Risk of complications and urinary incontinence following cytoreductive prostatectomy: a multi-institutional study / 亚洲男科学杂志(英文版)

Emerging evidence has suggested that cytoreductive prostatectomy (CRP) allows superior oncologic control when compared to current standard of care androgen deprivation therapy alone. However, the safety and benefit of cytoreduction in metastatic prostate cancer (mPCa) has not been proven. Therefore, we evaluated the incidence of complications following CRP in men newly diagnosed with mPCa. A total of 68 patients who underwent CRP from 2006 to 2014 at four tertiary surgical centers were compared to 598 men who underwent radical prostatectomy for clinically localized prostate cancer (PCa). Urinary incontinence was defined as the use of any pad. CRP had longer operative times (200 min vs 140 min, P < 0.0001) and higher estimated blood loss (250 ml vs 125 ml, P < 0.0001) compared to the control group. However, both overall (8.82% vs 5.85%) and major complication rates (4.41% vs 2.17%) were comparable between the two groups. Importantly, urinary incontinence rate at 1-year after surgery was significantly higher in the CRP group (57.4% vs 90.8%, P < 0.0001). Univariate logistic analysis showed that the estimated blood loss was the only independent predictor of perioperative complications both in the unadjusted model (OR: 1.18; 95% CI: 1.02-1.37; P = 0.025) and surgery type-adjusted model (OR: 1.17; 95% CI: 1.01-1.36; P = 0.034). In conclusion, CRP is more challenging than radical prostatectomy and associated with a notably higher incidence of urinary incontinence. Nevertheless, CRP is a technically feasible and safe surgery for selecting PCa patients who present with node-positive or bony metastasis when performed by experienced surgeons. A prospective, multi-institutional clinical trial is currently underway to verify this concept.

Pulsed Radiofrequency Application for the Treatment of Pain Secondary to Sacroiliac Joint Metastases

Sacroiliac (SI) joint pain can result from degeneration, infection, malignancy, and trauma. Patients with metastatic bone pain who do not respond to conventional treatment may need more aggressive neuroinvasive approaches. Recently, pulsed radiofrequency (PRF) neuromodulation has emerged as a promising treatment alternative for refractory cases of SI joint pain. Nevertheless, there is no report on the treatment of pain arising from SI joint metastases with PRF. We are reporting about a 63-year-old woman suffering from buttock pain due to breast cancer metastases in the SI joint. We treated this patient with PRF neuromodulation of the L4-S3 primary dorsal rami and lateral branches using a rotating curved needle technique. The patient tolerated the procedures well, without any complications. She experienced about 70% reduction in pain, and pain relief was sustained for 10 months. This result suggests that PRF neuromodulation is a safe, effective treatment for pain from SI joint metastases.

Effect-site concentration of remifentanil for blunting hemodynamic responses to tracheal intubation using light wand during target controlled infusion-total intravenous anesthesia / 대한마취과학회지

BACKGROUND: Transillumination using a light wand is an alternative type of laryngoscope used for tracheal intubation. There is little information available on the effect-site concentration of remifentanil required to control hemodynamic changes induced by tracheal intubation using the transillumination method during total IV anesthesia. We therefore conducted this study to determine the effect-site concentration of remifentanil blunting hemodynamic responses after tracheal intubation in patients receiving propofol anesthesia. METHODS: We enrolled 26 healthy adult patients (ASA physical status I-II), aged 16-67 scheduled for surgery within 2 hours. All patients received a target-controlled infusion of 4 microg/ml propofol. The effect-site target-concentration of remifentanil of 5.0 ng/ml was chosen for the first patient. We used the Dixon's up-and-down sequential allocation method for determining the next remifentanil concentration. The time required for tracheal intubation was measured as the level of intubation stimulation. RESULTS: The average intubation time was 13.9 +/- 9.1 seconds. From the Dixon's method, the EC50 of remifentanil blunting the hemodynamic response to tracheal intubation was 2.94 ng/ml. CONCLUSIONS: This study shows that effect-site concentrations of remifentanil of 2.94 ng/ml is effective in blunting sympathetic responses to tracheal intubation in 50% of patients with normal airway anatomy when combined with a target controlled infusion of propofol (4 microg/ml).

Anesthetic management of a neonate with Antley-Bixler syndrome: A case report

Antley-Bixler syndrome is a congenital anomaly of multiple bones and cartilage, and this was first reported by Antley and Bixler in 1975. It is characterized by craniosynostosis, midface hypoplasia with choanal stenosis and atresia, radiohumeral synostosis and femoral bowing. This is sometimes accompanied by cardiac, renal, gastrointestinal and genital malformations. The risk of respiratory distress is high in the infants with this syndrome, and this is most commonly caused by choanal stenosis and atresia. Careful anesthetic management is needed for these infants because of the potential risk of a difficult airway and respiratory complications. We report here on our experience with the anesthetic management of a neonate with Antley-Bixler syndrome and we review the relevant literature.

Reversible airway obstruction caused by changing the size and length of an endotracheal tube in a premature neonate with suspected tracheomalacia: A case report / 대한마취과학회지

Tracheomalacia is a malformation of the tracheal membranosa. It is maintained during spontaneous breathing but can be altered by bronchoscopy or positive airway pressure. Tracheomalacia is associated with a high mortality and may cause prolonged intubation and ventilation. Here, the case of a 13-day-old infant with jejunoileal stenosis that had surgery is reported. During induction of general anesthesia, endotracheal intubation was attempted several times with different sized endotracheal tubes. Airway obstruction occurred after the endotracheal intubation. After the airway was maintained, the operation was completed. Tracheomalacia was diagnosed after otolaryngology evaluation postoperatively.

Airway management using laryngeal mask airway in insertion of the Montgomery tracheal tube for subglottic stenosis: A case report / 대한마취과학회지

The Montgomery tracheal tube (T-tube) is a device used as a combined tracheal stent and airway after laryngotracheoplasty for patients with tracheal stenosis. This device can present various challenges to anesthesiologists during its placement, including the potential for acute loss of the airway, inadequate administration of inhalation agents, and inadequacy of controlled mechanical ventilation. The present case of successful airway management used a laryngeal mask airway under total intravenous anesthesia with propofol and remifentanil in the insertion of a Montgomery T-tube in a tracheal resection and thyrotracheal anastomosis because of severe subglottic stenosis.

Epidural anesthetic management of a patient with amyotrophic lateral sclerosis (ALS): A case report / 대한마취과학회지

Amyotrophic lateral sclerosis (ALS) is a degenerative disease of motor ganglia in the anterior horn of spinal cord and spinal pyramidal tracts. The impairments of respiratory function and weakened upper airway muscle affect anesthetic management. General anesthesia may cause respiratory problem. Regional anesthesia such as spinal and epidural anesthesia is also relative contraindication for patients with a motor neuron disease, including ALS, for the fear of exacerbating the disease. Therefore patients with ALS are needed careful management during perioperative period. We report a case of epidural anesthesia for transurethral ureteroscopic lithotripsy in a patient with ALS. The patient recovered from anesthesia without exacerbating the disease.

An analysis of correlation between remifentanil effect site concentration and age blunting hemodynamic response to endotracheal intubation

BACKGROUND: There are many studies using propofol-remifentanil target controlled infusion (TCI) for the prevention of adverse hemodynamic changes during tracheal intubation. Most of these studies suggested optimal remifentanil target concentration without considering age. The purpose of this study is to analyze the correlation between concentration of remifentanil and age to blunting adverse hemodynamic responses during tracheal intubation. METHODS: We enrolled ASA physical state I or II 55 patients, aged 12-75 years undergoing elective surgery. Anesthesia was induced using a propofol TCI (Marsh model). A 4micro/ml effect-site concentration of propofol was chosen. Rocuronium 0.6 mg/kg was administered after the patients lost consciousness. Remifentanil TCI (Minto model) was started 1 minute after the propofol injection. Initially, a 3 ng/ml effect-site concentration was chosen. The next concentration was chosen using Dixon's up-and-down method. The non-invasive blood pressure and heart rate were recorded before induction (baseline), after the remifentanil infusion, immediately after intubation as well as 1 and 3 minutes after intubation. RESULTS: Probit analysis revealed a remifentanil effect site EC50 and EC95 in all patients to be 1.768 ng/ml (S.E. +/-0.136) and 2.912 ng/ml (S.E. +/-0.307). Final probit equation was as following consisted with age and remifentanil effect site concentration. Probit = -2.588 + 1.886 remifentanil effect site concentration -0.022 x Age. CONCLUSIONS: The probability of success rate of blunting adverse hemodynamic response is related to the concentration of remifentanil directly and age inversely.

Healing Potential of the Transected Posterior Cruciate Ligament of the Rabbit

PURPOSE: We intended to investigate the spontaneous healing response of the posterior cruciate liga-ment(PCL) of the knee to the location of injury in a mature rabbit model. MATERIALS AND METHODS: In the group I(30 rabbits), PCLs were transected at femoral insertion site and in the group II(30 rabbits), they were transected at mid-substance. Subsequent changes were investigated by histological examination with Hematoxylin-Eosin(HE) staining, immunohistochemical analysis for growth factors and biomechanical test with Instron machine(model 4206). Sham operation was performed on the contralateral side, which was used as the control. RESULTS: On gross inspection, significant difference was not observed between the two groups but scar tissue was thicker in group II than group I. On histological examination and immuno-his-to-chem-i-cal study, there was no significant differnce too. On tensile stress test with Instron machine, ultimate tensile strength steadily increased with time, but it was significantly lower than control in both groups. The length of healed ligaments also increased with time in both groups. CONCLUSION: The spontaneous healing of the PCL can occur in the mature rabbit, yet there were no significant differences of healing characteristics between group I and II. The healed ligaments were elongated and biomechanical properties were far inferior to those of control. We expect the further study on spontaneous healing of PCL with more researches on the other factors which are not considered in this

A Job Analysis in Common Managemant Dietitian of School Foodservice: Centering around Kyoung sang buk-do

The purpose of this research is to analysis the general job of 76 dietitian on common management of school food service in Kyoung-buk area. In this research we asked them some general aspects, and made use of three variants(job performing time, the degree of major recognition, and the degree of difficulty) each question after classifying their jobs into 13 standard jobs. Statistical data analysis was completed using SPSS package program. The results of this survey showed the following : 1. The types of common management are as in the following : of the whole 76, 37 on the rotative trip to one single school, 8 to two schools, 1 to three schools, 28 on the trip to one single school plus central food production and 1 on the trip to two schools plus central food production. 2. The average job performing time in his or her school is 2813 minutes(8.52 hours) per week. 3. The factor of the evaluation and study of school foodservice has the highest level in every variant, but there were no standard job which needed the high-level difficulty and the longer job performing time as it needed the low degree of major recognition.

Effect of Human Cord Serum on Oocyte Maturation and Cumulus Cell Expansion / 대한불임학회지

This study was performed to investigate the stimulating effect on oocyte maturation and cumulus cell expansion in TC199 media by human cord serum (HCS) supplementation. Immature mouse oocyte cumulus complexes (OCCs) were cultured in TC199 media supplemented with bovine serum albumin (BSA), HCS and human chorionic gonadotropin (hCG) instead of luteinizing hormone (LH) respectively, and the expression of cumulus expansion and oocyte maturation were observed. After 4hr and 24hr culture with or without OCCs, media containing 0.4% BSA, 10% HCS and 10 lU hCG respectively were collected and analyzed for changing concentrations of estradiol (E2), progesterone(P4), testosterone(T), and PGF2. There were no elevation of E2, T, and PGF2 by OCCs culture, but minute elevation of P4 level by 24hr OCCs culture in hCG supplementation (p=0.048). The stimulating pattern of cumulus expansion of OCCs by HCS and hCG supplementation was similar to our previously report using Ham's F-10 media, however oocyte maturation rates after 24hr OCCs culture in all media were increased by 20~30% compared to Ham's F-10 media. These results suggest that LH in HCS induce cumulus expansion probably by P4 secretion of OCCs, and TC199 is efficient media for immature mouse oocyte maturation.

Effect of Human Cord Serum on the Hormone Production by Mouse Oocyte Cumulus Complexes in vitro / 대한산부인과학회잡지

In our previous study, it was shown that human cord serum stimulated cumulus expansionin vitro by cumuli oophori isolated from mice primed with pregnant mare serum gonadotropin(PMSG), and suggested that there were some gonadotropin-like components stimulating cumulusexpansion in human cord serum. In this paper we assess whether there are gonadotropinstimulating cumulus expansion in human cord serum and sex steroid hormone production fromoocyte cumulus complexes(OCCs). The contents of follicle stimulating hormone(FSH) andluteinizing hormone(LH) were measured in human cord serum: follicle stimulating hormone levelwas basal, but luteinizing hormone was as high as 142.4 mIU/ml even in inactivated serum.After short term culture(4hr), with or without OCCs, medium containing 0.4% bovine serumalbumin(BSA) as control or 10% human cord serum(HCS) was collected and analyzed for itscontent of estradiol, progesterone and testosterone. Little or no sex steroid contents were detectedin any control media with or without OCCs. In contrast, a moderate or small amount ofsex steroid contents was detected in culture medium containing cord serum. OCCs secretedminute but not significant amounts of estradiol, progesterone, and testosterone when culturedin media containing cord serum. After 4, 8, and 22hr culture with OCCs, similar patterns ofcumulus expansion were observed in media containing cord serum, human chorionic gonadotropin(HCG) instead of luteinizing hormone(LH), and HCS plus HCG. However, no cumulus expansionwas observed in any control media.It is suggested that luteinizing hormone in human cord serum induces cumulus expansionand affects the secretion of sex steroid hormones by OCCs during culture.

Boutonniere Deformity, 3 cases / 대한정형외과학회잡지

No abstract available in English.

A Case Report of Asthmatic Breathing with Lidocaine / 대한마취과학회지

Lidocaine is considered a safe and effective local anesthetic in anesthesiology and is the standard to which new amide anesthetics are compared. As it an amide derivative, and the frequency with which lidocaine elicits an allergic response is much less than that of anesthetics derived from paraaminobenroic acid esters. Case reports od sensitivity to lidoeaine have been reported, but they are rare. This 29 year old male patient had on episode of asthmatic breathing after supraclavicular brachial plexus block using 30 ml of 1% lidocaine with epinephrine(1:200,000). We report a case of asthmatic breathing due to lidocaine and a review of the literature for allergy local anesthetics.

Anesthetic Management for the Palient with Insuliaoma / 대한마취과학회지

Hyperinsullinism and the resultant hypoglycemia are hallmarks of functioning beta islet cell tumors of the pancreas. The management of one case of insulinoma during surgery for the removal of the tumor is described and the available literature on the subject reviewed. The outline of the anesthetic management for the insulinoma is as follows: 1) Anesthetists should understand the signs and the symptoms of hypoglycemia and hyperglycemia. 2) Preoprative management: a) infusion of glucose for avoiding hypoglycemia due to NPO after midnight. b) glucocorticosteroid administration with premedications. 3) Operative management: a) continuous determination of blood glucose level may be helpful. b) Maintenance of the glucose level about 50mg% above symptomatic CNS level have the advantage that exicision of the infulinoma can be immediately judged. c) The use of an agent that decreases CMRO2 and does not affect the insulin-glucose ratio is rational choice when concern about hypoglycemia exists. Thiopental-enflurane anesthesia with controlled ventilation maintaining normocarbia is recommended. d) beta-adrenergic blocker. These drugs must be avoided in the hypoglycemic state.