BACKGROUND: This study was designed to examine the interactions between mivacurium and vecuronium when administered during a standardized technique. METHODS: Eighty patients (ASA physical status I or II) were randomly assigned to one of four groups (n=20). Their neuromuscular function was measured in response to ulnar nerve supramaximal square-wave TOF stimulation at 10-sec intervals. After the attainment of a stable baseline neuromuscular response, the patients were randomly assigned to receive a rapid iv bolus of either: (1) 3M group (n=20): mivacurium 0.21 mg/kg. Alone, or (2) 2M1V group (n=20): mivacurium 0.14 mg/kg plus vecuronium 0.05 mg/kg, or (3) 1M2V group (n=20): mivacurium 0.07 mg/kg plus vecuronium 0.10 mg/kg, or (4) 3V group (n=20): vecuronium 0.15 mg/kg alone. The onset time of the neuromuscular block, time of recovery of T1 to 25% and reblock time (the time from the reinjection of vecuronium at the time of recovery of T1 to 25% to the time of recovery of T1 to 25%: T25-25) were measured. The intubating condition was evaluated clinically with a scoring system. RESULTS: The onset of block in the 3M group was 33% slower than in the 3V group. The time durations until 25% recovery in the 2M1V, 1M2V and 3V groups were longer than in the 3M group, and the durations in the 1M2V and 3V groups were longer than in the 2M1V group. The T25-25 reblock times of the 2M1V, 1M2V and 3V groups were prolonged in comparison to that of the 3M group. There was no difference in intubating conditions between any of the groups. CONCLUSIONS: A combination of mivacurium with vecuronium provides rates of onset and duration of block which are more effective than an equivalent dose of mivacuriun alone as an additive reaction.
Anesthesia, General* ; Humans ; Neuromuscular Blockade* ; Ulnar Nerve ; Vecuronium Bromide*

BACKGROUND: Hepatocyte growth factor (HGF) is a potent mitogenic cytokine. C-met protein, which is known to be the HGF receptor has transmembrane tyrosine kinase activity and is encoded by the c-met oncogene. The HGF/c-met signaling pathway may play various roles in the carcinogenesis of various organs. METHODS: We examined HGF and c-met mRNA expression by utilizing reverse transcription polymerase chain reaction on 40 surgically resected intracranial meningiomas (25 benign, 10 atypical, and 5 anaplastic cases). RESULTS: An HGF overexpression was detected in 28%, 50%, and 80% of the benign, atypical and anaplastic meningiomas, respectively; a high expression of HGF or the coexpression of HGF/c-met was detected in the high grade meningiomas (the atypical and anaplastic cases, p=0.046, p=0.014). An HGF expression was statistically significant in the recurrent meningiomas (p=0.003), and HGF expression was significantly lower than c-met mRNA expression in benign meningiomas (p=0.034). CONCLUSIONS: There was no correlation between histologic subtypes and HGF/c-met expression. Determination of HGF expression can be used as a molecular predictor for recurrence of meningioimas. These results suggest that HGF and c-met expression in meningiomas may be associated with anaplastic progression.
Hepatocyte Growth Factor ; Hepatocytes ; Meningioma ; Neoplasm Recurrence, Local ; Oncogenes ; Polymerase Chain Reaction ; Protein-Tyrosine Kinases ; Proto-Oncogene Proteins c-met ; Recurrence ; Reverse Transcription ; RNA, Messenger

OBJECTIVE: To evaluate correlation of preoperative anemia with clinical outcomes in patients with early stage cervical cancer who were treated with radical hysterectomy and lymph node dissection. METHODS: Patients who underwent radical hysterectomy and lymph node dissection for cervical cancer from January 2001 to February 2012 were included in this study. Clinicopatholgoical factors included in univariate and multivariate analysis were age, tumor histology, FIGO (International Federation of Gyneocology and Obstetrics) stage, preoperative hemoglobin, depth of invasion, tumor size, parametrial involvement, resection margin, and lymph node status. RESULTS: A total of 387 patients were retrospectively analyzed in this study; 141 patients (36.4%) had preoperative anemia (hemoglobin <12 g/dL) and 16 out of 141 patients (11.3%) received blood transfusion for correction of preoperative anemia. Patients with preoperative anemia showed significant association with age <50 years, more advanced stage, non-squamous cell carcinoma histology, larger tumor size, deeper stromal invasion, and lymph node metastasis (P<0.05). Both relapse-free survival and overall survival were worse in patients with preoperative anemia in univariate analysis. In multivariate analysis, overall survival was worse in patients with preoperative anemia, but relapse-free survival was not associated with preoperative anemia. In the intergroup analysis of anemic patients for the effect of preoperative blood transfusion, preoperative anemia correction did not affect survival. CONCLUSION: Preoperative anemia was not an independent prognostic factor for survival in patients with early cervical cancer. However, it was associated with poor prognostic factors. Further study in large population is needed.
Anemia* ; Blood Transfusion ; Humans ; Hysterectomy ; Lymph Node Excision ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Retrospective Studies ; Uterine Cervical Neoplasms*

Paranasal sinus mucocele is a slowly expanding benign lesion which can occur as a result of obstruction in the sinus ostium or ostial tract. Frontal sinus mucocele differ from mucoceles of other sinuses in that the frontal outflow tract is usually narrower and less accessible. Since the introduction of endoscopic sinus surgical instrument and techniques, there has been an increasing trend towards the use of endoscopic transnasal technique for managing the paranasal sinus mucoceles. Some studies also recommend the use of intrafrontal stent to reduce the rate of restenosis of frontal sinus outflow tract. We experienced a case of recurrent frontal sinus mucocele complicated by visual disturbance and periorbital swelling. To treat this condition, an intranasal marsupialization was performed and an intrafrontal stent was applied. This paper reports the particulars of this case with a review of related literature.
Frontal Sinus* ; Mucocele* ; Stents* ; Surgical Instruments

Sclerosing stromal tumor (SST) was first delineated as a distinct ovarian sex cord stromal tumor in 1973 by Chalvardjian and Scully. It is a benign neoplasm, distinguished from other ovarian stromal tumors by the production of collagen and a pseudolobular pattern, and it tends to occur in the second and third decades of life in diagnosed patients. We discovered two rare cases of SST in post-menopausal women which are the topic of this report. These case studies are accompanied by a brief review of the literature.
Collagen ; Female ; Humans ; Menopause ; Ovarian Neoplasms ; Ovary* ; Sex Cord-Gonadal Stromal Tumors

Incidences of blowout fractures have increased due to rapid industrialization and rise in violent crimes. However, there have been few studies on the proper follow-up guidelines or protocol after reduction of the orbital wall for patients working in a high atmospheric pressure environment. We have experienced a pilot with an orbital medial wall fracture who underwent reduction through an endoscopic approach. The patient underwent the Valsalva maneuver and scan of paranasal sinuses 8 weeks after reduction. Emphysema did not occur in the orbit even after the Valsalva maneuver and he was able to return to his workplace without any complications. We report this case with a brief review of the literature.
Atmospheric Pressure ; Crime ; Emphysema ; Follow-Up Studies ; Humans ; Incidence ; Orbit ; Paranasal Sinuses ; Valsalva Maneuver ; Industrial Development

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Reinke's edema begins with a chronic diffuse edema on the surface of the lamina propria of the vocal folds. It frequently occurs in women, smokers, professional voice users, and in patients with gastroesophageal reflux disease. Herein, we report the case of a patient who experienced ventilation difficulties during general anesthesia using positive pressure mask ventilation.
Airway Management* ; Airway Obstruction ; Anesthesia, General ; Edema* ; Female ; Gastroesophageal Reflux ; Humans ; Masks ; Mucous Membrane ; Ventilation ; Vocal Cords ; Voice

BACKGROUND AND OBJECTIVES: Tuberculous cervical lymphadenitis is a clinically common cervical inflammatory disease. But there are controversies in the management in spite of high prevalence. The aim of this study was to investigate proper treatment modality, such as antituberculous chemotherapy and surgery. SUBJECTS AND METHOD: The study was based on a retrospective chart review in 65 patients with tuberculous cervical lymphadenitis who were treated between January 2001 and May 2005 at Gachon University Gil Medical Center, Incheon, Korea. We have studied clinical manifestations, characteristics of the neck masses, diagnostic approach, radiologic finding, treatment modality, treatment response, and prognosis. RESULTS: Females were more affected, by about three fold, than males and the prevalence rate was higher in younger patients ranging from 20 to 30. The diagnosis was made over 89% with the initial tests such as FNAB, AFB stain and tuberculous PCR. The successful treatment rate just with anti-tuberculous medication was 90.6%. Especially, in the patients with abscess formation, treatment was successful in 90% only with anti-tuberculous medication. Seventeen cases were treated with medication and surgical management. These patients underwent selective neck dissection or mass excision to remove the entire lesion and there were no recurrence. CONCLUSION: Tuberculous lymphadenitis can be managed well just with anti-tuberculous medication. But, if local symptoms get worse even though the patient is under medical treatment, early surgical treatment is needed. The important thing is to remove the entire lesion when the surgical treatment must be taken.
Abscess ; Diagnosis ; Drug Therapy ; Female ; Humans ; Incheon ; Korea ; Lymphadenitis* ; Male ; Neck ; Neck Dissection ; Polymerase Chain Reaction ; Prevalence ; Prognosis ; Recurrence ; Retrospective Studies ; Tuberculosis, Lymph Node

Unexpected displacement of a dental implant into the maxillary sinus is an unusual but potential complication in dental procedure. A dental implant that migrates into the maxillary sinus often develops paranasal sinusitis and cause diverse peri-implant soft tissue complications. A 59-year-old man complaining of nasal obstruction for several months presented with a huge polypoid mass in the nasal cavity. He had undergone a dental implant procedure in the maxilla at a dental clinic seven years ago. The implant fixture was found displaced to the maxillary sinus. The migrated fixture and nasal mass were removed by endonasal endoscopic surgery and mini Caldwell-Luc operation. The pathology was diagnosed as an inverted papilloma. To our knowledge, this is the first case reported in the literature regarding a dental implant complication that developed independently of sinonasal inverted papilloma.
Dental Clinics ; Dental Implants ; Displacement (Psychology) ; Maxilla ; Maxillary Sinus ; Nasal Cavity ; Nasal Obstruction ; Papilloma, Inverted ; Sinusitis