Background: Bupivacaine was introduced to be a long-acting spinal anesthetic agent. It has been argued about whether the addition of epinephrine prolongs the bupivacaine action or not. The aim of this present investigation was to find out the effect of additional epinephrine on spinal anesthesia with bupivacaine. Methods: 47 patients undergoing an operation on lower extremity were randomly allocated to 2 groups. All patients were anesthetized by subarachnoid block with 0.5% bupivacaine in 8% glucose, which was mixed with 0.2 ml of normal saline in group non-E (n=24) and 0.2 ml of 1:1,000 epinephrine in group E (n=23). We evaluated blood pressure and heart rate, the sensory and motor blockade and voiding time after spinal anesthesia. Results: The systolic blood pressure (SBP) at 8 and 10 min after anesthesia were lower in group non-E than in group E (p<0.05). The trend of decreasing diastolic blood pressure was similar in both groups. The heart rate(HR) at 2 min after anesthesia was lower in group non-E than in group E (p<0.05). The sensory block in T10 was produced faster in group non-E (7 min) than in group E (11 min)(p<0.05). And the maximal sensory block level and its reaching time was T7 and 14 min in group non-E, and T8 and 17 min in group E (p=0.12, p=0.11). Two segment regression time was 124 min in group non-E, and 184 min in group E (p=011). The onset time of motor block to Bromage scale 3 was 12 min in group non-E and 16 min in group E (p=0.06). The recovery time from complete motor block to Bromage scale 1 after maximal motor block was 263 min in group non-E, and 278 min in group E. The time at which patients voided after anesthesia was 469 min in group non-E, and 466 min in group E. Three patients urinated by using a urinary catheter in each group. Conclusions: The addition of epinephrine to bupivacaine for spinal anesthesia can slow the decrease in SBP and increase the HR at early stage of anesthesia, and slow the sensory block.
Anesthesia ; Anesthesia, Spinal* ; Blood Pressure ; Bupivacaine* ; Epinephrine* ; Glucose ; Heart ; Heart Rate ; Humans ; Lower Extremity ; Urinary Catheters

BACKGROUND: The risk of bleeding during extracorporeal membrane oxygenation (ECMO) is a potential deterrent in performing tracheostomy at many centers. To evaluate the safety of surgical tracheostomy (ST) in critically ill patients supported by ECMO, we reviewed the clinical correlation between preoperative coagulation status and bleeding complication-related ST during ECMO. METHODS: From April 1, 2012 to March 31, 2016, ST was performed on 38 patients supported by ECMO. We retrospectively reviewed and analyzed the medical records including complications related to ST. RESULTS: Heparin was administered to 23 patients (60.5%) for anticoagulation during ECMO, but 15 patients (39.5%) underwent ECMO without anticoagulation. Of the 23 patients administered anticoagulation therapy, heparin infusion was briefly paused in 13 prior to ST. The median platelet count, international normalized ratio, and activated partial thromboplastin time before ST were 126 ×109/L (range, 46 to 434 ×109/L), 1.2 (range, 1 to 2.3) and 62 seconds (27 to 114.2 seconds), respectively. No peri-procedural clotting complications related to ECMO were observed. Two patients (5.3%) suffering from ST-related major bleeding required surgical hemostasis. Minor bleeding after ST occurred in two cases (5.3%). No significant difference was found according to anticoagulation management (P = 0.723). No fatality was attributable to ST. CONCLUSIONS: The complication rates of ST in the patients supported by ECMO were low. Therefore, ST performed by an experienced operator, and with careful optimization of coagulation status, is a relatively safe procedure; the use of ST with ECMO should thus not be dismissed on account of the potential for bleeding caused by the administration of anticoagulants.
Anticoagulants ; Critical Illness ; Extracorporeal Membrane Oxygenation* ; Hemorrhage ; Hemostasis, Surgical ; Heparin ; Humans ; International Normalized Ratio ; Medical Records ; Partial Thromboplastin Time ; Platelet Count ; Retrospective Studies ; Tracheostomy*

The term malignant mesenchymoma has been applied to those tumors of the soft tissue of mesenchymal origin which are composed of tumor cells differentiating into two or more unrelated malignant forms in addition to the fibrosarcomatous element. Recently authors experienced a case of malignant mesenchymoma in the right axillary area. Microscopically the sarcoma revealed multiple pattern of differentiation, including liposarcoma, malignant schwannoma, fibrosarcoma, malignant fibrous histiocytoma and rhabdomyoblastoma. The presence of rhabdomyblastic cells were proved by immunochemical study utilizing desmin. This patient was treated with surgical excision and radiation.

No abstract available.
Dinoprost* ; Female ; Laparoscopes* ; Pregnancy ; Pregnancy, Tubal*

Development of a malignant tumor within a mature cystic teratoma is a serious event, and occurs in about 1%~4% of cases. The malignant transformation occurs most frequently in the squamous epithelium with the formation of a squamous cell carcinoma. There are 10 cases reported in the literature, in Korea. We report 4 additional cases, which include 3 squamous cell carcinomas and 1 adenosquamous carcinomas, arising in cystic teratoma of the ovary.

No abstract available.
Head* ; Neck*

Gallstone ileus is a well-known complication of cholelithiasis, but is relatively rare. Most ectopic gallstones are located in the small bowel; they are rarely found in the stomach and duodenum. We describe the imaging findings of a case of intragastric gallstone, as well as a case in which duodenal obstruction was caused by a large gallstone (Bouveret's syndrome).
Cholelithiasis ; Duodenal Obstruction ; Duodenum ; Gallstones* ; Ileus ; Stomach

PURPOSE: The purpose of this study was to evaluate the fracture strength of straight and angled zirconia abutments for internal hex and external hex implants. MATERIALS AND METHODS: Twenty internal hex implants and 20 external hex implants were prepared. The prefabricated straight zirconia abutments and 17-degree-angled zirconia abutments were connected to those 40 implants. The specimens were classified into 4 groups depending on the connection type and abutment angulation; internal hex implant/straight abutment, group INS; internal hex implant/angled abutment, group INA; external hex implant/straight abutment, group EXS; external hex implant/angled abutment, group EXA. All specimens were loaded at a 30-degree angle with a crosshead speed of 1 mm/min using universal testing machine. The fracture loads were analyzed using 2-way ANOVA and independent t-test (α= .05). RESULTS: The mean fracture load for INS was 955.91 N, 933.65 N for INA, 1267.20 N for EXS, and 1405.93 N for EXA. External hex implant showed a significantly higher fracture load, as compared to internal hex implant (P < .001). No significant differences in fracture loads were observed between the straight and angled abutment in internal hex implants (P = .747) and external hex implants (P = .222). Internal hexes of abutments were fractured horizontally in internal connection implants, while lingual cervical neck portions were fractured in external connection implants. CONCLUSION: The zirconia abutments with external hex implants showed significantly higher fracture strength than those with internal hex implants. However there was no difference in fracture strength between the straight and 17-degree-angled zirconia abutment connected to both implant systems.
Neck

BACKGROUND: Advanced age alone should not be a serious deterrent to surgery. Preoperative evaluation of concomitant illness, operation time, accurate and minimal, but adequate surgery will serve to minimize morbidity and mortality in elderly patients. METHODS: The total number of surgical patients admitted to Kwang Hye Hospital, Pusan, from March 1994 to August 1996 was 3211, and the number of surgical geriatric patients admitted during the same period was 214. Operations were performed on 139 patients. We recorded information about age, sex, anesthesia type, operation time, non malignancy vs malignancy, emergency vs elective "Surgery", coexisting disease, and APACHE II score, and we examined the patients for results affecting postoperative morbidity and mortality. RESULTS: Postoperative complications occured in 55 cases (39.6%), and the operative mortality was 2.2%. The significant factors affecting postoperative morbidity were emergency operation, malignancy and APACHE II score. The operation time and coexisting diseases were not significant. Age had little effect on the postoperative prognosis CONCLUSIONS: Performance of elective surgery and preoperative evaluation of the APACHE II score are important factors.
Aged ; Anesthesia ; APACHE ; Busan ; Emergencies ; Humans ; Mortality ; Postoperative Complications ; Prognosis

BACKGROUND: In Korea, tuberculosis is resistant to isoniazid (INH) and/or rifampicin (RIF) in more than 10% of cases. To prevent the spread of resistant Mycobacterium tuberculosis strains, it is crucial to develop more rapid resistance detection methods. METHODS: To determine the feasibility of using direct sequencing for detecting INH- and RIF-resistant strains, the katG gene, the regulatory region of the inhA gene, and the 81-bp hot-spot region of the rpoB gene from 95 culture isolates and 46 respiratory specimens were sequenced. Total 141 culture isolates were classified by conventional drug susceptibility testing (DST) as INH(R)/RIF(R) (N=30), INH(R)/RIF(S) (N=23), INH(S)/RIF(R) (N=15), and INH(S)/RIF(S) (N=73). RESULTS: Compared with phenotypic DST, the overall sensitivity and specificity of sequencing were 83.0% (44/53) and 96.6% (85/88), respectively, for INH resistance, and 93.3% (42/45) and 100% (96/96), respectively, for RIF resistance. The rates were similar between culture isolates and respiratory specimens. Interestingly, three specimens with inhA -15C>T mutation were susceptible to INH by conventional DST. CONCLUSIONS: Detection of mutations in the katG codon 315, the inhA regulatory region, and the hot-spot region of rpoB would be useful for rapid detection of INH and RIF resistance in Korea.
Antitubercular Agents/*pharmacology ; Bacterial Proteins/*genetics ; Catalase/*genetics ; Drug Resistance, Multiple, Bacterial ; Genotype ; Humans ; Isoniazid/*pharmacology ; Mutation ; Mycobacterium tuberculosis/*genetics/isolation & purification ; Oxidoreductases/*genetics ; Republic of Korea ; Rifampin/*pharmacology ; Sensitivity and Specificity ; Sequence Analysis, DNA/*methods