Myringotomy and ventilation tube insertion are widely performed in pediatric patients with chronic otitis media. This procedure is performed under general anesthesia or sedation with local anesthesia infiltration in pediatric patients. In this case report, we report a case of transient facial paralysis in a pediatric patient who underwent myringotomy and ventilation tube insertion using sevoflurane inhalation and four-quadrant blocks with lidocaine.

Anisakiasis is a zoonotic parasitic infection associated with consumption of raw fish or uncooked seafood. We report a rare case of suspected esophageal anisakiasis-induced dysphagia. A 66-year-old man patient without any medical history was admitted to our hospital for evaluation of acute dysphagia. Following intake of abalone sashimi for dinner, he experienced sudden difficulty with swallowing the day before his emergency department visit. He developed skin rash and pruritus throughout his body, shortly thereafter. He also had chest and upper abdominal pain and diarrhea. He had experienced similar symptoms after consumption of raw fish on two previous occasions. Dysphagia improved 9 days later. Gastroscopy performed after symptom onset showed small erosions and edematous mucosa in the mid esophagus. Abdominopelvic computed tomography (CT) showed distal esophageal wall thickening and small bowel obstruction with concomitant ascites. We suspected anisakiasis based on the following criteria: 1) Skin rash after the third episode of consumption of raw fish or seafood (anisakiasisspecific immunoglobulin E class 4). 2) CT-documented small intestinal obstruction and ascites. 3) Eosinophil-dominant fluid observed on ascitic fluid analysis. Therefore, it is reasonable to conclude that temporary dysphagia in this patient was attributable to esophageal anisakiasis associated with raw seafood consumption.

Background: Awake craniotomy is a well-tolerated procedure for the resection of brain tumors residing within or close to the eloquent cortical areas. Monitored anesthesia care (MAC) is a dominant anesthetic approach for awake craniotomy; however, it is associated with inherent challenges such as desaturation and hypercapnia, which may lead to various complications. The prevention of respiratory insufficiency is important for successful awake craniotomy. As measures to avoid respiratory depression, the use of high-flow nasal cannula (HFNC) can improve patient oxygenation and monitor the oxygen reserve index (ORi) to detect hypoxia earlier. Case: We report two cases of awake craniotomy with MAC using HFNC and ORi. We adjusted the fraction of inspired oxygen of the HFNC according to the ORi level. The patient underwent successful awake craniotomy without a desaturation event or additional airway intervention. Conclusions Combined HFNC and ORi monitoring may provide adequate oxygen reserves in patients undergoing awake craniotomy.

The purpose of our study was to determine the most accurate analytic method to define in vitro chemosensitivity, using clinical response as reference standard in prospective clinical trial, and to assess accuracy of adenosine triphosphate-based chemotherapy response assay (ATP-CRA). Forty-eight patients with chemo-naive, histologically confirmed, locally advanced or metastatic gastric cancer were enrolled for the study and were treated with combination chemotherapy of paclitaxel 175 mg/m2 and cisplatin 75 mg/m2 for maximum of six cycles after obtaining specimen for ATP-CRA. We performed the receiver operator characteristic curve analysis using patient responses by WHO criteria and ATP-CRA results to define the method with the highest accuracy. Median progression free survival was 4.2 months (95% confidence interval [CI]: 3.4-5.0) and median overall survival was 11.8 months (95% CI: 9.7-13.8) for all enrolled patients. Chemosensitivity index method yielded highest accuracy of 77.8% by ROC curve analysis, and the specificity, sensitivity, positive and negative predictive values were 95.7%, 46.2%, 85.7%, and 75.9%. In vitro chemosensitive group showed higher response rate (85.7% vs. 24.1%) (P=0.005) compared to chemoresistant group. ATP-CRA could predict clinical response to paclitaxel and cisplatin chemotherapy with high accuracy in advanced gastric cancer patients. Our study supports the use of ATP-CRA in further validation studies.
Adenosine Triphosphate/*analysis ; Adult ; Aged ; Antineoplastic Agents, Phytogenic/administration & dosage ; Antineoplastic Combined Chemotherapy Protocols/*administration & dosage ; Cisplatin/administration & dosage ; Drug Screening Assays, Antitumor/*methods ; Female ; Humans ; Korea ; Male ; Middle Aged ; Outcome Assessment (Health Care)/methods ; Paclitaxel/administration & dosage ; Reproducibility of Results ; Sensitivity and Specificity ; Stomach Neoplasms/*diagnosis/*drug therapy/metabolism ; Treatment Outcome

Objective: This study examined whether related experts within the same organ know the standardized viscosity system of fluids and can manufacture solutions consistently. Methods: The subjects of this study were 22 rehabilitation ward nurses, 21 non-rehabilitation ward nurses, and 19 occupational therapists. The additional thickeners, manufacturing time and order, viscosity appropriateness, and solution homogeneity were measured for IDDSI level 4, 3, and 2 solutions manufactured using xanthan gum-based food thickeners. Results: The viscosity appropriateness in the three groups in stages IDDSI levels 4 and 3, but there was a significant difference among the three groups in stage IDDSI level 2. The factors affecting viscosity appropriateness were group and homogeneity of solution. The rehabilitation nurse group produced thicker solutions than the IDDSI standard compared to the other group. The homogeneity of the solution showed significant differences among the three groups in IDDSI levels 4, 3, and 2. The factors affecting homogeneity included the manufacturing order and job group, which often resulted in a clumping phenomenon when water was added first. Compared to the groups of therapists, the clumping phenomenon was significantly higher in the nurse (IDDSI level 3) and non-rehabilitation nurse groups (IDDSI level 4, 3) than the occupational therapists group. Conclusion This study showed that awareness and education about the liquid stage are necessary for medical personnel involved in hydration for patients with dysphagia and that consistent application using a standardized food thickener protocol at an institution is necessary.

Objective: This study examined whether related experts within the same organ know the standardized viscosity system of fluids and can manufacture solutions consistently. Methods: The subjects of this study were 22 rehabilitation ward nurses, 21 non-rehabilitation ward nurses, and 19 occupational therapists. The additional thickeners, manufacturing time and order, viscosity appropriateness, and solution homogeneity were measured for IDDSI level 4, 3, and 2 solutions manufactured using xanthan gum-based food thickeners. Results: The viscosity appropriateness in the three groups in stages IDDSI levels 4 and 3, but there was a significant difference among the three groups in stage IDDSI level 2. The factors affecting viscosity appropriateness were group and homogeneity of solution. The rehabilitation nurse group produced thicker solutions than the IDDSI standard compared to the other group. The homogeneity of the solution showed significant differences among the three groups in IDDSI levels 4, 3, and 2. The factors affecting homogeneity included the manufacturing order and job group, which often resulted in a clumping phenomenon when water was added first. Compared to the groups of therapists, the clumping phenomenon was significantly higher in the nurse (IDDSI level 3) and non-rehabilitation nurse groups (IDDSI level 4, 3) than the occupational therapists group. Conclusion This study showed that awareness and education about the liquid stage are necessary for medical personnel involved in hydration for patients with dysphagia and that consistent application using a standardized food thickener protocol at an institution is necessary.

Objective: This study examined whether related experts within the same organ know the standardized viscosity system of fluids and can manufacture solutions consistently. Methods: The subjects of this study were 22 rehabilitation ward nurses, 21 non-rehabilitation ward nurses, and 19 occupational therapists. The additional thickeners, manufacturing time and order, viscosity appropriateness, and solution homogeneity were measured for IDDSI level 4, 3, and 2 solutions manufactured using xanthan gum-based food thickeners. Results: The viscosity appropriateness in the three groups in stages IDDSI levels 4 and 3, but there was a significant difference among the three groups in stage IDDSI level 2. The factors affecting viscosity appropriateness were group and homogeneity of solution. The rehabilitation nurse group produced thicker solutions than the IDDSI standard compared to the other group. The homogeneity of the solution showed significant differences among the three groups in IDDSI levels 4, 3, and 2. The factors affecting homogeneity included the manufacturing order and job group, which often resulted in a clumping phenomenon when water was added first. Compared to the groups of therapists, the clumping phenomenon was significantly higher in the nurse (IDDSI level 3) and non-rehabilitation nurse groups (IDDSI level 4, 3) than the occupational therapists group. Conclusion This study showed that awareness and education about the liquid stage are necessary for medical personnel involved in hydration for patients with dysphagia and that consistent application using a standardized food thickener protocol at an institution is necessary.

Objective: This study examined whether related experts within the same organ know the standardized viscosity system of fluids and can manufacture solutions consistently. Methods: The subjects of this study were 22 rehabilitation ward nurses, 21 non-rehabilitation ward nurses, and 19 occupational therapists. The additional thickeners, manufacturing time and order, viscosity appropriateness, and solution homogeneity were measured for IDDSI level 4, 3, and 2 solutions manufactured using xanthan gum-based food thickeners. Results: The viscosity appropriateness in the three groups in stages IDDSI levels 4 and 3, but there was a significant difference among the three groups in stage IDDSI level 2. The factors affecting viscosity appropriateness were group and homogeneity of solution. The rehabilitation nurse group produced thicker solutions than the IDDSI standard compared to the other group. The homogeneity of the solution showed significant differences among the three groups in IDDSI levels 4, 3, and 2. The factors affecting homogeneity included the manufacturing order and job group, which often resulted in a clumping phenomenon when water was added first. Compared to the groups of therapists, the clumping phenomenon was significantly higher in the nurse (IDDSI level 3) and non-rehabilitation nurse groups (IDDSI level 4, 3) than the occupational therapists group. Conclusion This study showed that awareness and education about the liquid stage are necessary for medical personnel involved in hydration for patients with dysphagia and that consistent application using a standardized food thickener protocol at an institution is necessary.