BACKGROUND: The speed of injection of local anesthetic solutions into the subarachnoid space may influence the spread of these agents in the cerebrospinal fluid by the amount of turbulence generated, especially with large volume. To determine the proper injection speed of anesthetics in hypobaric spinal anesthesia on jack-knife position, the anesthetic level and duration were measured with the fast or slow injection speed. METHODS: Twenty patients for perianal surgery in jack-knife position under hypobaric spinal anesthesia were randomly assigned to one of two groups. Tetracaine (0.1%) in distilled water 5 ml was administered to all the patients. Group I patients received the drug with the speed of injection as 5 ml/20 sec (15 ml/min) and the others (Group II) as 5 ml/4 min (1.25 ml/min). The mean arterial pressures and heart rates at the preanesthetic period, and 5, 10, 15 and 20 min after the end of injection were measured. The anesthetic levels at 5, 10, 15 and 20 min after the injection and anesthesia duration were measured. RESULTS: There was no significant difference in mean arterial pressures, heart rates and anesthetic duration between two groups. The anesthetic level 20 min after the injection was higher in Group I than Group II, and not different at the other time sequences. CONCLUSION: At the injection speed within 1.25-15 ml/min in hypobaric spinal anesthesia on jack-knife position at 15o head-down, we acquired appropriate anesthetic level and duration for perianal surgery without any undesirable effects.
Anesthesia ; Anesthesia, Spinal* ; Anesthetics ; Arterial Pressure ; Cerebrospinal Fluid ; Head-Down Tilt* ; Heart Rate ; Humans ; Subarachnoid Space ; Tetracaine* ; Water

BACKGROUND: Some of elective surgical procedures may be postponed or cancelled due to inadequate preoperative assessment and preparation. To minimize this problem, our preadmission anesthesia consultation clinic had been designed and managed at the outpatient department. The case referral pattern and efficacy of the clinic were evaluated for 1 year. METHODS: The study was done collected prospectively on 881 patients referred to the clinic from January to December 1997, 1 year. The age, sex, departmental distribution of consultation, ASA physical status of patients, the clinical department and reasons of consultation, and satisfaction of the patients or their parents were analized prospectively. The preoperative hospital stay periods before and after the opening of the clinic were compared. RESULTS: The sex ratio(M/F) were 6/4. Thirty-seven percent of the patients were under 10 years old and 11.8% were twenties. ENT(48.4%), ophthalmology(15.6%), general surgery(12.6%) were mainly referral departments. Reasons for consultation were related to chest X-ray abnormality(28.9% of the cases) and EKG abnormality(17.9%). The majority of consultation had pediatric(30%) and cardiologic problem(26%). URI(54.2%) and liver disease(12.6%) were major disease entities to postpone their surgery. In 2.7% of the patients, their admission or operation were postponed by the anesthesiologists in the clinic. Ninety-one percent of the patients were satisfied to visit the clinic. CONCLUSION: We conclude that reduction in preoperative hospital stay and shortening in delay of surgery are provided, and most patients are satisfied to the preadmission anesthesia consultation clinic.
Anesthesia* ; Child ; Electrocardiography ; Humans ; Length of Stay ; Liver ; Outpatients ; Parents ; Prospective Studies ; Referral and Consultation ; Surgical Procedures, Elective ; Thorax

BACKGROUND: The aim of this study was to examine the relationship between the provision of safety and health information (PSHI) and occupational injuries. METHODS: This study was based on data from the 4th Korean Working Conditions Survey (KWCS) (2014). The sample consisted of data from 24,527 wage workers and was divided into high-risk and low-risk groups, depending on the probability of occupational injury. The high-risk group included subjects who could cause harm to themselves or others due to errors during work. We applied chi-squared tests and logistic regression analyses to examine the relationship between PSHI and occupational injuries. RESULTS: In the high-risk group, workers with no PSHI showed an adjusted odds ratio of 1.81 for occupational injury (95% CI 1.33–2.47). In contrast, there was no statistically significant relationship between PSHI and the incidence of occupational injury in the low-risk group. CONCLUSIONS: To prevent occupational injuries, multi-faceted approaches that take different levels of injury risk into account are needed. Among workers with a high risk of occupational injury, more a stringent safety education program is required.
Education ; Incidence ; Logistic Models ; Occupational Injuries ; Odds Ratio ; Salaries and Fringe Benefits

STUDY DESIGN: Retrospective case-control study. OBJECTIVES: To compare the clinical and radiographic outcomes of a hybrid construct (HC) of cervical artificial disc replacement (CADR) combined with anterior cervical discectomy and fusion (ACDF) (group I) with 2-level ACDF (group II) in patients with 2-level cervical disc disease. SUMMARY OF LITERATURE REVIEW: ACDF is reported to potentially promote degenerative changes in the adjacent segment. CADR has been expected to reduce the risk of adjacent segment degeneration. However, its clinical course has yet to be sufficiently clarified. MATERIALS AND METHODS: Twenty-six patients underwent 2-level cervical disc surgery. Single-level CADR combined with ACDF was performed in 14 patients. Twelve patients underwent 2-level ACDF. Clinical profiles were assessed using the neck disability index (NDI) and visual analogue scale scores of arm and neck pain. Dynamic lateral cervical radiographs were obtained preoperatively and at 1, 6, 12, and 18 months postoperatively. The range of motion (ROM) of the overall cervical spine (C2-7) and the adjacent segments was measured. RESULTS: Group I showed superior NDI 18 months postoperatively (p < 0.05). The mean C2-7 ROM of both groups recovered to the preoperative ROM. At 18 months postoperatively, the C2-7 ROM of group I was higher than that of group II (p < 0.05). The superior adjacent segment ROM was higher in group II (p < 0.05), starting at 6 months. The inferior adjacent segment ROM showed no significant difference between the groups (p>0.05). CONCLUSIONS: The HC group showed comparable clinical and radiographic outcomes to those of the 2-level ACDF group. HC can be used selectively in the treatment of patients with 2-level cervical disc disease.
Arm ; Case-Control Studies ; Cervical Vertebrae ; Diskectomy* ; Female ; Humans ; Neck ; Neck Pain ; Range of Motion, Articular ; Retrospective Studies ; Spinal Fusion ; Spine ; Total Disc Replacement*

Endometriosis is a benign gynecologic disease, characterized by the presence and growth of functional endometrial-like tissue outside uterus. This ectopic endometrial tissue is most commonly found in the peritoneum, ovaries and uterosacral ligaments, but extremely rarely there is involvement of the appendix or cecum. Here we report a case of cecal endometriosis presenting as a subepithelial tumor diagnosed by surgical excision.
Appendix ; Cecum ; Colonic Neoplasms ; Endometriosis* ; Female ; Genital Diseases, Female ; Ligaments ; Ovary ; Peritoneum ; Uterus

BACKGROUND/AIMS: Limited data exist on the outcome of gastroesophageal reflux disease (GERD) treatment and its impact on the health-related quality of life (HRQoL) in the Asian population. This study aims to evaluate the treatment outcomes, to investigate the factors associated with recurrence, and to evaluate the impact of the treatment outcome on the HRQoL in a Korean GERD population. METHODS: This was a prospective, multicenter study involving a total of 824 GERD patients. The response to treatment was assessed at week 4 (or week 8 for the patients who did not achieve complete resolution [CR] at week 4). The EQ-5D questionnaire was used at baseline, end of treatment, and first recurrence to assess the HRQoL. To assess GERD symptoms, contact of patients by phone at 1, 6, and 12 months following treatment was carried out. RESULTS: CR was achieved in 65.6% and recurrence was observed in 47.8% following treatment. CR and recurrence rates did not differ by the presence of esophagitis. Multivariate analysis revealed that acid regurgitation (odds ratio 2.249; 95% confidence interval 1.293-3.912; P = 0.004) and both acid regurgitation and heartburn (odds ratio 2.330; 95% confidence interval 1.392-3.901; P = 0.001) were independent risk factors for GERD recurrence. EQ-5D scores were more improved in patients with CR than in those without CR, and worsened more during follow-up in patients with recurrence than in those without recurrence. CONCLUSIONS: We should achieve complete symptom relief and attempt to prevent recurrence in GERD patients to improve their HRQoL.
Asian Continental Ancestry Group ; Esophagitis ; Follow-Up Studies* ; Gastroesophageal Reflux* ; Heartburn ; Humans ; Multivariate Analysis ; Prospective Studies* ; Quality of Life* ; Recurrence* ; Risk Factors ; Treatment Outcome

Pincer nail deformity is a severe condition in which the nail bed becomes compressed and the nail shows an overcurvature. We retrospectively analyzed 13 pincer nail deformities treated using our nail plate and bed reconstruction technique. Visual analogue scale scores, the width of nail root, width of nail tip, height of nail tip, width index, and height index were assessed before and after surgery. The overcurvature was corrected after detachment of the nail plate. The nail fold was pushed underneath the nail plate and then fixed. The width of nail tip significantly increased after surgery (p < 0.05) and was maintained during follow-up. The height of nail tip decreased after surgery (p < 0.05). This nail plate and bed reconstruction technique is a simple and quick surgical method for correcting deformities and reduces risks of complications such as skin necrosis and infection compared to other existing surgical techniques. We recommend this efficient surgical technique for the treatment of pincer nails.
Congenital Abnormalities* ; Follow-Up Studies ; Methods ; Nails, Malformed ; Necrosis ; Retrospective Studies ; Skin

BACKGROUND: Resilient individuals have a comprehensive ability to adapt to various life circumstances. Psychological resilience predicts an individual’s physiological response to stress. The 10-item Connor-Davidson Resilience Scale (CD-RISC) is a widely used measure to quantify the level of self-perceived resilience. This study examined the psychometric properties of a Korean version of the 10-item Connor-Davidson Resilience Scale (10-item K-CD-RISC) on workers in Gumi, South Korea, exposed to hydrofluoric acid (HF). METHODS: The questionnaires included the 10-item K-CD-RISC and Beck Anxiety Inventor (BAI), the Impact of Event Scale-Revised-Korean version (IES-R-K), the Rosen-berg Self Esteem Scale (RSES), the Center for Epidemiologic Studies-Depression Scale (CES-D), and the Perceived Stress Scale (PSS). These were randomly distributed at 237 workplaces near the HF-spill site, in the Gumi 4 complex. The responses of 991 (67.3%) workers were analyzed. RESULTS: The exploratory factor analysis shown that a single-factor model was consistent with the original design of the 10-item CD-RISC. The scale also demonstrated good internal consistency (Cronbach’s alpha = 0.95). Scores on the scale reflected different levels of resilience with respect to personal factors (age, gender, marital status, and education and income levels) that are thought to be differentiated. Differences of resilience were also reflected by psychiatric symptoms (anxiety and depression). Moreover, the total score of scale positively correlated with RSES, whereas the IES-R-K, BAI, CES-D, and the PSS negatively correlated with the 10-item K-CD-RISC. CONCLUSIONS: The 10-item K-CD-RISC has good psychometric properties and is applicable for victims exposed to noxious chemical such as HF.
Anxiety ; Education ; Gyeongsangbuk-do ; Humans ; Hydrofluoric Acid ; Inventors ; Korea ; Marital Status ; Psychometrics ; Resilience, Psychological ; Self Concept ; Stress Disorders, Post-Traumatic