Background: This study investigated a safe and effective bolus dose and lockout time for patient-controlled sedation (PCS) with dexmedetomidine for dental treatments. The depth of sedation, vital signs, and patient satisfaction were investigated to demonstrate safety. Methods: Thirty patients requiring dental scaling were enrolled and randomly divided into three groups based on bolus doses and lockout times: group 1 (low dose group, bolus dose 0.05 µg/kg, 1-minute lockout time), group 2 (middle dose group, 0.1 µg/kg, 1-minute), and group 3 (high dose group, 0.2 µg/kg, 3-minute) (n = 10 each). ECG, pulse, oxygen saturation, blood pressure, end-tidal CO2 , respiratory rate, and bispectral index scores (BIS) were measured and recorded. The study was conducted in two stages: the first involved sedation without dental treatment and the second included sedation with dental scaling. Patients were instructed to press the drug demand button every 10 s, and the process of falling asleep and waking up was repeated 1-5 times.In the second stage, during dental scaling, patients were instructed to press the drug demand button. Loss of responsiveness (LOR) was defined as failure to respond to auditory stimuli six times, determining sleep onset. Patient and dentist satisfaction were assessed before and after experimentation. Results: Thirty patients (22 males) participated in the study. Scaling was performed in 29 patients after excluding one who experienced dizziness during the first stage. The average number of drug administrations until first LOR was significantly lower in group 3 (2.8 times) than groups 1 and 2 (8.0 and 6.5 times, respectively). The time taken to reach the LOR showed no difference between groups. During the second stage, the average time required to reach the LOR during scaling was 583.4 seconds. The effect site concentrations (Ce) was significantly lower in group 1 than groups 2 and 3. In the participant survey on PCS, 8/10 in group 3 reported partial memory loss, whereas 17/20 in groups 1 and 2 recalled the procedure fully or partially. Conclusion PCS with dexmedetomidine can provide a rapid onset of sedation, safe vital sign management, and minimal side effects, thus facilitating smooth dental sedation.

OBJECTIVES: There is a great deal of interest in the possibility that environmental factors may influence the risk of developing allergic rhinitis (AR) in early life. We investigated the simultaneous effects of mode of delivery and duration of breastfeeding on the development of AR in children. METHODS: Data from 1,374 children participating in the Allergic Rhinitis Cohort Study for kids (ARCO-kids study) was analyzed. All subjects were divided into AR or non-allergic rhinitis (NAR) groups. Data on environmental factors, mode of delivery and duration of breastfeeding were collected using a questionnaire. RESULTS: Compared with short-term breastfeeding (<6 months), long-term breastfeeding (≥12 months) was significantly associated with a lower prevalence of AR (adjusted odds ratio [aOR], 0.54; 95% confidence interval [CI], 0.34 to 0.88). Children in the AR group also had a higher cesarean delivery rate than those in the NAR group (39.1% vs. 32.8%, P=0.05). Regarding the combined effects of mode of delivery and duration of breastfeeding, long-term breastfeeding with a vaginal delivery strongly suppressed the development of AR, compared to short-term breastfeeding with a cesarean delivery (aOR, 0.47; 95% CI, 0.30 to 0.73). CONCLUSION: Long-term breastfeeding (≥12 months) and a vaginal delivery are associated with a lower risk of developing childhood AR.
Breast Feeding ; Cesarean Section ; Child ; Cohort Studies ; Delivery, Obstetric ; Female ; Humans ; Odds Ratio ; Pregnancy ; Prevalence ; Rhinitis ; Rhinitis, Allergic

Trigger wrist is a relatively rare disease compared to trigger finger, which is the most common disorder found in hands. Patients with trigger wrist usually complain about the following symptoms: snapping and clicking or triggering around carpal tunnel with or without mild to moderate median neuropathy. There are a total of five cases of trigger wrist: three cases of anomalous muscle belly of flexor digitorum superficialis and two cases of fibroma around flexor tendon sheath within carpal tunnel. This study reports on two of those cases: one with anomalous muscle and the other with fibroma of flexor tendon sheath. Accurate examination and proper diagnosis are mandatory to obviate improper and time-wasting treatment for patients with trigger wrist.
Adult ; Female ; Fibroma ; Humans ; Male ; *Tenosynovitis/physiopathology/radiography/surgery ; *Wrist/physiopathology/radiography/surgery

The etiology and pathophysiology of takotsubo cardiomyopathy have not yet been fully clarified. We report a case of takotsubo cardiomyopathy associated with severe hypocalcemia secondary to hypoparathyroidism. A 69-year-old woman presented with acute pulmonary edema caused by severe left ventricular dysfunction with apical ballooning compatible with takotsubo cardiomyopathy. Laboratory tests revealed severe hypocalcemia secondary to idiopathic hypoparathyroidism. Coronary angiography showed normal coronary artery function. Her symptoms and signs of heart failure improved dramatically with the correction of hypocalcemia through calcium and calcitriol replacement.
Aged ; Calcitriol ; Calcium ; Coronary Angiography ; Coronary Vessels ; Female ; Heart Failure ; Humans ; Hypocalcemia ; Hypoparathyroidism ; Pulmonary Edema ; Takotsubo Cardiomyopathy ; Ventricular Dysfunction, Left

BACKGROUND AND OBJECTIVES: This study aims to evaluate audiologic results and subjective satisfaction of bone anchored hearing aids (BAHA) patients. SUBJECTS AND METHOD: Preoperative air-conduction and bone-conduction thresholds, postoperative aided thresholds were measured for 14 patients. To evaluate patient satisfaction, two questionnaires derived from single sided deafness (SSD) questionnaire and Bern Benefit in SSD questionnaire were used. RESULTS: The mean age of patients, consisting of 8 males and 6 females, was 40.0+/-5.9 year. Ten patients (71%) received implantations for conductive or mixed hearing loss and 4 (29%) for SSD. The mean follow-up period was 27.8+/-5.6 months. The mean preoperative bone-conduction threshold of conductive or mixed hearing loss group was 21.4 dB and the mean air-conduction threshold was 65.4 dB. The mean bone-conduction threshold of SSD group was 60.0 dB and the mean air-conduction threshold was 105.9 dB. The postoperative aided threshold was significantly improved in conductive or mixed hearing loss group (p=0.005). The patients in the conductive or mixed hearing loss group showed more satisfaction with BAHA than those in the SSD group did, but the degree of satisfaction was not statistically significant (p=0.08 for questionnaire 1, p=0.12 for questionnaire 2). Patients with better preoperative bone-conduction threshold and patients with better preoperative speech discrimination score showed more satisfaction with BAHA in the questionnaire 1 (p=0.045, p=0.036). CONCLUSION: BAHA can be considered effective and beneficial for patients with conductive or mixed hearing loss and SSD. Further studies will be needed to choose the appropriate indications for BAHA, especially in SSD group in Korea.
Bone Conduction ; Deafness ; Female ; Follow-Up Studies ; Hearing ; Hearing Aids ; Hearing Loss, Conductive ; Hearing Loss, Mixed Conductive-Sensorineural ; Humans ; Korea ; Male ; Patient Satisfaction ; Surveys and Questionnaires ; Silver Sulfadiazine ; Speech Perception ; Suture Anchors

PURPOSE: Toxic alcohols are responsible for accidental and suicide motivated poisonings, resulting in death or permanent sequelae for the afflicted patients. Major therapeutic modalities in these cases include treatment with alcohol dehydrogenase inhibitors and extracorporeal elimination. There have been a number of case reports of toxic alcohol intoxication in Korea. The purpose of this study was to review the clinical characteristics of patients suffering toxic alcohol intoxication. METHODS: We retrospectively reviewed the medical records of patients who presented with toxic alcohol intoxication at 8 emergency departments (ED) from Jun 2005 to Nov 2011. Patients who ingested methanol, isopropyl alcohol, ethylene glycol, and other alcohols except ethanol, were included in this study. The clinical characteristics of these patients were analyzed to include anion and osmolar gap, and estimated concentration of alcohol in the body. RESULTS: During the study period, 21 patients were identified who had ingested toxic alcohol (methanol; 12 patients, ethylene glycol; 9 patients). At ED arrival, the mean anion gap was 18.7+/-6.9 and the osmolar gap was elevated in 13 patients. Oral and IV ethanol were administrated to 11 patients in order to inhibit alcohol dehydrogenase. Extracorporeal elimination procedures such as hemodialysis were performed in 9 patients. There were no fatalities, but the one patient suffered permanent blindness. CONCLUSION: This study found that ethylene glycol and methanol were the substances ingested which produced toxic alcohol intoxication. The patients presented with high anion gap metabolic acidosis and were typically treated with oral ethanol and hemodialysis.
2-Propanol ; Acid-Base Equilibrium ; Acidosis ; Alcohol Dehydrogenase ; Alcohols ; Emergencies ; Ethanol ; Ethylene Glycol ; Ethylenes ; Humans ; Korea ; Medical Records ; Methanol ; Renal Dialysis ; Retrospective Studies ; Stress, Psychological ; Suicide

A contrast media is essential for the diagnostic accuracy of vascular structure or soft tissue imaging study. The incidence of extravasation of contrast media is very low (0.03% to 0.17%), but higher (0.25% to 0.9%) when using mechanical infuser. We report a case of 64-year-old female patient suffered from acute compartment syndrome, such as pain, skin discoloration in forearm and limitation of finger movement associated with extravasation of contrast media during the coronary angio-computed tomography.
Compartment Syndromes ; Contrast Media ; Extravasation of Diagnostic and Therapeutic Materials ; Female ; Fingers ; Forearm ; Humans ; Incidence ; Middle Aged ; Skin ; Upper Extremity

PURPOSE: Distal radius fractures involving distal radioulnar joint (DRUJ) are common. After the fracture treatment, pain on the ulnar side of wrist, limitation of forearm rotation and instabilities can be remained. The purpose of this study was to address the importance of anatomical reduction for DRUJ injuries. METHODS: Of 115 cases with a distal radius fracture involving DRUJ, 61 cases involving sigmoid notch of the radius or having a ulnar styloid process base fracture were evaluated. At an average of six months follow-up, their final outcomes were investigated using radiologic findings, functional disabilities of the arm, shoulder and hand (DASH) and visual analogue scale (VAS) pain scores and wrist motion of pronation/supination. RESULTS: Satisfied radiologic reduction rate was 73.8%(45/61) in average, which was most favorable in external fixator group (82.4%, 28/34). The mean functional DASH score was 29.0 points and mean VAS for pain was 5.0. The mean range of wrist motions for pronation/supination was 59.5degrees/55.7degrees. CONCLUSION: Distal radius fractures involving DRUJ should be classified into the basic categories of unstable distal radius fracture, and immediate anatomical reduction is needed by operative treatment to avoid painful forearm rotation.
Arm ; Colon, Sigmoid ; External Fixators ; Follow-Up Studies ; Forearm ; Hand ; Joints ; Radius ; Radius Fractures ; Shoulder ; Wrist

BACKGROUND/AIMS: The identification of significant coronary arterial disease (CAD) is important to reduce perioperative ischemic insult and the possibility of repeated open-chest surgery in patients scheduled to undergo valvular surgery. However, there are no published data on the incidence of significant CAD in these patients. Thus, we examined the prevalence of significant CAD in patients scheduled to undergo valvular surgery. METHODS: From January 2005 to June 2011, all consecutive adult patients diagnosed with significant valvular disease and scheduled for an elective open valvular operation were retrospectively investigated at Chungnam National University Hospital and Chonbuk National University Hospital. Patients who underwent emergent valvular operations due to acute aortic dissection or trauma and concomitant valvular operations at the time of coronary artery bypass graft (CABG) surgery were excluded. RESULTS: During the study period, a total of 431 patients (58 +/- 13 years old, 204 males) were included. The distributions of mitral (241 patients) and aortic valvular disease (230 patients) were similar. Coronary angiography was performed in 297 patients (68.9%). Of these, 36 (12.1%) showed significant CAD and 32 underwent concomitant CABG operations. Based on a multivariate analysis, the presence of CAD was significantly associated with old age (> or = 65 years old) [odds ratio (OR) = 3.081, 95% confidence interval (CI) = 1.372-6.921, p = 0.006], more cardiovascular risk factors (> or = 3) (OR = 3.002, 95% CI = 1.386-6.503, p = 0.005), and the presence of aortic stenosis (OR = 2.763, 95% CI = 1.269-6.013, p = 0.010). CONCLUSIONS: The incidence of significant CAD was 12.1% in adult patients who underwent valvular operations in Korea. CAD was more common in patients with old age, aortic stenosis, and multiple cardiovascular risk factors.
Adult ; Aortic Valve Stenosis ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Artery Disease ; Heart Valve Diseases ; Humans ; Incidence ; Korea ; Multivariate Analysis ; Prevalence ; Retrospective Studies ; Risk Factors ; Transplants

PURPOSE: The purpose of the current study is to evaluate the clinical and radiographic outcomes of primary total hip arthroplasty (THA) using a single titanium tapered stem with alumina bearing, which was performed through a modified direct lateral approach. MATERIALS AND METHODS: One hundred twenty consecutive primary THAs were performed in 102 patients, and retrospectively reviewed. There were 53 men and 49 women of mean age 54 years, and all patients were followed for a minimum follow-up period of 5 years (range, 5-8.1 years). Clinical outcomes assessment consisted of calculation of the Harris hip score (HHS), and evaluation of the presence of thigh pain or limp. Sequential radiographs were evaluated for implant migration, osteolysis, reactive line, cortical hypertrophy, or evidence of component loosening. RESULTS: At the final follow-up, the mean preoperative HHS of 46 points improved to 94 points; and activity-related thigh pain occurred in two hips, and mild limps in four hips. There was no evidence of implant migration, osteolysis, or component loosening. Audible squeaking was present in two hips, without pain and radiographic abnormality. Dislocation occurred in three hips. CONCLUSION: The minimum 5-year results of titanium tapered stem with alumina bearing in cementless primary THA, using a modified direct lateral approach, were encouraging.
Aldosterone ; Aluminum Oxide ; Arthroplasty ; Arthroplasty, Replacement, Hip ; Dislocations ; Female ; Follow-Up Studies ; Hip ; Humans ; Hypertrophy ; Male ; Osteolysis ; Outcome Assessment (Health Care) ; Prostheses and Implants ; Retrospective Studies ; Tacrine ; Thigh ; Titanium ; Ursidae