BACKGROUND: Laryngoscopy and tracheal intubation for general anesthesia are potent stimuli to the cardiovascular system due to sympathetic stimulation. The aim of this study was to compare the hemodynamic responses with different administration routes of lidocaine on blood pressure and heart rate changes associated with tracheal intubation. METHODS: Sixty patients were randomly assigned to spray group (Group 1, n=20) received 10% lidocaine 1.5 mg/kg spray to intratracheally immediately before tracheal intubation, IV group (Group 2, n=20) received 2% lidocaine 1.5 mg/kg intravenously before 90 sec tracheal intubation and control group (Group 3, n=20). Anesthesia was induced with thiopental 5 mg/kg IV, vecuronium 0.1 mg/kg and 50% N2O-O2- 2vol % enflurane. After 5 minutes, tracheal intubation was performed. Mean arterial pressure and heart rate were measured at preintubation and immediately postintubation, 1, 3, 5 mins after tracheal intubation. RESULTS:The differences of mean arterial pressure which were measured at preintubation and immediately postintubation and 1 minute after intubation in group 1 were significantly lower than those in other group (p<0.05). The differences of heart rate which measured at preintubation and 1 minute after intubation were lower than those in group 3 (p<0.05). CONCLUSIONS: For the suppression of sympathetic stimulation following tracheal intubation, 10% lidocaine spray to the laryngotrachea is an effective method to suppress cardiovascular response.
Anesthesia ; Anesthesia, General ; Arterial Pressure ; Blood Pressure ; Cardiovascular System ; Enflurane ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Intubation* ; Laryngoscopy ; Lidocaine* ; Thiopental ; Vecuronium Bromide

PURPOSE: Postoperative wound infection accounts for approximately 15% of all hospital infections. Methicillin-resistant Staphylococcus aureus (MRSA) infections are 14% of the domestic hospital infections and this is increasing in incidence over time. The aim of this study was to retrospectively evaluate the relationship between wound dehescence after urologic surgery and MRSA infection. MATERIALS AND METHODS: Thirty patients (25 males and 5 females) who experienced wound dehescence after urologic surgery were subdivided into two separate groups; the MRSA group and non-MRSA group, and they were retrospectively analyzed via a chart review according to the age of the patients, the associated disease, the hepatic or renal functional status, the admission duration, the use of preoperative antibiotics and the number and duration of inserted catheters. RESULTS: The mean age of the MRSA group and the non-MRSA group was 62.6+/-12.4 years and 59.3+/-19.9 years, respectively (p=0.235). The elapsed operative time in the MRSA group and non-MRSA group was 355.8+/-99.5 minutes and 305.8+/-90.2 minutes, respectively (p=0.021). Contrary to 35.2+/-23.6 days of catheter duration in the MRSA group, that of the non-MRSA group was 14.6+/-8.5 days (p=0.007). The tendency for MRSA infection was observed for an increased duration of drain placement, a decreased hepatic or renal function and the preoperative antibiotic use. The extent of admission was obviously longer for the MRSA group (39.6+/-23.5 days) than for the non-MRSA group (28.9+/-9.9 days) (p=0.013). CONCLUSIONS: Wound dehescence assocated with MRSA infection is intimately related to the elapsed operative time and the period of catheter-insertion, which in turn increases the number of admission days.
Anti-Bacterial Agents ; Catheters ; Cross Infection ; Humans ; Incidence ; Male ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus* ; Operative Time ; Retrospective Studies ; Staphylococcus aureus ; Surgical Wound Infection ; Wound Infection ; Wounds and Injuries*

BACKGROUND: Ventricular remodeling after myocardial infarction increase mortality and morbidity. Two-dimensional echocardiography in acute myocardial infarction provides a useful diagnostic tool for evaluation of ventricular remodeling. The aims of this study were to verify whether follow-up two-dimensional echocardiography could detect ventricular enlargement after acute myocardial infarction and to find early echocardiographic predictors and clinical charateristics of ventricular enlargement. METHODS: Two-dimensional echocardiography was done prospectively at 2 week, 3 month, and 6 month after the first Q-wave acute myocardial infarction in 18 patients. The control group was 11 patients of a normal chest roentgenogram and echocardiogram who were studied for chest pain or arrhythmia. The patients were divided by the mean value of the control group left ventricular end-diastolic volume index(LVEDVI) 56.8ml/m2. The group A was more than 60ml/m2(the control group LVEDVI 56.8ml/m2) and the group B was less than 60ml/m2 of LVEDVI at 2 week post myocardial infarction. The left vantricular volume was measured by the modified disk method at the apical four chamber view. The wall motion abnormality of left ventricle was examined by the recommendation of the American Society of Echcardiography. RESULTS: The left vntricular end-diastolic volume and the left ventricular end-systolic volume were enlarged after 3 month of acute myocardial infarction in the group A compare with those of the control group. There was no ventricular enlargement during 6 month after myocardial infarction in the group B. The frequency of ventricular enlargement was increased in anterior myocardial infarction. There was no difference in left ventricular ejection fraction at 2 week post myocardial infarction between the group A(51.4+/-15.7%) and the group B(50.8+/-10.3%). The wall motion score index more than 1.5 at 2 week post myocardial infarction means the enlarged LVEDVI more than 60ml/m2 and the group of ventricular enlargement. CONCLUSION: The left ventricular enlargement could be diagnosed by the follow-up two-dimensional echocardiography in acute myocardial infarction. The echocardiographic early predictors of ventricular enlagement were the left ventricular end-diastolic volume greater than 60ml/m2 and increased wall motion score index more than 1.5 at 2 week post myocardial infarstion. The anterior myocardial infarction was the electrocardiographic predictor of ventricular dilatation. Therefore these early predictors could identify the patients of ventricular enlargement and these patients could be a candidate of follow-up echocardiography and of a specific treatment for limiting ventricular remodeling.
Arrhythmias, Cardiac ; Chest Pain ; Dilatation ; Echocardiography* ; Electrocardiography ; Follow-Up Studies ; Heart Ventricles ; Humans ; Mortality ; Myocardial Infarction* ; Prospective Studies ; Stroke Volume ; Thorax ; Ventricular Remodeling

PURPOSE: To evaluate the therapeutic efficacy of phacoemulsification in treating phacomorphic glaucoma. METHODS: We observed 25 eyes of 25 patients who had undergone phacoemulsification and intraocular lens implantation for the treatment of phacomorphic glaucoma. Intraocular pressure (IOP), best corrected visual acuity (BCVA), depth of anterior chamber, management and complications between preoperative and postoperative periods were analyzed retrospectively. RESULTS: The mean IOP was 49.0 +/- 10.6 mmHg (range: 31~70 mmHg) before the operation and 13.2 +/- 2.8 mmHg (range: 8~20 mmHg) at 36 months after surgery (Paired T-test, p<0.0001). We could not find any case with increased IOP in our series for more than 3 years. The postoperative IOP decreased significantly the day after surgery (Paired T-test, p<0.0001). Improvement of postoperative visual acuity was remarkable from the first week after operation (Paired T-test, p<0.0001). Postoperatively, the visual acuity was improved except for one eye with preoperative visual acuity of no light perception. Especially, BCVA in 15 cases (60%) was above 20/40. Preoperatively, the anterior chambers were extremely shallow (average: 1.5 +/- 0.3 mm) by the swollen lens, and the average postoperative anterior chamber depth increased significantly by 2.6 +/- 0.1 mm on A-scan. The ratio of lens thickness to axial length factor was 2.5 +/- 0.1, indicating the shallow anterior chamber. Continuous postoperative medical treatment for IOP control was needed in one case, where peripheral anterior synechiae were observed by gonioscopy immediately after surgery. CONCLUSIONS: Phacoemulsification is a very safe and effective procedure for the treatment of phacomorphic glaucoma.
Anterior Chamber ; Glaucoma* ; Gonioscopy ; Humans ; Intraocular Pressure ; Lens Implantation, Intraocular* ; Lenses, Intraocular* ; Phacoemulsification* ; Postoperative Period ; Retrospective Studies ; Visual Acuity

PURPOSE: A cross-calibration equation is needed to compare bone mineral density measured by different dual X-ray absoptiometry systems. We performed this study to establish appropriate cross-calibration equations between two different dual X-ray absorptiometry systems. MATERIALS AND METHODS: Bone mineral density of anterior-posterior lumbar spine (L2-4 level) and femoral neck were measured in 109 women (55+/-11yr) using two different dual X-ray absorptiometry systems (Lunar EXPERT-XL) and Hologic QDR 4500-A). Bone mineral density values measured by two systems, including area, bone mass content, bone mineral density and percentile of young normals were compared and cross-calibration equations between two systems derived. RESULTS: The bone mineral density values of 109 women measured by Lunar system were 0.958+/-0.17 g/cm2 at L2-4 and 0.768+/-0.131 g/cm2 at femur neck, which were significantly higher (13+/-6% at L2-4 and 19+/-7% at femur neck, p<0.001) than those (0.851+/-0.144 g/cm2 at L2-4 and 0.649+/-0.108 g/cm2 at femur neck) by Hologic system. Bone mineral content and percentile of young normals measured by Lunar system were also significantly higher than those by Hologic system (p<0.001), whereas there was no difference in area (p>0.05). There was a high correlation between bone mineral density values of L2-4 and femoral neck obtained with both dual X-ray absortiometry systems (r=0.96 and 0.95, respectively). Cross-calibration equations relating the bone mineral density were Lunar=1.1287xHologic-0.0027 for L2-4 and Lunar=l.1556xHologic+0.0l82 for femoral neck. CONCLUSION:: We obtained cross-calibration equations of bone mineral density between Lunar EXPERT-XL and Hologic QDR 4500-A. These equations can be useful in comparing bone mineral density obtained by different dual X-ray absorptiometry systems.
Absorptiometry, Photon* ; Bone Density* ; Female ; Femur ; Femur Neck ; Humans ; Osteoporosis ; Spine

This study proposed a mechanical model of the excimer laser photorefractive keratectomy(PRK) for myopia patients utilizing finite element method, which is a simulation technique widely used in engineering fields. The outcomes of the surgery depends on many factors, which are also dependent on each other. In this study, some mechanical factors are selected and the effects of the selected factors on the surgical results were analyzed. One of the important factors in the finite element analysis is the mechanical properties of the object. The representative characteristic of the human cornea is that it shows highly nonlinear property in the stress-strain relationship like most soft tissues in the human body. Therefore, the nonliear property was adopted in this study. Other important mechanical properties which affect the outcomes of the surgery are: a preoperative thickness, intraocular pressure, diameter of ablation zone and the depth of ablation. With various changes of the those mechanical factors, the outcomes of the surgery were predicted using the finite element method. The results show the qualitative agreement with clinical outcomes also promising agreement quantitatively. Therefore, this study shows a potential of the finite element method in clinical application of excimer laser PRK.
Cornea ; Finite Element Analysis ; Human Body ; Humans ; Intraocular Pressure ; Lasers, Excimer* ; Myopia ; Photorefractive Keratectomy*

Primary malignant melanoma occurring within the male urethra is very rare. Here we report a case of malignant melanoma of the urethra in a 74-year-old man. He presented with asymptomatic gross hematuria for 5 months. His glans penis and adjacent penile skin had become discolored black 10 years ago. Cystourethroscopy showed a smooth oval-shaped elevated mass in the fossa navicularis. There were no abnormal findings in the proximal urethra and urinary bladder. Computed tomography did not detect any inguinal lymph node enlargement or distant metastases. The patient underwent partial penectomy and ilioinguinal lymph node dissection. Grossly, the distal urethra revealed an ovoid pigmented nodule, that measured 1 x 0.5 cm. Microscopic findings showed a nodular malignant melanoma arising in the urethral mucosa with pagetoid spread to the epidermis of the glans penis. There were no recurrences over a period of 12 months after surgery without chemotherapy. This is the second case of a primary malignant melanoma of the male urethra in Korea.
Aged ; Epidermis ; Hematuria ; Humans ; Korea ; Lymph Node Excision ; Lymph Nodes ; Male ; Melanoma ; Mucous Membrane ; Neoplasm Metastasis ; Penis ; Recurrence ; Skin ; Urethra ; Urinary Bladder

Salicylate, the active ingredient of aspirin can cause sensorineural hearing loss and tinnitus when plasma concentrations reach a critical level. The ototoxic mechanisms of salicylate remain unclear but hearing and tinnitus usually recovers a few days after intoxication. There have been few reports of salicylate-induced ototoxicity in Korea, and the majority is caused by a low dose of aspirin. Herein, we report a case of sudden hearing loss and tinnitus after acute salicylate intoxication and review recent updates on salicylate ototoxicity.
Aspirin ; Hearing ; Hearing Loss ; Hearing Loss, Sensorineural ; Hearing Loss, Sudden ; Korea ; Plasma ; Sodium Salicylate ; Tinnitus

Objective The aim of this study was to evaluate the clinicopathologic findings of eight patients with primary cancer of fallopian tube diagnosed and treated in the department of Obstetrics and Gynecology, University of Ulsan, Asan Medical Center for nine years. Methods Demographic characteristics, symptoms, signs, stage, tumor grade, mode of therapy and survival of patients were reviewed retrospectively. Results The patients with primary cancer of fallopian tube constituted 0.4% of all gynecologic malignancies encountered during this period. The age of patients ranged 42 to 70 years(mean+/- S.D.; 53.9+/-9.9) and half of patients were postmenopausal and two patients were nulliparous. Patients were treated by simple or radical hysterectomy and bilateral salpingoophorectomy with or without omentectomy and five patients received postoperative chemotherapy. The FIGO surgical stages of the patients were I(4 cases), II(2 cases), III(1 case) and IV(1 case). There were 3 cases of adenocarcinoma, 3 cases of malignant mixed Mullerian tumor, 1 case of undifferentiated carcinoma and 1 case of serous cystic tumor of low malignancy potential. Serum CA 125 values were followed during treatment and decreased during clinical remission and increased at the time of tumor progression. The mean follow-up duration was 24.3(+28.3) months and 7 patients were alive free of disease and one patients with stage Ic died of the disease. Conclusion Primary fallopian tube cancer is an extremely rare malignancy of the female genitalia and preoperative diagnosis of this disease is difficult. Cytoreductive surgery and postoperative combination chemotherapy seem to be effective treatment and CA 125 value could reflect the disease status during the treatment and follow-up of patients.
Adenocarcinoma ; Carcinoma ; Chungcheongnam-do ; Diagnosis ; Drug Therapy ; Drug Therapy, Combination ; Fallopian Tube Neoplasms ; Fallopian Tubes* ; Female ; Follow-Up Studies ; Genitalia, Female ; Gynecology ; Humans ; Hysterectomy ; Obstetrics ; Retrospective Studies ; Ulsan

Salivary duct carcinoma is an uncommon aggressive malignant epithelial neoplasm with similarity to intraductal carcinoma of the breast. This neoplasm occurs most often in the parotid gland of middle-aged and older males. About 7% of reported tumors occured in the submandibular gland. The report of salivary duct carcinoma with calcification is rare. We report a case of salivary duct carcinoma with calcification in the submandibular gland. The patient was a 73-year-old male with a mass of the right submandibular gland for 1 year. On the fine needle aspiration cytology, the aspirate showed scant cellularity, small clusters of tumor cells, and scattered small calcifications. Nuclei of the tumor cells showed mild pleomorphism and round to oval in shape, and cytoplasm was abundant and finely granular. Nucleoli were indistinct and necrosis was not noted. There were no cribriform or papillary arrangements of tumor cells. Cytologic findings of salivary duct carcinoma are variable depending on histologic findings, and calcifications could be an additional cytologic finding.
Aged ; Biopsy, Fine-Needle* ; Breast ; Carcinoma ; Carcinoma, Intraductal, Noninfiltrating ; Cytoplasm ; Humans ; Male ; Necrosis ; Parotid Gland ; Salivary Ducts* ; Salivary Glands ; Submandibular Gland*