BACKGROUND: Fiberoptic bronchoscope guided intubation is an important method of difficult airway management. The use of specific airways has been devised to assist the fiberoptic intubation. The authours compared effectiveness of separated airway with fiberoptic bronchoscope guided intubation and the hemodynamic responses. METHODS: 104 adult patients of American Society of Anesthesiologists grading (ASA) I-II who scheduled for surgery under general anesthesia were randomly divided into the Laryngoscope group (L group, n = 30) or the Fiberoptic bronchoscope group (F group, n = 36) or the Fiberoptic bronchoscope with separated airway (MF group, n = 38). A Fiberoptic bronchoscope guided intubation and a fiberoptic bronchoscope with separated airway and a direct laryngoscope was performed after inducing anesthesia. Intubation time, Jaw thrust incidence, mean blood pressure and heart rate after anaesthesia induction, at intubation and every two minute for a further 7 min were recorded. RESULTS: The intubation time was significantly shorter in the MF group (58.3 +/- 13.7 sec) than F group (71.9 +/- 22.1 sec). Jaw thrust incidence was lower in the MF group (60.5%) than F group (100%). The changes of MAPs and HRs during the observation were not significantly different in three group. CONCLUSIONS: Fiberoptic intubation using separated airway reduced intubation time and the incidence of jaw thrust.
Adult ; Airway Management ; Anesthesia ; Anesthesia, General ; Blood Pressure ; Bronchoscopes ; Heart Rate ; Hemodynamics ; Humans ; Incidence ; Intubation ; Jaw ; Laryngoscopes

Torticollis is an abnormal, asymmetric head or neck position which usually caused by imbalance of paracervical muscles. The traumatic torticollis can be caused by following events; atlantoaxial rotatory subluxation, atlantoaxial dislocation, cervical vertebral fractures, and injury to the cervical musculature. Especially, acute traumatic atlantoaxial rotatory subluxation usually presents limitation of cervical range of motion without pain or neurologic deficit. We report a case of a 58 year-old man who developed the acute atlantoaxial rotatory subluxation right after the chiropractic therapy, which induced the limitation of cervical range of motion to 52.5% of normal range. The magnetic resonance image revealed the facture of the odontoid process and the partial injury in transverse ligaments of the atlas. He underwent intramuscular botulinum toxin injection and 10 days of continuous cervical traction 15 hours a day using a 5 kg weight. The range of the cervical motion restored up to 90.2% of normal range.
Atlanto-Axial Joint ; Botulinum Toxins ; Chiropractic ; Dislocations ; Head ; Ligaments ; Muscles ; Neck ; Neurologic Manifestations ; Odontoid Process ; Range of Motion, Articular ; Reference Values ; Torticollis ; Traction

OBJECTIVE: This study aims to evaluate the efficacy of high-voltage microcurrent therapy in patients with herniated lumbar disc (HLD) presenting radicular or back pain.METHOD: This is a retrospective study with 33 patients who are complaining pain with HLD findings on magnetic resonance image. Microcurrent therapy was applied to leg or paralumbar area. Treatment was conducted for seven minutes with 250~1000 uA intensity as high as the patients could tolerate via stimulating probe with roller type and the frequency was 60 Hz with a sine wave pulse. The visual analogue scale (VAS) was measured just before and after the treatment.RESULTS: The degree of pain reduction (ΔVAS) was 1.6 points after treatment on average. The ΔVAS according to the diagnosis, stenosis, dermatome area, medication, pain site and caudal epidural block was not statistically significant. However, the ΔVAS according to the number of treatments (< 3, ≥ 3 times) showed a statistically significant difference (p=0.04).CONCLUSION: High-voltage microcurrent therapy may help reduce lumbar or lumbosacral radiating pain after the procedure. The effect was better when microcurrent was applied three times or more. This result suggests that the microcurrent would have cumulative effect on reducing radicular or back pain in patients with HLD.
Back Pain ; Constriction, Pathologic ; Diagnosis ; Electric Stimulation ; Humans ; Intervertebral Disc Displacement ; Leg ; Methods ; Retrospective Studies ; Visual Analog Scale

OBJECTIVE: To determine the relationship between cervical sagittal parameters and the degree of the cervical disc degeneration at each cervical level by using cervical plain radiographs and disc degeneration grading.METHOD: This study analyzed 110 patients with posterior neck pain. Cervical radiographic measurements included the occipito-cervical (O~C2) angle; sagittal Cobb angles of C1~C2, C2~C7; and sagittal vertical axis (SVA) of C1~C7 and C2~C7. The degenerations of cervical discs at each level were evaluated through Pfirrmann grading system by magnetic resonance images of the cervical spine. The correlations between the cervical sagittal measurements and the disc degeneration at each level were analyzed by Spearman's correlation.RESULTS: A significant correlation was found for the C2~C7 angle with disc degenerations at C2~C6 levels. O~C2 angle was correlated significantly with disc degenerations at C2~C4 and C5~C7 levels. There was significant correlation between C1~C2 angle and disc degeneration at C6~C7 level. No significant relationship was found between the cervical SVA and the cervical disc degeneration at all cervical levels.CONCLUSION: Cervical sagittal parameters representing cervical angles (C2~C7, O~C2, and C1~C2 angles) were significantly correlated with the degree of the cervical disc degeneration. These findings suggest that the loss of the natural cervical lordosis rather than loss of natural SVA could be correlated with progression of the cervical disc degeneration.
Animals ; Cervical Vertebrae ; Female ; Humans ; Intervertebral Disc Degeneration ; Kyphosis ; Lordosis ; Methods ; Neck Pain ; Spine

The known causes of dysphagia following cervical spine surgery include pre-vertebral soft tissue swelling, decreased posterior pharyngeal movement, and impaired upper esophageal sphincter opening. Some studies have suggested that dysphagia is associated with movement of the cervical vertebrae during swallowing. In the present case, a 59-year-old man with a limited cervical range of motion due to ankylosing spondylitis slipped and fell, resulting in a C7 vertebral body fracture. He underwent anterior cervical discectomy as well as C5-T1 anterior fusion and C5-T2 level postero-lateral fusion. After surgery, he showed signs and symptoms of aspiration. A video-fluoroscopic swallowing study (VFSS) revealed incomplete laryngeal elevation, cricopharyngeal dysfunction, and vallecular remnant. Aspiration was observed in the semisolid-swallowing test. The patient's dysphagia could be attributed to two main causes. First, the esophagus might have been compressed by thickened pre-vertebral soft tissue after surgery. Second, the cervical range of motion, which was already limited by ankylosing spondylitis, might have been limited further by the anterior fusion of the cervical spine. In conclusion, a preoperative evaluation, including VFSS, should be considered before cervical spinal surgery, particularly in patients with ankylosing spondylitis presenting with a limited cervical range of motion.
Cervical Vertebrae ; Deglutition ; Deglutition Disorders* ; Diskectomy ; Esophageal Sphincter, Upper ; Esophagus ; Female ; Humans ; Middle Aged ; Range of Motion, Articular ; Spine ; Spondylitis, Ankylosing*

Purpose: This study aimed to compare the surgical and oncological outcomes between totally laparoscopic pylorus-preserving gastrectomy (TLPPG) with intracorporeal anastomosis and laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG) with extracorporeal anastomosis. Materials and Methods: A retrospective analysis was performed in 258 patients with cT1N0 gastric cancer who underwent laparoscopic pylorus-preserving gastrectomy using two different anastomosis methods: TLPPG with intracorporeal anastomosis (n=88) and LAPPG with extracorporeal anastomosis (n=170). The following variables were compared between the two groups to assess the postoperative surgical and oncological outcomes: proximal and distal margins, number of resected lymph nodes (LNs) in total and in LN station 6, operation time, postoperative hospital stay, and postoperative morbidity including delayed gastric emptying (DGE). Results: The average length of the proximal margin was similar between the TLPPG and LAPPG groups (2.35 vs. 2.73 cm, P=0.070). Although the distal margin was significantly shorter in the TLPPG group than in the LAPPG group (3.15 vs. 4.08 cm, P=0.001), no proximal or distal resection margin-positive cases were reported in either group. The average number of resected LN was similar in both groups (36.0 vs. 33.98, P=0.229; LN station 6, 5.72 vs. 5.33, P=0.399). The operation time was shorter in the TLPPG group than in the LAPPG (200.17 vs. 220.80 minutes, P=0.001). No significant differences were observed between the two groups in terms of postoperative hospital stay (9.38 vs. 10.10 days, P=0.426) and surgical complication rate (19.3% vs. 22.9%), including DGE (8.0% vs. 11.8%, P=0.343). Conclusions The oncological safety and postoperative complications of TLPPG with intracorporeal anastomosis are similar to those of LAPPG with extracorporeal anastomosis.

BACKGROUND AND OBJECTIVES: We assessed plaque erosion of culprit lesions in patients with acute coronary syndrome in real world practice. SUBJECTS AND METHODS: Culprit lesion plaque rupture or plaque erosion was diagnosed with optical coherence tomography (OCT). Intravascular ultrasound (IVUS) was used to determine arterial remodeling. Positive remodeling was defined as a remodeling index (lesion/reference EEM [external elastic membrane area) >1.05. RESULTS: A total of 90 patients who had plaque rupture showing fibrous-cap discontinuity and ruptured cavity were enrolled. 36 patients showed definite OCT-plaque erosion, while 7 patients had probable OCT-plaque erosion. Overall, 26% (11/43) of definite/probable plaque erosion had non-ST elevation myocardial infarction (NSTEMI) while 35% (15/43) had ST elevation myocardial infarction (STEMI). Conversely, 14.5% (13/90) of plaque rupture had NSTEMI while 71% (64/90) had STEMI (p<0.0001). Among plaque erosion, white thrombus was seen in 55.8% (24/43) of patients and red thrombus in 27.9% (12/43) of patients. Compared to plaque erosion, plaque rupture more often showed positive remodeling (p=0.003) with a larger necrotic core area examined by virtual histology (VH)-IVUS, while negative remodeling was prominent in plaque erosion. Overall, 65% 28/43 of plaque erosions were located in the proximal 30 mm of a culprit vessel-similar to plaque ruptures (72%, 65/90, p=0.29). CONCLUSION: Although most of plaque erosions show nearly normal coronary angiogram, modest plaque burden with negative remodeling and an uncommon fibroatheroma might be the nature of plaque erosion. Multimodality intravascular imaging with OCT and VH-IVUS showed fundamentally different pathoanatomic substrates underlying plaque rupture and erosion.
Acute Coronary Syndrome* ; Humans ; Membranes ; Myocardial Infarction ; Plaque, Atherosclerotic ; Rupture* ; Thrombosis ; Tomography, Optical Coherence ; Ultrasonography

BACKGROUND AND OBJECTIVES: The effects of fenofibrate on C-reactive protein (CRP) are under debate. We investigated the effect of fenofibrate on CRP levels and the variables determining changes. SUBJECTS AND METHODS: This case-control study enrolled 280 hypertriglyceridemic patients who were managed either with 200 mg of fenofibrate (Fenofibrate group, n=140) or with standard treatment (comparison group, n=140). CRP levels were measured before and after management for 2 months. RESULTS: CRP levels decreased in both the fenofibrate (p=0.003) and comparison (p=0.048) groups. Changes in CRP levels were not significantly different between the two groups (p=0.27) and were negatively associated with baseline CRP levels (r=-0.47, p<0.001). In patients with a baseline CRP level > or =1 mg/L, CRP levels also decreased in both groups (p=0.000 and p=0.001 respectively), however, more in the fenofibrate group than in the comparison group (p=0.025). The reduction of CRP was associated with higher baseline CRP levels (r=-0.29, p=0.001), lower body mass index (BMI, r=0.23, p=0.007), and fenofibrate therapy (r=0.19, p=0.025). CRP levels decreased more in the fenofibrate group than in the comparison group in patients with a BMI < or =26 kg/m2 with borderline significance (-1.21+/-1.82 mg/L vs. -0.89+/-1.92 mg/L, p=0.097). In patients with a high density lipoprotein-cholesterol level <40 mg/dL, CRP levels were reduced only in the fenofibrate group (p=0.006). CONCLUSION: Fenofibrate reduced CRP levels in hypertriglyceridemic patients with high CRP and/or low high density lipoprotein-cholesterol levels and without severe overweight. This finding suggests that fenofibrate may have an anti-inflammatory effect in selected patients.
Body Mass Index ; C-Reactive Protein ; Cardiovascular Diseases ; Case-Control Studies ; Fenofibrate ; Humans ; Lipoproteins ; Overweight

Magnetic resonance imaging (MRI) has become a crucial tool for evaluating mediastinal masses considering that several lesions that appear indeterminate on computed tomography and radiography can be differentiated on MRI. Using a three-compartment model to localize the mass and employing a basic knowledge of MRI, radiologists can easily diagnose mediastinal masses. Here, we review the use of MRI in evaluating mediastinal masses and present the images of various mediastinal masses categorized using the International Thymic Malignancy Interest Group’s three-compartment classification system. These masses include thymic hyperplasia, thymic cyst, pericardial cyst, thymoma, mediastinal hemangioma, lymphoma, mature teratoma, bronchogenic cyst, esophageal duplication cyst, mediastinal thyroid carcinoma originating from ectopic thyroid tissue, mediastinal liposarcoma, mediastinal pancreatic pseudocyst, neurogenic tumor, meningocele, and plasmacytoma.

Purpose: The European Organization for Research and Treatment of Cancer quality of life (QOL) questionnaires (QLQ-C30, QLQ-OG25, and QLQ-STO22) are widely used for the assessment of gastric cancer patients. This study aimed to use these questionnaires to evaluate QOL in postgastrectomy patients. Methods: We prospectively evaluated 106 patients with distal gastrectomy (DG), 57 with pylorus-preserving gastrectomy (PPG), and 117 with total gastrectomy (TG). Body weight and QOL questionnaires were evaluated preoperatively and postoperatively (at 3 weeks, and 3, 6, and 12 months). Results: TG patients had significantly more weight loss than DG/PPG patients. Compared with DG, patients after PPG had less dyspnea (P = 0.008) and trouble with coughing (P = 0.049), but more severe symptoms of insomnia (P = 0.037) and reflux (P = 0.030) at postoperative 12 months. Compared with DG/PPG, TG was associated with worse body image, dysphagia, eating, and taste in both OG25 and STO22. Moreover, OG25 revealed worse QOL in the TG group with respect to odynophagia, eating with others, choked when swallowing, trouble talking, and weight loss. The QOL of patients who received chemotherapy was worse than those in the chemo-free group in both physical functioning and symptoms such as nausea/vomiting, appetite loss, and trouble with taste; however, these side effects would soon disappear after finishing chemotherapy. Conclusion PPG was similar to DG in terms of postoperative QOL and maintaining body weight, while TG was always inferior to both DG and PPG. Adjuvant chemotherapy can affect both body weight and QOL despite being reversible.