Most regional anesthesia in breast surgeries is performed as postoperative pain management under general anesthesia, and not as the primary anesthesia. Regional anesthesia has very few cardiovascular or pulmonary side-effects, as compared with general anesthesia. Pectoral nerve block is a relatively new technique, with fewer complications than other regional anesthesia. We performed Pecs I and Pec II block simultaneously as primary anesthesia under moderate sedation with dexmedetomidine for breast conserving surgery in a 49-year-old female patient with invasive ductal carcinoma. Block was uneventful and showed no complications. Thus, Pecs block with sedation could be an alternative to general anesthesia for breast surgeries.
Anesthesia ; Anesthesia, Conduction ; Anesthesia, General* ; Breast* ; Carcinoma, Ductal ; Conscious Sedation ; Dexmedetomidine ; Female ; Humans ; Mastectomy, Segmental* ; Middle Aged ; Nerve Block ; Pain, Postoperative

BACKGROUND: This study was undertaken to compare the hemodynamic effects of thiopental and propofol administration as induction agents during desflurane anesthesia. METHODS: One hundred twenty unpremedicated ASA physical status 1 patients who were aged 20-60 years and who scheduled for elective surgery under general anesthesia were randomly divided into two groups. In group T, thiopental sodium (5 mg/kg) was used to induce anesthesia, whereas propofol (2.5 mg/kg) was used in group P. In each group, the inspired concentration of desflurane was increased to 4.0 vol% shortly after a thiopental or propofol injection. After 10 manual baggings, the target was increased to produce an end-tidal concentration of desflurane (ETdesf) of 8.0 vol%, and this was maintained until the end of the study by adjusting the vaporizer setting. The heart rate (HR) and mean arterial pressure (MAP) were measured at baseline, 2 min and 5 min after induction and at 2 min after intubation. RESULTS: The heart rate was significantly increased in the two groups compared with baseline. In the P group, the mean blood pressure was decreased at 2 and 5 min after induction compared with baseline, whereas the mean blood pressure in the T group was significantly increased after induction. The mean blood pressure was significantly lower in group P than that in group T at 2 and 5 min after the injection of the induction agent. However, the heart rate did not differ significantly between two groups. CONCLUSIONS: During desflurane anesthesia, the heart rate did not differ significantly between the two groups, yet the mean blood pressure was significantly lower when using propofol than that when using thiopental sodium.
Aged ; Anesthesia ; Anesthesia, General ; Arterial Pressure ; Blood Pressure ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Isoflurane ; Nebulizers and Vaporizers ; Propofol ; Thiopental

OBJECTIVE: It is widely known that the menopausal complication in the surgical menopause is to proceed rather than that of natural menopause. But, it has not obviously been proven so far. In this study, we surveyed whether BMD between surgical and natural menopausal group, in terms of decrease of the BMD of the menopausal complication would have a difference. METHOD: By using dual energy X-ray absorptiometry, we compared 2nd-4th Lumbar spine BMD in 28 of surgical menopause with that of 187 of natural menopause. RESULT: There is no obvious distinction in FSH and estradiol concentration between two groups. Surgical and natural menopausal groups showed the BMD -1.046+/-0.175 g/cm2, -0.942+/-0.124 g/cm2, respectively. Also, there is no statistical significance. CONCLUSION: Although there is no statistical significance in the BMD of the surgical menopausal group was lower than that of the natural menopausal group. Prevention of the menopausal complication as well as decrease of the BMD in the surgical menopausal group needs to be required more active attitude.
Absorptiometry, Photon ; Bone Density* ; Estradiol ; Female ; Humans ; Menopause ; Spine

PURPOSE: We evaluated oncologic outcomes following radical prostatectomy (RP) in patients with a Gleason score (GS) of 7 with tertiary Gleason pattern 5 (TGP5). MATERIALS AND METHODS: We retrospectively reviewed the medical records of 310 patients who underwent RP from 2005 to 2010. Twenty-four patients who received neoadjuvant or adjuvant antiandrogen deprivation or radiation therapy were excluded. Just 239 (GS 6 to 8) of the remaining 286 patients were included in the study. Patients were classified into four groups: GS 6, GS 7 without TGP5, GS 7 with TGP5, and GS 8. We analyzed preoperative clinical factors, postoperative pathological outcomes, and biochemical recurrence (BCR). RESULTS: TGP5 in GS 7 was an independent predictor of primary Gleason pattern 4, tumor volume larger than 10%, positive surgical margin, and lymphovascular invasion. The presence of TGP5 in GS 7 was not associated with BCR-free survival. Subgroup analyses revealed that BCR-free survival did not differ significantly between patients with GS 7 with TGP5 and those with GS 8 (p=0.120). In addition, time to BCR in patients with a higher percentage of TGP5 was shorter than that in patients with a lower percentage of TGP5. TGP5 in GS 7 was not a significant predictive factor for BCR, whereas prostate-specific antigen density and a positive surgical margin were shown to be independent predictors of BCR. CONCLUSIONS: TGP5 in GS 7 was an independent predictor of unfavorable pathologic outcomes. The rate of BCR was similar in GS 7 disease with TGP5 and in GS 8 disease, even though TGP5 was not a significant predictive factor for BCR in Cox proportional hazards models.
Disease Progression ; Humans ; Medical Records ; Neoplasm Grading ; Proportional Hazards Models ; Prostate-Specific Antigen ; Prostatectomy ; Recurrence ; Retrospective Studies ; Tumor Burden

Colonoscopy is commonly used as a screening tool for colorectal polyps and cancer. It also offers a chance to remove polyps via the polypectomy technique. Colonoscopic polypectomy is a relatively safe procedure, yet there is the possibility of serious complications such as perforation and bleeding. Postpolypectomy coagulation syndrome presents with pain, fever, an elevated white blood cell count and signs of peritoneal irritation, and usually within 12 hours of the procedure. No free air is seen on plain films or a CT scan, which is different from frank bowel perforation. The management of postpolypectomy coagulation syndrome includes fasting, antibiotics and intravenous hydration. We report here on a case of a 53-year-old woman who underwent right hemicolectomy because she presented with fever, signs of peritoneal irritation and shock after colonoscopic polypectomy. The final diagnosis was postpolypectomy coagulation syndrome as there was no perforation in the resected specimen.
Anti-Bacterial Agents ; Colonic Polyps ; Colonoscopy ; Fasting ; Female ; Fever ; Hemorrhage ; Humans ; Leukocyte Count ; Mass Screening ; Middle Aged ; Polyps ; Shock

PURPOSE: To compare the accuracy of central true net corneal power (cTNP) and mean true net corneal power (mTNP) of the Pentacam system to give a keratometry (K) reading for calculating IOL (intraocular lens) power in eyes following refractive surgery. METHODS: Refraction, an automated K-reading (Km), cTNP and mTNP were measured for 15 eyes that required cataract surgery and had previously undergone refractive surgery. The difference between postoperative manifest refraction values and target refraction values calculated with the SRK/T formula using cTNP were compared with the one using mTNP. RESULTS: The mean deviation from the desired post-cataract refractive outcome was 0.60 diopter (D) +/-0.47 (standard deviation) using cTNP; 0.75+/-0.54 using mTNP (p=0.386). The actual refraction was within +/-0.50D of the intended refraction for 60% (cTNP) and 33.3% (mTNP) of eyes, and within +/-1.00D for 93% (cTNP) and 66.7% (mTNP) of eyes. CONCLUSIONS: Although not statistically significant, the cTNP showed better accuracy than mTNP to give a keratometry (K) reading for post-refractive surgery eyes requiring cataract surgery.
Adult ; Cornea/*pathology/physiopathology/surgery ; Corneal Topography/*methods ; Female ; Humans ; *Lenses, Intraocular ; Male ; Middle Aged ; Myopia/*surgery ; Prosthesis Design ; *Refraction, Ocular ; *Refractive Surgical Procedures

BACKGROUND: KIT and PDGFRA are tyrosine kinase receptors. Stem cell factor/KIT-mediated signaling plays a role in normal spermatogenesis, and the alteration of KIT is important in the pathogenesis of seminomas/dysgerminomas (SD). METHODS: To determine the role of expression and mutation of the KIT and PDGFRA genes, we analyzed 16 seminoma cases, 4 spermatocytic seminoma (SS) cases and 8 dysgerminoma cases for KIT and PDGFRA expression and mutation of KIT (exons 9, 11, 13, and 17) and PDGFRA (exons 12 and 18) using PCR-SSCP methods. RESULTS: KIT was immunohistochemically positive in all 24 SD cases, and one of four (25%) SS cases. PDGFRA was immunohistochemically evident in 16 of the 24 (66.6%) SD cases, and two of the four (50%) SS cases. KIT expression was significantly reduced in SS compared with seminoma (p=0.0035). Four cases (14.3%) displayed mutation in KIT exon 17 or PDGFRA exon 12. Distant metastasis was present in three cases (10.7%), one of which had a nonsense mutation in KIT. CONCLUSIONS: These results indicate that KIT is expressed in the majority of SD cases, but not in most SS cases. However, there was no significant correlation between the clinicopathologic features and mutation or expression of KIT and PDGFRA.
Codon, Nonsense ; Dysgerminoma ; Exons ; Neoplasm Metastasis ; Proto-Oncogene Proteins c-kit ; Receptor Protein-Tyrosine Kinases ; Receptor, Platelet-Derived Growth Factor alpha ; Seminoma ; Spermatogenesis ; Stem Cells

BACKGROUND AND OBJECTIVE: The endothelial function, carotid intima-media thickness (CIMT) and arterial stiffness are known as surrogates of atherosclerosis, but it is not clear whether these surrogates can discriminate patients with coronary artery disease (CAD) from those with risk factor. The intention was to compare these 3 surrogates in patients with CAD and those with risk factor only. SUCJECTS AND METHODS: Forty-three patients with CAD (mean age:58, 32 men), 18 age and sex matched healthy people (mean age:52, 9 men) and 16 patients (mean age:53, 12 men) with atherosclerosis risk factor only were enrolled. The endothelial function (flow-mediated brachial artery dilation, FMD) and CIMT were measured by high-resolution ultrasound and the arterial stiffness by an oscillometric method. RESULTS: There was a significant difference between the CAD and risk factor groups (3.46+/-1.3% vs. 5.77+/-2.54%, p<0.05), but there was no significant difference between the risk factor and healthy groups (5.29+/-2.0% vs. 5.77+/-2.54%, p>0.05) in the measured FMD. The CIMT showed a significant difference between the CAD and healthy groups (0.89+/-0.14 mm vs. 0.78+/-0.07 mm, p<0.05), but there was no significant difference between the CAD and risk factor groups(0.89+/-0.14 mm vs. 0.83+/-0.12 mm, p>0.05). There were significant differences among all groups in relation to the arterial stiffness (CAD group:1524+/-289 cm/sec, risk group:1342+/-202 cm/sec, healthy group:1195+/-119 cm/sec, p<0.05). The arterial stiffness showed significant correlation with the FMD (r=-0.322, p=0.005) and CIMT (r=0.310, p=0.007). CONCLUSION: Of the 3 surrogates, the arterial stiffness measurement showed the best reliability in differentiating the CAD from the risk factor only groups as well as from healthy subjects. This study suggests the arterial stiffness can be used as a novel noninvasive test for early diagnosis of CAD in patients at high risk of atherosclerosis.
Arteries ; Atherosclerosis ; Brachial Artery ; Carotid Intima-Media Thickness ; Coronary Artery Disease* ; Coronary Vessels* ; Early Diagnosis ; Endothelium ; Humans ; Intention ; Risk Factors* ; Ultrasonography ; Vascular Stiffness*

PURPOSE: The patient-reported outcome measure (PROM) is used to quantify the subjective state of patients before and after the treatment. The electronic method was recently developed and used for the completion of PROM, in addition to the conventional paper and pencil method. This study identified whether the results of Foot Function Index (FFI) and Foot and Ankle Outcome Score (FAOS) using the paper and pencil method was different from those using the electronic method. MATERIALS AND METHODS: Between May 2016 and August 2016, 42 patients who were admitted to the Seoul Foot and Ankle Center two days before surgery were included for evaluation. The mean age was 46 years (range, 21~72 years). There were 29 males and 13 females. To use the electronic method, the PADAS software (PADAS, Seoul, Korea) was implemented using a touch pad. The primary trial of FFI and FAOS was performed using either the paper-and-pencil method or the electronic method. At 24 hours after the primary test, a secondary trial of FFI and FAOS was performed using the other method. Then, we identified the reliability of FFI and FAOS between the two methods by calculating the intraclass coefficient. RESULTS: Twenty-two patients underwent the first trial using the paper-and-pencil method, and 20 patients underwent the first trial using the electronic method. Of the 42 patients, 8 patients were excluded from this study and only 34 patients were included in this study. The reliability of FFI was excellent with an intraclass coefficient of 0.957, and the reliability of FAOS was also excellent with an intraclass coefficient of 0.840. CONCLUSION: The paper-and-pencil method and the electronic method have the same result for the completion of FFI and FAOS in this study. Therefore, it is commonly considered that the completion of FFI and FAOS using the electronic method can be applied in practice.
Ankle* ; Data Collection ; Female ; Foot* ; Humans ; Male ; Methods* ; Outcome Assessment (Health Care) ; Seoul

Anaplasia ; Biopsy ; Chondrocytes ; Diagnosis ; Fibroblasts ; Head ; Humans ; Jaw ; Mandible ; Mitosis ; Neck ; Osteoblasts ; Osteosarcoma ; Sarcoma ; Survival Rate