BACKGROUNDS: When measuring lung function and response to bronchodilator, MDI(metered-dose inhaler) is commonly used but unfamiliarity of its use and cold sensation by the puffed gas decrease reliability of the result. Spacer can reduce the cold freon effect and undesired oropharyngeal deposition caused by the rapid evaporation of the propellant and there are many studies which showed more effectiveness of spacer on the treatment of children with asthma but no study whether it is effective on the bronchodilator response test in the first medical examination of old age. Therefore, we tested whether the use of spacer can reduce the cold freon effect and improve the bronchodilator response in the first medical examination of old age. METHODS: Two hundred of elderly patients( 65years) who had never used MDI were measured the bronchodilator response. Subjects were randomised to either spacer-user or spacer-nonuser. Twenty minutes after 400 g fenoterol was administered, FEV1 (forced expiratory volume in one second) was measured. Bronchoconstriction was defined as a decrease in FEV1 by 10% or greater after bronchodilator inhalation. We further devided each group into normal or obstructive group, obstructive group was defined as FEV1<80% of predicted and FEV1/FVC<70%. RESULTS: In normal group, spacer-user(n=83) showed greater bronchodilator response than spacer-nonuser(n=66), 6.43% vs 3.81% respectively(p<0.05) and two case of bronchoconstriction occured only in spacer-nonuser. In obstructive group, there is no significant difference in bronchodilator response between spacer-user(n=18) and spacer-nonuser(n=33), 12.32% vs 11.16% respectively(p>0.05) but brochoconstriction(n=1) occured only in spacer-nonuser. CONCLUSION: Spacer improved bronchodilator response and prevented bronchoconstriction, in the first medical examination of old age.
Aged ; Asthma ; Bronchoconstriction ; Child ; Chlorofluorocarbons ; Fenoterol ; Humans ; Inhalation ; Lung ; Sensation

PURPOSE: To evaluate the morphological differences between malignant and inflammatory lesions that arise from the cecal or pericecal region on CT by analyzing not only the mass itself but also the changes of surrounding structures. SUBJECTS AND METHODS: We reviewed CT scans of 38 cases of cecal lesions confirmed by pathology(16 malignant lesions and 22 inflammatory lesions). The analytical points were :the changes of bowel wall mass, the changes of surrounding structures, strands of retroperitoneal fat, pericecal fluid collection, and regional lymphadenopathy. RESULTS: The malignant bowel wall thickening(18.0mm) was thicker than inflammatory one(ll.4mm)(p < 0.001). Concentric bowel wall thickening was seen in 87.5%(14/16) of malignant lesions and 36%(8/22) of the inflammatory lesions. The pericecal fat stranding was circumferential in 84%(16/22) of inflammation and eccentric in 64%(916) of malignancy(p < 0.01). Pericolic fat infiltration was more extensive in inflammatory lesions(p < 0.005). The strands of retroperitoneal fat were more frequently found in inflammatory lesions(p < 0.05). The pericecal fluid collection was seen in 55%(12/22) of inflammatory lesions and none of malignant lesions. There was no difference in the presence of pericecal lymphadenopathy between the two groups. CONCLUSION: Malignant cecal masses have thicker and concentric bowel wall thickening, and narrower and eccentric pericolic fat infiltration. On the other hand, inflammatory masses have relatively thinner and eccentric bowel wall thickening, and more extensive and circumferential pericolic fat infiltration sometimes accompanied by abnormal fluid collection.
Cecum* ; Hand ; Inflammation ; Intra-Abdominal Fat ; Lymphatic Diseases ; Tomography, X-Ray Computed

The reliability of emergency ultrasonographic(US) detection of hemoperitoneum and solid organ injury in blunt abdominal trauma was evaluated retrospectively. From October 1,1995 to August 31,1996,90 patients were included in the study. Ultra- sonographic findings showed a sensitivity, specificity, and accuracy of 97.6%, 97.9%, and 98.1%, respectively, in detecting intraabdominal fluid collection. We believe that US in an emergency center is a quick, safe screening method in the evaluation of blunt abdominal trauma. In our department, US has replaced diagnostic peritonaeal lavage(DPL) and computed tomography(CT) as the screening study of first choice.
Emergencies* ; Hemoperitoneum* ; Humans ; Mass Screening ; Retrospective Studies ; Sensitivity and Specificity ; Ultrasonography*

We recently encountered an interesting case of acute inferior ST segment elevation myocardial infarction (STEMI). This patient had a rare anatomic variation, single coronary artery. The right coronary artery originate from the left circumflex proper artery, not from aorta, was totally obstructed with thrombi. Though it took more time to figure out the patient's coronary anatomy and the culprit lesion, we successfully performed primary percutaneous coronary intervention within the guideline-recommended time period. We performed left coronary angiography at the beginning. This strategy could be helpful in determining the culprit lesion and preventing unnecessary procedural delay in acute inferior STEMI.
Anatomic Variation ; Aorta ; Arteries ; Coronary Angiography ; Coronary Vessel Anomalies ; Coronary Vessels* ; Humans ; Myocardial Infarction* ; Percutaneous Coronary Intervention

Primary malignant melanoma of the vagina is an exceedingly rare entity, accounting for about 3% of all primary vagina1 malignant tumors and 0.3% of all melanoma. The overall 5-year survival in patients with primary vaginal melanoma is notoriously poor, estimated to be between 13% and 19%. A case of primary malignant melanoma of the vagina treated with the wide local excision of vagina and rectum was presented with a brief review of literature.
Humans ; Melanoma* ; Rectum* ; Vagina*

BACKGROUND: Recently introduced plateletpheresis systems (AmicusTM software version 2.41 and MCS + LDP Rev. C) were evaluated for their performance. METHOD: Single-needle procedure was used for all donors, 127 with the AmicusTM and 85 with the MCS +. The targeted platelet yield was 3.2x1011. Components were evaluated for component yields, collection time, collection efficiency and incidence of donor reactions due to citrate. RESULTS: The collection time was significantly shorter with the AmicusTM (mean 57 min vs. 71 min, p< 0.05), and in 9 donors with a mean preapheresis platelet count of 325x103 /microliter the whole procedure could be completed within 40 minutes. However, the total processing time, including preprocessing and postprocessing time, between AmicusTM (78.0 min) and MCS + (74.3 min) was not statistically different. Mean platelet yield for AmicusTM and MCS + were 3.6x1011 and 3.4x1011, respectively. With 82.4% of SDPs collected with the MCS + having a platelet count of 3.0~3.9x1011, compared to 65.4% with the AmicusTM, the MCS + was more accurate in predicting the platelet yield of the final products. All components showed a residual WBC count of 5.0x106, and in 99.2% and 97.6% of components collected with the AmicusTM and MCS +, respectively, had a residual WBC count of less than 1.0x106. Mild donor reactions due to citrate tended to be more common on the MCS + (14.1%), which also used significantly more ACD (mean 342.5 mL vs. 268.0 mL, p< 0.05), than on the AmicusTM (5.5%). CONCLUSION: The plateletpheresis systems evaluated in this study allow the collection of leukoreduced SDPs of high quality within a reasonable time.
Blood Platelets ; Citric Acid ; Humans ; Incidence ; Platelet Count ; Plateletpheresis* ; Tissue Donors

We analyzed records at Chonnam university hospital from Sep. 1. 1993 to Aug. 31. 1996 to assess clinical significance of the foreign body in the gastrointestinal tract. There were 133 episodes consisting of 79 pediatric and 54 adult patients as possible to review. In the pediatric patients, the coin was the most common cause of foreign body ingestion, while adult patients were usually caused by bones and meat. We removed foreign bodies in the oral cavity and oropharynx in 12 cases using direct laryngophanmgoscpy and forcep. Endoscopy was performed successfully in 47 of 51 patients in which was attempted; there were two complications composed of an aspiration pneumonia and a mediastinitis due to esophageal perforation. There were spontaneous passage of foreign bodies in 48 cases. We observed complications in 6 cases in which 4 cases needed operations due to complications. Foreign bodies which pass into the stomach can be observed for development of complications, as 94% of foreign bodies which reach the stomach spontaneously pass. Only 4 patients required interventions, which was done without mortality.
Adult ; Eating* ; Endoscopy ; Esophageal Perforation ; Foreign Bodies* ; Gastrointestinal Tract ; Humans ; Jeollanam-do ; Meat ; Mediastinitis ; Mortality ; Mouth ; Numismatics ; Oropharynx ; Pneumonia, Aspiration ; Stomach ; Surgical Instruments

BACKGROUND: Because difficult airways are not commonly encountered, simulation of a difficult airway using a cervical collar has become a well-established technique of for modeling difficult laryngoscopic views and evaluating interventions for use in difficult airway scenarios. In this study, we have determined the optimal remifentanil concentrations (EC50 and EC95) required for i-gel insertion in anesthetized patients fitted with cervical collars at propofol effect-site concentrations of 4.0 and 6.0 microg/ml (group 4.0 and group 6.0). METHODS: The remifentanil dosage for each propofol effect-site concentration group was determined by the modified Dixon's up-and-down method using previous results. The experiment was started using a 4.0 ng/ml effect-site remifentanil concentration, and the dose was reduced by 0.5 ng/ml for the next attempt when tube insertion was successful; if tube insertion failed, the dose for the next attempt was increased by 0.5 ng/ml. RESULTS: EC50 and EC95 were respectively 2.11 ng/ml (95% CI, 1.78-2.26 ng/ml) and 2.44 ng/ml (95% CI, 2.28-3.67 ng/ml) for the 4.0 group, and 0.42 ng/ml (95% CI, -1.30 to 0.77 ng/ml) and 0.75 ng/ml (0.56-14.3 ng/ml) for the 6.0 group. CONCLUSIONS: In this study, a cervical collar was attached and head fixation was performed to induce a difficult airway. The optimal concentration of remifentanil at a propofol effect-site concentration of 4.0 microg/ml was greater than 2.44 ng/ml (95% CI, 2.28-3.67 ng/ml), and that at the propofol effect-site concentration of 6.0 microg/ml was greater than 0.75 ng/ml (0.56-14.3 ng/ml).
Head ; Humans ; Propofol

A 33-year-old male visited the emergency room with abdominal pain which developed after a vomiting episode. Based on the pneumomediastinum findings from a chest radiograph and a contrast-enhanced chest and abdominal computed tomography scan, the patient was diagnosed with Boerhaave's syndrome. Preoperative radiologic findings showed no pneumothorax or pleural effusion. Once anesthesia was administered, the patient developed near complete cardiopulmonary collapse due to a bilateral tension pneumothorax, which was treated by bilateral thoracentesis, followed by chest tube insertion. Despite a left side rupture, the damaged right lung was unable to overcome single right ventilation, so the surgery was completed via right thoracotomy. The ruptured site was treated, and the patient was transferred to the intensive care unit. We discuss the anesthetic implications of this disease and how to prevent fatal complications.
Abdominal Pain ; Adult ; Anesthesia* ; Anesthesia, General ; Chest Tubes ; Emergency Service, Hospital ; Humans ; Intensive Care Units ; Lung ; Male ; Mediastinal Emphysema ; Pleural Effusion ; Pneumothorax* ; Positive-Pressure Respiration ; Radiography, Thoracic ; Rupture ; Thoracotomy ; Thorax ; Ventilation ; Vomiting

BACKGROUND: The benefits of video-assisted thoracoscopic surgery (VATS) have been demonstrated over the past decades; as a result, VATS has become the gold-standard treatment for primary spontaneous pneumothorax (PSP). Due to improvements in surgical technique and equipment, single-port VATS (s-VATS) is emerging as an alternative approach to conventional three-port VATS (t-VATS). The aim of this study was to evaluate s-VATS as a treatment for PSP by comparing operative outcomes and recurrence rates for s-VATS versus t-VATS. METHODS: Between March 2013 and December 2015, VATS for PSP was performed in 146 patients in Kyungpook National University Hospital. We retrospectively reviewed the medical records of these patients. RESULTS: The mean follow-up duration was 13.4±6.5 months in the s-VATS group and 28.7±3.9 months in the t-VATS group. Operative time (p<0.001), the number of staples used for the operation (p=0.001), duration of drainage (p=0.001), and duration of the postoperative stay (p<0.001) were significantly lower in the s-VATS group than in the t-VATS group. There was no difference in the overall recurrence-free survival rate between the s-VATS and t-VATS groups. CONCLUSION: No significant differences in operative outcomes and recurrence rates were found between s-VATS and t-VATS for PSP. Therefore, we cautiously suggest that s-VATS may be an appropriate alternative to t-VATS in the treatment of PSP.
Drainage ; Follow-Up Studies ; Gyeongsangbuk-do ; Humans ; Medical Records ; Operative Time ; Pneumothorax* ; Recurrence ; Retrospective Studies ; Survival Rate ; Thoracic Surgery, Video-Assisted*