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/AIMS: Endoscopic treatment has been broadly applied to superficial esophageal neoplasms. Endoscopic submucosal dissection (ESD) allows for high rates of en bloc resection, precise histological assessment, and low rates of local recurrence. The aim of this study was to evaluate the outcomes of ESD for superficial esophageal neoplasms. METHODS: We retrospectively reviewed 36 esophageal ESDs for superficial squamous neoplasms in 32 patients between March 2009 and August 2014 at Gangnam Severance Hospital. RESULTS: The median patient age was 64 years, and 30 men were included. The indications were early squamous cell carcinoma in 26 lesions, adenoma with high-grade dysplasia in five lesions, and low-grade dysplasia in five lesions. The en bloc resection and R0 resection rates were 97.2% (35 of 36) and 91.7% (33 of 36), respectively. Microperforation and post-ESD bleeding occurred in 5.6% (2 of 36) and 5.6% (2 of 36), respectively. Post-ESD esophageal strictures developed in five patients (13.9%). Five patients (15.6%) had an additional treatment after ESD (concurrent chemoradiation therapy in three, radiation therapy in one, and surgery in one patient). There was no disease-specific mortality during the median follow-up of 31 months. CONCLUSIONS: Favorable clinical outcomes were observed in ESD for superficial esophageal squamous neoplasms. Esophageal ESD could be a good treatment option in terms of efficacy and safety.
Adenoma ; Carcinoma, Squamous Cell ; Constriction, Pathologic ; Esophageal Neoplasms ; Follow-Up Studies ; Hemorrhage ; Humans ; Male ; Mortality ; Recurrence ; Retrospective Studies ; Treatment Outcome

An ossifying fibromyxoma is a benign neoplasm which usually presents in soft tissue. It is a rare tumor of uncertain differentiation which virtually always acts in a clinically-benign fashion. Most patients present with a small, painless, well-defined, often lobulated subcutaneous mass, which affects the extremities, or less commonly the trunk, head and neck, and mediastinum. Its typical microscopic appearance is that of lobulated nests of uniform, round-to-oval shaped cells, separated by fibromyxoid stroma, in which an incomplete marginal shell of mature bone can be seen. We herein report the first case of an ossifying fibromyxoid tumor of the neck in Korea.
Extremities ; Fibroma* ; Head ; Humans ; Korea ; Mediastinum ; Neck*

Eccrine poroma is a benign neoplasm, whicn is thought to originate from the eccrine sweat gland. Previous studies suggest that these are primarily lesions of the hairless acral surface. We report a clinicopathological case of a 30-year-old man who presented with a 2.0 by 1.2 cm sized, unusual scalp lesion, which proved to be an eccrine poroma. There has been no local recurrence in the 4 months since complete excision.
Adult ; Humans ; Poroma* ; Recurrence ; Scalp* ; Sweat Glands

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: Laparoscopic cholecystectomy (LC) has replaced open cholecystectomy (OC) for the treatment of gallbladder disease. However certain cases still require conversion to open procedures. Identifying these patients at the risk of conversion remains difficult. This study evaluated risk factors that may predict conversion from a laparoscopic to an open procedure. METHODS: From January 1994 to December 2004, a total of 582 laparoscopic cholecystectomies were performed at Seoul Medical Center. A retrospective analyses of clinical parameters including patient demographics, clinical histories, laboratory data, ultrasound results, intraoperative details and postoperative pathologic findings were performed. RESULTS: A total of 30 patients (5.2%) had their cholecystectomies converted to an open procedure. Causes for conversion were inability to correctly identify the anatomy of surgical field due to adhesion and inflammation (56.7%), bile duct injury (13.3%), bleeding (13.3%) and others (16.7%). Univariate analysis showed that ASA (the classification of American Society of Anesthesiologists, p = 0.034), previous abdominal operation history (p = 0.008), RUQ tenderness(right upper quadrant tenderness, p = 0.002), acute cholecystitis (p < 0.001) and time elapsing between diagnosis and operation (p = 0.013) to be risk factors. Multivariate analysis revealed that acute cholecystitis (4.2 greater odds ratio [OR] of conversion, p = 0.002) and previous abdominal operation history (3.6 greater odds ratio [OR] of conversion, p = 0.003) were positive independent predictive factors for conversion to open cholecystectomy. CONCLUSION: Although laparoscopic cholecystectomy is a safe and beneficial procedure in the management of patients with gallbladder disease, there are still many chances of conversion of laparoscopic to open cholecystectomy. In this study, patients with acute cholecystitis and previous abdominal operation histories were more likely to require conversion to an open procedure. These two positive independent predictive factors can help operators to make early decision and to counsel patients undergoing laparoscopic cholecystectomy with regards to the posibility of conversion to an open procedure.
Bile Ducts ; Cholecystectomy* ; Cholecystectomy, Laparoscopic ; Cholecystitis, Acute ; Classification ; Conversion to Open Surgery ; Demography ; Diagnosis ; Gallbladder Diseases ; Hemorrhage ; Humans ; Inflammation ; Multivariate Analysis ; Odds Ratio ; Retrospective Studies ; Risk Factors ; Seoul ; Ultrasonography

BACKGROUND AND OBJECTIVES: Most cases of sudden deafness remain idiopathic. The majority of these cases are unilateral in their occurrences, whereas bilateral simultaneous involvement is rarely seen. We analyzed the clinical characteristics and treatment results between bilateral and unilateral sudden sensorineural hearing loss (SSNHL), and considered the possible causes and provided available data for planning the appropriate treatment for bilateral SSNHL. SUBJECTS AND METHOD: Three hundred forty seven patients who visited the Department of Otolaryngology in Ajou University Hospital from June, 1994 to February, 2003 were classified into 3 groups. Of these 347 patients, 16 patients (32 ears) had SSNHL simultaneously in both ears (Group I), 23 patients had SSNHL sequentially in both ears (Group II), and 308 patients had unilateral SSNHL (Group III). We reviewed their charts for pure tone audiometry information, medical history and lipid panel information to compare bilateral SSNHL with unilateral SSNHL. RESULTS: The incidence of simultaneous bilateral SSNHL (Group I) was 4.6% of overall patients with SSNHL. Bilateral SSNHL occurs more commonly in patients of older age, with preexisting DM. Lpid panel abnormalities were compared with unilateral SSNHL. The recovery rate of hearing in simultaneous bilateral SSNHL (Group I) was 37.5% for both ears and 62.5% of patients, compared with 56.5% in unilateral SSNHL (Group III). CONCLUSION: Bilateral SSNHL is a very rare disease and the outcome from treatment is important for patients' quality of life. Recognition of similarities and differences between bilateral and unilateral SSNHL can help in counseling and managing the patients.
Audiometry ; Counseling ; Ear ; Hearing ; Hearing Loss, Sensorineural* ; Hearing Loss, Sudden ; Humans ; Incidence ; Otolaryngology ; Quality of Life ; Rare Diseases

No abstract available.

No abstract available.

BACKGROUND AND OBJECTIVES: High-dose steroid therapy has been known as the treatment of choice for sudden sensorineural hearing loss (SSNHL). However, about one third of patients do not generally respond to any treatments, and there seem to be no definitive treatment for the patients with refractory SSNHL. We prospectively studied the effect of intratympanic steroid injection (ITSI) for patients with refractory SSNHL. SUBJECTS AND METHOD: Sixty six patients with SSNHL, who were refractory to a course of oral steroid therapy, were included in this study. Thirty three patients (34 ears) were treated with ITSI and the other 33 patients had no further treatments as control. ITSI was performed with dexamethasone in the supine position on 4 separate occasions over the course of 2 weeks. Hearing was assessed immediately before every injection, and at 1 and 4 weeks after therapy. Hearing improvement was defined as more than 10 dB in pure tone average (PTA). RESULTS: Hearing improvement was observed in 13 (39.4%) of 33 patients who underwent ITSI and in 2 (6.1%) of 33 patients in control group. Five of 13 showed hearing improvement over 20 dB in PTA, and 11 of 20 patients showed no improvement in PTA by ITSI, but showed improvement over 10dB in some frequencies. There were no definite prognostic factors between the patients who responded to ITSI and those who didn't. CONCLUSION: ITSI is a simple and effective therapy for patients with refractory SSNHL.
Dexamethasone ; Ear, Middle ; Hearing ; Hearing Loss, Sensorineural* ; Hearing Loss, Sudden ; Humans ; Prospective Studies ; Steroids ; Supine Position