BACKGROUND: The purpose of this study was to evaluate the safety and efficacy of low-flow anesthesia with a semi-closed circle anesthesia system in infants. METHODS: Twenty, ASA physical status 1 or 2, infants were randomly assigned into two groups: high-flow anesthesia (HFA) or low-flow anesthesia (LFA). An identical semi-closed Dr ger circle anesthesia system (Cato) was used to all patients. Initial fresh gas flow (FGF) was N2O 1.5 L/min and O2 1.5 L/min in both groups. This FGF of 3 L/min was maintained in the HFA group. After 10 min of HFA, the FGF was reduced to 500 ml/min (N2O 250 ml/min and O2 250 ml/min) in the LFA group. RESULTS: Hypoxic or hypercarbic gas concentrations were not observed in all patients. Enflurane consumption during LFA was about 1/3 of that during HFA (6.8 +/- 1.3 ml vs. 19.5 +/- 5.8 ml). The mean highest esophageal temperature was similar in both groups. The mean highest inspiratory gas and soda lime temperatures were significantly higher in the LFA group than in the HFA group. CONCLUSIONS: Low-flow anesthesia in a circle system with a fresh gas flow of N2O 250 ml/min and O2 250 ml/min could be performed safely and economically for infants.
Anesthesia* ; Enflurane* ; Humans ; Infant*

BACKGROUND: Whether monitored anesthetic care (MAC) under total intravenous anesthesia can substitute for spinal anesthesia in knee arthroscopic surgery in regard to frequency of postoperative complications, degree of postoperative pain and degree of the satisfaction of patients and operator was investigated. METHODS: Sixty healthy patients were allocated randomly into a spinal group (n = 30) who received spinal anesthesia and an MAC group (n = 30) who received TIVA for anesthesia for arthroscopic surgery. All patients were NPO for 8 hours before surgery were premedicated and monitored with an EKG, noninvasive blood pressure and pulse oximeter. Heavy 0.5% bupivacaine, 10 - 12 mg, was used for spinal anesthesia and fentanyl 2ng/kg, propofol 1 mg/kg, ketamine 0.3 mg/ kg, and ketorolac 30 mg were given intravenously for induction and propofol was maintained at 3 - 4 mg/kg/h for TIVA. Local anesthetics infiltration was done at the arthroscopic portal site and fentanyl 25ng and propofol 20 mg were added intermittently. Postoperative complication (nausea, vomitting, back pain, dizziness, pain or voiding difficulty) and satisfaction of the patients and surgeon were investigated by VAS and 5 grade methods, respectively. RESULTS: The frequency and degree of back pain, pain at the operative site and voiding difficulty occured less and the VAS was decreased in the MAC group while in the recovery room, 6 hours and the day after the operation. The grade of satisfaction of the patients and that of the surgeon were also high in the MAC group. CONCLUSIONS: These results show that, if careful airway management is provided, MAC under TIVA is a more useful anesthetic method than spinal anesthesia in an arthroscopy.
Airway Management ; Anesthesia ; Anesthesia, Intravenous* ; Anesthesia, Spinal* ; Anesthetics, Local ; Arthroscopy* ; Back Pain ; Blood Pressure ; Bupivacaine ; Dizziness ; Electrocardiography ; Fentanyl ; Humans ; Ketamine ; Ketorolac ; Knee ; Pain, Postoperative* ; Postoperative Complications* ; Propofol ; Recovery Room

BACKGROUND: Calcium disturbance may clinically produce diaphragmatic weakness. Extracellular calcium is necessary for diaphragmatic contraction, suggesting that the diaphragm behaves more like cardiac muscle. The effect of extracellular Ca2 concentrations on the relaxation action of vecuronium was studied in rat hemidiaphragm-phrenic nerve preparations. METHODS: Hemidiaphragm-phrenic nerve preparations were obtained from male Sprague-Dawley rats (200 300 g). Preparations were bathed in Kreb's solution of (mM): NaCl 118, KCl 5, CaCl2 2.5, NaHCO3 30, KH2PO4 1, MgCl2 1 and glucose 11, then maitained at 37oC when aspirated with a mixture of 95% O2 and 5% CO2. Isometric forces generated in response to 0.1 Hz, 2 Hz for 2 seconds and, 50 Hz for 2 seconds with supramaximal electrical stimulation (0.2 msec, rectangular) to the phrenic nerve, were measured with a force transducer. Single twitch tension and peak tetanic tension were calculated as a percentage of control. TOF fade was calculated as (1-(T4/T1))x100. Each preparation was exposed to the alterations in calcium concentrations of the Kreb's solution (3.75, 3.125, 1.5, 1.25, 0.625, 0.3125 (mM)), and the adequate volume of vecuronium stock solution was added to the tissue bath for desired bath concentration. The effects of calcium and vecuronium were allowed to reach a steady state before measurement of tension parameters was done. Single twitch tensions or peak tetanic tensions, which were measured at each calcium concentration, were compared respectively. EC5, EC25, EC50, EC75, and EC95 of vecuronium for a single twitch tension, TOF fade, and peak tetanic tension at each calcium concentration, were calculated using a sigmoid Emax model. We compared the EC50 of vecuronium according to calcium concentrations. Data was compared by the Kruskal-Wallis test with a post hoc Wilcoxon rank sum test. A p-value of below 0.05 was considered significant. RESULTS: The range of calcium concentration studied didn't produce differences among single or tetanictensions respectively. The EC50's of vecuronium decreased as calcium concentration decreased. CONCLUSIONS: The reduction of calcium concentration can augment the action of vecuronium on the diaphragm.
Animals ; Baths ; Calcium* ; Colon, Sigmoid ; Diaphragm ; Electric Stimulation ; Glucose ; Humans ; Magnesium Chloride ; Male ; Myocardium ; Neuromuscular Agents* ; Paralysis ; Phrenic Nerve ; Rats* ; Rats, Sprague-Dawley ; Relaxation ; Transducers ; Vecuronium Bromide*

OBJECTIVE: In Gunsan, Jeollabuk-do, Korea, we wanted to determine if the sluggish local economy could affect citizens' health behaviors, especially mental health. METHODS: We divided Gunsan-si into 5 living areas and conducted Small-Area Estimations and confirmed the modified compound estimation value using the 2013-2017 Community Health Survey data and population data from Gunsan-si. RESULTS: The health behaviors and mental health of the residents of the western living area(Soryong-dong, Misung-dong), which is an industrial hub of Gunsan, had deteriorated or decreased compared to those of other regions. CONCLUSIONS Although there are limitations in analyzing the community health survey data using the small-area estimation method, it could be useful data for evaluating regional gaps and health level.

Intussusception is the most common cause of intestinal obstruction in early childhood and characterized by periodic colicky abdominal pain or irritability, vomiting, current jelly stool, and sausage-like abdominal mass. Meckel's diverticulum is common intestinal anomaly presenting with painless rectal bleeding during first 2 year of age. It is recognized as a common leading point of intussusception in childhood. Hematemesis is the rare clinical manifestation of both intussusception and Meckel's diverticulum. A 7-year-old girl presented with hematemesis was diagnosed as having intussusception by abdominal ultrasonography. Meckel's diverticulum was the leading point of intussusception in this case.
Abdominal Pain ; Child ; Female ; Hematemesis* ; Hemorrhage ; Humans ; Intestinal Obstruction ; Intussusception* ; Meckel Diverticulum* ; Ultrasonography ; Vomiting

PURPOSE: Owing to the trend of a nuclear family the concern and protection are still more increasing than before. The patients admitted to hospital for intussusception, as well as their parents, seem to be under great stress when non- operative treatments fail. In order to identify those patients likely to fail an attempted non-operative treatment, and to administer prompt treatment, the patients that came to our hospital for pediatric intussusception were analyzed. METHODS: 285 cases, between 2000 and 2003 were reviewed. They were divided into two groups from their medical records, and retrospectively compared. Group I included 243 pneumoreduction cases and group II 42 operation cases. To find the probability of non-operative treatment failure, an attempt was made to analyze and score the risk factors that increase the possibility of operative treatment. RESULTS: The factors contributing to an increased possibility of operative treatment were fever, leukocyte count, plain abdominal X-ray findings and duration of symptoms. CONCLUSION: This study revealed that fever, leukocyte count, plain abdominal X-ray findings and duration of symptoms contributed to an increased possibility of operative treatment. An increase in the sum of the scores of each factor increased the possibility of operative treatment. This simple scoring system could eliminate excessive and repeated pneumoreduction, thus indicating its potential value as a useful aid in surgical decision making for high failure rate cases of pneumoreduction in intussusception.
Decision Making ; Fever ; Humans ; Intussusception* ; Leukocyte Count ; Medical Records ; Nuclear Family ; Parents ; Retrospective Studies ; Risk Factors ; Treatment Failure

Biliary stents are widely used not only for palliative treatment of malignant biliary obstruction but also for benign biliary diseases. Each plastic stent or self-expandable metal stent (SEMS) has its own advantages, and a proper stent should be selected carefully for individual condition. To compensate and overcome several drawbacks of SEMS, functional self-expandable metal stent (FSEMS) has been developed with much progress so far. This article looks into the outcomes and defects of each stent type for benign biliary stricture and describes newly introduced FSEMSs according to their functional categories.
Bile Ducts, Extrahepatic ; Biliary Tract ; Constriction, Pathologic ; Drug-Eluting Stents ; Palliative Care ; Plastics ; Stents

Rheumatoid arthritis (RA) is a chronic inflammatory disease involving multiple joints. The cervical spine is often affected, and cases involving atlantoaxial joint can lead to instability. Anterior atlantoaxial subluxation in RA patients can lead to posterior neck pain or occipital headache because of compression of the C2 ganglion or nerve. Here, we report the successful treatment of a RA patient with occipital radiating headache using pulsed radiofrequency therapy at the C2 dorsal root ganglion.
Arthritis, Rheumatoid ; Atlanto-Axial Joint ; Ganglia, Spinal ; Ganglion Cysts ; Headache* ; Humans ; Joints ; Neck Pain ; Spine

The vast majority of discoid menisci are lateral. A medial discoid meniscus is very rare. A 33-year-old and a 15-year-old male patient were diagnosed as having a complete medial discoid meniscus by means of magnetic resonance imaging and arthroscopic procedures. The first patient had a peripheral tear along with cystic degeneration, and the second had a horizontal tear. One was treated successfully by an arthroscopic partial meniscectomy with a peripheral repair, and the other by an arthroscopic partial meniscectomy. We report two cases of medial discoid meniscus with a brief review of literature.
Adolescent ; Adult ; Arthroscopy ; Humans ; Magnetic Resonance Imaging ; Male ; Menisci, Tibial*

Background: The Korean Red Cross adopted HIV NAT for blood donor screening in 2005 using a minipool assay. In June 2012, the NAT system was replaced with the individual assay. This study examined the characteristics of HIV NAT reactive blood donors to determine if there was any difference in their features between 10 years ago and later. Methods: This study analyzed the HIV RNA quantitative values and the distribution of HIV subtypes using 118 HIV NAT positive blood donations (37 in 2007, 20 in 2008, 32 in 2017 and 29 in 2018). Results: No significant variations of the quantitative values of HIV RNA and the distribution of HIV subtypes 10 years ago and later were observed. This study failed to produce quantitative values of three samples due to the low titer. The mean titer of HIV RNA of the remaining 115 samples were 5.14×10 4 IU/mL. The dominant HIV subtype of the HIV NAT reactive donors was B showing 54.2% (64/118). Approximately 5.9% (7/118) of the samples showed the HIV subtype C. Forty-seven samples (39.8%) showed the circulating recombinant form (CRF). Conclusion The rate of HIV subtype B in this study (54.2%) has decreased compared to the results of the past study (95.2%). Some of the cases showing CRF were identified as B in the past study because CRF3, 8, 9, 14, and 15 are recombinant forms, including subtype B.