No abstract available.
C-Reactive Protein* ; Humans ; Membranes* ; Prospective Studies* ; Rupture*

BACKGROUND: The aim of this study was to estimate the optimal depth of nasotracheal tube placement. METHODS: We enrolled 110 patients scheduled to undergo oral and maxillofacial surgery, requiring nasotracheal intubation. After intubation, the depth of tube insertion was measured. The neck circumference and distances from nares to tragus, tragus to angle of the mandible, and angle of the mandible to sternal notch were measured. To estimate optimal tube depth, correlation and regression analyses were performed using clinical and anthropometric parameters. RESULTS: The mean tube depth was 28.9 ± 1.3 cm in men (n = 62), and 26.6 ± 1.5 cm in women (n = 48). Tube depth significantly correlated with height (r = 0.735, P < 0.001). Distances from nares to tragus, tragus to angle of the mandible, and angle of the mandible to sternal notch correlated with depth of the endotracheal tube (r = 0.363, r = 0.362, and r = 0.546, P < 0.05). The tube depth also correlated with the sum of these distances (r = 0.646, P < 0.001). We devised the following formula for estimating tube depth: 19.856 + 0.267 × sum of the three distances (R2 = 0.432, P < 0.001). CONCLUSION: The optimal tube depth for nasotracheally intubated adult patients correlated with height and sum of the distances from nares to tragus, tragus to angle of the mandible, and angle of the mandible to sternal notch. The proposed equation would be a useful guide to determine optimal nasotracheal tube placement.
Adult* ; Female ; Humans ; Intubation ; Male ; Mandible ; Neck ; Surgery, Oral

No abstract available.
Child* ; Humans ; Infant* ; Urinary Tract Infections* ; Urinary Tract*

A 47-year-old man was referred to the operating room to treat a dentigenous cyst of the mandibular bone. Initial assessment of the airway was considered normal. However, after the induction of anesthesia, we could not intubate the patient due to severe distortion of the glottis. Fiberoptic bronchoscopy and video laryngoscopy were not effective. Intubation using a retrograde wire technique was successful. After the conclusion of surgery, the patient recovered without any complications. Subsequent magnetic resonance imaging of the patient's neck showed a 6 × 4 × 8.6 cm heterogeneous T2 hyperintense, T1 isointense well-enhancing mass in the prestyloid parapharyngeal space. The patient was scheduled for excision of the mass. We planned awake intubation with fiberoptic bronchoscopy. The procedure was successful and the patient recovered without complications. Anesthetic induction can decrease the muscle tone of the airway and increase airway distortion. Therefore, careful airway assessment is necessary.
Airway Management* ; Anesthesia ; Bronchoscopy ; Glottis ; Humans ; Intubation ; Laryngoscopy ; Magnetic Resonance Imaging ; Middle Aged ; Neck ; Operating Rooms

A 47-year-old man was referred to the operating room to treat a dentigenous cyst of the mandibular bone. Initial assessment of the airway was considered normal. However, after the induction of anesthesia, we could not intubate the patient due to severe distortion of the glottis. Fiberoptic bronchoscopy and video laryngoscopy were not effective. Intubation using a retrograde wire technique was successful. After the conclusion of surgery, the patient recovered without any complications. Subsequent magnetic resonance imaging of the patient's neck showed a 6 × 4 × 8.6 cm heterogeneous T2 hyperintense, T1 isointense well-enhancing mass in the prestyloid parapharyngeal space. The patient was scheduled for excision of the mass. We planned awake intubation with fiberoptic bronchoscopy. The procedure was successful and the patient recovered without complications. Anesthetic induction can decrease the muscle tone of the airway and increase airway distortion. Therefore, careful airway assessment is necessary.
Airway Management* ; Anesthesia ; Bronchoscopy ; Glottis ; Humans ; Intubation ; Laryngoscopy ; Magnetic Resonance Imaging ; Middle Aged ; Neck ; Operating Rooms

BACKGROUND: Identifying early markers of septic complications can aid in the diagnosis and therapeutic management of hospitalized patients. In this study, the utility of procalcitonin (PCT) vs. C-reactive protein (CRP) as early markers of sepsis was compared. METHODS: A series of 2,697 consecutive blood samples was collected from hospitalized patients and serum PCT and CRP levels were measured. Patients were categorized by PCT level as follows: < 0.05 ng/ml, 0.05-0.49 ng/ml, 0.5-1.99 ng/ml, 2-9.99 ng/ml, and > 10 ng/ml. Diagnostic utility was analyzed by receiver operating characteristic (ROC) curves. RESULTS: Mean CRP levels varied among the five PCT categories at 0.31 ± 2.87, 5.65 ± 6.26, 13.78 ± 8.01, 12.15 ± 10.16, and 17.77 ± 10.59, respectively (P < 0.05). PCT and CRP differed between positive and negative blood culture groups (PCT: 15.9 vs. 4.78 mg/dl; CRP: 11.5 ng/ml vs. 9.57 ng/ml; P < 0.05). The areas under the ROC curves (PCT, 95% confidence interval [CI]: 0.743, range: 0.698-0.789 at a threshold of 0.5 ng/ml; CRP, 95% CI: 0.540, range: 0.478-0.602 at a threshold of 8 mg/l) differed for PCT and CRP (P < 0.05). CONCLUSIONS: Therefore, PCT is a reliable marker for sepsis diagnosis and is more relevant than CRP in patients with a positive blood culture. These findings can be useful for the treatment of critically ill sepsis patients.
C-Reactive Protein ; Critical Illness* ; Diagnosis ; Humans ; ROC Curve ; Sepsis*

BACKGROUND: Identifying early markers of septic complications can aid in the diagnosis and therapeutic management of hospitalized patients. In this study, the utility of procalcitonin (PCT) vs. C-reactive protein (CRP) as early markers of sepsis was compared. METHODS: A series of 2,697 consecutive blood samples was collected from hospitalized patients and serum PCT and CRP levels were measured. Patients were categorized by PCT level as follows: < 0.05 ng/ml, 0.05-0.49 ng/ml, 0.5-1.99 ng/ml, 2-9.99 ng/ml, and > 10 ng/ml. Diagnostic utility was analyzed by receiver operating characteristic (ROC) curves. RESULTS: Mean CRP levels varied among the five PCT categories at 0.31 ± 2.87, 5.65 ± 6.26, 13.78 ± 8.01, 12.15 ± 10.16, and 17.77 ± 10.59, respectively (P < 0.05). PCT and CRP differed between positive and negative blood culture groups (PCT: 15.9 vs. 4.78 mg/dl; CRP: 11.5 ng/ml vs. 9.57 ng/ml; P < 0.05). The areas under the ROC curves (PCT, 95% confidence interval [CI]: 0.743, range: 0.698-0.789 at a threshold of 0.5 ng/ml; CRP, 95% CI: 0.540, range: 0.478-0.602 at a threshold of 8 mg/l) differed for PCT and CRP (P < 0.05). CONCLUSIONS: Therefore, PCT is a reliable marker for sepsis diagnosis and is more relevant than CRP in patients with a positive blood culture. These findings can be useful for the treatment of critically ill sepsis patients.
C-Reactive Protein ; Critical Illness* ; Diagnosis ; Humans ; ROC Curve ; Sepsis*

Low-grade endometrial stromal sarcoma (LGESS) with intravascular extension is very rare, with only 26 cases having been reported. We experienced a case of LGESS with inferior vena cava (IVC) extension. A 60-year-old female presented with left leg edema. She had a history of total hysterectomy, and was diagnosed of leiomyoma at that time. On imaging study, tumor masses were located around both common iliac veins (CIV), and within the CIV and IVC. The pelvic masses on both side and IVC mass were resected, and then the patient received adjuvant hormonal therapy and radiotherapy over the remnant pelvic masses. LGESS with IVC extension is difficult to distinguish from intravascular leiomyomatosis. LGESS is a malignant disease and commonly recurs, even in early stages. Accurate diagnosis, complete resection, proper adjuvant therapy and close follow-up are very important.
Diagnosis ; Edema ; Female ; Follow-Up Studies ; Humans ; Hysterectomy ; Iliac Vein ; Korea ; Leg ; Leiomyoma ; Leiomyomatosis ; Middle Aged ; Radiotherapy ; Sarcoma, Endometrial Stromal* ; Vena Cava, Inferior*

PURPOSE: The purpose of this study was to investigate factors which effect clinical nurses' exhaustion. METHODS: This research was conducted targeting 140 clinical nurses. Data were collected from 18 September to 30 September 2015. Data were analyzed using the program SPSS/WIN 18.0. Descriptive statistics, t-test, ANOVA, Pearson correlation coefficient, and Stepwise multiple regression analysis were used. RESULTS: Burnout was significantly different by age (F=7.99, p=.001), marital status (t=8.69, p=.004), department area (F=7.65, p<.001), frequency of night work in a month (F=7.65, p=<.001), and clinical career (F=3.68, p=.028). There was positive correlations between menstrual attitudes of participants and premenstrual syndrome (r=34, p<.001), menstrual attitudes and stress (r=.40, p<.001), and menstrual attitudes and burnout (r=.16, p=.031). There were positive correlations between premenstrual syndrome and stress (r=.46, p<.001), between premenstrual syndrome and burnout (r=.35, p<.001), and between stress and burnout (r=.36, p<.001). Factors influencing burnout were premenstrual syndrome (β=.335) and age (β=.216), with an explanatory power of 18.0%. CONCLUSION: There is a need to develop and apply program for reducing clinical nurses' pre-menstrual syndrome. In addition, policies are needed to allow for menstruation leave, thereby making it legal.
Female ; Marital Status ; Menstruation ; Premenstrual Syndrome*

PURPOSE: Because of the complexity and un-expectation of the courses and clinical features for the complex anal fistula, the management of it presents a difficult surgical challenge. Various techniques have been used, such as seton placement, advancement flap closure, muscle filling procedure, and fibrin glue injection. The classic lay-open and seton placement may distort the anal anatomy and result in poor functional outcomes, such as incontinence. Also, advancement flap techniques are associated with relatively high recurrence rates. This study assesses the results of surgery for a complex anal fistula, as performed in Hangun Hospital, Busan. Operative procedures were comprised of two or more separate procedures, including 1) a total fistulectomy, 2) muscle reconstruction, sometimes muscle transposition, 3) direct closure of the primary opening without making a mucosal advancement flap, and 4) a drainage procedure and/or other minor procedure. METHODS: Surgical procedures were performed on 22 patients (18 males) with a complex anal fistula between July 2004 and December 2004. The clinical and the manometric results were analyzed with respect to postoperative recurrence, delayed wound healing, and postoperative fecal incontinence. RESULTS: Nineteen of the 22 patients were completely healed without any sequelae. Treatment failure was encountered in one patient two months postoperatively, when an additional fistulotomy was performed to achieve a cure. There were two patients displaying delayed healing, who were successfully treated by curettage. No patient complained of postoperative fecal incontinence in either the clinical examination on the manometric study (mean resting pressure, 75.5+/-3.5 mmHg; maximal squeeze pressure, 175.7+/-10.3 mmHg). CONCLUSIONS: This short- term study suggests that a direct closure of the internal opening after a total fistulectomy can be an alternative surgical option for the treatment of a complex anal fistula.
Curettage ; Drainage ; Fecal Incontinence ; Fibrin Tissue Adhesive ; Humans ; Muscles ; Rectal Fistula ; Recurrence ; Surgical Procedures, Operative ; Treatment Failure ; Wound Healing