Effect of hydroxyapatite on critical-sized defect / 대한악안면성형재건외과학회지

BACKGROUND: Xenologous or synthetic graft materials are commonly used as an alternative for autografts for guided bone regeneration. The purpose of this study was to evaluate effectiveness of carbonate apatite on the critical-size bone defect of rat's calvarium. METHODS: Thirty-six critical-size defects were created on 18 adult male Sprague-Dawley rat calvaria under general anesthesia. Calvarial bones were grinded with 8 mm in daimeter bilaterally and then filled with (1) no grafts (control, n = 10 defects), (2) bovine bone mineral (Bio-Oss®, Geistlich Pharma Ag. Swiss, n = 11 defects), and (3) hydroxyapatite (Bongros®, Bio@ Inc., Seongnam, Korea, n = 15 defects). At 4 and 8 weeks after surgery, the rats were sacrificed and all samples were processed for histological and histomorphometric analysis. RESULTS: At 4 weeks after surgery, group 3 (42.90 ± 9.33 %) showed a significant difference (p < 0.05) compared to the control (30.50 ± 6.05 %) and group 2 (28.53 ± 8.62 %). At 8 weeks after surgery, group 1 (50.21 ± 6.23 %), group 2 (54.12 ± 10.54 %), and group 3 (50.92 ± 6.05 %) showed no significant difference in the new bone formation. CONCLUSIONS: Bongros®-HA was thought to be the available material for regenerating the new bone formation.

Treatment of Traumatic Esophagopleural Fistula Using the Over-the-Scope-Clip System

Esophagopleural fistula (EPF) is a rare condition that is usually accompanied by severe infection and life-threatening morbidity. Here, we report the successful treatment of an EPF by closing an esophageal orifice using the over-the-scope-clip (OTSC) system without postprocedural complications. A 41-year-old man had serious thoracic and abdominal trauma due to a traffic accident. Computed tomography revealed findings suggestive of esophageal rupture due to Boerhaave syndrome. An emergent explorative operation was performed for primary repair with the insertion of a vacuum-assisted closure device. A postoperative upper gastrointestinal series revealed an EPF tract connecting the left pleural space and distal esophagus. We performed an endoscopic procedure using the "traumatic-type"OTSC to seal the EPF, and the esophageal orifice was completely healed 2 weeks postoperatively. The OTSC system might represent a safe and feasible modality for the treatment of EPF.

Cryptococcus neoformans Cellulitis with Cryptococcemia in a Patient on Maintenance Hemodialysis / 대한내과학회지

Cryptococcus neoformans is a fungus that causes opportunistic infections in immunocompromised hosts. Skin lesions are found in 10-20% of systemic cryptococcal infections, usually secondary to cryptococcemia, while primary cutaneous cryptococcosis with cryptococcemia is very rare. We report a case of rapidly spreading cryptococcal cellulitis in a 64-year-old male on maintenance hemodialysis taking steroids for encapsulated peritoneal sclerosis. Bluish bullous cellulitis developed on the left forearm and spread rapidly to the other forearm. We identified C. neoformans in the blood and skin lesions. We treated him successfully with liposomal amphotericin B and fluconazole for 15 months. We also review the literature.

A Case of Pancreatic Neuroendocrine Tumor Mimicked Intraductal Papillary Mucinous Neoplasm / 대한췌담도학회지

Neuroendocrine tumors of the pancreas are exremely rare tumors, but recent imaging examination advances, diagnostic frequency is also increasing. However, there is difficulty of diagnosis of pancreatic serotonin producing neuroendocrine tumors, because tumors grow slowly and clinical symptoms are not significant. A 60-year-old male patient with pancreatic duct dilatation progresses gradually during the seven years without obstructing lesion in imaging studies, we suspected the mass as intraductal papillary mucinous neoplasm. However, we diagnosed his case as neuroendocrine tumor after surgery and report here with literature review.

Recurrent Pneumothorax after Etanercept Therapy in a Rheumatoid Arthritis Patient: A Case Report / 전남의대학술지

The use of anti-tumor necrosis factor (anti-TNF) agents for rheumatoid arthritis (RA) patients who are refractory to disease-modifying anti-rheumatic drugs is gradually increasing. Etanercept is the first anti-TNF agent to be approved for RA treatment and is also the most widely used. However, aggravation of interstitial lung disease after etanercept treatment in RA patients has been reported recently. We report the first case of recurrent spontaneous pneumothorax with progression of interstitial lung disease after initiating etanercept therapy. The withdrawal of etanercept and a change to adalimumab, a different class of TNF inhibitor, achieved clinical stabilization.

Recurrent Pneumothorax after Etanercept Therapy in a Rheumatoid Arthritis Patient: A Case Report / 전남의대학술지

The use of anti-tumor necrosis factor (anti-TNF) agents for rheumatoid arthritis (RA) patients who are refractory to disease-modifying anti-rheumatic drugs is gradually increasing. Etanercept is the first anti-TNF agent to be approved for RA treatment and is also the most widely used. However, aggravation of interstitial lung disease after etanercept treatment in RA patients has been reported recently. We report the first case of recurrent spontaneous pneumothorax with progression of interstitial lung disease after initiating etanercept therapy. The withdrawal of etanercept and a change to adalimumab, a different class of TNF inhibitor, achieved clinical stabilization.

Amniotic fluid embolism that took place during an emergent Cesarean section: A case report / 대한마취과학회지

Amniotic fluid embolism (AFE) is a rare but fatal obstetric emergency, characterized by sudden cardiovascular collapse, dyspnea or respiratory arrest and altered mentality, disseminated intravascular coagulation (DIC). It can lead to severe maternal morbidity and mortality, but the prediction of its occurrence and treatment are very difficult. We experienced a case of AFE during emergent Cesarean section in a 40(+6) weeks healthy pregnant woman, age 33. Sudden dyspnea, hypotension, signs of pulmonary edema and DIC were developed during Cesarean section, and cardiac arrest followed after these events. The course of these events was so rapid and catastrophic, which was consistent with AFE. Thus, we report this case precisely and review pathophysiology, diagnosis, treatment of AFE by referring to up-to-date literatures.

Interscalene brachial plexus block: depth and angle from the skin insertion point to the brachial plexus and to C6-7 intervertebral foramen / 대한마취과학회지

BACKGROUND: The angle and depth from the insertion point to the brachial plexus (BP) and C6-7 intervertebral foramen (IF) was examined to prevent critical complications of an interscalene brachial plexus block (ISBPB), such as an epidural or subdural injection of local anesthetics and spinal cord injury. METHODS: Thirty patients (female = 12, male = 18), aged 20-64 years, undergoing shoulder or upper limb surgery were examined. ISBPB was performed at the interscalene groove intersecting the extended transverse line from the cricoid cartilage. A needle was then advanced towards the C6 transverse process (TP) and C6-7 IF under the C-arm fluoroscopic guidance. The depth and angle of the needle path intersecting the sagittal plane from the skin insertion point to BP, transverse process (TP) and IF were measured. RESULTS: The mean depth of the needle from the insertion point to BP, TP and IF were 2.6 +/- 0.3 cm, 3.2 +/- 0.4 cm, 3.7 +/- 0.3 cm in the female patients, and 2.7 +/- 0.3 cm, 3.6 +/- 0.5 cm, 4.1 +/- 0.3 cm in the male patients. The mean angle of the needle path at the same point was 56.0 +/- 7.2o (range, 42.0-65.0degrees), 54.2 +/- 5.8degrees, 53.7 +/- 4.4degrees in the female patients, and 59.3 +/-8.3degrees (45.0-75.0degrees), 54.0 +/- 6.3degrees, 54.9 +/- 4.2degrees in male patients. There were significant differences in the depth from the skin to the TP and IF between males and females. CONCLUSIONS: These findings are expected to provide a guideline for more accurate needle placement and successful block during ISBPB.

Interscalene brachial plexus block: depth and angle from the skin insertion point to the brachial plexus and to C6-7 intervertebral foramen / 대한마취과학회지

BACKGROUND: The angle and depth from the insertion point to the brachial plexus (BP) and C6-7 intervertebral foramen (IF) was examined to prevent critical complications of an interscalene brachial plexus block (ISBPB), such as an epidural or subdural injection of local anesthetics and spinal cord injury. METHODS: Thirty patients (female = 12, male = 18), aged 20-64 years, undergoing shoulder or upper limb surgery were examined. ISBPB was performed at the interscalene groove intersecting the extended transverse line from the cricoid cartilage. A needle was then advanced towards the C6 transverse process (TP) and C6-7 IF under the C-arm fluoroscopic guidance. The depth and angle of the needle path intersecting the sagittal plane from the skin insertion point to BP, transverse process (TP) and IF were measured. RESULTS: The mean depth of the needle from the insertion point to BP, TP and IF were 2.6 +/- 0.3 cm, 3.2 +/- 0.4 cm, 3.7 +/- 0.3 cm in the female patients, and 2.7 +/- 0.3 cm, 3.6 +/- 0.5 cm, 4.1 +/- 0.3 cm in the male patients. The mean angle of the needle path at the same point was 56.0 +/- 7.2o (range, 42.0-65.0degrees), 54.2 +/- 5.8degrees, 53.7 +/- 4.4degrees in the female patients, and 59.3 +/-8.3degrees (45.0-75.0degrees), 54.0 +/- 6.3degrees, 54.9 +/- 4.2degrees in male patients. There were significant differences in the depth from the skin to the TP and IF between males and females. CONCLUSIONS: These findings are expected to provide a guideline for more accurate needle placement and successful block during ISBPB.

Experimental Study for Influence of Film-Screen Combination on Image Quality

PURPOSE: In determining image quality of mammography,many factors are related. Selection of film and screen is one of them. Authors took phantom images of nine film-screen combinations under properly controlled conditions and compared them to evaluate their image qualities. In addition, KVp, mAs and surface dose were evaluated at each combination to deterrhine proper exposure conditions. MATERIALS AND METHODS: Using phantom,images of nine film-screen combinations composed of Fuji MI-NC, UM-MA, UM-MH films and Fuji Fine,Medium, Kodak Min-R screeens were taken. Phantom(Ackermann Mammochip Phantom) was composed of simulations for microcalcifications, fibers, nodules, lymph nodes, breast tissue and breast cancer masses. For phantom of 4.5 cm compressed breast equivalent, 28 KVp was used. For 1.5 and 3.0 cm equivalant phantoms, 24 KVp and 26 KVp was used. At each KVp, mammographic images were taken at various mAs. Among images taken by this process, best images were selected and then, according to scoring method, comparison of image quality for each combination was done. With dosimation strip, surface doses for various conditions were evaluated. RESULTS: Combination of Fuji UM-MA film and Fuji Fine screen showed best image quality regardless of KVp or phantom thickness. For the best image, 10 mAs with 26 KVp was most ideal while mAs with 24 KVp was optimal for equivalent phantom of 3.0 cm thickness breast. At this condition, surface dose was less than other combinations when combinations involving UM-MH films were used. On the other hand,when combinations involving MI-NC films were used, surface dose was higher than others. CONCLUSION: Using phantom, image quality of film-screen combinations could be evaluated and compared. Such process can contribute to best quality image with decreased exposure and can play a role in quality asurance program.

A Clinical Observasion of Pediatric Caudal Anesthesia / 대한마취과학회지

Pediatric caudal anesthesia was done in 50 infants and children under 15 years of age, who were to undergo surgery of the inguinal region, urethra, perineum and lower extremity. All cases were given 1mg/kg body weight of 1% lidocaine solution with adrenaline 1: 200,000. The results were as follows: 1) Pediatric caudal anesthesia was simple, easy and reliable in technique and the success rate was high (94%). 2) There was one case of convulsion following lidocaine injection and it was treated immediately with thiopental, diazepam and ventilation with 100% oxygen. 3) As additional measure to provide a more cooperative state was need ed i.e. intravenous administration of 5mg/kg body weight of thiopental. 4) Anesthetic effect was judged satisfactory in 47 cases (84%). There was 2 poor anesthesia results and 1 failure. All 3 cases needed inhalation anesthesia. One failure was accidental intravenous injection of lidocaine solution. 5) The onset time of analgesia ranged from 1 to 5 minutes(average 2.5min.) after injection of lidocaine solution into sacral canal. 6) Complete analgesia was established 8~25 minutes(average 15.6min.) after injection of lidocain solution. Highest dermatome level of analgesia was T11-T4. 7) The duraion of analgesia, which was measured from maiximum analgesia to regression of analgesia of 2 dermatomes, ranged from 70 to 130 minutes(average 98.5 min.). 8) The average operation time was 70 minutes, so that pediatric caudal anesthesia is desirable in an operation lasting about 1 hour. 9) Cardiovascular and respiratory changes were minimal. 10) Theis anesthetic method was especially helpful in postoperative management because of continuous anal esic effect. From the above results, it my be concluded that caudal anesthesia in pediatric surgery is useful for the patients, anesthetists, surgeons, nurses and parents.

Clinical Analysis of Anesthesia for Cheiloplasty and Palatoplasty in Children under 10 Years Old Age / 대한마취과학회지

We had experience of 464 cases of anesthesia for repair of cleft lip and cleft palate under 10 years of age. The analyzed results are as follows: 1) The 464 cases were divided into 5 age groups and 165 cases(35.6%) were in the under 2 years age group. Sex distribution was 291 males(66.2%) and 173 females(37.3%) 2) 377 cases(81.3%) were under 20kg of body weight. 3) There were 229 cleft lip cases (29.3%), 233 cleft palate cases, and 1 case each of (50.2%), of naso-ocular fistular correction and oro-ocular correction. 4) There were 386 cases elective surgery and 2 were emergency cases. 5) All cases had general anesthesia by means of endotracheal intubation 377 cases(81.3%) with a non-rebreathing system and 87 cases(18.8%) had a semi-closed absorption system. 6) The main anesthetic was halothane in 462 cases(99.6%) and Valium-Demerol and ether was 1 case each. 7) The mean blood loss in palatoplastry was 10ml/kg of body weight but it was 13.7ml/kg in the 5~10kg of body weight group, 11.6ml/kg in the 10kg~20kg of body weight group and 7.5ml/kg in the 20~30kg of body weight group. 8) Incidence of cleft lip combined with cleft palate was 211 cases(45.5%) among 464 cases and 149 cases(51.2%) were males and 62 cases(35.8%) were females. 9) The most common type of cleft lip was left incomplete lip(30.1%) and of cleft palate it was left complete palate(30.5%). 10) Familial history was found in 56 cases(12%).