Decreased S100B expression in chronic liver diseases

BACKGROUND/AIMS: Hepatic innervation in liver diseases is not fully understood. We here evaluated S100B expression as a marker of hepatic nerves in patients with various chronic liver diseases, topographically and semi-quantitatively. METHODS: Liver specimens were obtained from 70 subjects (three controls, and 32 chronic hepatitis B, 14 chronic hepatitis C, 14 liver cirrhosis, and seven hepatocellular carcinoma patients). The hepatic nerve density was calculated based on immunohistochemical staining of S100B protein in the portal tracts and hepatic lobules. S100B mRNA levels were semi-quantitatively assessed as the S100B/glyceraldehyde 3-phosphate dehydrogenase (GAPDH) mRNA ratio. RESULTS: The densities of the hepatic nerves in portal tracts of chronic liver diseases were not significantly different from those of normal controls but the hepatic nerve densities in lobular areas of liver cirrhosis were significantly decreased (p = 0.025). Compared to the control, the S100B/GAPDH mRNA ratio was significantly decreased in chronic liver diseases (p = 0.006) and most decreased in chronic hepatitis C patients (p = 0.023). In chronic liver diseases, The S100B/GAPDH mRNA ratio tended to decrease as the fibrosis score > 0 (p = 0.453) but the overall correlation between the S100B/GAPDH mRNA ratio and fibrosis score was not statistically significant (r = 0.061, p = 0.657). CONCLUSIONS: Hepatic innervation is decreased in cirrhotic regenerating nodules compared to the control group and seems to decrease in early stages of fibrosis progression. Further studies are needed to clarify the association between changes of hepatic innervation and chronic liver disease progression.

The Effects of Self-directed Practice using Peer-tutoring on Confidence, Performance and Learning Satisfaction of Nursing Students in Practicing Core Nursing Skills / 한국간호교육학회지

PURPOSE: The purpose of the non-equivalent control group pretest-posttest study was to test the effects of self-directed nursing practice using peer-tutoring, on the level of confidence, performance and learning satisfaction of nursing students in practicing core nursing skills. METHODS: The data were collected from 80 junior nursing students at a nursing college in Daejeon before and after 3 weeks of intervention on practicing six core nursing skills, according to the highest order of priority. The subjects were divided into the peer-tutoring practice group (PTPG, n=40) and the lecturer-guided practice group (LGPG, n=40). The data were analyzed using mean, frequency, and t-test. RESULTS: The PTPG scored statistically higher than the LGPG on the performance of ‘indwelling urinary catheterization’ and ‘wearing protection equipment while entering quarantine room & disposing waste’ The PTPG scored statistically higher than the LGPG on the confidence of ‘indwelling urinary catheterization’ and ‘inserting intravenous catheterization’. The PTPG scored statistically higher on learning satisfaction than LGPG. CONCLUSION: The results showed that self-directed nursing practice using peer-tutoring could be effective for nursing students in improving proficiency in core nursing skills and might be applied to core nursing skills training.

Radiographic basal ganglia abnormalities secondary to nonketotic hyperglycemia with unusual clinical features

A 77-year-old woman was admitted to a local clinic for altered consciousness and presented with a suspected basal ganglion hemorrhage detected on brain computed tomography. The patient was stuporous, but her vital signs were stable. Her initial blood glucose was 607 mg/dL, and a hyperdense lesion was found in the right basal ganglion on brain computed tomography. T1-weighted magnetic resonance imaging revealed high signal intensity in the right basal ganglion. Electroencephalography showed no seizure activity. The patient was treated with a fluid infusion, and serum glucose level was controlled with insulin. The patient gradually recovered consciousness and was alert within 24 hours as serum glucose level normalized. The basal ganglion lesion caused by hyperglycemia was not accompanied by involuntary limb movement. This is the first report of a patient presenting with decreased consciousness and typical neural radiographic changes associated with nonketotic hyperglycemia but without movement abnormalities.

Meta-analysis of Predictive Clinicopathologic Factors for Lymph Node Metastasis in Patients with Early Colorectal Carcinoma

The objective of this study was to conduct a meta-analysis to determine risk factors that may facilitate patient selection for radical resections or additional resections after a polypectomy. Eligible articles were identified by searches of PUBMED, Cochrane Library and Korean Medical Database using the terms (early colorectal carcinoma [ECC], lymph node metastasis [LNM], colectomy, endoscopic resection). Thirteen cohort studies of 7,066 ECC patients who only underwent radical surgery have been analysed. There was a significant risk of LNM when they had submucosal invasion (> or = SM2 or > or = 1,000 microm) (odds Ratio [OR], 3.00; 95% confidence interval [CI], 1.36-6.62, P = 0.007). Moreover, it has been found that vascular invasion (OR, 2.70; 95% CI, 1.95-3.74; P or = SM2 or > or = 1,000 microm submucosal invasion, vascular invasion, lymphatic invasion, poorly differentiated carcinomas or tumor budding, it is deemed that a more extensive resection accompanied by a lymph node dissection is necessary. Even if the lesion is completely removed by an endoscopic resection, an additional surgical resection should be considered in patients with poorly or moderately differentiated carcinomas or lymphovascular invasion.

The Clinical Value of 18F-Fluorodeoxyglucose Uptake on Positron Emission Tomography/Computed Tomography for Predicting Regional Lymph Node Metastasis and Non-curative Surgery in Primary Gastric Carcinoma / 대한소화기학회지

BACKGROUND/AIMS: Accurate preoperative detection of regional lymph nodes and evaluation of tumor resectability is critical to determining the most adequate therapy for gastric cancer. The aim of this study is to identify a possible link between 18F-fluorodeoxyglucose (18F-FDG) uptake on PET scan combined with CT scan (PET/CT) and predictions of lymph node metastasis and non-curative surgery. METHODS: This study included 156 gastric cancer patients who underwent preoperative 18F-FDG PET/CT and surgery. In cases with perceptible FDG uptake in the primary tumor or lymph nodes, the maximum standardized uptake value (SUVmax) was calculated. RESULTS: In multivariate analysis, non-curative surgery (OR, 11.05; 95% CI, 1.10-111.08; p=0.041), tumor size (> or =3 cm) (OR, 7.39; 95% CI, 2.41-22.70; p or =3 cm) (OR, 3.15; 95% CI, 1.16-8.58; p=0.025) and lymph node metastasis (OR, 3.36; 95% CI, 1.23-9.14; p=0.018) showed significant association with 18F-FDG uptake in lymph node. When the SUVmax of the primary gastric tumor was greater than 3.75, the sensitivity and specificity of PET/CT with regard to the diagnosis of metastatic lymph node were 73.5% and 74.5%. When the SUVmax of the primary gastric tumor was greater than 4.35 and the FDG uptake of lymph nodes was positive, non-curative surgery was predicted with a sensitivity of 58.8% and specificity of 91.6%. CONCLUSIONS: A high FDG uptake of the gastric tumor was related to histologic positive lymph nodes and non-curative surgery.

The Impact of Radiation Exposure on the Prevalence of Functional Dyspepsia and Irritable Bowel Syndrome in Hospital Radiation Workers

BACKGROUND/AIMS: Health care workers inevitably encounter many physical hazards including ionizing radiation, and have increased levels of psychological disturbance. This study was designed to investigate the prevalence of functional gastrointestinal disorders among hospital radiation workers and to determine significant factors associated with these results. METHODS: Whole body radiation doses of radiation workers were evaluated using the electronic dosimeter. The prevalence of functional dyspepsia (FD) and irritable bowel syndrome (IBS) were assessed by the bowel symptom questionnaire. The subjects were classified according to radiation dose, sleep quality, and psychological stress level, and the prevalence of FD and IBS was comparatively analyzed. RESULTS: A total of 70 subjects were recruited. The prevalence of FD and IBS was 31.4% and 22.9%, respectively. The average radiation dose per exposed worker for 1 year was 0.56+/-0.92 mSv. By multivariate logistic regression analysis, a significant factor associated with the prevalence of FD was their high level of stress (odds ratio, 6.37; 95% confidence interval, 1.38-29.53). Between radiation workers with IBS and those without IBS, there was no significant difference in radiation exposure level, sleep quality, and stress level. There was no difference in the prevalence of IBS (40.0% vs. 15.8%, P=0.09) and FD (30.0% vs. 31.6%, P=0.92) between the relatively high-dose (total dose accumulated during the 3 years > or =9.4 mSv) and low-dose exposed group (<9.4 mSv). CONCLUSIONS: Occupational exposure to low levels of radiation does not seem to be significantly related to IBS and FD, but high stress level seems to be related to FD.

Impact of Shiftwork on Irritable Bowel Syndrome and Functional Dyspepsia

Disturbances in biological rhythms could lead to unfavorable health impact. This study aimed to evaluate the prevalence of functional dyspepsia (FD) and irritable bowel syndrome (IBS) in rotating shift workers, and to determine the factors that have significant association with the prevalence of FD and IBS. The research had been carried out among nurses and nursing assistants working at Ewha Womans University Mokdong Hospital between December 2010 and February 2011. The subjects completed self-reported questionnaires, including the quality of the sleep and the level of stress. The prevalence of FD and IBS defined by ROME III criteria, and factors associated the disorders in rotating shift workers were compared with those of day workers. A total of 207 subjects were included in the study with 147 rotating shift workers (71.0%), and 60 (29.0%) day workers. The prevalence of IBS in rotating shift workers was higher than that in day workers (32.7% vs 16.7%, P = 0.026). However, no significant difference in the prevalence of FD was observed between the two groups (19.7% vs 20.0%, P = 0.964). In the multivariate analysis, the risk factors for IBS were rotating shift work (OR, 2.36; 95% CI, 1.01-5.47) and poor sleep quality (OR, 4.13; 95% CI, 1.82-9.40), and the risk factors for FD were poor sleep quality (OR, 2.31; 95% CI, 1.01-5.28), and severe stress (OR, 2.19; 95% CI, 1.06-4.76). A higher prevalence of IBS among rotating shift workers could be directly associated with the circadian rhythm disturbance. The circadian rhythm disturbance may be related with the pathogenesis of IBS.

Diagnosis of Advanced Gastric Cancer

In Korea, gastric cancer is the most common cancer and the third leading cause of death from cancer. But recently, as a consequence of more accurate diagnostic and therapeutic strategies, mortality rate has decreased. The overall survival of patients with gastric cancer has increased markedly in Korea, due to the virtue of Korean National Cancer Screening Program. Nowadays, more than half of the patients are diagnosed as early gastric cancer. However, the survival of patients with advanced gastric carcinoma has not improved yet. Early detection of and treatment for AGC may improve outcomes, above and beyond the lead-time bias, in patients who have asymptomatic disease and a good performance status. Endoscopy ensures the most accurate diagnosis of gastric adenocarcinoma, while CT can be used to assess local and distant diseases. Endoscopy is the most useful method for securing the diagnosis of gastric adenocarcinoma and CT is also useful to assess local and distant diseases. PET imaging seems to have limited capacity detecting early gastric carcinomas. But PET/CT images of metastatic or advanced gastric adenocarcinoma can visualize primary tumors and also identify distant metastasis of solid organs with a high detection rate.

Meta-analysis: the Effect of Lactobacillus Supplementation on Helicobacter pylori Eradication Rates and Side Effects during Treatment

BACKGROUND/AIMS: Helicobacter pylori (H. pylori) is causally associated with gastritis and peptic ulcer diseases. Recent data have demonstrated that triple therapy with amoxicillin, clarithromycin, and a proton pump inhibitor has an eradication rate of only 74~76% and new therapeutic protocols may be necessary. The aim of this study was to investigate the effects of Lactobacillus as supplementation to anti-H. pylori regimens on H. pylori eradication rates and therapy-associated side effects. MATERIALS AND METHODS: The PubMed, Medline and Korean Medical Database were searched in January 2012, with no language restrictions, for randomized controlled trials; additional references were obtained from reviewed articles. We included trials comparing Lactobacillus supplementation to placebo or no treatment during anti-H. pylori regimens. Meta-analysis was performed with Review Manager. RESULTS: Eleven trials involving a total of 1,107 participants met the inclusion criteria. Compared with placebo or no intervention, Lactobacillus given along with anti-H. pylori regimens significantly increased the eradication rate [84.7% vs. 78.8%, odds ratio (OR) 1.75, 95% confidence interval (CI) 1.26~2.42] and reduced the risk of overall H. pylori therapy related adverse effects (35.4% vs. 48.6%, OR 0.56, 95% CI 0.38~0.81), particularly of diarrhea (7.5% vs. 20.6%, OR 0.31, 95% CI 0.18~0.54), bloating (19.2% vs. 29.9%, OR 0.53, 95% CI 0.32~0.88) and taste disturbance (17.6% vs. 34.8%, OR 0.37, 95% CI 0.21~0.64). There were no significant differences between groups in the risk of other adverse effects. CONCLUSIONS: Our review suggests that supplementation with Lactobacilli could be effective in increasing eradication rates of anti-H. pylori therapy. Furthermore, Lactobacilli showed a positive impact on some H. pylori therapy-related side effects, particularly diarrhea, bloating and taste disturbance.

The Clinical Meaning of Benign Colon Uptake in 18F-FDG PET: Comparison with Colonoscopic Findings

BACKGROUND/AIMS: Benign colon 18F-fluorodeoxyglucose (FDG) uptake is frequently observed in asymptomatic individuals. Aims of this study were to investigate the benign colon uptake by whole body FDG-positron emission tomography (PET) in asymptomatic adults and to correlate those results with colonoscopic and histologic findings. METHODS: Among 3,540 subjects who had undergone FDG-PET, 43 subjects who were diagnosed to have benign colon uptake in FDG-PET and underwent colonoscopy were retrospectively reviewed. Subjects were classified as diffuse or focal groups based on their FDG uptake patterns. PET results were analyzed together with colonoscopic and histologic findings. RESULTS: Forty-three subjects showed benign colon uptake in FDG-PET; 28 of them were shown as the diffuse group, while other 15 subjects were classified as the focal group. Five subjects among those showed diffuse uptake were diagnosed as adenoma. Seven among 15 subjects who showed focal uptake were diagnosed as adenocarcinoma (n=2), adenoma (n=3), or non-neoplastic polyp (n=2). Positive predictive values were 25% in the diffuse group and 47% in the focal group. CONCLUSIONS: We recommend that patients showing benign FDG uptake in the colon should be further evaluated by colonoscopy, especially for patients with focal FDG uptake.

A Case of Brunner's Gland Adenoma Presenting as Large Polyp with Stalk

Sporadic duodenal polyps are uncommon, being found at 5% of patient referred for upper endoscopy. They are often discovered incidentally and are usually asymptomatic. Endoscopic features and histologic results from endoscopically biopsied specimen cannot exclude malignancy. Recently, we experienced a Brunner's gland adenoma of duodenum mimicking malignant neoplasm. A 52-year-old female visited for evalution of a duodenal mass. A 3 cm sized polypoid mass located at the mesenteric border of 2nd portion of duodenum was found on endoscopic examination. Histologic results based on tissue taken from endoscopic biopsy showed gastric foveolar hyperplasia. Endoscopic polypectomy was performed to exclude malignancy and histological finding was consistent with Brunner's gland adenoma.

A Case of Primary Aortoenteric Fistula Mimicking Duodenal Subepithelial Tumor

Primary aortoenteric fistula is a fatal condition which poses a considerable diagnostic challenge because of its infrequency and nonspecific presentation. Here, the authors report the case of an 83-year-old man who presented with hematemesis and melena. During endoscopy, a 3 cm sized subepithelial mass with central ulceration was found in the second portion of the duodenum. At first, bleeding from a duodenal subepithelial tumor, such as, gastrointestinal stromal tumor was suspected. An endoscopic hemostasis trial failed and computed tomography (CT) scan was performed prior to possible angiographic embolization. The CT scan revealed the mass lesion observed by endoscopy as an aneurismal dilatation with fistula formation to the distal second portion of the duodenum. The patient succumbed to hypovolemic shock while preparations were being made for emergency surgery. This case provides an example of a primary aortoenteric fistula mimicking a duodenal subepithelial tumor during endoscopy.

Prevalence and Predictive Factors of Fecal Incontinence

BACKGROUND/AIMS: Most previous epidemiologic studies about fecal incontinence were performed in specific populations in Korea. We aimed to estimate the prevalence and predictive factors of fecal incontinence in adult Korean population, both men and women aged 20 years and over. METHODS: Subjects who had undergone medical check-up for health screening were enrolled. They completed the structured questionnaires, including demographics, gastrointestinal symptoms, medical and social histories, and also about their bowel habits. Logistic regression models were constructed to identify the predictive factors for having fecal incontinence. RESULTS: Among the total of 1,149 subjects (mean age, 44.8 +/- 10.2 years; 648 males), the overall prevalence of fecal incontinence was 6.4%, while the older group (> 50 years old) showed the higher prevalence than the younger group (< or = 50 years old) (10.4% vs 4.9%, P = 0.001) without gender difference. Most patients had mild fecal incontinence in 78.4%. By multivariate analysis, old ages (Odd ratio [OR], 3.1; 95% confidence interval [CI], 1.9-5.2; P < 0.001), watery stool (OR, 2.8; 95% CI, 1.5-4.9; P = 0.001) and functional diarrhea (OR, 2.7; 95% CI, 1.4-5.4; P = 0.004) were found to be independent predictors for fecal incontinence. CONCLUSIONS: The prevalence of fecal incontinence in Korean adults was 6.4%, and it was significantly more prevalent in older people without any gender difference. Aging and diarrhea were independent predictive factors of fecal incontinence. Therefore, proper control of the bowel pattern would lead to the prevention of fecal incontinence.

Sleep Disorder Associated with Gastroesophageal Reflux Disease / 대한내과학회지

BACKGROUND/AIMS: Gastroesophageal reflux disease (GERD) may contribute to the development of sleep disturbance, which may, in turn, provoke or worsen GERD. We evaluated the prevalence of GERD, non-erosive reflux disease (NERD), and extra-esophageal syndrome in subjects with self-reported sleep disturbance. METHODS: Subjects presenting for a health check-up were enrolled. Valid self-administered questionnaires provided information about reflux symptoms and sleep disturbances. We defined insomnia as self-reported sleep disturbance that occurred at least twice a week. GERD was defined as at least weekly symptoms of heartburn or acid regurgitation. Factors affecting sleep disturbance were revealed by a logistic regression analysis. RESULTS: We recruited 1,701 subjects (men 57.5%; mean age 45.0 +/- 15.0 years). The prevalence of sleep disturbance was 16.3%. GERD was reported in 14.8% of the subjects with insomnia and 7.1% of controls (p < 0.001). The prevalence of NERD was 13.7% in subjects with insomnia and 6.2% in controls (p < 0.001). The prevalence of extra-esophageal symptoms was higher in the insomniacs than controls. There was a significant correlation between the number of extra-esophageal symptoms and the frequency of sleep disturbance. Multivariate analysis showed that having GERD, NERD, extra-esophageal symptoms, and high depression and anxiety scores were predictors of sleep disturbance. CONCLUSIONS: The prevalence of GERD is higher in subjects with sleep disturbance. The number of extra-esophageal symptoms was correlated with the severity of poor sleep quality, regardless of the presence of erosive change. These findings have therapeutic implications for GERD, NERD, and extra-esophageal syndrome in patients with sleep disturbance, and future trials are warranted.

Clinicopathological Characteristics of Gastric Cancer and Survival Improvement by Surgical Treatment in the Elderly / 대한소화기학회지

BACKGROUND/AIMS: It has been known that elderly patients with gastric cancer show worse general condition and higher comorbidities. Therefore, few elderly patients undergo surgery. This study was designed to determine clinicopathological characteristics of gastric cancer in elderly patients and evaluate their survival improvements by the surgical treatment. METHODS: Gastric cancer patients, diagnosed at Ewha Womans University Mokdong Hospital between 2000 to 2004, were divided into two groups those aged > or =65 years vs. <65 years. Clinicopathological characteristics, incidence of postoperative complications, and survival time of patients in each group were analyzed. RESULTS: Total 370 patients were subjected and divided into the elderly and the younger group (55.4% vs. 44.6%). The elderly group showed higher incidences of hypertension and cardiovascular disease. Well differentiated adenocarcinoma was more frequently found in the elderly group (19.0% vs. 10.0%, p=0.025). There were no differences of operation time (242.6+/-70.7 vs. 257.3+/-83.8 min, p=0.115), postoperative hospital stays (15.8+/-10.6 vs. 14.7+/-9.8 days, p=0.361), and incidence of any complications (6.7% vs. 9.9%, p=0.309) between the two subgroups. The significant factors related with the elderly patient's survival were the tumor-node-metastasis (TNM) stage (stage I, hazard ratio [HR] 1.00; stage II, HR 1.28, 95% confidence interval [CI] 0.44-3.72; stage III, HR 4.06, 95% CI 2.08-7.92, stage IV, HR 9.78, 95% CI 4.97-19.26;p<0.001) and the treatment modality (laparoscopy, HR 1.00; open surgery, HR 3.90, 95% CI 2.43-6.26;p<0.001). The elderly patients who underwent gastric cancer surgery showed prolonged survival on TNM stage I, II, and III than those who were treated conservatively. CONCLUSIONS: In the elderly patients with gastric cancer, those who had received surgical treatments showed significantly higher survival rate than those who had treated conservatively. Therefore, aggressive surgical treatments should be seriously considered even for the elderly patients with gastric cancer.

Usefulness of Real-time Measurement of Colonoscopy Withdrawal Time during Fellow Training / 대한소화기내시경학회지

BACKGROUND/AIMS: Attempts to increase colonoscopy withdrawal time have been the topic of several recent publications. We assessed whether the real-time measurement of withdrawal time affected the withdrawal time and polyp detection rate. METHODS: Real-time colonoscopy withdrawal time was measured in 197 subjects in a study group and 184 subjects comprised a control group without real-time measurements. Colonoscopies were performed by four endoscopy specialists and three fellows during their first year of training. Withdrawal time, clinical features, bowel preparation, and polyp detection rates were comparatively analyzed. RESULTS: No significant differences in age, gender, bowel preparation, or polyp history were found in the two groups. Withdrawal time was significantly higher in the study group than that in the control group when a fellow performed the withdrawal. However, polyp detection rate did not significantly increase in the study group, regardless of physician. CONCLUSIONS: Real-time measurement of colonoscopy withdrawal time did not increase polyp detection rate, but the withdrawal time was significantly higher when a fellow performed the withdrawal phase than when a specialist performed withdrawal. Therefore, the real-time measurement of colonoscopy withdrawal time seems to be a useful tool for fellow training.

A Case of Gastric Lipoma Removed Using a Detachable Snare

Gastrointestinal lipoma is a benign tumor of mature adipose tissue, surrounded by fibrous capsule. They can be located anywhere in the gastrointestinal tract, but rarely in the stomach, especially at the cardia. Gastric lipoma accounts for approximately 2~3% of all benign gastric tumors, and 5% of all gastrointestinal lipomas. Lipoma tends to have very low malignant potential, but if it induces symptoms like abdominal pain or hemorrhage, it needs to be removed. We report a case of gastric lipoma which was successfully removed by only using a detachable snare. A 72-years-old woman who had no specific symptom was found to have a submucosal tumor at cardia. During endoscopy, the fatty internal material accidently came out after tearing the mucosa with biopsy, and it was successfully removed using a detdachable snare.

Simultaneous Herpes Simplex and Candida Esophagitis in Renal Transplant Patients / 대한소화기내시경학회지

Infectious esophagitis usually occurs in immunocompromised patients with AIDS, malignancy and those receiving immunosuppresive therapy. Common pathogens causing esophagitis include Candida, Herpes simplex virus and Cytomegalovirus. However simultaneous esophageal infection with both Candida and Herpes simplex virus has rarely been reported. The endoscopic findings of Herpes simplex esophagitis combined with Candida infection does not show typical findings due to diffuse whitish or yellowish plaques; hence, accurate diagnosis can be delayed. We observed concomitant infection of Herpes simplex virus and Candida causing esophagitis in a 45-year-old renal transplant patient who had been receiving immunosuppressive therapy. The patient showed marked reductions in clinical symptoms and in endoscopic findings after anti-fungal and acyclovir therapy.

Anesthetic management for the endoscopic sinus surgery of a patient with coexisting severe cervical spine ankylosing spondylitis and unruptured cerebral aneurysm: A case report / 대한마취과학회지

A 61-year-old man was admitted to the emergency room complaining of a severe left exophthalmos caused by frontal and ethmoid sinus mucoceles that were visualized on a brain computerized tomogram. In addition, he had coexisting ankylosing spondylitis with a 20 year duration that resulted in total fixation of the cervical spine and progressive thoracic kyphosis. An unruptured anterior communicating artery aneurysm was found incidentally on the cerebral angiogram. We report that the anesthetic management for endoscopic sinus surgery of a frontal sinus mucocele in a patient with coexisting severe cervical spine ankylosing spondylitis and an unruptured cerebral aneurysm requires a detailed preoperative assessment of the airway, cardiac, pulmonary, and neurologic system. This case highlights the need for careful measures to avoid rupturing the cerebral aneurysm by the increased blood pressure induced by endotracheal intubation and the infiltration of an epinephrine-containing local anesthetic.

The Carina as a Landmark for Evaluation of Adequate Central Catheter Tip Position with Computerized Tomography / 대한구급학회지

BACKGROUND: The aim of this study was to determine whether the carina can be used as a landmark for evaluation of adequate central catheter tip position, and to examine the relationship between easily measurable body size and variable anatomical parameter. METHODS: The SVC dimensions and relationship to radiographic landmarks were retrospectively determined from computerized tomography (CT) scans of 200 patients. The CT findings were assessed in terms of SVC length (SVCL), the distance between the carina and the right atrium inlet (CAL), and the sternal length (STL). Pearson's correlation and a regression test for height versus SVCL, STL versus SVCL and CAL were performed. RESULTS: The median length of the SVC was 4.2 cm (range; 1.6 to 7.2 cm) and the distance between the carina and the right atrium inlet was 2.4 cm (range; 0.8 to 5.6 cm). With the regression test, height was correlated with SVCL (r(2)=0.09), and STL was correlated with both SVCL (r(2)=0.12) and STL (r(2)=0.04). CONCLUSIONS: The carina was located always above the right atrium inlet. The carina was a reliable, simple anatomical landmark for the determination of correct placement with computerized tomography.