Background: Because the etiologies of bronchiectasis and related diseases vary significantly among different regions and ethnicities, this study aimed to develop a diagnostic bundle for bronchiectasis in South Korea. Methods: A modified Delphi method was used to develop expert consensus statements on a diagnostic bundle for bronchiectasis in South Korea. Initial statements proposed by a core panel, based on international bronchiectasis guidelines, were discussed in an online meeting and two email surveys by a panel of experts (≥70% agreement). Results: The study involved 21 expert participants, and 30 statements regarding a diagnostic bundle for bronchiectasis were classified as recommended, conditional, or not recommended. The consensus statements of the expert panel were as follows: A standardized diagnostic bundle is useful in clinical practice; diagnostic tests for specific diseases, including immunodeficiency and allergic bronchopulmonary aspergillosis, are necessary when clinically suspected; initial diagnostic tests, including sputum microbiology and spirometry, are essential in all patients with bronchiectasis, and patients suspected with rare causes such as primary ciliary dyskinesia should be referred to specialized centers. Conclusion Based on this Delphi survey, expert consensus statements were generated including specific diagnostic, laboratory, microbiological, and pulmonary function tests required to manage patients with bronchiectasis in South Korea.

Seborrheic dermatitis is a chronic recurrent inflammatory disorder presumed to be caused by increased sebaceous gland secretion, metabolic changes in the cutaneous microflora, and changes in the host immune function. Stellate ganglion block (SGB) is known to increase the blood flow rate without altering the blood pressure, heart rate, or cardiac output, to stabilize hypertonic conditions of the sympathetic nerves, and to affect the endocrine and immune systems. It is used in the differential diagnosis and treatment of autonomic nervous system disorders of the head, neck, and upper limbs. The authors report the first case of successful treatment of a patient with seborrheic dermatitis through repeated SGB trials.
Autonomic Nervous System Diseases ; Blood Pressure ; Cardiac Output ; Dermatitis, Seborrheic* ; Diagnosis, Differential ; Head ; Heart Rate ; Humans ; Immune System ; Neck ; Nerve Block ; Sebaceous Glands ; Stellate Ganglion* ; Upper Extremity

This case report involves tracheal intubation using i-gel(R) in combination with a lightwand in a patient with a difficult airway, classified as Cormack-Lehane grade 3. I-gel(R) was used during anesthesia induction to properly maintain ventilation. The authors have previously reported successful tracheal intubation on a patient with a difficult airway through the use of i-gel(R) and a fiberoptic bronchoscope. However, if the use of a fiberoptic bronchoscope is not immediately available in a patient with a difficult airway, tracheal intubation may be performed by using i-gel(R) and a lightwand in a patient with difficult airway, allowing the safe induction of anesthesia.
Airway Management ; Anesthesia ; Bronchoscopes ; Humans ; Intubation ; Intubation, Intratracheal* ; Laryngeal Masks ; Transillumination ; Ventilation

BACKGROUND: Lidocaine has been used widely to prevent propofol injection pain. Various methods of administration exist, such as lidocaine premixed with propofol or lidocaine pretreatment using a tourniquet, but it is unclear which method of lidocaine administration is more effective for the prevention of injection pain of propofol LCT/MCT. The purpose of this study was to compare pretreatment of lidocaine with a tourniquet and a premixed injection of lidocaine to prevent injection pain of propofol-LCT/MCT. METHODS: Patients were randomly allocated into the pretreatment group (n = 117) or the premixed group (n = 117). The pretreatment group was pretreated with 2 ml of lidocaine 2%, held with a tourniquet, before propofol-LCT/MCT injection. The premixed group was injected with a premixed solution of propofol-LCT/MCT and 2 ml of lidocaine 2%. To evaluate the incidence and severity of pain, spontaneous verbal expressions of pain, movement of hand, frowning, and moaning were recorded, and the patients were asked to recall their pain with the visual analogue score (VAS) 30 minutes after awakening from anesthesia. RESULTS: Overall, injection pain occurred in 13.7% of the pretreatment group and 15.4% of the premixed group, without any statistical difference (P = 0.71). There was no difference in spontaneous verbal expressions of pain, movement of hand, frowning, and moaning between the two groups. The pain intensity (VAS) also showed no difference between the two groups (P = 0.49). CONCLUSIONS: Pretreatment of lidocaine with a tourniquet showed no more benefit to prevent injection pain of propofol LCT/MCT compared to a premixed injection with lidocaine.
Anesthesia ; Emulsions ; Hand ; Humans ; Incidence ; Lidocaine* ; Methods ; Propofol ; Tourniquets*

BACKGROUND: Dexmedetomidine extends the duration of nerve block when administered perineurally together with local anesthetics by central and/or peripheral action. In this study, we compared the duration of nerve block between dexmedetomidine and epinephrine as an adjuvant to 1% mepivacaine in infraclavicular brachial plexus block. METHODS: Thirty patients, scheduled for upper limb surgery were assigned randomly to 3 groups of 10 patients each. We performed brachial plexus block using a nerve stimulator. In the control group (group C), patients received 40 ml of 1% mepivacaine. In group E, patients received 40 ml of 1% mepivacaine containing 200 microg of epinephrine as an adjuvant. In group D, patients received 40 ml of 1% mepivacaine containing 1 microg/kg of dexmedetomidine as an adjuvant. Sensory block duration, motor block duration, time to sense pain, and onset time were assessed. We also monitored blood pressure, heart rate, oxygen saturation and bispectral index. RESULTS: In group D and group E, sensory block duration, motor block duration and time to sense first pain were prolonged significantly compared to group C. However, there was no significant difference between group D and group E. CONCLUSIONS: Perineural 1 microg/kg of dexmedetomidine similarly prolonged nerve block duration compared to 200 microg of epinephrine, but slowed heart rate. Thus, dexmedetomidine is expected to be a good alternative as an adjuvant to local anesthesia in patients who are cautioned against epinephrine.
Anesthesia, Local ; Anesthetics, Local ; Blood Pressure ; Brachial Plexus* ; Dexmedetomidine* ; Epinephrine* ; Heart Rate ; Humans ; Mepivacaine* ; Nerve Block ; Oxygen ; Upper Extremity

BACKGROUND: Dexmedemomidine, a highly selective alpha-2 adrenoreceptor agonist has an analgesic and sedative effect without causing respiratory depression. In this study, we compared the duration of brachial plexus block (BPB), the time at which the patient first feels pain after performing BPB, the need for use of analgesics, and the occurrence rate of complications while continuous infusion with dexmedetomidine was used for sedation in patients undergoing BPB, to a control group, who were only infused with normal saline. METHODS: BPB was performed in 48 patients scheduled for upper limb surgery. Infraclavicular approach was provided with 40 ml of 1.5% mepivacaine and 200 microg of epinephrine using nerve stimulator. After verification of successful block, dexmedetomidine group received dexmedetomidine (loading dose 0.1 microg/kg/min for the first 10 minutes followed by a maintenance dose of 0.005 microg/kg/min as required to maintain bispectral index 60-80). In the control group, normal saline was infused at a rate of 10 ml/hr. The duration of BPB, the time at which the patient first feels pain after performing BPB, frequency of complication, and the use of analgesics of the both groups were checked. RESULTS: The motor and sensory block duration, and the time at which the patient first feels pain after BPB were longer in the dexmedetomidine group compared to the control group. And the need for analgesics were less in the dexmedetomidine group. CONCLUSIONS: Intravenous administration of dexmedetomidine prolongs the duration of BPB.
Administration, Intravenous ; Analgesics ; Brachial Plexus ; Dexmedetomidine ; Epinephrine ; Humans ; Hypnotics and Sedatives ; Mepivacaine ; Respiratory Insufficiency ; Upper Extremity

Spontaneous intracranial hypotension (SIH) is an uncommon disease that's caused by cerebrospinal fluid (CSF) leakage and this disease is considered to be an important cause of persistent headache. It is characterized by a postural headache in patients who are without any history of dural puncture or trauma. Conservative management, including bed rest analgesics and intravenous fluid administration, are the first-line treatment of SIH, and an autologous epidural blood patch (EBP) is generally indicated for those who fail the conservative management. We report here on a case of SIH with confirmed CSF leakage at the cervical, thoracic and lumbar levels, and this was successfully managed with a single autologous EBP at the lumbar level. We believe that an EBP at the leakage site with the highest pressure level should be considered as a primary treatment for SIH with multiple sites of leakage.
Analgesics ; Bed Rest ; Blood Patch, Epidural ; Headache ; Humans ; Intracranial Hypotension ; Punctures

Garlic(Allium sativum) is recognized as a sensitizing agent responsible for allergic contact dermatitis with food handlers and housewives. Lymphomatoid contact dermatitis, which is a type of allergic contact dermatitis, shows similar histologic features to Mycosis Fungoides. We report a 66-year-old male, who had applied garlic extract to both lower extremities and the trunk for 8 months for relieving his symptoms of arthralgia and generalized pruritis. He had complained of variable sized multiple erythematous pruritic papules on both lower extremities and the trunk and lymphadenopathy of both inguinal and axillary area. Skin biopsy was performed and the histological exam presented microscopically abnormal lymphocyte infiltration in the upper dermis. T-cell marker studies revealed strong CD3 positivity and increased CD4/CD8 ratio. The results of PCR-heteroduplex analysis showed negative for T-cell receptor- gene rearrangement and abscence of T-cell monoclonality. We could diagnose his skin lesion and generalized lymphadenopathy as lymphomatoid contact dermatitis which represented as a T-cell pseudolymphoma histologically. He was treated with local steroid injection and phototherapy and the skin lesion were improved without recurrence.
Aged ; Arthralgia ; Biopsy ; Dermatitis, Allergic Contact ; Dermatitis, Contact* ; Dermis ; Garlic* ; Gene Rearrangement ; Humans ; Lower Extremity ; Lymphatic Diseases ; Lymphocytes ; Male ; Mycosis Fungoides ; Phototherapy ; Pruritus ; Pseudolymphoma ; Recurrence ; Skin ; T-Lymphocytes

Adenomas of the major duodenal papilla are rare but clinically important since they are a premalignant condition. Endoscopic mucosal resection has emerged as the first line therary for ampullary adenoma. However, various complications such as pancreatitis, bleeding or duodenal perforation have been reported after endoscopic mucosal resection. To our knowledge, cholangitis has not been reported as a complication of the procedure in the literature. We report a case of papillary stenosis and cholangitis caused by endoscopic mucosal resection of ampullary adenoma. We performed the endoscopic biliary spincterotomy followed by biliary stenting and cholangitis was successfully controlled.
Adenoma* ; Ampulla of Vater ; Cholangitis* ; Constriction, Pathologic* ; Hemorrhage ; Pancreatitis ; Stents

Adenomas of the major duodenal papilla are rare but clinically important since they are a premalignant condition. Endoscopic mucosal resection has emerged as the first line therary for ampullary adenoma. However, various complications such as pancreatitis, bleeding or duodenal perforation have been reported after endoscopic mucosal resection. To our knowledge, cholangitis has not been reported as a complication of the procedure in the literature. We report a case of papillary stenosis and cholangitis caused by endoscopic mucosal resection of ampullary adenoma. We performed the endoscopic biliary spincterotomy followed by biliary stenting and cholangitis was successfully controlled.
Adenoma* ; Ampulla of Vater ; Cholangitis* ; Constriction, Pathologic* ; Hemorrhage ; Pancreatitis ; Stents