Therapeutic Effect of Squeezing the Punctum and Lacrimal Canaliculus in Canaliculitis Patients

PURPOSE: To report the therapeutic effect of squeezing the punctum and lacrimal canaliculus using Q-tips in canaliculitis patients. METHODS: From March 2004 to February 2014, 42 eyes of 42 patients diagnosed with canaliculitis at our clinic were retrospectively analyzed. To remove the discharge and concretions, the punctum and lacrimal canaliculus were squeezed using Q-tips without invasive procedures. RESULTS: The mean patient age was 56.39 years and mean follow-up period was 10.6 months. No statistical significance was observed in terms of rate of disease occurrence and mean age between males and females. Among the eyes analyzed, 30 (71.4%) were cured with only 1 squeezing procedure, 12 eyes (28.6%) required more than 2 procedures; 1 eye (2.3%) recurred and the period until recurrence was 3.8 months. CONCLUSIONS: Most studies support surgical management as the definitive therapy for canaliculitis to remove concretions that serve as a reservoir for bacteria. The gold standard treatments are curettage or canaliculotomy; however, these are not safe procedures and may result in epiphora in post-procedure patients due to the risk of lacrimal pump dysfunctioning or scarring of the canalicular system following invasive procedure. Squeezing punctum and lacrimal canaliculus only using Q-tips is effective in removing the canalicular concretions and without causing complications in the canalicular system.

The prophylactic effects of gabapentin on postoperative sore throat after thyroid surgery / 대한마취과학회지

BACKGROUND: Postoperative sore throat (POST) is considered a usual complication after tracheal intubation, especially, thyroid surgery. Gabapentin is a widely studied multimodal perioperative drug, which can be used to treat acute postoperative pain. The primary endpoints of this study was a reduction of the incidence of POST at rest and during the swallowing movements after thyroid surgery. And the second endpoints was a reduction of the intensity of the POST after thyroid surgery. METHODS: Seventy-one patients that underwent elective thyroid surgery received either gabapentin (Neurontin(TM) 600 mg) or placebo, orally, one hour before anesthesia. The VAS scores and incidences of POST and adverse effects were determined at 1 hr, 6 hr, 12 hr, and 24 hr after surgery at rest and during swallowing movement. RESULTS: The gabapentin group (N = 36) showed a lower incidence of POST than the placebo group (N = 35) (47% vs. 78%, P = 0.038), and had significant lower VAS score at 6 and 24 hours after surgery in the resting state. However, during the movement, no intergroup differences were found in terms of the incidence of POST (83% vs. 91%, P = 0.305) or VAS score. Furthermore, no significant difference was observed between the two groups, in adverse effects. CONCLUSIONS: Gabapentin (Neurontin(TM) 600 mg) administered 1 hr before anesthesia reduced the intensity and incidence of POST during the resting state without a significant adverse event, during the 24 hr after thyroid surgery. However, gabapentin did not reduce the intensity and incidence of POST during the swallowing movement.

Large Cell Neuroendocrine Carcinoma of the Thymus: A Two-Case Report

A large cell neuroendocrine carcinoma (LCNEC) of the thymus is a very rare malignant tumor that has a very poor prognosis. The detailed clinical features of LCNEC are still unknown, including the long term prognoses and the definitive modalities of the treatment for LCNEC of the thymus. We are reporting 2 cases of an enlarged LCNEC of the thymus, both of which were diagnosed and treated by surgical resection followed by postoperative adjuvant chemoradiation therapy. Although recurrences and metastases of the LCNEC were noticed 1 and 4 years postoperatively for each case, aggressive surgical resection and adjuvant chemoradiation therapy may be helpful for a patient's long term survival.

The effect of electrically heated humidifier on the body temperature and blood loss in spinal surgery under general anesthesia / 대한마취과학회지

BACKGROUND: General anesthesia often produces some degree of hypothermia and hypothermia causes much more blood loss during surgery than normothermia. Electrically heated humidifiers (EHHs) have been used for patients under general anesthesia and in the intensive care unit. However, the benefits of the EHH have not been widely reported in the literature. METHODS: Patients scheduled for posterior lumbar spine fusion, were randomly assigned to a mechanically ventilated with EHH circuit group or to a conventional respiratory circuit group. Their tympanic membrane temperature was monitored every 30 min after induction up to 180 min, and perioperative blood losses, transfusion requirements during surgery, and other complications were noted. RESULTS: Patients in the control group (n = 40) showed a lower mean body temperature at all times than immediately after induction, while the EHH group (n = 40) showed a lower body temperature from 60 minute after induction comparing to the initial temperature. Furthermore, patients in the EHH group had a higher mean body temperature than patients in the control group during surgery (35.9 +/- 0.4 vs 35.4 +/- 0.5, P < 0.001). Mean intraoperative blood loss (9.75 +/- 5.4 vs 7.48 +/- 3.9, P = 0.035) and transfusion requirements (57.5% vs 25%, P = 0.006) were significantly less in the EHH group, but postoperative blood loss, duration of hospitalization, and other complications were not significantly different in the two study groups. CONCLUSIONS: The use of an electrically heated humidifier did not prevent a body temperature drop under general anesthesia. However, it helped maintain body temperature and was associated less blood loss and transfusion requirement during surgery.

The effect of transdermal scopolamine plus intravenous dexamethasone for the prevention of postoperative nausea and vomiting in patients with epidural PCA after major orthopedic surgery / 대한마취과학회지

BACKGROUND: Postoperative nausea and vomiting (PONV) is common complication of Patient-Controlled Analgesia (PCA) after surgery. The authors sought to determine whether a transdermal scopolamine (TDS) patch in combination with IV dexamethasone is more effective than IV dexamethasone alone or IV dexamethasone plus IV ramosetron for reducing PONV in patients receiving epidural PCA after major orthopedic surgery. METHODS: 120 patients that received epidural PCA with hydromorphone and ropivacaine after major orthopedic surgery under spinal anesthesia were allocated to 3 groups: Group D (n = 40) received IV dexamethasone 8 mg, Group DR (n = 40) received IV dexamethasone 8 mg plus IV ramosetron 0.3 mg, Group DS (n = 40) received IV dexamethasone 8 mg plus a TDS patch (Group DS, n = 40). Nausea and vomiting incidences, VAS for nausea, the use of additional antiemetics, and adverse effects (a dry mouth, blurred vision, drowsiness) during the first 24 hours postoperatively were subjected to analysis. RESULTS: The DS Group had a significantly higher rate of complete remission of PONV than the D and DR groups (82.5% vs 47.5%, and 50.0%, respectively), and had lower rates of nausea (17.5% vs 55.0%, and 50.0%), and vomiting (10.0% vs 50.0%, and 25.0%), and required less antiemetics (5.0% vs 35.0%, 22.5%) than group D and Group DR during the first 24 hours after surgery. Furthermore, no inter-group differences were observed with respect to adverse effects in the three groups. CONCLUSIONS: The prophylactic use of a TDS patch plus dexamethasone was found to be a more effective means of preventing PONV in patients that received epidural PCA after major orthopedic surgery than dexamethasone alone or dexamethasone plus ramosetron without adversely affecting side effects.

The treatment of the pulmonary embolism with tissue plasminogen activator: A case report / 대한마취과학회지

Pulmonary embolism can occur in various situations and it can result in severe hemodynamic instability, including cardiac arrest. Because of its fatality, diagnosis and treatment should be immediate and proper. We report a case of pulmonary embolism just after combined spinal epidural anesthesia. We diagnosed pulmonary embolism by echocardiogram, spiral CT and pulmonary angiography. Besides immediate use of heparin, tissue plasminogen activator therapy was started with 10 mg bolus and 90 mg intravenous infusion during 2 hours. Despite the therapy, pulmonary embolism was not resolved and the patient was expired.

Changes in Ionized and Total Magnesium Concentration during Spinal Surgery / 대한마취과학회지

BACKGROUND: The incidence of postoperative hypomagnesemia in patients undergoing spinal surgery has been reported to be 70%. Ionized magnesium is considered to be the biologically active form, but until the early 1990s, only the total magnesium concentration could be measured. Currently, the ionized magnesium concentration as well as total magnesium concentration can be assessed due in part to the development of a selective electrode. The aim of this study was to more fully characterize the changes in the total and ionized magnesium concentrations in patients undergoing elective spinal fusion surgery. METHODS: The total and ionized magnesium, creatinine, albumin, urinary magnesium concentration, hematocrit, total amount of fluid administration, transfusion, blood loss, and urine output were evaluated both preoperatively and postoperatively in each patient. RESULTS: The total and ionized magnesium concentrations decreased from 0.783 mM/L and 0.529 mM/L preoperatively to 0.717 mM/L and 0.511 mM/L during the postoperative period, respectively. CONCLUSIONS: The incidence of total hypomagnesemia during spinal surgery was 15% but the incidence of ionized hypomagnesemia was only 3%.

Efficacy of Sufentanil during Laryngeal Microscopic Surgery / 대한마취과학회지

BACKGROUND: Various anesthetic agents have been used in laryngeal microscopic surgery, because the airway is shared with the surgeon, there is a short operation duration and intense cardiovascular stimulation occurs during the surgery. Sufentanil is superior than other anesthetic agents in blocking the cardiovascular response to the airway stimulation and a short duration of effects. METHODS: Thirty patients undergoing elective laryngeal microscopic surgery were randomized to receive sufentanil 0.125 microgram/kg (group 1, n = 10), sufentanil 0.25 microgram/kg (group 2, n = 10) or sufentanil 0.5 microgram/kg (group 3, n = 10). The bispectral index score, blood pressure, heart rate, recovery time from general anesthesia, the need for additional analgesics and naloxone and the postoperative complications associated with sufentanil were measured. RESULTS: The bispectral index, blood pressure and heart rate were similar in the three groups. Only four patients in group 3 required naloxone (P < 0.05). Three patients in group 1, one in group 2 and 0 in group 3 required an additional dose of sufentanil. Postoperative sore throat was detected in 6 patients in the immediate postoperative period and in 8 patients 6 hours after the end of anesthesia in group 1 (P < 0.05). CONCLUSIONS: Sufentanil is an effective analgesic for attenuating the cardiovascular responses of airway stimulation in laryngeal microscopic surgery. In addition, sufentanil 0.25 microgram/kg is an appropriate dose for the rapid recovery and attenuation of the cardiovascular response in laryngeal microscopic surgery.

Treatment and Prognostic Factors for Traumatic Liver Injury

PURPOSE: Due to its size and locatin, the liver is frequently injured in abdominal trauma. Recently, nonoperative management for liver injuries has been extended due to the development CT imaging, intensive care units, and their equipment and techniques. Herein, patients with traumatic liver injury were analyzed to evaluate its treatment and prognostic factors. METHODS: From 2001, January to 2003, July, 65 patients at our facility were confirmed to have traumatic liver injury. The operative or nonoperative managements were decided on the basis of the systolic blood pressure if no peritoneal irritation sign was noted. If the systolic blood pressure was stable, or recovered to within the normal range following hydration and transfusion at the emergency room, patients were managed nonoperatively. Hemodynamically unstable patients were managed operatively. The data were analysed using the SPSS program (Chi-squared tests and logistic regression analyses). RESULTS: 48 patients were treated nonoperatively, with 3 mortalities. The overall mortality rate was 15.8%, but only 6.4% in the nonoperative management group, compared to 67% in operative management group. In a Multivariate analysis the systolic blood pressure was found to be a reliable factor in traumatic liver injury and the mentality and ISS (injury severity score) reliable in finding complications in the nonoperative management group. The mentality was found statistically reliable for determining mortality in the operative management group, with the exception for the systolic blood pressure. CONCLUSION: The systolic blood pressure was an important indicator when considering the treatment plan in traumatic liver injury. An extensive study will be required that incorporates both nonoperative and operative management groups.

Intestinal Obstruction Due to Incarcerated Hernia at CAPD Catheter Insertion Site

Patients who have undergone peritoneal dialysis can frequently experience abdominal wall complications, such as hernia due to increased intraabdominal pressure and peritoneal leakage. However, no case of incarcerated abdominal wall hernia through catheter insertion site of CAPD has yet been reported Recently the authors experienced a case of intestinal obstruction due to an incarcerated hernia at the catheter insertion site of CAPD. We report this case and present a literature review.

Trocar(R)(Ethicon) Used Intraoperative Endoscopy in Acute Lower Gastrointestinal Bleeding

Occasionally it is difficult to preoperatively confirm the bleeding focus in acute lower gastrointestinal bleeding patients. Therefore, many diagnostic evaluations are needed - for example, colonoscopy, selective mesenteric angiography and Tc-99m RBC scintigraphy. However, if the bleeding focus remains unconfirmed preoperatively when the patient's state is unstable hemodynamically, the surgeon must inevitably perform exploratory laparotomy, followed by intraoperative endoscopy. We herein propose a new method of intraoperative endoscopy using Trocar(R) (Ethicon). Trocar(R) (Ethicon) was used in laparoscopic operation. This method has the merits of no air leakage, no contamination, fewer complicatons and ease of evaluation. We recommend that the use of Trocar(R) (Ethicon) in intraoperative endoscopy is essential in emergency operations for acute lower gastrointestinal bleeding.