BACKGROUND AND OBJECTIVES: Benign vocal cord lesions that are not responsive to medical and/or speech therapy are often treated by microlaryngeal surgery. The purpose of this study is to measure selected acoustic parameters to document quantitative changes in vocal quality before and after microlaryngeal surgery and to analyze differences of prognosis for various benign vocal cord lesions, such as vocal cord polyp, vocal cord nodule, and Reinke's edema. MATERIALS AND METHODS: The authors used a computerized acoustic analysis program (CSL-MDVP) to measure mean fundamental frequency (Fo), jitter, shimmer, and noise to harmonics ratio (NHR) from voice samples of selected patients who had benign vocal cord lesions before and after at least 10 weeks of surgery. RESULTS: The values of Fo and NHR showed no significant difference in all three groups. There was significant improvement in nodule regarding jitter. Also, there was significant improvement in the vocal cord polyp regarding jitter and shimmer. CONCLUSION: Jitter and shimmer will be effective acoustic parameters in documenting the quantitative changes in vocal quality before and after microlaryngeal surgery.
Acoustics* ; Edema ; Humans ; Noise ; Polyps ; Prognosis ; Speech Therapy ; Vocal Cords* ; Voice

Background: Severe fever with thrombocytopenia syndrome (SFTS) is a novel infection caused by the tick-borne SFTS virus. More than 200 patients are reported every year in Korea, but there is no established treatment. In patients with SFTS, therapeutic plasma exchange (TPE) can be applied. Methods: Clinical and laboratory characteristics of patients diagnosed with SFTS who underwent TPE were analyzed. The factors that can differentiate the prognosis between the patients who recovered after TPE and those who died were analyzed. Results: Ten patients were diagnosed with SFTS and treated with TPE. The mean age was 70.8 (49–85) years, with three men and seven females. The laboratory findings showed a decrease in white blood cell (WBC) count, platelet count, and serum albumin and an increase in AST, ALT, LDH, and CK levels. Patients performed an average of three (2∼4) TPE procedures at intervals of 1∼2 days, three of whom died. Compared to the results at admission, the WBC counts increased after TPE, and the platelet counts remained unchanged. The AST, LDH, and CK levels decreased by 2∼6 fold in the recovered patients and increased in those who died. Among them, the change in LDH was statistically significant between the two groups (P=0.0227). Conclusion TPE has been used as an adjuvant treatment in SFTS patients who do not have a definitive treatment to date. Additional studies, including small-scale studies such as this study, will be needed to establish the timing, interval, and predictive factors of the effect of TPE.

Background: Severe fever with thrombocytopenia syndrome (SFTS) is a novel infection caused by the tick-borne SFTS virus. More than 200 patients are reported every year in Korea, but there is no established treatment. In patients with SFTS, therapeutic plasma exchange (TPE) can be applied. Methods: Clinical and laboratory characteristics of patients diagnosed with SFTS who underwent TPE were analyzed. The factors that can differentiate the prognosis between the patients who recovered after TPE and those who died were analyzed. Results: Ten patients were diagnosed with SFTS and treated with TPE. The mean age was 70.8 (49–85) years, with three men and seven females. The laboratory findings showed a decrease in white blood cell (WBC) count, platelet count, and serum albumin and an increase in AST, ALT, LDH, and CK levels. Patients performed an average of three (2∼4) TPE procedures at intervals of 1∼2 days, three of whom died. Compared to the results at admission, the WBC counts increased after TPE, and the platelet counts remained unchanged. The AST, LDH, and CK levels decreased by 2∼6 fold in the recovered patients and increased in those who died. Among them, the change in LDH was statistically significant between the two groups (P=0.0227). Conclusion TPE has been used as an adjuvant treatment in SFTS patients who do not have a definitive treatment to date. Additional studies, including small-scale studies such as this study, will be needed to establish the timing, interval, and predictive factors of the effect of TPE.

No abstract available.
Carcinoma, Hepatocellular* ; Pregnancy*

OBJECTIVES: Delirium is a common postoperative complication in old adults associated with adverse events including functional decline, longer lengths of stay, and risk of institutionalization. The purpose of this study is to evaluate the incidence, preoperative, intraoperative, and postoperative risk factors of postoperative delirium in spine surgery. METHODS: Seventy-nine patients who underwent spine surgery were included. Preoperative assessments included current medical illness, number of comorbid problems, and the number of medications by past medical history, medical record, and interview with patients and caregivers. Intraoperative risk factors were evaluated. Laboratory data were checked preoperatively and postoperatively. The presence of delirium was determined by the Korean version of Delirium Rating Scale (K-DRS). RESULTS: Postoperative delirium was found in patients (7.6%). There was an association suggested between older age and postoperative delirium in spine surgery (p<0.05). An association was suggested between increasing numbers of medical conditions and postoperative delirium (p<0.05). Preoperative hemoglobin, hematocrit, sodium, potassium, calcium, albumin levels and postoperative hemoglobin and total protein levels were in the delirium group was significantly lower than those in control group (p<0.05). CONCLSION: This study showed that the postoperative delirium in spine surgery is not rare and several preoperative and postoperative factors are involved in the development of delirium. This pilot study is the first prospective trial in the area of postoperative delirium in spine surgery with a small sample size and short-term period, so further research with large sample size will be necessary.
Adult ; Aged ; Calcium ; Caregivers ; Delirium* ; Hematocrit ; Humans ; Incidence ; Institutionalization ; Medical Records ; Pilot Projects* ; Postoperative Complications ; Potassium ; Prospective Studies ; Risk Factors ; Sample Size ; Sodium ; Spine*

Purpose: To evaluate the efficacy and safety of udenafil 75 mg once daily in patients with erectile dysfunction following bilateral nerve-sparing robot-assisted laparoscopic radical prostatectomy (BNS-RALP). Materials and Methods: A multi-center, prospective, randomized, controlled, double-blind study was conducted. Among patients with localized prostate cancer with international index of erectile function-erectile function domain (IIEF-EF) score of 18 or higher before BNS-RALP, those who developed postoperative erectile dysfunction (IIEF-EF score 14 or less at 4 weeks after BNS-RALP) were enrolled. Enrolled patients were randomly assigned to the udenafil 75 mg daily group or the placebo group in a 2:1 ratio. Each subject was followed up at 8 weeks (V2), 20 weeks (V3), and 32 weeks (V4) to evaluate the efficacy and safety of udenafil. Results: In all, 101 patients were screened, of whom 99 were enrolled. Of the 99 patients, 67 were assigned to the experimental group and 32 to the control group. Ten (14.93%) patients in the experimental group and 10 (31.25%) in the control group dropped out of the study. After 32 weeks of treatment, IIEF-EF score of 22 or higher was seen in 36.51% (23/63) of patients in the experimental group and 13.04% (3/23) patients in the control group (p=0.021). The proportion of patients with IIEF-EF improvement of 25% or more compared to the baseline was 82.54% (52/63) in the experimental group and 62.96% (17/27) in the control group (p=0.058). Conclusions Udenafil 75 mg once daily after BNS-RALP improved the erectile function without any severe adverse effects.

BACKGROUND: Adriamycin (doxorubicin) is one of the widely used drugs in the treatment of a variety of solid and hematologic malignancies. However, the adriamycin-induced cardiomyopathy limits the prolonged use of this effective drug. Transthoracic echocardiography is the excellent tool in early detection and follow-up studies of adriamycin-induced cardiomyopathy. The aim of this study was to assess the cardiac function and morphology using a 15 MHz high-frequency imaging in rats. METHODS: Adriamycin was administrated intraperitoneally by six equal injections at a dose of 2.5 mg/kg over a period of 2 weeks for total cumulative dose of 15 mg/kg body weight in 12 male Sprague-Dawley rats (weight 367+/-39 g). Transthoracic echocardiography with a 15 MHz linear-array transducer was performed at baseline and additionally at 3 weeks to measure the left ventricular wall thickness and dimension from the parasternal short axis view with 2D guided M-mode and pulsed Doppler signals of mitral inflow. Within 2 days of echocardiography, the heart was harvested for electron microscopic evaluation after potassium-induced cardiac arrest. RESULTS: 1) The mortality rate during the experimental period was 0%. 2) Transthoracic echocardiography provided adequate 2D guided M-mode images and pulsed Doppler signals of mitral inflow in all rats. 3) In follow-up echocardiography, pericardial effusion was detected in 7out of 12 rats (58%). 4) Compared to baseline, end-diastolic dimensions were increased from 7.01+/-0.69 to 7.74+/-1.25 mm (p<0.001), end-systolic dimensions were increased from 4.13+/-0.69 to 5.22+/-1.12 mm (p<0.05), and interventricular septal and posterior wall thickness at end-systole and end-diastole were significantly decreased (p<0.05, respectively). 5) Fractional shortening was decreased from 43.0+/-6.8 to 32.7+/-8.0%, compared to baseline (p<0.05). 6) E/A ratio of mitral inflow changed significantly from 1.63+/-0.36 to 2.78+/-1.0, compared to baseline (p<0.05). CONCLUSION: Adriamycin administration at total cumulative dose of 15 mg/kg body weight over 2 weeks creates a reliable model of non-ischemic dilated cardiomyopathy in rats with a high success rate. Transthoracic echocardiography using a 15 MHz transducer provides adequate images for assessing the cardiac function and morphology in follow-up studies in adriamycin-induced cardiomyopathy of rats. These results suggest that transthoracic echocardiography using a 15 MHz Transducer is a promising tool for an assessment of adriamycin-induced cardiomyopathy in small animals.
Animals ; Axis, Cervical Vertebra ; Body Weight ; Cardiomyopathies* ; Cardiomyopathy, Dilated ; Doxorubicin ; Echocardiography* ; Follow-Up Studies ; Heart ; Heart Arrest ; Hematologic Neoplasms ; Humans ; Male ; Mortality ; Pericardial Effusion ; Rats* ; Rats, Sprague-Dawley ; Transducers*

BACKGROUND: Pulmonary embolism is associated with varying degrees of pulmonary vascular obstruction. This study was undertaken to establish whether the extent of perfusion defect in lung scintigraphy can be predicted from analysis of echocardiographic measurements in patients with pulmonary embolism. METHODS: We retrospectively studied 28 patients who presented with clinical evidence of pulmonary embolism. In order to compare the extent of perfusion defect in lung scintigraphy, we devised a scoring system (echocardiographic severity index, ESI) for various echocardiographic parameters, which include right ventricle size, area, shape, systolic function, and pulmonary artery pressure. [ESI=sum of scores/number of parameters measured]. RESULTS: The mean values (+/-SD) of each parameter were as follow; right ventricular end-diastolic dimension (RVedD), 34.5+/-5.7 mm; LVedD, 40.9+/-5.2 mm; ratio of RVedD to LVedD, 0.87+/-0.2; right ventricular end-diastolic area (RVedA), 24.7+/-9.5 cm2; right ventricular end-systolic area (RVesA), 17.8+/-7.8 cm2; fractional area change, 28.8+/-9.7%; angle between IVS and RV, 96.0+/-14.8degrees; RV hypokinesia, absence or mild in 29%, moderate in 50%, severe in 21%; TR grade, absence or mild in 25%, moderate in 43%, severe in 32%; pulmonary artery systolic pressure, <30 mmHg in 21%, 30 to 50 mmHg in 68%, >50 mmHg 11% of patients. The echocardiographic severity index (ESI) in patients with pulmonary embolism was 0.52+/-0.24, and the perfusion defect score was 0.21+/-0.14. There was a close correlation between the ESI and the extent of perfusion defect (r=0.622, p<0.01). CONCLUSION: The echocardiographic severity index may reflect the extent of the perfusion defects in patients with pulmonary embolism, therefore it is potentially applicable in clinical practice for evaluating patients with pulmonary embolism and furthermore in their follow-up over a period of time.
Blood Pressure ; Echocardiography* ; Follow-Up Studies ; Heart Ventricles ; Humans ; Hypokinesia ; Lung ; Perfusion ; Pulmonary Artery ; Pulmonary Embolism* ; Radionuclide Imaging ; Retrospective Studies

PURPOSE: The aims of this study were to evaluate the usefulness of the propagation velocity (Vp) measured by transthoracic color M-mode Doppler in patients with coronary artery disease and compare Vp with conventional diastolic function index using transmitral and pulmonary vein flow. METHODS: Study subjects were classified into two groups according to the presence of coronary artery disease (CAD): 44 subjects (M:F=22:22, mean age 63+/-12 yrs) with CAD (AMI; n=13 , unstable angina; n=5, stable angina; n=26); 31 normal subjects (M:F=13:18, mean age 43+/-15 yrs). Vp of early flow into left ventricular cavity measured by color M-mode Doppler was proposed as an index of left ventricular diastolic function. Vp was compared with conventional diastolic function index. RESULTS: 1. Vp in CAD patients (32.8+/-9.1 cm/sec) was lower than control (63.6+/-14.1 cm/sec)(p>0.01). Among CAD patients, Vp in CAD patients (30.1+/-8.6 cm/sec) with left ventricular hypertrophy (LVH) was lower than Vp in CAD patients without LVH (35.9+/-8.9 cm/sec)(p>0.01). 2. Vp was correlated with left ventricular ejection fraction (r=0.602, p>0.01), with D wave of pulmonary vein flow (r=0.540, p>0.01) and with E/A velocity ratio of mitral inflow (r=0.517, p>0.01) and negatively correlated with left ventricular mass index (r=-0.576, p>0.01). CONCLUSION: The propagation velocity measured by color M-mode Doppler is a useful index for evaluation of diastolic function of left ventricle in the patients with coronary artery disease.
Angina, Stable ; Angina, Unstable ; Coronary Artery Disease* ; Coronary Vessels* ; Echocardiography, Doppler* ; Heart Ventricles* ; Humans ; Hypertrophy, Left Ventricular ; Pulmonary Veins ; Stroke Volume