BACKGROUND: Combined spinal epidural anesthesia (CSE) often produces a more extensive spinal block than expected. This study was designed to evaluate the effects of CSE on subarachnoid block in patients undergoing lower extremity surgery. METHODS: Thirty-three patients who undergone lower extremity surgeries were randomly allocated to three groups of 11 patients each. Using needle through needle technique, all patients received a subarachnoid injection of hyperbaric 0.5% bupivacaine 1.6~2.0 ml through a 25G Whitacre spinal needle. Group 1 received no extradural injection for 25min, but group 2 and 3 received extradural saline 10 ml and bupivacaine 10 ml 5min after the subarachnoid injection, respectively. Levels of sensory and motor block were assessed at 4, 6, 8, 10, 15, 20, and 25 min after subarachnoid injection. RESULTS: The median values of maximum sensory block level were T7 in all groups. Levels of sensory blockade and the time to onset of maximum sensory blockade were similar among the three groups. There was no significant difference in the degree of motor block among three groups. CONCLUSIONS: This study suggests that extradural saline 10 ml or 0.5% bupivacaine 10 ml which injected 5min after subarachnoid injection does not significantly influence the level of subarachnoid block in lower extremity surgical patients. However, further study is required to declare the safety or optimal dose of extradural injection during CSE.
Anesthesia, Epidural* ; Bupivacaine ; Humans ; Injections, Epidural ; Lower Extremity* ; Needles

BACKGROUND: Tissue plasminogen activator (tPA) is known to be effective if given within 3 hours after the onset of ischemic stroke. However, no study has been performed regarding what proportion of patients with acute ischemic stroke are actually given tPA within this time window. We therefore tried to figure out the performance rate of thrombolytic therapy and acute prognosis in hyperacute ischemic stroke patients. METHODS: We prospectively registered all the acute ischemic stroke patients. Thrombolyic therapy was decided strictly according to the NINDS tPA protocol and clinical monitoring was done by the NIH Stroke Scale (NIHSS). If tPA was not given, the reason was recorded. RESULTS: Among 613 acute stroke patients during a period of 2.5 years, there were 146 (23.8%) hyperacute ischemic stroke patients within 3 hours after onset. Even in the 29 cases of in-hospital stroke, the rate of early detection and management was only 27.6% (8 cases). Among the hyperacute stroke population, 56 (38.4%) patients were treated with the thrombolytic agent and 27 patients showed positive responses. Thrombolytic therapy was not tried in the remaining 90 patients. The most common reason was expectation of favorable outcome without thrombolysis. But among these patients, subsequent neurological worsening was noticed in 9 patients, particularly in those with vertebrobasilar stroke. CONCLUSIONS: Urgent notice and management of ischemic stroke needs to be more emphasized not only to the general public, but also to medical personnel. More close observation is especially needed in vertebrobasilar stroke cases (J Korean Neurol Assoc 19(5):447~451, 2001)
Humans ; National Institute of Neurological Disorders and Stroke ; Prognosis* ; Prospective Studies ; Stroke* ; Thrombolytic Therapy* ; Tissue Plasminogen Activator

The problem of difficult intubation is well known to anesthesiologists. However, difficulties associated with the extubation of endotracheal tubes are not common, and few reports exist. However, untoward incidents of diverse etiology can occur and the complications of difficult extubation may be fatal. We experienced 2 cases of difficult extubations. One was due to adhesion of the tube to the tracheal wall and the other was due to a fold in the deflated cuff of an excessively large-sized tube. We managed these difficult extubations by rotating the tube with a MaGill forcep under direct laryngoscopy. We report upon these clinical experiences and include a brief review of the literature.
Intubation ; Laryngoscopy ; Surgical Instruments

PURPOSE: The purpose of this study was to determine trends in dietary vitamin E intakes and contributing food groups among Korean adults. METHODS: This study included 66,695 subjects aged ≥ 19 years who completed a nutrition survey as part of the Korea National Health and Nutrition Examination Survey (1998, 2001, 2005, 2007~2009, 2010~2012, 2013~2015). We estimated individual daily intakes of α-, β-, γ-, δ-tocopherol, and total vitamin E by linking food consumption data with a vitamin E database of commonly consumed foods. RESULTS: Daily vitamin E intake significantly increased from 6.4 mg α-TE/d in 1998 to 7.7 mg α-TE/d in 2013~2015 (p for trend < 0.0001) among men as well as from 5.4 mg α-TE/d in 1998 to 6.5 mg α-TE/d in 2013~2015 among women (p for trend < 0.0001). However, the intake of vitamin E was lower than the adequate intake (AI) of Dietary Reference Intakes for Koreans 2015 (2015 KDRI). In 2013~2015, men consumed 6.5 mg/d of α-tocopherol, 0.5 mg/d of β-tocopherol, 6.0 mg/d of γ-tocopherol, and 3.9 mg/d of δ-tocopherol, whereas women consumed 5.7 mg/d of α-tocopherol, 0.4 mg/d of β-tocopherol, 4.8 mg/d of γ-tocopherol, and 2.8 mg/d of δ-tocopherol. The major food groups contributing to vitamin E intake were vegetables (men: 23.3%, women: 22.7%), grains (men: 14.5%, women: 13.9%), and eggs (men: 13.0%, women: 12.5%). CONCLUSION: This study provides scientific evidence for vitamin E intake in Korean adults. Since the current intake of vitamin E was lower than the reference intakes set by 2015 KDRI, dietary vitamin E intake should be monitored regularly among Korean adults.
Adult* ; Eggs ; Female ; Humans ; Korea* ; Male ; Nutrition Surveys* ; Ovum ; Recommended Dietary Allowances ; Tocopherols ; Vegetables ; Vitamin E* ; Vitamins*

Background: During the coronavirus disease 2019 (COVID-19) pandemic, the incidence of rhinovirus (RV) is inversely related to the intensity of non-pharmacological interventions (NPIs), such as universal mask wearing and physical distancing. Methods: Using RV surveillance data, changes in the effect of NPIs were investigated in South Korea during the pandemic. The time to the first visible effect of NPIs after the onset of NPIs (T1), time to the maximum effect (T2), and duration of the maximum effect (T3) were measured for each surge. For each week, the RVdiff [(RV incidence during the pandemic) − (RV incidence within 5 years before the pandemic)] was calculated, and number of weeks for RVdiff to be below zero after NPIs (time to RVdiff ≤ 0) and number of weeks RVdiff remains below zero after NPIs (duration of RVdiff ≤ 0) were measured for each surge. Results: During the study period, four surges of COVID-19 were reported. As the pandemic progressed, T1 and T2 increased, but T3 decreased. Additionally, the “time to RVdiff of ≤ 0” increased and “duration of RVdiff of ≤ 0” decreased. These changes became more pronounced during the third surge (mid-November 2020), before the introduction of the COVID-19 vaccine, and from the emergence of the delta variant. Conclusion The effect of NPIs appears slower, the duration of the effect becomes shorter, and the intensity also decreases less than a year after the onset of the pandemic owing to people’s exhaustion in implementing NPIs. These findings suggest that the COVID-19 response strategy must be completely overhauled

BACKGROUND: Initial evaluation of injury severity in trauma patients is an important and challenging task. We aimed to assess whether easily measurable biochemical parameters (hemoglobin, pH, and prothrombin time/international normalized ratio [PT/INR]) can predict in-hospital mortality in patients with severe trauma. METHODS: This retrospective study involved review of the medical records of 315 patients with severe trauma and an injury severity score >15 who were managed at Gyeongsang National University Hospital between January 2005 and December 2015. We extracted the following data: in-hospital mortality, injury severity score, and initial hemoglobin level, pH, and PT/INR. The predictive values of these variables were compared using receiver operation characteristic curves. RESULTS: Of the 315 patients, 72 (22.9%) died. The in-hospital mortality rates of patients with hemoglobin levels <8.4 g/dl and ≥8.4 g/dl were 49.8% and 9.9%, respectively (P < 0.001). At a cutoff hemoglobin level of 8.4 g/dl, the sensitivity and specificity values for mortality were 81.9% and 86.4%, respectively. At a pH cutoff of 7.25, the sensitivity and specificity values for mortality were 66.7% and 77.8%, respectively; 66.7% of patients with a pH <7.25 died versus 22.2% with a pH ≥7.25 (P < 0.001). The in-hospital mortality rates for patients with PT/INR values ≥1.4 and <1.4 were 37.5% and 16%, respectively (P < 0.001; sensitivity, 37.5%; specificity, 84%). CONCLUSIONS: Using the suggested cutoff values, hemoglobin level, pH, and PT/INR can simply and easily be used to predict in-hospital mortality in patients with severe trauma.
Acidosis ; Biomarkers* ; Cohort Studies* ; Hospital Mortality* ; Humans ; Hydrogen-Ion Concentration ; Injury Severity Score ; International Normalized Ratio ; Medical Records ; Mortality ; Prothrombin ; Retrospective Studies* ; Sensitivity and Specificity

No abstract available.
Angiography, Digital Subtraction ; Venous Thrombosis

Despite the accuracy of nucleic acid amplification tests (NAATs), rapid antigen tests (RATs) for severe acute respiratory syndrome coronavirus-2 are widely used as point-of-care tests. A total of 282 pairs of reverse transcription-polymerase chain reaction and Standard Q COVID-19 Ag tests were serially conducted for 68 patients every 3–4 days until their discharge. Through a field evaluation of RATs using direct nasopharyngeal swabs, the sensitivities were 84.6% and 87.3% for E and RNA-dependent RNA polymerase (RdRp) genes, respectively, for specimens with cycle thresholds (Cts) < 25. The Ct values of E and RdRp genes for 95% detection rates by RATs were 16.9 and 18.1, respectively. The sensitivity of RAT was 48.4% after the onset of symptoms, which was not sufficient. RAT positivity gradually decreased with increased time after symptom onset and had continuously lower sensitivity than NAATs.

Background: Before the omicron era, health care workers were usually vaccinated with either the primary 2-dose ChAdOx1 nCoV-19 (Oxford-AstraZeneca) series plus a booster dose of BNT162b2 (Pfizer-BioNTech) (CCB group) or the primary 2-dose BNT162b2 series plus a booster dose of BNT162b2 (BBB group) in Korea. Methods: The two groups were compared using quantification of the surrogate virus neutralization test for wild type severe acute respiratory syndrome coronavirus 2 (SVNT-WT), the omicron variant (SVNT-O), spike-specific IgG, and interferon-gamma (IFN-γ), as well as the omicron breakthrough infection cases. Results: There were 113 participants enrolled in the CCB group and 51 enrolled in the BBB group. Before and after booster vaccination, the median SVNT-WT and SVNT-O values were lower in the CCB (SVNT-WT [before-after]: 72.02–97.61%, SVNT-O: 15.18–42.29%) group than in the BBB group (SVNT-WT: 89.19–98.11%, SVNT-O: 23.58–68.56%; all P < 0.001). Although the median IgG concentrations were different between the CCB and BBB groups after the primary series (2.677 vs. 4.700 AU/mL, respectively, P < 0.001), they were not different between the two groups after the booster vaccination (7.246 vs. 7.979 AU/mL, respectively, P = 0.108). In addition, the median IFN-γ concentration was higher in the BBB group than in the CCB group (550.5 and 387.5 mIU/mL, respectively, P = 0.014). There was also a difference in the cumulative incidence curves over time (CCB group 50.0% vs. BBB group 41.8%; P = 0.045), indicating that breakthrough infection occurred faster in the CCB group. Conclusion The cellular and humoral immune responses were low in the CCB group so that the breakthrough infection occurred faster in the CCB group than in the BBB group.

Rheumatoid arthritis is associated with an increased risk of hematological malignancy as a result of the RA itself or its treatment. We report here on an unusual case of a 55-year-old female with long-standing rheumatoid arthritis and who was treated with low dose methotrexate and hydrochloroquine. She was diagnosed with chronic myelogenous leukemia that manifested with severe thrombocytosis and basophilia, and this was treated with imatinib mesylate. After 6 months, she achieved a complete cytogenetic response of the CML and a complete resolution of all the RA symptoms without DMARDs.
Antirheumatic Agents ; Arthritis, Rheumatoid ; Benzamides ; Cytogenetics ; Female ; Hematologic Neoplasms ; Humans ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Mesylates ; Methotrexate ; Middle Aged ; Piperazines ; Pyrimidines ; Thrombocytosis ; Imatinib Mesylate