BACKGROUND: This study was designed to compare the hemodynamic changes in response to direct laryngoscopy of the McCoy blade and the Macintosh blade. METHODS: Sixty patients scheduled for elective gynecologic surgery were randomly allocated into two groups. The induction of anesthesia was done with thiopental sodium 5 mg/kg, fentanyl 2 mcg/kg, vecuronium 0.1 mg/kg. When the train of four arrived came at 0/4, the vocal cords were visualized with either the McCoy or the Macintosh laryngoscope blade for 10 seconds. Heart rate and blood pressure were recorded at 1 minute intervals for 5 minutes. RESULTS: Laryngoscopy caused significant increases in arterial blood pressure in both groups, while it had no effect on heart rate in either group. There were no significant differences in blood pressure and heart rate responses to laryngoscopy in the blades. CONCLUSIONS: The McCoy and the Macintosh blade show similar changes in heart rate and blood pressure after laryngoscopy.
Anesthesia ; Arterial Pressure ; Blood Pressure ; Female ; Fentanyl ; Gynecologic Surgical Procedures ; Heart Rate ; Hemodynamics* ; Humans ; Laryngoscopes* ; Laryngoscopy ; Thiopental ; Vecuronium Bromide ; Vocal Cords

BACKGROUND: One of the most important physical properties affecting the level of analgesia after intrathecal administration of a local anesthetic is baricity. This study was done to compare the distribution of 0.5% tetracaine in 5% glucose solution and in 10% glucose solution. METHODS: Tetracaine 2.6 ml (0.5% with 5% glucose or 10% glucose) added with 0.1% epinephrine 0.2 ml was administered to each of 20 patients. All patients' heights were within 160 170 cm. The cephalad spread of analgesia, the degree of motor block in the legs and hemodynamic values were assessed at 2-min intervals for the first 10 min and then at 5-min intervals until 30 min. RESULTS: In the 5% glucose and 10% glucose solutions, the maximum sensory level was T5.4 and T4.3, the maximum sensory block time was 128.1 min and 118.2 min and the time to complete motor block was 5.4 min and 5.2 min respectively. It was not statistically significant between groups. But T 8.1 (vs T 9.6 in the 5% glucose solution) of initial sensory level measured at 4 min after injection of drug was significantly higher (P < 0.05) in the 10% glucose solution. Maximum hemodynamic changes from the baseline were not different in two groups. CONCLUSIONS: Tetracaine 0.5% with 5% glucose or 10% glucose solutions showed similar distribution in the cerebrospinal fluid.
Analgesia ; Anesthesia, Spinal* ; Cerebrospinal Fluid ; Epinephrine ; Glucose* ; Hemodynamics ; Humans ; Leg ; Tetracaine*

Background: Adverse drug reactions (ADRs) to first-line anti-tuberculosis (TB) drugs are common; however, there have been few reports of nationwide epidemiologic studies on ADRs to anti-TB drugs in Korea. This study aimed to investigate the clinical characteristics of various ADRs to first-line anti-TB drugs using a nationwide database of ADRs. Methods: We used the Korea Adverse Event Reporting System (KAERS) database (2009– 2018). The study subjects were selected using the Korean Standard Classification of Diseases codes for pulmonary and extrapulmonary TB and electronic data interchange codes for isoniazid (INH), rifampicin (RIF), ethambutol (ETB), and pyrazinamide (PZA). The causality assessment of “possible,” “probable,” or “certain” by World Health Organization-Uppsala Monitoring Center System causality category was selected. Results: A total of 1,562,024 ADRs were reported in the KIDS-KAERS database from 2009 to 2018, where ADRs to first-line anti-TB drugs were 17,843 cases (1.14%). The most common causative drugs were RIF (28.7%), INH (24.0%), ETB (23.4%), and PZA (23.9%) in that order. 48.5% of cases were reported in the older patients (≥ 60 years). According to organ system, gastro-intestinal system disorder was most common (32.0%), followed by skin and appendage (25.9%), liver and biliary system (14.2%). Nausea was the most common ADR (14.6%), followed by hepatic enzyme elevation (14.2%), rash (11.7%), pruritus (9.1%), vomiting (8.9%), and urticaria (4.2%). Most ADRs appeared within 1 month, but ADRs such as neuropathy, paresthesia, hematologic abnormalities, renal function abnormalities and liver enzyme abnormality were also often reported after 2 months. Conclusion Our data are clinically informative for recognizing and coping with ADRs of antiTB drugs.

We experienced a case of incidental removal of granuloma of vocal cord after blind endotracheal intubation with lightwand. The patient was a 43-years-old female suffering from hoarseness for 2 months and diagnosed as vocal cord pyogenic granuloma developed after primary closure of thyroid cartilage laceration. She had a limited neck extension suggesting difficult intubation, so endotracheal intubation with lightwand was planned to secure airway. After endotracheal intubation using lightwand, the lesion of vocal cord could not be seen in the microscopic exam. We discovered and immediately removed the granuloma on the carina level using rigid bronchoscope.
Bronchoscopes ; Female ; Granuloma ; Granuloma, Pyogenic* ; Hoarseness ; Humans ; Intubation* ; Intubation, Intratracheal ; Lacerations ; Neck ; Thyroid Cartilage ; Vocal Cords*

BACKGROUND: This study was done to compare vacuum delivery and cesarean section rates in a large population before and after on-demand labor epidural analgesia became available. METHODS: We retrospectively investigated the overall sets of delivery modes in patients who gave birth during a 12-month period before the introduction of on-demand labor epidural analgesia, and those giving birth after labor epidural analgesia became available. Additionally, we compared the rates of cesarean section or vacuum delivery in patients delivering before and after the availability of on-demand labor epidural. RESULTS: Included were 3905 patients who delivered before, and 4318 patients who delivered after epidural analgesia became available. Labor epidural rates were 0.3% vs 14.7% for the before and after groups. The rates of cesarean delivery for dystocia in primary cesarean operation did not change (10% vs 10.5%), and vacuum delivery rates in the total vaginal delivery patients were not changed (15.1% vs 14.7%) for the before and after group. CONCLUSIONS: Increased epidural analgesia did not change the overall cesarean delivery rates for dystocia and vacuum - assisted delivery rates.
Analgesia, Epidural* ; Cesarean Section* ; Dystocia ; Female ; Humans ; Parturition ; Pregnancy ; Retrospective Studies ; Vacuum*

Oxygen therapy (OT) can relieve head pain in certain primary headache disorders, including cluster headache (CH). The exact underlying mechanism is currently uncertain, but suggested mechanisms include inhibition of the trigeminoautonomic reflex, modulation of neurotransmitters, and cerebral vasoconstriction. OT is the standard for acute treatment of CH, but patients with CH often experience considerable difficulties accessing home OT due to problems with insurance coverage. Inhalation of 100% oxygen at 6–12 L/min for 15–30 min using a non-rebreather face mask is one of the most effective acute therapies for CH, but several trials have indicated the superiority of higher oxygen flow rates of up to 15 L/min and/or using a demand-valve oxygen mask that can produce very high flow rates. Two randomized controlled trials have demonstrated the efficacy of OT in migraine, but obtaining reliable evidence is considered difficult because of different inhalation protocols, varying outcome measures, and small samples. There are some reports on the efficacy of OT as an adjuvant therapy in hypnic headache, primary headache in the emergency department, and even postdural puncture headache. The goal of this review article is to expand the knowledge regarding the use of oxygen in the treatment of headache disorders.

BACKGROUND: Internal jugular vein access is an essential part of patient management in many clinical settings and is usually achieved with a blind, anatomical landmark-guided technique. The purpose of this study is to evaluate whether a 2-dimensional ultrasound technique can improve on the traditional method. METHODS: Eighty patients undergoing elective open heart surgery were randomly assigned to an anatomical landmark group or ultrasound group (each n = 40). With the patient in the supine position, the head was rotated 30o to the contralateral side and triangle formed by the clavicle and both heads of the sternocleidomastoid muscle were identified. We accessed the internal jugular vein from the apex of the triangle toward the ipsilateral nipple in the anatomical landmark group. The internal jugular vein and carotid artery were visualized with two-dimensional ultrasound. We compared the number of advances made with the central venous cannulation needle, the time to blood aspiration, complications and failure rate. RESULTS: The failure rate was 22.5% using the anatomical landmark technique and 5% using the ultrasound technique. The vein was entered on the first attempt in 60% of patients using the landmark technique and in 63% using ultrasound (P>0.05). Mean attempts for puncture were 1.9 (anatomical) vs 1.6 (ultrasound-guided) (P>0.05). Complications occurred in 20% of cases using anatomical landmarks and in 5% using ultrasound (P>0.05). The average access time was 26.5 seconds by the anatomical approach and 56 seconds by the ultrasound approach (P< 0.05). CONCLUSIONS: Ultrasound-guided cannulation of the internal jugular vein did not significantly decrease failure rate, access time, complications, and attempts for puncture, nor did it increase the amount of successful first attempts. However an investigation using a larger number of patients will be needed.
Carotid Arteries ; Catheterization* ; Clavicle ; Head ; Humans ; Jugular Veins* ; Needles ; Nipples ; Punctures ; Supine Position ; Thoracic Surgery ; Ultrasonography ; Veins

Correct positioning of a double-lumen endobronchial tube (DLT) is essential for adequate ventilation, oxygenation, and lung separation during one-lung anesthesia. The displacement of a DLT by surgical manipulation, coughing, movements, or patient position changes have been reported. We experienced displacement of a left-sided DLT into the right bronchus during hilar dissection for carina sleeve right upper lobectomy in a 60-yr-old male patient. We emphasize the possibility of DLT dislocation during hilar dissection, so careful attention must be carried.
Anesthesia ; Bronchi* ; Cough ; Dislocations ; Humans ; Lung ; Male ; Oxygen ; Ventilation

PURPOSE: Conventional pathologic classifications of human renal cell carcinoma give little insight into oncogenesis and little assistance in predicting the clinical behavior of this disease. For genetic classification, deletion of the short arm of chromosome 3(3p), the hallmark of nonpapillary/clear cell RCC, is a major diagnostic criterion. Because of the limited routine applicability of cytogenetics and molecular genetic techniques we investigated fluorescence in situ hybridization(FISH) for the detection of this aberration in RCC. MATERIALS AND METHODS: Isolated nuclei from 8 human RCC paraffin embedded tissue sections were examined with a dual color FISH technique for loss of chromosome 3p. Telomeric DNA probe from 3p and an internal ploidy control probe, centromeric probe of chromosome 2, were applied to the isolated nuclei of RCC. RESULTS: 87.5% of the patients(7) lost chromosome 3p. The loss of 3p in the samples tested was unrelated to patient age, gender, tumor stage, and grade. CONCLUSIONS: FISH for the detection of loss in 3p from paraffin embedded tissue sections provides a sensitive and feasible methods for the genetic classification of kidney tumors and FISH is a very useful diagnostic tool for detection of the genetic aberrations of the tumors.
Arm ; Carcinogenesis ; Carcinoma, Renal Cell* ; Chromosomes, Human, Pair 2 ; Classification ; Cytogenetics ; DNA ; Fluorescence* ; Humans ; In Situ Hybridization* ; In Situ Hybridization, Fluorescence ; Kidney ; Molecular Biology ; Paraffin ; Ploidies

The purpose of this study was to evaluate the flow rate of elastomeric balloon infusor composed of rubber or silicone materials. Two models were studied: the Baxter Twoday Infusor and Advance Silicone Infusor. Each infusion device has a preset flow rate of 2 mL/hr. Fifteen units of each device were filled with 100 mL of normal saline. The flow rate was measured gravimetically using an electronic balance. The internal pressure of the balloon infusor was measured with a Digital pressure meter via the pressure transducer. The monitored internal pressure of the two kinds of infusor was not maintained uniformly during the entire delivery period, which was divided into 3 phases: the phase of decreasing, maintained, and increasing pressure during the delivery of drug. Both devices initially infused at a relatively high rate, followed by a somewhat steady flow rate. The flow rate distinctly increased in the small residual volume. The flow rate of the balloon infusor used in this study was not sustained uniformly during the entire delivery period and was in proportion to the internal pressure of the infusor regardless of the materials.
Analgesia, Patient-Controlled/*instrumentation ; Elasticity ; Equipment Design ; Human ; *Infusion Pumps ; Pain, Postoperative/*therapy ; Pressure