In contrast to younger patients, geriatric patients are generally considered to be a poor risk for anesthesia and surgery and greater care should be taken in anesthetic management, because many have chronic systemic diseases in addition to a decrease in physiologic function. To evaluate geriatric anesthetic experiences, we received clinical records of 1,062 patients aged over 65 out of 21,656 surgical cases performed at Korea University Hye-Wha Hospital from January 1980 to December 1986. The cases were analysed according to age, sex, department, preoperative physical status, anesthetic techniques and agents, duration of anesthesia, operation site, length of hospital stay, laboratory data(Chest X-ray, EKG), associated diseases, postoperative complications and mortality. The results are as follows: 1) Of the 1,062 geriatric surgical patients, 516 cases(48.6%) were 65~69 years of age. 2) The number of geriatric surgical cases was 1,062 of which 672(63.3%) were male and 390(36.7%) were female. 3) Most surgical cases were general surgery(401 cases, 37.8%). 4) The rate of elective and emergency surgery was 78.0%(829 cases) and 22.0%(233 cases), respectively. The ratio of insurance patients (737 cases, 69.4%) versus noninsurance patients(325 cases, 30.6%) was approximately 2:1. 5) The number of general anesthesia cases was 777 (73.2%), spinal anesthesia 244( 23.0%), epidural anesthesia, 21(.20%), and brachial plexus block, 5( 0.5%). The anesthetics were thalamonal and meperidine hydrochloride(238 cases, 22.4%), halothane(204 cases, 19.2%) and tetracaine(244 cases, 23.0%). 6) The duraion of anesthesia was within 1hour in 88 cases( 8.3%), 1~2 hours in 421 cases(39.6%), and 2~3 hours in 291 cases(27.4%). 7) The number of lower abdominal surgery cases was 497 (46.8%) and the number of upper abdominal surgery cases was 188(17.7%). 8) Preoperative laboratory findings were as follows: The findings of preoperative chest X-rays revealed that 219 cases(21.4%) were within normal mits. 182 cases(17.8%) had hypertensive heart, and 208 cases(20.4%) had atherosclerosis. The EKG, which was done on 90.8% of the patients, revealed that 333 cases (34.5%) were within normal limits, 77 cases(8.0%) showed left ventricular hypertrophy, 65 cases(6.7%) showed sinus bradycardia, and 27 cases(2.8%) showed myocardial ischemia. 9) Hypertension(88cases, 49.4%) was the most commonly associated disease. 10) The total number of postoperative complication cases was 73(6.9%). Seventeen cases showed wound infection and delayed skin closure, 19 cases showed pneumonia, and 7 cases showed atelectasis. 11) The total number of postoperative deaths was 18 cases(1.7%).
Anesthesia* ; Anesthesia, Epidural ; Anesthesia, General ; Anesthesia, Spinal ; Anesthetics ; Atherosclerosis ; Brachial Plexus ; Bradycardia ; Electrocardiography ; Emergencies ; Female ; Heart ; Humans ; Hypertrophy, Left Ventricular ; Insurance ; Korea ; Length of Stay ; Male ; Meperidine ; Mortality ; Myocardial Ischemia ; Pneumonia ; Postoperative Complications ; Pulmonary Atelectasis ; Skin ; Thorax ; Wound Infection

Background: Dual-type calcium channel blockers (CCBs), such as efonidipine and cilnidipine, are renoprotective drugs that reportedly reduce proteinuria by dilating afferent and efferent arterioles of the glomerulus. However, studies comparing the effect of dual-type CCB on proteinuria have not been conducted. Therefore, we aimed to compare the effect of dual-type CCB (efonidipine and cilnidipine) usage patterns in hypertensive patients with chronic kidney disease (CKD). Methods: This single-center, retrospective study included 53 patients with CKD who 1) initiated efonidipine or cilnidipine treatment while on a renin-angiotensin system inhibitor and 2) had received efonidipine or cilnidipine for at least one year. We compared usage patterns between the efonidipine and cilnidipine groups during the one-year period and analyzed the following outcomes: urinary protein-to-creatinine ratio, blood pressure, and serum creatinine. Results: The study included 25 patients in the efonidipine group and 28 patients in the cilnidipine group. In both groups, blood pressure and urinary protein-to-creatinine ratios tended to decrease; however, the change during each interval was not significant. Conclusions In patients with CKD who were on renin-angiotensin system inhibitor therapy, the addition of a dual-type CCB (i.e., efonidipine or cilnidipine) tended to reduce proteinuria; however, the change during each interval was not significant.

Background: Dual-type calcium channel blockers (CCBs), such as efonidipine and cilnidipine, are renoprotective drugs that reportedly reduce proteinuria by dilating afferent and efferent arterioles of the glomerulus. However, studies comparing the effect of dual-type CCB on proteinuria have not been conducted. Therefore, we aimed to compare the effect of dual-type CCB (efonidipine and cilnidipine) usage patterns in hypertensive patients with chronic kidney disease (CKD). Methods: This single-center, retrospective study included 53 patients with CKD who 1) initiated efonidipine or cilnidipine treatment while on a renin-angiotensin system inhibitor and 2) had received efonidipine or cilnidipine for at least one year. We compared usage patterns between the efonidipine and cilnidipine groups during the one-year period and analyzed the following outcomes: urinary protein-to-creatinine ratio, blood pressure, and serum creatinine. Results: The study included 25 patients in the efonidipine group and 28 patients in the cilnidipine group. In both groups, blood pressure and urinary protein-to-creatinine ratios tended to decrease; however, the change during each interval was not significant. Conclusions In patients with CKD who were on renin-angiotensin system inhibitor therapy, the addition of a dual-type CCB (i.e., efonidipine or cilnidipine) tended to reduce proteinuria; however, the change during each interval was not significant.

We had done one-lung ventilation using 9 Fr wire-guided endobronchial blocker and outer diameter 41-mm flexible fiberoptic bronchoscope in ruptured esophageal patient who expected difficult tracheal intubation and in esophageal cancer patient who was in need of mechanical ventilation during and after the operation.
Bronchoscopes ; Esophageal Neoplasms ; Humans ; Intubation ; One-Lung Ventilation* ; Respiration, Artificial

The concept of using high-dose immunosuppressive treatment (HDIT) with autologous stem cell transplantation (ASCT) to treat patients with refractory rheumatoid arthritis has been provided by animal studies and anecdotal case reports. Over the past five years, an increasing number of patients with refractory rheumatoid arthritis have received HDIT with ASCT as an adjunct to intense immunosuppression. Here, we present a case of refractory rheumatoid arthritis in a 54-yr-old woman using HDIT with ASCT. Peripheral blood stem cells were mobilized with cyclophosphamide (4 g/m(2)) followed by G-CSF (5microgram/kg/day). Leukapheresis continued daily until the number of harvested progenitor cells reached 2 x 10(6) CD34+ cells/kg after CliniMax(R) CD34+ positive selection. For HDIT, high-dose cyclophosphamide (total dose 200 mg/kg) and antithymocyte globulin (total dose 90 mg/kg) were administered and CD34+ cells were infused 24 hr after HDIT. The patient tolerated the treatment well but experienced an episode of neutropenic fever. She achieved an early dramatic improvement of joint symptoms during therapy. Fifty percent of improvement of rheumatoid arthritis by the American College of Rheumatology (ACR 50) preliminary definition was fulfilled during the 6 months following ASCT. Although further long-term follow-up is required, the patient's activity of arthritis has been stable since receiving HDIT with ASCT.
Antilymphocyte Serum/*therapeutic use ; Arthritis, Rheumatoid/*drug therapy/physiopathology ; Combined Modality Therapy/methods ; Cyclophosphamide/*therapeutic use ; Female ; *Hematopoietic Stem Cell Transplantation ; Humans ; Immunosuppressive Agents/*therapeutic use ; Middle Aged ; Transplantation, Autologous ; Treatment Outcome

Ligamentum flavum cysts have rarely been reported and known to be the uncommon cause of spinal compression and radiculopathy. A 63-year-old man presented right sciatica lasting for 1 month. Lumbar computerized tomography and magnetic resonance imaging demonstrated an extradural cystic mass adjacent to the L5-S1 facet joints. Partial hemilaminectomy and flavectomy at the L5-S1 space were performed, and then the cystic mass was excised. Histopathology confirmed a connective tissue cyst, which is consistent with the ligamentum flavum. Microscopic examination of the cyst wall revealed that it is closely packed collagen fibril. The symptom of patient was improved after surgery. Because of rarity of ligamentum flavum cysts and nonspecific clinical and radiologic findings, the preoperative diagnosis is not easy. The histologic features of ligamentum flavum cysts are distinct from other cystic lesion of lumbar spine. This study presents a case and literature review of ligamentum flavum cyst. We summarize the pathophysiology, occurrence, differential diagnosis of rare ligamentum flavum cyst, especially on lumbar spine.
Collagen ; Connective Tissue ; Diagnosis ; Diagnosis, Differential ; Humans ; Ligamentum Flavum* ; Lumbar Vertebrae ; Magnetic Resonance Imaging ; Middle Aged ; Radiculopathy ; Sciatica ; Spine* ; Zygapophyseal Joint

We report a case of pulmonary edema developed in a 33-year-old female who underwent two-stage bilateral carotid body tumor excision. About 1 month ago, she had undergone a left carotid body tumor excision. After the operation, her tongue was deviated to left side. Bilateral hypoglossal nerve injury was suspected. These injuries should be carefully monitored in patients who will undergo a similar procedure on both sides because a bilateral deficit of the hypoglossal nerve is poorly tolerated, resulting potentially serious pulmonary edema. In recovery room, she became pale and SpO2 was fall down. We reintubated her immediately and the pulmonary edema was treated using a supportive management. She was discharged without any signs of dyspnea or airway obstruction, but hypoglossal nerve injury remained. We discuss the possible etiology of the upper airway obstruction after the neck surgery and review the literatures associated with the pulmonary edema following upper airway obstruction.
Adult ; Airway Obstruction ; Carotid Body Tumor* ; Carotid Body* ; Dyspnea ; Female ; Humans ; Hypoglossal Nerve ; Hypoglossal Nerve Diseases ; Hypoglossal Nerve Injuries ; Neck ; Pulmonary Edema* ; Recovery Room ; Tongue

BACKGROUND: The XN-series (Sysmex, Japan) is the new hematology analyzer from Sysmex, with new channels to improve the accuracy of differential leukocyte count and platelet count in the low cell count range. We evaluated the analytical performance and low white blood cell (WBC) mode of the XN-2000. METHODS: Precision, linearity, and carryover were evaluated for the analyzer. We analyzed the accordance of complete blood count (CBC), reticulocyte count, and differential leukocyte count between the XN-2000 and XE-2100 (Sysmex), using 200 samples from normal controls and patients. For 80 samples with a WBC count <1.5x10(9) cells/L, the low WBC mode was evaluated by comparing the automated count with a manual differential count as the reference. RESULTS: The coefficients of variation of precision were <5% for most CBC parameters and <10% for differential leukocyte count. All results obtained with the XN-2000 showed good correlation with those obtained with the XE-2100. The correlation coefficients (r) were >0.9800 for all CBC parameters except mean corpuscular hemoglobin concentration, mean platelet volume, and platelet distribution width, and >0.9900 for differential leukocyte count except monocytes and basophils. The low WBC mode provided accurate counts for neutrophils and lymphocytes, with r>0.9300 for samples with a WBC count of 0.1-1.5x10(9) cells/L. CONCLUSIONS: The XN-2000 showed good analytical performance and correlation with the existing model, the XE-2100. The XN-2000 provided accurate results for differential leukocyte count in samples with a WBC count of 0.1-1.5x10(9) cells/L, and reduced manual slide reviews.
Basophils ; Blood Cell Count ; Blood Platelets ; Cell Count ; Erythrocyte Indices ; Hematology* ; Humans ; Leukocyte Count* ; Leukocytes ; Lymphocytes ; Mean Platelet Volume ; Monocytes ; Neutrophils ; Platelet Count ; Reticulocyte Count

The chromosome band 11q23 is a common target region of chromosomal translocation in different types of leukemia, including infantile leukemia and therapy-related leukemia. The target gene at 11q23, MLL, is disrupted by the translocation and becomes fused to various translocation partners. We report a case of AML with a rare 3-way translocation involving chromosomes 1, 9, and 11: t(1;9;11)(p34.2;p22;q23). A 3-yr-old Korean girl presented with a 5-day history of fever. A diagnosis of AML was made on the basis of the morphological evaluation and immunophenotyping of bone marrow specimens. Flow cytometric immunophenotyping showed blasts positive for myeloid lineage markers and aberrant CD19 expression. Karyotypic analysis showed 46,XX,t(1;9;11)(p34.2;p22;q23) in 19 of the 20 cells analyzed. This abnormality was involved in MLL/MLLT3 rearrangement, which was confirmed by qualitative multiplex reverse transcription-PCR and interphase FISH. She achieved morphological and cytogenetic remission after 1 month of chemotherapy and remained event-free for 6 months. Four cases of t(1;9;11)(v;p22;q23) have been reported previously in a series that included cases with other 11q23 abnormalities, making it difficult to determine the distinctive clinical features associated with this abnormality. To our knowledge, this is the first description of t(1;9;11) with clinical and laboratory data, including the data for the involved genes, MLL/MLLT3.
Antigens, CD19/metabolism ; Bone Marrow Cells/pathology ; Child, Preschool ; Chromosomes, Human, Pair 1 ; Chromosomes, Human, Pair 11 ; Chromosomes, Human, Pair 9 ; Female ; Humans ; Immunophenotyping ; In Situ Hybridization, Fluorescence ; Karyotyping ; Leukemia, Myeloid, Acute/*diagnosis/genetics/immunology ; Myeloid-Lymphoid Leukemia Protein/*genetics ; Nuclear Proteins/*genetics ; *Translocation, Genetic

BACKGROUND/AIMS: To date, high-resolution manometry has been used mainly in the study of esophageal motility disorders and has been shown to provide more physiological information than conventional manometry, and is easier to interpret. This study aimed to evaluate the usefulness of high-resolution anorectal manometry (HRARM) compared to water-perfused anorectal manometry. METHODS: Patients who complained of chronic constipation with/without fecal incontinence underwent both water-perfused anorectal manometry and HRARM in a random order on the same day. Resting and squeezing pressures of the anal sphincter, attempted defecation, rectoanal inhibitory reflex, rectoanal contractile reflex, Rao's type of dyssynergia during attempted defecation, anal canal length, defecation dynamic parameters and measurement times for each method were analyzed. RESULTS: Of 14 patients, 7 were female, and the median age was 59 years (range 35-77). Indications for manometry were constipation (n = 8) and constipation with fecal incontinence (n = 6). Resting and squeezing pressures showed that the 2 methods were strongly correlated (resting pressure: r = 0.746, P = 0.002; squeezing pressure: r = 0.921, P < 0.001). In attempted defection, one equivocal case with water-perfused anorectal manometry was diagnosed type I pelvic floor dyssynergia with HRARM providing detailed pressure changes in internal and external anal spincters, and puborectalis muscle which improved assessment of anorectal disorders. The measurement time for HRARM was significantly shorter than that for water-perfused anorectal manometry (11.3 vs 23.0 minutes, P < 0.001). CONCLUSIONS: Both water-perfused anorectal manometry and HRARM are well tolerated and reliable methods of evaluating defecation disorders of pelvic floor dysfunction. HRARM is likely to provide better physiological information and to require a shorter measurement time compared to water-perfused anorectal manometry.
Anal Canal ; Ataxia ; Constipation ; Defecation ; Esophageal Motility Disorders ; Fecal Incontinence ; Female ; Humans ; Manometry* ; Pelvic Floor ; Reflex