In adult patients with dental phobia, dental treatment may be difficult, or may not be possible. Depending on the level of fear or anxiety, non-pharmacological or pharmacological behavior management techniques are used in the dental treatment of such patients. Among the pharmacological behavior management techniques, minimal sedation, that is, the lowest depth of sedation, can be easily obtained in adult patients using oral sedatives, does not require special equipment or tools, and does not affect ventilatory and cardiovascular function. Diazepam is an anxiolytic drug belonging to the benzodiazepine family that, in addition to relieving anxiety, produces muscle relaxation, and is a representative drug used in adult patients with fear of dental treatment. Herein, we report the case of a 50-year-old woman with severe dental fear who successfully underwent long-term dental treatment in approximately 20 visits with minimal sedation using oral diazepam. In addition, we reviewed the considerations for the use of benzodiazepines for minimal sedation.

In adult patients with dental phobia, dental treatment may be difficult, or may not be possible. Depending on the level of fear or anxiety, non-pharmacological or pharmacological behavior management techniques are used in the dental treatment of such patients. Among the pharmacological behavior management techniques, minimal sedation, that is, the lowest depth of sedation, can be easily obtained in adult patients using oral sedatives, does not require special equipment or tools, and does not affect ventilatory and cardiovascular function. Diazepam is an anxiolytic drug belonging to the benzodiazepine family that, in addition to relieving anxiety, produces muscle relaxation, and is a representative drug used in adult patients with fear of dental treatment. Herein, we report the case of a 50-year-old woman with severe dental fear who successfully underwent long-term dental treatment in approximately 20 visits with minimal sedation using oral diazepam. In addition, we reviewed the considerations for the use of benzodiazepines for minimal sedation.

PURPOSE: The objective of this study was to analyze diabetic foot patients' direct service costs until the cure of the disease. MATERIALS AND METHODS: The subjects of this study were randomly sampled 60 patients who had been treated for diabetic foot at one of two tertiary hospitals and cured of the disease during from January 2008 to December 2009, and whose diagnostic code was E11.5 or E14.5. Data were collected from medical records and direct service costs were analyzed using data on the payments of individual service charges. Direct service costs spent at other medical institutions for the same disease were excluded. Collected data were analyzed using descriptive statistics. RESULTS: The subjects' mean hospital stay was 29 days, and mean period until cure was 132 days. The inpatient cost per patient was 10,844,648 won, outpatient cost was 715,751 won, and home care services cost was 641,854 won, so total direct service cost per patient was 11,913,419 won. The total direct service cost in patients who had their foot amputated was 12,769,822 won, 1.3 times higher than without amputation, who had vascular intervention was 16,219,477 won, 1.9 times higher than non-vascular intervention, who had both infection and artery occlusion was 17,522,435 won, 2.0 times higher than either infection or artery occlusion. CONCLUSION: In diabetic foot patients, the direct service cost was highest as 17,522,435 won in patients accompanied with both infection and occlusion of lower extremity artery.
Amputation ; Arteries ; Diabetic Foot ; Direct Service Costs ; Fees and Charges ; Foot ; Home Care Services ; Humans ; Inpatients ; Length of Stay ; Lower Extremity ; Medical Records ; Outpatients ; Tertiary Care Centers

BACKGROUND: A rapid increase in desflurane concentration induces tachycardia and hypertension and increases plasma catecholamine concentration. No clinical study is available as to whether the desflurane-induced circulatory responses is blunted by the rate of increase in inhaled desflurane concentration although there were many studies about methods to blunt the circulatory responses. The current study examined to compare desflurane-induced circulatory responses by the rate of increase in inhaled desflurane concentration. METHODS: Unpremedicated sixty ASA physical status 1 patients, aged 20-60 years, scheduled for elective surgery under general anesthesia were randomly allocated into one of two groups. The inspired concentration of desflurane via mask was increased to 12.0 vol% abruptly (group 1), or during 120 seconds (group 2). The target was to produce an end-tidal concentration of desflurane (ETdesf) of 10.0 vol% which was maintained until the end of the study by adjusting the vaporizer setting, when necessary. Heart rate (HR), mean arterial pressure (MAP), cardiac index (CI), systemic vascular resistance (SVR), ETdesf, end-tidal concentration of carbon dioxide, and peripheral oxygen saturation were measured at baseline and every 30 seconds for 5 minutes after inhalation of desflurane and for 2 minutes after intubation. RESULTS: HR, blood pressure, and CI were significantly increased in two groups compared with baseline, but significant differences in maximum values were not observed between two groups. There were no significant differences between groups of the ETdesf at the maximal HR and MAP. Incidences of hypertension and tachycardia were lesser in slowly increased inhaled desflurane concentration (group 2) than abruptly increased group (group 1). CONCLUSIONS: The present study demonstrates that increasing inhaled desflurane concentration slowly for mask ventilation is partially effective in attenuating desflurane-induced circulatory responses.
Anesthesia, General ; Arterial Pressure ; Blood Pressure ; Carbon Dioxide ; Heart Rate ; Humans ; Hypertension ; Incidence ; Inhalation ; Intubation ; Masks ; Nebulizers and Vaporizers ; Oxygen ; Plasma ; Tachycardia ; Vascular Resistance ; Ventilation

OBJECTIVE: This study was performed to evaluate the clinical efficacy of high risk HPV DNA test using PCR for the detection of high-grade CIN or invasive cancer from patients with ASCUS or LSIL on Papanicolaou smear. METHODS: Sixty one patients with a Papanicolaou smear report of atypical squamous cells of undetermined significance or a low-grade squamous intraepithelial lesion underwent Cervical colposcopy and directed cervical biopsy and human papillomavirus test by PCR. We compared the detection rate of the high grade CIN and invasive cancer by Papanicolaou smear method only with that of both Papanicolaou smear and HPV PCR method. and we decided to be significant when P value was below 0.05 by SAS (v 6.02) program. RESULTS: The detection rate of high risk HPV DNA was 50.8% (31/61). The detection rate of high risk HPV DNA in high grade CIN and invasive cancer was 84.2% (16/19). Higher the grade of biopsy, more the detection rate of high risk HPV DNA. False negative rate which appeared high grade CIN or invasive cancer by biopsy was 31.2% (19/61) in Papanicolaou smear method only and 4.9% (3/61) in both Papanicolaou smear and HPV DNA method. CONCLUSION: We thought that additional HPV DNA test was useful to dectect behind high grade CIN or invasive cancer when the Papanicolaou smear result was ASCUS or LSIL.
Biopsy ; Colposcopy ; Diagnosis* ; DNA ; Human Papillomavirus DNA Tests* ; Humans ; Papanicolaou Test ; Polymerase Chain Reaction

OBJECTIVE: Our purpose was to evaluate the safety and efficacy of pelviscopic surgery. METHODS: Between May 1996 and April 2000, we evaluated indication of operation, mean age, parity, previous operation history, type of operation, duration of hospitalization and complications. RESULTS: The results are summarized as follows ; 1) The mean age of patients was 34.8 years with ranges between 20 and 55 years old. 2) The majority of patients were between 36 years and 40 years old(23.6%). 3) The major clinical indications included 174 cases of adnexal mass(33.4%), 125 cases of ectopic pregnancy(24.0%), 59 cases of endometriosis(11.3%). 4) The types of operation composed of 168 cases diagnostic laparoscopy(30.7%), salpingectomy(17.2%), cystectomy(11.4%), LAVH(11.2%). 5) Previous laparotomy history was found in 146 cases(28.0%). 6) The mean duration of hospitalization was 4.4 days. CONCLUSIONS: The pelviscopy can be safely performed, resulting in reduced surgical morbidity, less blood loss, less postoperative discomfort and pain, shortened hospital stays and shorter recovery days. With the increased use of markers and ultrasonography to decrease the possibility of inappropriate surgery, combined with more defined exterpation techniques, the interest in laparoscopic ovarian surgery is burgeoning. And technologic advances afford us the opportunity to offer patients a number of alternatives to open surgery. The choice of anesthetic technique varies with requirements of the surgeon, the health status and preference of the patient, the type of facility and the availability of well trained professionals, support personnel and equipment. In conclusion, the pelviscopic surgery is alternative to laparotomy.
Female ; Hospitalization ; Humans ; Laparotomy ; Length of Stay ; Middle Aged ; Parity ; Ultrasonography

OBJECTIVES: Our study was to measure how well semiquantitative three-dimensional ultrasonographic measures of amniotic fluid in the third trimester, to investigate the relationship between three-dimensional amniotic fluid volume and amniotic fluid index, two dimensional amniotic fluid volumes. METHODS: We compared amniotic fluid volume as measured by three-dimensional ultrasonographic techniques with amniotic fluid index including two dimensional amniotic fluid volume in 33 women during in the third trimester. RESULTS: There was highly significant linear correlations of three-dimensional amniotic fluid volumes with AFI (r=0.6898) and two dimensional amniotic fluid volume (r=0.7926). CONCLUSION: Three-dimensional ultrasonographic technology has clinical significance as a tool to measure amniotic fluid volume. There are highly significant correlations of three dimensional amniotic volumes with AFI and two dimensional volume.
Amniotic Fluid* ; Female ; Humans ; Pregnancy ; Pregnancy Trimester, Third ; Pregnant Women* ; Ultrasonography*

OBJECTIVES: Our study was to measure how well semiquantitative three-dimensional ultrasonographic measures of amniotic fluid in the third trimester, to investigate the relationship between three-dimensional amniotic fluid volume and amniotic fluid index, two dimensional amniotic fluid volumes. METHODS: We compared amniotic fluid volume as measured by three-dimensional ultrasonographic techniques with amniotic fluid index including two dimensional amniotic fluid volume in 33 women during in the third trimester. RESULTS: There was highly significant linear correlations of three-dimensional amniotic fluid volumes with AFI (r=0.6898) and two dimensional amniotic fluid volume (r=0.7926). CONCLUSION: Three-dimensional ultrasonographic technology has clinical significance as a tool to measure amniotic fluid volume. There are highly significant correlations of three dimensional amniotic volumes with AFI and two dimensional volume.
Amniotic Fluid* ; Female ; Humans ; Pregnancy ; Pregnancy Trimester, Third ; Pregnant Women* ; Ultrasonography*