BACKGROUND: Combined spinal epidural anesthesia (CSE) often produces a more extensive spinal block than expected. This study was designed to evaluate the effects of CSE on subarachnoid block in patients undergoing lower extremity surgery. METHODS: Thirty-three patients who undergone lower extremity surgeries were randomly allocated to three groups of 11 patients each. Using needle through needle technique, all patients received a subarachnoid injection of hyperbaric 0.5% bupivacaine 1.6~2.0 ml through a 25G Whitacre spinal needle. Group 1 received no extradural injection for 25min, but group 2 and 3 received extradural saline 10 ml and bupivacaine 10 ml 5min after the subarachnoid injection, respectively. Levels of sensory and motor block were assessed at 4, 6, 8, 10, 15, 20, and 25 min after subarachnoid injection. RESULTS: The median values of maximum sensory block level were T7 in all groups. Levels of sensory blockade and the time to onset of maximum sensory blockade were similar among the three groups. There was no significant difference in the degree of motor block among three groups. CONCLUSIONS: This study suggests that extradural saline 10 ml or 0.5% bupivacaine 10 ml which injected 5min after subarachnoid injection does not significantly influence the level of subarachnoid block in lower extremity surgical patients. However, further study is required to declare the safety or optimal dose of extradural injection during CSE.
Anesthesia, Epidural* ; Bupivacaine ; Humans ; Injections, Epidural ; Lower Extremity* ; Needles

The problem of difficult intubation is well known to anesthesiologists. However, difficulties associated with the extubation of endotracheal tubes are not common, and few reports exist. However, untoward incidents of diverse etiology can occur and the complications of difficult extubation may be fatal. We experienced 2 cases of difficult extubations. One was due to adhesion of the tube to the tracheal wall and the other was due to a fold in the deflated cuff of an excessively large-sized tube. We managed these difficult extubations by rotating the tube with a MaGill forcep under direct laryngoscopy. We report upon these clinical experiences and include a brief review of the literature.
Intubation ; Laryngoscopy ; Surgical Instruments

PURPOSE: To estimate the effect and toxicity of bimonthly low-dose leucovorin (LV) and fluorouracil (5-FU) bolus plus continuous infusion(LV5FU2) with docetaxel combination chemotheraphy in patients with inoperable or postoperative relapsed gastric cancer. MATERIALS AND METHODS: Total 27 patients are enrolled in this study. LV 20 mg/m2 (bolus), 5FU 400 mg/m2 (bolus), 5-FU 600 mg/m2 (24-hour continuous infusion) on day 1, 2, 15, and 16, docetaxel 60 mg/m2 (1-hour infusion) on day 15 every 4 weeks. RESULTS: Total of 141 cycles were administered and response rate were 36.8% with 2 complete response (10.5%) and 5 partial response (26.3%) in 19 evaluable patients. The median response duration is 8.1 months (95% CI, 4.0~12.1). The median progression-free survival time is 6.7 months (95% CI, 5.0~8.5) and the median overall survival time is 11.9 months (95% CI, 4.8~19.1). The grade 3-4 toxcity of neutropenia (24.8%) and anemia (11.3%), neutropenic fever (2.8%) is observed. The grade 1 toxcity of injection site reaction is observed all patients and the grade 1-2 toxcity of alopecia is observed 60%. CONCLUSIONS: LV5FU2 with docetaxel combination chemotheraphy is effective and tolerable in patients with inoperable or postoperative relapsed gastric cancer.
Alopecia ; Anemia ; Disease-Free Survival ; Drug Therapy, Combination ; Fever ; Fluorouracil ; Humans ; Leucovorin ; Neutropenia ; Stomach Neoplasms ; Taxoids

No abstract available.
Teratoma*

PURPOSE: The purpose of this study was to establish optimal imaging acquisition conditions for the GE Advance(TM) PET imaging system by performing the acceptance tests designed by National Electrical Manufacturers Association (NEMA) protocol and General Electric Medical Systems (GEMS) test procedures. MATERIALS AND METHODS: Performance tests were carried out with 18FDG radioactivity source and phantoms by using a standard acquisition mode. Transaxial resolution and scatter fraction tests were performed with a line source and axial resolution with a point source, respectively. A cylindrical phantom made of polymethylmethacrylate (PMMA) was used to measure sensitivity, count rate losses and randoms, uniformity correction, and attenuation inserts were added to measure remaining tests. The test results were acquired in a diagnostic acquisition mode and analyzed mainly on high sensitivity mode. RESULTS: Transaxial resolution and axial resolution were measured as average of 4.65 mm and 3.98 mm at 0 cm, and 6.02 mm and 6.71 mm at 20 cm on high sensitivity mode, respectively. Average scatter fraction was 9.87%, and sensitivity was 225.8 kcps/micronCi/cc of trues. Activity at 50% deadtime was 4.6 Ci/cc, and the error of count rate correction at that activity was from 1.49% to 3.83%. Average nonuniformity for total slice was 8.37%. The accuracy of scatter correction was -0.95%. The accuracies of attenuation correction were 5.68% for air, 0.04% for water and -6.51% for polytetrafluoroethylene (PTFE). CONCLUSION: The results satisfied most acceptance criteria, indicating that the GE AdvanceTM PET system can be optimally used for clinical applications.
Electrons* ; Fluorodeoxyglucose F18 ; Polymethyl Methacrylate ; Polytetrafluoroethylene ; Positron-Emission Tomography* ; Radioactivity ; Water

Infection of cattle with bovine leukemia virus (BLV) has been observed and reported worldwide, including in Korea. The onsite identification of infected cattle would help decreasing and eradicating BLV infections on farms. Here, we present a new immunochromatographic assay that employs monoclonal antibodies (MAbs) for the detection of antibodies against BLV in the field. BLV envelope glycoprotein (gp)51 was expressed in E. coli, and MAbs against recombinant BLV gp51 were generated for the development of an immunochromatographic assay to detect BLV antibodies in cattle. The sensitivity and specificity of the assay were determined by comparing these results with those obtained from a standard enzyme linked immunosorbent assay (ELISA). A total of 160 bovine sera were used to evaluate the new immunochromatographic assay. Using ELISA as a reference standard, the relative specificity and sensitivity of this assay were determined to be 94.7% and 98%, respectively. Because of its high sensitivity and specificity, this BLV antibody detection assay would be suitable for the onsite identification of BLV infection in the field.
Agriculture ; Animals ; Antibodies* ; Antibodies, Monoclonal ; Cattle ; Deltaretrovirus Antibodies ; Deltaretrovirus Infections ; Enzootic Bovine Leukosis* ; Enzyme-Linked Immunosorbent Assay ; Glycoproteins ; Immunochromatography* ; Korea ; Leukemia Virus, Bovine* ; Sensitivity and Specificity

This study investigated that the antioxidative effect of freeze-dried cranberry powder against protein and lipid oxidation and ameliorative effect of serum lipid profile in rat fed atherogenic diet. Six weeks old male Sprague-Dawley rats were divided into the following four groups: normal diet group with 5% corn oil (control), atherogenic diet group with 5% corn oil, 10% lard, 1% cholesterol, and 0.5% sodium cholate (HFC), atherogenic plus 2% cranberry powder diet group (HFC + C2), and atherogenic plus 5% cranberry powder diet group (HFC + C5), and respective diet and water were fed daily for 6 weeks. After the experimental period, the serum lipid profile, such as total cholesterol, HDL-cholesterol, LDL-cholesterol, and triglyceride, ferric reducing ability of plasma (FRAP), plasma phenolics content, superoxide dismutase (SOD) activity, serum protein carbonyl and thiobarbituric acid reactive substances (TBARS) levels were examined. Total phenolic compound and total flavonoid levels in freeze-dried cranberry powder were 9.94 mg/g and 8.12 mg/g, respectively. Serum total cholesterol and LDL-cholesterol levels were not significantly different for cranberry powder treatment, but serum HDL-cholesterol level was significantly increased in HFC + C5 group compared with HFC group. Plasma FRAP value tended to be increased by cranberry powder treatment though there was no significant difference. Plasma total phenol concentrations and SOD activities were not significantly different among all groups. Serum protein carbonyl and TBARS levels were significantly decreased in HFC + C5 group compared with HFC group. Overall results suggested that freeze-dried cranberry powder might have the serum lipid improving effect, as well as antioxidative effect demonstrated by its protective effect against protein and lipid oxidation.
Animals ; Biomarkers ; Cholesterol ; Corn Oil ; Diet ; Diet, Atherogenic ; Dietary Fats ; Humans ; Male ; Oxidative Stress ; Phenol ; Plasma ; Rats ; Rats, Sprague-Dawley ; Sodium Cholate ; Superoxide Dismutase ; Thiobarbiturates ; Thiobarbituric Acid Reactive Substances ; Vaccinium macrocarpon ; Water

Despite the accuracy of nucleic acid amplification tests (NAATs), rapid antigen tests (RATs) for severe acute respiratory syndrome coronavirus-2 are widely used as point-of-care tests. A total of 282 pairs of reverse transcription-polymerase chain reaction and Standard Q COVID-19 Ag tests were serially conducted for 68 patients every 3–4 days until their discharge. Through a field evaluation of RATs using direct nasopharyngeal swabs, the sensitivities were 84.6% and 87.3% for E and RNA-dependent RNA polymerase (RdRp) genes, respectively, for specimens with cycle thresholds (Cts) < 25. The Ct values of E and RdRp genes for 95% detection rates by RATs were 16.9 and 18.1, respectively. The sensitivity of RAT was 48.4% after the onset of symptoms, which was not sufficient. RAT positivity gradually decreased with increased time after symptom onset and had continuously lower sensitivity than NAATs.

Although colonoscopy is commonly performed, it is an invasive procedure that might produce complications such as hemorrhage and perforation. Colonic perforation is an abdominal emergency with high mortality requiring surgical intervention. Sometimes non-surgical teatment can be applied when perforation is small sized, located in the retoperitoneal spaces or surgical approach is impossible. We are reporting a case of colon perforation in 64-year-old female patient. The patient visited our hospital with symptoms of dizziness and dyspnea. She was anemic and we planned to find the possible cause of anemia. Rectal perforation was developed during the diagnostic colonoscopy. However the operation was not applicable due to arrhythmia and cardiogenic shock. Therefore endoscopic clipping was done at the perforation site. Afterwards nasogastric decompression, intravenous antibiotics and total parenteral nutrition were applied. She was treated successfully without any complications.
Anemia ; Anti-Bacterial Agents ; Arrhythmias, Cardiac ; Colon ; Colonoscopy ; Decompression ; Dizziness ; Dyspnea ; Emergencies ; Female ; Hemorrhage ; Humans ; Middle Aged ; Mortality ; Parenteral Nutrition, Total ; Shock, Cardiogenic

PURPOSE: Pancreacticoduodenectomy is the procedure of choice for managing periampullary malignancy. But pancreatojejunostomy site leakage is a very critical complication because it is hard to prevent leakage. The aim of this study is to analyze the risk factors of pancreatic leakage after pancreaticoduodenectomy. METHODS: We retrospectively reviewed 172 consecutive patients who had received pancreaticoduodenectomy at Inha University Hospital between Apr. 1996 and Mar. 2006. We analyzed the pancreatic leakage rates according to the clinical characteristics, the pathologic and laboratory findings and the anastomosis methods. RESULTS: There were differences in the mean age and pathologic findings between the two groups. There were 115 (66.9%) patients older than 60 years, while the other 57 patients (33.1%) were younger than 60 years. The incidence of developing pancreatic fistula in patients older than 60 years was 21.7% (25/115) while this was 8.8% (5/57) for the younger patients, and the difference was significant (p=0.03). The patients with a dilated pancreatic duct showed a lower rate of esser post-operative pancreatic fistula than the patients with a non-dilated duct (p=0.001). Other factors, including the anastomosis method and the pathologic diagnosis, didn't show any statistical difference. According to the pathologic diagnosis, the patients with pancreatitis and stomach cancer revealed pancreatic fistula to a smaller extent; there were 6 cases (3.5%) of pancreatitis and 22(12.8%) of stomach cancer. Among the case with pancreatic fistula, there were 0 cases of pancreatitis and 2 cases (6,7%) of stomach cancer, but the difference was not statistically significant. CONCLUSION: Our study demonstrated that pancreatic fistula is related to age and a dilated pancreatic duct. Surgeon must take these risk factors into consideration when performing pancreaticoduodenectomy. We recommend surgeons to use skillful technique to prevent pancreatic fistula.
Diagnosis ; Humans ; Incidence ; Pancreatic Ducts ; Pancreatic Fistula* ; Pancreaticoduodenectomy* ; Pancreaticojejunostomy ; Pancreatitis ; Retrospective Studies ; Risk Factors* ; Stomach Neoplasms