PURPOSE: The purpose of this study was to investigate differences between a pulmonary aspiration group and a non-pulmonary aspiration group in glucose concentration of tracheal secretions by measuring time and feeding methods. METHOD: The subjects were 36 ICU patients who were receiving formula via nasogastric tubes and had endotracheal tubes or tracheostomy tubes. Tracheal secretions were collected by connecting suction traps to a suction catheter in three different times(within 1 hour after feeding, between 1 to 2 hours after feeding, and between 2 to 3 hours after feeding) for 2 days, overall six times. Glucose concentration of tracheal secretions was measured with the glucometer(Accucheck II). RESULTS: Glucose concentration of tracheal secretions increased in progression after feeding. The mean of specimens collected last(between two to three hours after feeding) was shown to be the highest value(M= 61.61 mg/dl) in the pulmonary aspiration group. Significantly(p=.000) more subjects(94.44%) in the pulmonary aspiration group received formula via a 50cc syringe than those in the non-pulmonary aspiration group(22.22%). CONCLUSION: Critically ill patients may need more time for head-elevation after tube feeding to prevent pulmonary aspiration. In practice, enteral formula should not be given the patients via a 50cc syringe anymore, instead a feeding bag or infusion pump should be used to prevent pulmonary aspiration.
Catheters ; Critical Illness ; Enteral Nutrition ; Feeding Methods* ; Glucose* ; Humans ; Infusion Pumps ; Suction ; Syringes ; Tracheostomy ; Surveys and Questionnaires

PURPOSE: The purpose of this study was to investigate differences between a pulmonary aspiration group and a non-pulmonary aspiration group in glucose concentration of tracheal secretions by measuring time and feeding methods. METHOD: The subjects were 36 ICU patients who were receiving formula via nasogastric tubes and had endotracheal tubes or tracheostomy tubes. Tracheal secretions were collected by connecting suction traps to a suction catheter in three different times(within 1 hour after feeding, between 1 to 2 hours after feeding, and between 2 to 3 hours after feeding) for 2 days, overall six times. Glucose concentration of tracheal secretions was measured with the glucometer(Accucheck II). RESULTS: Glucose concentration of tracheal secretions increased in progression after feeding. The mean of specimens collected last(between two to three hours after feeding) was shown to be the highest value(M= 61.61 mg/dl) in the pulmonary aspiration group. Significantly(p=.000) more subjects(94.44%) in the pulmonary aspiration group received formula via a 50cc syringe than those in the non-pulmonary aspiration group(22.22%). CONCLUSION: Critically ill patients may need more time for head-elevation after tube feeding to prevent pulmonary aspiration. In practice, enteral formula should not be given the patients via a 50cc syringe anymore, instead a feeding bag or infusion pump should be used to prevent pulmonary aspiration.
Catheters ; Critical Illness ; Enteral Nutrition ; Feeding Methods* ; Glucose* ; Humans ; Infusion Pumps ; Suction ; Syringes ; Tracheostomy ; Surveys and Questionnaires

Joubert syndrome and Joubert syndrome-related disorders (JSRDs) are rare autosomal recessive or X-linked disorders characterized by cerebellar vermis hypoplasia and a brain stem malformation, which presents as the “molar tooth sign” in magnetic resonance imaging (MRI). JSRDs are a group of clinically heterogeneous conditions that exhibit neurological manifestations and multiple organ involvement. JSRDs are also genetically heterogeneous, and approximately 20 causative genes that account for 45% of JSRDs have been identified. A 7-yr-old boy visited Wonkwang University Sanbon Hospital with the following presentations: no ocular fixation, ataxia, growth retardation, and hypotonia. Physical examination revealed facial dysmorphism, spindle shaped fingers, and height (99 cm) and weight (13 kg) below the third percentile. Ophthalmic examination revealed retinal dystrophy. A diagnosis of JSRDs was made based on clinical and brain MRI findings. We found two heterozygous variants c.2945 G>T; p.Arg982Met (G>T) and c.2216dupA; p.Phe740Valfs*2 (dupA) in AHI1, and a heterozygous c.3973C>T; p.Arg1325Trp (C>T) variant in KIF7 by whole exome sequencing (WES). Genetic analysis on the proband's father revealed that he had both AHI1 variants, but did not have the KIF7 variant, which was inconsistent with autosomal recessive inheritance. Therefore, the G>T variant and C>T variant were presumed to be of “uncertain significance.” Furthermore, one novel dupA variant was interpreted as “pathogenic,” while the second allele was not detected. Caution should be exercised while interpreting the significance of variants detected by WES. In addition, the involvement of genes other than the 20 known ones will require further investigation to elucidate the pathogenesis of JSRDs.
Alleles ; Ataxia ; Brain ; Brain Stem ; Cerebellar Vermis ; Child* ; Diagnosis ; Exome* ; Fathers ; Fingers ; Fixation, Ocular ; Humans ; Magnetic Resonance Imaging ; Male ; Muscle Hypotonia ; Neurologic Manifestations ; Physical Examination ; Retinal Dystrophies ; Tooth ; Wills

Varying types of polyps could occur in the vermiform appendix. However, it is very unusual. Collins found 57 cases (0.08%) of benign mucosal polyps in the 71,000 cases of appendectomy specimens. There has been no reported case of appendiceal polyp in the literature in Korea. The authors experienced two cases of polyp in the vermiform appendix. The first case was a 51 year-old male patient who received a left hemicolectomy due to colonic polyposis. The second case was a 71 year-old male patient who was treated by appendectomy under the clinical diagnosis of acute appendicitis. The microscopic type of both cases were hyperplastic polyp.
Male ; Humans

PURPOSE: The purpose of this study was to explore the level of professional self-concept, self-efficacy and job satisfaction among nurses who work at hemodialysis units. METHODS: With convenience sampling, 128 nurses working at hemodialysis settings in Chungcheong Province were participated in this study. Data were analyzed using SPSS/WIN 14.0 with descriptive statistics, t-test, ANOVA, and Pearson correlation coefficient. RESULTS: The mean scores were 2.68 for professional self-concept, 3.65 for self efficacy and 3.14 for job satisfaction. There were significant differences in professional self-concept according to age, religion, position and clinical experience. There was statistically significant difference in self-efficacy according to age. Also, there was statistically significant difference in job satisfaction according to age, marital status, hospital type, position, clinical experience, and the number of patients per nurse. Job satisfaction was positively correlated with professional self-concept and self-efficacy. CONCLUSION: These findings provided that interventions to enhance professional self-concept as well as the strategies to improve self-efficacy are very important.
Humans ; Job Satisfaction ; Marital Status ; Renal Dialysis ; Self Efficacy

Anthracofibrosis is luminal narrowing with a black anthracotic pigmentation on the bronchial mucosa. Extrapulmonary anthracofibrosis is very rare in head and neck region, and anthracofibrosis associated with adhesion to adjacent tissue can be misdiagnosed to malignancy. We report a rare case of a paraesophageal anthracofibrosis in a patient with advanced papillary thyroid cancer. The paraesophageal anthracofibrosis presented as a black colored hard mass with severe adhesion to the recurrent laryngeal nerve (RLN) during thyroid surgery, suspecting metastatic lymphadenopathy. With intraoperative frozen biopsy, unnecessary aggressive surgery with the injury of RLN can be avoided. Permanent histopathological examination of the mass revealed anthracofibrosis with strong positivity on Masson’s trichrome staining. This case highlights that anthracofibrosis should be included in differential diagnosis of paraesophageal masses, and frozen sectional biopsy can help in decision making during surgery. In addition, collagen might be involved in the adhesion of the anthracotic mass to the surrounding tissues.

BACKGROUND: Opioids are the most widely used drugs to minimize the increase of blood pressure and heart rate in endotracheal intubation during the induction of anesthesia. The purpose of this study was to compare the effects of fentanyl, alfentanil, and remifentanil on the cardiovascular response to laryngoscopic endotracheal intubation. METHODS: Eighty ASA I-II patients were randomly allocated to four groups. The patients received 10 ml intravenous saline (control group), 3microgram/kg fentanyl (fentanyl group), 10microgram/kg alfentanil (alfentanil group) or 0.5microgram/kg remifentanil followed by an infusion of 0.1microgram/kg/min remifentanil (remifentanil group). Anesthesia was induced with propofol and rocuronium and maintained with 2 vol% sevoflurane and 50% nitrous oxide in oxygen. The noninvasive blood pressure and heart rate were recorded before induction (baseline), after induction, before intubation, and at 1 min intervals until 5 min after endotracheal intubation. RESULTS: Arterial pressure and heart rate after endotracheal intubation were lower in the fentanyl, alfentanil, and remifentanil groups than in the control group (P < 0.05). There were no significant differences for arterial pressure or heart rate in the fentanyl, alfentanil, and remifentanil groups at any time. There were no significant differences for the incidence of hypotension and bradycardia among the four groups. CONCLUSIONS: Administration of 3microgram/kg fentanyl, 10microgram/kg alfentanil and 0.5microgram/kg remifentanil followed by an infusion of 0.1microgram/kg /min remifentanil have a similar effect in the suppression of the cardiovascular response to laryngoscopic endotracheal intubation during the induction of general anesthesia.
Alfentanil ; Analgesics, Opioid ; Androstanols ; Anesthesia ; Anesthesia, General ; Arterial Pressure ; Blood Pressure ; Bradycardia ; Fentanyl ; Heart Rate ; Humans ; Hypotension ; Incidence ; Intubation ; Intubation, Intratracheal ; Methyl Ethers ; Nitrous Oxide ; Oxygen ; Piperidines ; Propofol

BACKGROUND: Thoracotomy is considered one of the most painful surgical procedures. Thus optimal pain control is essential in the postoperative care of thoracotomy patients. In this randomized double-blinded study, we sought to determine an optimal dose-combination of sufentanil and ropivacaine 0.2% for postoperative epidural analgesia. METHODS: Forty-five of fifty-two patients that underwent thoracotomy were assigned to three groups to receive continuous high thoracic epidural analgesia with ropivacaine 0.2% + sufentanil 0.5microgram/ml (group I), ropivacaine 0.2% + sufentanil 0.75microgram/ml (group II), or ropivacaine 0.2% + sufentanil 1.0microgram/ml (group III). Upon completion of surgery, a thoracic epidural catheter was inserted at the T1-3 level, and moved downward by 5-7 cm. Epidural continuous infusion was administered at 5 ml/hr. Resting VAS (visual analogue scale), dynamic VAS, forced vital capacity, and side effects were recorded at three times: immediate after extubation; 12 hours after arrival at the ICU; and 24 hours after arrival at the ICU. RESULTS: Resting VAS was significantly lower in group III immediately after extubation (P < 0.05) and dynamic VAS was significantly lower in group III immediately after extubation, and 12 hours after arriving at the ICU (P < 0.05) than in the other two groups. The differences in ketorolac dosing number, sedation scores, respiratory depression, pruritus, nausea/vomiting, and motor block were not significant between the three groups. CONCLUSIONS: We conclude that the combination of ropivacaine 0.2% and sufentanil 1.0microgram/ml provides effective analgesia for post-thoracotomy pain with fewer side effects than the other two combinations tested.
Analgesia ; Analgesia, Epidural ; Catheters ; Humans ; Ketorolac ; Postoperative Care ; Pruritus ; Respiratory Insufficiency ; Sufentanil ; Thoracotomy* ; Vital Capacity

BACKGROUND: Melanogenesis is one of the characteristic parameters of differentiation in melanocytes and melanoma cells. Specific inhibitors of phosphatidylinositol 3-kinase (PI3K), such as wortmannin and LY294002, stimulate melanin production in mouse and in human melanoma cells, suggesting that PI3K and mammalian target of rapamycin (mTOR) might be involved in the regulation of melanogenesis. OBJECTIVE: The involvement of the mTOR pathway in regulating melanogenesis was examined using human MNT-1 melanoma cells, and the effects of the potent inhibitor of mTOR, rapamycin, in the presence or absence of alpha-melanocyte-stimulating hormone (alpha-MSH) were evaluated. METHODS: In cells treated with rapamycin, cell viability, melanin content, and tyrosinase (TYR) activity were measured and compared with untreated controls. Protein levels of TYR, tyrosinase-related protein (TYRP)-1, TYRP-2, and microphthalmia-associated transcription factor (MITF) were also analyzed by Western blot. RESULTS: In rapamycin-treated cells, the melanin content increased concomitantly with an elevation in TYR activity, which plays a major role in melanogenesis. There was also an up-regulation of TYR, TYRP-1, and MITF proteins. Combined treatment with rapamycin or wortmannin and alpha-MSH increased melanogenesis more strongly than alpha-MSH alone. CONCLUSION: Rapamycin-induced melanin formation may be mediated through the up-regulation of TYR protein and activity. Furthermore, rapamycin and wortmannin, inhibitors of mTOR and PI3K, respectively, have co-stimulatory effects with alpha-MSH in enhancing melanogenesis in melanocyte cells.
alpha-MSH ; Androstadienes ; Animals ; Cell Survival ; Chromones ; Humans ; Melanins ; Melanocytes ; Melanoma ; Mice ; Microphthalmia-Associated Transcription Factor ; Monophenol Monooxygenase ; Morpholines ; Phosphatidylinositol 3-Kinase ; Sirolimus ; Up-Regulation

BACKGROUND: Non-small cell lung cancer is one of the most frequent cause of death due to cancer in men, and its incidence among women is rapidly increasing. Although there has been a recent surge of interest in combined modality therapy for stage III non-small cell lung cancer(NSCLC), the optimal treatment is still not well established. Thoracic irradiation has long been the gold standard for locally advanced unresectable NSCLC. However, although conventional radiotherapy(XRT) can palliate symptom and improve local control of disease, it huts at most only a modest effect on survival. Recently, cisplatin(cia-diamminedichloroplatinum ) has been reported to enhance the cell-killing effect of radiation For patients with unresectable NSCLC, cisplatin-based concurrent chemoradiotherapy(CCRT) had the advantage of therapeutic response over XRT alone and therapeutic side effect more commonly occurred in CCRT group in EORTC(European Organization for Research and Treatment of Cancer) and other trials. Objectives : We compared therapeutic response, compliance, and side effects between CCRT and XRT in patients with advanced NSCLC. Patients and METHOD: Thirty patients with biopsy-proven inoperable NSCLC were randomized to one of two treatment arms. Arm A consisted of XRT, radiotherapy for 4~6 weeks(1.8 Gy given 20~33 times, in five fractions a week), and arm B consisted of CCRT, radiotherapy for 2 weeks(3 Gy given 10 times, in five fractions a week), followed by 3 week rest period and then radiotherapy 2 more weeks(2.5 Gy given 10 timed in five fractions a week), combined with 6mg cisplatin per square meter, given daily before radiotherapy. We evaluate therapeutic response, compliance, change of performance status, side effects, and radiation pneumonitis by using the author's made scoring system. RESULTS: There was no significant difference in therapeutic response and compliance. But there was a significantly lower laboratory complication and radiation pneumonitis in CCRT group (p<0.05). There's significant negative correlation between stage and therapeutic response score in both groups(R=0.353, p<0.05). In both groups, patients with squamous cell carcinoma had a tendency to higher therapeutic response score than those with adenocarcinoma. CONCLUSION: There was. no difference between CCRT and XRT in respect to therapeutic response and compliance. But CCRT had a advantage of decreased side effects.
Adenocarcinoma ; Arm ; Carcinoma, Non-Small-Cell Lung ; Carcinoma, Squamous Cell ; Cause of Death ; Chemoradiotherapy* ; Cisplatin ; Combined Modality Therapy ; Compliance ; Female ; Humans ; Incidence ; Lung Neoplasms* ; Lung* ; Male ; Radiation Pneumonitis ; Radiotherapy*