BACKGROUND: The i-gel(TM) (i-gel) is a new single-use supraglottic airway device with a non-inflatable cuff. This study investigated the safety and efficacy of the i-gel during general anesthesia in children. METHODS: Ninety-eight children at ASA physical status I-II who underwent general anesthesia were included in this prospective observatory study. The size of the i-gel was selected based on patient's body weight. We evaluated success rates, insertion time, airway leak pressure, fiberoptic examination, airway manipulation, airway quality, and postoperative complications. RESULTS: The first-attempt success rate was 96.9% with overall success rate of 98.0%. The insertion time was 15.6 +/- 4.7 seconds. The airway leak pressure was 28.2 +/- 5.9 cmH2O. The maximal peak inspiratory pressure was 15.4 +/- 3.0 cmH2O. On fiberoptic examination, vocal cords were visible in 86.5% of patients. During maintenance of anesthesia, manipulations of i-gel were required for 32 (33.3%) children to maintain airway. Controlled ventilation was possible in all cases, although excess leak transiently occurred in three children. Postoperative complications including blood-staining on device, cough, and sore throat were infrequent. CONCLUSIONS: The i-gel size at 1.5-2.5 provided a satisfactory airway and ventilation during anesthesia in children. However, i-gel required a number of manipulations to maintain patency of airway during general anesthesia.
Anesthesia ; Anesthesia, General* ; Body Weight ; Child* ; Cough ; Humans ; Pharyngitis ; Postoperative Complications ; Prospective Studies ; Ventilation ; Vocal Cords

STUDY DESIGN: Retrospective study. PURPOSE: To investigate the influence of fat infiltration at low back extensor muscles on osteoporotic vertebral fracture. OVERVIEW OF LITERATURE: In persons with stronger back muscles, the risk of osteoporotic vertebral fractures will likely be lower than in those persons with weaker back muscles. However, the degree of influence of fat infiltration of the back extensor muscle on osteoporotic vertebral fracture remains controversial. METHODS: Two hundred and thirty-seven patients who had undergone lumbar spine magnetic resonance imaging and bone mineral density (BMD) were enrolled in this study. The amount of low back extensor muscle was determined using the pseudocoloring technique on an axial view of the L3 level. The patients were divided into two groups: osteoporotic vertebral fracture group (group A) and non-fracture group (group B). The amount of low back extensor muscle is compared with BMD, degenerative change of disc, osteophyte grade of facet joint and promontory angle to reveal the association between these factors. RESULTS: A negative correlation is found between age and the amount of low back extensor muscle (p=0.001). The amount of low back extensor muscle in group A and group B was 60.3%+/-14.5% and 64.2%+/-9.3% respectively, thus showing a significantly smaller amount of low back extensor muscle in the osteoporotic vertebral fracture group (p=0.015). CONCLUSIONS: Fat infiltration of low back extensor muscle was increased in osteoporotic vertebral fracture patients. Therefore, fat infiltration of low back extensor muscle in an elderly person may be a risk factor of osteoporotic vertebral fracture.
Aged ; Bone Density ; Humans ; Magnetic Resonance Imaging ; Muscles* ; Osteophyte ; Retrospective Studies ; Risk Factors ; Spine ; Zygapophyseal Joint

BACKGROUND: Patient satisfaction with anesthesia is an important outcome of hospital care. The aim of this study was to assess the overall level of satisfaction with anesthetic care and to identify predictive factors associated with dissatisfaction. METHODS: Our subjects were adult in-patients with ASA 1-3 who had undergone an elective operation during the previous 12 months. The major measure of subjective outcome was the overall level of satisfaction with anesthetic care on the first day after operation. Patients were asked to rate if they were 'very satisfied', 'somewhat satisfied', 'neutral', 'somewhat dissatisfied' or 'very dissatisfied'. We also measured other predetermined outcomes, such as nausea, vomiting, pain and other complications. RESULTS: At the time of analysis, our database contained information on 3376 patients. 283 (8.4%) patients were 'very satisfied', 1826 (54.1%) were 'somewhat satisfied', 1119 (33.1%) were 'neutral', 133 (3.9%) were 'somewhat dissatisfied' and 15 (0.4%) were 'very dissatisfied' with their anaesthetic care. The number of postanesthetic factors (81.7%) were greater than the number of preanesthetic factors (8.8%) and intranesthetic factors (9.5%) for dissatisfaction with anesthetic care. The causes of dissatisfaction were postoperative pain (43 patients, 29.1%), postoperative nausea and vomiting (17, 11.5%), sore throat (17, 11.5%), waiting a long time before surgery (9, 6.1%), myalgia (6, 4.1%), back pain (6, 4.1%) and other complications. Strong relations were found between patient dissatisfaction and an anesthetic duration of more than 2 hours, moderate or severe postoperative pain, moderate to severe postoperative nausea and vomiting, and other anesthesia-related adverse events. CONCLUSIONS: This study found that patient satisfaction with anesthetic care is high and identified several factors associated with dissatisfaction that may be preventable or better managed.
Adult ; Anesthesia ; Back Pain ; Humans ; Myalgia ; Nausea ; Pain, Postoperative ; Patient Satisfaction ; Pharyngitis ; Postoperative Nausea and Vomiting ; Vomiting

PURPOSE: To evaluate clinical characteristics of pediatric nontraumaitc chylothorax and to suggest appropriate therapeutic managements. METHODS: We retrospectively reviewed medical records of 22 patients with nontraumatic chylothorax from January 2005 to December 2018 in the Children's Hospital of Seoul National University. We analyze their etiology, treatment, complications and outcome. RESULTS: Of the 22 patients, 16 were diagnosed before 1 year old and 6 after 1 year old. The causes of chylothorax under 1-year-old children were related to congenital factors (n=9), unknown causes (n=5), and high central venous pressure (n=2). The causes of chylothorax over 1-year-old children were related to congenital factors (n=3), unknown causes (n=1), high venous pressure (n=1), and lymphoma (n=1). All patients had dietary modification. Eight of them were cured by dietary modification, but there was no improvement in over 1-year-old children. Medication was added to patients refractory to dietary modification. Four patients with medication were improved and 5 were improved by surgical management. Nutritional, immunological and other complications occurred in many patients. Five death cases were reported. Four patients were under 1 year old and 1 was over 1 year old. The causes of nontraumatic chylothorax in dead patients were high central venous pressure (n=3), congenital (n=1), and unknown (n=1). CONCLUSION: Nontraumatic chylothorax more frequently occurs in under 1-year-old children. The most common cause is congenital factors. Stepwise management is effective in many patients, but specific treatment is needed in some cases. The prognosis is related to the onset of age and underlying diseases.
Central Venous Pressure ; Child ; Chylothorax ; Diet ; Food Habits ; Humans ; Lymphoma ; Medical Records ; Pediatrics ; Prognosis ; Retrospective Studies ; Seoul ; Venous Pressure

PURPOSE: To report the clinical results of the vascularized fibular graft in the treatment of intractable infected nonunion of femur. MATERIALS AND METHODS: We reviewed 3 patients who were performed vascularized fibular graft in treated for intractable infected nonunion of femur. They had received an average of 5.6 times(4~8 times) surgical treatment at different hospitals. 1 case was of a infected nonunion in a fracture treated with internal fixation, the fracture having occurred after resection of a malignant tumor and transplantation of pasteurized autologous bone. 2 cases occurred after internal fixation in closed fractures. Surgical treatment was performed an average of 4 times(3~5 times) at our hospital and in all of the cases debridement of necrotic tissue and sequestrectomy. And vascularized fibular graft was performed. In all cases unilateral external fixation devices were used, of these, 1 case was changed into internal fixation. The final conclusion was made by assessment of functional outcomes and complications according to the standards of Paley. RESULTS: As a result, in all of the cases bone union was achieved, and in the last follow up the functional results were excellent in 2 cases and good in 1 case. There were not presented leg length discrepancy of more than 2 cm, and further loss of knee joint motion. After previous treatment, average 23.3 months(16~30 months) was taken to eliminate infection and achieve complete bone union via vascularized fibular graft in our hospital. CONCLUSION: In treatment of intractable infected nonunion of femur, fairly good results can be expected after firm fixation, through debridement and vascularized fibular graft.
Debridement ; External Fixators ; Femur* ; Follow-Up Studies ; Fractures, Closed ; Humans ; Knee Joint ; Leg ; Transplants*

PURPOSE: Skin-sparing mastectomy (SSM) involves the resection of the nipple-areolar complex (NAC) along with the breast parenchyma, and this improves aesthetic outcome for breast cancer patients. Yet most patients desire preservation of the NAC. The purpose of this study was to determine the associated risk factors of NAC involvement and to identify the value of preoperative breast magnetic resonance imaging (MRI) for measuring the tumor-nipple distance (TND). METHODS: This prospective study was carried out in 92 breast cancer (3 patients with bilateral breast cancer) patients who underwent MRI and they had undergone modified radical mastectomy or SSM at the Department of Surgery in Soonchunhyang University Hospital from November of 2003 to March of 2006. The patients were divided into two groups: nipple-positive for malignancy (group 1; n=9) and nipple-negative for malignancy (group 2; n=86). We analyzed the risk factors of NAC involvement, including tumor size, nuclear grade, lymph node invasion, muticentricity, TND, the hormone recepor status, and lymphovascular invasion. The TND was measured by preoperative breast MRI (the imaging distance) in all patients and by the distance of specimens which were obtained postoperatively (the real distance) in 31 patients. RESULTS: The overall frequency of malignant nipple involvement was 9 of 95 (9.4%). There were no differences in tumor size, nuclear grade, lymph node invasion, muticentricity, the hormone recepor status and lymphovascular invasion between the two groups. The TND was identified as an independent predictor of malignant NAC involvement: the mean TND by breast MRI was 0.7 cm in group 1 and 2.7 cm in group 2 (p=0.01) the mean TND by pathologic measuring the specimen was 0.7 cm in group 1 and 3.2 cm in group 2 (p=0.02). In all the nipple involved cases, the tumor was within 2 cm of the nipple. In measuring the TND, there was no significant difference between the imaging distance of MRI and real distance of the sepcimen (p=0.166). CONCLUSION: The only predictive factor for malignant NAC invasion was TND in our study. NAC preservation would be appropriate for the patients with tumor located more than 2 cm away from the nipple. The TND as determined by preoperative MRI is considered to be helpful when deciding whether to preserve the NAC.
Breast Neoplasms* ; Breast* ; Humans ; Lymph Nodes ; Magnetic Resonance Imaging ; Mastectomy ; Mastectomy, Modified Radical ; Nipples* ; Prospective Studies ; Risk Factors

BACKGROUND: Prescribing potentially harmful drugs and omitting essential drugs to older patients is a common problem because they take so many medications. In this study, our goal was to identify potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) using Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) and Screening Tool to Alert doctors to the Right Treatment (START) criteria to improve proper prescription and reduce improper prescription. METHODS: Enrolled in this study were 117 patients older than 65 years old who were hospitalized at Inha University Hospital in Incheon due to pneumonia from January 2012 to March 2012. Patient data, including medical histories, current diagnoses, current medications, and biochemical data were recorded from electronic records. STOPP and START were applied to their clinical datasheets. RESULTS: STOPP criteria identified 24 patients who had 29 PIMs. Most potential inappropriate prescribing was of cardiovascular medications, followed by drugs whose primary effect is on the urogenital system and gastrointestinal system. START criteria identified 31 patients who had 46 PPOs. The cardiovascular system drugs comprised most of the PPOs. No PPOs were identified under the central nervous system criteria. CONCLUSION: Given the current Korean medical system conditions and considering the many clinically important situations when prescribing drugs, STOPP/START criteria are not absolute criteria to prevent improper prescription, but sagacious usage of these standards can help physicians to prescribe properly in clinical practice.
Cardiovascular System ; Central Nervous System ; Drugs, Essential ; Electronics ; Electrons ; Humans ; Inappropriate Prescribing ; Mass Screening ; Pneumonia ; Prescriptions ; Urogenital System

PURPOSE: Several studies have indicated that there are a number of differences in tumor biolog associated with race or ethnicity. The median age at the time of diagnosis for Korean women with breast cancer is 45 years, and this is approximately 15 years younger than Caucasian patients in the Western countries. We previously reported that was a significant difference found in the expression of HER-2/neu between Korean and Caucasian patients with early-onset breast carcinoma. In this study, we compared cyclooxygenase-2 (COX-2) expression between the two races. METHODS: One hundred and seventy two Korean women who were diagnosed with breast carcinoma at the age of 45 years or younger and 80 Caucasian women with breast carcinoma were selected for this study. The median age of both groups was 37 years and the tumor size was evenly distributed between the two group. Paraffin embedded blocks of primary tumor were processed for immunohistochemical COX-2 staining. The COX-2 expression was evaluated according to the percentage of positive cells and the intensity of staining. RESULTS: The proportion of tumors that stained positive for COX-2 in Korean and Caucasian women with early-onset breast carcinoma were 33.7% and 25%, respectively. The difference was not statistically significant (p = 0.104). Expression of COX-2 was associated with several clinicopathologic parameters, including positive lymph node status, large tumor size and negative estrogen receptor status. CONCLUSION: A significant difference was not found for the expression of COX-2 between the two groups of patients with early-onset breast carcinoma. Further research will be needed to identify the prognostic role for patients with early-onset breast carcinoma.
Breast Neoplasms* ; Breast* ; Continental Population Groups ; Cyclooxygenase 2* ; Diagnosis ; Estrogens ; Female ; Humans ; Lymph Nodes ; Paraffin

Vaginal agenesis is uncommon gynecologic condition, and the most common etiology is Mullerian agenesis also called Mayer-Rokitansky-Kster-Hauser (MRKH) syndrome. In such patients, the evaluation for associated malformations as well as careful non-surgical and surgical approach are essential. The neovaginoplasty is an important issue for these patients from a functional and a psychological standpoint. We describe two patients with Mullerian agenesis, who have undergone vaginal reconstruction by McIndoe technique.
Humans