BACKGROUND: Both remifentanil and sevoflurane are known for their rapid recovery characteristics, and the bispectral index (BIS) has been used as an indicator of the sedative state during anesthesia. Therefore, it is expected that if they are used together, the anesthetic-sparing effect of remifentanil and titration of the sevoflurane concentration using the BIS monitor will contribute to a faster recovery. This study examined the effect of a remifentanil infusion on the hemodynamics, the decrease in the sevoflurane concentration, and the recovery from BIS-guided sevoflurane anesthesia. METHODS: Thirty patients undergoing laparoscopic gynecologic surgery were assigned to receive a remifentanil (0.1microng/kg/min)(Group I) or saline infusion (Group II) with sevoflurane. The sevoflurane concentration was adjusted to maintain a BIS value between 40 and 60. The mean arterial pressure, heart rate, BIS, and end-tidal sevoflurane concentration were recorded during anesthesia. The eye opening time and the incidence of postoperative nausea, vomiting and shivering were checked. RESULTS: During anesthesia, the hemodynamics were more stable in Group I than in Group II with the reduced use of cardiovascular drugs. The BIS value was lower and the end tidal sevoflurane concentration was higher in group II than in group I. Group I had a shorter eye opening time and there was a similar incidence of postoperative nausea, vomiting and shivering in both groups. CONCLUSIONS: A remifentanil infusion with BIS-guided sevoflurane anesthesia produces more stable hemodynamics, reduced sevoflurane concentration, and a more rapid recovery without side effects than in BIS-guided sevoflurane anesthesia alone.
Anesthesia* ; Arterial Pressure ; Cardiovascular Agents ; Female ; Gynecologic Surgical Procedures ; Heart Rate ; Hemodynamics* ; Humans ; Incidence ; Postoperative Nausea and Vomiting ; Shivering ; Vomiting

PURPOSE: The development of publicized screening methods for breast carcinoma detection has led to a marked increase in the discovery of ductal carcinoma in situ (DCIS) or DCIS with microinvasion (DCIS-MI). Axillary lymph node status has been believed to be not only an indicator of prognosis, but also a direction of adjuvant therapy. But the incidence of axillary metastasis in DCIS or DCIS-MI has diversely found in from 0% to 20%. This study was performed to analyze the incidence of axillary metastasis and the predictive factors associated with axillary lymph node metastasis in DCIS or DCIS-MI. METHODS: Patients with DCIS or DCIS-MI and axillary lymph node dissection from 1987 to 2004 were selected from Korea University Medical Center. We reviewed their medical records for age, palpability and size of the tumor, histolgic subtype, nuclear grade, hormone receptor status, and pathologic slides. RESULTS: Fifty two patients in DCIS and Thirty eight patients in DCIS-MI were included in the study. Axillary lymph node metastases were identified in 2 patients (3.8%) in DCIS and 4 patients (10.5%) in DCIS-MI. Tumor size and nuclear grade in DCIS had a borderline significance in association with microinvasion. We could not be able to find any predictive factor associated with axillary lymph node metastasis in DCIS and DCIS-MI. CONCLUSION: Axillary lymph node metastasis in DCIS or DCIS-MI appeared to be not low and there was no predictive factor associated with axillary lymph node metastasis in DCIS and DCIS-MI. But DCIS patients with large tumor size and poor nuclear grade have the high possibility associated with microinvasion, therefore, in that cases, there is a need to consider the possibility of axillary metastasis.
Academic Medical Centers ; Breast ; Breast Neoplasms ; Carcinoma, Ductal* ; Carcinoma, Intraductal, Noninfiltrating* ; Humans ; Incidence ; Korea ; Lymph Node Excision ; Lymph Nodes* ; Mass Screening ; Medical Records ; Neoplasm Metastasis* ; Prognosis

BACKGROUND: Cystic liver disease is a rare disease entity, but its surgical management can vary from partial excision to hepatic lobectomy. This study was conducted to evaluate proper surgical management of cystic liver disease. METHODS: The authors reviewed the medical records of 26 patients who underwent operative management for cystic liver disease, consisting of 15 cases of simple cyst, 7 cases of biliary cystadenoma, 1 case of biliary cystadenocarcinoma, 1 case of polycystic disease and 2 cases of Caroli's disease. RESULTS: The 26 patients had a mean age of 57, with a male to female ratio of 1:4. Patients' main symptoms were right upper quadrant pain or discomfort, and epigastric pain. Their main physical findings were palpable mass and direct tenderness, but 23% of patients were aymptomatic and 35% had no physical findings. Preoperative diagnosis was made with abdominal ultrasound and computed tomogram. Intervening septum was identified in 27% of simple cysts and 100% of biliary cystadenoma. However neither diagnostic tool has 100% diagnostic accuracy. All cysts except polycystic disease were located at either both hepatic lobes but more right lobe in simple cysts. The mean size of all cysts were 10.2cm ranging from 2-to-22cm without any difference among simple cysts, cystadenomas, and cystadenocarcinoma. Operative methods for simple cysts were partial cystectomy with marsulpialization, total cystectomy and hepatic segmentectomy in 87% of cases, of which 2 cases were performed by laparoscopic approach. However partial cystectomy was confined to unilocular simple cyst. There was no recurrence of simple cyst postoperatively. Biliary cystadenoma were managed by total cyst excision, hepatic segmentectomy or lobectomy in 86% of cases, but one cystadenoma was managed by partial cystectomy with marsulpialization had a persisting cyst. One patient with polycystic liver disease died because of overwhelming sepsis with postoperative acute renal failure. CONCLUSION: For unilocular simple cyst, partial cystectomy with marsulpialization can be an acceptable surgical procedure, even with a laparoscopic approach. But for biliary cystadenoma, the cyst should be totally removed at least to prevent recurrence and transformation to cystadenocarcinoma. Therefore, correct preoperative diagnosis is a prerequisite for appropriate selection of operative methods.
Acute Kidney Injury ; Caroli Disease ; Cystadenocarcinoma ; Cystadenoma ; Cystectomy ; Diagnosis ; Female ; Humans ; Liver Diseases* ; Liver* ; Male ; Mastectomy, Segmental ; Medical Records ; Rare Diseases ; Recurrence ; Sepsis ; Ultrasonography

Failed back surgery syndrome (FBSS) is a condition characterized by extreme pain after spinal surgery. Treatment of FBSS is aimed at improving function, using interdisciplinary approaches that encompass rehabilitation, psychological therapy, and pain management. If no response to conventional treatment is noted, a more interventional technique such as spinal cord stimulation (SCS) should be used. SCS is a well-established method of managing a variety of chronic neuropathic pain conditions. A 32 year-old male patient afflicted by FBSS that was irresponsive to both medication and several repeated nerve blocks showed improvement of symptoms after cervical and thoracic SCS with a single electrode. Centered on the midline of the spinal cord, single-electrode SCS can be an effective method for relieving pain and improving function.
Adult ; Electrodes* ; Failed Back Surgery Syndrome* ; Humans ; Male ; Nerve Block ; Neuralgia ; Pain Management ; Rehabilitation ; Spinal Cord Stimulation* ; Spinal Cord*

Background: s/Aims: Rebleeding of gastric varices (GVs) after endoscopic variceal obturation (EVO) can be fatal. This study was performed to evaluate the usefulness of computed tomography (CT) for the prediction of rebleeding after EVO GV bleeding. Methods: Patients who were treated with EVO for GV bleeding and underwent CT before and after EVO were included. CT images of the portal phase showing pretreatment GVs and feeding vessels, and nonenhanced images showing posttreatment cyanoacrylate impaction were reviewed. Results: Fifty-three patients were included. Their mean age was 60.6±11.6 years, and 40 patients (75.5%) were men. Alcoholic liver disease was the most frequent underlying liver disease (45.3%). Complete impaction of cyanoacrylate in GVs and feeding vessels were achieved in 40 (75.5%) and 24 (45.3%) of patients, respectively. During the follow-up, GV rebleeding occurred in nine patients, and the cumulative incidences of GV rebleeding at 3, 6, and 12 months were 11.8%, 18.9%, and 18.9%, respectively. The GV rebleeding rate did not differ significantly according to the complete cyanoacrylate impaction in the GV, while it differed significantly according to complete cyanoacrylate impaction in the feeding vessels. The cumulative incidences of GV rebleeding at 3, 6, and 12 months were 22.3%, 35.2%, and 35.2%, respectively, in patients with incomplete impaction in feeding vessels, and there was no rebleeding during the follow-up period in patients with complete impaction in the feeding vessels (p=0.002). Conclusions Abdominal CT is useful in the evaluation of the treatment response after EVO for GV bleeding. Incomplete cyanoacrylate impaction in feeding vessels is a risk factor for GV rebleeding.

Intestinal tuberculosis is a common disease of extrapulmonary tuberculosis. A diagnosis of intestinal tuberculosis is difficult as the symptoms and laboratory findings are not specific for the disease. Intestinal tuberculosis may cause various complications, such as intestinal obstruction, intestinal perforation, intraabdominal abscess, intestinal hemorrhage and fistula formation. A duodenal fistula caused by tuberculosis is an especially rare condition. We experienced a case of intestinal tuberculosis with a duodenal fistula as a complication. The patient was a 25-year-old man that presented with weight loss and diarrhea. Esophagogastroduodenoscopy showed a deep ulcerative lesion on the third portion of the duodenum with a fistula opening. A histological finding revealed granulomatous inflammation with multinucleated giant cells. In addition, the result of a Tb PCR assay was positive. After two months of treatment with the appropriate medication, the symptoms improved and the fistula has closed completely. We report the case with a review of the literature.
Abscess ; Adult ; Diagnosis ; Diarrhea ; Duodenum ; Endoscopy, Digestive System ; Fistula* ; Giant Cells ; Hemorrhage ; Humans ; Inflammation ; Intestinal Obstruction ; Intestinal Perforation ; Polymerase Chain Reaction ; Tuberculosis* ; Ulcer ; Weight Loss

BACKGROUND: The purpose of this study was to assess the effect of our new video-assisted asthma education program on patients' knowledge regarding asthma and asthma control. METHODS: Adult asthmatics who were diagnosed by primary care physicians and followed for at least 1 year were educated via smart devices and pamphlets. The education sessions were carried out three times at 2-week intervals. Each education period lasted at most 5 minutes. The effectiveness was then evaluated using questionnaires and an asthma control test (ACT). RESULTS: The study enrolled 144 patients (mean age, 56.7±16.7 years). Half of the patients had not been taught how to use their inhalers. After participating in the education program, the participants' understanding of asthma improved significantly across all six items of a questionnaire assessing their general knowledge of asthma. The proportion of patients who made errors while manipulating their inhalers was reduced to less than 10%. The ACT score increased from 16.6±4.6 to 20.0±3.9 (p<0.001). The number of asthmatics whose ACT score was at least 20 increased from 45 (33.3%) to 93 (65.3%) (p<0.001). The magnitude of improvement in the ACT score did not differ between patients who received an education session at least three times within 1 year and those who had not. The majority of patients agreed to the need for an education program (95.8%) and showed a willingness to pay an additional cost for the education (81.9%). CONCLUSION: This study indicated that our newly developed education program would become an effective component of asthma management in primary care clinics.
Adult ; Asthma* ; Education* ; Humans ; Nebulizers and Vaporizers ; Pamphlets ; Physicians, Primary Care ; Primary Health Care*