Adequate Dose of Remifentanil for Endotracheal Intubation with Propofol without Muscle Relaxants / 대한마취과학회지

ation of remifentanil and the possibility of endotracheal intubation was as following: Probit (P) = - 1.38 (S.E.: 0.58) + 0.087 (S.E.: 0.23) x DRemi. The ED50 of remifentanil for endotracheal intubation without muscle relaxants was 2.12 (95% confidence interval: 1.42-2.62)microgram/kg and the ED95 was 4.01 (95% confidence interval: 3.31-5.92)microgram/kg. CONCLUSIONS: We concluded that adequate dose of remifentanil which make possible to endotracheal intubation without muscle relaxants after induction of general anesthesia with 1.5 mg/kg of propofol is 4.01microgram/kg in 95% of female patients and 2.12microgram/kg in 50% of female patients.

Effect of Low Dose Norepinephrine Infusion on Myocardial Oxygen Consumption and Lactate Metabolism / 대한마취과학회지

BACKGROUND: Norepinephrine infusion has been reported to be associated with adverse events in ischemic heart disease due to elevation of afterload and cardiac oxygen consumption. During coronary artery bypass graft, we observed changes of hemodynamic and laboratory parameters in low dose norepinephrine infusion. Also, we investigated effects of norepinephrine on cardiac oxygen metabolism by calculating oxygen consumption and lactate extraction ratio. METHODS: Fifteen patients, ASA PS class IV-V, scheduled for elective coronary artery bypass graft were enrolled in this study. All of the operations were performed under general anesthesia. During harvesting of graft vessels, norepinephrine was infused at the rate of 0.02microgram/kg/min, and then at the rate of 0.05microgram/kg/min. We measured various hemodynamic and laboratory parameters in three periods (baseline, NE 0.02microgram/kg/min, NE 0.05microgram/kg/min). Also we calculated oxygen consumption and lactate extraction ratio of myocardium. RESULTS: In the baseline period(no norepinephrine infusion), oxygen consumption (VO2) is 159.2 +/- 78.6 ml/min, lactate extraction ratio (LER) is 33.1 +/- 13.0%. After norepinephrine infusion at the rate of 0.02microgram/kg/min, VO2 is 157.6 +/- 55.7 ml/min, LER is 29.9 +/- 10.7%. After norepinephrine infusion at the rate of 0.05microgram/kg/min, VO2 is 212.5 +/- 134.5 ml/min, LER is 27.9 +/- 13.4%. Although VO2 and LER are changed in relation to the rate of norepinephrine infusion, there was no statistical significance. CONCLUSIONS: In conclusion, infusion of low dose norepinephrine during coronary artery bypass graft did not produce significant differences in myocardial oxygen consumption and lactate extraction ratio associated with myocardial oxygen balance.

Experience of Right Leg Pain Control by Left Epidural Space Inserted Spinal Cord Stimulator: A case report / 대한통증학회지

Spinal cord stimulation (SCS) was first attempted by Shearly et al for the relief of intractable pain. A spinal cord stimulator has traditionally been used for failed back surgery syndrome (FBSS) angina pectoris, complex regional pain syndrome (CRPS) and ischemic pain in the extremity. However, the complications associated with the use of a spinal cord stimulator, such as wound infection, hematoma, lead migration and device malfunction; make its long term application difficult. Here, our experience of an interesting case, in which intractable right leg pain was controlled using a spinal cord stimulator placed in the left epidural space, is reported, with a review of the literature.

Diffuse nesidioblastosis underwent reoperation after streptozotocin treatment / 대한내분비학회지

Nesidioblatosis is a term that describes small clusters of pancreatic islet cells budding off exocrine ducts, and is commonly reported in infants with intractable idiopathic hypoglucemia. The onset of nesidioblastosis in adults is an extremely rare entity associated with hypersecretion of insulin and the treatment of choice is pancreatic resection. Medical treatment, including somatostatin, propranolol, diazoxide, hydrochlorthiazide and streptozotocin have achieved limited success. We experienced a case of adult nesidioblastosis that underwent reoperation after the failure of medical treatment following an inappropriate first operation. A 54-year old man was admitted due to intermittent hypoglycemic symptoms, which had been relieved by carbohydrate ingestion. Hyperinsulinemic hypoglycemia was documented during a prolonged fast. Image studies found no localized lesion, so a distal pancreatectomy was performed. The pathological examination of the resected pancreas revealed irregularly sized islets and a scattering of small endocrine cell clusters throughout the acinar tissue and ductuloinsular complex. After a partial pancreatectomy the hypoglycemia had not disappeared. The patient did not want to undergo a reoperaton due to the post operative wound infection that occurred after the distal pancreatectomy. Therefore, diazoxide, somatostatin, propranolol, and streptozotocin was used as the alternative to an operation. However, the hypoglycemia persisted during and after the medical treatment. Finally, he underwent a near total pancreatectomy (85%), and the hypoglycemia disappeared. The extent of pancreatectomy is important in clinical outcome of patients with nesidioblastosis

Clinical and Ultrasonographic Characteristics of Malignant Thyroid Incidentalomas / 대한내분비학회지

BACKGROUND: High-resolution ultrasonography has made the detection of asymptomatic small thyroid possible. Recent increases in the detection of incidentalomas have created a clinical dilemma on how to properly manage such incidental nodules. We investigated the prevalence, clinical and ultrasonographic characteristics, and optimal diagnostic approach toward incidentally detected benign and malignant thyroid nodules of less than 1.5 cm in size. METHODS: A retrospective review was undertaken on the 1,475 patients who had visited Samsung Medical Center, Seoul Korea between January 1999 and December 2000. The review consisted of a physical examination of the thyroid gland, thyroid function test, antithyroid antibodies, thyroid ultrasonography, fine-needle aspiration biopsy, pathology and TNM staging of the incidentally detected thyroid nodules of less than 1.5 cm in size. RESULTS: The prevalence of thyroid incidentalomas was 13.4% and the malignancy rate within them was 28.8%. There were no significant differences in age, sex, thyroid function test and size between the benign and malignant incidentalomas. Ultrasonographic characteristics showed meaningful diagnostic value for the detection of malignancy in incidentalomas. Most malignant incidentalomas were of a low stage. CONCLUSION: Occult thyroid cancers are fairly common finding. There are no clinical difference between benign and malignant thyroid nodules less than 1.5 cm ; however, ultrasonographic fingings can be used to decision of optimal management strategies.

Correlation between Osteoporosis and Skin Thickness on CT Scan

PURPOSE: The purpose of this study was to evaluate the relationship between osteoporosis and skin thicknessas shown by CT scanning. MATERIALS AND METHODS: Eighty- six women with osteoporosis (mean age, 52) and 51 normalcontrols (mean age, 50) participated in the study. For a quantitative CT examinations, a CT scanner(Somatom Plus,Siemens) was used. Osteoporosis was defined as present when spinal bone mineral density was more than 2.5 standarddeviations below young normal density, as determined by quantitative CT. Patients with endocrinologic, malignantor collagen disease and undergoing antimetabolite or steroid therapy were excluded. The thickness of back skin wasretrospectively measured at the third lumbar vertebra level, as seen on CT films, using a conventional magnifier.For statistical analysis, Students' t test and Spearman's rank correlation were used. RESULTS: On the basis of CTscans, the mean thickness of back skin in the osteoporotic group(0.50+/-0.20 mm) was significantly less than innormal control subjects(0.80+/-0.23 mm) (p<0.001). Significant correlation was observed between skin thickness andbone mineral density(r=0.523, p<0.0001). Sensitivity, specificity, accuracy, and positive and negative predictivevalues were measured as 76, 78, 76, 88, 62% with a cut-off value of 0.6 and 84, 61, 77, 81, 66% with a cut-offvalue of 0.7, respectively. CONCLUSION: The present study demonstrated that the thickness of back skin, asmeasured by CT scanning, is predictive of osteoporosis.