BACKGROUND/AIMS: Despite improvements in surgical techniques and postoperative patient care, bile leakage can occur after hepatobiliary surgery and may lead to serious complications. The aim of this retrospective study was to evaluate the efficacy of endoscopic treatment of bile leakage after hepatobiliary surgery. METHODS: The medical records of 20 patients who underwent endoscopic retrograde cholangiopancreatography because of bile leakage after hepatobiliary surgery from August 2009 to September 2014 were reviewed retrospectively. Endoscopic treatment included insertion of an endoscopic retrograde biliary drainage stent after endoscopic sphincterotomy. RESULTS: Most cases of bile leakage presented as percutaneous bile drainage through a Jackson-Pratt bag (75%), followed by abdominal pain (20%). The sites of bile leaks were the cystic duct stump in 10 patients, intrahepatic ducts in five, liver beds in three, common hepatic duct in one, and common bile duct in one. Of the three cases of bile leakage combined with bile duct stricture, one patient had severe bile duct obstruction, and the others had mild strictures. Five cases of bile leakage also exhibited common bile duct stones. Concerning endoscopic modalities, endoscopic therapy for bile leakage was successful in 19 patients (95%). One patient experienced endoscopic failure because of an operation-induced bile duct deformity. One patient developed guidewire-induced microperforation during cannulation, which recovered with conservative treatment. One patient developed recurrent bile leakage, which required additional biliary stenting with sphincterotomy. CONCLUSIONS: The endoscopic approach should be considered a first-line modality for the diagnosis and treatment of bile leakage after hepatobiliary surgery.
Abdominal Pain ; Bile Ducts ; Bile* ; Catheterization ; Cholangiopancreatography, Endoscopic Retrograde ; Cholestasis ; Common Bile Duct ; Congenital Abnormalities ; Constriction, Pathologic ; Cystic Duct ; Diagnosis ; Drainage ; Hepatic Duct, Common ; Humans ; Liver ; Medical Records ; Patient Care ; Retrospective Studies ; Sphincterotomy, Endoscopic ; Stents

BACKGROUND: Because conventional echocardiographic parameters have several limitations, strain echocardiography has often been introduced in clinical practice. However, there are also obstacles in using it in clinical practice. Therefore, we wanted to find the current status of awareness on using strain echocardiography in Korea. METHODS: We conducted a nationwide survey to evaluate current use and awareness of strain echocardiography from the members of the Korean Society of Echocardiography. RESULTS: We gathered total 321 questionnaires from 25 cardiology centers in Korea. All participants were able to perform or interpret echocardiographic examinations. All participating institutions performed strain echocardiography. Most of our study participants (97%) were aware of speckle tracking echocardiography and 185 (58%) performed it for clinical and research purposes. Two-dimensional strain echocardiography was the most commonly used modality and left ventricle (LV) was the most commonly used cardiac chamber (99%) for clinical purposes. Most of the participants (89%) did not think LV strain can replace LV ejection fraction (LVEF) in their clinical practice. The common reasons for not performing routine use of strain echocardiography was diversity of strain measurements and lack of normal reference value. Many participants had a favorable view of the future of strain echocardiography. CONCLUSION: Most of our study participants were aware of strain echocardiography, and all institutions performed strain echocardiography for clinical and research purposes. However, they did not think the LV strain values could replace LVEF. The diversity of strain measurements and lack of normal reference values were common reasons for not using strain echocardiography in clinical practice.
Cardiology ; Echocardiography* ; Heart Ventricles ; Korea* ; Reference Values

Objective: To develop a new screening test for dysphagia patients with various etiologies.Method: We investigated 10 widely used screening tests based on previous studies. Contents of the screening tests were summarized into 76 items. By using modified Delphi technique, 23 items showing high average score (＞3.5) were selected as candidates for the new Clinical Dysphagia Scale (nCDS). A total of 216 dysphagia patients with various etiologies were tested with these items and underwent videofluoroscopic swallowing study (VFSS) simultaneously. We analyzed these data in statistical and clinical aspects to determine which items were more correlated with VFSS findings and which items are more appropriate for the screening test. Content validity was re-evaluated by consensus in an expert meeting. Consequentially, 8 items were selected for the nCDS.Result: The nCDS included 8 items: swallowing difficulty, structural defect (oral cavity, pharynx, larynx, or esophagus), lip sealing, tongue movement (forward and side to side), saliva swallowing, wet voice or gurgling voice (pre-swallowing), 5 ml water swallowing test (2 times), and laryngeal elevation during swallowing. The sensitivity and specificity of the nCDS score for detecting necessity of food modification were 83.8% and 58.3%, respectively.It was also well correlated with the functional dysphagia scale derived from the VFSS (Pearson's coefficient 0.525, P ＜0.01). Conclusion The nCDS is not only a good screening test for detecting necessity of food modification, but also a good diagnostic tool for evaluation of general swallowing function. Furthermore, it is simply applicable to dysphagic patients with various etiologies.

BACKGROUND: This prospective phase II study assessed the efficacy and toxicity of the combination of carboplatin, ifosfamide and etoposide for previously untreated patients with extensive-disease small cell lung cancer (ED-SCLC). METHODS: Patients with ED-SCLC received a combination chemotherapy with carboplatin AUC 6.0 on day 1, ifosfamide 1200 mg/m2 on day 1-3, and etoposide 100 mg/m2 on day 1-3. RESULTS: Forty-one patients received a median of six cycles of chemotherapy. A complete response was seen in 5 patients and a partial response was seen in 33 patients (overall response 95%). The median duration of the response was 5.1 months (95% CI; 3.4-6.8 months). The median time to progression and overall survival were 7.4 months (95% CI; 6.1-8.6 months) and 10.7 months (95% CI; 6.9-14.6 months), respectively, providing the one-year survival rate of 43.9%. Grade 3~4 anemia, neutropenia and thrombocytopenia occurred in 14%, 7% and 6% in a total of 212 cycles, respectively. Non-hematologic toxicities were generally mild and manageable. No treatment related death was observed. CONCLUSIONS: The combination chemotherapy of carboplatin, etoposide and ifosfamide showed an effective response rate and acceptable toxicity.
Anemia ; Area Under Curve ; Carboplatin* ; Drug Therapy* ; Drug Therapy, Combination ; Etoposide* ; Humans ; Ifosfamide* ; Neutropenia ; Prospective Studies ; Small Cell Lung Carcinoma* ; Survival Rate ; Thrombocytopenia

OBJECTIVES: The purpose of this study was to evaluate the characteristics of psychopathology, adverse drug effects, and subjective response to drugs that have a significant impact on the subjective quality of life in schizophrenic patients receiving atypical antipsychotics. METHODS: One hundred and one schizophrenic patients, who were receiving maintenance treatment with atypical antipsychotics, were evaluated. Subjective quality of life was assessed using the standardized Korean modification of a self-rating scale to measure subjective well-being under neuroleptics (KmSWN). Patients' psychopathology was evaluated using the Positive and Negative Syndrome Scale. Adverse effects and subjective response to drug were evaluated using the Liverpool University Neuroleptic Side Effect Rating Scale and the Drug Attitude Inventory-10, respectively. Correlation analysis and stepwise multiple regression analysis were conducted. RESULTS: In psychopathology, the severity of depression and anxiety showed the most significant correlation with the score of KmSWN. In adverse drug effects, the severity of psychic side effect and extrapyramidal side effect showed the most significant correlation with the score of KmSWN. Regarding subjective response to drug, significant correlation was observed between the severity of subjective negative response and the score of KmSWN. Stepwise multiple regression analysis revealed that psychic side effect, extrapyramidal side effect, and depression contributed significantly to the total score of KmSWN. These variables accounted for 59.7% of the total variance. CONCLUSION: The results of the present study suggest that psychic side effect, extrapyramidal side effect and depressive symptom are the clinical characteristics that are significantly associated with the subjective quality of life. An effective management strategy for these variables should be established in developing a treatment program to enhance the quality of life of patients with schizophrenia.
Antipsychotic Agents* ; Anxiety ; Depression ; Humans ; Psychopathology* ; Quality of Life* ; Schizophrenia

Usually FEV1 lower than 1 liter is considered as a contraindication to pneumonectomy. Therefore sometimes, the curative operations of the resectable lung cancer can not be performed in case of poor pulmonary functions. The usual criteria on the performance of pneumonectomy on high risk patients based on the preoperative assessment of pulmonary function may not predict the operative outcome with accuracy in the postoperative period. Nowadays, there are some arguing points about applying the values of preoperative PFTs to pulmonary resection surgery. We performed a right pneumonectomy for stage IIIb lung cancer in a patient with poor lung function test; FVC 2.17 L, FEV1 0.97 L, FEV1/FVC 44%, FEF 25~75% 0.42 L/sec, MVV 28 L/min, TLC 5.18 L, RV 2.99, DLCO 13.46. After the temporary ligation of right main pulmonary artery during 30 minutes, arterial blood gas and percutaneous oxygen saturation with the controlled ventilation with room air (FiO2=0.21) confirmed the hemodynamic and oxygenation stabilities, twice. After successful surgery, the patient was tolerated for 4 months. And the follow up PFTs at postoperative 3 months and 18 days showed as follows; FVC 1.20 L, FEV1 0.63 L, FEV1/FVC 53%, FEF 25~75% 0.31 L/sec, MVV 25 L/min, TLC 3.80 L, RV 2.33 L, DLCO 8.04. Through the intraoperative re-evaluation of pulmonary function in a patient with poor preoperative PFTs,had been conventionally considered as a contraindication to pneumonectomy, we report a successful surgery and anesthetic management with the literatures reviewed.
Anesthesia ; Follow-Up Studies ; Hemodynamics ; Humans ; Ligation ; Lung Neoplasms* ; Lung* ; Oxygen ; Pneumonectomy* ; Postoperative Period ; Pulmonary Artery ; Respiratory Function Tests* ; Ventilation

BACKGROUND: The effects of the levering laryngoscope (McCoy laryngoscope) on the laryngoscopic view classified by the Cormack and Lehane were investigated in this study. METHODS: The laryngoscopic view with the levering laryngoscope blade in neutral and best position were recorded respectively and analysed statistically. RESULTS: 109 laryngoscopic views were grade 1 or 2 and 12 were grade 3 or 4 in the neutral position with the McCoy blade. Only three patients were grade 3 or 4 in its best position and the others grade 1 or 2. The reduction in the incidence of difficult laryngoscopic view (grade 3 or 4) using the levering laryngoscope in its best position was statistically significant (p<0.01). CONCLUSIONS: Levering laryngoscope improves laryngoscopic view and also reduces the incidence of difficult intubation. So, we suggest that it is an useful instrument for the anesthesiologists in the difficult tracheal intubation.
Humans ; Incidence ; Intubation ; Laryngoscopes*

BACKGROUND: Propofol(2,6 diisopropylphenol) is a potent hypnotic currently formulated as an oil-in-water emulsion. Although previous studies reported decreases in arterial pressures and heart rate, no detailed studies of hemodynamic effects of propofol administration alone are available in Korea. This study is to determine the hemodynamic changes induced by doses of propofol. METHODS: Sixty patients(ASA physical status 1 or 2) were divided randomly into three groups as follows: group I, pmpofol 1.5 mg/kg; group 2, propofol 2.0 mg/kg; group 3, propofol 2.5 mg/kg. Heart rate and mean arterial pressure were measured by Datascope 2200I, and cardiac index(CI) and systemic vascular resistance index(SVRI) were obtained by doppler cardiac output monitor(Datascope Accucom 2) at the suprasternal notch before and after induction of propofol. RESULTS: Statistically significant decreases in mean arterial pressure were observed since 2 min after induction. CI was decreased from 2.94+/-0.51 to 2.35+/-0.57 L/min/m(2) at 6 min after induction of propofol 2.5 mg/kg, and no differences among groups. CI was also decreased in group 1 and 2 but without any significance. SVRI was decreased in all groups but there were no significance, and no differences among groups. CONCLUSIONS: The data suggest that the usual doses of propofol do not significantly cause hemodynamic changes, and a decrease in mean arterial pressure is a result of decreased CI and reduced SVRI.
Anesthetics ; Arterial Pressure ; Cardiac Output ; Heart Rate ; Hemodynamics* ; Korea ; Propofol* ; Vascular Resistance

The Pentaspan is a high molecular weight(250,000), hyperosmolar(320 mOsm/l) colloid solution and blood volume expander in clinical practice. Many researches revealed the decreasing of systemic vascular resistance and pulmonary vascular resistance after Pentaspan administration in vivo. Some colloid solution is contraindicated in acute renal failure. We tried to confirm the direct effects of the Pentaspan and its mechanism on the abdominal aorta and renal artery in vitro. The rat abdominal aorta and renal artery were precontracted with norepinephrine(10(-7) M/1) in 50 ml Krebs solution and 5 ml Pentaspan was infused. Ten mininutes after, changes of the vascular tones were obtained. The results were as follows. 1) The vascular tones were significantly decreased in both vessels. 2) Abdominal aorta group, renal artery group and with or without endothelium group were not significant different each other. 3) The vascular tones were not affected by with or without endothelium, indomethacin and methylene blue pretreatment. Smooth muscles were induced relaxation by the Pentaspan infusion and the relaxation were not dependent to endothelium derived relaxing factor, prostanoid and cyclic guanosinemonophosphate.
Acute Kidney Injury ; Animals ; Aorta, Abdominal* ; Arteries ; Blood Volume ; Colloids ; Endothelium ; Endothelium-Dependent Relaxing Factors ; Hydroxyethyl Starch Derivatives* ; Indomethacin ; Methylene Blue ; Muscle, Smooth ; Rats* ; Relaxation ; Renal Artery* ; Vascular Resistance

Absence of response to train of four(TOF) and single twitch stimulation at ulnar nerve did not guarantee ided intubation conditions after vecuronium. The double burst stimulation (DBS) introduced by Viby-Mogensen, made it easier to evaluate postoperative residual neuromuscular blockade manually than did the use of the TOF method. The purpose of this study was to examine which will be the best stimulus among DBS, TOF and single twitch stimulation(STS) for an indicator of the optimal time for tracheal intubation. One hundred and nine healthy patients were randomly allocated to three groups in which DBS(n=34), TOF(n=38) and STS(n=37) group. Anesthesia was induced with thiopental sodium 3-5 mg/kg and maintained 1% enflurane until intubation. Neuromuscular block was induced by intravenous vecuronium0.1 mg/kg, and applied facial nerve stimuli immediately by DBS, TOF and STS using INNERVATOR(Fisher and Paykel Co.) continuously. The complete relaxation time of orbicularis oculi muscle was closely observed with authors naked eyes. Tracheal intubation was performed immediately by the author after disappearance of the response to stimuli. The intubation time from intravenous injection of vecuronium was recorded, and the intubating conditions were evaluated by vocal cords opening, coughing reflex and response to laryngoscopy attempts. The intubation time was 195.9+/-74.7(90-390) seconds in DBS group, 180.9+/-49.8(100-290) seconds in TOF group and 167.7+/-37.9(90-270) seconds in STS group and there were no statistically significant difference. There were also no significance on vocal cords opening and response to laryngoscopy attempts in three groups but DBS group was statistically less cough reflex than TOF group and STS group(p<0.05). With the above results the authors concluded that DBS on the facial nerve with the orbicularis oculi muscle was most reliable index to determine the optimal time for tracheal intubation and the time was about l96 seconds after vecuronium.
Anesthesia ; Cough ; Enflurane ; Facial Nerve* ; Humans ; Injections, Intravenous ; Intubation* ; Laryngoscopy ; Muscle, Skeletal ; Neuromuscular Blockade ; Reflex ; Relaxation ; Thiopental ; Ulnar Nerve ; Vecuronium Bromide* ; Vocal Cords