BACKGROUND: There have been no studies of airway management strategies for difficult intubation and cannot intubate, cannot ventilate (CICV) situations in Korea. This study was intended to survey devices or methods that Korean anesthesiologists and intensivists prefer in difficult intubation and CICV situations. METHODS: A face-to-face questionnaire that consisted of a doctor's preference, experience and comfort level for alternative airway management devices was presented to anesthesiologists and intensivists at study meetings and conferences from October 2014 to December 2014. RESULTS: We received 218 completed questionnaires. In regards to difficult intubation, the order of preferred alternative airway devices was a videolaryngoscope (51.8%), an optical stylet (22.9%), an intubating laryngeal mask airway (11.5%), and a fiber-optic bronchoscope (10.6%). One hundred forty-two (65.1%) respondents had encountered CICV situations, and most of the cases were identified during elective surgery. In CICV situations, the order of preferred methods of infraglottic airway management was cricothyroidotomy (CT) by intravenous (IV) catheter (57.3%), tracheostomy by a surgeon (18.8%), wire-guided CT (18.8%), CT using a bougie (2.8%), and open surgery CT using a scalpel (2.3%). Ninety-eight (45%) of the 218 respondents were familiar with the American Society of Anesthesiologists' difficult airway algorithm or Difficult Airway Society algorithm, and only 43 (19.7%) had participated in airway workshops within the past five years. CONCLUSION: The videolaryngoscope was the most preferred device for difficult airways. In CICV situations, the method of CT via an IV catheter was the most frequently used, followed by wire-guided CT method and tracheostomy by the attending surgeon.
Airway Management ; Bronchoscopes ; Catheters ; Congresses as Topic ; Education ; Intubation* ; Intubation, Intratracheal ; Korea* ; Laryngeal Masks ; Methods ; Surveys and Questionnaires ; Tracheostomy

No abstract available.

No abstract available.
Dapsone*

PURPOSE: Tethered cord syndrome(TCS) is defined as low position of the conus medullaris by the abnormally fixed spinal cord with progressive neurologic deficit MATERIALS AND METHODS: To evaluate the findings of TCS at MRI and its diagnostic value, we performed a retrospective analysis of MRI of 30 patients with emphasis on clinical manifestation, level of conus medullaris, cause of tethering, and associated findings. RESULTS: Clinical presentation included back mass(26 cases), neurogenic bladder(5 cases), urinary incontinence(5 cases), progressive constipation(2 cases), skin dimpling(1 case), gait disturbance(1 case) and club foot (1 case). Neurologic deficit was developed in 11 cases(40% and mean age of these patients at the time of diagnosis was 8.6 years. The most common cause of tethering was lipoma(63%). The tips of conus medullaris were below the level of the second lumbar spine in all patients. The causes of tethering were lipomatous component(spinal lipoma and lipomyelomenigocele) in 67% myelomeningocele in 20%, presacral mass in 7%, thickened filum terminale in 3% and postoperative change in 3%. Associated anomalies included syringomyelia(20%) and hydrocephalus was associated in 3 out of 5 patients who underwent brain MRI. CONCLUSION: MRI clearly delineated the location of conus, tethering of the filum terminale with their causes and associated abnormalities. MRI examination is a very useful diagnostic tool for the early evaluation of TCS and the postoperative follow up.
Brain ; Cauda Equina ; Conus Snail ; Diagnosis ; Follow-Up Studies ; Foot ; Gait ; Humans ; Hydrocephalus ; Lipoma ; Magnetic Resonance Imaging ; Meningomyelocele ; Neural Tube Defects* ; Neurologic Manifestations ; Retrospective Studies ; Skin ; Spinal Cord ; Spine

Objectives: To determine the clinical characteristics of Korean patients with sporadic oculopharyngodistal myopathy. Methods: Three consecutive unrelated Korean patients with sporadic oculopharyngodistal myopathy participated in this study. Stepwise approaches were performed including careful clinical examination, electrophysiological study, pathology evaluation and genetic study. The literature on oculopharyngodistal myopathy was reviewed. Results: Clinically, our patients showed consistent features of initial distal limb weakness with variable ophthalmoplegia, bulbar weakness or proximal weakness. All the patients showed rimmed vacuoles and myopathic changes. Conclusion: Through the literature review and this study, we believe that initial distal limb weakness is a characteristic fi nding in patients with oculopharyngodistal myopathy in some ethnic groups.

PURPOSE: To investigate changes in the ovary revealed by MR imaging before and after radiotherapy in premenopausal patients with cervical carcinoma. MATERIALS AND METHODS: Thirty-three premenopausal patients with cervical carcinoma underwent radiation therapy at an average dosage of 11,279 (external: 5,352; internal: 5,927) cGy. Before and after this therapy, all underwent pelvic MR imaging using a 1.5T MR scanner (GE Medical Systems, Milwaukee, U.S.A.). The average interval of follow-up MR imaging was 7.2 months, and axial T1-weighted and axial and sagittal T2-weighted MR images were obtained. The presence, size number of follicles, and differentiation of the zonal anatomy of the ovary were determined by two radiologists, who reached a consensus. RESULTS: After radiation therapy, all patients ceased menstruation. For ovaries, the detection rates before and after radiation therapy were 94% (62/66) and 39% (26/66) (p<0.05), respectively, and average ovary size was 2.6x1.9x2.2 cm before and 1.7x1.3x1.4 cm after therapy (p<0.05). The average number of ovarian follicles before and after therapy was 5.1 and 3.1, respectively (p<0.05). T2-weighted imaging, demonstrated differentiation of zonal anatomy in 74% of cases (46/62) before radiotheraphy, and 15% (4/26) after (p<0.05). CONCLUSION: Our study has shown that after radiation therapy in premenopausal patients with cervical cancer, detection rates, average size, and the number of ovaries decreased, findings which are similar to those for normal postmenopausal ovary. MR imaging can reveal structural change in ovaries.
Cervix Uteri* ; Consensus ; Female ; Fluconazole ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging* ; Menstruation ; Ovarian Follicle ; Ovary* ; Radiotherapy* ; Uterine Cervical Neoplasms

PURPOSE: With gold electroforming system for the double crown, the secondary crown is electroformed directly onto the primary crown. An even thick layer of high precision can be acquired. It is thought that the retention of electroformed outer crown is primarily acquired by the adhesive force (surface tension) through the saliva which is interposed between precisely fitted inner and outer crown. The purpose of this study was to investigate the effect of taper and surface area of inner crown on the retentive force of electroformed outer crown according to the presence of saliva. MATERIALS AND METHODS: 32 titanium inner crowns with cervical diameter of 8 mm and cone angles of 0, 2, 4, 6 degrees, which had same surface area by regulated height, were machined on a lathe. Another 32 titanium inner crowns with cone angles of 0, 2, 4, 6 degrees, which had doubled surface area by increased cervical diameter, were fabricated. Eight specimens of each group, for a total of 64 titanium inner crowns, were prepared. The electroformed outer crowns were fabricated directly on the inner crowns by using electroforming machine(GAMMAT free, Gramm Technik, Germany). The tertiary frameworks were waxed-up on the electroformed outer crown and cast using nonprecious alloy(Rexillium(R)III, Jeneric(R)/ Pentronh(R) Inc., USA). The cast metal frameworks were sandblasted with alubimium oxides and cemented using resin cement(Superbond C and B, Sun Medical Co., Japan) over the electroformed copings of each specimen. Then, artificial saliva(Taliva(R), Halim Pharm Co., Korea) was sprayed between the inner and outer crown, and they were connected under 5 kg force. The retentive force was measured by the universal testing machine(Tinius Olsen 1000, Tinius Olsen, USA) with a cross-head speed of 66.67 mm/sec. The direction of cross-head travel was exactly aligned with the path of removal of the respective specimens. This measurement procedures for retentive force of electroformed outer crown with artificial saliva were repeated in the same way without presence of artificial saliva. RESULTS AND CONCLUSION: The following conclusions were drawn: 1. The retentive force of electroformed outer crown was decreased according to increased taper of inner crown(P<.05). 2. The retentive force of electroformed outer crown showed no significant differences according to surface area and the presence of artificial saliva(P>.05).
Adhesives ; Crowns* ; Oxides ; Saliva ; Saliva, Artificial ; Solar System ; Titanium

The renal function is under regulatory influence of central nervous system, in which various neurotransmitter and neuromodulator systems take part, and it has been known that kallikrein-kininogen- kinin system exists also in the brain, but its physiological role remains to be explored. This study was, therefore, undertaken to delineate the possible role of central kinin system in the regulation of renal function. Kallikrein given into a lateral ventricle(icv) of rabbit brain in doses ranging from 3 to 30 microgram/kg icv elicited increases in Na excretion and the fraction of filtered sodium excreted(FENa), as well as in urine flow rate. K excretion, however, did not parallel the Na excretion, but tended to decrease when the natriuresis reached its peak. Renal blood flow and glomerular filtration did not significantly change. Neither did free water reabsorption significantly change, but tended to decrease. The systemic blood pressure slightly increased. When 30 microgram/kg kallikrein was given intravenously, all the parameters of renal function and systemic blood pressure did not show any increase but decrease, primarily by decreased renal hemodynamics, resulting from transient hypotension. In experiments in which the plasma ANP was measured, the ANP level markedly increased, reaching more than 5 times the control value 25min after 30 microgram/kg icv, and lasting until the end of the experiment at 80min. The renal nerve activity increased with kallikrein, 30 microgram/kg icv, peaking at 1 min but it remained slightly increased until about 40 min, and then slightly declined. This indicates that the increased renal nerve activity may have antagonized or ameliorated the natriuretic effect of icv kallikrein. Lys-bradykinin(kallidin), a cleavage product from kallidinogen by kallikrein, when given icv in doses of 0.3 to 30 microgram/kg also produced increased Na excretion and diuresis. When CHA, a kallikrein inhibitor, was given icv in doses of 3-30 microgram/kg, elicited antidiuresis and antinatriuresis. However, pretreatment with CHA tended slightly to suppress the kallikrein effect. These results indicate that the central kallikrein- kinin system is involved in the central regulation of renal function, the activation of the system in the CNS resulting in increased natriuresis and diuresis, which are related to increased plasma ANP level, with the possible antagonistic effects of increased renal nerve activity.
Atrial Natriuretic Factor ; Blood Pressure ; Brain ; Central Nervous System ; Diuresis ; Filtration ; Hemodynamics ; Hypotension ; Kallidin* ; Kallikreins* ; Natriuresis ; Natriuretic Agents ; Neurotransmitter Agents ; Plasma ; Renal Circulation ; Sodium ; Water

Calcifying aponeurotic fibroma is a rare benign soft tissue tumor that primarily occurs in children and adolescents and has a strong predilection for the distal portion of the extremities and has a tendency to recur. A case of calcifying aponeurotic fibroma arising in the tip of 2nd digit of right hand of 24-year-old woman was presented. The lesion was solitary, 0.5X0.5cm sized, mildly tender, erythematous papule. Microscopic finding showed poorly circumscribed proliferation of dense fibrous tissue containing epihelioid-like fibroblasts, islands of metaplastic chondroid differentiation with focal calcification.
Adolescent ; Child ; Extremities ; Female ; Fibroblasts ; Fibroma* ; Hand ; Humans ; Islands ; Young Adult

Primary malignant lymphoma of the urinary bladder is extremely rare, and to our knowledge, no case described in the radiologic literature has been accompanied by calcification. We report a case in which the condition was associated with calcification, and describe the pelvic CT and MR imaging findings.
Adult ; Biopsy, Needle ; Bladder/pathology/radiography ; Bladder Neoplasms/complications/*pathology/*radiography ; Calcinosis/complications/*pathology/*radiography ; Fatal Outcome ; Female ; Human ; Lymphoma, T-Cell/complications/*pathology/*radiography ; Magnetic Resonance Imaging/methods ; Tomography, X-Ray Computed/methods