BACKGROUND: The combination of local anesthetics and opioids in the spinal anesthesia has a synergic analgesic effect. Therefore, we compared intraoperative conditions and clinical effects of low dose (5 mg) bupivacaine added with fentanyl versus a conventional dose(10 mg) of bupivacaine in spinal anesthesia for a transurethral resection of the prostate (TURP). METHODS: Forty five ASA class 1 and 2 patients scheduled for a TURP were randomly divided into three groups. Group B (n = 15) received bupivacaine 10 mg, group BF (n = 15) received bupivacaine 5 mg added with fentanyl 20microgram, and group BFE received bupivacaine 5 mg added with fentanyl 20microgram and 0.2 mg epinephrine. Blood pressure and heart rate were recorded every 5 minutes before and after spinal anesthesia. Sensory blockade was measured by a pin-prick test and motor blockade was evaluated by the Bromage motor scale. Side effects including pruritus, nausea, vomiting, respiratory depression, and intraoperative pain were observed. RESULTS: The duration of sensory and motor blockade in group BF was significantly shorter than in group B and group BFE (P<0.05). Without statistical significance, hypotension (6.7%) and bradycardia (13.3%) were observed in group B and pruritus (26.7%) and nausea (13.3%) occurred in all patients who received fentanyl. CONCLUSIONS: The addition of fentanyl 20microgram to low dose bupivacaine 5 mg resulted in short lasting motor and sensory block, compared with conventional dose bupivacaine 10 mg. Therefore, we concluded that the clinical application of this method could provide adequate analgesia with early discharge and no serious side effects for TURP patients.
Analgesia ; Analgesics, Opioid ; Anesthesia, Spinal* ; Anesthetics, Local ; Blood Pressure ; Bradycardia ; Bupivacaine* ; Epinephrine ; Fentanyl* ; Heart Rate ; Humans ; Hypotension ; Nausea ; Prostate* ; Pruritus ; Respiratory Insufficiency ; Transurethral Resection of Prostate ; Vomiting

PURPOSE: This study evaluated the effect of tissue plasminogen activator (TPA) on adhesion between the internal limiting membrane and the vitreous cortex in patients with diabetic macular edema. METHODS: This retrospective study included 14 eyes of 14 patients with diabetic macular edema without posterior vitreous detachment. The fourteen eyes were divided into two groups. In the first group, vitrectomy and internal limiting membrane (ILM) removal were performed after intravitreal TPA 0.1 cc (50 ug) injection the day before vitrectomy and in the second group, vitrectomy and ILM removal were performed without previous injection of TPA. We observed the ILM using electron microscopy and verified the effects of the TPA. RESULTS: Spontaneous posterior vitreous detachment occurred in 3 of 7 eyes in the first group. Internal limiting membranes removed by vitrectomy showed a smooth surface in 4 of 7 eyes in the first group and in 1 of 7 eyes in the second group. Seven eyes of the first group and 6 eyes of the second group revealed decreased foveal thickness and increased visual acuity 90 days postoperatively. CONCLUSIONS: Preoperative intravitreal TPA injection was helpful for achieving posterior vitreous detachment and for decreasing possible postoperative complications involving in remnant vitreous cortex in patients with diabetic macular edema.
Eye ; Humans ; Macular Edema ; Membranes ; Microscopy, Electron ; Postoperative Complications ; Retrospective Studies ; Tissue Plasminogen Activator ; Visual Acuity ; Vitrectomy ; Vitreous Detachment

PURPOSE: To evaluate the clinicopathological characteristics and prognosis of localized resectable genitourinary sarcomas in adults. MATERIALS AND METHODS: Between September, 1996 and November, 2008, 18 consecutive cases of adults (12 men and 6 women; median age 48.8 years) who were treated for primary genitourinary sarcomas were identified. The following variables were analyzed: patient age, gender, body mass index, American Society of Anesthesiologists (ASA) score, primary organ, tumor histology, size, necrosis, Federation Nationale des Centres de Lutte Contre le Cancer (FNCLCC) grade, and surgical margin positivity. Recurrence-free survival and disease-specific survival were the study end-points. RESULTS: The most common presenting symptom was a palpable mass (six cases, 33.3%), the most common site was the kidney (six cases, 33.3%), and the most common histological subtype was leiomyosarcoma (eight patients, 44.4%). Complete resection with negative surgical margins was achieved in 13 patients (72.2%). The median follow-up period was 49.9 months (range 6.4 to 147.6). The recurrence-free survival rates at 1, 3, and 5 years were 81.6%, 66.5%, and 66.5%, respectively. Recurrence-free survival only associated significantly with ASA score (p=0.018). The disease-specific survival rate at 1, 3, and 5 years was 88.9%, 76.2%, and 67.7%, respectively. Disease-specific survival was associated significantly only with FNCLCC grade (p=0.042). CONCLUSION: Although genitourinary sarcomas in adults are a rare group of tumors with a poor prognosis, some patients may have a favorable prognosis. Our findings suggest that FNCLCC grade is the most important prognostic factor for these patients.
Adult ; Aged ; Female ; Humans ; Immunohistochemistry ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Neoplasm Grading ; Prognosis ; Republic of Korea ; Sarcoma/metabolism/pathology/*surgery ; Urogenital Neoplasms/metabolism/pathology/*surgery ; Young Adult

Use of oral hypoglycemic agents during pregnant women with type 2 diabetes is controversial due to safety issues. Recently, randomized controlled trials support short-term safety of glyburide and metformin for the treatment of gestational diabetes mellitus. However, long-term safety data are not available. Moreover, use of oral hypoglycemic agents, except for metformin and glyburide, during pregnancy were limited to a few case reports. We report the case of a pregnant woman with type 2 diabetes unintentionally exposed to metformin and voglibose in addition to lercanidipine and bisoprolol during fetal organogenesis. The patient was continuously exposed to oral agents because we were not aware of her pregnancy until 22 weeks of gestation. After pregnancy was confirmed, we replaced oral hypoglycemic agents with insulin and discontinue betablockers. Delivery occurred without maternal or fetal complications.
Bisoprolol ; Diabetes, Gestational ; Female ; Glyburide ; Humans ; Hypoglycemic Agents ; Insulin ; Metformin* ; Organogenesis ; Pregnancy ; Pregnancy Trimester, Second* ; Pregnancy* ; Pregnant Women*

OBJECTIVES: Physical activity (PA) is an established protective factor for many chronic diseases. Numerous studies have established positive relationships between social networks and PA. Accordingly, this study examined the relationship between social network structures (specifically the network size and the number and proportion of same-sex alters) and self-reported PA in Korean middle-age adults, where the term “alter” refers to a respondent’s social network members. METHODS: We analyzed 8,092 participants of the Cardiovascular and Metabolic Diseases Etiology Research Center cohort. We assessed the association between each network structure variable and PA level using a linear regression model. Then, we employed logistic regression to evaluate associations between social network structure and adherence to guideline-recommended exercise levels. Socio-demographic factors and health status measures were used as covariates. RESULTS: In both sexes, the social network size and proportion of same-sex network members showed positive relationships with total and moderate-to-vigorous PA. Notably, female participants with a greater number of kin were more likely to satisfy the recommended amount of total PA. CONCLUSIONS These findings suggest that large scale, same-sex intervention programs can help to achieve recommended PA regimens.

OBJECTIVES: Physical activity (PA) is an established protective factor for many chronic diseases. Numerous studies have established positive relationships between social networks and PA. Accordingly, this study examined the relationship between social network structures (specifically the network size and the number and proportion of same-sex alters) and self-reported PA in Korean middle-age adults, where the term “alter” refers to a respondent’s social network members. METHODS: We analyzed 8,092 participants of the Cardiovascular and Metabolic Diseases Etiology Research Center cohort. We assessed the association between each network structure variable and PA level using a linear regression model. Then, we employed logistic regression to evaluate associations between social network structure and adherence to guideline-recommended exercise levels. Socio-demographic factors and health status measures were used as covariates. RESULTS: In both sexes, the social network size and proportion of same-sex network members showed positive relationships with total and moderate-to-vigorous PA. Notably, female participants with a greater number of kin were more likely to satisfy the recommended amount of total PA. CONCLUSIONS These findings suggest that large scale, same-sex intervention programs can help to achieve recommended PA regimens.

This study aimed to investigate the concentrations of nonpersistent endocrine-disrupting chemicals (EDCs) and per- and polyfluoroalkyl substances (PFAS) in human milk through a literature review and to affirm the association between EDCs and lifestyle factors based on the reviewed literature. We analyzed studies reporting EDC concentrations in breast milk from literature published on Google Scholar and PubMed between 2000 and 2022. In Korea, most EDC concentrations in breast milk were comparable to or lower than those in other countries. However, the concentrations of PFAS in breast milk, especially perfluorooctanoic acid, have shown an increasing trend compared to the past in Korea. Considering the potential risks of EDCs, breastfeeding mothers should take measures to minimize their exposure to these chemicals.

PURPOSE: The Korean government has tried to decrease the suicide death rate over the last decade. Suicide attempts, particularly non-fatal attempts, are the most powerful known risk factor for a completed suicide. An analysis of suicide attempt methods will help establish the effective preventive action of suicide. Fit prevention according to the method of suicide attempt may decrease the incidence of suicide death. Self-poisoning is suggested as a major method of both suicide attempts and suicide death. The aim of this study was to determine if a self-poisoning patient is a suitable target for the prevention of the suicide. METHODS: This was retrospective analysis of a prospective cohort, which included patients who presented to the emergency department (ED) after a self-harm or suicide attempt from Jan 2013 to Dec 2017. The proportion of methods in suicide attempts, psychological consultation, and fatality according to the suicide attempt method were analyzed. The types of poison were also analyzed. RESULTS: Poisoning was the most common method of suicide attempts (52.1%). The rate of psychological consultations were 18.8% for all patients and 29.1% for poison patients (p < 0.001). The rate of mortality in poisoning was 0.6%. Psychological consultation was performed more frequently in admission cases than discharged cases. The most common materials of poisons was psychological medicines and sedatives that had been prescribed at clinics or hospital. CONCLUSION: Self-poisoning is a major method of suicide attempt with a high rate of psychiatric consultation, low mortality rate, versus others methods. The prevention of suicide death for suicide attempts may focus on self-poisoning, which is the major method of suicide attempts. A suitable aftercare program for self-poisoning may be an effective method for preventing suicide if an early diagnosis and management of psychiatric disorders through psychiatric consultation can be made, and early connection to social prevention program for non-fatal patients are possible.
Aftercare ; Cohort Studies ; Early Diagnosis ; Emergency Service, Hospital ; Humans ; Hypnotics and Sedatives ; Incidence ; Methods ; Mortality ; Poisoning ; Poisons ; Prospective Studies ; Referral and Consultation ; Retrospective Studies ; Risk Factors ; Suicide*

Intestinal obstruction involves a partial or complete blockage of the bowel which results in the failure of intestinal contents to pass through. The mechanical causes of obstruction may include the followings: hernias, postoperative adhesions or scar tissue, impacted feces, gallstones, tumors, granulomatous processes, intussusception, volvulus, foreign bodies, and etc. Hernias are the third leading cause of intestinal obstruction by 10% approximately. However, most hernias are the cases with abdominal wall, inguinal or internal hernia. Femoral, obturator, lumbar, or sciatic hernia as the cause of obsturction is rare. Furthermore, the cases accompanying soft tissue necrosis are seldomly reported. Herein, we report a case of intestinal obstruction caused by strangulated femoral hernia accompanying soft tissue necrosis in a 78-years-old female patient.
Aged ; Diagnosis, Differential ; Female ; Hernia, Femoral/*complications/diagnosis/surgery ; Humans ; Intestinal Obstruction/diagnosis/*etiology/surgery ; Necrosis ; Skin/*pathology ; Tomography, X-Ray Computed

Nephrogenic fibrosing dermopathy (NFD) is a rare cutaneous fibrosing disorder that primarily affects patients with a history of renal disease. NFD manifests with induration, thickening and hardening of the skin with brawny hyperpigmentation. Lesions are typically symmetrical and usually develop on the limbs and trunk. Flexion contractures of the joints may be a feature of the disease. Histopathological features of NFD include proliferation of dermal fibroblasts and dendritic cells, thickened collagen bundles, increased elastic fibers and focal mucin deposition. Although the pathogenesis remains largely unknown, some of the factors implicated in the pathogenesis include renal dysfunction, circulating fibrocytes, vascular injury, and gadolinium which is a contrast material used in magnetic resonance imaging. Currently, no definitive or uniformly effective therapies are available for the treatment of NFD. We herein describe the case of a 44-year-old female NFD patient who undergoes significant improvement of skin lesions and associated joint contracture after renal transplantation.
Adult ; Carubicin ; Collagen ; Contracture ; Dendritic Cells ; Elastic Tissue ; Extremities ; Female ; Fibroblasts ; Gadolinium ; Humans ; Hyperpigmentation ; Joints ; Kidney Transplantation ; Magnetic Resonance Imaging ; Mucins ; Nephrogenic Fibrosing Dermopathy ; Skin ; Vascular System Injuries