Acromegaly is a chronic,debilitating disease by excessive growth hormone production due to pituitary adenoma. Anesthesiologists are frequently confronted with problems such as excessive mandible protrusion, macroglossia and tracheal stenosis, which make intubation very difficult and risky in acromegalic patients.So, the authors tried to predict difficult intubation because acromegalic patients have anatomical change of airway.With X-ray film of acromegalic patient, measuring atlanto-occipital gap(2.5 mm), mandible ramus angle(8.4 cm), mandibulo-hyoid distance (35 mm), level of hyoid bone (between 4th and 5th cervical bone) provide clues to perceive difficult intubation. By abnormal data of these measurements, we can anticipate the difficult intubation with moderate accuracy compared with normal patient. It is prudent to consider using other methods such as fiberoptic bronchoscopic intubation, blind endotracheal intubation and transtracheal jet ventilation when difficult endotracheal intubation is predicted in those patients. (Korean J Anesthesiol 1995; 29: 310~314)
Acromegaly* ; Growth Hormone ; Humans ; Hyoid Bone ; Intubation ; Intubation, Intratracheal* ; Macroglossia ; Mandible ; Pituitary Neoplasms ; Tracheal Stenosis ; Ventilation ; X-Ray Film

Gout is one of the most common forms of acute inflammatory arthritis caused by long-standing hyperuricemia. Various clinical and epidemiological studies have demonstrated that uric acid, which is strongly associated with the pathogenesis of gout, is closely related with increased cardiovascular (CV) risk. Thus, properly controlling uric acid levels within its physiological level using urate-lowering therapy has been hypothesized to improve CV outcomes. Recently, however, on the basis of the results of the largest prospective, the double-blind, randomized controlled trial, entitled “the Cardiovascular Safety of Febuxostat or Allopurinol in Patients with Gout (CARES),” has aroused the possibility of increased CV-related and all-cause mortality in patients receiving febuxostat. Largely on the basis of this unpredicted result, the US and Korea Food and Drug Administration issued a public safety alert concerning the high risk of CV death with the use of febuxostat in February 2019. This unexpected announcement left many rheumatologists confused when they decide the first-line urate-lowering drug in Korea. In this review, we searched for previous studies on uric acid and increased risk of CV disease. In addition, we will introduce various interpretations of the results of the CARES trial and discuss the best choice of urate-lowering therapy for Korean.

BACKGROUND: Mirror movement is common in young children, and it could be seen in normal adults. Several mechanisms including motor pathway reorganization involved in motor recovery after stroke. Motor pathway reorganization has been reported to be a mechanism in several studies of patients with mirror movement. However, the correlation of motor recovery and mirror movement has been debated. We studied the degree of mirror movement in stroke patients compared with a controlled group to look into their relationship. METHODS: Our controls were 50 adults without neurologic symptoms and signs. The hemiparetic group was comprised 94 patients who had incurred unilateral brain lesion: 36 patients were acute stroke patients, 58 patients were chronic stroke patients. Mirror movements were assessed by three different tasks: abduction of thumb, sequential finger tapping, and grasping. We analyzed mirror movements in controls and patients, and tried to find a correlation between the degree of mirror movement and the recovery of motor power in chronic stroke patients. RESULTS: In controls, male exhibited more frequent mirror movement than female at specific tasks, and there was no difference between tasks of right or left hand. In stroke patients, there was more mirror movement in the nonparetic hand than in the paretic one during the movement of contralateral hand. In acute stroke, the frequency of mirror movement had no variability according to the degree of motor power. The recovery of motor power at a late stage was not correlated with the degree of mirror movement. Consclusions: Motor pathway reorganization seems to be insignificant for motor recovery because the degree of mirror movement was not correlated with the recovery of motor power in this study.
Adult ; Brain ; Child ; Female ; Fingers ; Hand ; Hand Strength ; Humans ; Male ; Neurologic Manifestations ; Stroke* ; Thumb

No abstract available.
Catheters* ; Cystic Adenomatoid Malformation of Lung, Congenital* ; Fetal Therapies* ; Lung*

No abstract available.
Arthritis, Rheumatoid* ; Birds* ; Early Diagnosis* ; Humans

BACKGROUND: Because of the common etiologic factor, such as smoking, lung cancer and chronic obstructive Pulmonary disease are often present in the same patient. The preoperative prediction of remaining pulmonary function after the resectional surgery is very important to prevent serious complication and postoperative respiratory failure. 99mTc-MAA perfusion scan has been used for the prediction of postoperative pulmonary function, but it may be inaccurate in case of large V/Q mismatching. We compared 99mTc-DTPA radioaerosol inhalation scan with 99mTc-MAA perfusion scan in predicting postoperative lung function. METHOD: Preoperative inhalation scan and/or perfusion scan were performed and pulmonary function test were performed preoperatively and 2 month after operation. We predicted the postoperative pulmonary functions using the following equations. Postpneumonectomy FEV1=Preop FEV1x% of total function of lung to remain RESULTS: 1) The inhalation scan showed good correlations between measured and predicted FEV1, FVC and FEF25-75%. (correlation coefficiency; 0.94, 0.91, 0.87 respectively). 2) The perfusion scan also showed good correlations between measured and predicted FEV1, FVC and FEF25-75%. (correlation coefficiency; 0.86, 0.72, 0.97 respectively). 3) Among three parameters, FEV1 showed the best correlations in the prediction by lung scans. 4) Comparison between inhalation scan and perfusion scan in predicting pulmonary function did not show any significant differneces except FVC. CONCLUSION: The inhalation scan and perfusion scan are very useful in the prediction of postoperative lung function and don't make a difference in the prediction of pulmonary function although the former showed a better correlation in FVC.
Humans ; Inhalation* ; Lung ; Lung Neoplasms ; Perfusion* ; Pulmonary Disease, Chronic Obstructive ; Respiratory Function Tests ; Respiratory Insufficiency ; Smoke ; Smoking

PURPOSE: A tube thoracostomy is an invasive procedure that places patients at risk for complications. Tube thoracostomies are frequently performed by emergency medicine residents. Thus, the purpose of the study was to assess both the complication rate for tube thoracostomies performed by emergency medicine residents and the factors associated with these complications. METHODS: A retrospective chart review of all patients who had undergone a tube thoracostomy performed by emergency medicine residents between January 2008 and February 2009 was conducted at a university hospital. Complications were divided into major and minor complications and into immediate and delayed complications. Complications requiring corrective surgical intervention, requiring the administration of blood products, or involving situations requiring intravenous antibiotics were defined as major. Complications that were detected within 2 hours were defined as immediate. RESULTS: Tube thoracostomies were performed in 189 patients, and 70 patients(37%) experienced some complications. Most complications were immediate and minor. In multiple logistic regressions, BMI, hypotension and resident seniority were significantly associated with complications. CONCLUSION: The prevalence of complications was similar to these in previous reports on the complications of a tube thoracostomy. Most complications from tube thoracostomies performed by emergency medicine residents were immediate and minor complications. Thus, emergency medicine residents should be allowed to perform closed tube thoracostomies instead of thoracic surgeons.
Anti-Bacterial Agents ; Emergencies ; Emergency Medicine ; Humans ; Hypotension ; Logistic Models ; Prevalence ; Retrospective Studies ; Thoracostomy

Intravascular lymphoma is characterized by an exclusively intravascular distribution of tumor cells. Intravascular natural killer/T-cell lymphoma (IVNKTL) is extremely rare, highly aggressive, commonly Epstein-Barr virus (EBV)–positive, and predominantly affects the skin and central nervous system. Here we report a case of IVNKTL diagnosed in a 67-year-old female, presenting with persistent intermittent fever and skin rashes throughout the body. Incisional biopsy of an erythematous lesion on the chest exhibited aggregation of medium to large-sized atypical lymphoid cells confined to the lumen of small vessels that were positive for CD3, granzyme B, and CD56 on immunohistochemistry and EBV-encoded RNA in situ hybridization. EBV DNA was also detected in serum after diagnosis. With a review of 26 cases of IVNKTL to date, we suggest that active biopsy based on EBV DNA detection may facilitate early diagnosis of IVNKTL.

The aim of the present study is to investigate the contribution of Ca2+-activated K+ (KCa) channels and delayed rectifier K+ (KV) channels to the resting membrane potential (RMP) in rabbit middle cerebral arterial smooth muscle cells. The RMP and membrane currents were recorded using the whole-cell patch configuration and single KCa channel was recorded using the outside-out patch configuration. Using the pipette solution containing 0.05 mM EGTA, the RMP was -25.76+/-5.08 mV (n=12) and showed spontaneous transient hyperpolarizations (STHPs). The membrane currents showed time- and voltage-dependent outward currents with spontaneous transient outward currents (STOCs). When we recorded the membrane potential using the pipette solution containing 10 mM EGTA, the RMP was depolarized and did not show STHPs. The membrane currents showed no STOCs but only showed slowly inactivating outward currents. External TEA (1 mM) reversibly inhibited the STHPs, depolarized the RMP, reduced the membrane currents, abolished STOCs, and decreased the open probability of single KCa channel. When KV currents were isolated, the application of 4-AP (5 mM) depolarized the RMP. The important aspect of our results is that KCa channel is responsible for the generation of the STHPs in the membrane potential and plays an important role in the regulation of the RMP and KV channel is also responsible for the regulation of the RMP in rabbit middle cerebral arterial smooth muscle cells.
Egtazic Acid ; Membrane Potentials* ; Membranes ; Muscle, Smooth* ; Myocytes, Smooth Muscle* ; Tea