The treatment for epilepsy has been studied throughout the course of human history. However, radical treatment of epilepsy has only been discovered recently with introduction of surgical treatment until now, palliative drug administration was common practice. During the anesthetic procedure for epilepsy surgery it is necessary for the patient to be alert and to cooperate with the surgeon while mapping and subcutaneous EEG test are carried out during the surgery. For this type of procedure, a new I.V. anesthetic, propofol is considered to be an ideal anesthetic agent because propofol is a short-acting and clear headed I.V. anesthetic agent for induction as the well as the maintenance of genenral anesthesia. In this study, only propofol was administered intravenously in 20 randomiied patients scheduled for brain surgery for epilepsy treatment. The mean infusion rate was 100 mcg/kg/min to maintain a satisfactory anesthesia. For the induction of anesthesia, slightly higher doses were required. The cardiovascular effects of propofol infusion was associated with slightly decrease of systolic, diastolic and mean arterial pressures. Arterial blood gases were analyzed for the evaluation of ventilatory function. PaCO2 were 41+/-4.23 mmHg preoperatively, 44+/-5.28 mmHg 30 min. following sedation, 42+/-6.35 mmHg 30 min. following awakening, 46+/-6.37 mmHg 30 min. following resedation, 44+/-4.79 mmHg at 2 hours and 44+/-6.51 mmHg at 4 hours after resedation and 36+/-3.98 mmHg 30 min. following recovery. PaO2 were 101+/-31.3 mmHg preoperatively, 190+/-47.13 mmHg 30 min. following sedation, 195+/-32 mmHg 30 min. following awakening, 209+/-29.23 mmHg 30 min. and 210+/-34.55 mmHg at 2 hours and 190+/-37.36 mmHg 4 hours following resedation, and 10.2+/-31.36 mmHg 30 min. following. PH were 7.38 preoperatively, 7.34+/-0.04 following sedation, 7.34+/-0.03 30 min. following awakening, 7.34+/-0.03 at 30 min. following resedation, 7.35+/-0.03 at 2 hours and 7.36+/-0.03 at 4 hours following resedation, and 7.38+/-3.98 at 30 min. after recovery. The duration of anesthesia was 8.5-12 hours. The duration of propofol anesthesia ranged from 8 to 9 hours. The awakening time from the cessation of propofol infusion ranged from 3 to 17 minutes. As the result of this study, we came to the conclusion that propofol is an ideal intravenous anesthetic for brain surgery for epilepsy treatment.
Anesthesia* ; Arterial Pressure ; Brain* ; Electroencephalography ; Epilepsy* ; Gases ; Head ; Humans ; Hydrogen-Ion Concentration ; Propofol*

The treatment for epilepsy has been studied throughout the course of human history. However, radical treatment of epilepsy has only been discovered recently with introduction of surgical treatment until now, palliative drug administration was common practice. During the anesthetic procedure for epilepsy surgery it is necessary for the patient to be alert and to cooperate with the surgeon while mapping and subcutaneous EEG test are carried out during the surgery. For this type of procedure, a new I.V. anesthetic, propofol is considered to be an ideal anesthetic agent because propofol is a short-acting and clear headed I.V. anesthetic agent for induction as the well as the maintenance of genenral anesthesia. In this study, only propofol was administered intravenously in 20 randomiied patients scheduled for brain surgery for epilepsy treatment. The mean infusion rate was 100 mcg/kg/min to maintain a satisfactory anesthesia. For the induction of anesthesia, slightly higher doses were required. The cardiovascular effects of propofol infusion was associated with slightly decrease of systolic, diastolic and mean arterial pressures. Arterial blood gases were analyzed for the evaluation of ventilatory function. PaCO2 were 41+/-4.23 mmHg preoperatively, 44+/-5.28 mmHg 30 min. following sedation, 42+/-6.35 mmHg 30 min. following awakening, 46+/-6.37 mmHg 30 min. following resedation, 44+/-4.79 mmHg at 2 hours and 44+/-6.51 mmHg at 4 hours after resedation and 36+/-3.98 mmHg 30 min. following recovery. PaO2 were 101+/-31.3 mmHg preoperatively, 190+/-47.13 mmHg 30 min. following sedation, 195+/-32 mmHg 30 min. following awakening, 209+/-29.23 mmHg 30 min. and 210+/-34.55 mmHg at 2 hours and 190+/-37.36 mmHg 4 hours following resedation, and 10.2+/-31.36 mmHg 30 min. following. PH were 7.38 preoperatively, 7.34+/-0.04 following sedation, 7.34+/-0.03 30 min. following awakening, 7.34+/-0.03 at 30 min. following resedation, 7.35+/-0.03 at 2 hours and 7.36+/-0.03 at 4 hours following resedation, and 7.38+/-3.98 at 30 min. after recovery. The duration of anesthesia was 8.5-12 hours. The duration of propofol anesthesia ranged from 8 to 9 hours. The awakening time from the cessation of propofol infusion ranged from 3 to 17 minutes. As the result of this study, we came to the conclusion that propofol is an ideal intravenous anesthetic for brain surgery for epilepsy treatment.
Anesthesia* ; Arterial Pressure ; Brain* ; Electroencephalography ; Epilepsy* ; Gases ; Head ; Humans ; Hydrogen-Ion Concentration ; Propofol*

BACKGROUND: Although idiopathic cardiomyopathies(i-CMP) are very important in all age groups, the epidemiology of i-CMP in children has not been well defined. A retrospective study in Korean children was performed in 1998 to obtain basic data on i-CMP. MATERIAL AND METHOD: The medical records of all patients aged birth to 15 years from the hospitals where pediatric cardiologists worked were reviewed to obtain information on i-CMP. Pediatric cardiologists from a total of 22 hospitals were participated in reviewing the medical records of their patients and filling up the protocol. The data were pooled to the study committee and reviewed. RESULTS: Of the 278 cases with i-CMP, there were dilated cardiomyopathy (d-CMP) in 182 (65.4%): hypertrophic cardiomyopathy (h-CMP) in 74 (26.6%): restrictive cardiomyopathy (r-CMP) and unclassified in 17 (6.1%) and 5 (1.9%) each. The average annual occurrence of new cases as a whole was 2.65 per 100,000 (95% CI: 1.5-3.7): d-CMP, 1.73/100,000/year (95% CI: 0.73-2.73): h-CMP, 0.71/100,000/year (95% CI: 0.35-1.07): r-CMP, 0.16/100,000/year (95% CI: 0.02-0.3). The median age at the time of diagnosis was 11 months in d-CMP: 3.0 years in h-CMP: 6.9 years in r-CMP. The survival rate in d-CMP was 76% at 1 year, 72.5% at 2 year, 70% at 5 year. There was no difference in survival rate according to age (in d-CMP, between children less than 2 years of age and over 2 years of age (74% vs. 79% at 1 year: 67% vs. 76% at 5 year, p=NS): in h-CMP, between children less than 1 year of age and over 1 year of age (84% vs. 96% at 1 year: 63% vs. 81% at 5 year, p=NS)). R-CMP showed the worst survival rate (72% at 1 year, 30.2% at 5 year). CONCLUSION: In spite of the inherent defects of retrospective analysis, this study provides the useful epidemiological data in children with i-CMP. However, more systemic approach is needed to define the nature of the i-CMP in children.
Cardiomyopathies* ; Cardiomyopathy, Dilated ; Cardiomyopathy, Hypertrophic ; Cardiomyopathy, Restrictive ; Child* ; Diagnosis ; Epidemiology ; Humans ; Medical Records ; Parturition ; Retrospective Studies ; Survival Rate

PURPOSE: Minimally invasive surgery (MIS) in abdomen and thorax has been widely accepted for pediatric diseases. Thoracoscopic surgery has the advantage of less pain, better cosmetic outcomes and less musculoskeletal sequelae in comparison to open surgery. We would like to share our initial experience with thoracoscopic surgery performed by one pediatric surgeon. METHODS: We performed a retrospective review of patients who underwent thoracoscopic surgery by one pediatric surgeon between April 2010 and August 2017 in Department of Pediatric Surgery, Seoul National University Children's Hospital. RESULTS: There were totally 18 cases; 8 cases for esophageal atresia, 3 cases for congenital diaphragm hernia, 2 cases for diaphragm eventration, 2 cases for esophageal duplication cyst, 2 cases for pleural mass and 1 case for esophageal bronchus. At the operation, median age was 9.5 months (range, 0-259 months) and median body weight was 9.4 kg (range, 1.9-49.4 kg). Median operative time was 157.5 minutes (range, 45-335 minutes). There was no case of open conversion and 2 cases of minor leakage at anastomosis site in case of esophageal atresia. Median follow-up month was 5 months (range, 0-87 months). During follow-up, 4 cases of esophageal atresia showed anastomosis site narrowing and average 2.5 times (range, 1-5 times) of esophageal balloon dilatation was done. CONCLUSION: We performed thoracoscopic surgery in case of esophageal, diaphragm disease and pleural mass. Thoracoscopic surgery can be an effective and feasible option of treatment for well-selected pediatric patients of intra-thoracic disease including esophagus, diaphragm and mediastinum disease.
Abdomen ; Body Weight ; Bronchi ; Diaphragm ; Diaphragmatic Eventration ; Dilatation ; Esophageal Atresia ; Esophagus ; Follow-Up Studies ; Hernia ; Humans ; Mediastinum ; Minimally Invasive Surgical Procedures ; Operative Time ; Pediatrics ; Retrospective Studies ; Seoul ; Thoracoscopy* ; Thorax

BACKGROUND AND OBJECTIVES: Increased central arterial stiffness is an emerging risk factor for cardiovascular disease. Acute aerobic exercise reduces arterial stiffness, while acute resistance exercise may increase arterial stiffness, but this is not a universal finding. We tested whether an acute resistance exercise program was associated with an increase in arterial stiffness in healthy young men. SUBJECTS AND METHODS: Thirteen healthy subjects were studied under parallel experimental conditions on 2 separate days. The order of experiments was randomized between resistance exercise (8 resistance exercises at 60% of 1 repeated maximal) and sham control (seated rest in the exercise room). Carotid-femoral pulse wave velocity (PWV) and aortic augmentation index as indices of aortic stiffness were measured using applanation tonometry. Measurements were made at baseline before treatments, 20 minutes, and 40 minutes after treatments (resistance exercise and sham control). RESULTS: There was no difference in resting heart rate or in arterial stiffness between the two experimental conditions at baseline. At 20 minutes after resistance exercise, heart rate, carotid-femoral PWV and augmentation index@75(%) were significantly increased in the resistance exercise group compared with the sham control (p<0.05). Brachial blood pressure, central blood pressure and pulse pressure were not significantly increased after resistance exercise. CONCLUSION: An acute resistance exercise program can increase arterial stiffness in young healthy men. Further studies are needed to clarify the effects of long-term resistance training on arterial stiffness.
Blood Pressure ; Cardiovascular Diseases ; Collodion ; Exercise ; Heart Rate ; Humans ; Male ; Manometry ; Pulse Wave Analysis ; Resistance Training ; Risk Factors ; Salicylamides ; Vascular Stiffness

ATP-sensitive potassium channels (KATP channels) play an important role in insulin secretion from pancreatic beta cells. We have investigated the effect of propofol on KATP channels in cultured single pancreatic beta cells of rats. Channel activity was recorded from membrane patches using the patch-clamp technique. In the inside-out configuration bath-applied propofol inhibited the KATP channel activities in a dose-dependent manner. The half-maximal inhibition dose (ED50) was 48.6+/-8.4 micrometer and the Hill coefficient was 0.73 0.11. Single channel conductance calculated from the slope of the relationship between single channel current and pipette potential (+20~+100 mV) was not significantly altered by propofol (control: 60.0+/-2.7 pS, 0.1 mM propofol: 58.7+/-3.5 pS). However, mean closed time was surely increased. Above results indicate that propofol blocks the KATP channels in the pancreatic beta cells in the range of its blood concentrations during anesthesia, suggesting a possible effect on insulin secretion and blood glucose level.
Anesthesia ; Animals ; Blood Glucose ; Insulin ; Insulin-Secreting Cells ; KATP Channels* ; Membranes ; Patch-Clamp Techniques ; Propofol* ; Rats*

PURPOSE: The oncologic safety of immediate breast reconstruction (IBR) has been demonstrated. However, the outcome of IBR for locally advanced breast cancer (LABC) is still under debate. We compared the survival outcome of LABC patients who underwent IBR vs. mastectomy alone. METHODS: We retrospectively analyzed a total of 248 patients with stage III breast cancer who were treated with mastectomy between 2004 and 2015. The study subjects were divided into 2 groups: patients who received IBR (n=77) or mastectomy alone (MA) (n=171). We compared disease-free survival (DFS) of both groups. RESULTS: Median follow-up duration was 49 months and the mean age of patients was 49 years. Patients in the IBR group were significantly younger and had lower body mass index (BMI) than those in the MA group. In a univariate analysis, IBR group showed better DFS than the MA group (DFS 81.3 months vs. 49.8 months, p<0.001). There was no delay in adjuvant treatment in the IBR group. In a multivariate analysis, IBR was associated with better DFS (hazard ratio (HR) for recurrence: 0.37, 95% CI 0.20–0.69, p=0.002) when adjusted for potential prognostic factors. In a subgroup analysis performed according to disease stage (IIIA and IIIB/IIIC), DFS was significantly better in IBR than MA group in both stage subgroups (p<0.001). CONCLUSION We demonstrated that patients who underwent IBR showed better DFS outcome compared with patients who underwent mastectomy alone. Our results can help surgeons to determine if IBR is an option in patients with LABC.

Clonorchis sinensis is currently the most important parasite affecting public health problems in the Republic of Korea. We investigated the prevalence of C. sinensis infection among residents living along 5 major rivers in Korea. A total of 42,562 individual stool samples were collected from 37 localities and examined using the formalin-ether sedimentation technique. Helminth eggs were detected in 4,052 (9.5%) residents and 3,586 (8.4%) were infected with C. sinensis. The egg positive rate of C. sinensis in Nakdong, Seomjin, Geum, Yeongsan, and Han River was 11.7%, 9.9%, 6.5%, 3.1%, and 1.0%, respectively. The overall prevalence of clonorchiasis by sex was 11.2% in males and 6.2% in females. The age-prevalence was the highest in the 50-59 years band. It has been reconfirmed that the endemicity of clonorchiasis is higher in southern areas of Korea, especially along Nakdong and Seomjin Rivers. A combination of continuous control programs with health education initiatives is urgently required in these highly endemic areas of clonorchiasis in Korea.
Clonorchiasis ; Clonorchis sinensis* ; Eggs ; Female ; Geum ; Health Education ; Helminths ; Humans ; Korea ; Male ; Ovum ; Parasites ; Prevalence* ; Public Health ; Republic of Korea* ; Rivers*

Tracheobronchopathia osteochondroplastica (TO) is a rare benign disease of unknown etiology characterized by accumulation of calcium phosphate in the submucosa of large airways and benign proliferation of bone and cartilage resulting in nodular formation. We report a case of tracheobronchopathia osteochondroplastica diagnosed by Endobronchial ultrasonography in a 56-year-old man. Chest Computed Tomography revealed thickening of tracheal and bronchial wall, and multiple nodules through whole trachea. Endobronchial ultrasonography showed numerous submucosal nodules with hetero-echogenecity in the third and fourth layers. Histopathological examination revealed nonspecific bronchitis with squamous metaplasia and metaplastic ossification. We confirmed tracheobronchopathia osteochondroplastica. The patient's symptoms were successfully treated with antibiotics and oxygen supplyment. endobronchial ultrasonography can helpful diagnosis in tracheobronchopathia osteochondroplastica.
Anti-Bacterial Agents ; Bronchitis ; Calcium ; Calcium Phosphates ; Cartilage ; Humans ; Metaplasia ; Middle Aged ; Osteochondrodysplasias ; Oxygen ; Thorax ; Trachea ; Tracheal Diseases

Purpose: Advances in chemotherapeutic and targeted agents have increased pathologic complete response (pCR) rates after neoadjuvant systemic therapy (NST). Vacuum-assisted biopsy (VAB) has been suggested to accurately evaluate pCR. This study aims to confirm the non-inferiority of the 5-year disease-free survival of patients who omitted breast surgery when predicted to have a pCR based on breast magnetic resonance imaging (MRI) and VAB after NST, compared with patients with a pCR who had undergone breast surgery in previous studies. Methods The Omission of breast surgery for PredicTed pCR patients wIth MRI and vacuumassisted bIopsy in breaST cancer after neoadjuvant systemic therapy (OPTIMIST) trial is a prospective, multicenter, single-arm, non-inferiority study enrolling in 17 tertiary care hospitals in the Republic of Korea. Eligible patients must have a clip marker placed in the tumor and meet the MRI criteria suggesting complete clinical response (post-NST MRI size ≤ 1 cm and lesion-to-background signal enhancement ratio ≤ 1.6) after NST. Patients will undergo VAB, and breast surgery will be omitted for those with no residual tumor. Axillary surgery can also be omitted if the patient was clinically node-negative before and after NST and met the stringent criteria of MRI size ≤ 0.5 cm. Survival and efficacy outcomes are evaluated over five years.Discussion: This study seeks to establish evidence for the safe omission of breast surgery in exceptional responders to NST while minimizing patient burden. The trial will address concerns about potential undertreatment due to false-negative results and recurrence as well as improved patient-reported quality of life issues from the omission of surgery. Successful completion of this trial may reshape clinical practice for certain breast cancer subtypes and lead to a safe and less invasive approach for selected patients.