Background: Conventional laryngoscopy with Macintosh blade requires a movement of the head, neck and cervical spine. The Bullard laryngoscope is an anatomically shaped, potentially eliminating the need for cervical spine extension. Bullard and Macintosh laryngoscopes were compared by measuring the degree of cervical spine extension by radiological measurement. Methods: Eighteen patients requiring endotracheal intubation were studied. Anesthesia was induced in neutral head position followed by laryngoscopy. Each patients was intubated two times by Macintosh and Bullard laryngoscope in random order. Radiographic evaluation was performed to determine the degree of cervical spine extension on four occasions; before induction, during facial mask ventilation, and during Bullard and Macintosh laryngoscopy. Results: The extension of cervical spine was significantly less following Bullard laryngoscopy than Macintosh laryngoscopy for best view (p<0.05). Conclusions: The Bullard laryngoscope can be used with less cervical spine extension than Macintosh laryngoscope. It may be useful in patients in whom cervical spine movement is limited or undesirable.
Anesthesia ; Head ; Humans ; Intubation, Intratracheal ; Laryngoscopes ; Laryngoscopy* ; Masks ; Neck ; Spine* ; Ventilation

BACKGROUND: This study was aimed to investigate the perception on working conditions and utilization of clinical research coordinators (CRCs) among investigators and sponsors. METHODS: The participants of this cross-section study were 114 investigators and 138 sponsors including clinical research associates (CRAs) who have worked with CRCs. Data was collected with paper or electronic form of self-administered questionnaires and analyzed with descriptive statistics and chi2 test or t test. RESULTS: Among investigators and sponsors, 56.1 % and 95.0 % perceived regular full-time positions as proper type of CRC employment, respectively. Those who perceived monthly salary with incentive as proper payment system were 67.5 % of investigators and 68.8 % of sponsors. The proper salary for 2-year CRCs and 5-year CRCs were significantly higher in sponsors than investigators. Investigators perceived CRCs could handle 3 studies as the same time and 5 studies per year. In regard to the difficulty in utilizing CRCs, 68.4 % of investigators perceived lack of experienced CRCs and 84.8 % of sponsors did frequent turnover. Those who responded pooling CRCs by hospital or clinical trial centers as a good solution to hire CRCs easily were 81.6 % of investigators and 58.0 % of sponsors. CONCLUSION: Almost all investigators and sponsors perceived CRCs were helpful for improving the quality of clinical trials. We recommend each institution or clinical trial centers could introduce the central CRCs' employment and management with proper salary and workload based on the results to maintain experienced CRCs and lessen the turnover of CRCs.
Calcium Hydroxide ; Electronics ; Electrons ; Employment ; Humans ; Motivation ; Surveys and Questionnaires ; Research Personnel ; Salaries and Fringe Benefits ; Zinc Oxide

BACKGROUND: This study was aimed to investigate the current two years' clinical research coordinators (CRCs) employment and estimate total number of CRCs in Korea. METHODS: The participants were administrative officers or head CRCs in institutions designated by Korea Food & Drug Administration (KFDA). Data on the current status of CRCs' employment was collected with self-administered questionnaires or telephone interview. And total number of CRCs in Korea was estimated based on ratio between the number of the KFDA approved clinical trials and current number of CRCs. RESULTS: The number of CRCs was 1381 at 36 centers in 2009 and 1444 at 37 centers in 2010. About 79 percent of CRCs were employed by investigators. The estimated number of CRCs was from 1677 to 1763 at 135 centers in 2009 and from 1802 to 1890 at 142 centers in 2010 based on number of clinical trials approved by KFDA. Two third of regional clinical trial centers (RCTCs) had written employment policy, and 25 percent of RCTCs employed CRCs in a regular position. All RCTCs had educational programs for CRCs and supported CRCs for training outside. 75 percent of RCTCs provided ID card for CRCs belonging to investigators to access to hospital document. Half of RCTCs had CRC registration system in hospital-wide. CONCLUSION: The number of CRCs in Korea can be easily estimated with the number of KFDA approved clinical trials. Majority of RCTCs still employed CRCs in an irregular position, which should be switched to regular position to reduce the CRCs' unsatisfaction. It is also needed to develop centralized CRC management system for CRCs belonging to investigators.
Calcium Hydroxide ; Employment ; Head ; Humans ; Interviews as Topic ; Korea ; Surveys and Questionnaires ; Research Personnel ; Zinc Oxide

BACKGROUND: There are reports suggesting the effect of red blood cells (RBCs) on blood coagulation. The effects of red blood cells (RBCs) on coagulation were investigated in vitro while maintaining other coagulation elements constant. METHODS: Twenty-five healthy male volunteers were enrolled. Citrated fresh whole blood was drawn from each subjects and processed into washed RBCs and platelet-rich plasma (PRP). To make six different hematocrit groups with each blood, PRP was mixed with the same volume of serially diluted washed RBCs. Reaction time, coagulation time, clot formation rate, and maximum amplitude were measured using recalcified TEG. RESULTS: The mean +/- SD of six different hematocrit was 38.0 +/- 2.3% (group 1), 28.9 +/- 2.2% (group 2), 21.3 +/- 1.9% (group 3), 13.8% +/- 1.6% (group 4), 7.1 +/- 1.0% (group 5), and 0 +/- 0% (group 6). The platelet count ranged from 141,000 to 292,000/mm3. Maximum amplitude (r = -0.4213, P< 0.001) and alpha angle (r = -0.216, P< 0.05) showed statistically significant negative linear relationship with hematocrit. CONCLUSIONS: A gradual reduction in hematocrit was associated with a shortened coagulation time, no changes in reaction time. This study results suggest that a gradual reduction in the RBC mass in vitro accelerates coagulation and forms stronger fibrin strands.
Blood Coagulation ; Erythrocytes ; Fibrin ; Hematocrit ; Humans ; Male ; Platelet Count ; Platelet-Rich Plasma ; Reaction Time ; Thrombelastography

No abstract available.
Analgesia* ; Cesarean Section* ; Emergencies* ; Female ; Pregnancy ; Spinal Cord Injuries* ; Spinal Cord*

Vocal cord paralysis is one of the most serious anesthetic complications related to endotracheal intubation. The practitioner should take extreme care, as bilateral vocal cord paralysis can obstruct the airway and lead to disastrous respiratory problems. There have been many papers on bilateral vocal cord paralysis after neck surgery, but reports on such a condition after lung surgery are very rare. We report a case of bilateral vocal cord paralysis detected after removal of a double-lumen endotracheal tube in a 67-year-old patient who underwent wedge resection by video-assisted thoracoscopic surgery. We also note that he recovered spontaneously without complications within a day.
Aged ; Humans ; Intubation, Intratracheal ; Lung ; Neck ; Thoracic Surgery, Video-Assisted ; Vocal Cord Paralysis ; Vocal Cords

Polycythemia vera is a chronic progressive myeloproliferative disease characterized by increased circulating red blood cells, and the hyperviscosity of the blood can lead to an increased risk of arterial thrombosis. In a previous survey regarding postoperative outcomes in polycythemia vera patients, an increased risk of both vascular occlusive and hemorrhagic complications have been reported. Aortic surgery involving cardiopulmonary bypass may be associated with the development of a coagulopathy, and as a result, the occurrence of thrombotic complications should be avoided after coronary anastomosis. Thus, optimizing the hemostatic balance is an important concern for anesthesiologists. However, only a few cases of anesthetic management in polycythemia vera patients undergoing concomitant aorta and coronary arterial bypass surgery have ever been reported. Here, we experience a polycythemia vera patient who underwent an emergency repair of a type-A aortic dissection and concomitant coronary artery bypass grafting, and report this case with a review of the relevant literature.
Aorta ; Cardiopulmonary Bypass ; Coronary Artery Bypass* ; Coronary Vessels* ; Emergencies* ; Erythrocytes ; Humans ; Polycythemia Vera* ; Polycythemia* ; Thrombelastography ; Thrombosis

Transesophageal echocardiography (TEE) is a relatively noninvasive and highly valuable diagnostic modality to monitor cardiac surgery. TEE is utilized to estimate the results of the surgical correction or the cardiac function on a real time basis. Accordingly, the frequency of TEE usage is increasing. Previous studies have shown low risk of TEE-associated complications; nonetheless, major gastrointestinal trauma can occur on a rare occasion. We herein present a case of Mallory-Weiss laceration after an intraoperative TEE examination.
Echocardiography, Transesophageal ; Humans ; Mallory-Weiss Syndrome ; Mitral Valve ; Organothiophosphorus Compounds ; Thoracic Surgery

OBJECTIVE: The present study aimed to evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) at a high frequency using a miniaturized device compared to standard rTMS and sham rTMS for the treatment of depression. METHODS: Fifty-four patients with depression were randomly assigned to either 15 days of miniaturized, standard, or sham rTMS. The stimulation consisted of 60 trains of 5 seconds at 10 Hz for 30 minutes. Clinical measures were assessed at baseline and on the final day of the stimulation. RESULTS: A repeated-measures analysis of variance revealed a significant main effect of time and a time by group interaction on Hamilton Rating Scale for Depression scores. There were no significant correlations between individual motor thresholds and changes of clinical outcomes. Our results revealed a significant reduction in the Hamilton Rating Scale for Depression in the miniaturized and standard groups compared to the sham group. CONCLUSION: The antidepressant utility of miniaturized rTMS using subthreshold stimulation was comparable to that of standard stimulation.
Antidepressive Agents ; Depression ; Humans ; Transcranial Magnetic Stimulation

OBJECTIVE: After the Sewol ferry disaster, bereavement with suicidal ideation was a critical mental health problem that was accompanied by various neuropsychological symptoms. This study examined the frontal alpha asymmetry (FAA), heart rate variability (HRV), and several psychological symptoms in bereaved family members (BFM) after the Sewol ferry disaster. METHODS: Eighty-three BFM after the Sewol ferry disaster were recruited. We assessed FAA, HRV, and psychological symptoms, including depression, post-traumatic stress, post-traumatic growth factor, anxiety, grief, and positive resources, between BFM with the presence and absence of current suicidal ideation. RESULTS: Compared to BFM without suicidal ideation, BFM with suicidal ideation showed a higher FAA with right dominance. Significant differences in psychological symptoms were observed between the groups. In BFM with suicidal ideation, the low: high frequency (LF:HF) ratio correlated with social resources and support. CONCLUSION: The FAA and LF:HF ratio may be biomarkers that represent the pathological conditions of BFM with suicidal ideation. If researched further, they may shed light on the interaction between bereavement with suicidal ideation and social resources for therapeutic intervention.
Anxiety ; Bereavement ; Biomarkers ; Depression ; Disasters* ; Grief ; Heart Rate* ; Heart* ; Humans ; Mental Health ; Suicidal Ideation*