The author reports an anesthetic experience of right adrenalectomy. The patient was 38 years old male, having suffered from pheochromocytoma. Thiopental sodium, 300mg of 2.5% was used for induction, followed by N2O, O2, and halothane for maintenance and 0.1% S.C.C. solution in 500 ml of 5% D/W solution, dripped intravenously for muscle relaxation. AS the time of surgical manipulation of the gland, blood pressure was suddenly raised to 250/160mmHg, and a few minutes later massive bleeding, about 1800ml in amount, was detected in the operating and then the heart was arrested. Resuscitation was performed with adequate oxygenation and medications. The patient recovered well without any sequelae. The importance of preoperative preparation, sufficient sedation, smooth anesthetic induction, complete analgesia, good muscle relaxation, adequate ventilation and proper cardiovascular control are discussed together with the choice of anesthetic agents and practices.
Adrenalectomy ; Adult ; Analgesia ; Anesthetics ; Blood Pressure ; Halothane ; Heart ; Hemorrhage ; Humans ; Male ; Muscle Relaxation ; Oxygen ; Pheochromocytoma* ; Resuscitation ; Thiopental ; Ventilation

Anesthesia was induced with intravenous thiopental, followed by succinylcholine, N2O-O2-halothane and pancuronium. An endotracheal semiclosed circle absorption technic with controled ventilation was performed. Under continuous monitoring of blood pressure, pulse, EKG, CVP and urine output, the patient tolerated during the anesthetic period well. And high blood pressure was adequately controlled by increasing the percentage of halothane concentration only.
Absorption ; Adrenalectomy* ; Anesthesia ; Blood Pressure ; Electrocardiography ; Halothane ; Humans ; Hypertension ; Pancuronium ; Succinylcholine ; Thiopental ; Ventilation

PURPOSE: The goal of this study was to evaluate the diagnostic accuracy of preoperative fine needle aspiration biopsy cytology (FNAB-C) in predicting lateral lymph node metastasis in papillary thyroid cancer patients. METHODS: A total of 592 patients who underwent thyroid cancer surgery and intra-operative lateral cervical LN frozen section or RND, from January 2002 to December 2011, were evaluated retrospectively. Among them, 228 cases had suspicious findings in FNAB-C of lateral nodes. We reviewed their radiological and pathological reports. RESULTS: Intra-operative frozen section examination was performed in 540 cases and RND was performed in 314 cases. This study included 534 women (83.4%) and 106 men (16.6%). Patients' ranged in age from 9 to 83 years (mean, 45.65 years). FNAB-C was performed in 228 cases. The sensitivity and specificity of FNAB-C was 71.5% and 78.6%, respectively; 35.9% of cases had a false negative result. The combination of FNAB-C and intra-operative frozen section test sensitivity and specificity was 87.2% and 93.6%, respectively. CONCLUSION: The results for sensitivity in FNAB-C actually appear low, and false negative results were very high. In papillary thyroid cancer in patients with FNAB-C, even if the result is negative, if lymph node metastasis is suspected based on radiologic evidence, frozen section examination should be performed for determination of metastasis.
Biopsy ; Biopsy, Fine-Needle ; Female ; Frozen Sections ; Humans ; Lymph Nodes ; Male ; Neoplasm Metastasis* ; Retrospective Studies ; Sensitivity and Specificity ; Thyroid Neoplasms*

Various methods have been used on patients with skeletal Class II division 1 malocclusion. The activator, Frankel appliance, headgear, Herbst appliance, and Twin-block appliance are some examples. The ideal treatment effect using these appliances would be to inhibit horizontal and vertical growth of the maxilla while promoting mandibular growth and obtaining optimum dentition. The Teuscher appliance has a simultaneous combined headgear effect with maxillary growth inhibition and an activator effect with mandibular growth promotion. The purpose of this study was to examine how well these effects were clinically obtained and the results are as follows. 1. The forward growth of the maxilla was effectively inhibited. 2. The downward-forward growth of the maxillary dentoalveolar complex was inhibited. 3. Growth promotion of the mandible was not observed. 4. The overjet, overbite, molar key were effectively improved. 5. The protruded upper lip and facial profile were improved.
Dentition ; Humans ; Lip ; Malocclusion* ; Mandible ; Maxilla ; Molar ; Orthodontic Appliances, Functional ; Overbite

Purpose: This qualitative study aimed to explore the lived and true meaning of experiences of middle-aged patients with complex regional pain syndrome. Methods: The participants were 10 men and women aged 40 to 60 years who received outpatient treatment at a university hospital, could communicate, and agreed to participate in the study. Data were collected through individual interviews using open and semi-structured questions from September 2019 to July 2021 and were analyzed using the content analysis method suggested by Hsieh and Shannon (2005). Results: As a result of this study, 42 summarized semantic units related to life experience, 15 subthemes, and seven themes were derived. The seven themes were “pressed by severe pain,” “frustrated because I cannot be part of the community,” “distressed because people do not recognize my disease,” “sad about conflicts with family,” “unmotivated because of desperate life,” “appreciating for support,” and “putting oneself together and living daily life.” Conclusion The vivid experiences of the participants derived in this study are the basic data for developing treatment guidelines. In the future, we propose a study on life and family care experiences according to the developmental characteristics of the life cycle of patients with complex regional pain syndrome and develop and apply programs to support patients and their families.

Neonatal liver abscesses are rare, carry a high mortality rate, and are difficult to diagnose. The diagnosis of liver abscesses in the neonate cannot be established from the clinical presentation alone. Risk factors for liver abscesses in neonates are maternal infection, sepsis, umbilical venous catheterization, omphalitis, and necrotizing enterocolitis. In this report, we describe a preterm infant (32 weeks, 1,580 g) who presented with abdominal distension, respiratory difficulties, and a persistent inflammatory response in spite of broad spectrum antibiotic treatment; a large (6x5 cm) solitary pyogenic liver abscess was identified at 9 days of age. It appeared that the liver abscess had originated in the uterus and umbilical venous catheterization facilitated its spread. Percutaneous drainage under abdominal ultrasound guidance was performed and prolonged antibiotics were treated for 5 weeks, effecting a cure.
Anti-Bacterial Agents ; Catheterization ; Catheters ; Drainage ; Enterocolitis, Necrotizing ; Humans ; Infant, Newborn ; Infant, Premature ; Liver ; Liver Abscess ; Liver Abscess, Pyogenic ; Risk Factors ; Sepsis ; Uterus

Background: This study was conducted on the experiences, limitations, and factors necessary for increasing participation in emergency care outside a medical institution for physicians working in a tertiary hospital. Methods: This study was conducted by analyzing data from 150 physicians working in a tertiary hospital. The physicians’ intent to participate in emergencies outside the medical institution was measured as frequencies and percentages, and chi-square test was performed. Multi-logistic regression was used to determine factors affecting the physicians’ willingness to participate emergencies outside the medical institution. Results: Out of 103 respondents, 52 (50.5%) said that they do not want to participate in future emergency situations. Among them, 38 (73.1%) said that legal burden associated with medical accidents dissuaded them from intervening in future emergencies. Also, 33 (63.5%) said that ‘a firm guarantee of exemption from legal responsibility’ was needed to convince them to participate in emergency patient care. There were no meaningful results in the analysis of factors affecting future participation in emergency care. Conclusion It was found that the reason they do not participate in emergency care is because they feel that they bear the risk of legal liability. We suggest that providing more legal immunity could be a way to encourage doctors to step up in emergency situations. At the same time, it is recommended that a more suitable environment be provided for physicians in such situations, so that they can be able to fulfill their ethical duties in emergency medical care.

Schwannoma is a benign tumor rarely found in the head and neck and much less commonly found in the intraparotid facial nerve. It is a slow-growing encapsulated tumor originating from the Schwann cells or axonal nerve sheath. It can occur anywhere along the course of the facial nerve. Patients may present with symptoms of facial palsy, but the most common presenting symptom is an asymptomatic swelling. Diagnosis is usually difficult before surgical removal and histopathological examination. We report a rare case of intraparotid facial nerve schwannoma in a 57-year-old female who had sustained a mass of the right preauricular area for 3 years. She reported no pain or facial muscle weakness. Enhanced computed tomography findings revealed the impression of pleomorphic adenoma. However, intraoperative gross findings were not characteristic of pleomorphic adenoma, and a frozen biopsy was performed resulting in the impression of a nerve sheath tumor. We performed an extracapsular surgical excision without parotidectomy. Permanent histopathology and immunohistochemistry reports diagnosed the mass as schwannoma. There were no complications including facial palsy after surgery. No recurrence was found at 6 months after surgery
Adenoma, Pleomorphic ; Axons ; Biopsy ; Diagnosis ; Facial Muscles ; Facial Nerve ; Facial Paralysis ; Female ; Head ; Humans ; Immunohistochemistry ; Middle Aged ; Neck ; Neurilemmoma ; Parotid Gland ; Recurrence ; Schwann Cells