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*

Sclerosing mesenteritis is a rare disease presenting as chronic inflammation and fibrosis of mesentery around the small and large intestine. And in most cases, it shows indolent and benign clinical course resulting in favorable prognosis. It is often diagnosed through characterized radiologic finding in abdominal examinations including computed tomography scan. However, it is important to rule out other conditions involving mesentery when diagnosing sclerosing mesenteritis. In the case of malignancy, the method of treatment and prognosis can be completely different therefore thorough examinations are essential. We herein report a 75-year-old male who suffered from frequent diarrhea and weight loss. Initially, he was diagnosed with sclerosing mesenteritis through abdominal computed tomography scan showing "misty" soft-tissue attenuation around the mesenteric vessel. However, follow up positron emission tomography scan and biopsy finding confirmed the common bile duct cancer with lymph node metastasis.
Aged ; Biopsy ; Cholangiocarcinoma* ; Common Bile Duct ; Diarrhea ; Fibrosis ; Follow-Up Studies ; Humans ; Inflammation ; Intestine, Large ; Lymph Nodes* ; Male ; Mesentery ; Methods ; Neoplasm Metastasis* ; Panniculitis ; Panniculitis, Peritoneal* ; Positron-Emission Tomography ; Prognosis ; Rare Diseases ; Weight Loss

Sclerosing mesenteritis is a rare disease presenting as chronic inflammation and fibrosis of mesentery around the small and large intestine. And in most cases, it shows indolent and benign clinical course resulting in favorable prognosis. It is often diagnosed through characterized radiologic finding in abdominal examinations including computed tomography scan. However, it is important to rule out other conditions involving mesentery when diagnosing sclerosing mesenteritis. In the case of malignancy, the method of treatment and prognosis can be completely different therefore thorough examinations are essential. We herein report a 75-year-old male who suffered from frequent diarrhea and weight loss. Initially, he was diagnosed with sclerosing mesenteritis through abdominal computed tomography scan showing "misty" soft-tissue attenuation around the mesenteric vessel. However, follow up positron emission tomography scan and biopsy finding confirmed the common bile duct cancer with lymph node metastasis.
Aged ; Biopsy ; Cholangiocarcinoma* ; Common Bile Duct ; Diarrhea ; Fibrosis ; Follow-Up Studies ; Humans ; Inflammation ; Intestine, Large ; Lymph Nodes* ; Male ; Mesentery ; Methods ; Neoplasm Metastasis* ; Panniculitis ; Panniculitis, Peritoneal* ; Positron-Emission Tomography ; Prognosis ; Rare Diseases ; Weight Loss

We have recently encountered a case of Kasabach-Merritt syndrome which was characterized by hemangioma, thrombocytopenia, and Disseminated Intravascular Coagulation. The baby was delivered at 35 weeks gestation. A large hemangioma covered right forearm. He received interferon alfa-2a for 120 days after 20 day steroid treatment failure. Blood platelet count increased to acceptable range (>20,000/mm3) after 8weeks of interferon alfa-2alpha treatment and the size of hemangioma decreased.
Disseminated Intravascular Coagulation ; Forearm ; Hemangioma ; Interferons* ; Kasabach-Merritt Syndrome* ; Platelet Count ; Pregnancy ; Thrombocytopenia ; Treatment Failure

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

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

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: 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

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