Stenotic or hypoplastic coronary arteries occupy vital features in the clinical situations. The pseudohypoplasia might be defined as a macroscopic hypoplasia based on the diameter of an artery compared with contralateral artery but is not hypoplasia both anatomically and histopathologically. During a routine dissection course, a pseudohypoplasia in right coronary artery was recognized in an 82-year-old Korean female cadaver who had a common mesenteric trunk and a fibromuscular dysplasia in the left vertebral artery. Although macroscopic hypoplasia was discovered, the right coronary artery had normal anatomical features and the left coronary artery showed atherosclerotic changes on the main trunk. The right coronary artery was misread to have hypoplasia due to atherosclerotic aneurysm on left coronary artery. Since macroscopic hypoplasia in radiological and surgical situations may lead to confusion to interpret its pathophysiology just like this case, the better anatomical knowledge on the coronary artery can help to prevent misleading approaches.
Aneurysm ; Arteries ; Atherosclerosis ; Cadaver ; Coronary Vessels ; Female ; Fibromuscular Dysplasia ; Humans

Embryonic stem cells (ESCs) and induced pluripotent stem cells (iPSCs), which are collectively called pluripotent stem cells (PSCs), have emerged as a promising source for regenerative medicine. Particularly, human pluripotent stem cell-derived cardiomyocytes (hPSC-CMs) have shown robust potential for regenerating injured heart. Over the past two decades, protocols to differentiate hPSCs into CMs at high efficiency have been developed, opening the door for clinical application. Studies further demonstrated therapeutic effects of hPSC-CMs in small and large animal models and the underlying mechanisms of cardiac repair. However, gaps remain in explanations of the therapeutic effects of engrafted hPSC-CMs. In addition, bioengineering technologies improved survival and therapeutic effects of hPSC-CMs in vivo. While most of the original concerns associated with the use of hPSCs have been addressed, several issues remain to be resolved such as immaturity of transplanted cells, lack of electrical integration leading to arrhythmogenic risk, and tumorigenicity. Cell therapy with hPSC-CMs has shown great potential for biological therapy of injured heart; however, more studies are needed to ensure the therapeutic effects, underlying mechanisms, and safety, before this technology can be applied clinically.
Biocompatible Materials ; Bioengineering ; Biological Therapy ; Cell- and Tissue-Based Therapy ; Embryonic Stem Cells ; Heart ; Humans ; Induced Pluripotent Stem Cells ; Models, Animal ; Myocytes, Cardiac ; Pluripotent Stem Cells ; Regeneration ; Regenerative Medicine ; Therapeutic Uses

Embryonic stem cells (ESCs) and induced pluripotent stem cells (iPSCs), which are collectively called pluripotent stem cells (PSCs), have emerged as a promising source for regenerative medicine. Particularly, human pluripotent stem cell-derived cardiomyocytes (hPSC-CMs) have shown robust potential for regenerating injured heart. Over the past two decades, protocols to differentiate hPSCs into CMs at high efficiency have been developed, opening the door for clinical application. Studies further demonstrated therapeutic effects of hPSC-CMs in small and large animal models and the underlying mechanisms of cardiac repair. However, gaps remain in explanations of the therapeutic effects of engrafted hPSC-CMs. In addition, bioengineering technologies improved survival and therapeutic effects of hPSC-CMs in vivo. While most of the original concerns associated with the use of hPSCs have been addressed, several issues remain to be resolved such as immaturity of transplanted cells, lack of electrical integration leading to arrhythmogenic risk, and tumorigenicity. Cell therapy with hPSC-CMs has shown great potential for biological therapy of injured heart; however, more studies are needed to ensure the therapeutic effects, underlying mechanisms, and safety, before this technology can be applied clinically.

BACKGROUND: Respiratory dynamics may be monitored and evaluated indirectly by measuring the peak inspiratory pressure and plateau pressure. In this study, the respiratory dynamics of patients undergoing spinal surgery using a Jackson surgical table were observed with a device after converting their position from supine to prone. The effects of the dynamic compliance and airway resistance were observed from the changes in peak inspiratory pressure and plateau. METHODS: Twenty five patients were selected as subjects scheduled to undergo lumbar spine surgery. After intubation, the patients were ventilated mechanically with a tidal volume of 10 ml/kg and a respiration rate of 10/min. Anesthesia was maintained with sevoflurane 1.5%, nitrous oxide 2 L/min and oxygen 2 L/min. The peak inspiratory pressure, plateau pressure, resistance, compliance, arterial oxygen tension, carbon dioxide tension, heart rate and arterial blood pressure were measured at 10 minutes after the induction of anesthesia. These parameters were measured again 10 minutes after placing the patient in the prone position. RESULTS: The prone position did not significantly affect the arterial oxygen tension, carbon dioxide tension, blood pressure and heart rate, but significantly increased the peak inspiratory pressure and resistance and decreased the dynamic compliance. CONCLUSIONS: The peak inspiratory pressure was increased using a Jackson surgical table to minimize the abdominal pressure when converting from the supine to prone position. This might be due to a decrease in lung and chest compliance as well as an increase in airway resistance.
Airway Resistance ; Anesthesia ; Arterial Pressure ; Blood Pressure ; Carbon Dioxide ; Compliance ; Heart Rate ; Humans ; Intubation ; Lung ; Methyl Ethers ; Nitrous Oxide ; Oxygen ; Prone Position ; Respiratory Mechanics ; Respiratory Rate ; Spine ; Thorax ; Tidal Volume

Regional anesthesia for non-obstetric surgery in parturients is a method to decrease patient and fetal risk during general anesthesia. Thoracic interfascial nerve block can be used as an analgesic technique for surgical procedures of the thorax. The Pecs II block is an interfascial block that targets not only the medial and lateral pectoral nerves, but also the lateral cutaneous branch of the intercostal nerve. Pecto-intercostal fascial block (PIFB) targets the anterior cutaneous branch of the intercostal nerve. The authors successfully performed a modified Pecs II block and PIFB without complications in a parturient who refused general anesthesia for breast surgery.
Anesthesia, Conduction ; Anesthesia, General ; Breast* ; Female ; Humans ; Intercostal Nerves ; Methods ; Nerve Block* ; Pregnant Women* ; Thoracic Nerves ; Thorax

Regional anesthesia for non-obstetric surgery in parturients is a method to decrease patient and fetal risk during general anesthesia. Thoracic interfascial nerve block can be used as an analgesic technique for surgical procedures of the thorax. The Pecs II block is an interfascial block that targets not only the medial and lateral pectoral nerves, but also the lateral cutaneous branch of the intercostal nerve. Pecto-intercostal fascial block (PIFB) targets the anterior cutaneous branch of the intercostal nerve. The authors successfully performed a modified Pecs II block and PIFB without complications in a parturient who refused general anesthesia for breast surgery.
Anesthesia, Conduction ; Anesthesia, General ; Breast* ; Female ; Humans ; Intercostal Nerves ; Methods ; Nerve Block* ; Pregnant Women* ; Thoracic Nerves ; Thorax

Due to rapid evolution and technological advancements, medical personnel now require special training outside of their safe zones. Anesthesiologists face challenges in practicing in locations beyond the operating room. New locations, inadequate monitoring devices, poor assisting staff, unfamiliarity of procedures, insufficient knowledge of basic standards, and lack of experience compromise the quality of patient care. Therefore, anesthesiologists must recognize possible risk factors during anesthesia in nonoperating rooms and familiarize themselves with standards to improve safe practice. This review article emphasizes the need for standardizing hospitals and facilities requiring nonoperating room anesthesia, and encourages anesthesiologists to take the lead in applying these practice guidelines to improve patient outcomes and reduce adverse events.
Anesthesia* ; Deep Sedation ; Humans ; Monitoring, Intraoperative ; Operating Rooms* ; Patient Care ; Risk Factors

OBJECTIVE: The purpose of this study was to compare psychiatric comorbid disorders and psychological outcomes in children and adolescents with Attention-deficit/hyperactivity disorder (ADHD). METHODS: Subjects were divided into a child group (aged under 12 years) and an adolescent group (aged 12 years and above). All subjects were diagnosed with ADHD based on the DSM IV diagnostic criteria using the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Korean Version (K-SADS-PL-K). The K-SADS-PL-K was also used to evaluate those psychiatric disorders comorbid with ADHD. And the Korean version of the Child Behavior Checklist (K-CBCL) was used to examine the subjects' psychological outcomes. RESULTS: The rate of comorbidity in adolescent group was significantly higher than that in the child group. In particular, the adolescent group had a significantly higher ratio of comorbid conduct disorder and mood disorder than the child group. With respect to the predominantly inattentive type and Not Otherwise Specified, the school subscale scores on the K-CBCL for the children were significantly higher than those for the adolescents. CONCLUSION: These results suggest that the psychiatric comorbidity may differ between adolescents and children with ADHD. Therefore when treating adolescents with ADHD, more careful assessment and treatment targeting a range of comorbidities are needed.
Adolescent ; Checklist ; Child ; Child Behavior ; Comorbidity ; Conduct Disorder ; Humans ; Mood Disorders

The aim of this study is to describe the clinical characteristics of prepubertal- and adolescent-onset bipolar disorder (BD) and to identify any clinical differences between patients with prepubertal- and adolescent-onset BD. We analyzed the clinical records of 53 inpatients with BD. These patients were divided into prepubertal-onset and adolescent-onset groups. We also divided the subjects into narrow, intermediate, and broad phenotypes according to the definitions proposed by Leibenluft and colleagues. Of the total sample, 16 patients (30.2%) were in the prepubertal-onset group and 37 (69.8%) were in the adolescent-onset group. Patients with prepubertal-onset BD were more likely to display an insidious clinical presentation, atypical features, and comorbid psychopathology. And the majority of the subjects, especially in the prepubertal-onset group, were classified under the intermediate and broad phenotypes. These results suggest that the clinical presentation of BD with prepubertal-onset is different from that of adolescent-onset BD. It is inferred that a significant number of patients with prepubertal- and adolescent-onset BD do not meet DSM-IV criteria for mania or hypomania from the results of this study.

Encountering a patient with unanticipated laryngotracheal stenosis (LTS) during anesthetic induction is challenging for an anesthesiologist. Because routine history taking and pre-anesthetic evaluation cannot rule out the possibility of LTS, other measures should be taken. Perioperative airway maintenance is considered crucial for avoiding complications such as airway edema, bleeding, obstruction, collapse, and ultimately respiratory failure and arrest. We report an unanticipated tracheal stenosis discovered during anesthetic induction that hindered endotracheal intubation. Because airway maintenance was difficult, we postponed surgery until determining the cause of the difficult entry, considered possible therapeutic approaches (both anesthetic and surgical), and provided successful surgery with a continuous epidural block.
Airway Management ; Constriction, Pathologic ; Edema ; Hemorrhage ; Humans ; Intubation* ; Intubation, Intratracheal ; Respiratory Insufficiency ; Tracheal Stenosis*