OBJECTIVE: This study was carried out to compare the clinical outcome of elective single cleavage-embryo transfer (eSCET) to that of elective single blastocyst-embryo transfer (eSBET) in human IVF-ET. METHODS: This study was a retrospective study which analyzed for 614 women who visited the Daegu Maria Clinic from August 2008 to December 2009. All were under 37 years old and had more than 8 mm of endometrial thickness on the day of hCG administration and at least one good quality embryo on day 3. The eSCETs were performed on day 3 (n=450) and the eSBETs were conducted on day 5 (n=164). RESULTS: The numbers of retrieved oocytes, fertilized oocytes, and day 3 good quality embryos were significantly lower in the eSCET group (12.1+/-6.0, 8.2+/-4.6, and 4.2+/-3.1, respectively) compared to the eSBET group (16.7+/-7.2, 12.1+/-5.0, and 8.5+/-4.5, respectively; p<0.001). However, the clinical pregnancy, implantation, on-going pregnancy, and live birth rates of the eSCET group (46.7, 46.9, 40.0, and 36.7%, respectively) were not statistically different from those of the eSBET group (51.2, 51.8, 45.1, and 43.9%, respectively; p=0.318, 0.278, 0.254, and 0.103, respectively). CONCLUSION: These results suggested that elective single embryo transfer should be performed regardless of the developmental stage to women less than 37 years old who had more than 8 mm of endometrial thickness on the hCG administration day and at least one good quality embryo on day 3 in order to reduce the twin pregnancy rate without reducing the whole pregnancy rate.
Embryonic Structures ; Female ; Humans ; Live Birth ; Oocytes ; Pregnancy ; Pregnancy Rate ; Pregnancy, Twin ; Retrospective Studies ; Single Embryo Transfer ; Twins

OBJECTIVE: This study was carried out to compare the clinical outcome of elective single cleavage-embryo transfer (eSCET) to that of elective single blastocyst-embryo transfer (eSBET) in human IVF-ET. METHODS: This study was a retrospective study which analyzed for 614 women who visited the Daegu Maria Clinic from August 2008 to December 2009. All were under 37 years old and had more than 8 mm of endometrial thickness on the day of hCG administration and at least one good quality embryo on day 3. The eSCETs were performed on day 3 (n=450) and the eSBETs were conducted on day 5 (n=164). RESULTS: The numbers of retrieved oocytes, fertilized oocytes, and day 3 good quality embryos were significantly lower in the eSCET group (12.1+/-6.0, 8.2+/-4.6, and 4.2+/-3.1, respectively) compared to the eSBET group (16.7+/-7.2, 12.1+/-5.0, and 8.5+/-4.5, respectively; p<0.001). However, the clinical pregnancy, implantation, on-going pregnancy, and live birth rates of the eSCET group (46.7, 46.9, 40.0, and 36.7%, respectively) were not statistically different from those of the eSBET group (51.2, 51.8, 45.1, and 43.9%, respectively; p=0.318, 0.278, 0.254, and 0.103, respectively). CONCLUSION: These results suggested that elective single embryo transfer should be performed regardless of the developmental stage to women less than 37 years old who had more than 8 mm of endometrial thickness on the hCG administration day and at least one good quality embryo on day 3 in order to reduce the twin pregnancy rate without reducing the whole pregnancy rate.
Embryonic Structures ; Female ; Humans ; Live Birth ; Oocytes ; Pregnancy ; Pregnancy Rate ; Pregnancy, Twin ; Retrospective Studies ; Single Embryo Transfer ; Twins

BACKGROUND: Urapidil is a new antihypertensive agent known to diminish total peripheral vascular resistance by postsynaptic alpha 1-adrenergic blockade and central sympatholytic activity. The purpose of this study was to determine its effectiveness and safety in preventing hemodynamic responses to endotracheal intubation under general anesthesia. METHODS: Thirty normotensive, ASA physical status I patients for elective surgery were selected randomly. They were divided into three groups(Group 1: control group with saline, Group 2: urapidil 0.4 mg/kg, Group 3: urapidil 0.5 mg/kg, n=10 in each group). The drugs were injected 3 minutes before induction with thiopental sodium(4 mg/kg) and succinylcholine(1 mg/kg). Endotracheal intubation was performed 5 minutes after the drugs injection. After endotracheal intubation, vecuronium 0.1 mg/kg was injected and 50% nitrous oxide in oxygen and 2Vol% enflurane were inhaled. We measured the blood pressure and the heart rate with noninvasive method at one minute interval for 5 minutes. RESULTS: In group 3, no significant increase in systolic blood pressure after endotracheal intubation was noted(p<0.05). Urapidil groups showed increase in heart rate at 1, 2 minutes after urapidil injection(p<0.05) and did not blunt increase in heart rate after endotracheal intubation. The side effects of urapidil(hypotension, dizziness, headache and chest tightness) occured in a patient of group 3. CONCLUSIONS: We found that the blood pressure response was effectively controlled, but the change in heart rate was not controlled by urapidil 0.5 mg/kg injection before induction.
Anesthesia, General ; Arterial Pressure* ; Blood Pressure ; Dizziness ; Enflurane ; Headache ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Intubation ; Intubation, Intratracheal* ; Nitrous Oxide ; Oxygen ; Thiopental ; Thorax ; Vascular Resistance ; Vecuronium Bromide

BACKGROUND: Brachial plexus is invested by a fascial envelope, which forms a perineural and perivascular space that extends all the way from the cervical intervertebral foramen to the distal axilla. Therefore a single injection of a local anesthetic into any sites of this space can provide anesthesia of the entire brachial plexus. Nowadays many methods of brachial plexus block have been developed but there are some severe complications and they can't prevent tourniquet pain completely. METHODS: We have performed parascalene technique for brachial plexus block in 206 cases from Jan., 1992 to Dec.,1994. We studied the cases retrospectively by reviewing patients' anesthesia records. The technique for parascalene block is the injection of local anesthetic solution into the lower part of the posterior triangle of the neck at the point 1.5~2.0 cm above the clavicle at the lateral border of the anterior scalene muscle. RESULTS: We could provide the proper anesthesia for the upper extremity and shoulder operation without any remarkable complications except Honor's syndrome of 3 cases. And there were no tourniquet pain in all 96 cases who had used tourniquet. CONCLUSIONS: The parascalene approach is the useful, safe and reliable method for brachial plexus block.
Anesthesia ; Anesthetics ; Axilla ; Brachial Plexus* ; Bupivacaine ; Clavicle ; Lidocaine ; Neck ; Retrospective Studies ; Shoulder* ; Tourniquets ; Upper Extremity*

PURPOSE: Endoscopic thyroidectomy using a cervico-axillary approach (CAA) provides optimal visualization with a smaller dissection plane. Despite the excellent cosmetic results and high patient satisfaction, the surgical and oncologic safety of CAA endoscopic surgery has not been fully established. The present study evaluated the feasibility, safety, and surgical outcomes of CAA endoscopic thyroidectomy. METHODS: From October 2009 to April 2012, 100 patients with papillary thyroid cancer underwent CAA endoscopic thyroidectomy. Patient demographics, pathologic features, and surgical outcomes including complications and recurrence were collected. RESULTS: CAA endoscopic thyroidectomy was successful in all patients, and none required conversion to open thyroidectomy. All patients underwent ipsilateral thyroid lobectomy with or without central compartment neck dissection. The mean tumor size was 1.0±0.6 cm (range, 0.5~1.6), and 35.0% of tumors showed extrathyroidal extension. The mean number of harvested lymph nodes was 4.1±4.4, and metastasis was found in 12.0% of patients. The mean surgical time was 175.2±50.4 min, mean intraoperative blood loss was 42.5±69.2 ml, and the mean hospital stay was 3.3±0.6 days. There were five cases of postoperative transient hypocalcemia and eight cases of vocal cord palsy. No permanent complication or postoperative bleeding was observed. Patients continued to be seen for a median period of 63.7 months, and no recurrence of thyroid cancer was seen. CONCLUSION: CAA endoscopic thyroidectomy is a feasible and safe procedure for low-risk thyroid cancer, with excellent cosmesis. It can be recommended as an alternative option for selected patients with low-risk thyroid cancer.
Demography ; Hemorrhage ; Humans ; Hypocalcemia ; Length of Stay ; Lymph Nodes ; Neck Dissection ; Neoplasm Metastasis ; Operative Time ; Patient Satisfaction ; Recurrence ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy* ; Vocal Cord Paralysis

In thyroid hormone resistance syndrome (THR) TSH levels are normal or elevated despite thyroid hormone levels being elevated. THR is distinguished from TSH-producing pituitary adenoma by TRH stimulation and alpha-subunit tests, thyroid hormone receptor (TR) beta gene analysis, and sellar MRI. A 24-year old man with diffuse goiter visited our hospital complaining of fatigue, heat intolerance, palpitation, and weight loss. He had elevated total T3 and free T4 levels, but normal TSH levels. Serum TSH levels during TRH stimulation tests performed before and after T3 suppression showed normal and non-suppressible responses, respectively. The serum basal alpha-subunit test result was normal. A TR beta gene R438H mutation was identified, and a pituitary mass with cystic change was identified by sellar MRI. We report a case of THR with a mutation (R438H) in the TR beta gene, the first case of its kind in Korea.
Fatigue ; Genes, erbA ; Goiter ; Hot Temperature ; Korea ; Pituitary Neoplasms ; Receptors, Thyroid Hormone ; Thyroid Gland ; Thyroid Hormone Receptors beta ; Thyroid Hormone Resistance Syndrome ; Weight Loss

OBJECTIVE: This study was performed to compare the clinical outcome of elective single embryo transfer (eSET) performed at the cleavage stage to that of elective double embryo transfer (eDET). METHODS: Of the women less than 36 years old who visited Daegu Maria from January 2008 to April 2009, the only women (n=330) with more than 8 mm of endometrial thickness and at least one good quality embryo, who were treated with GnRH agonist long protocol, were included in this study. After information about complications that can arise by multiple embryo transfer, either eSET or eDET was conducted by their request (167 and 163, respectively). RESULTS: The implantation rate of eSET group was significantly higher than that of eDET group (53.9% vs. 40.2%, p<0.01). The twin pregnancy rate of eSET group was significantly lower than that of eDET group (1.1% vs. 32.3%, p<0.001). However, there were no significant differences between two groups in the clinical pregnancy (53.3% vs. 60.7%, p=0.172), ongoing pregnancy (47.3% vs. 54.6%, p=0.185) and live birth rates (44.9% vs. 50.9%, p=0.275). The number of the surplus embryos which developed to the blastocyst stage and cryopreserved at that stage was significantly higher in eSET group than that of eDET group (3.2+/-2.6 vs. 2.1+/-2.4, p<0.001). CONCLUSION: These results suggest that eSET should reduce significantly the multiple baby pregnancy without decreasing the whole pregnancy rate in women with less than 36 years old.
Blastocyst ; Embryo Transfer ; Embryonic Structures ; Female ; Gonadotropin-Releasing Hormone ; Humans ; Live Birth ; Pregnancy ; Pregnancy Rate ; Pregnancy, Twin ; Single Embryo Transfer

BACKGROUND: The glottis can be exposed by a Glidescope(R) during endotracheal intubation using either the epiglottis or valleculae elevation method. We compared the epiglottis and valleculae elevation methods for endotracheal intubations performed with a Glidescope(R) using differences in success rate, time spent for tracheal intubation and percent of glottic opening. METHODS: Forty medical students without experience using a Glidescope(R) participated in this prospective, randomized study in which they intubated a tracheal tube into a manikin. All participants performed tracheal intubation using the 2 forementioned methods. Twenty students exposed the vocal cord by placing the blade tip in the valleculae (valleculae elevation method; VEM). The other 20 students directly elevated the epiglottis with the blade (epiglottis elevation method; EEM). We separated intubating time into 3 parts: turnaround time to exposing the vocal cord, tube passing time and first ventilating time. RESULTS: The success rate of tracheal intubation using VEM (86.7%, 104/120) was higher than that using EEM (65.8%, 79/120) (p < 0.001). VEM resulted in a lower total intubation time (VEM vs. EEM, 23.5 +/- 5.3 vs. 29.0 +/- 8.7, p = 0.001). The key factor of this difference was the tube passing time (VEM vs. EEM, 7.4 +/- 2.5 vs. 12.8 +/- 7.4, p < 0.001). CONCLUSIONS: Exposing the vocal cord by using VEM during tracheal intubation with a Glidescope(R) can increase the success rate of tracheal intubation and shorten the time of endotracheal intubation in novices.
Epiglottis ; Glottis ; Humans ; Intubation* ; Intubation, Intratracheal ; Laryngoscopes ; Manikins ; Methods* ; Prospective Studies ; Students, Medical ; Vocal Cords

OBJECTIVE: The purposes of this study were to evaluate size-specific dose estimate (SSDE) of low-dose CT (LDCT) in the Korean Lung Cancer Screening (K-LUCAS) project and to determine whether CT protocols from Western countries are appropriate for lung cancer screening in Korea. MATERIALS AND METHODS: For participants (n = 256, four institutions) of K-LUCAS pilot study, volume CT dose index (CTDI(vol)) using a 32-cm diameter reference phantom was compared with SSDE, which was recalculated from CTDI(vol) using size-dependent conversion factor (f-size) based on the body size, as described in the American Association of Physicists in Medicine Report 204. This comparison was subsequently assessed by body mass index (BMI) levels (underweight/normal vs. overweight/obese), and automatic exposure control (AEC) adaptation (yes/no). RESULTS: Size-specific dose estimate was higher than CTDI(vol) (2.22 ± 0.75 mGy vs. 1.67 ± 0.60 mGy, p < 0.001), since the f-size was larger than 1.0 for all participants. The ratio of SSDE to CTDI(vol) was higher in lower BMI groups; 1.26, 1.37, 1.43, and 1.53 in the obese (n = 103), overweight (n = 70), normal (n = 75), and underweight (n = 4), respectively. The ratio of SSDE to CTDI(vol) was greater in standard-sized participants than in large-sized participants independent of AEC adaptation; with AEC, SSDE/CTDI(vol) in large- vs. standard-sized participants: 1.30 ± 0.08 vs. 1.44 ± 0.08 (p < 0.001) and without AEC, 1.32 ± 0.08 vs. 1.42 ± 0.06 (p < 0.001). CONCLUSION: Volume CT dose index based on a reference phantom underestimates radiation exposure of LDCT in standard-sized Korean participants. The optimal radiation dose limit needs to be verified for standard-sized Korean participants.
Body Mass Index ; Body Size ; Cone-Beam Computed Tomography ; Humans ; Korea ; Lung Neoplasms* ; Lung* ; Mass Screening* ; Overweight ; Pilot Projects ; Radiation Dosage ; Radiation Exposure ; Thinness ; Tomography, X-Ray Computed

BACKGROUND: Continuous epidural catheterization is a popular and effective procedure for postoperative analgesia. However, continuous epidural catheterization has associated complications such as venous puncture, dural puncture, subarachnoid cannulation, suboptimal catheter placement, and paresthesia because the tip of the epidural catheter touches thenerves of the dura in the epidural space. In this study, we compared the incidence of paresthesia in two different lengths of epidural catheter insertion. METHODS: One hundred women undergoing gynecologic or orthopedic surgery were enrolled in this prospective, double-blinded, randomized study. All patients were randomly divided into two groups based on the insertion length of the epidural catheter 2 cm (group A) or 4 cm (group B). A Tuohy needle was inserted in the lumbarspinal region with a bevel directed cephalad by use of the median approach, and then the epidural space was confirmed by the loss of resistance technique with air. While the practitioner inserted an epidural catheter into the epidural space, a blind observer checked for paresthesia or withdrawal movement. RESULTS: In 97 included patients, 30.6% of the patients in group A (n = 49) had paresthesia, versus 31.3% in group B (n = 48). Withdrawal movements were represented in 2% and 6% of the patients in group A and group B, respectively. There was no difference in the incidence of paresthesia and withdrawal movement between the two groups. CONCLUSIONS: There is no clear relationship for the incidence of catheter-related paresthesia according to the catheter length inserted into the epidural space for epidural analgesia.
Analgesia ; Analgesia, Epidural ; Catheterization* ; Catheters* ; Epidural Space ; Female ; Humans ; Incidence* ; Needles ; Orthopedics ; Paresthesia* ; Prospective Studies ; Punctures