BACKGROUND: This study was designed to compare the hemodynamic changes in response to direct laryngoscopy of the McCoy blade and the Macintosh blade. METHODS: Sixty patients scheduled for elective gynecologic surgery were randomly allocated into two groups. The induction of anesthesia was done with thiopental sodium 5 mg/kg, fentanyl 2 mcg/kg, vecuronium 0.1 mg/kg. When the train of four arrived came at 0/4, the vocal cords were visualized with either the McCoy or the Macintosh laryngoscope blade for 10 seconds. Heart rate and blood pressure were recorded at 1 minute intervals for 5 minutes. RESULTS: Laryngoscopy caused significant increases in arterial blood pressure in both groups, while it had no effect on heart rate in either group. There were no significant differences in blood pressure and heart rate responses to laryngoscopy in the blades. CONCLUSIONS: The McCoy and the Macintosh blade show similar changes in heart rate and blood pressure after laryngoscopy.
Anesthesia ; Arterial Pressure ; Blood Pressure ; Female ; Fentanyl ; Gynecologic Surgical Procedures ; Heart Rate ; Hemodynamics* ; Humans ; Laryngoscopes* ; Laryngoscopy ; Thiopental ; Vecuronium Bromide ; Vocal Cords

A 69-year-old male presented with a week of worsening headache, mild dizziness and left side weakness,and the radiological work-up of his brain displayed an enhancing mass on the right frontal lobe.The tumor was totally resected. The patient was initially diagnosed with glioblastoma multiforme. Hisneurologic symptoms recovered after surgery. He underwent adjuvant radiotherapy with concurrent temozolomide.Approximately 7 months after surgery, the patient complained of epigastric pains. AbdominalCT scan showed multiple hepatic metastasis and multiple lymphadenopathy. Chest CT andTorso positron emission tomography-CT scans for additional metastasis study revealed multiple metastaticlesions in the right lung, left pleura, liver, lymph nodes, bones, and muscles. Percutaneous liverbiopsy was performed, and associated pathology was consistent with sarcomatous component. Afterliver biopsy, brain tumor pathology was reviewed, which revealed typical gliomatous and sarcomatouscomponents. The patient was therefore diagnosed with metastatic gliosarcoma. The patient was in aseptic condition with aggravated pleural effusion. The patient died 9 months after the diagnosis of primarygliosarcoma.

We report a case of bronchoesophageal fistula detected during induction of general anesthesia in brain abscess patient. Bubbling sound at substernal area and gas bubble at oral cavity during manually assisted mask ventilation, especially inspiration, were detected. Barium esophagography, gastroscopy and bronchoscophy were performed to know the nature of fistula after neurosurgical operation. The patient had a bronchoesophageal fistula due to unproperly treated old pulmonary tuberculosis. Esophageal opening of fistula located at midesophagus about 27 cm distance from incisor, while bronchial opening located at apical segment of right superior bronchus. It depends on the size, location, and duration of fistula to manifest clinical symptom. In bronchoesophageal fistula, the size of opening tends to be small and gradual symptom onset while relatively large and early in TEF. Therefore, knowledge of the differences of two types of fistula are essential to manage the patient who have these types of fistula.
Anesthesia, General* ; Barium ; Brain Abscess* ; Brain* ; Bronchi ; Fistula* ; Gastroscopy ; Humans ; Incisor ; Masks ; Mouth ; Tuberculosis ; Tuberculosis, Pulmonary ; Ventilation

Krukenberg tumor of the primary breast carcinoma is rare and this is almost invasive lobular carcinoma. They are usually bilateral and frequent in premenopausal women. Diagnosis of symptomatic Krukenberg tumor is reported to be 1 or 2 year after the diagnosis of primary neoplasm. But sometimes it is discovered prior to the detection of the primary breast carcinoma. Unexpected ovarian micrometastasis was recognized after oophorectomy of normally appearing ovaries in breast cancer patients. Existence of Krukenberg tumor means advanced primary disease and possible metastasis to other organs, and have a poorer prognosis. We report a case of Krukenberg tumors occurred 3 years after the diagnosis of primary ductal type breast carcinoma.
Breast Neoplasms* ; Breast* ; Carcinoma, Lobular ; Diagnosis ; Female ; Humans ; Krukenberg Tumor* ; Neoplasm Metastasis* ; Neoplasm Micrometastasis ; Ovariectomy ; Ovary* ; Prognosis

Although the Codman-Hakim programmable valve is one of most popular shunt systems used in the clinical practice for the treatment of hydrocephalus, malfunctions related with this system have been also reported which lead to underdrainage or overdrainage of the cerebrospinal fluid. While obstruction of the ventricular catheter by tissue materials or hematoma and catheter disconnection are relatively common, the malfunction of the valve itself is rare. Herein, we report on a rare case of shunt overdrainage caused by displacement of the pressure control cam after pressure adjustment. A 57-year-old female, who underwent a ventriculoperitoneal shunt eight years ago, experienced aggravating symptoms of shunt overdrainage after pressure adjustment. Displacement of the pressure control cam was revealed on the X-ray, and a shunt revision was performed. The purpose of this report is to provide a working knowledge of the valve structure and to enhance the ability to interpret the valve setting on an X-ray for diagnosis of valve malfunction.
Catheters ; Cerebrospinal Fluid ; Cerebrospinal Fluid Shunts ; Diagnosis ; Equipment Failure ; Female ; Hematoma ; Humans ; Hydrocephalus ; Middle Aged ; Ventriculoperitoneal Shunt

BACKGROUND AND OBJECTIVES: Nucleotide binding to purinergic P2Y receptors contributes to the regulation of fluid and ion transport in the middle ear epithelial cells. Here, we investigated the regulatory mechanism of the P2Y2 receptor agonist, uridine-5'-triphosphate (UTP), on Cl- transport in cultured normal human middle ear epithelial (NHMEE) cells. MATERIALS AND METHOD: Electrophysiological measurements were performed in monolayers of cultured NHMEE cells. Short circuit currents (Isc) were measured from the cells mounted in Ussing chambers under various conditions. RESULTS: Apical addition of UTP in presence of amiloride evoked a transient rise and a sustained response in Isc due to Cl- efflux. Application of different Cl- channel blockers to the apical side of the cells significantly decreased UTP-induced Isc. Niflumic acid (NFA), a known blocker of Ca(2+)-activated chloride channels (CACC), and CFTRinh172, a selective inhibitor of cystic fibrosis transmembrane conductance regulator (CFTR), partially inhibited the UTP-induced Cl- secretion, respectively. CONCLUSION: Cl- transport across the airway epithelia plays a predominant role in regulating airway hydration. In this study, UTP is shown to increase both CACC and CFTR-dependent Cl- secretion in NHMEE cells, suggesting their role in fluid and ion transport in the middle ear epithelium.
Amiloride ; Chloride Channels ; Cystic Fibrosis ; Cystic Fibrosis Transmembrane Conductance Regulator ; Ear, Middle ; Epithelial Cells ; Epithelium ; Humans ; Ion Channels ; Ion Transport ; Niflumic Acid ; Receptors, Purinergic P2Y ; Uridine Triphosphate

Objective: Burr hole trephination is a common treatment for chronic subdural hematoma, intracranial hematoma, and intraventricular hematoma due to its effective drainage of hematoma, minimal invasiveness and short operation time. However, cosmetic complications such as scalp depression can occur. The aim of this study was to evaluate the usefulness of an allogenic acellular dermal matrix (ADM) to prevent scalp depression at the burr hole site. Methods: A retrospective analysis was performed with 75 cases in 66 patients who were treated with burr hole trephination from January 2018 to December 2019. These cases divided into 2 groups; based on the method used to cover the burr hole site: Gelfoam packing only (GPO) and ADM. The degree of the scalp depression was measured from the more recent follow-up brain computed tomography scan. Results: There was a significant difference in the degree of scalp depression between GPO and ADM groups (p=0.003). No significant correlation between patient's age and the degree of scalp depression (GPO: p=0.419, ADM: p=0.790). There were no wound infection complication in either group. Conclusion ADM is a suitable material to prevent scalp depression after burr hole trephination.

BACKGROUND: During 2009 pandemic period, many Koreans were infected and admitted with Influenza A/H1N1. The primary aim of this study was to evaluate whether the structures of an intensive care unit (ICU) were associated with the outcomes of critically ill patients. METHODS: This retrospective observational study examined critically ill adult patients with influenza A/H1N1, who were admitted to 24 hospitals in Korea, from September 2009 to February 2010. We collected data of ICU structure, patients and 90 days mortality. Univariate and multivariate logistic regression analysis, with backward elimination, were performed to determine the most significant risk factors. RESULTS: Of the 239 patients, mortality of 90 days was 43%. Acute physiology and chronic health evaluation (APACHE) II score (p < 0.001), sequential organ failure assessment (SOFA) score (p < 0.0001), nurse to beds ratio (p = 0.039) and presence of intensivist (p = 0.024) were significant risk factors of 90 days mortality. Age (p = 0.123), gender (p = 0.304), hospital size (p = 0.260), and ICU type (p = 0.409) were insignificantly associated with mortality. In a multivariate logistic regression analysis, patients with less than 6 SOFA score had significantly lower mortality, compared with those with more than 10 SOFA score (odds ratio 0.156, p < 0.0001). The presence of intensivist had significantly lower mortality, compared with the absence (odds ratio 0.496, p = 0.026). CONCLUSIONS: In critically ill patients with influenza A/H1N1, the severity of the illness and presence of intensivist might be associated with 90 days mortality.
Adult ; APACHE ; Critical Illness ; Health Facility Size ; Humans ; Influenza, Human ; Critical Care ; Intensive Care Units ; Korea ; Logistic Models ; Pandemics ; Retrospective Studies ; Risk Factors

BACKGROUND: Pulmonary infiltrate in immunocompromised hosts has many infectious and non- infectios etiologies. To evaluate the diagnostic yield and therapeutic implication of two invasive diagnostic methods, such as bronchoscopy and surgical lung biopsy, we performed retrospective analysis of these patients. METHODS: All immunocompromised patients admitted to Samsung Medical Center from October 1995 to August 1998 who underwent bronchoscopy and/or surgical lung biopsy for the diagnosis of pulmonary infiltrates were included in this study. Confirmative diagnostic yield, the rate of changed therapeutic plan and patients' survival were investigated. RESULTS: Seventy-five episodes of pulmonary infiltrates developed in 70 patients(M : F = 46 : 24, median age 51). Underlying diseases of patients were hematologic malignancy(n=30), organ transplantatio n(n=11), solid tumor(n=12), connective tissue disease(n=6) and others. Confirmative diagnosis was made in total 53 cases (70.7%), of which 70.2% had infectious etiology. Diagnostic yields of bronchoscopy, bronchoalveolar lavage(BAL), transbronchial lung biopsy(TBLB) and surgical lung biopsy were 35.0%(21/60), 31.4%(16/51), 25.0%(9/36) and 80.0%(20/25). Therapeutic plan was changed in 40%(24/60) of patients after bronchoscopy and in 36%(9/25) of patients after surgical lung biopsy. More patients survived (84.4% vs 60.5%, p=0.024) when therapeutic plan was changed after invasive diagnostic study. CONCLUSION: Bronchoscopy and surgical lung biopsy are helpful for the therapeutic implication of pulmonary infiltrates in immunocompromised hosts. Large-scale prospective case-control study may further clarify their limitation and usefulness.
Biopsy* ; Bronchoscopy* ; Case-Control Studies ; Connective Tissue ; Diagnosis* ; Humans ; Immunocompromised Host* ; Lung* ; Retrospective Studies

BACKGROUND: Sleeve lobectomy of the main bronchus has been proposed to spare lung tissue in patients who cannot tolerate pneumonectomy because of impaired lung function. The purpose of this study was to evaluate whether sleeve lobectomy can preserve lung function as expected from preoperative evaluation of lung function in patients with non-small cell lung cancer. METHOD: Between January 1995 and March 1998, 15 patients with non-small cell lung cancer who underwent sleeve resection were evaluated. Preoperative evaluations included spirometry and quantitative lung perfusion scan, from which predicted postoperative FEV1 was calculated. At least 3 months after operation follow up spirometry and bronchoscopy were performed. Predicted FEV1 was compared with measured postoperative FEV1. RESULT: Fourteen men and one woman, with median age of 58 years, were reviewed. The diagnosis was squamous cell carcinoma in 13 patients and adenocarcinoma of lung in 2 patients. Our results showed a excellent preservation of pulmonary function after sleeve lobectomy. Correlation between the predicted (mean, 2180 +/- 570mL) and measured FEV1 (mean, 2293 +/- 499mL) was good ( r = 0.67, P< 0.05 ). Furthermore, patient with low FEV1 (<2L) showed improved lung function after sleeve lobectomy. CONCLUSION: These findings indicated a complete recovery of the reimplanted lung lobes after sleeve lobectomy. Therefore, this technique could be safely used in lung cancer patients with impaired lung function.
Adenocarcinoma ; Bronchi ; Bronchoscopy ; Carcinoma, Non-Small-Cell Lung ; Carcinoma, Squamous Cell ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Lung Neoplasms* ; Lung* ; Male ; Perfusion ; Pneumonectomy ; Respiratory Function Tests ; Spirometry