Objective: This study aimed to evaluate the effectiveness of video laryngoscopy (VL; Glidescope) compared to direct laryngoscopy (DL) when performing endotracheal intubation (ETI) in trauma patients with cervical spine immobilization. Methods: This was a retrospective clinical study. A total of 98 trauma patients with cervical spine immobilization were included. These patients underwent intubation using VL and DL from 2009 to 2014 in the emergency department. All data were collected through electronic medical records. The primary outcome was the first-attempt intubation success rate of ETI. Secondary outcomes were complications of ETI, including esophageal intubation and tooth injuries. We compared the outcomes of the two devices. Results: VL showed higher first-attempt ETI success rates compared to DL (94.0% vs. 74.5%, P=0.011). There were no statistically significant differences in the ETI complication rates between VL and DL such as esophageal intubation (2.0% vs. 4.3%, P=0.610) and tooth injuries (6.0% vs. 10.6%, P=0.478). The multivariate analysis showed that VL was an independent factor for predicting higher first-attempt intubation success with an odds ratio of 4.538 (95% confidence interval, 1.084-18.988; P=0.038) Conclusion For patients with cervical spine immobilization, VL could provide a higher first-attempt ETI success rate compared to DL in a real clinical setting.

BACKGROUND: Acute myelogenous leukemia (AML) is the most common cause of leukemia in adults. Allogeneic bone marrow transplantation (BMT) for the treatment of AML is done worldwide now. METHODS: Between November 1987 and June 1998, we performed allogeneic BMT for 27 patients with AML from HLA-identical sibling donors. We reviewed medical records of these patients. RESULTS: The median age of patients was 31 (range, 15~43) and male to female ratio was 18 : 9. Conditioning regimens were BU/CY (busulfan, cyclophosphamide) for 22 patients, TBI/CY (total body irradiation, cyclophosphamide) for 3 patients, and TBI/VP/CY (TBI, VP-16, cyclophosphamide) for 2 patients. Cyclosporine and methotrexate were used in 18 patients for prophylaxis of graft-versus-host disease (GVHD), and cyclosporine and methyl-prednisolone were used in 9 patients. The median nucleated cell dose given to patients was 4.1x108 /kg. All evaluable patients achieved absolute neutrophil count of 500 /microliter after median 15 days after BMT (range, 11~45 days). Twenty-five percent of patients developed acute GVHD (> or = grade II) and there was no patient with grade IV acute GVHD. Twenty-nine percent developed chronic GVHD. Hepatic venoocclusive disease (VOD) occurred in 7 patients (26%). At the time of BMT, 16 patients were in the first remission status and 11 patients were in the advanced disease status. After a median follow-up of 27 months (range 7~127 months), the actuarial disease-free survival at 5 years was significantly higher in the first remission group than the others (44% vs. 9%; P=0.05). The difference of 5 year overall survival between these two groups approached statistical significance (50%for the first remission group and 12% for the others; P=0.13). There were 17 deaths. The causes of death were relapse (8 patients, 47%), VOD (3 patients, 18%), sepsis (2 patients, 12%), interstitial pneumonia (2 patients, 12%), chronic GVHD (1 patient, 6%), and drug-toxicity (1 patient, 6%). Eary deaths (<100 days) occurred in 6 patients (22%). CONCLUSION: Allogeneic BMT for patients with AML was most successful when done during the first remission. Clinical features of patients with AML treated with allogeneic BMT were similar to those from Western countries, but the incidence and severity of acute GVHD seem to be lower.
Adult ; Bone Marrow Transplantation* ; Bone Marrow* ; Cause of Death ; Cyclosporine ; Disease-Free Survival ; Etoposide ; Female ; Follow-Up Studies ; Graft vs Host Disease ; Humans ; Incidence ; Leukemia ; Leukemia, Myeloid, Acute* ; Lung Diseases, Interstitial ; Male ; Medical Records ; Methotrexate ; Neutrophils ; Recurrence ; Retrospective Studies* ; Sepsis ; Siblings ; Tissue Donors

BACKGROUND: The outcome of hematopoietic stem cell transplantation (HSCT) for patients with severe aplastic anemia (SAA) in Seoul National University Hospital was analyzed retrospectively. METHODS: Between January, 1990 and March, 1999, 25 patients with SAA underwent HSCT. Their medical records were reviewed. Statistical analyses were done about survival and complication after HSCT. RESULTS: The median age of patients was 22 (range, 14~43) and male to female ratio was 18 : 7. Twenty two were HLA matched non- identical siblings. Three were one identical twin, one one-locus mismatched father and one HLA matched unrelated donor, respectively. Conditioning regimens were CY/TLI (cyclophosphamide, total lymphoid irradiation) for 18 patients, CY/ATG (CY, antithymocyte globulin) for 3, CY/ buffy (CY, unirradiated buffy- coat) for 2, CY/ ATG/TLI for 1, BU/CY (busulfan, CY) for 1. For prophylaxis of graft-versus-host disease (GVHD), cyclosporine and methotrexate were used in all patients except for identical twin. The median nucleated cell dose given to patients was 4.5x108/kg (range, 2.0~5.9). All evaluable patients achieved absolute neutrophil count of 500/microliter after median 17 days of HSCT (range, 12~27) and untransfused platelet count over 20,000/microliter after median 21 days of HSCT (range, 13~67). Six patients (24%, grade I : 3, II : 1, III : 1, IV : 1) developed acute GVHD and 8 (32%, limited : 4, extensive : 4) developed chronic GVHD. Hepatic venoocclusive disease (VOD) occurred in 2 patients (8%). Rejection occured in 4 patients (16 %), but among 22 allogeneic transplant recipients from HLA matched siblings, only one (5%) lost graft. After a median follow-up of 32 months (range 9~120 months), 5 year overall survival of all patients was 87%, and that of 22 allogeneic recipients from HLA matched sibling donors was 95%. Four patients (16%) died. Causes of death were VOD in one case, rejection with pneumonia one, acute GVHD one. One died from traffic accident in a cured state. CONCLUSION: Experiences from our center suggest that HSCT is an effective treatment for patients with severe aplastic anemia. Long- term survival is especially excellent for patients who have matched related donors.
Accidents, Traffic ; Anemia, Aplastic* ; Cause of Death ; Cyclosporine ; Fathers ; Female ; Follow-Up Studies ; Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation* ; Hematopoietic Stem Cells* ; Humans ; Male ; Medical Records ; Methotrexate ; Neutrophils ; Platelet Count ; Pneumonia ; Retrospective Studies ; Seoul ; Siblings ; Tissue Donors ; Transplantation ; Transplants ; Twins, Monozygotic ; Unrelated Donors