A pilonidal cyst is known to be a recurrent infectious disease in the sacrococcygeal region and it usually affects adolescents and adults. It is often misdiagnosed as a simple abscess or a sebaceous cyst, so there are many patients with pilonidal cysts who have gone through several operations. Although many treatments for this malady have been reported, the principle treatment for pilonidal cysts is radical excision. We report here on two cases of pilonidal cyst and the patients were misdiagnosed as having a simple abscess. We planned to perform incision and drainage, but the lesions were finally diagnosed as pilonidal cysts and so we performed radical excision for the treatment. We also review the medical literature on abscesses that occur in the sacrococcygeal region in early adulthood.
Abscess ; Adolescent ; Adult ; Communicable Diseases ; Drainage ; Epidermal Cyst ; Humans ; Pilonidal Sinus ; Sacrococcygeal Region

Background: In this study, we compared the incidents of humidifier disinfectants and incidents of mild hepatitis in Japan to highlight the differences in government response in the health care field in terms of “chain of responsibility”. Methods: We examined whether the three mechanisms of action and the chain of responsibility hypothesis were applied to compare the cases of Korea and Japan. The incident of Japan occurred in 1987 in Misawa city, Aomori prefecture. In the 1990s, the safety of blood products increased dramatically. However, relief for infected victims was neglected. Green Cross did not notify the parties. In Korea, in the spring of 2011, a number of lung disease patients were accidentally admitted to a hospital in Seoul, and a female patient with respiratory failure symptoms expired. The Korea Centers for Disease Control and Prevention conducted animal tests and the Ministry of Health and Welfare issued an order for forced collection of humidifier disinfectants. Results: In the case of Japan, the Ministry of Health and Welfare had to take responsibility for follow-up measures such as the investigation of the cause, so it was tied to a “chain of responsibility”. However, in the case of Korea, the Ministry of Health and Welfare was free from the chain. Conclusion Through the comparison between the cases of Japan and Korea, we confirmed that whether or not a government organization chooses to conceal responsibility depends on its past behavior, which is whether it is free from the chain of responsibility or not. Therefore, it was reaffirmed that an organization (ministry or department) free from the chain of responsibility must exist within the government.

The video laryngoscope is a novel instrument for intubation that enables indirect visualization of the upper airway. It is recognized for its ability to enhance Cormack-Lehane grades in the management of difficult airways.Notably, video laryngoscopy is associated with equal or higher rates of intubation success within a shorter time frame than direct laryngoscopy.Video laryngoscopy facilitates faster and easier visualization of the glottis and reduces the need for Magill forceps, thereby shortening the intubation time. Despite the advanced glottic visualization afforded by video laryngoscopy, nasotracheal tube insertion and advancement occasionally fail. This is particularly evident during nasotracheal intubation, where oropharyngeal blood or secretions may obstruct the visual field on the monitor, thereby complicating video laryngoscopy. Moreover, the use of Magill forceps is markedly challenging or nearly unfeasible in this context, especially in pediatric cases. Furthermore, the substantial blade size of video laryngoscopes may restrict their applicability in individuals with limited oral apertures.This study aimed to review the literature on video laryngoscopy, discuss its clinical role in nasotracheal intubation, and address the challenges that anesthesiologists may encounter during the intubation process.

BACKGROUND: The purpose of this study was to evaluate the effect of palonosetron combined with dexamethasone for the prevention of PONV compared to dexamethasone alone in women who received intravenous patient-controlled analgesia (IV-PCA) using fentanyl. METHODS: In this randomized, double-blinded, placebo-controlled study, 204 healthy female patients who were scheduled to undergo elective surgery under general anesthesia followed by IV-PCA for postoperative pain control were enrolled. Patients were divided into two groups: the PD group (palonosetron 0.075 mg and dexamethasone 5 mg IV; n = 102) and the D group (dexamethasone 5 mg IV; n = 102). The treatments were given after the induction of anesthesia. The incidence of nausea, vomiting, severity of nausea, and the use of rescue anti-emetics during the first 48 hours after surgery were evaluated. RESULTS: The incidence of PONV was significantly lower in the PD group compared with the D group during the 0-24 hours (43 vs. 59%) and 0-48 hours after surgery (45 vs. 63%) (P < 0.05). The severity of nausea during the 6-24 hours after surgery was significantly less in the PD group compared with the D group (P < 0.05). The incidence of rescue antiemetic used was significantly lower in the PD group than in the D group during the 0-6 hours after surgery (13.1 vs. 24.5%) (P < 0.05). CONCLUSIONS: Palonosetron combined with dexamethasone was more effective in preventing PONV compared to dexamethasone alone in women receiving IV-PCA using fentanyl.
Analgesia, Patient-Controlled* ; Anesthesia ; Anesthesia, General ; Antiemetics ; Dexamethasone* ; Female ; Fentanyl ; Humans ; Incidence ; Nausea ; Pain, Postoperative ; Postoperative Nausea and Vomiting* ; Vomiting

Local anesthetic systemic toxicity (LAST) refers to the complication affecting the central nervous system (CNS) and cardiovascular system (CVS) due to the overdose of local anesthesia. Its reported prevalence is 0.27/1000, and the representative symptoms range from dizziness to unconsciousness in the CNS and from arrhythmias to cardiac arrest in the CVS. Predisposing factors of LAST include extremes of age, pregnancy, renal disease, cardiac disease, hepatic dysfunction, and drug-associated factors. To prevent the LAST, it is necessary to recognize the risk factors for each patient, choose a safe drug and dose of local anesthesia, use vasoconstrictor , confirm aspiration and use incremental injection techniques. According to the treatment guidelines for LAST, immediate application of lipid emulsion plays an important role. Although lipid emulsion is commonly used for parenteral nutrition, it has recently been widely used as a non-specific antidote for various types of drug toxicity, such as LAST treatment. According to the recently published guidelines, 20% lipid emulsion is to be intravenously injected at 1.5 mL/kg. After bolus injection, 15 mL/kg/h of lipid emulsion is to be continuously injected for LAST. However, caution must be observed for >1000 mL of injection, which is the maximum dose. We reviewed the incidence, mechanism, prevention, and treatment guidelines, and a serious complication of LAST occurring due to dental anesthesia. Furthermore, we introduced lipid emulsion that has recently been in the spotlight as the therapeutic strategy for LAST.
Anesthesia, Dental ; Anesthesia, Local ; Arrhythmias, Cardiac ; Cardiovascular System ; Causality ; Central Nervous System ; Dizziness ; Drug-Related Side Effects and Adverse Reactions ; Heart Arrest ; Heart Diseases ; Humans ; Incidence ; Parenteral Nutrition ; Pregnancy ; Prevalence ; Risk Factors ; Unconsciousness

Hysteroscopy is utilized for making the diagnosis and treating a series of uterine disease. It's advantages are more accurate removal of lesion, a short operating time, low morbidity and rapid postoperative recovery. However, serious complications can happen following hysteroscopic surgery. The complications can be divided into the procedure-related, media-related and postoperative events. The procedure-related complications include cervical laceration, uterine perforation, bowel and bladder injury, and hemorrhage. The media-related complications include hyponatremia, gas embolism and excessive fluid absorption. The postoperative events include endometritis and postoperative synechiae. We experienced hyponatermia with pulmonary edema due to excessive fuid absorption in a 52-year-old woman who underwent elective hysteroscopic myomectomy under general anesthesia. She was treated with oxygen therapy, normal saline and furosemide and she recovered without sequelae.
Absorption ; Anesthesia, General ; Embolism, Air ; Endometritis ; Female ; Furosemide ; Hemorrhage ; Humans ; Hyponatremia ; Hysteroscopy ; Lacerations ; Middle Aged ; Oxygen ; Pulmonary Edema ; Urinary Bladder ; Uterine Diseases ; Uterine Perforation

Hemophilia A is a hemorrhagic disease caused by coagulation factor VIII deficiency. In head and neck cancer surgery, especially during a reconstructive one, complications can occur. These include hematomas due to bleeding which can then lead to flap ischemia, necrosis, and impaired wound healing. There are fewer cases of reconstructive surgery in patients with hemophilia A. Here in we report, a reconstructive surgery that involved mass resection, partial glossectomy (right), selective neck dissection (right, Levels I, II, III, IV), and reconstruction at the lateral arm free flap (left) in a 25-year-old man with hemophilia A. The surgery was successfully performed without any complications after pretreatment with Factor VIII concentrate, which has not been reported earlier.

Nasotracheal intubation is commonly performed under general anesthesia in oral and maxillofacial surgery. For the convenience of surgery, nasal Ring-Adair-Elwyn (RAE) tubes are mainly used. Because the nasal RAE tubes were bent in an “L” shape, the insertion depth was limited. Particularly, it is necessary to accurately determine the appropriate depth of the RAE tubes in children. Several types of nasal RAE tubes are used in the medical market, which vary in material and length. We performed endotracheal intubation using a nasal RAE tube for double-jaw surgery, but air leakage persisted even when the air pressure in the cuff was increased. When checked with a laryngoscope, it was confirmed that the tube was pushed out, and the cuff was caught on the vocal cords, causing air leakage. Since inserting the tube deeply did not solve the problem, replacing it with a nasal RAE tube (Polar TM , Preformed Tracheal Tube, Smith Medical, Inc., USA) did not cause air leakage; thus, we reported this case.

Hemophilia A is a hemorrhagic disease caused by coagulation factor VIII deficiency. In head and neck cancer surgery, especially during a reconstructive one, complications can occur. These include hematomas due to bleeding which can then lead to flap ischemia, necrosis, and impaired wound healing. There are fewer cases of reconstructive surgery in patients with hemophilia A. Here in we report, a reconstructive surgery that involved mass resection, partial glossectomy (right), selective neck dissection (right, Levels I, II, III, IV), and reconstruction at the lateral arm free flap (left) in a 25-year-old man with hemophilia A. The surgery was successfully performed without any complications after pretreatment with Factor VIII concentrate, which has not been reported earlier.