Background: Conventional laryngoscopy with Macintosh blade requires a movement of the head, neck and cervical spine. The Bullard laryngoscope is an anatomically shaped, potentially eliminating the need for cervical spine extension. Bullard and Macintosh laryngoscopes were compared by measuring the degree of cervical spine extension by radiological measurement. Methods: Eighteen patients requiring endotracheal intubation were studied. Anesthesia was induced in neutral head position followed by laryngoscopy. Each patients was intubated two times by Macintosh and Bullard laryngoscope in random order. Radiographic evaluation was performed to determine the degree of cervical spine extension on four occasions; before induction, during facial mask ventilation, and during Bullard and Macintosh laryngoscopy. Results: The extension of cervical spine was significantly less following Bullard laryngoscopy than Macintosh laryngoscopy for best view (p<0.05). Conclusions: The Bullard laryngoscope can be used with less cervical spine extension than Macintosh laryngoscope. It may be useful in patients in whom cervical spine movement is limited or undesirable.
Anesthesia ; Head ; Humans ; Intubation, Intratracheal ; Laryngoscopes ; Laryngoscopy* ; Masks ; Neck ; Spine* ; Ventilation

PURPOSE: We intended to investigate the clinical features and the predictors of febrile seizure plus(FS+), not suspected of generalized epilepsy with febrile seizure plus (GEFS+). METHODS: We selected 24 patients, aged more than 6 years old, who were admitted to Myongji Hospital of Kwandong University from January, 2001 to March, 2005 due to febrile seizures. All of those had neither a family history of febrile seizures or epilepsy nor abnormalities in the EEG or MRI. We examined sex, age of seizure onset, type of seizure, duration of seizure, the time until seizure after fever and frequency of febrile seizure. We investigated also the statistical significances of these clinical features by comparing with patients of simple febrile seizure(FS) as a control group. RESULTS: The male to female of the FS+ group was 2:1, which had no statistical significance compared with the FS. The age of seizure onsets in the FS+(39.4+/-5.0 months) was significantly older than FS the group(24.1+/-2.1 months)(P<0.05). In the types of seizures, non-generalized tonic clonic seizures occurred significantly more often in the FS+ group(20.9%) than the FS(8.4%)(P<0.05). The frequency of febrile seizures also was high in the FS+ group(n=3.2+/-0.8) than the FS group(n=1.1+/-0.1)(P<0.05). The duration of seizures and the time until seizure after fever did not have statistical significance. CONCLUSION: We suggest that FS+ can be characterized by late onsets of initial seizures, more frequent non-generalized tonic clonic seizures and recurrent febrile seizures. Therefore, FS+ should be suspected for patients more than 4 years old with non-generalized tonic clonic seizures or recurrent febrile seizures of more than 4 times.
Child ; Child, Preschool ; Electroencephalography ; Epilepsy ; Epilepsy, Generalized ; Female ; Fever ; Humans ; Magnetic Resonance Imaging ; Male ; Seizures ; Seizures, Febrile*

PURPOSE: Headache is a common neurologic symptom in children but chronic headache in them must be diagnosed in different ways. The aim of this study is to determine the algorithm of diagnostic approach for children with chronic headache and know the clinical significance of dizziness in evaluating those children. METHODS: We recruited children with headache at Myongji Hospital from January 2004 to July 2006. The study was based on a retrospective review of their medical records and interviews with the children and their parents. We divided them into two groups : Group A headache with dizziness, Group B headache without dizziness. RESULTS: The medical records of 86 children and adolescents with headache were reviewed. Age for group A ranged from 10 to 15 years(73.7%) and gender ratio was 1:1.7. Age for group B ranged mostly under 7 years(56.3%) and gender ratio was 1:0.85. Headache in group A frequently occurred predominantly in the morning(37.3%). The duration of the attack was over 90 min(87.5%) in group A and over 90 min(50.0%) in group B. Associated symptoms were mainly nausea(34.2%), vomiting(18.4%), blurred vision(12.7%) in group A. Over 90% of them had headache 4 times a week and so did dizziness. The final diagnoses in cases of group A were migraine(31.6%), orthostatic hypotension(15.8%), postural orthostatic tachycardia syndrome(13.2%), and benign paroxysmal positional vertigo(10.5%). While in group B diagnoses included sinusitis(50.0%), migraine(31.3%), and complications of migraine(8.3%). CONCLUSION: This study revealed high percentage of headache concurred with dizziness in children. The association of headache with dizziness is complex and maybe coincidental. If chronic headache with dizziness in girls occurs mainly in the morning, it maybe related to vestibular disorder and orthostatic instability. In conclusion, dizziness and other associated symptoms or clinical features should carefully be assessed in the diagnosis of headache.
Adolescent ; Child ; Dizziness ; Headache ; Headache Disorders ; Humans ; Medical Records ; Neurologic Manifestations ; Parents ; Retrospective Studies ; Tachycardia

Osteomyelitis of the maxilla is a relatively rare disease. Although the advent of antibiotics has decreased its incidence and morbidity significantly, osteomyelitis still remains a potentially dangerous condition because of the possible risk of intracerebral complications. Clinically, patients present facial swelling, localized pain and tenderness, low-grade fever, draining sinus tracts, suppuration, dental loss, and sequestrum formation. We experienced a case of osteomyelitis of the maxilla with associated aspergillosis. In this paper, we report this case with a review of literature.
Anti-Bacterial Agents ; Aspergillosis* ; Fever ; Humans ; Incidence ; Maxilla* ; Osteomyelitis* ; Rare Diseases ; Suppuration

Background: In this study, we aimed to investigate whether opioid-sparing anesthesia (OSA) reduces postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic gynecological surgery. Methods: Adult patients undergoing elective laparoscopic gynecological surgery were randomly assigned to either the opioid-using anesthesia (OUA) or the OSA groups. In the OUA group, remifentanil was administered as an opioid during general anesthesia. In the OSA group, apart from a single dose of 5 μg/kg of alfentanil for tracheal intubation, no other opioids were used. In both groups, a multimodal intravenous non-opioid analgesic regimen was used preferentially in the post-anesthesia care unit (PACU). The primary outcome was the incidence of PONV, assessed by symptoms until the postoperative day 1. Results: A total of 120 patients were included in this study. The incidence of nausea in the PACU was significantly lower in the OSA group compared to in the OUA group (31.7% in the OSA group vs. 51.7% in the OUA group, P = 0.026). Pain scores and the incidence of opioid analgesic administration were lower in the OSA group during PACU stay, resulting in a significantly lower number of patients requiring rescue opioid analgesics (3.3% vs. 18.3%, P = 0.008). There were no significant differences in intraoperative vital signs, hemodynamic interventions, or duration of PACU and hospital stay between the two groups. Conclusions OSA significantly reduced postoperative nausea, pain scores, and the need for rescue analgesics in the PACU without increasing hemodynamic instability in patients undergoing laparoscopic gynecological surgery.

Background: In this study, we aimed to investigate whether opioid-sparing anesthesia (OSA) reduces postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic gynecological surgery. Methods: Adult patients undergoing elective laparoscopic gynecological surgery were randomly assigned to either the opioid-using anesthesia (OUA) or the OSA groups. In the OUA group, remifentanil was administered as an opioid during general anesthesia. In the OSA group, apart from a single dose of 5 μg/kg of alfentanil for tracheal intubation, no other opioids were used. In both groups, a multimodal intravenous non-opioid analgesic regimen was used preferentially in the post-anesthesia care unit (PACU). The primary outcome was the incidence of PONV, assessed by symptoms until the postoperative day 1. Results: A total of 120 patients were included in this study. The incidence of nausea in the PACU was significantly lower in the OSA group compared to in the OUA group (31.7% in the OSA group vs. 51.7% in the OUA group, P = 0.026). Pain scores and the incidence of opioid analgesic administration were lower in the OSA group during PACU stay, resulting in a significantly lower number of patients requiring rescue opioid analgesics (3.3% vs. 18.3%, P = 0.008). There were no significant differences in intraoperative vital signs, hemodynamic interventions, or duration of PACU and hospital stay between the two groups. Conclusions OSA significantly reduced postoperative nausea, pain scores, and the need for rescue analgesics in the PACU without increasing hemodynamic instability in patients undergoing laparoscopic gynecological surgery.

Background: In this study, we aimed to investigate whether opioid-sparing anesthesia (OSA) reduces postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic gynecological surgery. Methods: Adult patients undergoing elective laparoscopic gynecological surgery were randomly assigned to either the opioid-using anesthesia (OUA) or the OSA groups. In the OUA group, remifentanil was administered as an opioid during general anesthesia. In the OSA group, apart from a single dose of 5 μg/kg of alfentanil for tracheal intubation, no other opioids were used. In both groups, a multimodal intravenous non-opioid analgesic regimen was used preferentially in the post-anesthesia care unit (PACU). The primary outcome was the incidence of PONV, assessed by symptoms until the postoperative day 1. Results: A total of 120 patients were included in this study. The incidence of nausea in the PACU was significantly lower in the OSA group compared to in the OUA group (31.7% in the OSA group vs. 51.7% in the OUA group, P = 0.026). Pain scores and the incidence of opioid analgesic administration were lower in the OSA group during PACU stay, resulting in a significantly lower number of patients requiring rescue opioid analgesics (3.3% vs. 18.3%, P = 0.008). There were no significant differences in intraoperative vital signs, hemodynamic interventions, or duration of PACU and hospital stay between the two groups. Conclusions OSA significantly reduced postoperative nausea, pain scores, and the need for rescue analgesics in the PACU without increasing hemodynamic instability in patients undergoing laparoscopic gynecological surgery.

Background: In this study, we aimed to investigate whether opioid-sparing anesthesia (OSA) reduces postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic gynecological surgery. Methods: Adult patients undergoing elective laparoscopic gynecological surgery were randomly assigned to either the opioid-using anesthesia (OUA) or the OSA groups. In the OUA group, remifentanil was administered as an opioid during general anesthesia. In the OSA group, apart from a single dose of 5 μg/kg of alfentanil for tracheal intubation, no other opioids were used. In both groups, a multimodal intravenous non-opioid analgesic regimen was used preferentially in the post-anesthesia care unit (PACU). The primary outcome was the incidence of PONV, assessed by symptoms until the postoperative day 1. Results: A total of 120 patients were included in this study. The incidence of nausea in the PACU was significantly lower in the OSA group compared to in the OUA group (31.7% in the OSA group vs. 51.7% in the OUA group, P = 0.026). Pain scores and the incidence of opioid analgesic administration were lower in the OSA group during PACU stay, resulting in a significantly lower number of patients requiring rescue opioid analgesics (3.3% vs. 18.3%, P = 0.008). There were no significant differences in intraoperative vital signs, hemodynamic interventions, or duration of PACU and hospital stay between the two groups. Conclusions OSA significantly reduced postoperative nausea, pain scores, and the need for rescue analgesics in the PACU without increasing hemodynamic instability in patients undergoing laparoscopic gynecological surgery.

BACKGROUND: Using rotational thromboelastometry (ROTEM) analysis, we investigated the difference in blood hemostasis, based on the primary anesthetic agents used during general anesthesia. METHODS: Sixty-six adult patients scheduled for elective ophthalmic surgery under general anesthesia were evaluated with regard to changes in each parameter in INTEM, EXTEM, and FIBTEM analyses. The patients received intravenous anesthesia with propofol and remifentanil (TIVA group) or inhalation anesthesia with sevoflurane (SEVO group). The ROTEM tests were performed 10 min before starting anesthesia and 1 h after finishing anesthesia. The INTEM and EXTEM analyses included the clotting time (CT), clot firmness time (CFT), alpha angle (alpha), and maximum clot firmness (MCF). The FIBTEM analyzed only MCF. Maximum clot elasticity (MCE) was calculated by (MCF x 100) / (100 - MCF). The platelet component of clot strength was calculated as follows: MCE(platelet) = MCE(EXTEM) - MCE(FIBTEM). RESULTS: The preoperative and postoperative parameters (CT, CFT, alpha, and MCF) in the INTEM, EXTEM, and FIBTEM analyses were not significantly different between the two groups. The MCE(platelet) also did not show a significant difference. CONCLUSIONS: Presuming that the ophthalmic surgery had a minimal traumatic effect, we conclude that both anesthetic agents cause negligible changes in ROTEM analyses postoperatively.
Adult ; Anesthesia ; Anesthesia, General ; Anesthesia, Inhalation ; Anesthesia, Intravenous ; Anesthetics ; Blood Platelets ; Elasticity ; Hemostasis* ; Humans ; Propofol* ; Thrombelastography

PURPOSE: To report four cases of split cornea transplantation involving separate Descemet membrane keratoplasty and Deep anterior lamella keratoplasty from a single cornea. CASE SUMMARY: Four donor corneas were separated into the endothelium and other layers. The endothelial layers were transplanted into 4 pseudophakic bullous keratopathy patients, and the other layers were stored in corneal storage media. Deep anterior lamella keratoplasties were performed with the stored corneas in 2 lipid keratopathy and 2 keratoconus patients. Postoperatively, all grafted corneas were stable. CONCLUSIONS: The authors report the first 4 cases of split cornea transplantation in Korea, which is experiencing a shortage of donated corneas. Split cornea transplantation will be of benefit to a large number of patients by separating a single cornea into separate layers to be implanted into two patients.
Cornea* ; Corneal Transplantation* ; Descemet Membrane ; Endothelium ; Humans ; Keratoconus ; Korea ; Tissue Donors ; Transplants