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Humans ; Orthognathic Surgery ; Publications ; Snoring

Vulvar melanosis (VM) is clinically characterized by asymmetric macules or patches of varying size with a tan to black color and irregular borders. VM is more commonly found among perimenopausal women with a median age of 42 years. The exact pathogenesis of VM is not well understood. The proposed etiological factors for VM include oral contraceptive use, infection with human papillomavirus, and chronic inflammatory skin diseases such as lichen sclerosus et atrophicus. Histologic examination can easily differentiate mucosal lentiginosis from melanoma, but VM superimposed on a background of anogenital lichen sclerosus, both clinically and histologically, may mimic malignant melanoma. There have been two cases of VM associated with Dowling-Degos disease in the Korean dermatologic literature. To the best of our knowledge, this is the first case of VM associated with lichen sclerosus et atrophicus in the Korean dermatologic literature.

Syringoid eccrine carcinoma (SEC) is a rare cutaneous malignant tumor thought to be derived from eccrine sweat glands. It is usually present in the scalp and face and often occurs in the fourth to seventh decades of life. A 76-year-old female patient visited our department with a 3-year history of a lesion showing a 5×4 cm-sized erythematous firm plaque with ulceration on her right shoulder. Histological findings revealed a tumor consisting of numerous proliferating tubular structures with two layers of basaloid cells with cellular atypia. Some ductal structures showed a tadpole appearance. Based on these findings, the final diagnosis was SEC. The patient was treated with slow Mohs micrographic surgery and a full-thickness skin graft and did not show any recurrence during the follow-up period of 6 months. Herein, we report a very rare case of a 76-year-old woman diagnosed with SEC that developed on the right shoulder.

Vulvar melanosis (VM) is clinically characterized by asymmetric macules or patches of varying size with a tan to black color and irregular borders. VM is more commonly found among perimenopausal women with a median age of 42 years. The exact pathogenesis of VM is not well understood. The proposed etiological factors for VM include oral contraceptive use, infection with human papillomavirus, and chronic inflammatory skin diseases such as lichen sclerosus et atrophicus. Histologic examination can easily differentiate mucosal lentiginosis from melanoma, but VM superimposed on a background of anogenital lichen sclerosus, both clinically and histologically, may mimic malignant melanoma. There have been two cases of VM associated with Dowling-Degos disease in the Korean dermatologic literature. To the best of our knowledge, this is the first case of VM associated with lichen sclerosus et atrophicus in the Korean dermatologic literature.

PURPOSE: High frequency oscillatory ventilation (HFOV) is used to support infants with severe respiratory failure unresponsive to conventional ventilation (CV). We reviewed chest radiographs before and after HFOV with clinical correlation in infants with respiratory distress syndrome (RDS). METHODS: Eighteen very low birth weight infants with RDS who had HFOV were included in this study. All patients were diagnosed as having RDS clinically and radiologically. Mean gestational age of infants was 27 weeks (range : 24-31 weeks). The mean duration of HFOV was 3 days (range : 14 hours-9 days). The chest radiographs of these infants within 3 hours before and after application of HFOV were retrospectively reviewed. Radiological findings based on aeration and parenchymal densities were classified into improved, no change, and progressed. Medical records were reviewed for FiO2 levels, clinical outcomes, complications, and causes of death. RESULTS: In 15 of 18 infants, aeration and parenchymal densities were improved and FiO2 levels were also improved after HFOV. Four of these 15 infants who showed improvement of radiological findings developed pneumothorax, sepsis, pulmonary or intestinal bleeding, and subsequently died. In remaining 3 infants in whom chest radiographs after HFOV showed no interval change or progression, oxygenation was also worsened and all died. CONCLUSION: Chest radiographs of HFOV-treated, very low birth weight infants showed improvement of aeration and parenchymal densities in most cases. Clinical outcome was good in infants who showed improvement on chest radiographs compared to those of progression group as far as there was no associated complication. Knowledge of radiological changes after HFOV will help in interpretation of chest radiographs in those HFOV-treated infants.
Cause of Death ; Gestational Age ; Hemorrhage ; Humans ; Infant* ; Infant, Very Low Birth Weight* ; Medical Records ; Oxygen ; Pneumothorax ; Radiography, Thoracic ; Respiratory Insufficiency ; Retrospective Studies ; Sepsis ; Ventilation*

BACKGROUND: A light plane of general anesthesia is chosen for fetal safety during a cesarean section. Therefore an experience of wakefulness and pain perception is not infrequent and can be distressful to patients. The electroencephalogram-derived bispectral index (BIS) is a promising new method to assess anesthetic adequacy. This study was designed to assess the adequacy of general anesthesia and to evaluate the usefulness of the BIS in monitoring the awareness during a cesarean section. METHODS: Twenty one parturients undergoing general anesthesia for an elective caesarean section were examined. Anesthesia was induced with 4 mg/kg thiopental and 1 mg/kg succinylcholine, and then followed with a mixture of 50% N2O, 50% O2 and 0.8% enflurane at a flow of 4 L/min. Before administration of succinylcholine, a tourniquet was applied to the free arm and inflated to 250 mmHg. Responsiveness to verbal commands using the Tunstall isolated forearm technique was detected and the BIS was monitored throughout the study period. RESULTS: The incidence of responsiveness to verbal commands were 33% at the time of skin incision and fetal delivery respectively. BIS values of response to commands were significantly higher than that of no respose at both time points (p < 0.05). Fisher's exact test suggested that the BIS value less than 75 was related to unresponsiveness to verbal commands at time of skin incision (p < 0.05) and the BIS less than 85 at fetal delivery (p < 0.05). CONCLSIONS: These results suggest that adequate anesthesia is not provided with a mixture of 50% N2O, 50% O2 and 0.8% enflurane at a flow of 4 L/min at the time of skin incision and fetal delivery. In addition BIS could be a predictor of awareness during cesarean section under general anesthesia.
Anesthesia ; Anesthesia, General* ; Arm ; Cesarean Section* ; Consciousness Monitors* ; Enflurane ; Female ; Forearm ; Humans ; Incidence ; Pain Perception ; Pregnancy ; Skin ; Succinylcholine ; Thiopental ; Tourniquets ; Wakefulness

Background: Many studies have assessed the risk factors for adverse drug reactions (ADRs) in elderly patients. However, most of these studies have focused on risk factors for ADRs, not serious ADRs (s-ADRs). s-ADRs are commonly found in hospitalized patients. s-ADRs warrant imminent but thorough investigations, given their critical impact on patient health. Therefore, this retrospective study aimed to assess the associated risk factors for s-ADRs in elderly hospitalized patients. Methods: In-patients aged >65 years having ADRs during hospitalization at a university hospital in Korea between 2010 and 2012 were included. Medical professionals spontaneously reported ADRs using an electronic submission system at the study hospital. Further, all descriptions of ADRs were characterized and categorized through the screening of electronic medical records. We compared the characteristics of patients having s-ADRs with those of patients not having s-ADRs. Results: There were 353 cases of ADRs, 67 of which were s-ADRs. Patients taking more than eight concomitant drugs showed the highest odds ratio (OR, 11.99; 95% confidence interval [CI], 3.42–42.03). The ratio of aspartate aminotransferase (AST)/alanine aminotransferase (ALT) was also significantly related to s-ADRs (OR, 2.78; 95% CI, 1.33–5.81). The use of antibiotics (OR, 2.39; 95% CI, 1.13–5.02) and antineoplastics (OR, 4.17; 95% CI, 1.09–15.94) were significant risk factors. Conclusion Our findings highlight the importance of polypharmacy. Liver function tests (AST/ALT ratio) must be monitored carefully within high-risk groups for ADRs.

BACKGROUND: Stellate ganglion block (SGB) has been used to treat over 150 diseases which include diabetes mellitus and gout. This study was planned to investigate whether stellate ganglion block (SGB) could lower the levels of blood glucose, uric acid, epinephrine, and norepinephrine. METHODS: Sixty Sprague-Dawley rats within the weight of 250-350 gm were randomly devided into four groups. CS group was normal group with sham SGB with normal saline, CL group was normal group with SGB with lidocaine, DS group was diabetic group with SGB with normal saline, DL group was diabetic group with SGB with lidocaine. The diabetes was induced by intraperitoneal injection of 40 mg/kg of streptozotocin in citrate buffer (0.01 M, pH 4.5). Nondiabetic groups were given same amount of the citrate buffer. Seven days after the last injection of the streptozotocin blood glucose level was checked and more than 300 mg/dl was considered diabetic. The SGB was performed three times at right superior cervical ganglion two days apart from two days after the conformation of diabetes. Successful SGB was conformed by the ipsilateral ptosis or conjunctival congestion. Blood samplings from tail vein for the check of glucose, uric acid, and catecholamines were done before the injection of streptozotocin, seven days after the last injection of streptozotocin, and two days after the last SGB. RESULTS: The SGB with lidocaine reduced the blood glucose level only in the diabetic rats while SGB with the saline did not. The epinephrine levels were increased in the diabetics and decreased by the SGB with lidocaine without any statistical significance. Norepinephrine and uric acid levels had not been effected by the SGB and both of them had no correlationship with the glucose level. CONCLUSIONS: SGB in the diabetic rats decreases the blood glucose level. But for the effects of the SGB on the level of epinephrine further study would be needed.
Animals ; Blood Glucose* ; Catecholamines* ; Citric Acid ; Diabetes Mellitus ; Epinephrine ; Estrogens, Conjugated (USP) ; Glucose ; Gout ; Hydrogen-Ion Concentration ; Injections, Intraperitoneal ; Lidocaine ; Norepinephrine ; Rats* ; Rats, Sprague-Dawley ; Stellate Ganglion* ; Streptozocin ; Superior Cervical Ganglion ; Uric Acid* ; Veins

BACKGROUND: The purpose of this study was to assess the effect of rocuronium pretreatment on the succinylcholine induced biochemical changes and fasciculations, myalgia and to compare it with vecuronium pretreatment. METHODS: We have studied 60 patients undergoing minor elective surgery, in a prospective double blinded method. Three groups of 20 patients each were pretreated with saline 0.01 ml/kg (group C), rocuronium 0.05 mg/kg (group R), or vecuronium 0.007 mg/kg (group V). Three minutes after the pretreatment, 1.5 mg/kg succinylcholine was injected. Serum potassium five minutes after succinylcholine and creatine kinase 24 hr after operation were measured. Fasciculations and postoperative myalgia at 24 and 48 h were evaluated. RESULTS: The increase in creatine kinase and incidence of fasciculations were lowest in the rocuronium group (33 IU/L; 15%) and followed by vecuronium group (58 IU/L; 50%) and highest in the control group (101 IU/L; 100%). The increase in serum potassium concentration (0.3 mEq/L) was not attenuated by any regimen. The incidence of postoperative myalgia on day 1 and day 2 was lower in the rocuronium (40%, 30%) and the vecuronium (50%; 35%) group than control group (85%; 75%). CONCLUSIONS: Rocuronium pretreatment is more effective in reducing creatine kinase rise and fasciculations after succinylcholine than vecuronium. However rocuronium and vecuronium are also effective in preventing postoperative myalgia.
Creatine Kinase ; Fasciculation ; Humans ; Incidence ; Myalgia* ; Potassium ; Prospective Studies ; Succinylcholine* ; Vecuronium Bromide

Benign metastasizing leiomyoma (BML) is a rare entity, defined as a muscle tumor in association with one or more smooth muscle tumor of the uterus and without evidence of any extra uterine primary site. The lung is the most common site of involvement,(2) and the etiology of BML remains unknown. We experienced a case of BML arising in pelvic and para-aortic lymph nodes and report with a brief review of literature.
Leiomyoma ; Lung ; Lymph Nodes ; Muscles ; Smooth Muscle Tumor ; Uterus