A 68 year old, ASA physical status 11, hypertensive male patient underwent open reduction, angulated blade plate fixation, and bone graft of femur intertrochanteric fracture due to non-union. Anesthesia was induced with thiopental and succinylcholine and maintained with vecuronium- Halothane-nitrous oxide-oxygen. Three uints whole blood was transfused and any significnat change in vital signs and EKG were not found during 4 hours operation. Soon after the patient was recovered. But he was found to be hemiplegia and sensory disturbance on the next day. Brain CT revealed infarction of middle cerebral artery territory. He expired 7 days following the surgery despite strenuous supportive measure.
Aged ; Anesthesia ; Brain ; Cerebral Infarction* ; Electrocardiography ; Femur ; Hemiplegia ; Humans ; Infarction ; Male ; Middle Cerebral Artery ; Succinylcholine ; Thiopental ; Transplants ; Vital Signs

PURPOSE: Recently, vancomycin-resistant enterococci (VRE) have become one of the major nosocomial pathogens in Korea. However, there have been few studies on the epidemiology of VRE colonization among neonates. In this study, we investigated the prevalence of VRE colonization, risk factors for VRE, and how to control the spread of VRE infection in the Neonatal Intensive Care Unit (NICU) of Pusan National University Hospital (PNUH). METHODS: We retrospectively reviewed medical records of 192 neonates who were admitted to the NICU of PNUH from March 2006 to March 2007. Surveillance cultures from rectal swabs for detecting VRE were obtained weekly during the study period. We analyzed the prevalence of VRE and various risk factors. RESULTS: The rate of VRE colonization among NICU patients was 25% (48/192). Thirty five of these VRE colonized patients were transferred to the NICU from other local hospitals. Compared with the non-VRE group, the risk factors associated with VRE colonization were lower birth weight, congenital heart disease, applied mechanical ventilation, use of a central venous catheter, chest tubing, a history of surgery, and use of antibiotics. CONCLUSION: VRE colonization among patients admitted to the NICU is rapidly increasing. Monitoring and managing premature neonates from the beginning of the birth process, avoiding many invasive procedures, avoiding antibiotics such as vancomycin and third generation cephalosporin are important for preventing the emergence and spread of VRE colonization in the NICU.
Anti-Bacterial Agents ; Birth Weight ; Central Venous Catheters ; Colon ; Heart Diseases ; Humans ; Infant ; Infant, Newborn ; Intensive Care, Neonatal ; Korea ; Medical Records ; Parturition ; Prevalence ; Respiration, Artificial ; Retrospective Studies ; Risk Factors ; Thorax ; Vancomycin ; Vancomycin Resistance

Purpose: To investigate the effect of preemptive systemic analgesia using patient-controlled analgesia (PCA) on postoperative pain after evisceration. Methods: Of the patients who underwent evisceration under general anesthesia in our hospital, 55 who were able to evaluate pain using a numeral rating scale (NRS) were included. The patients were divided into two groups: group 1 used PCA after surgery, and group 2 used PCA preemptively before surgery. We compared the two groups in terms of the NRS pain scores on the day of surgery and 1, 2, and 3 days after surgery, and according to whether additional analgesics were used. Results: The 55 patients included 17 in group 1 and 38 in group 2. The NRS at 3, 5, and 7 hours on the day of surgery tended to be lower in group 2, but not significantly (p > 0.05). The NRS on days 1 and 2 after surgery was significantly lower in group 2 (p = 0.014 and p = 0.027, respectively), and the NRS on day 3 after surgery was also lower, although not significantly (p = 0.059). Significantly fewer cases required additional analgesics in group 2 compared to group 1 on the day of surgery and 1, 2, and 3 days after surgery (p = 0.001, p < 0.001, p < 0.001, and p = 0.008, respectively). Conclusions Using preemptive systemic PCA in evisceration significantly reduced the postoperative pain, and PCA itself was an effective administration method due to the high rate of pain control without the need for additional analgesics.

No abstract available.
Bowen's Disease*

No abstract available.
Vulva

Purpose: Sclerotic lines have been detected at specific locations on the forearm and metaphysis of the lower extremities (femur and tibia) in some patients with atypical femoral fractures (AFFs) associated with long-term bisphosphonate (BP) use. Herein, we present our preliminary data relating to the factors associated with the occurrence of sclerotic lines in patients diagnosed with AFFs. Methods: We inspected the clinical charts of patients who were prescribed BPs at our institution between 2010 and 2020. Fifty-six patients were finally investigated, including patients with sclerotic line lesions at the radial tuberosity (21 patients), and those without any pathognomonic lesions on either radius on a simple radiograph (35 patients). Results: No significant between-group differences in basic demographic characteristics, bone mineral density, or the total period of BP administration were observed (p>0.05). Multivariate analyses of the variables that exhibited significant between-group differences in the univariate analyses demonstrated that the time since the last BP administration at the time of AFF diagnosis (odds ratio [OR], 0.441) and the concurrent presence of similar lines on the femur (OR, 36.00) were significantly associated with the presence of sclerotic lines on the proximal radius. The cutoff time after the last BP administration at the time of AFF diagnosis was 16.5 months, which may serve as a predictor for the development of a sclerotic line around the radial tuberosity. Conclusion Sclerotic lines on the proximal radius were detected more frequently in patients who had been recently treated with a BP or had similar lines on the lower extremities.

Purpose: Sclerotic lines have been detected at specific locations on the forearm and metaphysis of the lower extremities (femur and tibia) in some patients with atypical femoral fractures (AFFs) associated with long-term bisphosphonate (BP) use. Herein, we present our preliminary data relating to the factors associated with the occurrence of sclerotic lines in patients diagnosed with AFFs. Methods: We inspected the clinical charts of patients who were prescribed BPs at our institution between 2010 and 2020. Fifty-six patients were finally investigated, including patients with sclerotic line lesions at the radial tuberosity (21 patients), and those without any pathognomonic lesions on either radius on a simple radiograph (35 patients). Results: No significant between-group differences in basic demographic characteristics, bone mineral density, or the total period of BP administration were observed (p>0.05). Multivariate analyses of the variables that exhibited significant between-group differences in the univariate analyses demonstrated that the time since the last BP administration at the time of AFF diagnosis (odds ratio [OR], 0.441) and the concurrent presence of similar lines on the femur (OR, 36.00) were significantly associated with the presence of sclerotic lines on the proximal radius. The cutoff time after the last BP administration at the time of AFF diagnosis was 16.5 months, which may serve as a predictor for the development of a sclerotic line around the radial tuberosity. Conclusion Sclerotic lines on the proximal radius were detected more frequently in patients who had been recently treated with a BP or had similar lines on the lower extremities.

Purpose: Sclerotic lines have been detected at specific locations on the forearm and metaphysis of the lower extremities (femur and tibia) in some patients with atypical femoral fractures (AFFs) associated with long-term bisphosphonate (BP) use. Herein, we present our preliminary data relating to the factors associated with the occurrence of sclerotic lines in patients diagnosed with AFFs. Methods: We inspected the clinical charts of patients who were prescribed BPs at our institution between 2010 and 2020. Fifty-six patients were finally investigated, including patients with sclerotic line lesions at the radial tuberosity (21 patients), and those without any pathognomonic lesions on either radius on a simple radiograph (35 patients). Results: No significant between-group differences in basic demographic characteristics, bone mineral density, or the total period of BP administration were observed (p>0.05). Multivariate analyses of the variables that exhibited significant between-group differences in the univariate analyses demonstrated that the time since the last BP administration at the time of AFF diagnosis (odds ratio [OR], 0.441) and the concurrent presence of similar lines on the femur (OR, 36.00) were significantly associated with the presence of sclerotic lines on the proximal radius. The cutoff time after the last BP administration at the time of AFF diagnosis was 16.5 months, which may serve as a predictor for the development of a sclerotic line around the radial tuberosity. Conclusion Sclerotic lines on the proximal radius were detected more frequently in patients who had been recently treated with a BP or had similar lines on the lower extremities.

BACKGROUND: 'Masked Hypertension' is a phenomenon of blood pressure that is normotensive by clinic measurement but proves to be hypertensive by 24 hour-AMBP and is associated with many cardiovascular complications and its clinical importance has become the center of public interest. However, in Korea no study concerning masked hypertension has ever been published so far. We investigated the frequency and the related factors of masked hypertension among Koreans. METHODS: Overall, 53 volunteers from Incheon and Seoul, Korea, who were 40 years old and abov were enrolled from August 2003 to August 2004. We checked their blood pressure and pulse rate every hour using an ambulatory blood pressure monitoring device [SpaceLabs 90207] for 24 hours. Masked hypertension was defined as office mean BP less than 140/90 mmHg and daytime mean BP over 135/85 mmHg. RESULTS: Among the total, 15 subjects met the criteria of masked hypertension (28.3%) Current smoking (P=0.021), higher clinic mean SBP (P=0.011) and DBP (P=0.027), and prehypertension (P=0.04) were identified as related factors. And when adjusted for sex by logistic regression, only current smoking was statistically significant (P=0.039) and prehypertension showed borderline significance (P=0.092) (CI=95%). Additionally, mean pulse pressures and mean standard deviation of individual mean SBP were higher in the masked hypertension group. CONCLUSION: The frequency of masked hypertension was 28.3% the and related factors were current smoking and higher office BP, especially prehypertension that was introduced in JNC-7. The fact that the pulse pressure and the variability of individual SBP were higher in the masked hypertension group remains thought-provoking.
Adult ; Blood Pressure ; Blood Pressure Monitoring, Ambulatory ; Heart Rate ; Humans ; Incheon ; Korea ; Logistic Models ; Masked Hypertension* ; Masks* ; Prehypertension ; Seoul ; Smoke ; Smoking ; Volunteers*

Background: A proper depth of percutaneous central venous catheter (PCVC) is very important to reduce procedural time and prevent various complications in very low birth weight (VLBW) infants who require minimal handling or have a sensitive skin. The objective of this study was to suggest a formula for faster and proper insertion of PCVC in VLBWIs to prevent unintended consequences of patients’ conditions. Methods: Prospective data of VLBW infants admitted from June 2015 to January 2018 who had PCVC inserted via the great saphenous vein within seven days after birth were analyzed.Correlations of length of inserted PCVC with body weight, body length, and postmenstrual age at the date of PCVC insertion were determined with a linear regression analysis. Using results of this analysis, a formula to determine the optimal insertion length of PCVC was derived. Coefficient of determination was used to assess how well outcomes were replicated by the formula. Results: The formula to predict the proper insertion length of PCVC via the great saphenous vein at popliteal crease level was obtained as follows: Optimal Length (cm) = 3.8 × Body Weight (kg) + 11.1. With everyday movements such as flexion and extension of the lower extremities, the mean difference in catheter tip position was 7.0 ± 3.9 mm, which was not significant enough to escalate the risk of catheter tip displacement. The rate of catheterrelated complications was as low as 4.9% in this study. Conclusions The formula derived from this study to predict the optimal PCVC insertion length could benefit VLBW infants by reducing procedural time and lowering the risk of complications.