PURPOSE: Although central obesity is a risk factor for erosive esophagitis, information regarding the association between central obesity and non-erosive reflux disease (NERD) is still scarce. The purpose of this study was to investigate the risk factors for NERD by comparing NERD patients and healthy controls. MATERIALS AND METHODS: Comprehensive clinical data from 378 patients who underwent esophagogastroduodenoscopy from December 2012 to May 2013 and had no visible esophageal mucosal breakage were analyzed. The Korean version of GerdQ questionnaire was used to diagnose NERD. The association between central obesity and NERD was assessed after matching subjects according to propensity scores. RESULTS: There were 119 NERD patients and 259 controls. In multivariate analysis, central obesity, female gender, and younger age were significantly associated with NERD [odds ratio (OR)=2.55, 1.93, and 1.80; p=0.001, 0.005, and 0.011, respectively]. After adjusting for 12 clinical variables using propensity score matching, 114 NERD patients were matched to 114 controls. All variables were well balanced between the two groups (average D before matching: 0.248, after matching: 0.066). Patients with NERD were more likely to have central obesity than healthy controls (28.1% vs. 7.9%). After adjusting for propensity scores and all covariates in multivariable logistic regression analyses, central obesity was still found to be a significant risk factor for NERD (OR=4.55, p<0.001). CONCLUSION: Central obesity appears to be an independent risk factor for NERD. This result supports the presence of an association between GERD and central obesity, even in the absence of esophageal erosion (NERD).
Endoscopy, Digestive System ; Esophagitis ; Female ; Gastroesophageal Reflux ; Humans ; Logistic Models ; Multivariate Analysis ; Obesity, Abdominal* ; Propensity Score ; Risk Factors*

The occurrences of thyrotoxicosis in patients with myasthenia gravis have been reported before the knowledge of the pathogenesis of the two disease. Thytotoxicosis is known to occur in 3 to 6 percent of patients with myasthenia gravis and myasthenia gravis occurs in only a fraction of 1 percent of the thyrotoxic populatian. Myasthenia gravis is currently considered as a systemic autoimmune disorder of acetylcholine receptor and often presented with other autoimmune diseases such as SLE, Rheumatoid arthritis. We experienced a 18-year-old woman who presented with graves disease and isolated ocular myasthenia gravis. Chest CT didnot reveal enlarged thymus. The usual treatement of myasthenia gravis associated with thymtoxicosis consists of medical control of the thyrotoxicosis, then thymectomy and later subtotal thyroidectomy. Her ptosis and thyrotoxicosis have improved after the medicatian of anticholinesterase and propylthiourecil. A case of ocular myasthenia gravis with Gravesdisease was experienced, so we reported the case with a brief review of literature.
Acetylcholine ; Adolescent ; Arthritis, Rheumatoid ; Autoimmune Diseases ; Female ; Graves Disease ; Humans ; Myasthenia Gravis ; Thymectomy ; Thymus Gland ; Thyroidectomy ; Thyrotoxicosis ; Tomography, X-Ray Computed

PURPOSE: The surgical treatment of anal stenosis includes internal sphincterotomy, rotaton flap and advancement flap according to the stenosis degree, recently, Christensen performed house shaped advancement flap and reported fair results. We compared and analyzed the surgical methods and results in patients with moderate and severe anal stenosis who underwent house shaped advancement flap and C-anoplasty. METHODS: We have performed this study with 6 cases using the house shaped advancement flap and 6 cases using the C-anoplasty. The out come was assessed by clinical characteristics, surgical method, operation time, duration of hospitalization, healing time, postoperative complications, results. RESULTS: The average operation time was 38 min in those house shaped advancement flap cases and 63 min in C-anoplasty cases. The average time of hospitalization was 6 days and 9 days, respectively, and the average time of healing was 28 days and 46 days, respectively. In those house advancement flap cases, surgery could be done in 2 directions at the same time in 4 cases and 3 directions in 2 cases; as for those C-anoplasty cases, surgery could be done in 1 direction in 4 cases and 2 directions in 1 case. Two complications were observed in C-anoplasty, one flap infection and one flap necrosis, and in house shaped advancement flap, no complication was observed. CONCLUSIONS: House shaped advancement flap have several advantages compared to the C-anoplasty, and since house shaped advancement flap could be performed in 2 to 3 directions or even 4 directions at the same time, the anus could sufficiently expanded in severe anal stenosis patients. The house shaped advancement flap might be one of the good method in treating anal stenosis.
Anal Canal ; Constriction, Pathologic* ; Hospitalization ; Humans ; Necrosis ; Postoperative Complications

BACKGROUND: It has been known that a patient head in sniffing position for lightwand facilitated tracheal intubation is not an anatomically appropriate method. However, there is no evidence nor study whether it is true or not. In this study, we compared success rates of lightwand facilitated tracheal intubation in neutral position versus sniffing position. METHODS: With informed consent, sixty adult patients of ASA physical status I or II were randomly allocated into two groups: neutral position (N) or sniffing position (S) group. A lightwand and tube were bent at approximately a 90degrees degree angle for N group and a 60 degree angle for S group on the basis of mouth axis and pharyngeal axis. The time to intubation, success rates of 1st trial of intubation, overall intubation success rates, hemodynamic changes and complications during the procedure were recorded. RESULTS: There was no significant difference in the time to intubation, success rates of 1st trial of intubation, overall intubation success rates, hemodynamic changes and complications between neutral position and sniffing position groups. CONCLUSIONS: Success rates of lightwand facilitated tracheal intubation in neutral position versus sniffing position showed no significant difference. Therefore, both positions are suitable for lightwand assisted intubation.
Adult ; Axis, Cervical Vertebra ; Head* ; Hemodynamics ; Humans ; Informed Consent ; Intubation* ; Mouth

BACKGROUND: It has been known that a patient head in sniffing position for lightwand facilitated tracheal intubation is not an anatomically appropriate method. However, there is no evidence nor study whether it is true or not. In this study, we compared success rates of lightwand facilitated tracheal intubation in neutral position versus sniffing position. METHODS: With informed consent, sixty adult patients of ASA physical status I or II were randomly allocated into two groups: neutral position (N) or sniffing position (S) group. A lightwand and tube were bent at approximately a 90degrees degree angle for N group and a 60 degree angle for S group on the basis of mouth axis and pharyngeal axis. The time to intubation, success rates of 1st trial of intubation, overall intubation success rates, hemodynamic changes and complications during the procedure were recorded. RESULTS: There was no significant difference in the time to intubation, success rates of 1st trial of intubation, overall intubation success rates, hemodynamic changes and complications between neutral position and sniffing position groups. CONCLUSIONS: Success rates of lightwand facilitated tracheal intubation in neutral position versus sniffing position showed no significant difference. Therefore, both positions are suitable for lightwand assisted intubation.
Adult ; Axis, Cervical Vertebra ; Head* ; Hemodynamics ; Humans ; Informed Consent ; Intubation* ; Mouth

BACKGROUND: Elevation of intubating laryngeal mask airway (ILMA) handle increase the efficacy of the seal by pressing the cuff more firmly into the periglottic tissues and many clinicians apply an upward force to ILMA handle during blind intubation. In this study, we compared the first intubation success rate through ILMA during intubation with or without handle elevation. METHODS: With informed consent, fifty adult patients of ASA physical status I or II were selected. After insertion of ILMA size 4, optimal ventilation was established by slightly rotating the device in the sagittal plane, using the metal handle, until the least resistance to bag ventilation is achieved. Ventilation grade and fiberoptic bronchoscopic view were evaluated at the proper position. Intubation using ILMA was limited to first attempt regardless of successful tracheal intubation. After intubated tube was removed, ILMA was slightly elevated away from the posterior pharyngeal wall using the metal handle, and ventilation grade with fiberoptic bronchoscopic view were evaluated, then intubation was proceeded. Success rates of both methods on the first attempt were calculated. RESULTS: Ventilation grade and fiberoptic bronchoscopic view had no significant differences under the intubation using ILMA with or without handle elevation. Success rates of intubation on the first attempt with and without handle elevation were 78% and 82%. Therefore both methods had no significant differences. CONCLUSIONS: Blind tracheal intubation using ILMA with handle elevation is not necessary to get higher intubation success rates on the first attempt. Finding proper ventilation position and technical experience are required for successful blind tracheal intubation using ILMA.
Adult ; Humans ; Informed Consent ; Intubation* ; Laryngeal Masks* ; Ventilation

Brugada syndrome is an arrhythmogenic disease that is manifested by specific patterns of right bundle branch block with ST elevation in right precordial (V1-V3) ECG leads causing ventricular fibrillation, leads to a sudden death without organic heart problems. It is an incomplete penetrating autosomal dominant disease that is due to mutation in SCN5A gene, coding for Na+ channel of cardiac muscles. This syndrome is more common and may be endemic in southeast Asia. Although it is a highly risky disease, it's preventive treatment for arrhythmia has not been established yet. We experienced a case of 28 year old man who had wedge resection of lung because of spontaneous pneumothorax under general anesthesia and who was suspected Brugada syndrome based on specific ECG patterns and a family history of his father's sudden death after syncope.
Adult ; Anesthesia, General ; Arrhythmias, Cardiac ; Asia, Southeastern ; Brugada Syndrome* ; Bundle-Branch Block ; Clinical Coding ; Death, Sudden ; Electrocardiography ; Heart ; Heart Arrest ; Humans ; Lung ; Myocardium ; Pneumothorax ; Syncope ; Ventricular Fibrillation

A 13-year-old girl was admitted with massive hemoptysis and hematemesis. An estimated volume was about 400 cc. The blood was frothy and mixed with sputum and food. She had no history of epistaxis, choking, joint pain or trauma. Her vital sign was stable and physical examination was normal except for bilateral crackles and ronchi on auscultation of the lungs. Laboratory data on arrival including blood counts, liver enzyme, urinalysis and electrolytes were all normal. Chest CT showed bilateral extensive centrilobular ground glass opacity nodules and there were suspicious blood clots in the right bronchus. There was no evidence of pleural effusion, increased vascular markings, abscess or brochiectasis. We performed an upper GI endoscopy and bronchoscopy, it was all normal. On cytology from bronchoalveolar lavage, cell count was 1,660/microL with 63% of macrophages laden with erythrocytes and 35% lymphocytes. Tuberculosis PCR from this fluid was negative and AFB stain, Gram stains were all negative. She has had a second attack on day seven, emergency bronchial angiography was performed. There was dysplastic bronchial artery with a tortuous change, shunting to the pulmonary artery. Bronchial artery embolization was performed successfully using embolization particles. Follow-up blood counts, electrolytes and chest radiogram were all normal. There was no further episode of hemoptysis twelve months after embolization.
Abscess ; Adolescent ; Airway Obstruction ; Angiography ; Arthralgia ; Auscultation ; Bronchi ; Bronchial Arteries* ; Bronchoalveolar Lavage ; Bronchoscopy ; Cell Count ; Child ; Coloring Agents ; Electrolytes ; Emergencies ; Endoscopy ; Epistaxis ; Erythrocytes ; Female ; Follow-Up Studies ; Glass ; Hematemesis ; Hemoptysis* ; Humans ; Liver ; Lung ; Lymphocytes ; Macrophages ; Physical Examination ; Pleural Effusion ; Polymerase Chain Reaction ; Pulmonary Artery* ; Respiratory Sounds ; Sputum ; Thorax ; Tomography, X-Ray Computed ; Tuberculosis ; Urinalysis ; Vital Signs

Vasovagal syncope is elicited by the Bezold-Jarisch reflex, triggered by anxiety, emotional stress or pain. It is the result of reflexively increasing parasympathetic tone and decreasing sympathetic tone sensed by chemoreceptor in vagus nerve and mechanoreceptor of ventricle, which causes bradycardia, systemic vasodilatation and profound hypotension. Although it is a transient episode in many cases, it could give rise to cardiac arrest. Diabetic autonomic neuropathy can lead to significant change in blood pressure and pulse rate, bradycardia, hypotension, and even cardiac arrest by increasing the risk of hemodynamic instability under general or regional anesthesia. We have experienced a patient who had once cardiac arrest following after positional change and recovered in a few minutes. The patient was supposed to have diabetic autonomic neuropathy under the emotional stress and anxiety before spinal anesthesia was done. We believe that this is the result of combination between paradoxical Bezold-Jarisch reflex caused by overactivation of parasympathetic nerve system and autonomic nervous system instability precipitated by diabetic autonomic neuropathy.
Anesthesia, Conduction ; Anesthesia, Spinal* ; Anxiety ; Autonomic Nervous System ; Blood Pressure ; Bradycardia ; Death, Sudden, Cardiac* ; Diabetic Neuropathies ; Heart Arrest ; Heart Rate ; Hemodynamics ; Humans ; Hypotension ; Mechanoreceptors ; Reflex ; Stress, Psychological ; Syncope, Vasovagal ; Vagus Nerve ; Vasodilation

BACKGROUND: Sevoflurane anesthesia is associated with emergence agitation in children. In this study, we compared the emergence and recovery profiles of children who received sevoflurane with fentanyl or alfentanil for inguinal herniorrhaphy. METHODS: Forty-five children receiving sevoflurane anesthesia for inguinal herniorraphy were assigned to three groups. Saline 0.1 ml/kg (group S), alfentanil 10microgram//kg (group A) or fentanyl 1microgram//kg (group F) was administered intravenously at the beginning of fascia closure. Duration of operation and anesthesia and emergence time were evaluated at the operating room. Agitation score, a degree of pain, the time of stay in PACU (postanesthetic care unit) and postoperative side effects were evaluated by a blinded observer at the PACU. RESULTS: The emergence time was prolonged in the group F compared to the other groups. The time of stay in PACU was prolonged in the group F compared to the group S. Group A and F had lower agitation score and pain score in comparison with that of the group S at the 0, 5, 10, 15 min in the PACU. Agitation score was also significantly lower in the group F compared to the group A at 30 min. CONCLUSIONS: We suggest that intravenous administration of alfentanil 10microgram//kg or fentanyl 1microgram//kg at the closure of fascia could effectively reduce the agitation score. Alfentanil also does not delay from emergence and the time of stay in the PACU.
Administration, Intravenous ; Alfentanil* ; Anesthesia* ; Child* ; Dihydroergotamine* ; Fascia ; Fentanyl ; Herniorrhaphy ; Humans ; Operating Rooms