Background: Perioperative anaphylaxis is a life-threatening clinical condition characterized by severe respiratory and cardiovascular manifestations. Neuromuscular blocking agents are the most common cause of anaphylaxis during anesthesia. Case: We report a case of rocuronium-induced anaphylaxis treated with sugammadex. A 75–year-old woman was scheduled to undergo spinal surgery. She had no history of allergies. After the injection of rocuronium, she developed hypotension and tachycardia, and skin rashes and urticaria appeared. The patient received sugammadex to delay the operation, and her vital signs were stabilized. On the 76th postoperative day, we performed intradermal tests for rocuronium, propofol, and cefazolin. Diluted rocuronium alone induced 14 mm of flare and 8 mm of wheal within 5 min, both of which disappeared within 15 min after the intradermal injection. Conclusions Sugammadex is a useful rocuronium antagonist that can be used to treat rocuronium-induced anaphylaxis.

The purpose of this study is to present the information on the duration of treatment and the cost of work-related low back pain. Using the compensation-database for 1997 work-related low back pain (n=9,277), this study estimated the duration of treatment, the cost of work-related low back pain, the relationship between them, and probability of being off treatment at different intervals. The mean and the median of the treatment duration are 252.6 days and 175 days. The mean and the median of the cost of total insurance benefit are 37,700,000 won and 14,400,000 won. The treatment duration of 51% of the study subjects was less than 6 months and their cost accounted for 10.2% of the total insurance benefit. The subjects who were treated more than 24 months were 5.8% but it accounted for 29.2% of the cost. It was found that approximately 50% of the subjects who will remain on treatment at the end of n months would be off treatment at the end of n+5 months. This study presents the point in time when the low back pain (LBP) workers need to prepare to return to work by forecasting their off-treatment period. From the treat duration and cost perspectives, this study may be utilized as evidence for active management of work-related LBP.
Absenteeism ; Back Injuries/*therapy ; Bayes Theorem ; *Cost of Illness ; Costs and Cost Analysis ; Disability Evaluation ; Humans ; Insurance, Health ; Korea ; Low Back Pain/*therapy ; Sick Leave ; Time Factors ; Work ; Workers' Compensation

Epithelioid hemangioendothelioma(EH) is a rare vascular tumor of low-grade malignancy. It was previously described as intravascular bronchioloalveolar tumor (IVBAT). But electron microscopic study and immunohistochemical staining results have proved endothelial origin. Patients are usually asymptomatic and the tumors are found incidentally on routine chest X-rays. Most patients show a slowly progressive clinical course, even though some patients occasionally die as results of respiratory failure or extrathoracic complications. Confirmative diagnosis is made through thoracoscopic or open-lung biopsy. There is still no effective therapeutic modality for pulmonary EH. We have experienced a 55-year-old woman whose simple chest x-ray film revealed bilateral multiple small nodules. The nodules were histopathologically and immunohistochemically diagnosed as primary epithelioid hemangioendothelioma of the lung. The possibility of metastatic disease was excluded thorough clinical, laboratory and radiological studies. Comparison of radiographic chest film taken 3 years ago showed no significant progression of the pulmonary nodular lesions. Conservative management was instituted and careful 4 months follow-up showed no significant changes.
Biopsy ; Diagnosis ; Female ; Follow-Up Studies ; Hemangioendothelioma, Epithelioid* ; Humans ; Lung ; Middle Aged ; Respiratory Insufficiency ; Thorax ; X-Ray Film

No abstract available.
Lutein* ; Plasma*

The purpose of this study was to examine the effects of anti-sperm antibody (ASA) on the fertilization processes using conventional IVF and ICSI procedure in human and hamster oocytes. In human IVF, we have observed restricted fertilization with sperm testing positive for ASA. (23~90% IgA, 60-97 % IgG). However, if ICSI was perform in the next IVF cycle with the same patients, we could successfully fertilize the oocytes (37%; p<0.001), thus achieving pregnancy and delivery. When the sperm were cocultured in medium containing ASA, there were binding of ASA to sperm surface. In addition, the mean rate of the acrosomal reaction in an in vitro acrosome reaction test was lower for Ab-bound sperm (43.5%) than for Ab-free sperm group (51.3%, p<0.05). We used human sperm and hamster oocytes to confirm the negative effects of the ASA on fertilization. The sperm and/or oocytes have been expose to medium containing ASA before IVF and ICSI. In this experiment, the ASA was bound to the oocyte and sperm surface. The following results were obtain by using various combinations of ASA free or ASA bound sperm with ASA free or ASA bound oocytes for IVF. When ASA free sperm were inseminate with ASA free and ASA bound hamster oocytes, the fertilization rates are 89.6% and 74.3% respectively. However, when ASA bound human sperm were use the results were 62.5% and 55.6% respectively. These shows the fertilization rate was significantly decreased in both ASA bound and ASA free oocytes when using ASA bound sperm. No difference found when ASA are present on the oocyte surface. When the hamster oocytes was treated by ICSI with ASA free or ASA bound human spermatozoa, no significant difference was found. These results showed that ICSI is the most promising method for couples who fertilization was not possible by conventional IVF because of ASA.
Acrosome Reaction ; Animals ; Antibodies* ; Cricetinae ; Family Characteristics ; Fertilization ; Humans ; Immunoglobulin A ; Oocytes ; Pregnancy ; Sperm Injections, Intracytoplasmic* ; Spermatozoa

As surgical trend for breast cancer changes, the method for breast reconstruction is also changing. Due to improved diagnostic techniques and public awareness, more and more patients with breast cancer are diagnosed at earlier stage and the number of patients who undergo skin sparing mastectomy is also increasing. Skin sparing mastectomy has several advantages for immediate breast reconstruction over modified radical mastectomy. Its preservation of breast skin envelope and inframammary fold made it possible to provide more natural breast mound shape without any evidence of increased local recurrence of malignancy. Furthermore, in case of immediate breast reconstruction after modified radical mastectomy, procedures for nipple-areolar reconstruction was deferred for fear of postoperative deformation and vascular problem of the flap. This interval made patients less satisfied with the result and postoperative adjuvant treatment had to be sometimes postponed. To avoid these limitations, "one-stage" breast reconstruction including nipple-areolar complex was performed after skin sparing mastectomy. From December 1998 to March 2000, a total of 12 patients with breast cancer underwent skin-sparing mastectomies, which were followed by immediate reconstruction using our new technique. After long-term follow-up, no major complication including flap necrosis or asymmetry was found and all patients were satisfied with the results. With careful patient selection and adequate intra-operative flap tailoring, this new technique could offer lots of advantages to both surgeons and patients.
Breast Neoplasms ; Breast* ; Female ; Follow-Up Studies ; Humans ; Mammaplasty* ; Mastectomy ; Mastectomy, Modified Radical ; Necrosis ; Patient Selection ; Recurrence ; Skin

As surgical trend for breast cancer changes, the method for breast reconstruction is also changing. Due to improved diagnostic techniques and public awareness, more and more patients with breast cancer are diagnosed at earlier stage and the number of patients who undergo skin sparing mastectomy is also increasing. Skin sparing mastectomy has several advantages for immediate breast reconstruction over modified radical mastectomy. Its preservation of breast skin envelope and inframammary fold made it possible to provide more natural breast mound shape without any evidence of increased local recurrence of malignancy. Furthermore, in case of immediate breast reconstruction after modified radical mastectomy, procedures for nipple-areolar reconstruction was deferred for fear of postoperative deformation and vascular problem of the flap. This interval made patients less satisfied with the result and postoperative adjuvant treatment had to be sometimes postponed. To avoid these limitations, "one-stage" breast reconstruction including nipple-areolar complex was performed after skin sparing mastectomy. From December 1998 to March 2000, a total of 12 patients with breast cancer underwent skin-sparing mastectomies, which were followed by immediate reconstruction using our new technique. After long-term follow-up, no major complication including flap necrosis or asymmetry was found and all patients were satisfied with the results. With careful patient selection and adequate intra-operative flap tailoring, this new technique could offer lots of advantages to both surgeons and patients.
Breast Neoplasms ; Breast* ; Female ; Follow-Up Studies ; Humans ; Mammaplasty* ; Mastectomy ; Mastectomy, Modified Radical ; Necrosis ; Patient Selection ; Recurrence ; Skin

PURPOSE: To assess the usefulness of breath-hold fast MR imaging of liver with fat suppression (FS) by application of chemical saturation technique in the diagnosis of regional fatty changed suspected in sonography. MATERIALS AND METHODS: Thirteen patients who had focal lesions with diffuse, homogeneous signal changes after FS through chemical saturation technique without additional changes of imaging parameter during MR imaging of liver were selected. T1-weighed fast low-angle shot and T2-weighted turbo spin-echo sequences were obtained with or without FS during each single breath-holding session. Subjective changes of signal intensity between the pre-FS and the FS images were compared with the sonographic findings in each lesion. RESULTS: Seven lesions of decreased signal intensity after FS on T1 or T2-weighted images, including three lesions only at FS T1 images, were regarded as focal fat infiltration. All seven lesions had compatible sonographic findings as homogenously echogenic areas. Another six lesions of subjectively increased signal intensity including two lesions only at FS T2 images were regarded as focal fat sparing. All six lesions had sonographic findings as homogenous echo poor areas suggesting focal fat sparing. In cases regarded as fat infiltration, score changes were more prominent at FS T1 images than FS T2 images(p=0.0002). In cases regarded as fat sparing, score changes were more prominent at FS T2 images than FS T1 images(p=0.042). CONCLUSION: Breath-hold fast T1 and T2-weighted MR imaging with and without chemical saturation pre-pulse may be sufficient for characterization of regional fatty changes in the different ferential diagnosis of focal hepatic lesion found at sonography.
Diagnosis ; Humans ; Liver* ; Magnetic Resonance Imaging* ; Ultrasonography

Background: The OptiscopeTM and the backward, upward, rightward pressure (BURP) maneuver are widely used in clinical practice because the BURP maneuver facilitates intubation by improving visualization of the larynx. However, the effect of the BURP maneuver is unclear when using the OptiscopeTM. Therefore, we retrospectively investigated the effect of the BURP maneuver on intubation using the OptiscopeTM. Methods: Sixty-eight patients intubated with the OptiscopeTM were enrolled. We used the BURP maneuver in Group A (n = 33) and the conventional maneuver (which does not use the BURP maneuver) in Group B (n = 35). BURP application status was a binary variable representing whether the BURP maneuver was used during the intubation. A multiple linear regression analysis was performed to assess the effects of the BURP application status on intubation time controlling for body mass index, preoperative dental injury status, obstructive sleep apnea history, thyromental distance, sternomental distance (SMD), interincisor distance, history of neck rotation restriction, and Mallampati classification. Results: There was no difference in the intubation time between the two groups. According to the regression model (R2 = 0.308, P = 0.007), the BURP maneuver (Group A) decreased the intubation time by 6.089 seconds (95% confidence interval 1.303–10.875, P = 0.014) compared to Group B. Conclusion The BURP maneuver reduced intubation time when using the OptiscopeTM.

PURPOSE: To report the long-term surgical outcomes of a muscle union procedure in patients with paralytic strabismus. METHODS: We retrospectively reviewed the medical records of 20 patients who underwent muscle union procedure for paralytic strabismus from September 2010 to March 2018. We analyzed the clinical results before and at the final visit after surgery. We also compared the outcomes of the first year after surgery between patients with sixth cranial nerve palsy, with third cranial nerve palsy and with medial rectus muscle rupture after endoscopic sinus surgery. RESULTS: The mean follow-up duration was 42 ± 20 months (12–79 months). The mean age at surgery was 40 ± 19 years (7–65 years). Eleven patients underwent surgery for sixth cranial nerve palsy, six patients underwent surgery for third cranial nerve palsy, and three patients underwent surgery for medial rectus rupture after endoscopic sinus surgery. The mean horizontal deviation at the primary eye position was 58 ± 19 prism diopters before surgery and decreased to 14 ± 17 prism diopters at the final visit. The success rate at the last visit was 60%. The mean horizontal deviation at postoperative 1 year was 4 ± 9 prism diopters in the sixth nerve palsy group and 26 ± 16 prism diopters in the third nerve palsy group (p = 0.002). The success rate was 91% in the sixth nerve palsy group and 33% in the third nerve palsy group at postoperative 1 year (p = 0.017). There were no complications during surgery or anterior segment ischemia for any of the patients. CONCLUSIONS A muscle union procedure had good long-term surgical outcomes in patients with paralytic strabismus, especially in patients with sixth cranial nerve palsy. However, in the case of third cranial nerve palsy or rupture of the medial rectus muscle, the effects were limited.