A 14-month-old female patient was admitted for the laparoscopic excision of a complicated urachal cyst. General anesthesia was induced with thiopental and rocuronium and maintained with sevoflurane and the intermittent administration of vecuronium. During the insufflation of CO2 her intra-abdominal pressure was maintained below 12 cmH2O to avoid excessive hypercarbia. Thirty minutes after CO2 insufflation initiation, end tidal CO2 increased to 74 mmHg at a peak inspiratory airway pressure of 24 cmH2O. Laparoscopic excision of the urachal cyst was performed within 2 hours without a further change in end tidal CO2, blood pressure, heart rate, or O2 saturation. Before extubation, O2 saturation by pulse oxymetry was 99% and end tidal CO2 was 45-50 mmHg. The patient was discharged without any problem 5 days after the operation. We report on this clinical experience and include a brief review of the literature.
Anesthesia, General ; Blood Pressure ; Female ; Heart Rate ; Humans ; Infant ; Insufflation ; Thiopental ; Urachal Cyst* ; Vecuronium Bromide

PURPOSE: To investigate the relationship between early treatment response to definitive chemoradiotherapy (CRT) and survival outcome in patients with limited stage small cell lung cancer (LS-SCLC). MATERIALS AND METHODS: We retrospectively reviewed 47 patients with LS-SCLC who received definitive CRT between January 2009 and December 2012. Patients were treated with systemic chemotherapy regimen of etoposide/carboplatin (n = 15) or etoposide/cisplatin (n = 32) and concurrent thoracic radiotherapy at a median dose of 54 Gy (range, 46 to 64 Gy). Early treatment volume reduction rate (ETVRR) was defined as the percentage change in gross tumor volume between diagnostic computed tomography (CT) and simulation CT for adaptive RT planning and was used as a parameter for early treatment response. The median dose at adaptive RT planning was 36 Gy (range, 30 to 43 Gy), and adaptive CT was performed in 30 patients (63.8%). RESULTS: With a median follow-up of 27.7 months (range, 5.9 to 75.8 months), the 2-year locoregional progression-free survival (LRPFS) and overall survival (OS) rates were 74.2% and 56.5%, respectively. The mean diagnostic and adaptive gross tumor volumes were 117.9 mL (range, 5.9 to 447 mL) and 36.8 mL (range, 0.3 to 230.6 mL), respectively. The median ETVRR was 71.4% (range, 30 to 97.6%) and the ETVRR >45% group showed significantly better OS (p < 0.0001) and LRPFS (p = 0.009) than the other group. CONCLUSION: ETVRR as a parameter for early treatment response may be a useful prognostic factor to predict treatment outcome in LS-SCLC patients treated with CRT.
Chemoradiotherapy* ; Disease-Free Survival ; Drug Therapy ; Follow-Up Studies ; Humans ; Radiotherapy ; Retrospective Studies ; Small Cell Lung Carcinoma* ; Treatment Outcome ; Tumor Burden

PURPOSE: To investigate the relationship between early treatment response to definitive chemoradiotherapy (CRT) and survival outcome in patients with limited stage small cell lung cancer (LS-SCLC). MATERIALS AND METHODS: We retrospectively reviewed 47 patients with LS-SCLC who received definitive CRT between January 2009 and December 2012. Patients were treated with systemic chemotherapy regimen of etoposide/carboplatin (n = 15) or etoposide/cisplatin (n = 32) and concurrent thoracic radiotherapy at a median dose of 54 Gy (range, 46 to 64 Gy). Early treatment volume reduction rate (ETVRR) was defined as the percentage change in gross tumor volume between diagnostic computed tomography (CT) and simulation CT for adaptive RT planning and was used as a parameter for early treatment response. The median dose at adaptive RT planning was 36 Gy (range, 30 to 43 Gy), and adaptive CT was performed in 30 patients (63.8%). RESULTS: With a median follow-up of 27.7 months (range, 5.9 to 75.8 months), the 2-year locoregional progression-free survival (LRPFS) and overall survival (OS) rates were 74.2% and 56.5%, respectively. The mean diagnostic and adaptive gross tumor volumes were 117.9 mL (range, 5.9 to 447 mL) and 36.8 mL (range, 0.3 to 230.6 mL), respectively. The median ETVRR was 71.4% (range, 30 to 97.6%) and the ETVRR >45% group showed significantly better OS (p < 0.0001) and LRPFS (p = 0.009) than the other group. CONCLUSION: ETVRR as a parameter for early treatment response may be a useful prognostic factor to predict treatment outcome in LS-SCLC patients treated with CRT.
Chemoradiotherapy* ; Disease-Free Survival ; Drug Therapy ; Follow-Up Studies ; Humans ; Radiotherapy ; Retrospective Studies ; Small Cell Lung Carcinoma* ; Treatment Outcome ; Tumor Burden

This study was conducted in order to assess whether the form of the shade guide affects in deciding the color of the teeth using the shade guide. Eight shade light cured composite resins (Esthet-X, Dentsply, Milford, USA) were used in this study. Shade guides including the model of maxillary central incisors, teeth-form shade guide, doughnut form shade guide, and shade guide with perforated gray shield were prepared with eight shade composite resins and provided the codes randomly. After arranging the models of teeth, 19 dentists working at the clinic of the Dentistry of Chonnam University Hospital and 65 students of college of dentistry, Chonnnam University selected the shade guides corresponding to the color of each tooth on the gray board under the D65 standard illuminant. B1 shade showed highest accuracy of about 95% among all shade guides of 3 forms applied to the test and regardless of observer, tooth form shade guide showed the highest accuracy (p < 0.05), and the doughnut form showed the lowest accuracy (p < 0.05). At the time of deciding on the color of the teeth using the shade guides as a result of above, the forms of the shade guides can affect the accuracy, and it suggests that the development of the diversified forms of shade guides, which may obtain more accurate results, is required.
Composite Resins ; Dentistry ; Dentists ; Humans ; Incisor ; Jeollanam-do ; Tooth

PURPOSE: To evaluate the long-term results of Descemet's stripping automated endothelial keratoplasty in Korea (DSAEK). METHODS: Seven patients with bullous keratopathy who underwent DSAEK and who were followed-up for more than 18 months were reviewed retrospectively. Best corrected visual acuity, refraction, corneal thickness, and endothelial cell count were examined before and after surgery. RESULTS: The mean follow-up period was 19.9 +/- 2.9 months (18 to 24 months), and the mean age was 61.42 +/- 10.13 years (46 to 76 years). Six patients (85.7%) showed successful results after surgery. Best corrected visual acuity (logMAR) was significantly improved from 1.62 (median) to 1.15 (median) (p = 0.027) at one month after surgery and was maintained until the final follow-up period. There were no statistical differences in spherical ametropia or astigmatism before or 18 months after the operation. Graft failure was observed in one case, in which penetrating keratoplasty was performed 12 months after DSAEK. CONCLUSIONS: Long term results of DSAEK showed fast visual recovery, low ametropia and astigmatism. DSAEK may be a good option for the surgical management of corneal endothelial disease.
Astigmatism ; Corneal Transplantation ; Endothelial Cells ; Follow-Up Studies ; Humans ; Keratoplasty, Penetrating ; Korea ; Refractive Errors ; Retrospective Studies ; Transplants ; Visual Acuity

PURPOSE: To present a surgical result of rectus muscle transposition with silicone band without suture on the sclera in strabismus fixus with high myopia. CASE SUMMARY: A 73-year-old female patient with a 20-year history of bilateral esotropia and hypotropia visited our clinic. The patient`s right eye was aphakic because crystalline lens removal was performed 17 years earlier and the left eye was phthisical after retinal detachment, due to high myopia. Ocular movements in both eyes were severely restricted in all directions with the cornea barely visible. Ultrasound examination revealed posterior staphyloma of the retina. The axial length measurement was 32 mm in the right eye, and could not be measured in the left eye. Posterior tenon fixation of the medial rectus and inferior rectus muscle tendon was performed, in addition, fixation of the lateral half of the superior rectus and superior half of the lateral rectus muscle on the silicone band 10 mm posterior to each muscle's scleral insertion as a transposition procedure was performed. At 6 months postoperatively, there was no residual esotropia or hypotropia. The right eye maintained a gaze limitation but improved abduction and supraduction. CONCLUSIONS: In strabismus fixus with high myopia, posterior tenon fixation and muscle transposition with silicone band is an effective method without complication.
Aged ; Cornea ; Esotropia ; Eye ; Female ; Humans ; Lens, Crystalline ; Muscles ; Myopia ; Retina ; Retinal Detachment ; Sclera ; Silicones ; Strabismus ; Sutures ; Tendons

BACKGROUND AND OBJECTIVES: Bone conduction (BC) auditory brainstem response (ABR) is an important factor in determining the type of hearing loss especially in infants and other difficult-to-test populations. However, multiple constraints including technical difficulties make evaluating BC ABR less feasible in the clinic, and there is also lack of information that guides clinicians how to evaluate it. The purpose of this study is to compare the latency of wave V in BC and air conduction (AC) ABR in normal hearing infants and gather reference values for wave V latency of BC ABR. SUBJECTS AND METHOD: A total of 210 ears of normal hearing, of those not belong to the hearing loss risk group, were included. All the infants underwent ABR evoked by clicks via AC (3A insert phone) and BC (Radioear B-71, vibrator positioned on the mastoid) under sedation. The latency of wave V at 30 dB nHL by BC and AC was compared and analyzed according to age. RESULTS: The results revealed that in every age group in the study, wave V latency at 30 dB nHL of BC ABR was shorter than that of AC ABR. There was a significant decrease in BC and AC latencies with age, but among each consecutive age group, significant latency change was not identified after 6 months old. CONCLUSION: The latency of BC ABR in young children was shorter than that of AC ABR, and it decreased significantly as age increased. However, the reference data should be considered by taking each laboratory's test parameter into consideration.
Bone Conduction* ; Child ; Ear ; Evoked Potentials ; Evoked Potentials, Auditory, Brain Stem* ; Hearing Loss ; Hearing* ; Humans ; Infant* ; Reference Values

BACKGROUND: Diabetes mellitus is the most common endocrinopathy encountered in the perioperative period and has long been assumed to increase perioperative risk. However, when diabetes mellitus was segregated from old age and the complications of it, it was questioned that diabetes mellitus itself increased perioperative risk. In this study, we investigated the influence of hyperglycemia on the length of postoperative hospital stay. METHODS: We studied 100 patients undergone intra-abdominal operations with general anesthesia. These patients were divided into the hyperglycemic group (n = 20) with postoperative blood glucose level higher than 10 mM and the non-hyperglycemic group (n = 80) with glucose level lower than 10 mM and we investigated the length of postoperative hospital stay, serum electrolyte, serum chemistry, arterial blood gas values, and base excess by unmeasured anions. We also divided these patients into the diabetic patients group (n = 15) and the non-diabetic patients group (n = 85) and compared the same variables. RESULTS: The length of postoperative hospital stay was significantly prolonged in the hyperglycemic group (20.9 +/- 9.0 days) compared with the non-hyperglycemic group (16.2 +/-8.5 days), and the cumulative postoperative hospital stay curves based on Kaplan-Meier method also showed significant difference between the two groups. When we compared the length of postoperative hospital stay between the diabetic and the non-diabetic patients, there was no significant difference. CONCLUSIONS: This study demonstrated that hyperglycemia prolonged the length of postoperative hospital stay. This finding suggests that the patient's glucose level should be monitored and controlled within an adequate range perioperatively.
Anesthesia, General ; Anions ; Blood Glucose ; Chemistry ; Diabetes Mellitus ; Glucose ; Humans ; Hyperglycemia* ; Length of Stay* ; Perioperative Period

PURPOSE: A number of factors related to overall survival (OS) have been addressed in advanced non-small cell lung cancer (NSCLC). This study was conducted to determine the impact of whole-body metastatic regions on survival outcome in advanced non-squamous NSCLC. MATERIALS AND METHODS: Between March 2005 and February 2011, 112 eligible patients with newly confirmed stage IV non-squamous NSCLC, available for epidermal growth factor receptor (EGFR) mutation status 18-21 analysis, and accessible for the determination of pretreatment whole-body metastatic regions were enrolled in this retrospective study. The total number of synchronous metastatic regions was scored according to the following disease sites: abdomen/pelvis, lung to lung/pulmonary lymphangitic spread, bone, pleura/pleural effusion/pericardial effusion, neck/axillary lymph nodes, other soft tissue, brain. RESULTS: The median age of the cohort was 65 years (range, 31 to 88 years). The median whole-body metastatic score was 2 (range, 1 to 6), and bone and lung to lung were the most common metastatic sites. EGFR mutations were observed in 40 (35.7%) patients with a deletion in exon 19 and Leu858Arg mutation in exon 21 being detected in 16 (40.0%) and 19 (47.5%) patients, respectively. Multivariate analysis for OS revealed that treatment factors (p=0.005), performance status (p=0.006), whole-body metastatic score (p<0.001), and EGFR mutation status (p=0.095) were significantly or marginally associated with OS. CONCLUSION: The results of the present study demonstrated that whole-body metastatic extent strongly affects survival outcome, even after adjustment for other significant variables in advanced non-squamous NSCLC. The clinical validity of more curative multimodal approaches in cohorts with limited metastases remains to be explored.
Adenocarcinoma ; Carcinoma, Non-Small-Cell Lung ; Cohort Studies ; Exons ; Humans ; Lung ; Lung Neoplasms ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Receptor, Epidermal Growth Factor ; Retrospective Studies

BACKGROUND: Many terminal cancer patients and families are affected with physical, emotional, and social problems. Many people claim that a type of medical services is needed to manage them such as hospice palliative care. There have not been many studies of cancer patients and families with respect to their opinions and attitudes on hospice palliative care for terminal cancer patients, although their views on it is important. METHODS: We surveyed 687 in-patients, out-patients and their families with cancer in 8 hospitals. The self-administered questionnaires included the following; 1) socio-demographic and clinical variables; 2) opinions on hospice palliative care; 3) attitudes on ethical issues associated with hospice palliative care; 4) factors associated with withholding futile care at the end-of-life. The data were analyzed with x2-test, Mantel-Haenszel x2-test, and multiple logistic regression. RESULTS: Almost 90% of the subjects agreed to the need of obtaining hospice palliative care with health care insurances and reaching a social consensus on the contents of its programs. Five hundred and seventy six (83.8%) subjects agreed to the need of using advanced directives. Two hundred and eighty five (72.2%) cancer patients and 200 (68.5%) families agreed to the need of withholding futile care at the end-of-life and of people accepting their cancer diagnosis with insight and living in the metropolis as they were more likely to do. In the multivariate analysis, the attitudes on withholding futile care at the end-of-life was significantly different only by insight of cancer diagnosis (OR; 1.09-3.15). CONCLUSION: This study showed that hospice palliative care should be established through social consensus on the issues related to ethics and insurances, and that cancer patients and families must have a right to choose such services with informed decision-making.
Consensus ; Delivery of Health Care ; Diagnosis ; Ethics ; Hospices* ; Humans ; Insurance ; Logistic Models ; Multivariate Analysis ; Outpatients ; Palliative Care* ; Social Problems ; Surveys and Questionnaires