A new balloon dissector, a modification of a Foley catheter, was devised and it can be used either as a dissector or a tissue expander. Since most operating time was spent in balloon manipulation (inflation/deflation), the duct for saline injection was made to be wider than the Foley catheter. As a result, the balloon could be inflated faster than before. In order to reduce the scar at the donor site, harvest of the sural nerve using endoscopic technique is currently applied, but utilization of this method is technically difficult and requires a long operating time. For these reasons, new our method of using a balloon dissector was devised. The balloon dissector can also be used for immediate intraoperative tissue expansion for the reconstruction of small skin defects without distortion. We have found that the advantages of using the new balloon dissector include a reduction in operating time, preservation of the perforating vessels, and primary closure with less tension. In addition, this simple and inexpensive instrument is cost-beneficial to patients.
Catheters ; Cicatrix ; Humans ; Skin ; Sural Nerve ; Tissue Donors ; Tissue Expansion ; Tissue Expansion Devices

Granular cell tumors were originally described in 1926 by Abrikossoff as myoblastic myomas. They usually occur as solitary tumors but can be multiple in about 10% of cases. They have a predilection for the skin, subcutaneous tissue and tongue, but also occur in many other organs. We report a case of solitary granular cell tumor on the palm. This is a very unusual location of this disease which merits consideration.
Granular Cell Tumor* ; Myoblasts ; Myoma ; Skin ; Subcutaneous Tissue ; Tongue

Malignant hyperthermia is defined as a potentially fatal hypermetabolic syndrome characterized by hyperpyrexia, skeletal muscle rigidity, tachycardia, respiratory and metabolic acidosis, cyanosis etx. There is no simple noninvasive test to identify the susceptible individuals. A history of hyperpyrexia and/or muscle rigidity during previous general or a family history of such a condition provides the anesthesiologist with valuable information. Avoidance of potent inhalational anesthetic agents and other triggering agenta, and the selective use of regional anesthesia with either a local anesthetic agent or neuroleptic anesthesia, are the usual acceptable guidelines in the anesthetic management of susceptible individuals. Dentrolene sodium has been shown to be effective in the prevention and treatment of malignant hyperthermia in malignant hyperthermia susceptible swine. We gave Dantrolene sodium orally as a part of the prophylaxia for malignant hyperthermia in a 34yearts-old woman who underwent an emergency bilateral salpingectomy and who had a family history of malignant hyperthermia. We report on this patient with a family history of hyperthermia and reviewed the literature concerning malignant hyperthermia.
Acidosis ; Anesthesia ; Anesthesia, Conduction ; Anesthetics ; Cyanosis ; Dantrolene ; Emergencies ; Female ; Fever ; Humans ; Malignant Hyperthermia* ; Muscle Rigidity ; Muscle, Skeletal ; Salpingectomy ; Sodium ; Swine ; Tachycardia

Purpose: Female sexual dysfunction is defined as a disorder of sexual desire, arousal, or orgasm, and/or sexual pain, resulting in personal distress that impacts on the quality of life and interpersonal relationships. It is a compilation of problems that has both biological and psychosocial components and is multifactorial in its etiology. In this study, the female sexual dysfunction in overactive bladder (OAB) patients was evaluated. Materials and Methods: The subjects included 63 female who visited our health care center for health medical examinations without voiding symptoms (control group) and 37 female patients with OAB. All patients were asked to complete the Brief index of sexual functioning for women (BISF-W), which had been translated into Korean. The Beck depression inventory (BDI) and State-Trait anxiety inventory (STAI) were also used to assess the relationship between the sexual dysfunction and anxiety or depression. The results were analyzed statistically by ANCOVA using age as a covariant. Results: The mean ages in the OAB and control groups were 35.47+/-6.76 and 42.70+/-9.68 years, respectively. The mean scores of desire in the OAB and control groups were 3.92+/-3.09 and 8.92+/-4.99, for arousal were 6.78+/-3.85 and 11.06+/-5.60, frequency of sexual activity 3.92+/-5.24 and 8.53+/-4.52, receptivity/initiation 10.08+/-3.71 and 11.47+/-4.91, orgasm 13.19+/-6.97 and 19.72+/-7.36, relationship satisfaction 7.12+/-1.68 and 7.11+/-1.88 and physical problems affecting sexual function 12.14+/-6.17, 11.83+/-5.05, respectively. The OAB group shows decreased sexual desire, arousal, frequency of sexual activity and orgasm compared to the control group (p<0.05). However, there were no differences in anxiety or depression between the two groups and there was no sexual dysfunction due to anxiety or depression in either group. Conclusions: Female sexual dysfunction was more common in OAB patients than the controls. OAB is one of the important factor affecting female sexual dysfunction. Consideration should be given with regard to female sexual dysfunction in patients with OAB.
Anxiety ; Arousal ; Delivery of Health Care ; Depression ; Female* ; Humans ; Orgasm ; Quality of Life ; Sexual Behavior ; Sexuality ; Urinary Bladder ; Urinary Bladder, Overactive*

Malaria remains one of the most important infectious diseases in the world. For those not immuned to malaria, delayed diagnosis and treatment have been associated with an increase in morbidity and mortality, and development of severe complications. Pulmonary edema is one of the serious complications in falciparum malaria. It usually occurs in association with cerebral malaria, acute renal failure, high parasitemia, and delayed antimalarial treatment, as well as treatment-related side effects. We report two cases of severe falciparum malaria with rapidly developed pulmonary edema, which was not combined with cardiac decompensation or fluid overload. Both patients had a history of traveling to foreign countries, Thailand and Ghana, which chloroquine-resistant malaria is distributed. The first patient who developed hyperbilirubinemia, hypoglycemia, thrombocytopenia, decreased mentality, multi-organ failure, and pulmonary edema with acute respitatory distress syndrome, was treated with quinine, doxycycline, hemodialysis, and mechanical ventilation. The patient was recovered with a sequela of restrictive lung change. The second patient also developed anemia, thrombocytopenia, mental confusion, and pulmonary edema with aucte lung injury. Through the treatment of quinine, diuretics, and high concentration of oxygen via facial mask, the patient was successfully recovered without any sequela.
Acute Kidney Injury ; Anemia ; Communicable Diseases ; Delayed Diagnosis ; Diuretics ; Doxycycline ; Ghana ; Humans ; Hyperbilirubinemia ; Hypoglycemia ; Lung ; Lung Injury ; Malaria ; Malaria, Cerebral ; Malaria, Falciparum* ; Masks ; Mortality ; Oxygen ; Parasitemia ; Plasmodium falciparum* ; Plasmodium* ; Pulmonary Edema ; Quinine ; Renal Dialysis ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult* ; Thailand ; Thrombocytopenia

Mycobacterium shinjukuense is a novel species of nontuberculous mycobacteria (NTM) that was first reported in Japan in 2011. It is a slow-growing NTM pathogen that can cause chronic pulmonary infections. There are only a few reported cases of M. shinjukuense infections, all of which are from Japan. We reported a case of chronic lung disease caused by M. shinjukuense. The organism was identified by 16S rRNA, rpoB, and hsp65 gene sequencing. To the best of our knowledge, this was the first confirmed case of lung disease caused by M. shinjukuense outside of Japan.
Bronchiectasis ; Japan ; Korea* ; Lung Diseases* ; Lung* ; Mycobacterium* ; Nontuberculous Mycobacteria

BACKGROUND: Spinal anesthesia for urologic surgery in elderly patients is preferred. The addition of opioids to local anesthetics reduces the side effects of spinal anesthesia. This study examined the effects of intrathecal fentanyl 10microgram and 20microgram when administered with hyperbaric 0.5% bupivacaine to elderly patients undergoing urologic surgery. METHODS: Forty-five elderly patients undergoing urologic surgery were randomized into the following three groups: group 1, bupivacaine 7.5 mg; group 2, bupivacaine 5 mg + fentanyl 10microgram; and group 3, bupivacanie 5 mg + fentanyl 20microgram. The total volume of intrathecally injected was adjusted to 1.5 ml with sterile normal saline. Spinal anesthesia was administered with a 25 G Quincke needle at the L3-4 or L4-5 interspace in the lateral position. The neural block was assessed using a pinprick test and the Bromage scale. RESULTS: There were no significant differences in the onset time of the T10 sensory block, peak level of the sensory block, and onset time of the peak level. The duration of the sensory block was significantly shorter in group 2 than in group 1 (P = 0.017). The duration of the motor block was longer in group 1 than in groups 2 and 3 (P = 0.016, P = 0.04). Pruritus was observed more often in group 3 (37.5%) and shivering was more common in group 1 (P = 0.005). CONCLUSIONS: The addition of fentanyl 10microgram and 20microgram to bupivacaine 5 mg provides adequate anesthesia for elderly patients undergoing urologic surgery with fewer side effects, and fentanyl 10microgram is recommended as outpatient anesthesia.
Aged ; Analgesics, Opioid ; Anesthesia ; Anesthesia, Spinal ; Anesthetics, Local ; Bupivacaine ; Fentanyl ; Humans ; Needles ; Outpatients ; Pruritus ; Shivering

BACKGROUND: Spinal anesthesia for urologic surgery in elderly patients is preferred. The addition of opioids to local anesthetics reduces the side effects of spinal anesthesia. This study examined the effects of intrathecal fentanyl 10microgram and 20microgram when administered with hyperbaric 0.5% bupivacaine to elderly patients undergoing urologic surgery. METHODS: Forty-five elderly patients undergoing urologic surgery were randomized into the following three groups: group 1, bupivacaine 7.5 mg; group 2, bupivacaine 5 mg + fentanyl 10microgram; and group 3, bupivacanie 5 mg + fentanyl 20microgram. The total volume of intrathecally injected was adjusted to 1.5 ml with sterile normal saline. Spinal anesthesia was administered with a 25 G Quincke needle at the L3-4 or L4-5 interspace in the lateral position. The neural block was assessed using a pinprick test and the Bromage scale. RESULTS: There were no significant differences in the onset time of the T10 sensory block, peak level of the sensory block, and onset time of the peak level. The duration of the sensory block was significantly shorter in group 2 than in group 1 (P = 0.017). The duration of the motor block was longer in group 1 than in groups 2 and 3 (P = 0.016, P = 0.04). Pruritus was observed more often in group 3 (37.5%) and shivering was more common in group 1 (P = 0.005). CONCLUSIONS: The addition of fentanyl 10microgram and 20microgram to bupivacaine 5 mg provides adequate anesthesia for elderly patients undergoing urologic surgery with fewer side effects, and fentanyl 10microgram is recommended as outpatient anesthesia.
Aged ; Analgesics, Opioid ; Anesthesia ; Anesthesia, Spinal ; Anesthetics, Local ; Bupivacaine ; Fentanyl ; Humans ; Needles ; Outpatients ; Pruritus ; Shivering

This study was performed to decide the possibility of special health examination to the hospital employees. We carried out questionnaire survey for 830 subjects at 2 general hospitals located in Pusan city. The summary of this study are as follows. 1. Above 10% of total hospital employees were replied that they exposed to 16 hazard items, such as dust, noise, stress and etc. Among them, over 50% of hospital employees exposed to dust(69.8%), noise(52.3%), stress(60.1%). And hospital employees exposed to alcoholic disinfectant(41.3%), radiation(34.6%), drug(33.3%), VDT(25.2%), and aldehyde(18.7%) also. 2. 63% of the hospital employees replied that there were hazardous factors in hospital environments, and 80% insisted the necessity for hospital environment measuring. 35.7% of respondents replied that they had never taken the education about hazardous factors. 35.7% of the total respondents answered that they didn't use protective equipment when exposed to hazardous factors. And 48.6% answered they took periodic health examination. Only 7.2% replied that ventilation condition of office room was proper. As shown in above results, hospital employees are exposed to various hazards, and turn out neglecting to health problems caused these hazardous factors. So at first, it is necessary to measuring hospital working environment, and then will be decided the possibility of special health examination to the hospital employees.
Alcoholics ; Busan ; Data Collection ; Dust ; Education ; Hospitals, General ; Humans ; Noise ; Questionnaires ; Ventilation

This study was performed to decide the possibility of special health examination to the hospital employees. We carried out questionnaire survey for 830 subjects at 2 general hospitals located in Pusan city. The summary of this study are as follows. 1. Above 10% of total hospital employees were replied that they exposed to 16 hazard items, such as dust, noise, stress and etc. Among them, over 50% of hospital employees exposed to dust(69.8%), noise(52.3%), stress(60.1%). And hospital employees exposed to alcoholic disinfectant(41.3%), radiation(34.6%), drug(33.3%), VDT(25.2%), and aldehyde(18.7%) also. 2. 63% of the hospital employees replied that there were hazardous factors in hospital environments, and 80% insisted the necessity for hospital environment measuring. 35.7% of respondents replied that they had never taken the education about hazardous factors. 35.7% of the total respondents answered that they didn't use protective equipment when exposed to hazardous factors. And 48.6% answered they took periodic health examination. Only 7.2% replied that ventilation condition of office room was proper. As shown in above results, hospital employees are exposed to various hazards, and turn out neglecting to health problems caused these hazardous factors. So at first, it is necessary to measuring hospital working environment, and then will be decided the possibility of special health examination to the hospital employees.
Alcoholics ; Busan ; Data Collection ; Dust ; Education ; Hospitals, General ; Humans ; Noise ; Questionnaires ; Ventilation