PURPOSE: Recently, the bispectral index monitor has been promoted as an objective measure of sedation depth during pediatric procedural sedation in the emergency department (ED). However, rectal administration of thiopental sodium for pediatric procedural sedation has not been validated. METHODS: Patients aged one to seven years and undergoing primary closure procedures for simple facial and hand laceration in the ED were enrolled. Procedural sedation was performed by rectal administration of thiopental sodium. The bispectral index score and the Ramsay Sedation Scale were recorded every 10 minutes during sedation. The investigator and treating physician were blinded to bispectral index scores, which were later correlated with the Ramsay Sedation Scales values. Receiver operator characteristic (ROC) curves were conducted to determine the ability of the bispectral index score to discriminate various thresholds of sedation depth. RESULTS: One hundred thirty paired measurements were obtained from 12 patients. The Spearman's correlation coefficient for paired measurements, was -0.906 (95% confidence interval: [-9.8] ~ [-8.1], p<0.001). ROC curve analysis demonstrated a high discriminatory power for bi-spectral index scores in predicting the level of sedation, with areas under the curve at least 0.95 for all Ramsay Sedation Scale thresholds. CONCLUSION: Bispectral index monitoring can serve as a useful, objective measure of sedation depth in pediatric procedural sedation with rectal administration of thiopental sodium in the ED.
Administration, Rectal ; Consciousness Monitors* ; Emergencies* ; Emergency Service, Hospital* ; Hand ; Humans ; Lacerations ; Research Personnel ; ROC Curve ; Thiopental* ; Weights and Measures

Perioperative hypothermia can occur frequently and lead to various complications. Laparoscopic procedures do not require a large incision or exposure of the viscera, but a prolonged and high pressure procedure can lead to unexpected hypothermia. Hypothermia prolongs the time-course of non-depolarizing neuromuscular blocking agents by reducing the plasma clearance significantly. Rocuronium, a new aminosteroidal neuromuscular blocking agent, can be influenced by reductions in plasma clearance and prolong the duration of action. Therefore, patients must receive ventilator care in the ICU. Aggressive measures were taken for hypothermia, and the patient was discharged without any complications. We report a case of delayed of neuromuscular blockade by rocuronium in a hypothermic patient during a laparoscopic procedure with a brief review of literatures.
Androstanols ; Humans ; Hypothermia ; Laparoscopy ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Plasma ; Ventilators, Mechanical ; Viscera

Corpus callsoum (CC) is the largest commissural fiber connecting the cerebral hemispheres. The gender difference in the size or the shape of CC is a long standing dispute. Some reported that adult female CC had more bulbous splenium and larger area considering brain size, but others failed to replicate this findings. There is no definite consensus on sexual dimorphism of CC yet, although extensive studies on sexual dimorphism has been expected to provide a clue to explain sociopsychological differences between male and female. This variable results are attributed to limited number of subjects, measured parameters, and method of measurement. We have employed comprehensive analytic parameters with large subjects to understand gender differences on CC of healthy Korean adults. We have analyzed the magnetic resonance image (MRI) in adults free from neurological disorders. The subjects were composed of 108 young people (3rd decade; male : 51, female : 57). Total area, its 5 sub-areas, linear parameters including height, length, and width and five specific angles of the CC were measured on the midsagittal MR images with NIH Image program (R) (Ver 1.6). The gender differences were observed in the area of splenium and length in the group. The male CC have larger splenium and longer length than female. The angle between neural axis and base of corpus callosum in female was significantly larger than that of male. This study reports not only gender difference of adult CC, but Korean adult standard morphometric data of CC research. These results might serve a useful basic data for various research in the fields of neuroanatomy, neuroradiology, and neuropsychiatry.
Adult* ; Axis, Cervical Vertebra ; Brain ; Cerebrum ; Consensus ; Corpus Callosum* ; Dissent and Disputes ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Nervous System Diseases ; Neuroanatomy ; Neuropsychiatry

PURPOSE: To report the initial clinical experience with single-incision laparoscopic gastric wedge resection for submucosal tumors. MATERIALS AND METHODS: The medical records of 10 patients who underwent single-incision laparoscopic gastric wedge resection between July 2009 and March 2011 were reviewed retrospectively. The demographic data, clinicopathologic and surgical outcomes were assessed. RESULTS: The mean tumor size was 2.5 cm (range, 1.2~5.0 cm), and the tumors were mostly located on the anterior wall (4/10) or along the greater curvature (4/10), of the stomach. Nine of ten procedures were performed successfully, without the use of additional trocars, or conversion to laparotomy. One patient underwent conversion to multiport laparoscopic surgery, to get simultaneous cholecystectomy safely. The mean operating time was 66.5 minutes (range, 24~132 minutes), and the mean postoperative hospital stay was 5 days (range, 4~7 days). No serious perioperative complications were observed. Of the 10 submucosal tumors, the final pathologic report revealed 5 gastrointestinal stromal tumors, 4 schwannomas, and 1 heterotopic pancreas. CONCLUSIONS: Single-incision laparoscopic gastric wedge resection for gastric submucosal tumors is feasible and safe, when performed by experienced laparoscopic surgeons. This technique provides favorable cosmetic results, and also short hospital stay and low morbidity, in carefully selected candidates.
Cholecystectomy ; Cosmetics ; Gastrectomy ; Gastrointestinal Stromal Tumors ; Humans ; Laparoscopy ; Laparotomy ; Length of Stay ; Medical Records ; Neurilemmoma ; Retrospective Studies ; Stomach ; Stomach Neoplasms ; Surgical Instruments ; Surgical Procedures, Minimally Invasive

Pneumothorax is the presence of gas in the pleural space. Traumatic pneumothorax results from penetrating or nonpenetrating chest injuries and iatrogenic pneumothorax occurs as a consequence of a diagnostic or therapeutic maneuver. When interventional muscle and soft tissue stimulation (IMNS) therapy is performed, iatrogenic pneumothorax is not common, but once it has occurred, it gives suffering and pain to both the patient and physician. We experienced three cases of iatrogenic pneumothorax after IMNS therapy. Commonly, the patients with peumothorax are treated with a tube thoracostomy on admission, but these patients can be simply treated with simple observation, oxygen inhalation and simple aspiration without admission and the results are satisfactory. Although iatogenic pneumothorax after IMNS therapy appears to be an rare, IMNS procedure still must be done with care.
Humans ; Inhalation ; Oxygen ; Pneumothorax* ; Thoracic Injuries ; Thoracostomy

Frozen shoulder is characterized by pain in the shoulder and limitation of glenohumeral movement. The underlying pathologic changes in frozen shoulder are synovial inflammation with subsequent reactive capsular fibrosis. Capsular fibrosis is the ultimate course of frozen shoulder suffering from various causes irrespectively. Therefore, adhesions that are affecting the joint movement must be released. Most important diagnostic method is thoughtful history taking and physical examination, and ultrasonography is very valuable device of diagnosis and treatment. Interventional microadhesiolysis and nerve stimulation (IMNS) is effective to manage frozen shoulder patients. IMNS for frozen shoulder is composed of three release approaches. These are (1) subacromial, (2) posterior inferior capsular, and (3) subdeltoidal & subcoracoidal release and round needle can be used for each release. We report this experiences and recommand this technique for the treatment of frozen shoulder patients.
Bursitis ; Fibrosis ; Humans ; Inflammation ; Joints ; Needles ; Physical Examination ; Shoulder ; Stress, Psychological

Epidural anesthesia for cesarean section allows the mother to be awake, minimizes or completely avoids the problem of maternal aspiration and neonatal drug depression from general anesthetics. But epidural anesthesia has the potential to produce local anesthetic systemic toxicity or inadvertent high spinal block which is due to unintentional administration of drug into an epidural vessel or subarachnoid space. There are several ways to avoid these complications. These include careful aspiration of epidural catheter, fractionation of the epidural dose, and the use of epinephrine containing epidural test dose before injection of epidural dose. We report a case of a pregnant woman who had developed a seizure after an injection of the epidural anesthetic. This occurred despite using the techniques of aspiration and epinephrine containing epidural test dose injection. So we thought that the seizure occurred probably by the migration of epidural catheter while changing positions and it should be considered in all cases of epidural anesthesia.
Anesthesia, Epidural ; Anesthetics, General ; Catheters* ; Cesarean Section ; Depression ; Epinephrine ; Female ; Humans ; Mothers ; Pregnancy ; Pregnant Women ; Seizures ; Subarachnoid Space

PURPOSE: We evaluated brain perfusion SPECT findings of MELAS syndrome and mitochondrial myopathy in correlation with MR imaging in search of specific imaging features. MATERIALS AND METHODS: Subjects were five patients (four females and one male; age range, 1 to 25 year) who presented with repeated stroke-like episodes, seizures or developmental delay or asymptomatic but had elevated lactic acid in CSF and serum. Conventional non-contrast MR imaging and Tc-99m-ethyl cysteinate dimer (ECD) brain perfusion SPECT were performed and imaging features were analyzed. RESULTS: MRI demonstrated increased T2 signal intensities in the affected areas of gray and white matters mainly in the parietal (4/5) and occipital lobes (4/5) and in the basal ganglia (1/5), which were not restricted to a specific vascular territory. SPECT demonstrated decreased perfusion in the corresponding regions of MRI lesions. In addition, there were perfusion defects in parietal (1 patient), temporal (2), and frontal (1) lobes and basal ganglia (1) and thalami (2). In a patient with mitochondrial myopathy who had normal MRI, decreased perfusion was noted in left parietal area and bilateral thalami. CONCLUSION: Tc-99m ECD SPECT imaging in patients with MELAS syndrome and mitochondrial myopathy showed hypoperfusion of parieto-occipital cortex, basal ganglia, thalamus and temporal cortex, which were not restricted to a specific vascular territory. There were no specific imaging features on SPECT. The significance of abnormal perfusion on SPECT without corresponding MR abnormalities needs to be evaluated further in larger number of patients.
Basal Ganglia ; Brain* ; Female ; Humans ; Lactic Acid ; Magnetic Resonance Imaging ; Male ; MELAS Syndrome* ; Mitochondrial Encephalomyopathies ; Mitochondrial Myopathies* ; Occipital Lobe ; Perfusion ; Rabeprazole ; Seizures ; Thalamus ; Tomography, Emission-Computed, Single-Photon*

. Implants were placed immediately after tooth extraction on anterior alveolar ridges in the maxilla and mandible. The pinguide system was used to help determine the location and path of implants during the surgical process. The horizontal distance from implants to the outer border of alveolar bone was measured at the rim and middle of the implants in the cone beam computed tomography images. The alteration of alveolar bone was evaluated comparing the horizontal distances measured immediately after surgery and 3 months after surgery. RESULTS. The results show that more resorption occurred towards the labial bone than the lingual bone in the maxilla.A similar amount of labial and lingual bone resorption was observed in the mandible. CONCLUSION. Considering the horizontal alteration of alveolar bone, labio-lingual positioning of the implant towards the lingual bone in the maxilla and at the center of the alveolar ridge in the mandible is recommended when it is placed immediately after tooth extraction.

. Implants were placed immediately after tooth extraction on anterior alveolar ridges in the maxilla and mandible. The pinguide system was used to help determine the location and path of implants during the surgical process. The horizontal distance from implants to the outer border of alveolar bone was measured at the rim and middle of the implants in the cone beam computed tomography images. The alteration of alveolar bone was evaluated comparing the horizontal distances measured immediately after surgery and 3 months after surgery. RESULTS. The results show that more resorption occurred towards the labial bone than the lingual bone in the maxilla.A similar amount of labial and lingual bone resorption was observed in the mandible. CONCLUSION. Considering the horizontal alteration of alveolar bone, labio-lingual positioning of the implant towards the lingual bone in the maxilla and at the center of the alveolar ridge in the mandible is recommended when it is placed immediately after tooth extraction.