Oral dantrolene causes a dose-dependent depression of skeletal muscle contractility. A 52-year-old man treated with oral dantrolene for spasticity after spinal cord injury was scheduled to undergo irrigation and drainage of a thigh abscess under general anesthesia. He had taken 50 mg oral dantrolene per day for 3 years. Under standard neuromuscular monitoring, anesthesia was performed with propofol, rocuronium, and sevoflurane. A bolus dose of ED95 (0.3 mg/kg) of rocuronium could not depress T1 up to 95%. An additional dose of rocuronium depressed T1 completely and decreased the train-of-four (TOF) count to zero. There was no apparent prolongation of the neuromuscular blocking action of rocuronium. The TOF ratio was recovered to more than 0.9 within 40 minutes after the last dose of rocuronium. A small dose of oral dantrolene does not prolong the duration of action and recovery of rocuronium.
Abscess ; Anesthesia ; Anesthesia, General ; Dantrolene* ; Depression ; Drainage ; Humans ; Middle Aged ; Muscle Spasticity ; Muscle, Skeletal ; Neuromuscular Blockade ; Neuromuscular Monitoring ; Propofol ; Spinal Cord Injuries ; Thigh

PURPOSE: This study was conducted to assess the satisfaction, and factors influencing the satisfaction, of patients and guardians with the internal environment and safety of ambulances in Korea. METHODS: Participants were patients and guardians who were transported by public emergency medical service ambulance to an emergency medical center in June 2015. Data were collected using self-administered questionnaires. The degree of satisfaction with the ambulance was categorized as satisfaction (Likert scale 4 or 5) or dissatisfaction (Likert scale 1 or 2). The questionnaires comprised 3 categories: 1) demographics, 2) internal environment (space, light, temperature, humidity, soundproof, and odor), and 3) safety (vibration, leaning of body, and falling objects). RESULTS: Among 84 cases, 80.5% of patients and 83.7% of guardians gave positive responses regarding general satisfaction with the internal environment of the ambulance, but these percentages were lower regarding adequacy of space and light. Four factors had a statistically significantly influence on the degree of satisfaction: 1) sex of guardian regarding adequacy of space, 2) number of guardians regarding general satisfaction, 3) severity of patient regarding guardian's satisfaction with space, 4) diagnosis of patient (trauma vs non-trauma) regarding vibration during transport (all p<0.05). CONCLUSION: Overall, patients and guardians were satisfied with the internal environment and safety of ambulances except for adequacy of space and light.
Ambulances* ; Demography ; Diagnosis ; Emergencies* ; Emergency Medical Services* ; Humans ; Humidity ; Korea* ; Patient Satisfaction ; Pilot Projects* ; Vibration

PURPOSE: Idiopathic granulomatous mastitis (IGM) is a rare disease characterized by noncaseating granulomatous inflammation of unknown origin. Because its clinical features are similar to those of other type of mastitis or breast cancer, accurate diagnosis and adequate treatment are essential to ensuring a short symptom duration and improving the quality of life. METHODS: The clinical, radiologic, pathophysiologic, and treatment data for 43 patients diagnosed with IGM at the Breast Cancer Center of Gachon University Gil Medical Center between 2005 and 2016 were retrospectively reviewed. RESULTS: Forty-one patients (95.34%) were of childbearing age, seven (16.27%) had a history of lactation, and five (11.62%) had a history of oral contraceptive use. In terms of radiologic findings, 30 patients (69.77%) were diagnosed with Breast Imaging-Reporting and Data System category ≥4A lesions. Corticosteroid therapy was administered to 36 patients (83.72%); overall, 18 patients (41.86%) did not require surgery and 25 patients (58.13%) underwent partial or total mastectomy. Twelve patients (27.90%) developed recurrence. CONCLUSION: IGM is a benign disease that can be misdiagnosed as breast cancer because of its similar clinical and radiologic findings. Proper diagnosis and treatment can be difficult, but delays may lead to prolonged pain and cosmetic and socioeconomic problems. Efforts should be aimed at establishing the cause of IGM and developing efficient protocols for its diagnosis and treatment.
Breast ; Breast Neoplasms ; Diagnosis* ; Female ; Granulomatous Mastitis* ; Humans ; Immunoglobulin M ; Inflammation ; Information Systems ; Lactation ; Mastectomy, Simple ; Mastitis ; Quality of Life ; Rare Diseases ; Recurrence ; Retrospective Studies* ; Steroids

Purpose: Hereditary parkinsonism genes consist of causative genes of familial Parkinson’s disease (PD) with a locus symbol prefix (PARK genes) and hereditary atypical parkinsonian disorders that present atypical features and limited responsiveness to levodopa (non-PARK genes). Although studies have shown that hereditary parkinsonism genes are related to idiopathic PD at the phenotypic, gene expression, and genomic levels, no study has systematically investigated connectivity among the proteins encoded by these genes at the protein-protein interaction (PPI) level. Materials and Methods: Topological measurements and physical interaction enrichment were performed to assess PPI networks constructed using some or all the proteins encoded by hereditary parkinsonism genes (n=96), which were curated using the Online Mendelian Inheritance in Man database and literature. Results: Non-PARK and PARK genes were involved in common functional modules related to autophagy, mitochondrial or lysosomal organization, catecholamine metabolic process, chemical synapse transmission, response to oxidative stress, neuronal apoptosis, regulation of cellular protein catabolic process, and vesicle-mediated transport in synapse. The hereditary parkinsonism proteins formed a single large network comprising 51 nodes, 83 edges, and three PPI pairs. The probability of degree distribution followed a power-law scaling behavior, with a degree exponent of 1.24 and a correlation coefficient of 0.92. LRRK2 was identified as a hub gene with the highest degree of betweenness centrality; its physical interaction enrichment score was 1.28, which was highly significant. Conclusion Both PARK and non-PARK genes show high connectivity at the PPI and biological functional levels.

PURPOSE: The purpose of this study is to evaluate the usefulness and necessity of an emergency medical service director program for board certified emergency physicians. METHODS: A retrospective analysis of records of direct medical advice provided by board certified emergency physicians in the Busan area from April 1, 2011 to July 11, 2011 was conducted. The medical and legal validity of the medical direction was evaluated by two independent emergency physicians with experience and certification in the field of medical control. RESULTS: Fifteen emergency physicians provided direct medical control during the study period. Five of them were certified as an emergency medical service (EMS) director by the Korean council of EMS physicians (KCEMSP), and the other 10 were not. An analysis of 992 cases of direct medical direction was performed. No differences in the diagnostic appropriateness and medical validity of medical advice were observed between the two groups. A significant difference was observed in legal validity (p=0.048). However, in multivariate analysis, experience as a certified emergency physician was a significant factor determining legal validity (p=0.02), while certification by the KCEMSP was not significant. CONCLUSION: The current EMS director certification program did not have a significant influence on the appropriateness of direct medical direction. EMS director courses and emergency medicine residency programs are in need of improvement in the legal aspect of prehospital emergency service.
Certification ; Emergencies ; Emergency Medical Service Communication Systems ; Emergency Medical Services ; Emergency Medicine ; Humans ; Internship and Residency ; Jurisprudence ; Multivariate Analysis ; Physician Executives ; Retrospective Studies