Detection of BRAF(V600E) Mutation using Peptide Nucleic Acid-Mediated PCR Clamping Method in Fine Needle Aspiration Cytology / 대한내분비외과학회지

PURPOSE: The aim of this study was to evaluate the diagnostic value of a peptide nucleic acid (PNA)-mediated PCR clamping method for the detection of BRAFV600E mutations in fine needle aspiration cytology (FNAC). METHODS: One hundred sixty four patients underwent FNAC to evaluate BRAFV600E mutations between April 2011 and November 2011. Among them, forty-two patients were diagnosed with papillary thyroid carcinoma in a permanent pathologic specimen. A PNA-mediated PCR clamping method and a Dual-Priming Oligonucleotide (DPO)-based Real-time PCR method were used to detect the BRAFV600E mutation. We compared the result of mutation between the two methods. RESULTS: A BRAF mutation was found in 31 samples created by the PNA-mediated PCR clamping method, and in 28 samples in the DPO-based Real-time PCR method. The rate of BRAF mutation was 73.8% in association with the PNA-mediated PCR clamping method, and 66.7% in association with the DPO-based Real-time PCR method. There was no statistical differences between the two methods (P>0.05). CONCLUSION: The PNA-mediated PCR clamping method may be an alternative to the DPO-based Real-Time PCR method for detection of BRAF mutations in thyroid nodules.

Isoflurane cracks the polycarbonate connector of extra-corporeal circuit: A case report / 대한마취과학회지

Cardiopulmonary bypass (CPB) is widely used for cardiac surgery by virtue of its proven safety over the course of its use during the past half century. Even though perfusion is safer, incidents still occur. During the repair of a ventricular-septal defect in an 11-month-old infant, we experienced a critical incident related to the potential hazardous effect of volatile anesthetics on the polycarbonate connector of extra-corporeal circuit. The damage to the polycarbonate connector had occurred after spillage of isoflurane during the filling of the vaporizer, causing it to crack and leak. The incident was managed by replacement of the cracked connector during a temporary circulatory arrest. The patient was hypothermic and the time off bypass was less than 1.5 min. There were no neurologic sequelae, the patient made an uneventful recovery. In conclusion, the spillage of volatile anesthetics can cause cracks in the polycarbonate connector of the extra-corporeal circuit, leading to potentially interruption of CPB.

Analysis of Nutritional Support Status in the Intensive Care Unit / 대한구급학회지

BACKGROUND: Nutritional support is important in intensive care for critically ill patients in an effort to decrease the mortality and morbidity. This study was conducted to evaluate the propriety of nutritional support and to understand the effect of a nutrition consultationin critically ill patients to assess and analyze nutritional status. METHODS: Between January and December 2006, patients who were admitted to the intensive care unit (ICU) > or = 7 days and between 20 and 80 years of age were included. Patients transferred to another hospital, patients discharged against medicine advice, and patients with unknown weight were excluded. Two hundred sixty-two patients were enrolled. The demographic data of patients and the state of nutritional support were reviewed by medical records. RESULTS: Two hundred sixty-two patients stayed in the ICU a mean of 16.0 +/- 9.8 days and received nutrition support for 11.0 +/- 8.4 days. Except 15 patients who did not receivenutritional support, the mean daily calculated caloric requirement of 247 patients was 1,406.2 +/- 253.8 kcal, the mean daily delivered caloric amount was 899.5 +/- 338.7 kcal, and the total delivered/required caloric ratio was 66.4 +/- 28.1%. The total delivered/required caloric ratio of the patients who received a nutritional consultation and the patients who did not receive nutritional consultation were 72.6 +/- 25.8% and 55.9 +/- 33.3%. CONCLUSIONS: In this study, we identified that critically ill patients received insufficient nutritional support. We recommend continuous monitoring and management for nutritional support by systematic administration of nutritional support teams.

A comparison of the consumption of inhaled anesthetics according to fresh gas flow and anesthetic circuits / 대한마취과학회지

BACKGROUND: In the Korean National Health Insurance Corporation (KNHIC), payment for inhaled anesthetics are made according to the simulated dose and not the consumed dose. We compare the consumption of inhaled anesthetics according to fresh gas flow (FGF) and anesthetic circuits to compare the consumption of anesthetics and the guidelines for KNHIC payments. METHODS: 161 patients were randomized into six groups who received isoflurane using a closed circuit (group I-C), a semi-closed circuit with FGF 3 L/min (group I-3), or 4 L/min (group I-4), as for the sevoflurane group (group S-C, S-3, and S-4). Mean arterial pressure (MAP) and heart rate (HR) were maintained within +/- 20% of baseline. Minimum alveolar concentration (MAC) and consumption of inhaled anesthetics were recorded by a new anesthetic machine. RESULTS: There were no significant differences among the groups for MAP, HR, and MAC. During anesthesia maintenance, the mean consumption per 15 minutes of inhaled anesthetics was significantly lower in group I-C (1.0 +/- 0.3 ml) than in group I-3 (3.5 +/- 0.7 ml) and than group I-4 (4.9 +/- 0.9 ml) and similar to the sevoflurane groups (group S-C [1.3 +/- 0.4 ml] vs group S-3 [5.3 +/- 1.0 ml] vs group S-4 [6.9 +/- 1.3 ml], respectively; P < 0.05). CONCLUSIONS: In sevoflurane groups, inhaled anesthetics were consumed more than in isoflurane groups. The KNHIC payment guidelines were close to the actual consumption of inhaled anesthetics under using a semi-closed circuit with FGF 3 L/min in sevoflurane and FGF 4 L/min in isoflurane.

A comparison of hemodynamics in elderly patients that were administered thiopental sodium or propofol to induce general anesthesia / 대한마취과학회지

BACKGROUND: Thiopental sodium and propofol are commonly used to induce anesthesia. This study was conducted to compare the hemodynamic effects of propofol and thiopental sodium during the induction of general anesthesia in elderly patients. METHODS: Forty patients undergoing general anesthesia were randomly divided into two groups. In group T, thiopental sodium was used to induce anesthesia, whereas propofol was used in group P. Hemodynamic changes in the mean blood pressure, heart rate, cardiac index (as determined using a NICCOMO monitor) and bispectral index (BIS) during induction were then compared between the two groups. In addition, the dosage of induction agent, time required until loss of response to verbal order (LOV) and eyelid reflex were compared between groups. RESULTS: The mean blood pressure was significantly lower in group P than in group T during the 1-5 min following LOV and during the 2, 3 min following intubation (P < 0.05). However, the heart rate did not differ significantly between the two groups. The cardiac index also did not differ significantly between groups, except during the first 3 min following LOV. Finally, the BIS value were significantly lower than the baseline values in both groups during induction. CONCLUSIONS: In elderly patients, the heart rate, cardiac index and BIS value did not differ significantly between the two groups. But the mean blood pressure was significantly lower in propofol than in thiopental sodium.

Effective removal of epistaxis during nasotracheal intubation utilizing a fiberoptic scope in a difficult airway: A case report / 대한마취과학회지

Nasal bleeding related to nasal trauma is the most common complication of nasotracheal intubation with a fiberoptic scope. When nasotracheal intubation with a fiberoptic scope is performed, profuse bleeding from the nasal cavity makes it difficult to handle a fiberoptic scope and may cause a hypoxemia. So when nasal bleeding occurs, it is important to suction the nasal cavity for easy handling of a fiberoptic scope. But, it may be difficult to suction in a nasal cavity with a fiberoptic suction port only. We report a patient with nasal bleeding following nasotracheal intubation with a fiberoptic scope because of articular trismus, and successful nasotracheal intubation utilizing a fiberoptic scope by suctioning with an extra suction apparatus.

Effective removal of epistaxis during nasotracheal intubation utilizing a fiberoptic scope in a difficult airway: A case report / 대한마취과학회지

Nasal bleeding related to nasal trauma is the most common complication of nasotracheal intubation with a fiberoptic scope. When nasotracheal intubation with a fiberoptic scope is performed, profuse bleeding from the nasal cavity makes it difficult to handle a fiberoptic scope and may cause a hypoxemia. So when nasal bleeding occurs, it is important to suction the nasal cavity for easy handling of a fiberoptic scope. But, it may be difficult to suction in a nasal cavity with a fiberoptic suction port only. We report a patient with nasal bleeding following nasotracheal intubation with a fiberoptic scope because of articular trismus, and successful nasotracheal intubation utilizing a fiberoptic scope by suctioning with an extra suction apparatus.

The malfunction of self-inflating bag resuscitator due to mis-assembly: A case report / 대한마취과학회지

A self-inflating bag resuscitator is universally used to ventilate patients during cardiopulmonary resuscitation and transfer. This device can be reused after sterilization and reassembly, and the mis-assembly of a resuscitator can possibly happen. We report here on a case of mis-assembly of a resuscitator valve that resulted to barotrauma and instability of a patient.

What is the Optimal Effect-site Concentration of Remifentanil for Minimizing the Cardiovascular Changes to Endotracheal Intubation during Induction with Propofol? / 대한마취과학회지

BACKGROUND: In this study, the optimal effect-site concentration of remifentanil for blunting hemodynamic responses to endotracheal intubation during total intravenous anesthesia using propofol were evaluated. METHODS: 137 ASA class I and II patients, aged 18-60 years, were randomly allocated to one of six groups according to the effect-site concentration of remifentanil. Remifentanil was then infused at a target effect-site concentration of 0, 1, 2, 3, 4 or 6 ng/ml in groups R0, R1, R2, R3, R4 and R6, respectively. Anesthesia was induced with propofol infusion at a target effect-site concentration of 4microgram/ml endotracheal intubation was performed 5 minutes after remifentanil administration. Blood pressure (BP), heart rate (HR) and cardiac index (CI) were recorded at the baseline and then every 30 seconds until 3 minutes after intubation. RESULTS: BP and HR in groups R0, R1 and R2 increased significantly after intubation when compared with the baseline values. The CI in group R0 also increased significantly after intubation when compared with the baseline values. Incidences of hypertension and hypotension were 50% and 5% in R0, 32% and 14% in R1, 18% and 32% in R2, 10% and 48% in R3, 8% and 54% in R4, and 0% and 81% in R6. There were also 2 cases in which the mean blood pressure was less than 50 mmHg in group R6. CONCLUSIONS: We suggest that the optimal target effect-site concentrations of remifentanil for blunting hemodynamic responses to endotracheal intubation are 3 or 4 ng/ml during total intravenous anesthesia using propofol at an effect-site concentration of 4microgram/ml.

Spontaneous Intracranial Hypotension after Post-dural Puncture Headache : A case report / 대한마취과학회지

Spontaneous intracranial hypotension (SIH) occurs without any preceding events such as lumbar puncture, surgery, trauma, or medical illness. It is characterized by a postural headache that is aggravated whilst in the erect or sitting position, and is relieved in the supine position. A postural headache usually resolves either spontaneously or with conservative treatment. An epidural block is a very important treatment for lumbago and is mostly performed for pain control. However, an incidental dural puncture is possible during epidural block and anesthesiology and pain medicine doctor should be familiar with an epidural block. Radioisotope cisternography is a highly sensitive, reliable and safe technique for confirming of the presence and location of cerebrospinal fluid (CSF) leakage. We report two cases of spontaneous intracranial hypotension that was diagnosed by SIH through cisternography in a situation where the post-dural puncture headache was primarily suspected as being the cause. If a postural headache occurs after an epidural block through an epidural needle without CSF leakage, other causes e.g. dural puncture need to be identified.

The Breakage of Epidural Catheter during Continuous Epidural Analgesia for Cancer Pain: A case report / 대한마취과학회지

During pain control by continuous epidural analgesia, the breakage of epidural catheter is a very rare complication. We experienced breakage of epidural catheter in patient of cancer pain during continuous epidural analgesia. We performed epidural catheterization between T12 and L1 level for pain control. After 6 weeks of epidural catheterization, abruptly patient complained severe pain. When we applied negative pressure to catheter by syringe before epidural injection of bolus dose, a few airs were aspirated. We strongly suspected breakage of catheter, and the breakage in 1617 cm from epidural catheter tip was confirmed by normal saline administration via epidural catheter. After new epidural catheter inserted again, patient's pain was controlled by VAS 24 and another complications were not appeared. We must carefully manage the catheter because of complications of epidural catheter.

The Utility of Upper Limb Sympathetic Block by Modified Injection Technique in Stellate Ganglion Block / 대한마취과학회지

BACKGROUND: From our clinical experiences, there are some problems with a paratracheal stellate ganglion block at the 6th cervical level e.g. small changes in blood flow to the upper extremities and more difficulty in differentiating sympathetically-maintained pain from neuropathic pain. This study compared the effectiveness of the classic injection technique and the modified injection technique in paratracheal stellate ganglion block at the 6th cervical level. METHODS: Forty patients were randomly divided into 2 groups. In Group I, the patients underwent a paratracheal stellate ganglion block at the 6th cervical level with 1% mepivacaine 6 ml using the classic injection technique. In Group II, the patients underwent a paratracheal stellate ganglion block at the 6th cervical level with 1% mepivacaine 6 ml using the modified injection technique by applying strong pressure to the cephalad portion of the needle entry point. The skin temperature of the first finger was measured before and after the stellate ganglion block, and the warm sensation on the face and upper extremities, hoarseness and upper extremity paralysis were examined. RESULTS: The increase in skin temperature of the first finger after the procedure was 0.26 +/- 0.22 degrees C in Group I and 0.84 +/- 0.63 degrees C in Group II, which was statistically significant (P < 0.05). There were no significant differences in the warm sensation on the face and upper extremities, hoarseness and upper extremity paralysis between the two groups. CONCLUSIONS: The modified injection technique is more effective in the sympathetic block on the upper extremities than the classic injection technique.

Subject The Effect of Apolipoprotein E Overexpression on Plasma Lipoprotein Profile in Mice Fed on Long-term High Cholesterol Diet

BACKGROUND AND OBJECTIVES: Apolipoprotein E (apoE), a 34-kD plasma glycoapolipoprotein, plays a key role in lipoprotein metabolism by facilitating cellular uptake of remnants of triglyceride-rich chylomicrons and VLDL and may have other important biological functions. Various studies using apoE-knockout mice have elucidated the role of apoE in lipolysis, remnant clearance, and atherogenesis. Despite the growing evidence of the protective role exerted by apoE against atherosclerosis, the direct in vivo effects of the apoE overexpression on lipoprotein metabolism in the presence of endogenous mouse apoE are not yet fully understood. In this study, the technique of adenovirus-mediated gene transfer was employed to investigate the in vivo effect of apoE overexpression on lipid level and lipoprotein profile in mice fed on normal chow or high cholesterol diet. MATERIALS AND METHODS: Recombinant adenovirus (rAd.mApoE) containing mouse apoE cDNA driven by a cytomegalovirus promoter was generated and infused via tail vein in mice fed on normal chow or high cholesterol diet. Recombinant adenoviruses have emerged as the most efficient vectors for transient delivery of functional genes to the mammalian liver. RESULTS: rAd.mApoE in the various mouse tissues one week after injection was expressed mainly in the liver. ApoE overexpression decreased the cholesterol and triglyceride concentration in mice fed on normal chow. In mice fed on high cholesterol diet, apoE overexpression resulted in decrease in triglyceride concentration and increase in cholesterol. VLDL and LDL fraction were decreased, HDL was increased by apoE overexpression in both mice fed on normal chow and high cholesterol diet. CONCLUSION: These data suggest that overexpression of mouse apoE in mice with endogenous apoE may exert antiatherogenic effect by inducing favorable change in the lipoprotein profile, regardless of diet and consequent plasma lipid level. In the future, the studies regarding the effect of human apoE overexpression on the lipid and lipoprotein profile in mice fed on normal chow and high cholesterol diet will be helpful to understand the species differences or similarities in apoE activity.