Arytenoid subluxation or recurrent laryngeal nerve paralysis may result from injury to the larynx following endotracheal intubation or blunt laryngeal trauma. Early diagnosis is important for appropriate treatment and better prognosis. A 62-years-old man was admitted for cholecystectomy. He was intubated without any difficulty and nasogastric tube was inserted with the help of laryngoscope and Magill forcep before surgery. He had a weak voice and hoarseness after atraumatic extubation and those symptoms did not improve even 2 days after. Indirect laryngoscopy, videolaryngotelescopy, electromyography(EMG) and computed tomographic findings revealed anterior, inferior subluxation of left cricoarytenoid cartilage associated with left thyroarytenoid muscle denervation and resultant unilateral vocal cord palsy. Conservative treatment for 40 days after the operation and follow-up examination was done. The voice quality was improved and indirect laryngoscopy examination showed that right vocal cord crossed midline in a attempt to meet its paralyzed counterpart on phonation.
Anesthesia, General* ; Cartilage ; Cholecystectomy ; Denervation ; Early Diagnosis ; Follow-Up Studies ; Hoarseness ; Intubation, Intratracheal ; Laryngeal Muscles ; Laryngoscopes ; Laryngoscopy ; Larynx ; Paralysis* ; Phonation ; Prognosis ; Recurrent Laryngeal Nerve* ; Surgical Instruments ; Vocal Cord Paralysis ; Vocal Cords ; Voice ; Voice Quality

No abstract available.
Appointments and Schedules*

No abstract available.
Reference Values*

BACKGROUND: Hydration, the water content of the stratum corneum, is an important factor in both the appearance and the barrier function of the skin. Many non-invasive methods have been developed in order to assesa the hydration state of the skin and the effect of various moisturizers. The hydrometer and carneometer are commercially available instruments which are widely used in dermatologic research. OBJECTIVE: Our purpose was to compare the measuring usefulnes of both instruments on normal subjects with a wide range of hydration states of the hornylayer. METHODS: We measured the conductance with the hydrometer and the capacitance with the corneometer in various hydrating eonditions and compared both insruments. RESULTS: Conductance had a non linear correlation with capacita ice. Capacitance measured with the corneometer had a high sensitivity to moisture in a wide range of hydration levels. On the other hand, conductance guaged with the hydrometer showed a few sensitivity to moisture at a low level. When the hydretion level was measured after a moiturizer was added, 10 % urea cream showed a sharp increase by 256% in terms of conductanae, and H-base by 97.8%. Mineral oil decreased by 41.5% and petrolatum by 62% respectively. On the other hand, when measured in terms of capacitance under the same conditions as above, 38.9 increase in 10% urea cream, 19.3% increase in H-base, 20% decrease in mineral oil, and 43.5 % decrease in petrolatum were reported. Conductance showed a higher hygroscopicity and a lower water holding capacity than capacitance did. When the measurement of the moisture level iri virious parts of the human body is performed, the corneometer provided us with more stable alies than the hydrometer. While the hydrometer can not the available and appropriate under the condition of insulation, the corneometer can measure moisture levels even down at the depth of 250mm. When measured after the oily surface of the forehead was cleansed with soft tissue, conductance and capacitance revealed higher values of moisture levels than before the eleanin. However, there is no statistical significance in these values. CONCLUSION: The hydrometer is a more appropriate tool for the measurement of moisture at a high level, and the corneometer at a low moisture level. The hydrcmeter is a more sensitive method of measuring the increase and the decrease in the moisture level.
Forehead ; Hand ; Human Body ; Ice ; Lasers, Gas ; Mineral Oil ; Petrolatum ; Skin* ; Urea ; Water ; Wettability

BACKGROUND: Hydration, the water content of the stratum corneum, is an important factor in both the appearance and the barrier function of the skin. Many non-invasive methods have been developed in order to assesa the hydration state of the skin and the effect of various moisturizers. The hydrometer and carneometer are commercially available instruments which are widely used in dermatologic research. OBJECTIVE: Our purpose was to compare the measuring usefulnes of both instruments on normal subjects with a wide range of hydration states of the hornylayer. METHODS: We measured the conductance with the hydrometer and the capacitance with the corneometer in various hydrating eonditions and compared both insruments. RESULTS: Conductance had a non linear correlation with capacita ice. Capacitance measured with the corneometer had a high sensitivity to moisture in a wide range of hydration levels. On the other hand, conductance guaged with the hydrometer showed a few sensitivity to moisture at a low level. When the hydretion level was measured after a moiturizer was added, 10 % urea cream showed a sharp increase by 256% in terms of conductanae, and H-base by 97.8%. Mineral oil decreased by 41.5% and petrolatum by 62% respectively. On the other hand, when measured in terms of capacitance under the same conditions as above, 38.9 increase in 10% urea cream, 19.3% increase in H-base, 20% decrease in mineral oil, and 43.5 % decrease in petrolatum were reported. Conductance showed a higher hygroscopicity and a lower water holding capacity than capacitance did. When the measurement of the moisture level iri virious parts of the human body is performed, the corneometer provided us with more stable alies than the hydrometer. While the hydrometer can not the available and appropriate under the condition of insulation, the corneometer can measure moisture levels even down at the depth of 250mm. When measured after the oily surface of the forehead was cleansed with soft tissue, conductance and capacitance revealed higher values of moisture levels than before the eleanin. However, there is no statistical significance in these values. CONCLUSION: The hydrometer is a more appropriate tool for the measurement of moisture at a high level, and the corneometer at a low moisture level. The hydrcmeter is a more sensitive method of measuring the increase and the decrease in the moisture level.
Forehead ; Hand ; Human Body ; Ice ; Lasers, Gas ; Mineral Oil ; Petrolatum ; Skin* ; Urea ; Water ; Wettability

BACKGROUND: Recently, Doppler echocardiography has been widely used to evaluate left ventricular(LV) diastolic filling. However, There are only limited date about the influence of LV systolic function on the pattern of left ventricular diastolic filling. METHODS: To evaluate the changes of Doppler echocardiographic parameters of left ventricular filling induced by variations in left ventricular systolic function in dilated cardiomyopathy(DC) with heart failure(HF), 25 patients(M : F=14 : 11) with DC and HF, and 21 age-matched normal subjects(M : F=13 : 8) were examined by ECG, phonocardiography and echocardiography. From the Doppler recording, A2D(time from second heart sound to the onset of early diastolic mitral flow), peak velocity at early diastole(E) and late diastole(A), ratio of E to A velocity(E/A) and flow velocity integral(FVI) were measured. RESULTS: In 22 patients with DC and HF without mitral regurgitation(MR), A2D was significantly prolonged(119.5+/-12.7 vs 92.4+/-14.1msec, p<0.01), and early diastolic peak velocity and E/A velocity ratio were decreased as compared with the normal subjects(E=0.39+/-0.08 vs 0.57+/-0.12m/sec, p<0.01, E/A : 0.87+/-0.19 vs 1.33+/-0.19 vs 1.33+/-0.18, p<0.05). There were significant correlations between A2D and FVI(r=+0.73, p<0.01), and between E/A velocity ratio and FVI(r=-0.78, p<0.01). However, in 3 patients with MR, A2D(88.7+/-12.1msec), E(0.56+/-0.05m/sec), and E/A(1.32+/-0.12) were similar to those in normal subjects, despite of decreased FVI(12.0+/-0.9cm). CONCLUSIONS: These data show that a change of left ventricular systolic function in patients without MR may influence a diastolic filling pattern of left ventricle but not in patient with MR, and suggest that MR masks left ventricular distolic filling abnormalities.
Cardiomyopathy, Dilated* ; Echocardiography ; Echocardiography, Doppler* ; Electrocardiography ; Heart ; Heart Sounds ; Heart Ventricles ; Humans ; Masks ; Phonocardiography ; Ventricular Function, Left*

PURPOSE: To evaluate the incidence, risk factors and prognosis of delirium in elderly patients with intertrochanteric fractures of femur. MATERIALS AND METHODS: 162 patients who underwent operation for intertrochanteric fracture of femur from July 2005 to January 2007 were reviewed retrospectively. Delirium was diagnosed by using Confusion Assessment Method (CAM). Medical records were reviewed for the information of the patients, Gross motor function classification of Palisano et al. was used for the evaluation of ambulatory status. Univariate analysis and multivariate analysis were done to find out the risk factors. RESULTS: 2 cases out of 162 (1.2%) met the criteria of delirium at admission, and 39 cases (24.1%) after surgery. Univariate analysis and multivariate analysis identified age, hematocrit, dementia, the duration of opiate use, and pulmonary complication as risk factors. Hospital stay was longer and postoperative ambulatory status was worse in the patients with delirium. CONCLUSION: Delirium is a frequent complication of intertrochanteric fractures of old age and associated with worse results. Cognitive function as well as physical status should be evaluated before and after surgery. Delirium needs more active prevention and treatment for better results.
Aged ; Delirium ; Dementia ; Femur ; Hematocrit ; Hip Fractures ; Humans ; Incidence ; Length of Stay ; Medical Records ; Multivariate Analysis ; Prognosis ; Retrospective Studies ; Risk Factors

It has been generally believed that the impaction or eruption of mandibular third molars has significant correlations with the growth of the mandible, size of mandibular arch and size of teeth. The purpose of this study was to examine if there is any correlation between the status of eruption of mandibular third molars and the amount of mandibular crowding. The effect of missing of third moalrs to mandibular crowding was studied as well. 140 adult students of Yonsei University were selected and divided into three groups according to the status of mandibular third molars, Group 1) congenital missing group, Group 2) eruption group, and Group 3) impaction group. The tooth size, dimensions of the mandibular dental arch, and the amount of crowding were measured and compared. Results were as follows; 1. There was no statistically significant difference in tooth size between the missing group and the eruption group(p<0.05). Impaction group showed larger total tooth material, incisal tooth material, and individual tooth size except central incisors compared to missing group (p<0.05). Impaction group showed larger total tooth material, incisal tooth material compared to eruption group as well(p<0.05). When individual tooth size was compared, impaction group had larger central incisors, canines, and second premolars than eruption group(p<0.05). 2. Missing group showed larger intermolar width than impaction group and it was statistically significant(p<0.05). 3. When compared the amount of total crowding, impaction group showed the largest amount of crowding, then eruption group, and missing group showed the least amount of crowding respectively(p<0.05). There was no statistically significant difference between missing group and eruption group in the amount of incisal crowding (p<0.05). Impaction group showed the largest amount of incisal crowding among all three groups(p<0.05).
Adult ; Bicuspid ; Crowding* ; Dental Arch ; Humans ; Incisor ; Mandible ; Molar, Third* ; Tooth

Preadolescent children with deficient maxillae are suitable candidates for the maxillary protraction appliance(MPA). The theoretical effect of the MPA is protraction or anterior displacement of the maxilla. However, it is known that complex effects such as anterior displacement of the maxillary teeth, downward and backward rotation of the mandible, linguoversion of the mandibular anterior incisors, are known to play a role in improving the Cl III malocclusion. There have been much studies with regard to maxillary protraction, but the different effects of MPAs depending on the vertical facial pattern are not known precisely. This study was based on 67 patients (31 males, 36 females) aged from 6 years 6 months to 13 years 3months, who visited the Dept. of Orthodontics at Yonsei Univ., Dental Hospital and diagnosed as skeletal Class III with maxillary deficiency. They were divided into 3 groups (low, average, high angle groups) depending on gonial angle and the SNMP (Go-Gn) angle, respectively. Pretreatment and post-treatment lateral cephalograms were used to compare the effects of MPA and the following conclusions were obtained: 1) A significantly large amount of backward movement of the B point was observed in patients with a low SNMP angle. Those with a high SNMP angle had significant forward movement at A point. 2) The patients with low gonial angle had the least forward movement at the A point, and those with a high angle had more forward movement. 3) In comparing the arcTan of the A point, the high angle group showed more horizontal movement while the low angle group showed more vertical movement. 4) There was no significance between the treatment duration of the SNMP and the Gonial angle groups.
Child ; Humans ; Incisor ; Male ; Malocclusion ; Mandible ; Maxilla ; Orthodontics ; Tooth

BACKGROUND: Pain following shoulder surgery is usually severe and difficult to control using conventional postoperative pain control maneuvers. Therefore, we investigated the pain control efficacy, PONV (postoperative nausea vomiting) and complications by the use of a continuous brachial plexus block in patients who had undergone shoulder surgery. METHODS: Thirty three shoulder surgery patients were enrolled in this study. According to the Borgeat's modified lateral technique, 30 ml of 0.37% ropivacaine were injected into the patients, which was followed by insertion of a continuous brachial plexus catheter into the plexus sheath. The operation was then conducted under general anesthesia, and postoperative pain was evaluated in the recovery room 12, 24, 36, and 48 hr after surgery. In addition, nausea and vomiting was calculated using the visual analogue scale (VAS) and sedation was evaluated using the modified Ramsay score. A total of 400 ml of 0.2% Ropivacaine was administered at a rate of 8 ml/hr to control the postoperative pain for 2 days. In addition, other neurological complications were investigated, and the catheter tips were cultured after they were removed to determine if any infection had occurred. RESULTS: The postoperative pain scores were below 2 on the 10 cm VAS, and the level of nausea and vomiting was also satisfactorily (< 2/10 cm VAS). In addition, the mean sedation score of the patients in the recovery room was 2. There were complications including motor weakness (24%), dyspnea (15%), Hornor's syndrome (9%), postauricular numbness (9%) and metallic taste (3%), however, there were no patients who complained of neurological symptoms after one month of follow-up, and no signs of infection were found when the results of catheter tip cultures were evaluated. CONCLUSIONS: The use of a continuous interscalene brachial plexus block is a feasible method of postoperative pain control for patients who undergo major shoulder surgery.
Anesthesia, General ; Brachial Plexus* ; Catheters ; Dyspnea ; Follow-Up Studies ; Humans ; Hypesthesia ; Nausea ; Nerve Block ; Pain, Postoperative ; Postoperative Nausea and Vomiting ; Recovery Room ; Shoulder* ; Taste Disorders ; Vomiting