A Case of Splenic Botryomycosis Caused by Streptococcus mitis in a Patient with a Previous Distal Gastrectomy / 대한내과학회지

Botryomycosis is an uncommon chronic suppurative bacterial infection of the skin and visceral organs seen primarily in immunocompromised patients. Here, we report a case of splenic botryomycosis caused by Streptococcus mitis in a 53-year-old immunocompetent woman with a history of distal gastrectomy for advanced gastric cancer.

Prognostic Implications of Primary Tumor Resection in Stage IVB Colorectal Cancer in Elderly Patients

PURPOSE: The aim of this study was to identify prognostic factors in stage IVB colorectal cancer in elderly patients, focusing on the influence of treatment modalities, including palliative chemotherapy and primary tumor resection. METHODS: A cohort of 64 patients aged over 65 years who presented with stage IVB colorectal cancer at the Gangneung Asan Hospital between July 1, 2001, and December 31, 2009, was analyzed. Demographics, tumor location, tumor grade, performance status, levels of carcinoembryonic antigen (CEA), level of aspartate aminotransferase (AST), and distant metastatic site at diagnosis were analyzed. Using the treatment histories, we analyzed the prognostic implications of palliative chemotherapy and surgical resection of the primary tumor retrospectively. RESULTS: The cohort consisted of 30 male (46.9%) and 34 female patients (53.1%); the median age was 76.5 years. Primary tumor resection was done on 28 patients (43.8%); 36 patients (56.2%) were categorized in the nonresection group. The median survival times were 12.43 months in the resection group and 3.58 months in the nonresection group (P < 0.001). Gender, level of CEA, level of AST, Eastern Cooperative Oncology Group performance status, tumor location, and presence of liver metastasis also showed significant differences in overall survival. On multivariate analysis, male gender, higher level of CEA, higher AST level, and no primary tumor resection were independent poor prognostic factors. In particular, nonresection of the primary tumor was the most potent/poor prognostic factor in the elderly-patient study group (P = 0.001; 95% confidence interval, 2.33 to 21.99; hazard ratio, 7.16). CONCLUSION: In stage IVB colorectal cancer in elderly patients, resection of the primary tumor may enhance survival.

Two Cases of Electrocautery Incision Therapy Using an Insulated-tip Knife for Treatment of Symptomatic Benign Short-segment Colonic Stenosis Following Colonic Resection / 대한소화기학회지

Anastomotic stenosis of the colon is not an uncommon finding; however, its frequency varies from one study to another. Traditionally, postoperative colonic stenosis is managed surgically. However, endoscopic therapy has recently become the preferred treatment modality over traditional surgery. Good short-term success has been achieved with use of endoscopic balloon dilation; however, restenosis may occur over time in 14% to 25% of patients. The current report showed the effectiveness and usefulness of an insulated-tip knife (IT-knife) for electrocautery therapy of a patient with symptomatic anastomotic colonic stenosis.

The Train-of-Four Ratio Profile During Onset and Offset Following Administration of Neuromuscular Blocking Agents / 대한마취과학회지

BACKGROUND: The train of four (TOF) stimulation is valuable to study pharmacodynamics associated with the interaction between muscle relaxants and receptors in the neuromuscular junction. TOF fade expresses presynaptic effect diminished output of transmitters. The aim of this study was to examine differences in presynaptic effects of different relaxants by measuring the TOF ratio during the onset and offset of block. METHODS: Eighty four healthy adult patients of ASA grades I or II were included in the study. The muscle relaxants studied were vecuronium (0.08 mg/kg), atracurium (0.5 mg/kg), mivacurium (0.15 mg/kg), rocuronium (0.6 mg/kg) and succinylcholine (1.0 mg/kg, 0.1 mg/kg, 0.2 mg/kg, 0.4 mg/kg). The TOF ratios were measured at approximate height of first response in the TOF (T1) of 75, 50 and 25% during onset and offset. Especially its ratios were measured at first depress of T1 during onset and its corresponding T1 during offset following administration of subclinical doses of succinylcholine. RESULTS: In the non-depolarizing muscle relaxants, TOF fade is more evident during offset than onset (p<0.05). The extent of fade varies between muscle relaxants. The greatest TOF fade has been shown in rocuronium during onset. In the succinylcholine, the TOF fade is apparent during onset and related to doses given (p<0.05). However the significant TOF fade is not seen during offset. CONCLUSIONS: All muscle relaxants, including both depolarizing and nondepolarizing agent, have predominantly postsynaptic and presynaptic effects. Furthermore, the fact that moderate TOF fade after subclinical doses of succinylcholine occurred obviously during onset of block is possibly indicating a greater presynaptic receptor blocking action.

CT Classification and Surgical Treatment of Intra-Articular Fractures of the Calcaneus / 대한정형외과학회잡지

Computed tomography was used in the evaluation of intra-articular fractures of the calcaneus to develop and reasonable treatment program and predict prognosis. Twenty-four fractures of the calcaneus in the twenty-two patients were shown to involve the posterior facet and classified by the images of coronal CT scan; Type 1(non-displaced), Type 2(displaced) and Type 3(comminuted). There were one Type 1, fourteen Type 2, and nine type 3 fractures, all of which were treated with open reduction, internal fixation, with or without bone graft. The length of follow-up ranged from eighteen to thirty-six months(mean, 23 months). the results were fraded by a predetermined point system. The one Type 1 had an excellent result. Of the fourteen Type 2 fractures, four had and excellent result; seven good result; two fair; and one poor. Of the nine Type 3 fractures, two had good; three fair; and four poor result. On the basis of our study, we believed that open reduction and internal fixation was a good method of treatment for the displacce or mildly comminuted intra-articular fractures of the cal-caneus.

Effects of Midazolam on CNS and Antagonistic Effect of Flumazenil / 대한마취과학회지

The effects of midazolam and diazepam which were used as an induction agent of general anesthesia were evaluated. And flumazenil which is a potent competitive inhibitor of the specific binding of benzodiazepines at the receptor level was evaluated too. Sixty patients were divided into three groups as follows: Group I (n=20); Midazolam (average 0.24 mgkg-1) was administered as an induction agent and flumazenil (average 0.24 mgkg-1) was administered in recovery room Group II (n=20); Diazepam (average 0.35 mgkg-1) was administered as an induction agent and flumaxenil (average 0.25 mgkg-1) was administered in recovery room Group III (n=20); Midazolam (average 0.24 mgkg-1) was administered as an induction agent and normal saline was administered in recovery room instead of flumaxenil The result were as follows: 1) Systolic and diastolic blood pressure and heart rate were not changed significantly, except diastolic blood pressure decreased significantly (p<0.05) in group II, after intravenous administration of midazolam and diazepam. But these were all increased significantly (p<0.001) after endotracheal intubation in all groups. 2) Systolic and diastolic blood preasure and heart rate were not changed significantly after intravenous administration of flumazenil in group I, II and there were no significant differences between each groups. 3) Tidal volume was increased significantly (p<0.05) in group 1 from 15 min after administration of flumazenil. There were no significant changes in all groups in respiratory rate. SaO2 was increased significantly (p<0.05, p<0.001) in group I, II from 5 min after administration of flumazenil. But it was increased significantly (p<0.05) in group III from 20 min after administration of normal saline too. EtCO2 was decreased insignificantly in all groups. 4) Recovery from anesthesia according to Modified Steward Coma Scale was much improved immediately after administration of flumazenil and was significant (p<0.001) statistically in group I, II from 5 min after administration of flumazenil and reached complete recovery from 20 min after administration of flumaxenil. It was increased gradually and become significant in group III from 10 min after administration of normal saline. These changes of group I, II were significant (p<0.05) compared with group III and reached complete recovery from 60 min after administration of flumazenil.