Succinylcholine (Sch) has long been used to facilitate laryngoscopy and endotracheal intubation for general anesthesia, because of a rapid onset of intense but brief paralysis. However, exaggerated potassium (K+) release following Sch, sufficient to cause ventricular dysrhythmias and cardiac arrest, has sporadically been reported in susceptible conditions, including spinal cord injury, severe burn, massive trauma and neuromuscular disorder. And diazepam has been shown to attenuate the increase in serum K+ following Sch administration. The purpose of this study was to assess the effect of Sch on serum K+ in patients with spinal cord lesions, and to assess the effect of pretreatment with diazepam (0.05 mg/kg IV) on potassium flux. The results were as follows: 1) Baseline K+ values were not significantly different among the groups. 2) The time to peak increases in K+ was 3 minutes following Sch in all groups. 3) The magnitude of maximum increases in K' following Sch were 0.32 Eq/l, 0.63 mEq/l, 0.06 mEq/I and 1,10 mEq/I in group 1, group 2A, group 2B, and group 3, respectively. 4) Diazepam pretreatment attenuated the increases in K+ following Sch. From the above results, it can be concluded that Sch may safely be used to facilitate intubation in paraplegic patients, provided that they are normokalemic and pretreated with diazepam.
Anesthesia, General ; Burns ; Diazepam ; Heart Arrest ; Humans ; Hypnotics and Sedatives ; Intubation ; Intubation, Intratracheal ; Laryngoscopy ; Paralysis ; Potassium* ; Spinal Cord Injuries ; Spinal Cord* ; Succinylcholine*

Purpose: Patients with respiratory failure associated with neurological dysfunction often require mechanical ventilator support, which poses increased economic burden and ventilator-associated complications. A diaphragm pacing system (DPS) is an implanted device that provides respiratory support for such patients. In this systematic review, we reviewed the literature to assess the safety and efficacy of DPS for patients with respiratory failure resulting from amyotrophic lateral sclerosis (ALS) or cervical spinal cord injuries. Materials and Methods: The following databases were searched from July 10 to July 30, 2018: MEDLINE, EMBASE, Cochran library, KoreaMed, Research Information Sharing Service, Korean studies Information Service System, Korea Institute of Science and Technology Information, and Korean Medical database. The abstracts and full texts of the searched articles were reviewed by two reviewers. Results: The search keywords generated 197 articles: two randomized controlled trials, two case-control studies, and one case report involving patients with ALS; one cohort study, one case-control study, and two case reports involving patients with cervical spine injury; and one case report involving patients with both conditions were included. The primary outcome was safety profile (complications and adverse event) and efficacy (overall survival and sleep improvement). Complications and adverse events were more common in patients with ALS and spinal cord injury receiving DPS than in controls. Efficacy outcomes were inconsistent across ALS studies. Conclusion Based on safety and efficacy results, we do not support using DPS to manage respiratory failure in patients with ALS or cervical spine injury.

PURPOSE: To compare chest radiographic findings of pulmonary tuberculosis in non-AIDS immunocom- promised adult patients with those in immunocompetent patients. MATERIAL AND METHOD: Eighty six patients who had pulmonary tuberculosis were included in the study. Of these, 41 were non-AIDS immunocompromised adult patients and 45 were immunocompetent adult patients. Chest radiographs obtained from 86 patients were retrospectively evaluated with regard to the followings ;the anatomic distribution and extent of tuberculous lesions, typical or atypical patterns of radiographic findings. We then compared the results in non-AIDS immunocompromised adult patients with those in immunocompetent adult patients. RESULTS: The characteristic manifestation of pulmonary tuberculosis was a tendency of pulmonary lesions to localize in the apico-posterior segments of the upper lobe and the superior segment of the lower lobe in both groups but more wide distribution such as the anterior segment and the lingular segment of the upper lobe and the basal segments of the lower lobe was frequently identified in non-AIDS immunocompromised adult patients, and also bilateral, multisegmental and multilobular extents were common findings. in immunocompetent adult patients, more common findings were in local exudative and productive lesions and several cavities in preferential sites. Atypical plain radiographic findings were more common in non-AIDS immunocompromised adult patients, and which were multiple cavitary lesions, wide extent of bronchogenic spread and tuberculous pneumonia, and .miliary disseminations and mass like lesions. CONCLUSIONS: Pulmonary tuberculosis in non-AIDS immunocompromised adult patients is characterized by frequent bilateral distribution, wide pulmonary extent, and atypical radiographic findings.
Adult* ; Humans ; Pneumonia ; Radiography, Thoracic ; Retrospective Studies ; Tuberculosis, Pulmonary*

PURPOSE: To compare, with the use of chest radiographic findings, improvement and complications in newborns treated with exogenous surfactant for hyaline membrane disease(HMD), and an untreated control group. MATERIALS AND METHODS: Thirty-six patients with HMD were randomly assigned to a control group (n=18) or surfactant treated group (n=18). As part of an initial evaluation of their pulmonary status, we then performed a retrospective statistical analysis of chest radiographic findings obtained in exogenous surfactant treated and untreated infants within the first 90 minutes of life. Subsequent examinations were performed at less than 24 hours of age. RESULTS: Chest radiograph before treatment showed no significant differences between the two groups, but significant improvement was noted in the surfactant treated group, in contrast to the control group. The most common chest radiographic finding after surfactant administration was uniform (n=15) or disproportionate (n=2) improvement of pulmonary aeration. Patent ductus arteriosus developed in three treated neonates and in four cases in the control group. Air leak occurred in three cases in the treated group and in five cases in the control group. In one treated patient pulmonary hemorrhage developed and intracranial hemorrhage occurred in three treated neonates and in four cases in the control group. Bronchopulmonary dysplasia was developed in 6 cases of treated group and 3 cases of control group. CONCLUSION: A chest radiograph is considered to be helpful in the evaluation of improvement and complications of HMD in infants treated with surfactant.
Bronchopulmonary Dysplasia ; Ductus Arteriosus, Patent ; Hemorrhage ; Humans ; Hyalin* ; Hyaline Membrane Disease* ; Infant ; Infant, Newborn ; Intracranial Hemorrhages ; Membranes ; Radiography, Thoracic ; Retrospective Studies

BACKGROUND: The Glidescope Videolaryngoscope (GVL) is a newly developed video laryngoscope. It offers a significantly improved laryngeal view and facilitates endotracheal intubation in difficult airways, but it is controversial in that it offers an improved laryngeal view in normal airways as well. And the price of GVL is expensive. We hypothesized that intubation carried out by fully experienced anesthesiologists using the GVL with appropriate pre-anesthetic preparations offers an improved laryngeal view and shortened intubation time in normal airways. Therefore, the aim of this study was to compare the GVL with the Macintosh laryngoscope in normal airways and to determine whether GVL can substitute the Macintosh laryngoscope. METHODS: This study included 60 patients with an ASA physical status of class 1 or 2 requiring tracheal intubation for elective surgery. All patients were randomly allocated into two groups, GVL (group G) or Macintosh (group M). ADS (airway difficulty score) was recorded before induction of anesthesia. The anesthesiologist scored vocal cord visualization using the percentage of glottic opening (POGO) visible and the subjective ease of intubation on a visual analogue scale (VAS). The time required to intubate was recorded by an assistant. RESULTS: There was a significant increase in POGO when using the GVL (P < 0.05). However, there was no difference in the time required for a successful tracheal intubation using the GVL compared with the Macintosh laryngoscope. The VAS score on the ease of intubation was significantly lower for the GVL than for the Macintosh laryngoscope (P < 0.05). CONCLUSIONS: GVL could be a first-line tool in normal airways.
Anesthesia ; Humans ; Intubation ; Intubation, Intratracheal ; Laryngoscopes ; Vocal Cords

A 46-year-old man had noticed an asymptomatic, small, yellowish, papular eruption on the scalp about one year ago. Since then, the lesions had slowly increased in size and number. There was no family history of similar lesions. An incision made into the cysts discharged oily yellow material. Biopsy of a lesion disclosed that the cysts had typical features of steatocystoma multiplex histologically. This case was a unique eruptive variety of steatocystoma multiplex on the scalp.
Biopsy ; Humans ; Middle Aged ; Scalp* ; Steatocystoma Multiplex*

OBJECTIVE: Emergency department (ED) visits by nonurgent patients are controversial because they are considered one of the causes of ED overcrowding and an example of the improper use of medical resources. On the other hand, some non-urgent patients do require hospitalization. The purpose of this study was to compare hospitalized and discharged patients who were classified as nonurgent upon their initial ED visit and identify the predictive factors associated with hospitalization in nonurgent patients visiting an ED. METHODS: Among a nonurgent patient group visiting an urban university hospital ED in 2016, the hospitalized and discharged patients were compared. RESULTS: A total of 13,988 nonurgent patients were analyzed, of which 773 (5.5%) were hospitalized. The predictive factors related to hospitalization for nonurgent patients were as follows: male, age 65 years or older, ED visits during outpatient clinic availability, and in the evening, heart rate greater than 100 per minute, respiration rate greater than 20 per minute and body temperature over 38℃ CONCLUSION: Among nonurgent patients, there are patients who require hospitalization. If these predictive factors are considered in the initial ED triage, it should improve the safe treatment of nonurgent patients and improve the efficiency of the use of limited resources.
Ambulatory Care Facilities ; Body Temperature ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital* ; Hand ; Heart Rate ; Hospitalization* ; Hospitals ; Humans ; Male ; Respiratory Rate ; Triage

Background: Pediatric trigger digit (TD) does not appear at birth but is diagnosed after birth by finding a flexion contracture of the thumb or other fingers. The reported incidence of pediatric TDs varies from 0.5 to 5 cases per 1,000 live births without sex-specific predominance. We performed a nationwide large-scale study to determine the prevalence and incidence of pediatric TDs and analyzed operative treatment for pediatric TDs using the National Health Insurance data of South Korea. Methods: Patients with pediatric TDs, aged 0–10 years between 2011 and 2020, were included in this study. Children born between 2011 and 2015 were set as the reference population and followed up until 2020. We calculated the prevalence and incidence rates of pediatric TDs according to age and sex and analyzed the operation rate, age at surgery, time interval from initial diagnosis to surgery, and follow-up period. Patient selection and treatment were based on International Classification of Diseases, 10th Revision (ICD-10). Results: The prevalence rates of pediatric TDs ranged from 0.063% to 0.084%. Girls had a higher prevalence rate (0.066%–0.094%) than boys (0.060%–0.075%). The total incidence rate was 77.6/100,000 person-years, and the incidence rate was higher in girls (84.8) than in boys (70.7). Among 2,181,814 children born between 2011 and 2015, 12,729 were diagnosed with pediatric TDs, of which 1,128 (8.9%) underwent operative management. The means of age at initial diagnosis, age at surgery, and the time interval between diagnosis and operation were 2.76 ± 1.91 years, 3.79 ± 2.19 years, and 1.15 ± 1.71 years, respectively. Conclusions High prevalence and incidence rates of pediatric TDs were found in 2- to 3-year-old patients. Among pediatric patients, 8.9% underwent operative management that was most frequently conducted between 2 and 3 years of age (within 1 year of initial diagnosis).

BACKGROUND: Nefopam has been known as an inhibitor of the reuptake of monoamines, and the noradrenergic and/or serotonergic system has been focused on as a mechanism of its analgesic action. Here we investigated the role of the spinal dopaminergic neurotransmission in the antinociceptive effect of nefopam administered intravenously or intrathecally. METHODS: The effects of intravenously and intrathecally administered nefopam were examined using the rat formalin test. Then we performed a microdialysis study to confirm the change of extracellular dopamine concentration in the spinal dorsal horn by nefopam. To determine whether the changes of dopamine level are associated with the nefopam analgesia, its mechanism was investigated pharmacologically via pretreatment with sulpiride, a dopaminergic D2 receptor antagonist. RESULTS: When nefopam was administered intravenously the flinching responses in phase I of the formalin test were decreased, but not those in phase II of the formalin test were decreased. Intrathecally injected nefopam reduced the flinching responses in both phases of the formalin test in a dose dependent manner. Microdialysis study revealed a significant increase of the level of dopamine in the spinal cord by intrathecally administered nefopam (about 3.8 fold the baseline value) but not by that administered intravenously. The analgesic effects of intrathecally injected nefopam were not affected by pretreatment with sulpiride, and neither were those of the intravenous nefopam. CONCLUSIONS: Both the intravenously and intrathecally administered nefopam effectively relieved inflammatory pain in rats. Nefopam may act as an inhibitor of dopamine reuptake when delivered into the spinal cord. However, the analgesic mechanism of nefopam may not involve the dopaminergic transmission at the spinal level.
Analgesia ; Animals ; Dopamine ; Microdialysis ; Nefopam* ; Pain Measurement ; Rats* ; Spinal Cord ; Spinal Cord Dorsal Horn ; Sulpiride ; Synaptic Transmission

PURPOSE: To assess the value of MR imaging in the diagnosis of medial collateral ligament injury of the knee, we used MR imaging to evaluate the characteristic findings in MCL tears and the frequency of associated knee joint injury. MATERIALS AND METHODS: We retrospectively reviewed 26 patients within four weeks of MCL injury, analysed MR findings and correlated them with surgical findings. We evaluated discontinuity, heterogeneous signal intensityof MCL, thin band- like low signal intensity at MCL, facial edema, loss of clear demarcation of adjacent fat andalso combined bone injury, meniscus injury and other ligament injury. RESULTS: Complete MCL tears were present in 14 patients and partial tears in 12. Complete tears showed discontinuity of MCL, fascial edema and loss of clear demarcation from adjacent fat in 11 patients (79%) ; proximal MCL tears are more common than distal tears. Partial tears showed thin band-like low signal intensity within MCL, fascial edema and loss of clear demarcation fromadjacent fat in seven patients (58%) ; all patients with MCL injury showed fascial edema ; in 12 patients there was loss of clear demarcation from adjacent fat. We could not, however, distinguish between complete tears and partial tears when MCL showed heterogeneous high signal intensity. Combined bone injury in MCL tears was found in eight patients (62%) ; the most common sites of this were the lateral femoral condyle and lateral tibial plateau. There was associated injury involving other ligaments(ACL:50%; PCL: 27%). Combined meniscus injury in MCL tearswas present in 17 patients and the most common meniscus site (50%) is the posterior horn of the medial meniscus. CONCLUSION: Complete MCL tears showed discontinuity of MCL and partial tears showed a thin band-like low signal intensity within MCL. All patients with MCL injury showed fascial edema, and loss of clear demarcation fromadjacent fat. Various other injuries combine with MCL tears. MR imaging is therefore useful in the evaluation ofmedial collateral ligament injury and associated knee joint injury.
Animals ; Collateral Ligaments* ; Diagnosis ; Edema ; Horns ; Humans ; Knee Joint* ; Knee* ; Ligaments ; Magnetic Resonance Imaging* ; Menisci, Tibial ; Retrospective Studies