BACKGROUND: There have been no studies of airway management strategies for difficult intubation and cannot intubate, cannot ventilate (CICV) situations in Korea. This study was intended to survey devices or methods that Korean anesthesiologists and intensivists prefer in difficult intubation and CICV situations. METHODS: A face-to-face questionnaire that consisted of a doctor's preference, experience and comfort level for alternative airway management devices was presented to anesthesiologists and intensivists at study meetings and conferences from October 2014 to December 2014. RESULTS: We received 218 completed questionnaires. In regards to difficult intubation, the order of preferred alternative airway devices was a videolaryngoscope (51.8%), an optical stylet (22.9%), an intubating laryngeal mask airway (11.5%), and a fiber-optic bronchoscope (10.6%). One hundred forty-two (65.1%) respondents had encountered CICV situations, and most of the cases were identified during elective surgery. In CICV situations, the order of preferred methods of infraglottic airway management was cricothyroidotomy (CT) by intravenous (IV) catheter (57.3%), tracheostomy by a surgeon (18.8%), wire-guided CT (18.8%), CT using a bougie (2.8%), and open surgery CT using a scalpel (2.3%). Ninety-eight (45%) of the 218 respondents were familiar with the American Society of Anesthesiologists' difficult airway algorithm or Difficult Airway Society algorithm, and only 43 (19.7%) had participated in airway workshops within the past five years. CONCLUSION: The videolaryngoscope was the most preferred device for difficult airways. In CICV situations, the method of CT via an IV catheter was the most frequently used, followed by wire-guided CT method and tracheostomy by the attending surgeon.
Airway Management ; Bronchoscopes ; Catheters ; Congresses as Topic ; Education ; Intubation* ; Intubation, Intratracheal ; Korea* ; Laryngeal Masks ; Methods ; Surveys and Questionnaires ; Tracheostomy

OBJECTIVE: Human embryonic stem (ES) cells have a great potential in regenerative medicine and tissue engineering. The human ES cells could be differentiated into specific cell types by treatments of growth factors and alterations of gene expressions. However, the efficacy of guided differentiation and isolation of specific cells are still low. In this study, we characterized isolated cells from differentiated human ES cells by magnetic activated cell sorting (MACS) system using specific antibodies to cell surface markers. METHODS: The undifferentiated hES cells (Miz-hESC4) were sub-cultured by mechanical isolation of colonies and embryoid bodies were spontaneously differentiated with DMEM containing 10% FBS for 2 weeks. The differentiated cells were isolated to positive and negative cells with MACS system using CD34, human epithelial antigen (HEA) and human fibroblast (HFB) antibodies, respectively. Observation of morphological changes and analysis of marker genes expression were performed during further culture of MACS isolated cells for 4 weeks. RESULTS: Morphology of the CD34 positive cells was firstly round, and then it was changed to small polygonal shape after further culture. The HEA positive cells showed large polygonal, and the HFB positive spindle shape. In RT-PCR analysis of marker genes, the CD34 and HFB positive cells expressed endodermal and mesodermal genes, and HEA positive cells expressed ectodermal genes such as NESTIN and NF68KD. The marker genes expression pattern of CD34 positive cells changed during the extension of culture time. CONCLUSION: Our results showed the possibility of successful isolation of specific cells by MACS system from undirected differentiated human ES cells. Thus, MACS system and marker antibodies for specific cell types might be useful for guided differentiation and isolation of specific cells from human ES cells.
Antibodies ; Ectoderm ; Embryoid Bodies ; Endoderm ; Fibroblasts ; Gene Expression ; Humans* ; Intercellular Signaling Peptides and Proteins ; Mesoderm ; Nestin ; Regenerative Medicine ; Tissue Engineering

PURPOSE: To analyse complications and to review usefulness of large needle(18G) in percutaneous transhepatic biliary drainage(PTBD). MATERIALS AND METHODS: 46 patients underwent PTBD in 52 occassions using large needle. 44 of 46 patients had either definite or suspicious malignant biliary obstruction, and most patients were poor in general dondition. Complications were classified as acute type if developed within 30 days and as delayed type if developed after 30 days. Acute type was subdivided into severe and mild forms. RESULTS: Severe forms of complications were death(5.8%), septicemia(3.8%), and bile peritonitis(1.9%). There were not different from the rate of complication in PTBD using fine needle but the procedure was much more simple. CONCLUSION: We PTBD using large neddie is a simple and safe procedure for prompt bile decompression.
Bile ; Decompression ; Drainage* ; Humans ; Needles*

No abstract available.

PURPOSE: The purpose of the study is to investigate the correlation between the symptoms and the incidence of anatomical variant without mucosal abnormality. MATERIALS AND METHODS: Out of 892 patients with CT performed for the evaluation of sinus disease symptoms between March 1991 and March 1993, we observed the anatomic variations in 82 symptomatic patients without mucosal abnormality(male:female=43:39, mean age 36. 4 years). The control group included 88 patients with facial bone CT performed for the evaluation of trauma during the same period while patients with recent paranasal sinusitis were excluded. (male:female=76:12, mean age 22. 4 years). The scouis were performed with 5-ram section thickness from posterior margin of sphenoid sinus to anterior margin of posterior ethmoid and then with 3 mm thickness from anterior margin of posterior ethmoid to anterior margin of frontal sinus. The artatomic variations included nasoseptal deviation, concha bullosa, Hailer cells, Agger nasi cells, etc. RESULTS: The anatomic variations were demonstrated in 71 our of 82 symptomatic patients(86. 5%), whereas they were seen 26 of 88 patients(29. 5%) in control group. CONCLUSION: Our data suggest that there is a possible causal relationship between anatomic variations and symptomas. Even though without accompaning mucosal abnormalities, anatomic variations could contribute simply to its symptomas. ^natomic variants may obstruct or narrow the airway, leading to turbulating air flow or interrupting ucociliary movement, and finally may produce a series os symptoms.
Facial Bones ; Frontal Sinus ; Humans ; Incidence ; Sinusitis ; Sphenoid Sinus

BACKGROUND: Laryngoscopy and tracheal intubation for general anesthesia are potent stimuli to the cardiovascular system due to sympathetic stimulation. The aim of this study was to compare the hemodynamic responses with different administration routes of lidocaine on blood pressure and heart rate changes associated with tracheal intubation. METHODS: Sixty patients were randomly assigned to spray group (Group 1, n=20) received 10% lidocaine 1.5 mg/kg spray to intratracheally immediately before tracheal intubation, IV group (Group 2, n=20) received 2% lidocaine 1.5 mg/kg intravenously before 90 sec tracheal intubation and control group (Group 3, n=20). Anesthesia was induced with thiopental 5 mg/kg IV, vecuronium 0.1 mg/kg and 50% N2O-O2- 2vol % enflurane. After 5 minutes, tracheal intubation was performed. Mean arterial pressure and heart rate were measured at preintubation and immediately postintubation, 1, 3, 5 mins after tracheal intubation. RESULTS:The differences of mean arterial pressure which were measured at preintubation and immediately postintubation and 1 minute after intubation in group 1 were significantly lower than those in other group (p<0.05). The differences of heart rate which measured at preintubation and 1 minute after intubation were lower than those in group 3 (p<0.05). CONCLUSIONS: For the suppression of sympathetic stimulation following tracheal intubation, 10% lidocaine spray to the laryngotrachea is an effective method to suppress cardiovascular response.
Anesthesia ; Anesthesia, General ; Arterial Pressure ; Blood Pressure ; Cardiovascular System ; Enflurane ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Intubation* ; Laryngoscopy ; Lidocaine* ; Thiopental ; Vecuronium Bromide

Metastatic tumors to the oral cavity from other parts of the body are rarely reported and representing about 1-4% of all oral malignancies. The most common primary tumor site of oral metastatic tumor was the breast followed by the lung, kidney, thyroid, prostate, and colon. Oral metastasis of primary esophageal carcinoma is extremly rare and only 11 cases were reported till now. Only one case was metastased to the maxilla. We experienced a mteastatic squamous cell carcinoma to the maxilla and the scalp in a 52-year-old male patient who previously diagnosed as esophageal carcinoma and performed operation with post operative radiation therapy. We report the case with literature review.
Breast ; Carcinoma, Squamous Cell ; Colon ; Humans ; Kidney ; Lung ; Male ; Maxilla* ; Middle Aged ; Mouth ; Neoplasm Metastasis ; Prostate ; Scalp* ; Thyroid Gland

BACKGROUND: Malpositioning of the endotracheal tube within airway after intubation may results in serious complications, such as accidental extubation and inadvertent endobronchial intubation. Therefore, early detection of malposioning of the endotracheal tube is very impotant for deciding patient's prognosis. METHODS: We assessed the distance from the tip of the endotracheal tube to the carina according to the patient's age, sex, and the time, the location, and the route of intubation. The chest x-ray was taken for 333 patients (men, 226: women, 107) who were admitted to the intensive care unit of Wonju Christian Hospital from march 1, 1995 to February 28, 1996. Chest x-ray was obtained after intubation to verify endotracheal tube position. Appropriate endotracheal tube position on chest x-ray was defined as between 2 and 6 cm above the carina. RESULTS: Of the 333 intubations, 106 (31.8%) endotracheal tubes were inappropriately placed according to the chest x-ray. The percentage of malpositioned endotracheal tubes (<2 cm) was higher in women than in men (11.2% vs. 5.3%, p<0.05), with higher in night (7 PM to 7 AM) than in day (7 AM to 7 PM) (42% vs. 24%, p<0.05). Distance from the carina to the tip of endotracheal tube is 4.34 +/- 1.77cm in women and 5.23 +/- 1.64cm in men. Thus, position of the endotracheal tube in women is deeper than men (p<0.001). CONCLUSIONS: We conclude that the chest x-ray for confirmation of endotracheal tube position after endotracheal intubation may remain the standard of practice. And endotracheal tube position should be carefully assessed immediately after tracheal intubation, particularly in women and at night.
Female ; Gangwon-do ; Humans ; Incidence* ; Intensive Care Units ; Intubation ; Intubation, Intratracheal* ; Male ; Prognosis ; Thorax*

A 52-year-old man was found dead in the driver's seat of his tank lorry. The tank lorry was used to transport industrial wastewater to a disposal plant; the material was transferred into a storage tank with the help of compressed air. The wastewater contained methylene chloride and 2-chloropyridine. No respiratory protective equipment was used while working under these conditions. The autopsy report showed extensive edema and congestion of the brain, lung, and intraperitoneal organs. The concentrations of methylene chloride in lung and brain were reported at 398 and 67 mg/kg, respectively.
Autopsy ; Brain ; Compressed Air ; Edema ; Estrogens, Conjugated (USP) ; Humans ; Lung ; Methylene Chloride ; Middle Aged ; Pyridines ; Waste Water

PURPOSE: Biliary dyskinesia was considered as a wastebasket of quasi-biliary disease which could not be clearly explained under the basis of morphologic pathology. This entity was a source of confusion because of misconception and poor understanding. Recent introduction of biliary manometric technique enlightened some of these disorders. We evaluated the cholangiographic morphology of these disorders to clarify and to characterize the some characteristic findings, subsequently in order to help the diagnosis. MATERIALS AND METHODS: Five cases were confirmed by this technique as sphincter of Oddi dysfunction for last 13 months. All patients were female and age range was 53 to 75 years old. All patients were suffered from intermittent and recurrent biliary type pain. RESULTS: ERCP showed five common findings. The common bile duct was dilated over 12ram in all patients. Different from recurrent pyogenic cholangiohepatitis, intrahepatic ducts were proportionally dilated as extrahepatic ducts, in four patients and they branched normally and ductal wall was smooth. Transient or persistent meniscus sign was observed in four patients. All patients showed delayed emptying of contrast media from the common bile duct into the duodenum. Following IV injection of cholecystokinin, persistent meniscus disappeared and contrast media inflowed into the duodenum. CONCLUSION: Identification of all or some characteristic cholangiographic findings may eliminate a cumbersome and painful biliary manometric test for the diagnosis of sphincter of Oddi dysfunction.
Aged ; Biliary Dyskinesia ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystokinin ; Common Bile Duct ; Contrast Media ; Diagnosis ; Duodenum ; Female ; Humans ; Manometry* ; Pathology ; Sphincter of Oddi Dysfunction* ; Sphincter of Oddi*