Relationship between Alcohol Consumption and Testosterone Deficiency according to Facial Flushes among Middle-Aged and Older Korean Men / 가정의학회지

Background@#This study examined the relationship between alcohol consumption and total testosterone deficiency based on facial flushing among Korean men. @*Methods@#A total of 314 men were included in this study and divided into non-drinkers (n=78) and drinkers (n=236). Drinkers were also divided into flushers (n=96) and non-flushers (n=140). Flushers and non-flushers were separated into two groups based on the amount of alcohol consumed: moderate drinkers (≤8 standard drinks per week) and heavy drinkers (>8 standard drinks per week). Total testosterone 8 drinks per week) who flush compared to that in non-drinkers.

Validation of the Simplified Palliative Prognostic Index to Predict Survival for Advanced Cancer Patients in Home Hospice Setting / 가정의학회지

Background@#The simplified Palliative Prognostic Index (sPPI) substitutes a single item from the Communication Capacity Scale (CCS) for the delirium item of the original PPI. This study aimed to examine the validity of the sPPI for patients with advanced cancer in a home-based hospice care setting. @*Methods@#This study included 75 patients with advanced cancer who received home-based hospice care. We used medical records maintained by professional hospice nurses who had visited the patients in their homes. Based on their sPPI score, patients were divided into three groups—A (<4), B (≥4 and <6), and C (≥6)—to compare survival. Further, we investigated the sPPI’s accuracy using the area under the receiver operating characteristic curve (AUC) and sensitivity and specificity for 3- and 6-week survival. We used three sPPIs including different substitutions for the delirium item (two methods using the CCS and one using the Korean Nursing Delirium Screening Scale). @*Results@#The median survival was 60–61 days for group A, 27–30 days for group B, and 12–16 days for group C. The difference in survival was significant (P<0.05). The AUC was 0.814–0.867 for 3-week survival and 0.736–0.779 for 6-week survival. For 3- and 6-week survival, prognostic prediction showed sensitivities of 76.2%–90.9% and 76.3%–86.8%, and specificities of 64.2%–88.7% and 51.4%–70.3%, respectively. @*Conclusion@#The sPPI, which is measured by professional hospice nurses, has acceptable validity to predict survival for patients with advanced cancer in a home hospice setting in South Korea.

Validation of the Simplified Palliative Prognostic Index to Predict Survival for Advanced Cancer Patients in Home Hospice Setting / 가정의학회지

Background@#The simplified Palliative Prognostic Index (sPPI) substitutes a single item from the Communication Capacity Scale (CCS) for the delirium item of the original PPI. This study aimed to examine the validity of the sPPI for patients with advanced cancer in a home-based hospice care setting. @*Methods@#This study included 75 patients with advanced cancer who received home-based hospice care. We used medical records maintained by professional hospice nurses who had visited the patients in their homes. Based on their sPPI score, patients were divided into three groups—A (<4), B (≥4 and <6), and C (≥6)—to compare survival. Further, we investigated the sPPI’s accuracy using the area under the receiver operating characteristic curve (AUC) and sensitivity and specificity for 3- and 6-week survival. We used three sPPIs including different substitutions for the delirium item (two methods using the CCS and one using the Korean Nursing Delirium Screening Scale). @*Results@#The median survival was 60–61 days for group A, 27–30 days for group B, and 12–16 days for group C. The difference in survival was significant (P<0.05). The AUC was 0.814–0.867 for 3-week survival and 0.736–0.779 for 6-week survival. For 3- and 6-week survival, prognostic prediction showed sensitivities of 76.2%–90.9% and 76.3%–86.8%, and specificities of 64.2%–88.7% and 51.4%–70.3%, respectively. @*Conclusion@#The sPPI, which is measured by professional hospice nurses, has acceptable validity to predict survival for patients with advanced cancer in a home hospice setting in South Korea.

Treatment of Traumatic Esophagopleural Fistula Using the Over-the-Scope-Clip System

Esophagopleural fistula (EPF) is a rare condition that is usually accompanied by severe infection and life-threatening morbidity. Here, we report the successful treatment of an EPF by closing an esophageal orifice using the over-the-scope-clip (OTSC) system without postprocedural complications. A 41-year-old man had serious thoracic and abdominal trauma due to a traffic accident. Computed tomography revealed findings suggestive of esophageal rupture due to Boerhaave syndrome. An emergent explorative operation was performed for primary repair with the insertion of a vacuum-assisted closure device. A postoperative upper gastrointestinal series revealed an EPF tract connecting the left pleural space and distal esophagus. We performed an endoscopic procedure using the "traumatic-type"OTSC to seal the EPF, and the esophageal orifice was completely healed 2 weeks postoperatively. The OTSC system might represent a safe and feasible modality for the treatment of EPF.

Minimally invasive parathyroidectomy with or without intraoperative parathyroid hormone for primary hyperparathyroidism

PURPOSE: The improvement of intraoperative parathyroid hormone (IOPTH) assay and localization studies has enabled a minimally invasive parathyroidectomy (MIP) in primary hyperparathyroidism (pHPT). The aim of this study is to analyze the demographics, clinical presentations, and surgical outcomes of the pHPT patients who received surgical management with versus without IOPTH. METHODS: Analysis of a database was performed on 53 patients who underwent parathyroidectomy for pHPT from 2004 to 2013. Preoperative localization was done by both sestamibi scan and ultrasonography. We divided the patients into two groups (without IOPTH versus with IOPTH) and analyzed the surgical outcomes statistically between two groups. RESULTS: The concordance rate of Technetium 99m sestamibi scan and ultrasonography was 73.6% and 90.6%, respectively. The overall cure rate of group 1 (without IOPTH) was 94.9% and that of group 2 (with IOPTH) was 100%. The decline of PTH at postoperative 5 minutes and 10 minutes was 75.2% +/- 14.9% and 84.9% +/- 8.6% in cured patients. On the other hand, that of noncured patients at 5 minutes and 10 minutes was 17.2% +/- 9.7% and 8.2% +/- 2.2%. There was a significant difference in the drop rate of IOPTH between cured and persistent patients (P < 0.01). Pathological examination showed adenoma in 41 of 53 patients (77.4%) and hyperplasia in 10 of 53 patients (18.9%). CONCLUSION: Even though the localization studies were successful, IOPTH monitoring is essential to avoid a surgical failure in MIP.

Effects of Calcium and Potassium Channel Blockers on Local Anesthetics-Induced Relaxation in Rat Thoracic Aortic Rings / 대한마취과학회지

This study was designed to evaluate the effects of calcium and potassium channel blockers on local anesthetics-induced vascular relaxation of isolated rat thoracic aorta. In the presence of lidocaine and bupivacaine, the aortic rings previously contracted with phenylephrine(10(-4)M) were slightly contracted at the beginning of the administration of local anesthetics. But in the presence of tetracaine, aortic rings were not contracted at the beginnings. Verapamil, diltiazem and nifedipine in concentration of 10(-9)M to 10(-5)M produced cumulative concentration-dependent vasorelaxation significantly in the aortic rings previously contracted with phenylephrine(10(-4)M). In the presence of lidocaine, bupivacaine and tetracaine, verapamil, diltiazem and nifedipine in concentration of 10(-9)M to 10(-5)M caused dose-dependent vasorelaxation in aortic rings significantly. Tetraethylammonium HCl(TEA) in concentration of 10(-9)M to 10(-5)M did not produce dose-dependent vasorelaxation but slight contraction showed at the beginning of the administration. In the presence of lidocaine, bupivacaine, TEA in concentration of 10(-9)M to 10(-5)M did not produce vasorelaxation remarkably. But in the presence of tetracaine, TEA in concentration of 10(-9)M to 10(-5)M produced cumuIative concentration-dependent vasorelaxation significantly. These findings suggest that local anesthetics, especially tetracaine, which interact with calcium and potassium channel bleckers, lead to blockade of the sodium and calcium channels as well as potassium channels.