Objective To investigate the effects of different doses of dexmedetomidine on the anesthetic efficacy of propofol and remifentanil in patients undergoing plastic surgery.Methods Sixty ASA Ⅰ or Ⅱ patients of both sexes,aged 18-64 yr,weighing 45-75 kg,scheduled for elective plastic surgery,were randomly assigned into 3 groups (n =20 each):control group (C group),low loading dose dexmedetomidine group (D1 group) and high loading dose dexmedetomidine group (D2 group).Dexmedetomidine was infused at a rate of 0.4 μg· kg-1 · h-1 until 30 min before the end of surgery after a loading dose of dexmedetomidine 0.6 (group D1) or 1.0 μg/kg (group D2) was infused at 10 min before induction of anesthesia in groups D1 and D2.Anesthesia was induced with target-controlled infusion of propofol (target plasma concentraiton 4.0 μg/ml) and remifentanil (target effect-site concentraiton 2.0 ng/ml).After the patients lost consciousness,rocuronium 0.6 mg/kg was injected intravenously.The patients were mechanically ventilated after tracheal intubation.Anesthesia was maintained with target-controlled infusion of propofol (target plasma concentraiton 2.0-3.5 μg/ml) and remifentanil (target effectsite concentraiton 1.5-2.5 ng/ml).Narcotrend index was maintained at Class D.Narcotrend index,systolic pressure (SP),diastolic pressure (DP) and HR were recorded before anesthesia (baseline),at 10 min of dexmedetomidine infusion,at 0,1 and 5 min after tracheal intubation,at the end of dexmedetomidine infusion,and at 0,1and 5 min after removal of the endotracheal tube.The induction time,consumption of propofol and remifentanil,time for recovery of spontaneous breathing and orientation,extubation time,and Richmond Agitation Sedation Scale score at 10 min after removal of the endotracheal tube were recorded.The development of sinus bradycardia during operation and complications during recovery from anesthesia were also recorded.Results Compared with group C,the total consumption of propofol and remifentanil,Richmond Agitation Sedation Scale score at 10 min after removal of the endotracheal tube,and incidences of nausea,bucking and agitation during recovery from anesthesia,and Narcotrend index and HR at 10 min of dexmedetomidine infusion were significantly decreased in groups D1 and D2,and induction time was shortened in D2 group (P ＜ 0.05 or 0.01).The incidence of sinus bradycardia during operation was significantly higher in group D2 than in groups C and D1 (P ＜ 0.05).There was no significant difference in the time for recovery of spontaneous breathing and orientation,and extubation time between the three groups (P ＞ 0.05).There was no significant difference in SP,DP and HR before and after tracheal intubation and before and after removal of the endotracheal tube between groups D1 and D2 (P ＞ 0.05).Conclusion Infusion of dexmedetomidine at a rate of 0.4μg·kg-1 · h-1 after a loading dose of 0.6 μg/kg infused before induction of anesthesia can shorten the induction time,reduce the consumption of propofol and remifentanil,effectively inhibit the stress responses to tracheal intubation or removal of the endotracheal tube,and decrease the occurrence of side effects in patients undergoing plastic surgery.

The metabolism of thyroid hormone changes during pregnancy. Subclinical hypothyroidism during pregnancy may adversely affect the pregnancy outcomes and neuropsychological development of child, controversially. The diagnostic criteria of subclinical hypothyroidism during pregnancy need to be specific. It is important to figure out when should pregnancy with subclinical hypothyroidism be treated and what is the specific goal of the treatment.

The intrahepatic calculi are prevalent in east Asia and are regarded as malignant disease because diagnosis and treatment are difficult and complication and mortality are high. This study is a retrospective clinical review of 58 cases of patient with intrahepatic calculi in the Department of Surgery, Chungnam National University Hospital from July 1994 through June 1999. The incidence of intrahepatic calculi was 8.8% of total hepatobiliary calculi. The ratio of male to female was 1:2.4. The peak incidence was noted at the 6th decade (32.7%) and mean age was 52.1 years. About the site of stones, left intrahepatic duct (48.3%)was more prevalent than right intrahepatic duct (17.2%). 42 cases(72%) of the intrahepatic calculi were associated with GB stone(8%), CBD stone(45%) or both(19%). As to surgical method, choledochotomy with T-tube drainage was performed in 34 cases(59%), choledochoduodenostomy was in 3 cases(5%) and hepatic resection in 21 cases(36%). Among them choledochotomy with T-tube drainage was the most frequently performed procedure. The remnant stones are most commonly founded after choledochotomy and T-tube drainage (80%) followed after choledochoduodenostomy(33%) and after hepatic resection(24%). But, major postoperative complications such as bile leakage and intra-abdominal abscess are more frequent in casea of hepatic resection. So we suggest that agressive treatment modality such as hepatic resection is more reasonable than drainage procedure in the management of intrahepatic duct stone by the experienced expert.
Abdominal Abscess ; Bile ; Calculi* ; Choledochostomy ; Chungcheongnam-do ; Diagnosis ; Drainage ; Far East ; Female ; Humans ; Incidence ; Male ; Mortality ; Postoperative Complications ; Retrospective Studies

OBJECTIVETo compare the difference of anterior knee pain after total knee arthroplasty (TKA) between the ways using periosteal dissector and electric scalpel to release medial collateral ligament and pes anserinus.

METHODSFrom September 2009 to September 2012, 220 patients with unilateral osteoarthritis were treated with primary TKA in hospital 301. All the patients were randomly divided into periosteal dissector group (110 cases) or electric scalpel group (110 cases). In the periosteal dissector group, there were 47 males and 63 females,with an average age of (58.8 +/- 17.2) years old; the degree of genuavarus was (14.0 +/- 3.5) degrees; the weight was (65.6 +/- 12.8) kg; the body mass index (BMI) was (26.6 +/- 3.6) kg/m2. In the electric scalpel group,there were 49 males and 61 females,with an average age of (59.6 +/- 16.7) years old;the degree of genuavarus was (15.0 +/- 4.7) degrees; the weight was (66.4 +/- 13.4) kg; the BMI was (27.4 +/- 4.1) kg/m2. The mean follow-up period was 24.6 months. The AKS, VAS and HSS were used to evaluate clinical results.

RESULTSAll incisions healed at the first stage;no deep vein thrombosis of lower limbs or pulmonary embolism occurred. Knee infection occurred in 3 cases (1 in the periosteal dissector group and 2 in the electric scalpel group), and the 3 patients received stage 2 total knee revision using antibiotic bone cement and TC3 prosthesis. No recurrence of infection occurred during follow-up. Among the 20 patients who had anterior knee pain, 16 patients were in the periosteal dissector group and 4 patients were in the electric scalpel group. The occurrence rate of anterior knee pain in the electric scalpel group was lower than that in the periosteal dissector group. The AKS knee score and HSS score after total knee arthroplasty in the electric scalpel group were all higher than those in the periosteal dissector group, and the VAS in electric scalpel group was lower than that of periosteal dossector group.

CONCLUSIONCompared with using electric scalpel,using periosteal dissector used to release medial collateral ligament and pes anserinus may cause more anterior knee pain after total knee arthroplasty.

Adult ; Aged ; Arthroplasty, Replacement, Knee ; adverse effects ; Case-Control Studies ; Female ; Humans ; Knee Joint ; surgery ; Male ; Middle Aged ; Pain, Postoperative ; etiology ; Tibia ; pathology ; Treatment Outcome ; Young Adult

BACKGROUND/OBJECTIVES: Complementary and alternative medicines can be used to alleviate climacteric symptoms that significantly affect the quality of life of postmenopausal women. Isoflavones are the most common plant-based therapies for postmenopausal changes, but the results of previous studies have been controversial.MATERIALS/METHODS: To investigate whether isoflavones would affect menopausal symptoms as well as ovarian hormones, we performed a systematic review and metaanalysis. The PubMed and EMBASE databases were used to perform the systematic search.Included studies were limited to randomized controlled trials (RCTs) assessing the impact of isoflavone supplementation on menopausal symptoms. RESULTS: Eleven studies were included for the final quantitative assessment. Isoflavone intervention was varied between 49.3 and 135 mg of isoflavones per day for 12 wk–2 yrs.The meta-analysis showed that supplementation of isoflavones significantly increased the estradiol levels (standardized mean difference [SMD] = 0.615, P = 0.035) and Kupperman index (SMD = 3.121, P = 0.003) but had no significant effect on hot flashes, folliclestimulating hormone, and luteinizing hormone. However, both estradiol and the Kupperman index showed significant heterogeneity among studies (I2 = 94.7%, P < 0.001 and I2 = 98.1%, P < 0.001, respectively). CONCLUSIONS Although the results showed a significant SMD in estradiol and the Kupperman index, the results should be interpreted with caution due to the high heterogeneity. Further validation with a larger RCT will be necessary. Overall, isoflavone supplementation has distinct effects on the climacteric symptoms and hormonal changes in postmenopausal women.

BACKGROUND/AIMS: The changes in an Electrogastrography (EGG) in uremic patients on maintenance hemodialysis with dyspeptic complaints are not well known. The aim of this study was to investigate the EGG findings in uremic patients with dyspeptic complaints and note the difference of EGG findings between uremic patients with dyspeptic complaints and patients with functional dyspepsia. METHODS: Fifty two subjects were enrolled. They were assigned to: group I, healthy volunteers without dyspeptic complaints (n=15); group II, patients with dysmotility-like dyspepsia (n=22); or group III, uremic patients undergoing hemodialysis with dysmotility-like dyspepsia (n=15). The data was compared among groups. RESULTS: There was no difference in the percentage of normal slow wave frequency, and fed to fasting power ratio among the groups. However, frequencies of abnormal EGG findings were 4 (27%) in group I, 10 (40%) group II and 9 (60%) in group III. Therefore the frequency was marginally different among group I, group II or group III (p=0.06). CONCLUSIONS: Impaired gastric myoelectric activity was more frequently observed in uremic patients or patients with dysmotility-like dyspepsia than normal controls. However frequencies of abnormal EGG findings between uremic patients and patients with dysmotility-like dyspepsia were not significantly different.
Dyspepsia* ; Fasting ; Healthy Volunteers ; Humans ; Kidney Failure, Chronic ; Ovum ; Renal Dialysis*

Sjogren's syndrome is an autoimmune exocrinopathy characterised by decreased lacrymal and salivary gland function, resulting in keratoconjunctivitis sicca and dry mouth. The occurrence of malignant lymphoma is the most serious complication of Sjogren's syndrome. Recent reports have found that MALT lymphoma accounts for 46~56% of the malignant lymphoma that develop in patients with Sjogren's syndrome. The most common site of MALT lymphoma in patients of Sjogren's syndrome is parotid gland, but we experienced two cases of MALT lymphoma of lung in patients with Sjogren's syndrome. We report these cases with review of literature.
Humans ; Keratoconjunctivitis Sicca ; Lung* ; Lymphoma ; Lymphoma, B-Cell, Marginal Zone* ; Mouth ; Parotid Gland ; Salivary Glands ; Sjogren's Syndrome*

A scalp mass surgically excised from a 4-year-old Korean boy was identified as a tick through histological observations. In sections of the mass, characteristic features of a tick, including its gross contour, cuticular structures, well developed musculature and salivary glands, and the capitulum, were discovered. In particular, the capitulum is anteriorly protruded, which strongly suggests that the specimen be a hard tick of family Ixodidae. However, the present histological features were not enough to determine the genus and species of the tick, because information on sectional morphologies of different tick species is unavailable. This is a rare case of tick infestation on the scalp diagnosed in histological sections.
Tick Infestations/*diagnosis/pathology ; Scalp/*parasitology/*pathology ; Male ; Humans ; Child, Preschool

The purpose of the present study was to evaluate the clinical efficacy of guided tissue regeneration(GTR) using resorbable polylactic/polyglycolic copolymer(PLA/PGA) membrane in mandibular class II furcation involvement and to compare it to the clinical efficacy of only flap operation. Both procedures were conducted in 5 patients with class II furcation involvements. After 6 months of follow up, the probing pocket depth, clincial attachment level, bone probing depth, and radiographic changes were compared, and the following results were obtained: 1. GTR using PLA/PGA demonstrated a statistically significant reduction in probing pocket depth and bone probing depth, and the control group demonstrated a statistically significant reduction in bone probing depth. 2. The comparison between the experimental and control group failed to demonstrate statistically significant difference in clinical improvement, but more reduction in probing pocket depth and bone probing depth were observed in the experimental group. The probing pocket depth and the bone probing depth were 2.2+/-1.6mm and 2.4+/-1.1mm respectively in the control group, while they were 2.4+/-1.3mm and 3.0+/- 1.2mm respectively in the experimental group. 3. Radiographic change was not detectable for the both groups during the 6 months of follow up. 4. Sites with deeper probing pocket depth at baseline examination showed greater amount of clinical improvement in both groups. Other clinical factors didn't have any significant effect on the treatment results. It is concluded that though there are some limitations, PLA/PGA membrane is effective for the treatment of mandibular class II furcation involvement.
Follow-Up Studies ; Guided Tissue Regeneration* ; Humans ; Membranes*

PURPOSE: Bone morphogenetic protein (BMP) is a potent differentiating agent for cells of the osteoblastic lineage. It has been used in the oral cavity under a variety of indications and with different carriers. However, the optimal carrier for each indication is not known. This study evaluated the bone regenerative effect of rhBMP-2 delivered with different carrier systems. MATERIALS AND METHODS: 8 mm critical-sized rat calvarial defects were used in 60 male Sprague-Dawley rats. The animals were divided into 6 groups containing 10 animals each. Two groups were controls that had no treatment and absorbable collagen membrane only. 4 groups were experimentals that contained rhBMP-2 only and applied with absorbable collagen sponge(Collatape(R)), MBCP(R), Bio-Oss(R) each. The histological and histometric parameters were used to evaluate the defects after 2- or 8-week healing period. The shape and total augmented area were stable in all groups over the healing time. RESULTS: New bone formation was significantly greater in the rhBMP-2 with carrier group than control group. rhBMP-2/ACS was the highest in bone density but gained less new bone area than rhBMP-2/MBCP(R) and rhBMP-2/Bio-Oss(R). The bone density after 8 weeks was greater than that after 2 weeks in all groups. However, rhBMP-2 alone failed to show the statistically significant difference in new bone area and bone density compared to control group. Also MBCP(R) and Bio-Oss(R) particles remained after 8 weeks healing period. CONCLUSION: These results suggest that rhBMP-2 with carrier system is an excellent inductive agent for bone formation and we can use it as the predictable bone tissue engieering technique. Future study will likely focus on the kinetics of BMP release and development of carriers that is ideal for it.
Animals ; Bone and Bones ; Bone Density ; Bone Morphogenetic Protein 2 ; Bone Morphogenetic Proteins ; Bone Regeneration ; Collagen ; Humans ; Kinetics ; Male ; Membranes ; Mouth ; Osteoblasts ; Osteogenesis ; Rats ; Rats, Sprague-Dawley ; Recombinant Proteins ; Transforming Growth Factor beta