BACKGROUND: Diffusion of nitrous oxide into the cuff of the endotracheal tube (ETT) results in an increase in cuff pressure. This method was used to test whether tracheal morbidity is related to fill the cuff of the endotracheal tube with alkalinized lidocaine instead of air or lidocaine only. METHODS: Adult patients scheduled for total thyroidectomy surgery were randomly enrolled (n = 30 for each group).The ETT cuff was filled with air 6 ml (Group C), with 2% lidocaine 6 ml (Group L), or with alkalinized lidocaine (4 ml or 2 ml of 2% lidocaine) using 2 ml (Group A) or 4 ml (Group B) of 8.4% NaHCO3.After tracheal extubation, sore throat was evaluated by visual analog scale as the main end-point of the study. RESULTS: Compared with group air or lidocaine only, the alkalinized-lidocaine groups had a significant reduction in sore throat during the 24-h postoperative period (P < 0.001).The difference was not significant between the two alkalinized lidocaine groups. Cough before tracheal extubation, nausea, postoperative vomiting, dysphonia, and hoarseness after extubation were decreased in the alkalinized-lidocaine groups compared with Group C and L, and a better tolerance was recorded with alkalinized-lidocaine groups compared with Group C and L. CONCLUSIONS: We concluded that use of intracuff alkalinized lidocaine is an effective adjunct to endotracheal intubation instead of air or lidocaine only during nitrous oxide anesthesia, however there were no differences between two alkalinizations.
Adult ; Airway Extubation ; Anesthesia ; Cough ; Diffusion ; Dysphonia ; Hoarseness ; Humans ; Intubation, Intratracheal ; Lidocaine ; Nitrous Oxide ; Pharyngitis ; Postoperative Nausea and Vomiting ; Postoperative Period ; Sodium Bicarbonate ; Thyroidectomy ; Vomiting

Though anticoagulant therapy has been shown to improve outcomes dramatically, pulmonary embolism is a potentially fatal disease. A 82 years old female underwent elective operation for left femur neck fracture under general anesthesia. At the twenty-two postoperative days, she suddenly developed cyanosis with hypotension. She was transferred to intensive care unit and pulmonary embolism was diagnosed by pulmonary perfusion scan and echocardiography. Despite of diagnosis and treatment of pulmonaly embolism, she expired 29 hours after onset of symptom.
Aged, 80 and over ; Anesthesia, General ; Arthroplasty, Replacement, Hip* ; Cyanosis ; Diagnosis ; Echocardiography ; Embolism ; Female ; Femoral Neck Fractures ; Humans ; Hypotension ; Intensive Care Units ; Perfusion ; Pulmonary Embolism* ; Thromboembolism

PURPOSE: This study aimed to identify the early predictors of neurodevelopmental outcomes in infants undergoing therapeutic hypothermia for neonatal hypoxic ischemic encephalopathy. METHODS: The medical records of 24 neonates who underwent hypothermia therapy for hypoxic ischemic encephalopathy at the neonatal intensive care unit of Yeouido St. Mary's Hospital of the Catholic University of Korea between August 2013 and May 2016 were reviewed. Patients were divided into two groups according to their neurological outcome at the age of 18 to 24 months: a normal group (n=14), which included patients with normal neurological function, and an abnormal group (n=10), which included patients with neurological deficits. The clinical characteristics, clinical outcomes, and laboratory findings before and after hypothermia treatment were compared between the groups. RESULTS: There were no significant differences in the demographic characteristics between the two groups. With regard to clinical outcomes, only brain magnetic resonance imaging (MRI) findings showed significant differences between the normal and abnormal groups (21.4% vs. 100.0%, P < 0.001). With regard to laboratory findings, there were significant differences in the white blood cell (WBC) count after hypothermia treatment between the normal and abnormal groups (9.78±3.52 vs. 14.90±3.48, P=0.003). However, logistic regression analysis showed that the WBC count was not an independent risk factor for abnormal neurodevelopment (P>0.05). CONCLUSION: The presence of abnormal lesions on MRI was the most useful predictor of poor neurodevelopmental outcome in infants treated with therapeutic hypothermia after perinatal asphyxia.
Asphyxia ; Brain ; Humans ; Hypothermia ; Hypothermia, Induced ; Hypoxia-Ischemia, Brain ; Infant ; Infant, Newborn ; Intensive Care, Neonatal ; Korea ; Leukocytes ; Logistic Models ; Magnetic Resonance Imaging ; Medical Records ; Risk Factors ; Treatment Outcome

Purpose: We aimed to investigate changes in visiting patterns after the lifting of mask mandates in a single pediatric emergency medical center in Seoul, Korea. Methods: This retrospective study was based on the data of patients’ (≤ 18 years) visits to the emergency department (ED) of the center from January 1, 2022 through June 30, 2023. Clinical characteristics, Korean Triage and Acuity Scale (KTAS) level, ED outcomes, and length of stay were compared between before (March 20-June 30, 2022) and after (March 20-June 30, 2023) the lifting of mask mandates. The comparisons were iterated in the patients with infectious disease. Results: During the study period, a total of 18,654 children visited the ED. After the lifting of mask mandates, ED visits increased from 7,146 to 11,508 (61.0%; 95% confidence interval, 59.5-62.6; P < 0.001). The increase was more prominent in the age of 2-5 years (82.9%), infectious diseases (175.3%), KTAS level 3 (127.7%), and length of stay shorter than 3 hours (78.8%-92.6%). The number of patients per hour increased by 151.2% for 5 patients or more and over 3,000% for 10 or more. Median length of stay decreased (2.3 hours [interquartile range, 1.2-4.1] to 1.9 hours [1.1-3.5]; P < 0.001). The patients with infectious disease (n = 7,139) showed similar patterns of increase in the age of 2-5 years, KTAS level 3, and length of stay shorter than 3 hours, with an additional increase in the age of 6-18 years. Conclusion After the lifting of mask mandates, pediatric visits increased by 61%, with the highest increase in children with mild infectious diseases on weekends and at night, and the proportion of more than 10 visits per hour significantly increased. We need urgent and realistic support measures from health authorities.

Purpose: This study was performed to analyze clinical features and use of renal replacement therapy (RRT) for children who visit the pediatric emergency department with benign acute childhood myositis (BACM) or rhabdomyolysis. Methods: We retrospectively reviewed medical records of 289 children who visited the emergency department with BACM or rhabdomyolysis from January 2013 through December 2022. Clinical features, laboratory and microbiological findings, and outcomes were compared between children with the two diagnoses. Subsequently, multivariable logistic regressions were performed to identify factors associated with applying RRT. Results: Of the 289 children, a total of 212 were analyzed, including 93 with BACM and 119 with rhabdomyolysis. Influenza (70 of the 145 children [48.3%]) was the most common cause, followed by exercise (36 of 212 [17.0%]). Compared with the children with BACM, those with rhabdomyolysis showed significantly higher frequencies of being boys and hematuria, and higher concentrations of hemoglobin, creatinine, creatine kinase, and myoglobin. Continuous venovenous hemofiltration, a modality of RRT, was applied to 8 children (6.7%) with rhabdomyolysis, of whom 1 died. Creatine kinase was independently associated with the application of RRT (adjusted odds ratio, 1.06; 95% confidence interval, 1.00-1.12; P = 0.036). Conclusion Rhabdomyolysis in children who require RRT may be associated with a higher concentration of creatine kinase.

PURPOSE: Combined resection of invaded organ in advanced gastric cancer has been performed for complete removal of tumor and clearance of regional lymph node. However, higher morbidity and mortality associated with this procedure have been reported in recent large series and the efficacy of the procedure in survival remains controversial. In this study, we analyzed the efficacy of gastrectomy combined with invaded organ resection. METHODS: The medical records of 153 patients with T4 gastric carcinoma who underwent operation at Department of Surgery, Kangnam St. Mary's Hospital, The Catholic University of Korea from 1990 to 1998 were evaluated retrospectively. The patients were divided into three groups. Thirty five patients with combined resection were included in group I, and 72 patients with gastrectomy alone were in group II and 46 patients with no resection were included in group III. RESULTS: Pancreas was the most frequently invaded organ (100 patients: 65.4%), followed by colon (57 patients: 37.3%). The patients of group III were older than that of group I, and the tumor size was bigger in group I than group II. Incidence of the lower one third of the gastric cancer was higher in group II and III than that of group I. Histologically, undifferentiated carcinomas were more frequent in all groups. Postoperative complications in group I occurred in 11 patients (31.5%): intraabdominal abscess (4 patients: 11.4%), duodenal stump leakage (2 patients: 5.7%), renal failure (2 patients: 5.7%), and followed by bleeding, pulmonary complication, pancreatitis. Operative mortality of group I was 2.9%. The 5-year survival rate of group I and II was 15.6% and 3.1%, respectively and 0% in group III. In patients without peritoneal or liver metastasis, the 5-year survival rate of group I and II was 27.0% and 5.5%, respectively. But in patients with incurable factors, there was no difference in survival between the two groups. Median survival of group I with incurable factors was only 7 months. CONCLUSION: Combined resection of invaded organ in patients with T4 gastric carcinoma is a relatively safe procedure. Combined resection should be considered in patients without incurable factors such as peritoneal or liver metastasis.
Abscess ; Carcinoma ; Colon ; Gastrectomy ; Hemorrhage ; Humans ; Incidence ; Korea ; Liver ; Lymph Nodes ; Medical Records ; Mortality ; Neoplasm Metastasis ; Pancreas ; Pancreatitis ; Postoperative Complications ; Renal Insufficiency ; Retrospective Studies ; Stomach Neoplasms* ; Survival Rate

This study was performed to compare the healing quality of the allogenic acellular dermal matix (ADM) and xenogenic ADM combined with autologous split thicknessskin graft. Xenogenic ADM was obtained from two wild type pigs. Allogenic ADM was obtained from cynomolgus monkeys. ADM was stored with cryo-preservation. Full-thickness skin wounds were made on the back of two cynomolgus monkeys. In one monkey, wounds were covered by allogenic ADM combined with autologous split thickness skin graft (STSG) or autologous STSGonly. In another monkey, wounds were covered by xenogenic ADM combined with autologous skin graft or autologous skin graft only. Skin healing process was observed during 2 weeks and skin biopsies were performed on 3 months after skin transplantation. We obtained IACUC approval (ORIENT-IACUC-16053). Skin on the xenogenic ADM was necrotized 1 week after skin transplantation. Possibly due to the thickness of ADM, which block the blood supply from the subcutaneous tissue to the autologous skin graft. Skin biopsy revealed that less fibrotic change of the skin on the ADM compared with the skin without ADM. Xenogenic ADM can be used in high degree burn patients who can suffered from contracture after healing since it can reduce fibrotic change.
Acellular Dermis* ; Animal Care Committees ; Biopsy ; Burns ; Contracture ; Haplorhini ; Humans ; Macaca fascicularis ; Primates* ; Skin Transplantation ; Skin* ; Subcutaneous Tissue ; Swine ; Transplants* ; Wounds and Injuries

PURPOSE: Advanced gastric cancer that invades the subserosa can be classified into three subgroups according to the tumor cell growth patterns: expansive growth (ss alpha), infiltrative growth (ss gamma) and intermediate growth (ss beta). Serosal invasion is a well-known risk factor for peritoneal recurrence. It has been reported that the risk of peritoneal seeding of ssgamma is comparable with serosal tumor, although tumor cells do not actually reached the serosa as one of the histologic findings. In this study, the clinicopathologic features of subserosal tumors according to the growth pattern were analyzed. METHODS: One hundred and twenty-nine patients who underwent a gastrectomy for gastric cancer invading the subserosa at the Department of Surgery, Kangnam St. Mary's Hospital, The Catholic University of Korea, between 1994 and 1998, were retrospectively evaluated. No patients had any other organ tumor. The patients were divided into two groups: 86 non-infiltrative cancers (Group I, ss alpha and ss beta) and 43 infiltrative cancers (Group II, ss gamma) according to the tumor growth pattern. RESULTS: Undifferentiated carcinomas were more frequent group II than group I (83.7% vs. 27.9%, P=0.000). There was no difference in any of the other clinicopathological characteristics between the two groups, including age, gender, tumor size or lymph node metastasis. However, the recurrence patterns were significantly different between the two groups. The peritoneal recurrence rate was higher in group II than group I (71.4% vs 39.3%, P=0.036). The 5 and 10-year survival rates were 66.9 and 61.2% for group I and 50.4% and 40.4% for group II, respectively (P>0.05). CONCLUSION: A high incidence of peritoneal recurrence was noted in the infiltrative subserosal gastric cancer. Therefore, attention should be focused on the diagnosis of peritoneal recurrence during follow-up for this subtype of subserosal cancer.
Carcinoma ; Diagnosis ; Follow-Up Studies ; Gastrectomy ; Humans ; Incidence ; Korea ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis* ; Recurrence ; Retrospective Studies ; Risk Factors ; Serous Membrane ; Stomach Neoplasms* ; Survival Rate

PURPOSE: The purpose of this study was to compare four graft-tunnel angles (GTA), the femoral GTA formed by three different femoral tunneling techniques (the outside-in, a modified inside-out technique in the posterior sag position with knee hyperflexion, and the conventional inside-out technique) and the tibia GTA in 3-dimensional (3D) knee flexion models, as well as to examine the influence of femoral tunneling techniques on the contact pressure between the intra-articular aperture of the femoral tunnel and the graft. MATERIALS AND METHODS: Twelve cadaveric knees were tested. Computed tomography scans were performed at different knee flexion angles (0degrees, 45degrees, 90degrees, and 120degrees). Femoral and tibial GTAs were measured at different knee flexion angles on the 3D knee models. Using pressure sensitive films, stress on the graft of the angulation of the femoral tunnel aperture was measured in posterior cruciate ligament reconstructed cadaveric knees. RESULTS: Between 45degrees and 120degrees of knee flexion, there were no significant differences between the outside-in and modified inside-out techniques. However, the femoral GTA for the conventional inside-out technique was significantly less than that for the other two techniques (p<0.001). In cadaveric experiments using pressure-sensitive film, the maximum contact pressure for the modified inside-out and outside-in technique was significantly lower than that for the conventional inside-out technique (p=0.024 and p=0.017). CONCLUSION: The conventional inside-out technique results in a significantly lesser GTA and higher stress at the intra-articular aperture of the femoral tunnel than the outside-in technique. However, the results for the modified inside-out technique are similar to those for the outside-in technique.
Cadaver ; Femur/radiography/surgery ; Humans ; *Imaging, Three-Dimensional ; Knee Joint/surgery ; Models, Anatomic ; Posterior Cruciate Ligament/radiography/*surgery ; Reconstructive Surgical Procedures/*methods ; Tibia/radiography/surgery ; Tomography, X-Ray Computed

PURPOSE: Bone metastasis is not a common event in patients with gastric cancer. Therefore, most studies of bone metastasis in such patients have been in the form of case reports, so the clinical features of the bone metastasis are not well understood. To clarify metastatic patterns, the efficacy of radiation or chemotherapy, and the prognosis, we analyzed 29 cases of patients with bone metastases after curative surgery for gastric cancer. MATERIALS AND METHODS: Twenty-nine (29) gastric cancer patients with bone metastasis who underwent curative resection from January 1989 to December 2002 at the Departments of Surgery, Kangnam St. Mary's Hospital and Our Lady of Mercy's Hospital, The Catholic University of Korea, were analyzed. RESULTS: Nineteen (19) patients were males and, 10 patients were females. The mean age of the patients was 53+/-12 years. There were more Borrmann type-3 and type-4 cancers and more undifferentiated histologic types. Most of the original cancers were stage III or IV. The most frequently involved bone was the spine. Treatment after recurrence was done in 16 patients (55.2%). The median survival time after recurrence of the patients who received treatment was seven (7) months (0~75 months in range), which was significantly longer than that of the patients who did not received treatment (P=0.019). However, there was no difference according to the treatment modality (P=0.388). CONCLUSION: Bone metastasis after a curative resection of gastric cancer tends to occur in Borrmann type-3 and type-4 cancers, cancers with undifferentiated histology and, in stage III/IV disease. The prognosis of bone metastasis is dismal, and aggressive treatment is the only way to prolong survival.
Drug Therapy ; Female ; Humans ; Korea ; Male ; Neoplasm Metastasis* ; Prognosis ; Recurrence ; Spine ; Stomach Neoplasms*