This study was undertaken to estimate the effects of the induction agents on the bioparameters such as changes in blood pressure, pulse rate, Apgar score, patients movement, fetal arterial and venous blood gas analysis, memory and emergence reactions. 116 parturients undergoing cesarian section were divided into two groups: ketamine group and thiopental group, and were given 1.2 mg/kg ketamine in ketamine group and 4 mg/kg thiopental sodium in thiopental group as an induction agent respectively. The results were as follows; I) Blood pressure increased in both groups, but ketamine group less increased than thiopental group statistically. Pulse rate did not increased in skin incision in ketamine group statistically. 2) The patient's movement were 5 case(9%) in ketamine group and 17 cases(29%) in thiopental group. 3) There was not significant difference in fetal arterial and venous blood gas analysis. 4) In Apgar score, ketamine group is better than thiopental group. 5) There was no psychologic side reactions in both groups. 6) Postoperative recalling of intraoperative awareness occured in seven patients(12%) only in the thiopental group.
Apgar Score ; Blood Gas Analysis ; Blood Pressure ; Cesarean Section ; Female ; Heart Rate ; Humans ; Intraoperative Awareness ; Ketamine* ; Memory ; Pregnancy ; Skin ; Thiopental*

This report is concerned with our clinical experience of 150 cases of anesthesia for open heart surgery at department of anesthesiology, In chon Gil hospital from Februry, 1990 to April, 1993. The results were as follows ; 1) Among 150 cases, 68 cases (45.3%) were congenital heart disease and 82 cases (54.7%) were acquired heart disease. 62 cases (41.3%) were males and 88 cases (58.7%) were females. 2) Glycopyrrolate, diazepam, morphine, were used as premedicants. 3) Fentanyl, ketamine, diazepam, thiopental sodium were used as induction agents and injected singly or in combination. 4) In congenital cyanotic heart diseases, ketamine was used as main anesthetic agent. In other heart diseases, fentanyl, isoflurane, diazepam were used. 5) Vecuronium was used for intubation and maintenance of muscle relaxation. 6) Overall mortality rate was 3.3% (5 cases) and the causes of death were low cardiac output, respiratory insufficiency, mediastinal infection.
Anesthesia ; Anesthesiology ; Cardiac Output, Low ; Cause of Death ; Diazepam ; Female ; Fentanyl ; Glycopyrrolate ; Heart Defects, Congenital ; Heart Diseases ; Heart* ; Humans ; Incheon ; Intubation ; Isoflurane ; Ketamine ; Male ; Morphine ; Mortality ; Muscle Relaxation ; Respiratory Insufficiency ; Thiopental ; Thoracic Surgery* ; Vecuronium Bromide

The diagnosis of acute inflammation of the placenta, represented as acute chorioamnionitis, is important in that it is associated with a poor clinical outcome for both the mother and the fetus, including major perinatal morbidities such as sepsis, respiratory distress syndrome, and CNS damage. However, current medical trends in Korea seem to overlook the significance of a histopathological diagnosis of acute placental inflammation, mainly due to the indifferences of clinicians and pathologists. Since late 1993, histopathological examinations have been performed on preterm placentas at Seoul National University. These examinations have demonstrated acute placental inflammation in a significant number of cases. In the present study the incidence of acute placental inflammation was analyzed in 521 placentas which were submitted for pathological examinations in 1995. Examinations were performed to provide basic information on the incidence and profile of acute placental inflammation in this hospital and, thereby, to emphasize the significance of histopathological examinations of the placenta in the routine surgical pathology service. Among the 521 placentas, acute inflammation was found in 194 cases (37.2%). In preterm placentas acute inflammation was found in 39.6% of the cases (67/169), while 36.1% (127/352) of term placentas showed acute inflammation. Taking the delivery mode into account, 26.3% (49/186) of the placentas delivered by cesarean section showed acute inflammation, while 43.3% (145/335) of the transvaginally delivered placentas showed inflammation. The present analysis demonstrates the existence of acute inflammation in a significant proportion of placentas with different clinical settings. The importance of a histopathological examination in routine hospital practice should be emphasized.
Incidence

Mitochondrial neurogastrointestinal encephalomyopahty (MNGIE) is a rare disorder and is clinically characterized by ophthalmoparesis, peripheral neuropathy, leukoencephalopathy, gastrointestinal symptoms with intestinal dysmotility, and histologically abnormal mitochondria in muscle. A 32-year-old female showed external ophthalmoparesis, bilateral ptosis, quadriparesis, and sensory change below both ankle joints. Level of serum lactic acid was highly increased. The brain MRI showed diffusely increased signal intensity in the centrum semiovale and white matter. Electron microscopic finding showed paracrystalline inclusions in mitochondria of a few muscle fibers. (J Korean Neurol Assoc 19(3):309~312, 2001)
Adult ; Ankle Joint ; Brain ; Female ; Humans ; Lactic Acid ; Leukoencephalopathies ; Magnetic Resonance Imaging ; Mitochondria ; Mitochondrial Encephalomyopathies ; Ophthalmoplegia ; Peripheral Nervous System Diseases ; Quadriplegia

Infection following insertion of a breast implant is relatively uncommon, with an overall incidence of less than 4 percent, but can be devastating. Although its management options may be antibiotic therapy along with active surgical regimen like drainage, mechanical irrigation, debridement and implant removal, the efficacy of aforementioned therapeutic regimen is unclear in some cases, thus can be challenging. In particular cases of being chronic and refractory to therapy, spreading of infection which was originally localized in the periprosthetic space-over adjacent tissues by an aggressive curettage at the early stage appears to play a major role. Months elapse before a complete resolution of the infection, and it can also cause serious physical and mental issues in patients. Based on clinical and operative findings in four cases of a chronic, refractory and recurrent periprosthetic infection following an aggressive initial debridement and curettage, we suggest that surgeon should be watchful against debridement and curettage at the early stage of infection and pay special attention to make an accurate and limited curettage using endoscopy.
Breast Implants ; Curettage ; Debridement ; Drainage ; Endoscopy ; Female ; Humans ; Incidence ; Mammaplasty*

ATP-sensitive potassium channels (KATP channels) play an important role in insulin secretion from pancreatic beta cells. We have investigated the effect of propofol on KATP channels in cultured single pancreatic beta cells of rats. Channel activity was recorded from membrane patches using the patch-clamp technique. In the inside-out configuration bath-applied propofol inhibited the KATP channel activities in a dose-dependent manner. The half-maximal inhibition dose (ED50) was 48.6+/-8.4 micrometer and the Hill coefficient was 0.73 0.11. Single channel conductance calculated from the slope of the relationship between single channel current and pipette potential (+20~+100 mV) was not significantly altered by propofol (control: 60.0+/-2.7 pS, 0.1 mM propofol: 58.7+/-3.5 pS). However, mean closed time was surely increased. Above results indicate that propofol blocks the KATP channels in the pancreatic beta cells in the range of its blood concentrations during anesthesia, suggesting a possible effect on insulin secretion and blood glucose level.
Anesthesia ; Animals ; Blood Glucose ; Insulin ; Insulin-Secreting Cells ; KATP Channels* ; Membranes ; Patch-Clamp Techniques ; Propofol* ; Rats*

Purpose: Li-Fraumeni syndrome (LFS) is a rare autosomal cancer syndrome caused by a germline mutation in the TP53 gene. Breast cancer in LFS patients is of various subtypes;however, limited data are available on the clinicopathological features of these subtypes and their appropriate treatments. This study aimed to review the clinical features and treatments for breast cancer in South Korean patients with germline TP53 mutations. Methods: Data on the clinicopathological features and treatment of all breast cancer patients with LFS were collected retrospectively from the available database of 4 tertiary hospitals in the Republic of Korea. Results: Twenty-one breast cancer cases in 12 unrelated women with confirmed germline TP53 mutations were included in the study. The median age at diagnosis was 33.5 years. The histopathological diagnosis included invasive ductal carcinoma (n = 16), ductal carcinoma in situ (n = 3), and malignant phyllodes tumor (n = 2). While 42% and 31% of the cases were positive for estrogen and progesterone receptors, respectively, 52.6% were human epidermal growth factor receptor 2 (HER2) positive, and 21% were triple-negative. The treatments included mastectomy (52%) and breast-conserving surgery (38%). Five patients underwent radiotherapy (RT). The median follow-up period was 87.5 (8–222) months. There were 3 ipsilateral and 4 contralateral breast recurrences during the follow-up, and 8 patients developed new primary cancers. In the post-RT subgroup, there were 2 ipsilateral and 2 contralateral breast recurrences in 1 patient, and 4 patients had a new primary cancer. Conclusion As reported in other countries, breast cancer in LFS patients in South Korea had an early onset and were predominantly but not exclusively positive for HER2.A multidisciplinary approach with adherence to the treatment guidelines, considering mastectomy, and avoiding RT is encouraged to prevent RT-associated sequelae in LFS patients.

Purpose: Li-Fraumeni syndrome (LFS) is a rare autosomal cancer syndrome caused by a germline mutation in the TP53 gene. Breast cancer in LFS patients is of various subtypes;however, limited data are available on the clinicopathological features of these subtypes and their appropriate treatments. This study aimed to review the clinical features and treatments for breast cancer in South Korean patients with germline TP53 mutations. Methods: Data on the clinicopathological features and treatment of all breast cancer patients with LFS were collected retrospectively from the available database of 4 tertiary hospitals in the Republic of Korea. Results: Twenty-one breast cancer cases in 12 unrelated women with confirmed germline TP53 mutations were included in the study. The median age at diagnosis was 33.5 years. The histopathological diagnosis included invasive ductal carcinoma (n = 16), ductal carcinoma in situ (n = 3), and malignant phyllodes tumor (n = 2). While 42% and 31% of the cases were positive for estrogen and progesterone receptors, respectively, 52.6% were human epidermal growth factor receptor 2 (HER2) positive, and 21% were triple-negative. The treatments included mastectomy (52%) and breast-conserving surgery (38%). Five patients underwent radiotherapy (RT). The median follow-up period was 87.5 (8–222) months. There were 3 ipsilateral and 4 contralateral breast recurrences during the follow-up, and 8 patients developed new primary cancers. In the post-RT subgroup, there were 2 ipsilateral and 2 contralateral breast recurrences in 1 patient, and 4 patients had a new primary cancer. Conclusion As reported in other countries, breast cancer in LFS patients in South Korea had an early onset and were predominantly but not exclusively positive for HER2.A multidisciplinary approach with adherence to the treatment guidelines, considering mastectomy, and avoiding RT is encouraged to prevent RT-associated sequelae in LFS patients.

This study aimed to evaluate the imaging and pathological findings in axillary lymph nodes in patients with breast cancer who received concurrent ipsilateral coronavirus disease 2019 (COVID-19) vaccination. Of the 19 women with breast cancer who received concurrent COVID-19 vaccination shot in the arm ipsilateral to breast cancer, axillary lymphadenopathy was observed in 84.2% (16 of 19) of patients on ultrasound (US) and 71.4% (10 of 14) of patients on magnetic resonance imaging (MRI), and 21.0% (4 of 19) of patients were diagnosed with metastasis. Abnormal US and MRI findings of cortical thickening, effacement of the fatty hilum, round shape, and asymmetry in the number or size relative to the contralateral side were noted in more than half of the non-metastatic and metastatic lymph nodes; however, statistical significance was not noted. Axillary lymphadenopathy is commonly observed in patients with breast cancer who receive concurrent ipsilateral COVID-19 vaccination without specific differential imaging features. Thus, understanding the limitations of axillary imaging and cautious interpretation is necessary to avoid overestimation or underestimation of the axillary disease burden.

Purpose: Advances in chemotherapeutic and targeted agents have increased pathologic complete response (pCR) rates after neoadjuvant systemic therapy (NST). Vacuum-assisted biopsy (VAB) has been suggested to accurately evaluate pCR. This study aims to confirm the non-inferiority of the 5-year disease-free survival of patients who omitted breast surgery when predicted to have a pCR based on breast magnetic resonance imaging (MRI) and VAB after NST, compared with patients with a pCR who had undergone breast surgery in previous studies. Methods The Omission of breast surgery for PredicTed pCR patients wIth MRI and vacuumassisted bIopsy in breaST cancer after neoadjuvant systemic therapy (OPTIMIST) trial is a prospective, multicenter, single-arm, non-inferiority study enrolling in 17 tertiary care hospitals in the Republic of Korea. Eligible patients must have a clip marker placed in the tumor and meet the MRI criteria suggesting complete clinical response (post-NST MRI size ≤ 1 cm and lesion-to-background signal enhancement ratio ≤ 1.6) after NST. Patients will undergo VAB, and breast surgery will be omitted for those with no residual tumor. Axillary surgery can also be omitted if the patient was clinically node-negative before and after NST and met the stringent criteria of MRI size ≤ 0.5 cm. Survival and efficacy outcomes are evaluated over five years.Discussion: This study seeks to establish evidence for the safe omission of breast surgery in exceptional responders to NST while minimizing patient burden. The trial will address concerns about potential undertreatment due to false-negative results and recurrence as well as improved patient-reported quality of life issues from the omission of surgery. Successful completion of this trial may reshape clinical practice for certain breast cancer subtypes and lead to a safe and less invasive approach for selected patients.