BACKGROUND: Endotracheal intubation is accomplished for safe airway establishment, anaesthesia and operation in operating room, intensive care unit and emergency room mostly. Therefore, it will be beneficial that we predict and provide against difficult airway. With this view, our study was planned and carried out. METHODS: For 251 patients with ASA physical status I or II undergoing general aneathesia, the correlation between their age, sex, height, weight, BMI (body mass index), Samsoon & Young classification and laryngoscopic grades by Cormack & Lehane was investigated. RESULTS: Laryngoscopic grades were correlated significantly with patients' age and Samsoon & Young classification. Endotracheal intubation succeeded all, but, 8 patients (3.2%) were difficultly intubated with cricoid cartilage compression and stylet-using. CONCLUSIONS: Before intubating the trachea, it is desirable that patient' age, Samsoon & Young classification and the extent of neck's movement are assessed.
Classification ; Cricoid Cartilage ; Emergency Service, Hospital ; Humans ; Intensive Care Units ; Intubation, Intratracheal* ; Operating Rooms ; Trachea

BACKGROUND: It has been said that anesthesia and surgery tend to increse 'stress hormone' followed by reduction of GFR and urine flow. We have been noticed a polyuria during mastoidectomy with anesthesia. We hypothesized that a reduction of ADH secretion related to operative procedure might be a cause of a transient polyuria. METHODS: In 41 patients who were in ASA class I, mean arterial pressure (MAP), heart rates (HR), temperature, central venous pressure (CVP) were measured at before induction, just before drilling with irrigation, 30 minutes and 60 minutes after drilling with irrigation, and on arrival in recovery room by groups (room temperatured irrigating fluid and warm fluid were used in group 1 and group 2) during procedures. In 7 of 41, blood samples for antidiuretic hormone (ADH) and plasma osmolalities (Posm) were withdrawn at the same time points. In all patients, fluid were administered with 4 ml/kg/hour throughout the procedures. RESULTS: In group 1, mean urine volume were 5.0 and 6.4 ml/min during anesthesia and drilling with irrigation that was significantly more than in group 2 (3.6 and 4.2 ml/min). In 7 patients, ADH concentration was decreased during surgery compared to pre-induction level, while the Posm were in normal ranges. None of the MAP, HR and CVP showed significant changes. ADH concentrations were not significantly correlated to Posm. CONCLUSIONS: We suggest that a reduction of ADH secretion may have a major role in transient polyuria during mastoidectomy, which might be related to the mechanism that; 1) lowered temperature of hypothalamo-pituitary system by cold irrigating fluid may induce a transient ischemic changes of pituitary gland, 2) absorption of hypoosmolar irrigating fluid to central circulation may reduce central osmotic pressure.
Absorption ; Anesthesia ; Anesthesia, General* ; Arterial Pressure ; Central Venous Pressure ; Heart Rate ; Humans ; Osmolar Concentration ; Osmotic Pressure ; Pituitary Gland ; Plasma* ; Polyuria ; Recovery Room ; Reference Values ; Surgical Procedures, Operative

This study was longitudinally conducted to evaluate the intakes of protein, Ca, Mg and P of exclusively breast-fed infants compared with the Recommended Dietary Allowances (RDA) for Korean infants. Twenty Korean lactating women and their infants during the first 3 months of lactation in Incheon area were participated. Protein, Ca and Mg, and P contents in the milk were determined using semimicro Kjeldahl (N X 6.38) , atomic absorption spectrophotometer and colorimeter, respectively, and also the milk consumption of the infants was measured by the test-weighing method. Protein contents of the milk were 1.96, 1.63, 1.51, 1.25 and 1.16 g/100 ml, and protein intakes of the breast-fed infants were 9.00, 9.85, 9.17, 8.97 and 7.76 g/day at 7, 15, 30, 60 and 90 days postpartum. The average protein intake per body weight of the breast-fed infants was 1.84 g/kg/day. The average intakes of Ca, Mg, P were 172.1 mg/day, 15.2 mg/day and 91.4 mg/day, respectively, and the average Ca/P ratio was 1.91. There was positive correlation between protein and Ca, protein and p, and Ca and P contents while negative correlation between Mg and P, The body weight of breast-fed infants increased normally from 3.6+/-0.41 g at birth to three month during lactation. It is suggested that the breast-fed infants in Incheon area consume almost adequately protein, Ca and P from the milk compared with RDA for Korean infants.
Absorption ; Body Weight ; Female ; Humans ; Incheon ; Infant* ; Lactation* ; Milk ; Parturition ; Postpartum Period ; Recommended Dietary Allowances

A 35 years old female patient was admitted to our neuro-pain clinic with symptoms of low back pain(L4, L5 level) radiated to both lower(L3, L4, L5 level) extremities that developed 6 years prior to admission. Upon initial physical examination, motor weakness or sensory deficit was absent. But on straight leg raising test, it was restricted to 60 degree in both lower extremities. Low back pain and radiating pain improved significantly after we performed epidural steroid injection. However on the next day of procedure the patient complaints more pain and started to experience severe pain during overnight for 3 days. On computer tomography(CT, L3-S1 level), we find suspicious lesion of herniated nucleus pulposus at L5-S1. Otherwise were within normal limits. Based on these symptoms, to find the other lesions, subsequently magnetic resonance imaging(MRI) was performed. Spinal tumor was seen at L2-3 level(2 2 4 cm). Neurosurgical surgery was recommended, and operation was performed. The patient was diagnosed to ependymoma after excision and cytologic studies. Even if one lesion was diagnosed, it must be put off until any other diseases or underlying cancer are ruled out. We report a patient with spinal cord tumor missed on CT, but revealed on MRI in the evaluation and management of herniated nucleus pulposus related(L5-S1) low back pain.
Adult ; Ependymoma ; Extremities ; Female ; Humans ; Leg ; Low Back Pain ; Lower Extremity ; Magnetic Resonance Imaging ; Physical Examination ; Spinal Cord Neoplasms* ; Spinal Cord*

BACKGROUND: It is clinically important to know the distance of upper airway for airway management and respiratory care. The knowledge is useful for avoiding many possible complications due to endotracheal intubation by appropriate choice of endotracheal tube depth. METHODS: We investigated the distance from nose to carina according to the patient,s age, weight, height, sex with computed Tomography in 100 adults who had no anatomical abnormality of the upper airway, neck and head. RESULT: The length between upper incisor and vocal cord was 15.0+/-0.8 cm in male and 13.9+/-0.6 cm in female. The length between vocal cord and carina was 13.2+/-0.8 cm in male and 11.9+/-0.9 cm in female. The length between upper incisor and carina was 28.3 0.9 cm in male and 25.9+/-1.2 cm in female. The length between nose and vocal cord was 17.7+/-0.9 cm in male and 15.9+/-0.8 cm in female. The length between nose and carina was 30.9+/-1.2 cm in male and 27.9+/-1.3 cm in female. The distance of upper airway increased according to patient, s (n=100) height, weight and age(p<0.05). The distance of upper airway not increased according to female patient, s (n=36) age(p>0.05). CONCLUSION: The length between vocal cord and carina, nose and carina, incisor and carina increased according to patient, s (n=100) height, weight and age.
Adult ; Airway Management ; Female ; Head ; Humans ; Incisor ; Intubation, Intratracheal ; Male ; Neck ; Nose ; Vocal Cords

PURPOSE: To report a case of rhino-orbito-cerebral aspergillosis successfully treated with a combination of amphotericin B, posaconazole and amphotericin B irrigation. CASE SUMMARY: A 59-year-old male with hypertension, diabetes mellitus and hyperlipidemia was admitted to our neurology department for left facial paresthesia, pain and consulted to ophthalmology for left eyeball pain. His visual acuity was no light perception in the left eye, and fundus examination showed papilledema and a cherry-red spot. Left exophthalmos and complete ptosis with ophthalmoplegia were also observed. Orbital computed tomography revealed left maxillary and ethmoid sinusitis, and nasal endoscopic examination revealed a black eschar adjacent to the middle turbinate. Subsequent biopsy suggested mucormycosis. The patient was immediately treated with a combination of amphotericin B and posaconazole. In addition, left endoscopic sinus surgery was performed and aspergillosis was histopathologically confirmed. The patient underwent amphotericin B irrigation for 5 days after canula insertion up to orbital apex. The patient survived for 18 months and is still alive. CONCLUSIONS: A combination of amphotericin B, posaconazole and amphotericin B irrigation using the canula through the orbital apex may be helpful in treating patients with rhino-orbito-cerebral aspergillosis who refuse orbital exenteration.
Amphotericin B* ; Aspergillosis* ; Biopsy ; Diabetes Mellitus ; Ethmoid Sinus ; Ethmoid Sinusitis ; Exophthalmos ; Humans ; Hyperlipidemias ; Hypertension ; Male ; Middle Aged ; Mucormycosis ; Neurology ; Ophthalmology ; Ophthalmoplegia ; Orbit ; Papilledema ; Paresthesia ; Turbinates ; Visual Acuity

Cystic parathyroid adenoma is one of the rare causes of hyperparathyroidism, and is usually located in neck and mediastinum. This type of adenoma tends to cause increased serum level of parathyroid hormone and alkaline phosphatase, similar serum calcium level when compared to those of solid adenoma. Thanks to current radioimmunoassay and easy accessibility to serum autoanalyzer, serum calcium level and parathyroid hormone level are more easily measured, which in turn lead to more easier diagnosis of hyperparathyroidism. Also improvement in imaging and nuclear diagnostic method of parathyroid lesion are suggested to enable easy diagnosis of cystic parathyroid adenoma. A 35-year-old male presented with easy fatigability for 12 months. The serum calcium, phosphate, alkaline phosphotase were 11.5mg/dL, 1.4mg/dL, 194IU/L respectively and his parathyroid hormone level in serum was 126.42pg/mL. Neck CT showed enlargement of right lobe of thyroid gland with well defined inhomogenously enhanced density inside the right thyroid gland. The patient was diagnosed of hyperparathyroidim due to parathyroid adenoma and was surgically removed. The surgical biopsy showed cystic parathyroid adenoma. After operation his general condition was improved and serum calcium, phosphate, parathyroid hormone level were normalizd. We report a case of hyperparathyroidism caused by cystic parathyroid adenoma with brief review of literature.
Adenoma ; Adult ; Alkaline Phosphatase ; Biopsy ; Calcium ; Diagnosis ; Humans ; Hyperparathyroidism* ; Male ; Mediastinum ; Neck ; Parathyroid Hormone ; Parathyroid Neoplasms* ; Radioimmunoassay ; Thyroid Gland

BACKGROUND: Propofol injection pain is an unpleasant experience to patients and its prevalence can be influenced by age and gender. We determined the half maximal effective concentration (EC50) of remifentanil for preventing the microemulsion propofol injection pain in the male and female adult groups. METHODS: After institutional review board approval, a total of 60 patients were assigned into 2 groups depending on their gender: group M (male, 20-65 yr) and group F (female, 20-65 yr). Anesthesia was induced with propofol and remifentanil, by a target-controlled infusion. Target effect-site concentration (Ce) of propofol and remifentanil for the first patient started at 4.0 ug/ml and 4.0 ng/ml. Ce of remifentanil for each subsequent patient was determined by the response of the previous patient by the Dixon's up-and-down method (DUDM) with an interval of 0.2 ng/ml. After equilibration of plasma and effect site remifentanil concentration, propofol was administered, and the pain responses were observed. RESULTS: The remifentanil EC50 was 3.8 +/- 0.2 and 2.7 +/- 0.2 ng/ml in groups M and F, respectively, by DUDM. From Probit regression model, the remifentanil EC50 was 3.7 (3.0-4.3) and 2.7 (1.8-2.9) ng/ml in groups M and F, respectively. CONCLUSIONS: The remifentanil EC50 for preventing the moderate to severe injection pain of propofol was higher in males than in females.
Adult ; Anesthesia ; Ethics Committees, Research ; Female ; Gender Identity ; Humans ; Male ; Piperidines ; Plasma ; Prevalence ; Propofol

PURPOSE: The purpose of this study was to identify the relationship between self reported climacteric symptoms, and depression, and the quality of life in middle aged women. METHOD: The subjects of this study were 149 women from 40 to 64 years of age. Climacteric symptoms were measured with Neugarton's tool(1965) and depression with Zung's tool. Quality of life was related to self reported climacteric symptoms were education level(F=3.011, p=.035), income measured by Rho's tool(1988). RESULT: The general characteristic variables significantly level(F=2.670, p=.057), income satisfaction (F=3.413, p=.011), perceived subjective health condition(F=28.623, p=.000). The general characteristic variables significantly related to depression were age(t=-2.476, p=.014), education level(F=4.492, p.013), income satisfaction (F=2.845, p.026), perceived subjective health condition(F=8.468, p=.000). The general characteristics variables significantly related to quality of life were income level(F=5.010, p=.000), income satisfaction(F=6.314, p=.000), perceived subjective health condition(F=3.516, p<=.032), menstruation cycles(t=-2.66, p=.023). The relationship between self reported climacteric symptoms and depression had a statistically a positive correlation(r=.357, p=.000). The relationship between depression and quality of life had a statistically with a negative correlation(r=-.397, p=.000). CONCLUSION: These results may contribute to a better understanding of depression and quality of life in middle aged women. Therefore, health programs for prompting climacteric women's health should be a planned based on results of the study.
Climacteric* ; Depression* ; Education ; Female ; Humans ; Menstruation ; Middle Aged ; Quality of Life* ; Self Report ; Women's Health

BACKGROUND: We investigated the hypothesis that pretreatment with nefopam 20 mg would influence the onset and recovery profiles of rocuronium-induced neuromuscular block. METHODS: After Institutional Review Board approval, 134 patients, aged between 20–65 years, belonging to the American Society of Anesthesiologists physical status classification I or II, were randomly allocated to receive either 0.9% normal saline (control group) or nefopam 20 mg (nefopam group), infused over one hour before induction of anesthesia. Anesthesia was induced with remifentanil and propofol, followed by endotracheal intubation with rocuronium 0.6 mg/kg. We recorded the lag time, onset time, clinical duration, recovery index, recovery time, and total recovery time. RESULTS: We included 111 patients in the final analysis. The lag time, onset time, clinical duration, recovery index, recovery time, and total recovery time of the nefopam group (n = 57) were not significantly different compared with that of the control group (n = 54). CONCLUSIONS: Pretreatment with nefopam 20 mg one hour before induction of anesthesia does not have a significant influence on the onset and recovery profiles of rocuronium-induced neuromuscular block.
Anesthesia ; Classification ; Drug Interactions ; Ethics Committees, Research ; Humans ; Intubation, Intratracheal ; Nefopam* ; Neuromuscular Blockade* ; Neuromuscular Monitoring ; Neuromuscular Nondepolarizing Agents ; Propofol ; Prospective Studies*