Tracheal intubation for general anesthesia is usually performed using a rigid laryngoscope and reguires the mandible to be opened with forward and upward traction of the patient's jaw which may at times result in the inadvertant injury to temporomandibular joint(TMJ). The injury may include internal derangement, dislocation and hematoma of TMJ; subsequent intraarticular adhesion formation ; dislocation of the meniscus, and rarely auriculotemporal nerve damage from traumatic TMJ dislocation. We studied in 200 patients the size of mouth opening during intubation, the change of mouth opening by tracheal intubation evaluated after operation, and any TMJ disorder arising after tracheal intubation. The results were as follows; 1) The mean size of mouth opening before operation was 42.7+/-7.0 and 40.6+/-6.2mm in male and female patients, respectively. 2) The mean size of mouth opening during intubation was 24.7+/-2.6 and 23.4+/-2.7mm in male and female patients, respectively. When vecuronium was used to prevent fasciculation, the mean was 24.3+/-3.1 and 25.2+/-2.0mm in male and female patients, respectively. 3) One week following operation The mean size of mouth opening one week postoperation was 48.3+/-8.9 and 42.2+/-6.3mm in male and female patients, respectively. When vecuronium was used to prevent fasciculation, the mean size of mouth opening was 55.5+/-5.3 and 43.2+/-6.2mm in male and female patients, respectively. 4) Five patients complained of discomfort around TMJ after tracheal intubation. It seems that upward 45 mandibule lifting by laryngoscope caused trauma to TMJs.
Anesthesia, General ; Dislocations ; Fasciculation ; Female ; Hematoma ; Humans ; Intubation ; Intubation, Intratracheal* ; Jaw ; Laryngoscopes ; Lifting ; Male ; Mandible ; Mouth ; Temporomandibular Joint Disorders ; Temporomandibular Joint* ; Traction ; Vecuronium Bromide

OBJECTIVES: The purpose of this study was to quantitatively assess the degree of myasthenia gravis (MG) affecting mental health through the results of multiphasic military personality inventory in late adolescence. METHODS: We collected and analyzed the results of the military personality inventory for healthy controls and MG patients among the 19-year-old men who visited the Military Manpower Administration from February 2007 to January 2010. Military personality inventory invented for Korean military test has similar system to Minnesota multiphasic personality inventory. RESULTS: Among validity scales, each score of faking good, faking bad and infrequency subscales showed no difference between healthy control and MG groups, respectively (t=−0.51, p=0.607 ; t=0.11, p=0.913 ; t=1.41, p=0.158). Among neurosis scales, the score of somatization subscale was higher (t=2.29, p=0.023) in MG group. Among psychopath scales, the score of schizophrenia subscale was lower in MG group (t=−2.38, p=0.018). CONCLUSIONS According to MPI results, we can confirm that MG patients in late adolescence may be more concerned with their somatic symptoms than the control group, and that they may be more likely to abide by the regulation and be conventional in their behavior than the control group.

PURPOSE: High voltage electrical injury mainly occurs in the industrial field. It can cause serious complications and sequelae that lead to high social and economic costs. We investigated the causes of this to try to help prevent these injuries. METHODS: We reviewed 128 patients who incurred high voltage electrical injury during a 3-years period from Jan. 1, 2006 to Dec. 31, 2008. We performed a retrospective analysis of the medical records to review the epidemiology. We also performed a survey by telephone. The survey questions addressed the following: the duration of work, wearing safety equipment, the reason for working without safety equipment, did they receive safety education, was the safety education adequate, recognition of a high tension wire before working and did they understand the effect of high voltage on the human body. RESULTS: The safety education was relatively carried out well. But most patients did not wear safety equipment even though they knew they had to wear it (92%). The major reason was discomfort of wear it (72%). The hand was the most common injury site (80%). Most injuries occurred with 22,900 volt or less (92%). In spite of safety education, many patients were unaware of the effects of electrical injury on their body. CONCLUSION: Strengthened safety education can play a significant role in preventing high voltage electrical injury. At this point, the doctors who are experienced in treating high voltage electrical injury must actively participate in this safety education. We suggest that handy safety equipment can lessen the incidence of high voltage electrical injury. It is essential to develop a handy safety glove for 22,900V with considering that the hand was the most common injury site and the most frequent voltage for injury was 22,900 volt or less.
Electric Injuries ; Hand ; Human Body ; Humans ; Incidence ; Medical Records ; Protective Devices ; Retrospective Studies ; Safety Management ; Telephone

We examined whether alterations in vascular endothelial function and early structural changes in atherosclerosis are associated with microvascular complications in patients with type 1 diabetes mellitus (DM). Flow-mediated dilation (FMD) of the brachial artery and carotid intima-media thickness (IMT) measurement were performed in 70 young adults (aged 19 to 35 yr), 48 with type 1 DM, and 22 normal controls. Patients with diabetes had a lower peak FMD response (7.8+/-3.9 vs. 11.1 +/-1.9%, p<0.001) and increased IMT (0.51+/-0.10 vs. 0.42+/-0.07 mm, p<0.001) compared with controls. Twenty (41.7%) of the patients had microvascular complications including neuropathy, nephropathy, or retinopathy. In these complicated diabetic patients, we found a lower FMD response (6.1+/-2.5 vs. 9.9+/-3.5%, p=0.001) compared with diabetics without microvascular complications. The presence of microvascular complications was also associated with older age and longer duration of the disease. However, no differences were observed in IMT, body size, blood pressure, HbA1c, C-reactive protein, low-density lipoprotein or high-density lipoprotein cholesterol levels between complicated and non-complicated patients. Endothelial dysfunction and early structural atherosclerotic changes are common manifestations in type 1 DM, and endothelial dysfunction is thought to be an early event in the atherosclerotic process and important in the pathogenesis of microvascular complications.
Adult ; Diabetes Mellitus, Type 1/*complications ; Diabetic Angiopathies/*etiology ; Endothelium, Vascular/*physiology ; Female ; Humans ; Male ; *Microcirculation ; Tunica Intima/pathology ; Tunica Media/pathology ; Vasodilation

The anterior interosseous nerve innervates the flexor pollicis longus, the flexor digitorum profundus and the pronator quadratus. There are no sensory fibers from the anterior interosseous nerve leading to the skin. Paralysis of the anterior interosseous nerve that accompanies a Monteggia fracture has rarely been reported, and incomplete paralysis of the anterior interosseous nerve has almost not been reported. We experienced a patient with incomplete anterior interosseous nerve palsy involving the flexor pollicis longus as a complication of a Monteggia fracture. The paralysis of the flexor pollicis longus recovered 4 months after the surgery for the Monteggia fracture.
Humans ; Monteggia's Fracture ; Paralysis ; Skin

PURPOSE: Pulmonary hypertension can occur from diverse etiologies. It was reported that pulmonary hypertension also complicated dialysis patents, but the exact mechanisms were not determined. The aim of this study was to evaluate the prevalence and risk factors of pulmonary hypertension in maintenance hemodialysis patients. In addition, we studied the relationship between pulmonary hypertension and arteriovenous access. METHODS: Fifty-nine chronic hemodialysis patients underwent clinical evaluation. Pulmonary artery pressure (PAP) was estimated by Doppler echocardiography. Pulmonary hypertension was defined as PAP > or =35 mmHg. RESULTS: Mean PAP value of subjects was 39.3+/-13.2 mmHg. Pulmonary hypertension was found in 31 (53%) of patients receiving hemodialysis (49.0+/-10.6 mmHg; range 37 to 84 mmHg). Clinical and biochemical parameters did not differ significantly between patients with pulmonary hypertension and without pulmonary hypertension. In 19 patients, PAP was elevated from 27.8+/-10.2 mmHg to 41.8+/-11.9 mmHg (p<0.001) after onset of hemodialysis via arteriovenous fistula. And pulmonary hypertension developed in 12 of 15 patients with normal PAP after onset of hemodialysis treatment. CONCLUSION: The prevalence of pulmonary hypertension was high, and hemodialysis via arteriovenous access may be involved in the development of pulmonary hypertension.
Arteriovenous Fistula ; Dialysis ; Echocardiography, Doppler ; Humans ; Hypertension ; Hypertension, Pulmonary ; Kidney Failure, Chronic ; Prevalence ; Pulmonary Artery ; Renal Dialysis ; Risk Factors

PURPOSE: Coronary artery disease (CAD) is a major cause of mortality in chronic dialysis patients, and often occurs within the first year of dialysis. However, there is little evidence based on prospective trials in incident dialysis patients, and nobody knows which noninvasive test is best for screening the CAD in these patients. Therefore, we conducted this study to examine the prevalence of CAD and the accuracy of noninvasive tests that we can easil do for detection of CAD in incident dialysis patients. METHODS: We evaluated the prevalence of CAD using resting ECG, 2D echocardiography, 99m Tc tetrofosmin single photon emission computed tomography(SPECT) and the accuracy of these non-invasive screening tests in all 84 incident dialysis patients from March 2005 to September 2006 at the Hallym University SH Hospital in Korea. RESULTS: Of eighty-four patients, 23 (27.4%) had significant CAD. Fifteen (18.9%) patients had ischemic ECG change, and its positive predictive value and sensitivity were 66.7% and 45.0%, respectively. Resting 2D echocardiography had positive predictive value of 77.3%, sensitivity of 63.6% and lower specificity of 50.0%. 99m Tc tetrofosmin SPECT had positive predictive value of 73.3% and sensitivity of 73.3%. CONCLUSION: The prevalence of CAD in patients at the initiation of dialysis was 27.4%. 99m Tc tetrofosmin SPECT may be helpful for diagnosing CAD with ECG and 2D-echocardiography because of high sensitivity and positive predictive value.
Coronary Artery Disease* ; Coronary Disease ; Coronary Vessels* ; Dialysis* ; Echocardiography ; Electrocardiography ; Humans ; Kidney Failure, Chronic* ; Korea ; Mass Screening ; Mortality ; Prevalence* ; Sensitivity and Specificity ; Tomography, Emission-Computed, Single-Photon

Methanol poisoning is a medical emergency that requires rapid elimination of the toxin and its metabolites for recovery. The danger of methanol results from the accumulation of its toxic metabolite formic acid. This accumulation may result in the development of metabolic acidosis, visual impairment, and damage to the basal ganglia. Extracorporeal treatment is recommended in severe cases of methanol poisoning with coma, seizure, new vision deficits, metabolic acidosis, high serum anion gap, elevated methanol concentrations or impaired kidney function. Although the serum methanol concentration is helpful in determining the use of extracorporeal treatment, methanol assays are not standard laboratory tests in Korea. Herein, we report a case of methanol poisoning in which the patient's clinical improvement was confirmed using serum and urine methanol levels.
Acid-Base Equilibrium ; Acidosis ; Basal Ganglia ; Coma ; Emergencies ; Extracorporeal Circulation ; Kidney ; Korea ; Methanol* ; Osmolar Concentration ; Poisoning* ; Renal Replacement Therapy* ; Seizures ; Vision Disorders

BACKGROUND: Dialysis patients have impaired host defense mechanisms and frequently require antibiotics for various infective complications. In this study, we investigated whether dialysis patients have greater risk for Clostridium difficile-associated diarrhea (CDAD). METHODS: During the 4-year study period (2004-2008), 85 patients with CDAD were identified based on a retrospective review of C difficile toxin assay or histology records. Nosocomial diarrheal patients without CDAD were considered as controls (n=403). We assessed the association between renal function and the prevalence and clinical outcomes of CDAD. RESULTS: There was a significant difference in the prevalence rate of chronic kidney disease (CKD) between CDAD and non-CDAD patients (P<0.001). Sixteen patients (18.8%) of the CDAD group were treated with dialysis, whereas 21 patients (5.2%) of the non-CDAD group were treated with dialysis. There was a significant association between renal function and CDAD in patients on dialysis [odds ratio (OR)=4.44, 95% confidence interval (CI) 2.19-8.99, P<0.001], but not in patients with CKD stage 3-5 (OR=1.10, 95% CI 0.63-1.92, P=0.73). In multivariate analysis, CKD stage 5D was an independent risk factor for the development of CDAD (OR=13.36, 95% CI 2.94-60.67, P=0.001). CONCLUSION: Our data indicate that dialysis patients might be at a greater risk of developing CDAD, which suggests that particular attention should be provided to CDAD when antibiotic treatment is administered to dialysis patients.
Anti-Bacterial Agents ; Clostridium ; Clostridium difficile ; Defense Mechanisms ; Dialysis ; Diarrhea ; Humans ; Multivariate Analysis ; Prevalence ; Renal Insufficiency, Chronic ; Retrospective Studies ; Risk Factors

BACKGROUND: Dialysis patients have impaired host defense mechanisms and frequently require antibiotics for various infective complications. In this study, we investigated whether dialysis patients have greater risk for Clostridium difficile-associated diarrhea (CDAD). METHODS: During the 4-year study period (2004-2008), 85 patients with CDAD were identified based on a retrospective review of C difficile toxin assay or histology records. Nosocomial diarrheal patients without CDAD were considered as controls (n=403). We assessed the association between renal function and the prevalence and clinical outcomes of CDAD. RESULTS: There was a significant difference in the prevalence rate of chronic kidney disease (CKD) between CDAD and non-CDAD patients (P<0.001). Sixteen patients (18.8%) of the CDAD group were treated with dialysis, whereas 21 patients (5.2%) of the non-CDAD group were treated with dialysis. There was a significant association between renal function and CDAD in patients on dialysis [odds ratio (OR)=4.44, 95% confidence interval (CI) 2.19-8.99, P<0.001], but not in patients with CKD stage 3-5 (OR=1.10, 95% CI 0.63-1.92, P=0.73). In multivariate analysis, CKD stage 5D was an independent risk factor for the development of CDAD (OR=13.36, 95% CI 2.94-60.67, P=0.001). CONCLUSION: Our data indicate that dialysis patients might be at a greater risk of developing CDAD, which suggests that particular attention should be provided to CDAD when antibiotic treatment is administered to dialysis patients.
Anti-Bacterial Agents ; Clostridium ; Clostridium difficile ; Defense Mechanisms ; Dialysis ; Diarrhea ; Humans ; Multivariate Analysis ; Prevalence ; Renal Insufficiency, Chronic ; Retrospective Studies ; Risk Factors