With the innovation and improvements in medical science, longer life expectancy has been achieved and growing population is being diagnosed and treated as chronic diseases such as diabetes, chronic pulmonary obstructive disease or hypertension. These chronic diseases often affect multiple organs of cardiovascular and neuroendocrine system and blunt regulatory function which is crucial for the defense response against external and internal harmful stresses. The risk of perioperative complications including cardiovascular events is also higher in poorly controlled diabetes or hypertension. Therefore it is very important to evaluate and manage these problems preoperatively. This paper reviews preoperative management of common chronic diseases such as diabetes, hypertension, and chronic pulmonary obstructive disease.
Chronic Disease* ; Diabetes Mellitus ; Hypertension ; Life Expectancy ; Neurosecretory Systems ; Preoperative Care

BACKGROUND/AIMS: We analyzed chronological changes in hemoglobin according to renal function changes over a 5-year follow-up period. METHODS: We enrolled 5,266 adults with a glomerular filtration rate (GFR) > or = 60 mL/min/1.73 m2 at an initial examination at a routine health check-up; a follow-up examination was conducted 5 years later. We categorized the subjects according to GFR ratio (groups 1, 2, and 3, defined as GFRratio > or = 1.00, 0.75 to 0.99, and < 0.75, respectively). RESULTS: The mean hemoglobin level in subjects with a GFR of 60 to 74 was higher than in those with a GFR of 75 to 89 or > or = 90 mL/min/1.73 m2 at the initial examination (all p < 0.001). Among females and males, the frequencies of increased hemoglobin were 46.8% and 40.6% in the GFRratio group 1, 52.4% and 46.1% in group 2, and 59.6% and 52.5% in group 3 over the 5-year period, respectively (all p < 0.001). With multiple logistic regression, group 3 showed 1.594-fold (95% confidence interval [CI], 1.127 to 2.225) and 1.353-fold (95% CI, 1.000 to 1.830) higher likelihoods of increased hemoglobin over the 5-year follow-up period in females and males, respectively. The estimated difference in hemoglobin level was highest in group 3 in both genders. These findings were more evident in subgroups without metabolic syndrome, diabetes mellitus, hypertension, or GFR less than 90 mL/min/1.73 m2. CONCLUSIONS: Among a population with GFR > or = 60 mL/min/1.73 m2, a mild decrease in GFR over a 5-year follow-up period was associated with an increase in hemoglobin levels.
Adult ; Aged ; Biological Markers/blood ; Chi-Square Distribution ; Disease Progression ; Female ; Follow-Up Studies ; *Glomerular Filtration Rate ; Hemoglobins/*metabolism ; Humans ; Kidney/*physiopathology ; Kidney Diseases/blood/diagnosis/*physiopathology ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Republic of Korea ; Time Factors ; Up-Regulation

BACKGROUND: Although degree of motor blockade during high thoracic spinal anesthesia is difficult to determine, pulmonary function may reflect the level of motor blockade. So we checked pulmonary function during spinal anesthesia with two different local anesthetic agents. METHODS: 50 patients, ASA PS 1-2, were randomly divided into two groups. After basal pulmonary function test (FVC: forced vital capacity, FEV1: forced expiratory volume in one second, PEFR: peak expiratory flow rate, PEP: peak expiratory pressure, PIP: peak inspiratory pressure.), the patients received spinal anesthesia with either 0.5% hyperbaric bupivacaine or 0.5% hyperbaric tetracaine. Thirty minutes after injection, level of sensory blockade was checked by pinprick test and pulmonary function test was performed. RESULTS: Almost all the values of pulmonary function reduced after spinal anesthesia, but the degrees of reduction were not differ in two groups except PEP, which reduced more profoundly in tetracaine group than bupivacaine group. CONCLUSIONS: It is more desirable that we use bupivacaine rather than tetracaine as spinal anesthetic agent in the patient with poor pulmonary function.
Anesthesia, Spinal* ; Anesthetics ; Bupivacaine* ; Forced Expiratory Volume ; Humans ; Peak Expiratory Flow Rate ; Respiratory Function Tests ; Tetracaine* ; Vital Capacity

Early gastric cancer(EGC) is defined as carcinoma limited to the mucosa or submucosa, regardless of whether metastasis to lymph nodes have occurred, and the frequency of lymph node metastasis varies from 7 to 18%. The incidence of early gastric cancer has been increasing recently, probably with advance in the diagnostic procedure. Multiple gastric cancer, now cosidered to be a sort of multiple primary cancer by Moertels classification, is a special type of cancer in which two or more tumor lesions arise independently from the stomach. Multiple carcinoma was found in about 8.3% of 500 early gastric cancer cases at the National Cancer Center Hospital in Japan. In 77% of these, two lesions roexisted in the stomach. Coexistence of three lesions were found in 20% and more than four lesions in 3%. We report a case of multiple early gastric cancer of different histologic types in which two adenoma coexisted in the stomach.
Adenoma ; Classification ; Incidence ; Japan ; Lymph Nodes ; Mucous Membrane ; Neoplasm Metastasis ; Stomach ; Stomach Neoplasms*

Early gastric cancer(EGC) is defined as carcinoma limited to the mucosa or submucosa, regardless of whether metastasis to lymph nodes have occurred, and the frequency of lymph node metastasis varies from 7 to 18%. The incidence of early gastric cancer has been increasing recently, probably with advance in the diagnostic procedure. Multiple gastric cancer, now cosidered to be a sort of multiple primary cancer by Moertels classification, is a special type of cancer in which two or more tumor lesions arise independently from the stomach. Multiple carcinoma was found in about 8.3% of 500 early gastric cancer cases at the National Cancer Center Hospital in Japan. In 77% of these, two lesions roexisted in the stomach. Coexistence of three lesions were found in 20% and more than four lesions in 3%. We report a case of multiple early gastric cancer of different histologic types in which two adenoma coexisted in the stomach.
Adenoma ; Classification ; Incidence ; Japan ; Lymph Nodes ; Mucous Membrane ; Neoplasm Metastasis ; Stomach ; Stomach Neoplasms*

Inguinal hernia repair can result in paresthesia and/or pain in the inguinal region. Pharmacological and surgical management often yield inconsistent results associated with considerable risks and side effects. Radiofrequency thermocoagulation (RF) is a neuro-destructive treatment for severe pain, but associated with hypoesthesia, neuritis-like reactions, and occasional neuroma formation. Pulsed radiofrequency (PRF), unlike RF, delivers high intensity currents in pulses, is non-neurodestructive, and therefore less painful, without the potential complications. Here we report on PRF in chronic postoperative inguinal pain. A 23-year-old male who received right inguinal hernia repair and complained of right sided groin pain for approximately 10 years underwent PRF at the L1 and L2 dorsal root ganglia (DRG). He then reported a decrease in pain from 80-90/100 mm to 15-30/100 mm on a visual analogue scale (VAS), which lasted for twelve months.
Electrocoagulation ; Ganglia, Spinal* ; Groin ; Hernia, Inguinal ; Herniorrhaphy* ; Humans ; Hypesthesia ; Male ; Neuroma ; Paresthesia ; Spinal Nerve Roots* ; Young Adult

Peripheral nervous system involvement is common in systemic vasculitis, occurring most frequently in the polyarteritis nodosa (PAN) group of disorders and in rheumatoid vasculitis. Within the polyarteritis nodosa group of systemic necrotizing vasculitides, three subgroups have been described: classic polyarteritis nodosa, Churg-Strauss syndrome, and an overlap syndrome. Three patients with evidence of systemic vasculitis and peripheral neuropathy were clinically and electrophysiologically investigated. All cases presented clinically with mononeuropathy multiples considered typical pattern of ischemic involvement of the peripheral nerve. The causes included polyarteritis nodosa, its Churg-strauss variant, and the overlap syndrome. Pain and weakness were frequent symptoms. Nerve conduction studies were abnormal In all cases. Necrotizing vasculitis was present as pathologic findings in two cases. All patients were treated with prednisolone alone or in combination with other immunosuppressive agents or with plasmapheresis.
Churg-Strauss Syndrome ; Humans ; Immunosuppressive Agents ; Mononeuropathies* ; Neural Conduction ; Peripheral Nerves ; Peripheral Nervous System ; Peripheral Nervous System Diseases ; Plasmapheresis ; Polyarteritis Nodosa ; Prednisolone ; Rheumatoid Vasculitis ; Systemic Vasculitis ; Vasculitis*

Since 1990 when Wolff and co-authors proved that both RNA and DNA expression vectors containing interest gene were directly injected into mouse muscle and expressed the protein in vivo, the concept of gene vaccine has been broadly tested in the vaccine field. However, due to the limitations of technology and the misconception about RNA, most previous studies have focused on the DNA vaccine. Recently, the RNA vaccine has emerged as a new game-changing disruptive innovation technology in the vaccine field. This review has covered the characteristics of the RNA vaccine, including its strengths and weaknesses. Finally, we have suggested future directions for the RNA vaccine.
Animals ; DNA ; Mice ; RNA*

Purpose: Physician-modified endovascular stent grafts (PMEG) are a good treatment option for complex abdominal aortic aneurysms (AAAs), especially in high-risk patients not amenable to open repair, and when commercial fenestrated devices are not available. We report our single-center experience with PMEG for the treatment of complex AAAs. Methods: We retrospectively reviewed patients who underwent PMEG repair for AAA from November 2016 to September 2020 at our institution. Demographic data, anatomic characteristics, perioperative and postoperative outcomes, major adverse events, and 30-day mortality were analyzed. Results: We identified 12 patients who underwent PMEG for complex AAA. The mean age was 74 years and the mean maximal AAA diameter was 58.1 mm. Indications for treatment included 4 impending or contained ruptures, 2 mycotic aneurysms, and 6 symptomatic cases. The technical success rate was 91.7%. Aneurysm sac regression was observed in 7 patients (58.3%), including 2 cases of complete regression. There was 1 aneurysm-related mortality at 3 months due to mycotic aneurysm. Also, there was 1 postoperative complication case of transient renal failure requiring temporary dialysis. At 1 year, there was 1 branch occlusion from the initial failed cannulation case and 2 type 1A endoleaks, and there was 1 case of open explantation. Conclusion PMEG showed a low technical failure rate and acceptable midterm stent durability and sac stability, comparable to conventional endovascular aneurysm repair. Despite the small number of cases, there was a tendency for a high sac regression rate, although longer follow-up is needed.

Nephrocalcinosis is described as the deposition of calcium crystals in the renal parenchyma that result from prolonged states of hypercalcemia. Recently recognized is the deposition of calcium phosphate in the renal tubular injury by using sodium phosphate cathartics commonly used for the colonic cleansing. This phenomenon was termed phosphate nephropathy. Acute renal failure secondary to phosphate nephropathy has been increasingly recognized as a complication after the administration of sodium phosphate solution for colonoscopy. We report a case of acute phosphate nephropathy following oral sodium phosphate solution to cleanse the bowel for colonoscopy. A renal biopsy showed diffuse tubular calcium deposition.
Acute Kidney Injury ; Biopsy ; Calcium ; Calcium Phosphates ; Cathartics ; Colon ; Colonoscopy ; Hypercalcemia ; Nephrocalcinosis ; Phosphates ; Renal Insufficiency ; Sodium