Background: Although total intravenous anesthesia (TIVA) with propofol and remifentanil is frequently used to optimize intraoperative neurophysiological monitoring (IONM), the exact effect of remimazolam on IONM remains unknown. Here, we compared the effects of propofol and remimazolam along with remifentanil on IONM during TIVA. Methods: In this prospective, double-blind, randomized controlled trial, 64 patients requiring IONM during cervical spine surgery were administered either propofol (Group P) or remimazolam (Group R). The preoperative latencies of the somatosensory-evoked potentials (SEP; N20 for the median nerve and P37 for the tibial nerve) were measured. SEP latencies and amplitudes and motor-evoked potential (MEP) amplitudes were measured 30 min after anesthetic induction (T1), 30 min after surgical incision (T2), after laminectomy or discectomy (T3), immediately after plate insertion or pedicle screw fixation (T4), and before surgical wound closure (T5). The primary outcome was the between-group difference in the N20 latency changes measured at T1 and preoperatively. Results: The change in SEP latencies including N20 and P37 at T1 compared with preoperative time was not significantly different between Groups P and R. Except for the amplitude of the right abductor brevis, there was no significant group-by-time interaction effect for intraoperative MEP amplitudes or SEP latencies and amplitudes. Conclusions TIVA with remimazolam and remifentanil for cervical spine surgery yielded stable IONM, comparable to those observed with conventional TIVA with propofol and remifentanil. Further clinical trials are needed in other surgical contexts and with more diverse patient populations to determine the effects of remimazolam on IONM.

Background: Although total intravenous anesthesia (TIVA) with propofol and remifentanil is frequently used to optimize intraoperative neurophysiological monitoring (IONM), the exact effect of remimazolam on IONM remains unknown. Here, we compared the effects of propofol and remimazolam along with remifentanil on IONM during TIVA. Methods: In this prospective, double-blind, randomized controlled trial, 64 patients requiring IONM during cervical spine surgery were administered either propofol (Group P) or remimazolam (Group R). The preoperative latencies of the somatosensory-evoked potentials (SEP; N20 for the median nerve and P37 for the tibial nerve) were measured. SEP latencies and amplitudes and motor-evoked potential (MEP) amplitudes were measured 30 min after anesthetic induction (T1), 30 min after surgical incision (T2), after laminectomy or discectomy (T3), immediately after plate insertion or pedicle screw fixation (T4), and before surgical wound closure (T5). The primary outcome was the between-group difference in the N20 latency changes measured at T1 and preoperatively. Results: The change in SEP latencies including N20 and P37 at T1 compared with preoperative time was not significantly different between Groups P and R. Except for the amplitude of the right abductor brevis, there was no significant group-by-time interaction effect for intraoperative MEP amplitudes or SEP latencies and amplitudes. Conclusions TIVA with remimazolam and remifentanil for cervical spine surgery yielded stable IONM, comparable to those observed with conventional TIVA with propofol and remifentanil. Further clinical trials are needed in other surgical contexts and with more diverse patient populations to determine the effects of remimazolam on IONM.

Background: Although total intravenous anesthesia (TIVA) with propofol and remifentanil is frequently used to optimize intraoperative neurophysiological monitoring (IONM), the exact effect of remimazolam on IONM remains unknown. Here, we compared the effects of propofol and remimazolam along with remifentanil on IONM during TIVA. Methods: In this prospective, double-blind, randomized controlled trial, 64 patients requiring IONM during cervical spine surgery were administered either propofol (Group P) or remimazolam (Group R). The preoperative latencies of the somatosensory-evoked potentials (SEP; N20 for the median nerve and P37 for the tibial nerve) were measured. SEP latencies and amplitudes and motor-evoked potential (MEP) amplitudes were measured 30 min after anesthetic induction (T1), 30 min after surgical incision (T2), after laminectomy or discectomy (T3), immediately after plate insertion or pedicle screw fixation (T4), and before surgical wound closure (T5). The primary outcome was the between-group difference in the N20 latency changes measured at T1 and preoperatively. Results: The change in SEP latencies including N20 and P37 at T1 compared with preoperative time was not significantly different between Groups P and R. Except for the amplitude of the right abductor brevis, there was no significant group-by-time interaction effect for intraoperative MEP amplitudes or SEP latencies and amplitudes. Conclusions TIVA with remimazolam and remifentanil for cervical spine surgery yielded stable IONM, comparable to those observed with conventional TIVA with propofol and remifentanil. Further clinical trials are needed in other surgical contexts and with more diverse patient populations to determine the effects of remimazolam on IONM.

Background: Although total intravenous anesthesia (TIVA) with propofol and remifentanil is frequently used to optimize intraoperative neurophysiological monitoring (IONM), the exact effect of remimazolam on IONM remains unknown. Here, we compared the effects of propofol and remimazolam along with remifentanil on IONM during TIVA. Methods: In this prospective, double-blind, randomized controlled trial, 64 patients requiring IONM during cervical spine surgery were administered either propofol (Group P) or remimazolam (Group R). The preoperative latencies of the somatosensory-evoked potentials (SEP; N20 for the median nerve and P37 for the tibial nerve) were measured. SEP latencies and amplitudes and motor-evoked potential (MEP) amplitudes were measured 30 min after anesthetic induction (T1), 30 min after surgical incision (T2), after laminectomy or discectomy (T3), immediately after plate insertion or pedicle screw fixation (T4), and before surgical wound closure (T5). The primary outcome was the between-group difference in the N20 latency changes measured at T1 and preoperatively. Results: The change in SEP latencies including N20 and P37 at T1 compared with preoperative time was not significantly different between Groups P and R. Except for the amplitude of the right abductor brevis, there was no significant group-by-time interaction effect for intraoperative MEP amplitudes or SEP latencies and amplitudes. Conclusions TIVA with remimazolam and remifentanil for cervical spine surgery yielded stable IONM, comparable to those observed with conventional TIVA with propofol and remifentanil. Further clinical trials are needed in other surgical contexts and with more diverse patient populations to determine the effects of remimazolam on IONM.

A 34-year-old man who had undergone aortic valve replacement 8 years ago underwent an additional Bentall operation due to mechanical valve dehiscence 2 years later. Subsequently, he was diagnosed with Behçet disease and Batter syndrome. A week after being hospitalized again due to chest pain and dyspnea, a large pseudo-aneurysm was detected on computed tomography. Because of the excessively large size of the pseudo-aneurysm, surgical treatment seemed very risky. Therefore, we planned to perform thoracic endovascular aortic repair (TEVAR) and treated him successfully. However, the patient experienced recurrence of the same symptoms 4 months later, and was found to have type IV endoleak.He received a TEVAR procedure again, and it was successful.

OBJECTIVES: Despite increasing availability of global positioning system (GPS), no research has been conducted to analyze GPS data for exposure opportunities associated with time at indoor and outdoor microenvironments. We developed location-based and time-weighted spatial measures that incorporate indoor and outdoor time-location data collected by GPS. METHODS: Time-location data were drawn from 38 female subjects in California who wore a GPS device for seven days. Ambient standard deviational ellipse was determined based on outdoor locations and time duration, while indoor time weighted standard deviational ellipse (SDE) was developed to incorporate indoor and outdoor times and locations data into the ellipse measure. RESULTS: Our findings indicated that there was considerable difference in the sizes of exposure potential measures when indoor time was taken into consideration, and that they were associated with day type (weekday/weekend) and employment status. CONCLUSIONS: This study provides evidence that time-location weighted measure may provide better accuracy in assessing exposure opportunities at different microenvironments. The use of GPS likely improves the geographical details and accuracy of time-location data, and further development of such location-time weighted spatial measure is encouraged.
California ; Employment ; Female ; Geographic Information Systems* ; Humans

We report a very high serum level of serum CA 125 in a patient with adenomyosis. Elevated serum CA 125 is useful for the management of patients with ovarian cancer but has also been associated with several benign conditions, including adenomyosis, uterine fibroids, pelvic inflammatory disease, pregnancy, menstruation, and endometriosis. Adenomyosis refers to the endometrial glands and stroma located deep within the myometrium. Here we report a patient with an elevated, rising serum CA 125 level over 1,000 IU/mL without any malignancy. Exploratory laparoscopy with LAVH (Laparoscopically assisted vaginal hysterectomy) and multiple peritoneal biopsies were performed. Histologically, the lesion was confirmed to be an adenomyosis. The level of serum CA 125 was 38 IU/mL on the fifth postoperative day.
Adenomyosis ; Animals ; Biopsy ; Endometriosis ; Female ; Humans ; Laparoscopy ; Leiomyoma ; Menstruation ; Mice ; Myometrium ; Ovarian Neoplasms ; Pelvic Inflammatory Disease ; Pregnancy

OBJECTIVE: To examine the correlation among the preoperative serum levels of five biomarkers presumed to be useful for early detection of epithelial ovarian cancer and evaluate the relationships between serum levels of these five biomarkers and epithelial ovarian cancer stage. METHODS: We analyzed 56 newly diagnosed epithelial ovarian cancer patients. Preoperative serum levels of leptin, prolactin, osteopontin (OPN), insulin-like growth factor-II, and CA-125 were determined by ELISA. We also examined the correlation between the serum levels of the biomarkers and ovarian cancer stage. Significant differences in the mean serum levels of two proteins, leptin and CA-125, were observed between stage subsets. RESULTS: There was a significant negative correlation between prolactin and leptin and a significant positive correlation between prolactin and OPN. Of the five biomarkers, only the mean serum CA-125 level showed a significant positive correlation with cancer stage (Spearman rho=0.24, p<0.01). OPN showed a marginally significant positive correlation with stage (Spearman rho=0.14, p=0.07). CONCLUSION: We demonstrated the relationship between five biomarkers in epithelial ovarian cancer. These tumor markers may be useful in screening for ovarian cancer, in characterizing disease states, and in developing therapeutic interventions targeting these marker proteins. Large-scale studies that include potential confounding factors and modifiers are necessary to more accurately define the value of these novel biomarkers in ovarian cancer.
Biomarkers ; Enzyme-Linked Immunosorbent Assay ; Humans ; Leptin ; Mass Screening ; Neoplasms, Glandular and Epithelial ; Osteopontin ; Ovarian Neoplasms ; Prolactin ; Proteins ; Biomarkers, Tumor

Tumors of low malignant potential (also called borderline tumors) account for approximately 10% of malignant ovarian neoplasm. Borderline tumors have a much better prognosis and, because they are noninvasive, may be treated less radically than invasive ovarian cancer. The ability to distinguish borderline tumor from early stage malignant disease preoperatively considerably influences surgical treatment, and allows improved counseling of patients. CA 125 is a useful tumor marker in the diagnosis of malignant ovarian tumors. However, in the case of borderline ovarian tumor, the value of CA 125 as a diagnostic tool seems to be invalid. Herein, we report a case of borderline ovarian tumor with extremely elevated serum CA 125 level.
Counseling ; Humans ; Ovarian Neoplasms ; Prognosis

Tumors of low malignant potential (also called borderline tumors) account for approximately 10% of malignant ovarian neoplasm. Borderline tumors have a much better prognosis and, because they are noninvasive, may be treated less radically than invasive ovarian cancer. The ability to distinguish borderline tumor from early stage malignant disease preoperatively considerably influences surgical treatment, and allows improved counseling of patients. CA 125 is a useful tumor marker in the diagnosis of malignant ovarian tumors. However, in the case of borderline ovarian tumor, the value of CA 125 as a diagnostic tool seems to be invalid. Herein, we report a case of borderline ovarian tumor with extremely elevated serum CA 125 level.
Counseling ; Humans ; Ovarian Neoplasms ; Prognosis