Influence of the Phase of Menstrual Cycle on Postoperative Nausea and Vomiting after Breast Cancer Surgery / 이화의대지

OBJECTIVES: The phase of the menstrual cycle was demonstrated to have an influence on the incidence of postoperative nausea and vomiting (PONV) after gynecologic laparoscopic surgery, but little was known for breast surgery, which was shown to have relatively higher incidence of PONV, >60%. We performed this study to investigate the influence of the phase of menstrual cycle on PONV after breast cancer surgery. METHODS: A total of 103 patients, who were scheduled for breast cancer surgery under general anesthesia, were recruited, and patients with irregular menstrual cycles, history of previous history of PONV were excluded. Groups were divided in two ways as follows: 1) gynecologic classification: premenstrual and menstrual (days 25 to 6), follicular (days 8 to 12), ovulation (days 13 to 15), and luteal phase (days 20 to 24); 2) menstrual classification: menstrual (days 1 to 8) and non-menstrual (days 9 to 28). PONV were recorded using Rhodes index of nausea, vomiting and retching at postoperative 6 and 24 hours. RESULTS: The overall incidence of PONV during postoperative 24 hours was 35.4%. At the menstrual classification, the incidence of PONV at postoperative 24 hours was higher in the menstrual group than that in the non-menstrual group (16.7% vs. 4.2%, P=0.057). The severity of PONV, measured with Rhodes index of nausea, vomiting and retching was significantly different between menstrual and non-menstrual groups (P=0.034). CONCLUSION: The duration and severity of the PONV after breast cancer surgery were demonstrated to be prolonged and aggravated during menstruation, respectively. Therefore, consideration of menstrual cycle for scheduling breast cancer surgery could effectively prevent the PONV and reduce medical cost.

Therapeutic comparison of Surgery combined with chemotherapy and chemotherapy alone for Primary Gastrointestinal Lymphoma: A single center study / 고신대학교의과대학학술지

OBJECTIVES: There is still no consensus on the optimal treatment for primary gastrointestinal lymphoma (PGIL). The aim of this study was to compare surgery combined with chemotherapy and chemotherapy alone in PGIL. METHODS: We retrospectively reviewed and analyzed the treatment outcomes of 107 patients with primary gastrointestinal lymphoma diagnosed between March 1999 and December 2009 at Kosin University Gospel Hospital. Patients were divided into two groups: 35 patients who underwent surgery combined with chemotherapy (group A) and 72 patients who were treated with chemotherapy alone (group B). And we analyzed prognostic factors associated with short survival. RESULTS: The 5-year progression free survival rates (PFS) of group A and B were 86.7% and 66.1%, respectively (P = 0.037), while the 5-year overall survival rates (OS) were 86.8% and 68.4%, respectively (P = 0.129). In multivariate analysis, Both PFS and OS were not changed by treatment strategies (surgery combined with chemotherapy or chemotherapy only). The international prognostic index (IPI) was the only independent predictive factor for PFS. CONCLUSIONS: In our study, surgery combined with chemotherapy and chemotherapy only make no difference of survival rate. And further randomized prospective studies are needed to confirm a treatment strategies at improving survival outcomes in PGIL patients.

A Case of Type III Autoimmune Polyglandular Syndrome / 고신대학교의과대학학술지

The autoimmune polyglandular syndromes (APS) are groups of syndromes comprising a combination of endocrine and nonendocrine autoimmune diseases. Among of those four types of APS, the main characteristics of the 3 APS are autoimmune thyroid diseases associated to other autoimmune diseases, excluding Addison's disease. Type 3 APS are also subdivided into 3A, 3B, 3C, and 3D. Recently, we experience a case of APS manifesting 3A, 3C, and 3D subtype. A 28-year-old woman developed type I diabetes. According to her medical history, she had Graves' disease, vitiligo, auimmune hemolytic anemia and systemic lupus erythematosus (SLE). The antoantibodies associated with Graves' disease, SLE, and type I diabetes showed positive findings. We report this case with literatures review.

A Case of Pulmonary Hypertension Recurred by Graves' Disease / 고신대학교의과대학학술지

A few cases of severe pulmonary hypertension with right heart failure associated with Graves' disease were reported in the literature. However, cases of pulmonary hypertension with right heart failure recurred by Graves' disease is very rare. We describe the case of a 60-year old woman who had been treated pulmonary hypertension caused by right pulmonary artery thromboembolism seven years ago. Recently, her pulmonary hypertension with right heart failure was recurred by Graves' disease. The patient's symptoms of pulmonary hypertension was resolved after treatment of Graves' disease.

Direction of catheter insertion and the incidence of paresthesia during continuous epidural anesthesia in the elderly patients / 대한마취과학회지

BACKGROUND: Continuous epidural anesthesia is useful for endoscopic urologic surgery, as mostly performed in the elderly patients. In such a case, it is necessary to obtain successful sacral anesthesia, and the insertion of epidural catheter in the caudad direction may be needed. However, continuous epidural catherization has been related to paresthesias. This study aimed to evaluate the effects of the direction of the catheter insertion on the incidence of paresthesias in the elderly patients. METHODS: Two hundred elderly patients scheduled for endoscopic urologic surgery were enrolled. The epidural catheter was inserted at L2-3, L3-4, and L4-5 using the Tuohy needle. In Group I (n = 100), the Tuohy needle with the bevel directed the cephalad during the catheter insertion. In Group II (n = 100), it directed the caudad. During the catheter insertion, an anesthesiologist evaluated the presence of paresthesias and the ease or difficulty during the catheter insertion. RESULTS: In Group I (n = 97), 15.5% of the patients had paresthesias versus 18.4% in Group II (n = 98), and there was no significant difference between the two groups. In paresthesia depending on the insertion site and the ease or difficulty during the catheter insertion, there were no significant differences between the two groups. CONCLUSIONS: Our results concluded that the direction of epidural catheter insertion did not significantly influence the incidence of paresthesias in the elderly patients.

Myocardial bridge detected by changes in ECG before induction: A case report

Myocardial bridge, in which some of the epicardial coronary arterial segments are embedded in the muscle, has clinical significance because serious cardiac diseases such as angina, cardiac ischemia, myocardial infarction, and sudden cardiac death can occur. However, anesthetic management for the perioperative period for patients with myocardial bridge has remained controversial. We present a case of anesthetic management for total gastrectomy in a previously healthy 56-year-old male patient, who exhibited T-wave inversion and ST-segment depression in ECG monitoring on arrival to the operating room. While delaying the operation for further study, he was diagnosed as having myocardial bridge on a 3D-coronary CT. After confirmation of the normal coronary angiography, the patient underwent total gastrectomy uneventfully. There is no substitute for vigilance regarding the anesthesiologist.

The Combination Therapy with Peg-interferon Alfa and Ribavirin for Chronic Hepatitis C in Korea as an Initial Treatment / 고신대학교의과대학학술지

OBJECTIVES: The combination therapy with peginterferon and ribavirin has been used to treat chronic hepatitis C for several years in Korea but there is a few report about the results of the treatment. We evaluated safety and efficacy of the combination therapy with Peg-interferon and ribavirin and analyzed factors that may affect treatment. METHODS: Total 72 untreated chronic hepatitis C patients were administered pegylated interferon alfa-2a (180microg/week) or alfa-2b (1.5microg/kg/week) and ribavirin (800 mg/day in genotype 2, 1000-1200 mg/day in genotype 1). Duration of the treatment was 24 weeks in genotype 2 and 48 weeks in genotype 1. Response of the treatment was evaluated by rapid virologic response (RVR), early virologic response (EVR), end treatment virologic response (ETR), sustained virologic response (SVR) and adverse event. RESULTS: The RVR, EVR, ETR, SVR were 61.8%, 82.5%, 88.9% and 80.5% retrospectively. The SVR of genotype 1 was 63.4% and non-genotype 1 was 96.7%. Genotype (Odds ratio: 14.92) was an independent predictor of the SVR. Leukocytopenia, flu-like symptoms, itching, rash and anemia were common adverse events of the combination therapy and if then we reduced dose and there was one case of cessation. CONCLUSIONS: The combination therapy with Peg-interferon and ribavirin shows efficacy to the Korean patients with chronic hepatitis C as an initial treatment. Genotypes 2 and 3 were more likely to have a sustained virologic response.

Retinal Hemodynamic Study using a Scanning Laser Ophthalmoscope in Diabetic Retinopahty

To investigate retinal hemodynamics in diabetic retinopathy, the perifoveral capillary leukocyte velocity for retinal microcirculation was measured in eyes of 16 control. 12 non-proliferative diabetic retinopathy(NPDR) and 10 proliferative diabetic retinopathy(PDR) on the video fluorescein angiogram using a scanning laser ophthalmoscope(SLO 101, Rod-enstock, Munich, Germany) in 20 degrees retinal field. And the times of arm to retinal circulation, arterio-venous circulation and venous lamina flow for retinal macrocirculation were also measured in eyes of 18 control, 16 NPDR and 10 PDR in 40 degrees retinal field. There was not any statistically significant difference between control eyes(140.62 +/- 34.11 pixels/see, 1.21 +/- 0.29 mm/sec) and NPDR eyes(133.98 +/- 31.85 pixels/sec, 1.15 +/- 0.27 mm/sec) in mean perifoveal capillary leukocyte velocity(p=0.60). But it was significantly decreased in PDR eyes(108.80 +/- 26.19 pixels/see, 0.94 +/- 0.23 mm/sec) compared with control(p=0.01) and NPDR eyes(p=0.05). The were not any significant differences in the times of arm to retinal and arterio-venous circulation respectively(p>0.05) among the eyes of control(12.09 +/- 1.41 sec, 2.41 +/- 0.86 sec), NPDR(12.66 +/- 1.42 see, 2.32 +/- 0.96 sec) and PDR(12.90 +/- 1.51 see, 2.54 +/- 0.94 sec). But the venous lamina flow time was significantly decreased in eyes of NPDR(6.91 +/- 2.32 see, p=0.02) and PDR(7.03 +/- 1.89 sec, p=0.01) compared with that of control(5.46 +/- 1.18 see). These results indicate that a significant retinal microcirculatory deficit exists in the eyes of PDR, and venous lamina flow time may be a good index of retinal macrocirculatory deficit in diabetic retinopathy.

A Case of Choroidal Tuberculoma

It is Known that ocular tuberculosis occurs as a consequence of active infection from hematogenous spread or a hypersensitivity reaction to circtlating tuberculoproteins. The common findings of ocular tuberculosis are uveitis and choroidal tuberculoma. Paralleling the decrease of pulmonary tuberculosis and improvemem of differential diagnostic metnods, there has been a dramatic decline in the number of diagnosed cases of ocular tuberculosis. In a 65-year-old female a choroidal tumor was diagn03ed at our hospital a year ago Thereafter, she has been medicated with antituberculotic agents for brain tuberculosis in the other hospital. Recently she returned to our clinic cOffiJlaining of aggravated ocular symptom. The right vision was no light perception Enucleation of her right eye was perfomed under the impression of malignant tumor of choroid with secondary glaucoma. Pathologic findings of enucleated eyeball revealed the nature of tuberculoma; so, we report it with a review of literature.

A Case of Choroidal Tuberculoma

It is Known that ocular tuberculosis occurs as a consequence of active infection from hematogenous spread or a hypersensitivity reaction to circtlating tuberculoproteins. The common findings of ocular tuberculosis are uveitis and choroidal tuberculoma. Paralleling the decrease of pulmonary tuberculosis and improvemem of differential diagnostic metnods, there has been a dramatic decline in the number of diagnosed cases of ocular tuberculosis. In a 65-year-old female a choroidal tumor was diagn03ed at our hospital a year ago Thereafter, she has been medicated with antituberculotic agents for brain tuberculosis in the other hospital. Recently she returned to our clinic cOffiJlaining of aggravated ocular symptom. The right vision was no light perception Enucleation of her right eye was perfomed under the impression of malignant tumor of choroid with secondary glaucoma. Pathologic findings of enucleated eyeball revealed the nature of tuberculoma; so, we report it with a review of literature.

A clinical study upon avascular necrosis of femoral head following treatment of congenital dislocation of the hip / 대한정형외과학회잡지

No abstract available.