We have experienced an anesthetic management of a 34 year old female patient with pheochromocytoma of left adrenal gland. The anesthetic management of patients presents many difficult problems, such as hypertension, arrhythmia and hypotension. The patient had been treated with phenoxybenzamine for 2 weeks preoperatively. Following induction of anesthesia with intravenous fentanyl, thiopental sodium and vecuronium, endotracheal intubation was performed. Anesthesia was maintained with nitrous oxide, oxygen and isoflurane administration. Blood pressure and pulse were controlled well with nitroprusside and isoflurane. After removal of tumor, blood pressure was controlled by Hartman's solution, packed red cell and dopamine administration. The patient tolerated well despite the episodic hemodynamic changes. Importance of preoperative preparation, sufficient sedation, smooth induction, complete analgesia, good muscle relaxation and stable cardiovascular control has been discussed.
Adrenal Glands ; Adult ; Analgesia ; Anesthesia ; Anesthesia, Inhalation* ; Arrhythmias, Cardiac ; Blood Pressure ; Dopamine ; Female ; Fentanyl ; Hemodynamics ; Humans ; Hypertension ; Hypotension ; Inhalation* ; Intubation, Intratracheal ; Isoflurane* ; Muscle Relaxation ; Nitroprusside ; Nitrous Oxide ; Oxygen ; Phenoxybenzamine ; Pheochromocytoma* ; Thiopental ; Vecuronium Bromide

Local or general anesthesia is essential for safe operation. Patients in good preoperative condition are relatively to tolerable to the operation, but the patients in poor preoperative condition have the high mortality and morbidity during and after the operation. Therefore, we should choose the anesthetic agents and methods, which cause little effect to the patient's life. Among the intraventricular blocks, bundle branch is the most common type, and left bundle branch block may progress to a more serious condition of complete heart block. Optimal anesthetic management of patients with cardiovascular disease requires a thorough knowledge of normal cardiac physiology, the circulatory effects of the various anesthetic agents, and the pathophysiology and treatment of these diseases. The authors successfully performed balanced anesthesia in operation of a 63 year old female patient who showed complete left bundle branch block pattern in a preoperative electrocardiographic tracing without any subjective symptoms.
Anesthesia, General ; Anesthetics ; Balanced Anesthesia* ; Bundle-Branch Block* ; Cardiovascular Diseases ; Electrocardiography ; Female ; Heart Block ; Humans ; Middle Aged ; Mortality ; Physiology

Local or general anesthesia is essential for safe operation. Patients in good preoperative condition are relatively to tolerable to the operation, but the patients in poor preoperative condition have the high mortality and morbidity during and after the operation. Therefore, we should choose the anesthetic agents and methods, which cause little effect to the patient's life. Among the intraventricular blocks, bundle branch is the most common type, and left bundle branch block may progress to a more serious condition of complete heart block. Optimal anesthetic management of patients with cardiovascular disease requires a thorough knowledge of normal cardiac physiology, the circulatory effects of the various anesthetic agents, and the pathophysiology and treatment of these diseases. The authors successfully performed balanced anesthesia in operation of a 63 year old female patient who showed complete left bundle branch block pattern in a preoperative electrocardiographic tracing without any subjective symptoms.
Anesthesia, General ; Anesthetics ; Balanced Anesthesia* ; Bundle-Branch Block* ; Cardiovascular Diseases ; Electrocardiography ; Female ; Heart Block ; Humans ; Middle Aged ; Mortality ; Physiology

The Taylor's approach is a special paramedian approach to enter the L5-S1 interspace. The L5-S1 interspace is the largest in vertebral column. This approach is particularly useful when the interspace has been narrowed by pathologic bone destruction such as rheumatoid arthritis or osteoarthritis. Surgery in geriatric patients is associated with a markedly higher incidence of perioperative complication or mortality rate. Optimal anesthetic management of geriatric patients depends on understanding of the normal anatomy and physiologic changes in response to drug in aging. We studied of 3-geriatric patients with Taylor's approach. These patients had problems with respiratory dysfunction and anatomic constraints, which make other approaches unfeasible.
Aging ; Arthritis, Rheumatoid ; Humans ; Incidence ; Mortality ; Osteoarthritis ; Spine

BACKGROUND: Caudal injection of local anesthetics with morphine is the most common anesthetic technique for perianal operation and postoperative analgesia. This study was purposed to compare the onset time of caudal analgesia, postoperative analgesic effect and side effects. METHOD: Sixty healthy patients scheduled for perianal operation were divided into 2 groups randomly. Group I was given 2 mg of morphine in 20 ml of 2% mepivacaine via sacral hiatus. Group II was also given 2 mg of morphine in 20 ml of 0.5% bupivacaine caudally. We measured the onset time of caudal block, time to the first request of analgesics, the number of analgesics within 24 hours and the incidence of postoperative side effects. Analgesic effect was evaluated by visual analogue scales (VAS) at 1, 2, 6, 12 and 24 hours postoperatively. RESULT : The onset time of caudal block for operation and the first request time of analgesic for postoperative pain was significantly shorter in group I than group II. The analgesic use in the first 24 hours was significantly more in group I than group II. The side effects were similar in both groups. CONCLUSION: We concluded that the combined use of morphine and bupivacaine provided better postoperative analgesia than the combined use of morphine and mepivacaine.
Analgesia ; Analgesics ; Anesthetics, Local ; Bupivacaine* ; Humans ; Incidence ; Mepivacaine* ; Morphine* ; Pain, Postoperative ; Weights and Measures

PURPOSE: To report a case of isolated choroidal cystic lesion in the macula with no interval change for two years. CASE SUMMARY: A 29-year-old woman who had suspicious maculopathy was referred to our clinic. Her best corrected visual acuity was 20/20 in the affected right eye, which showed a choroidal cystic lesion on a fundus exam, fluorescein angiography, USG and OCT. The multifocal ERG showed reduced amplitudes of the cystic area in the right eye, and SLO microperimetry revealed reduced retinal sensitivity in the cystic lesion as well as a stable fixation and spared foveal function. There was no evidence of underlying ocular disease in clinical assessment, and the lesion had not undergone interval change for the past two years.
Adult ; Choroid ; Eye ; Female ; Fluorescein Angiography ; Humans ; Retinaldehyde ; Visual Acuity

Axial mesodermal dysplasia complex (AMDC) arises in variable combinations of craniocaudal anomalies such as musculoskeletal deformities, neuroschisis, or rhombencephalic developmental disorders. To the best of our knowledge, the co-existence of AMDC with associated musculoskeletal anomalies, medullary neuroschisis with mirror movements, and cranial nerve anomalies has not yet been reported. Here, we report the case of a 4-year-old boy whose clinical features were suggestive of Goldenhar syndrome and Poland syndrome with Sprengel deformity. Moreover, he showed mirror movements in his hands suspected of rhombencephalic malformation, and infranuclear-type facial nerve palsy of the left side of his face, the opposite side to the facial anomalies of Goldenhar syndrome. After conducting radiological studies, he was diagnosed with medullary neuroschisis without pontine malformations and Klippel-Feil syndrome with rib anomalies. Based on these findings, we propose that clinical AMDC can be accompanied by a wide variety of musculoskeletal defects and variable degrees of central nervous system malformations. Therefore, in addition to detailed physical and neurological examinations, imaging studies should be considered in AMDC.
Central Nervous System ; Child, Preschool ; Congenital Abnormalities ; Cranial Nerves ; Facial Nerve ; Goldenhar Syndrome ; Hand ; Humans ; Klippel-Feil Syndrome ; Male ; Medulla Oblongata ; Mesoderm* ; Neurologic Examination ; Paralysis ; Poland Syndrome ; Rhombencephalon ; Ribs

PURPOSE: The purpose of this study was to investigate the welfare status of nurses and the status of fixed night shifts and flexible work arrangements in both general hospitals and advanced general hospitals in Korea. METHODS: A total of 167 hospitals participated in this study, done from April to October 2018. RESULTS: There were 103 hospitals utilizing the fixed night shift system, 22 in the two-shift system, 3 in the fixed holiday shift, 79 in the fixed shift system, and 39 in the short-time working system. The average welfare benefits for nurses increased to 33.02 million won on average. However, welfare services for the nurses were poor: 41.8% of the respondents had a nurses' lounge, 81.7% were given dormitory space at their place of employment, 41.8% had access to welfare facilities, and 56.4% were provided with welfare support countermeasures. CONCLUSION: The results show an increasing trend of hospitals to utilize fixed night shift and flexible work arrangements. An institutional strategy at the national policy level should be established to implement flexible work arrangements including the fixed night shift system, which has a poor level of welfare.
Employment ; Holidays ; Hospitals, General ; Korea ; Surveys and Questionnaires

Peri-implantitis, in which inflammation caused by plaque and biofilm on the implant surface spreads to the hard tissue, can be treated by decontamination of the implant surface and reconstruction of the lost hard tissue through surgical methods. We have described the management of 3 peri-implantitis cases by decontamination of the implant surface using a round titanium brush and regenerative therapy. All cases showed clinical improvements, and no further radiographic bone loss was observed during a 2-year follow-up. This treatment method can be effective for clinical improvement and bone regeneration. However, a longer follow-up period is necessary to support these outcomes.

Acromegaly is a slowly progressing condition resulting from excess growth hormone (GH), generally caused by a GH-secreting pituitary adenoma. Cancer is the third most common cause of mortality in patients with acromegaly, and insulin-like growth factor 1 (IGF-1) is known to influence tumor formation by increasing cell proliferation and inhibiting apoptosis. Multiple myeloma (MM) is a plasma cell neoplasm, and previous studies have suggested the possible role of IGF-1 in its development of MM. However, no cases of acromegaly accompanied with MM have been reported in Asia to date. We here report the case of a 58-year-old woman with acromegaly accompanied with MM who presented with longstanding acromegalic manifestations resulting from a GH-secreting pituitary adenoma and also exhibited anemia, a reversed albumin/globulin ratio, and plasmacytosis on bone marrow examination. Because IGF-1 has been suggested to play an important role in the development and progression of MM, the patient promptly underwent surgical removal of the pituitary adenoma via a transsphenoidal approach. Since there is currently no consensus on therapeutic guidelines and suggested prognosis for MM with acromegaly, long-term follow-up of such cases is needed.
Acromegaly* ; Anemia ; Apoptosis ; Asia ; Bone Marrow Examination ; Cell Proliferation ; Consensus ; Female ; Growth Hormone ; Growth Hormone-Secreting Pituitary Adenoma ; Humans ; Insulin-Like Growth Factor I ; Middle Aged ; Mortality ; Multiple Myeloma* ; Neoplasms, Plasma Cell ; Pituitary Neoplasms ; Prognosis