy monitored general anesthesia / 대한마취과학회지

BACKGROUND: Monitoring of anesthetic depth is important for successful general anesthesia. It is well known that entropy or BIS monitoring assisted titration of anesthetic drugs decreases their consumption. This study evaluated the effect of remifentanil on consumption of sevoflurane during entropy monitored general anesthesia. METHODS: Patients were randomly assigned to two groups. The R group was administered 0.1 microgram/kg/min of remifentanil and inhaled sevoflurane, while the S group was administered only inhaled sevoflurane. Anesthesia was maintained using sevoflurane with nitrous oxide, and entropy was monitored. In both groups, the concentration of sevoflurane was adjusted to keep the state entropy (SE) value between 40 and 60. End-tidal sevoflurane concentration (ET), entropy value, systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were measured at 5 minute intervals, during a 25 minute period after intubation, skin suture and the end of surgery. RESULTS: ET was significantly lower in the R group than the S group. There were no significant differences in entropy value between R and S groups. CONCLUSIONS: Entropy monitored titration of sevoflurane with remifentanil administration decreased ET with stable hemodynamics.