No abstract available.
Fractures, Open*

BACKGROUND: The bispectral index, a parameter of electroencephalography (EEG) and a tool for the measurement of sedative state has been used in general anesthesia and for the assessment of sedative degree in intensive care units. The adverse effects of inhalation agents are various although hepatic toxicity, renal toxicity, postoperative nausea, and vomiting have been reported. This study was designed to evaluate the adverse effect of inhalation agents. METHODS: Forty-four adult patients scheduled for thyroidectomy under general anesthesia were randomly assigned to one group with a BIS below 40 (BIS40 group, n = 23) or to a group with a BIS from 50 to 60 (BIS60 group, n = 21). Hgb, WBC count, PLT count, renal function, and liver function were measured pre-and post-operatively (after 24 hrs). The degree of postoperative nausea and vomiting were estimated using the Rhodes Index of Nausea, Vomiting and Retching (RINVR) in postoperative 6 hrs, 12 hrs and 24 hrs. RESULTS: The amount of fentanyl used during the operation were greates in the BIS60 group than in the BIS40 group for adequate analgesia, and the preoperative and postoperative values of Hgb, WBC count, PLT count, AST, ALT, ALP, s-BUN, and s-creatine were not significantly different between the BIS40 and BIS60 groups. 6 hrs, 12 hrs and 24 hrs post-operatively no differences were observed between groups by RINVR in terms of nausea and vomiting. CONCLUSIONS: The adverse effect of an inhalation agent appears not to be related to its concentration when sevoflurane with BIS monitoring are used to reduced the amount of agent inhaled.
Adult ; Analgesia ; Anesthesia* ; Anesthesia, General ; Electroencephalography ; Fentanyl ; Humans ; Inhalation ; Intensive Care Units ; Liver ; Nausea ; Postoperative Nausea and Vomiting ; Thyroidectomy ; Vomiting

PURPOSE: The main issue with the current ultrasonography (US) guidelines is the overestimation of malignant and indeterminate nodules as they do not aid in making decisions to treat patients. To overcome this, new US guidelines for thyroid nodules that have been shown to be better correlated with cytologic results have been proposed. We also suggested specific indications for US-guided fine needle aspiration (FNA) using the new US guidelines. METHODS: Clinical and pathologic data from 925 patients and 1,419 thyroid nodules were retrospectively collected. All subjects underwent US- and US-guided FNA at Department of Surgery, Wonju Christian Hospital, between March 2010 and July 2011. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were calculated for both the current guidelines and the new guidelines. RESULTS: The accuracy, sensitivity, specificity, PPV, and NPV for the current guidelines in predicting malignancy were 24.1%, 99.3%, 62.2%, 25.0%, and 99.8%, respectively. The accuracy, sensitivity, specificity, PPV, and NPV for the new guidelines in predicting malignancy were 66.0%, 96.0%, 86.7%, 47.7%, and 99.4%, respectively. CONCLUSION: The use of the new US guidelines allow for a more accurate and specific diagnosis and a better treatment plan than the current guidelines. Additionally, the use of the new FNA guidelines may help prevent unnecessary FNAs and promote cost-effective follow-up for patients.
Biopsy, Fine-Needle ; Follow-Up Studies ; Humans ; Retrospective Studies ; Sensitivity and Specificity ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule

No abstract available.
Compartment Syndromes*

PURPOSE: External beam radiotherapy (EBRT) plays a controversial role in the management of differentiated thyroid cancer. We reviewed the outcomes of patients at our institution who had been treated with EBRT for advanced differentiated thyroid cancer. METHODS: Subjects included 35 patients who received thyroidectomy and EBRT at Yonsei University Wonju College of Medicine, Wonju Christian Hospital under the diagnosis of papillary thyroid cancer from January 1989 to September 2011. RESULTS: The 5 year overall locoregional control rate was 74.4%. No significant differences were found in locoregional progression- free survival for patients with complete resection, microscopic residual disease, or gross residual disease. CONCLUSION: The results of our study have shown that EBRT is effective for locoregional control of selected locally advanced papillary thyroid cancer, even with gross residual disease.
Diagnosis ; Gangwon-do ; Humans ; Radiotherapy* ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

PURPOSE: Fine needle aspiration cytology (FNAC) has become a standard diagnostic tool for thyroid nodules. The purpose of this study is to analyze the correlation between FNAC and the final histology to improve the diagnostic value. METHODS: We collected 792 patients who had undergone thyroidectomy, and we selected 549 patients who had undergone preoperative FNAC. The FNAC results were classified as non-diagnostic, malignancy, indeterminate and benign. The final pathologic reports were classified into two categories: malignant or benign. The individual histology was also identified. We retrospectively analyzed the pathologic result, the sensitivity, the specificity and the predictive value of the FNAC. RESULTS: Among 549 patients, their FNACs showed 47 non diagnostic results, 189 malignancies,136 indeterminate results and 177 benign results. The false positive rate was 1.1% and the false negative rate was 12.9%. The final pathology reports were 262 malignancies and 287 benign lesions. There were 42 (30.9%) malignancies among the 136 indeterminate cases. Adenomatous hyperplasia was the most common benign lesion and papillary carcinoma (containing micropapillary carcinoma) was the most common benign lesion. CONCLUSION: FNAC is an easy and safe diagnostic tool, but it still has many limitations. It is necessary to reduce the number of non diagnostic results. Technical advances, classification of the advanced categories of cytology and other staining methods can provide more specific results, and this can reduce the rate of performing unnecessary surgery.
Biopsy, Fine-Needle* ; Carcinoma, Papillary ; Classification ; Humans ; Hyperplasia ; Pathology ; Retrospective Studies ; Sensitivity and Specificity ; Thyroid Nodule ; Thyroidectomy* ; Unnecessary Procedures

PURPOSE: To evaluate the results of mosaicplasty and microfracture after surgical treatments for symptomatic osteochondral lesion of talus (OLT) by second-look arthroscopy. MATERIALS AND METHODS: 7 cases of mosaicplasty and 7 cases of microfracture were reviewed who undertook second-look arthroscopy at 6 months or one year after undertaking mosaicplasty or microfracture for OLT between December 2004 and October 2005. The mean age at first operation was 43.6 years (Range, 20-59) (Mosaicplasty; 43.9 years, Microfracture; 43.4 years). The mean size of cartilage defect was 15.0 x 7.7 mm in mosaicplasty and 7.1 x 6.6 mm in microfracture. Clinical outcomes were evaluated by Freiburg ankle score. Cartilage healing state was evaluated by Insall's classification for chondromalasia during second-look arthroscopy. RESULTS: By the Freiburg ankle score, 9 ankles (6 in mosaicplasty, 3 in microfracture) had excellent and 5 (1 in mosaicplasty, 4 in microfracture) had good results at the times of second-look arthroscopy. By Insall's classification, consistency of the osteochondral grafts and congruity between grafts and native cartilage (Grade I) were shown in 9 (6 ankles in mosaicplasty, 3 ankles in microfracture), a fissuring (Grade II) in one ankle of mosaicplasty, a fasciculation (Grade III) in one ankle of microfracture, and partial exposure of subchondral bone (Grade IV) in 3 ankles of microfractures. CONCLUSION: Mosaicplasty was more excellent in consistency and hardness of cartilage than microfracture. In some cases of microfracture, cartilage healing was incomplete at 6 months postoperatively, so second-look arthroscopy is necessary to identify. If incomplete cartilage healing was shown, additional procedure such as microfracture or mosaicplasty was needed.
Ankle ; Arthroscopy* ; Cartilage ; Classification ; Fasciculation ; Hardness ; Mortuary Practice ; Talus* ; Transplants

Malignant tumor originated from external auditory canal (EAC) is very rare with an annual incidence of around 1 per million. Pathologically, squamous cell carcinoma is incidentally most common, and adenoid cystic carcinoma, basal cell carcinoma, and melanoma follow in decreasing order. Due to the rarity of malignant tumor of EAC, there is no widely accepted treatment modality yet. But basal cell carcinoma, known to be less aggressive tumor, can be removed with a minimal safety margin and have better treatment results. Recently we experienced a case of basal cell carcinoma in the EAC, confined in the cartilaginous portion of EAC, presenting with intermittent otorrhea for several years. The patient was treated with a sleeve resection of the EAC with a safety margin reconstructed with a split-thickness skin graft. No tumor recurrence or complication was noted in the first postoperative year.
Aminocaproic Acids ; Carcinoma, Adenoid Cystic ; Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Ear Canal ; Humans ; Incidence ; Melanoma ; Recurrence ; Skin ; Transplants

BACKGROUND: Propofol has a high incidence of pain when administered by intravenous injection. Among the many different methods available, lidocaine is used most frequently to minimize this pain. Propofol also has a depressant action on hemodynamics, especially in the elderly. The present study was aimed to examine whether lidocaine affects hemodynamic changes associated with propofol injection and endotracheal intubation, and whether it attenuates propofol-induced pain. METHODS: Eighty patients, over 60 years old, ASA physical status I and II, were randomly divided into four groups of 20 each according to lidocaine dosage mixed with 2 mg/kg of propofol given over 30 seconds during the induction of anesthesia; 0 mg (control group), 20 mg, 40 mg and 80 mg. Mean arterial blood pressure (MAP), heart rate (HR), and bispectral index scale (BIS) were measured before anesthetic induction (baseline value), 1 minute after the start of induction, immediately before endotracheal intubation, and then every minute for 5 minutes. Injection pain was scored as none, mild, moderate, or severe. RESULTS: MAP decreased significantly following the propofol injection and then increased after endotracheal intubation in all four groups, the magnitude of this decrease did not differ among the groups. HR increased after the propofol injection and then decreased. It increased again after intubation in all four groups. BIS was decreased by the induction of anesthesia, but was not affected by endotracheal intubation in any group. The three lidocaine groups had a lower incidence and severity of propofol-induced pain than the control group, and the effect were comparable among the lidocaine-treated groups. CONCLUSIONS: Our results indicate that lidocaine 20, 40 or 80 mg mixed with propofol does not affect the hemodynamic changes associated with propofol and endotracheal intubation, but that they similarly attenuate the injection pain associated with propofol.
Aged* ; Anesthesia* ; Arterial Pressure ; Heart Rate ; Hemodynamics* ; Humans ; Incidence ; Injections, Intravenous ; Intubation ; Intubation, Intratracheal ; Lidocaine* ; Middle Aged ; Propofol

PURPOSE: Recently, the change to a more complex social structure has led to an increased frequency of traumas due to violence, accident and so on. In addition, the severity of the traumas and the frequency of penetrating injuries have also increased. Traumas to cervical and abdominal areas, what are commonly seen by general surgeons, can have mild to fatal consequences because in these areas, various organs that are vital to sustaining life are located. The exact location and characteristics of the injury are vital to treating patients with the trauma to these areas. Thus, with this background in mind, we studied, compared, and analyzed clinical manifestations of patients who were admitted to Wonju Christian hospital for penetrating injuries inflicted by themselves or others. METHODS: We selected and performed a retrospective study of 64 patients who had been admitted to Wonju Christian Hospital from January 2005 to December 2009 and who had cervical or abdominal penetrating injuries clearly inflicted by themselves or others. RESULTS: There were 51 male (79.7%) and 13 female (20.3%) patients, and the number of male patients was more dominant in this study, having a sex ratio of 3.9 to 1. The range of ages was between 20 and 86 years, and mean age was 43.2 years. There were 5 self-inflicted cervical injuries, and 19 self-inflicted abdominal injuries, making the total number of self-inflicted injury 24. Cervical and abdominal injuries caused by others were found in 11 and 29 patients, respectively. The most common area involved in self-inflicted injuries to the abdomen was the epigastric area, nine cases, and the right-side zone II was the most commonly involved area. On the other hand, in injuries inflicted by others, the left upper quadrant of the abdomen was the most common site of the injury, 14 cases. In the neck, the left-side zone II was the most injured site. In cases of self-inflicted neck injury, jugular vein damage and cervical muscle damage without deep organ injury were observed in two cases each, making them the most common. In cases with abdominal injuries, seven cases had limited abdominal wall injury, making it the most common injury. The most common deep organ injury was small bowel wounds, five cases. In patients with injuries caused by others, six had cervical muscle damage, making it the most common injury found in that area. In the abdomen, small bowel injury was found to be the most common injury, being evidenced in 13 cases. In self-inflicted injuries, a statistical analysis discovered that the total duration of admission and the number of patients admitted to the intensive care unit were significantly shorter and smaller, retrospectively, than in the patient group that had injuries caused by others. No statistically significant difference was found when the injury sequels were compared between the self-inflicted-injury and the injury-inflicted-by-others groups. CONCLUSION: This study revealed that, in self-inflicted abdominal injuries, injuries limited to the abdominal wall were found to be the most common, and in injuries to the cervical area inflicted by others, injuries restricted to the cervical muscle were found to be the most common. As a whole, the total duration of admission and the ICU admission time were significantly shorter in cases of self-inflicted injury. Especially, in cases of self inflicted injuries, abdominal injuries generally had a limited degree of injury. Thus, in our consideration, accurate injury assessment and an ideal treatment plan are necessary to treat these patients, and minimally invasive equipment, such as laparoscope, should be used. Also, further studies that persistently utilize aggressive surgical observations, such as abdominal ultrasound and computed tomography, for patients with penetrating injuries are needed.
Abdomen ; Abdominal Injuries ; Abdominal Wall ; Female ; Hand ; Humans ; Intensive Care Units ; Jugular Veins ; Laparoscopes ; Male ; Muscles ; Neck ; Neck Injuries ; Retrospective Studies ; Sex Ratio ; Violence