BACKGROUND: The size and depth of the double-lumen tube (DLT) are important for one-lung ventilation (OLV). In patients of a short stature, it is difficult to perform OLV successfully. We designed this study to evaluate the dimensions and margin of safety of the left main bronchi in patients of a short stature for appropriate OLV. METHODS: Chest computed tomography (CT) scans of 241 patients (22 male, 219 female) of a short stature (height below 155 cm) were analyzed retrospectively. The diameters of the trachea (DT), the right and left main bronchi (DR and DL), and the lengths of the right and left main bronchi (LR and LL) were measured at the coronal section of the chest CT scans using a picture archiving communication system program. RESULTS: There were no significant correlations between the heights and lengths of the right and left main bronchi. In addition, the ages and weights of the patients showed no significant correlations with the airway dimensions. The lengths of the bronchial lumen of the left-sided Mallinckrodt DLT show variations of 3 to 5.5 mm with tubes of identical sizes. The margin of safety is 13.8 +/- 4.1 mm assuming that appropriately sized DLTs are inserted. CONCLUSIONS: For successful and safe OLV in patients of a short stature, anesthesiologists should consider the length of the main bronchus and the actual length of the bronchial lumen of the DLT.
Body Height ; Bronchi ; Humans ; Male ; One-Lung Ventilation ; Retrospective Studies ; Thorax ; Tomography, X-Ray Computed ; Trachea ; Weights and Measures

BACKGROUND: The aim of this study was to measure the effect of smoking on bronchial mucus transport velocity with bronchoscope under total intravenous anesthesia. METHODS: Twenty six ASA physical status I male patients (13 smokers and 13 nonsmokers) were enrolled into this study. They scheduled to undergo elective orthopedic surgery and were operated under total intravenous anesthesia using propofol and remifentanil. Single drop (approximately 0.02 cc) of methylene blue was applied to the posterior mucosal surface of right main bronchus 5 cm away from carina by the bronchoscope with epidural catheter 30 minutes after tracheal intubation. Two, four minutes after methylene blue application, the transport of methylene blue was observed. Six minutes after methylene blue application, the distance of methylene blue movement was measured. RESULTS: Mean bronchial mucus transport distance and velocity of methylene blue in smoker group vs nonsmoker group was 9.1 +/- 5.5 mm and 1.5 +/- 1.0 mm/min vs 24.3 +/- 15.2 mm and 4.1 +/- 2.5 mm/min respectively. Mean bronchial mucus transport distance of methylene blue in the smoker group was shorter than that in the nonsmoker group (P value < 0.05). Mean bronchial mucus transport velocity of methylene blue in the smoker group was slower than that in the nonsmoker group (P < 0.05). CONCLUSIONS: Smoking may delay transport of bronchial secretion in terms of bronchial mucus transport velocity under total intravenous anesthesia.
Anesthesia, Intravenous ; Bronchi ; Bronchoscopes ; Catheters ; Humans ; Intubation ; Male ; Methylene Blue ; Mucus ; Orthopedics ; Piperidines ; Propofol ; Smoke ; Smoking

In spite of the American Heart Association recommendations for blood pressure measurement, many physicians measure blood pressure in only one arm that is easy to access at the time of measurement. This practice can lead to incorrect management with significant interarm blood pressure difference. We report a case of a 51 years old man who was scheduled to undergo vascular bypass graft under combined spinal-epidural anesthesia. In 60 minutes after anesthesia, the blood pressure of left arm dropped from 110/65 mmHg to 74/45 mmHg. The blood pressure was still 80/50 mmHg after two injections of ephedrine. After checking radial pulse tone strength, we found significant interarm blood pressure difference. The blood pressure of right arm was 150/70 mmHg. Postoperative CT angiogram revealed significant stenotic portion in the left subclavian artery. This case emphasizes the importance of bilateral blood pressure measurement, especially in patients with peripheral vascular disease.
American Heart Association ; Anesthesia ; Arm ; Blood Pressure ; Ephedrine ; Humans ; Peripheral Vascular Diseases ; Subclavian Artery ; Subclavian Steal Syndrome ; Transplants

OBJECTIVE: The purpose of this study is to evaluate the efficacy and safety of mirtazapine treatment in multicenter population consisting of Korean patients suffering from moderate-to-severe depression. METHODS: Total 163 of in and outpatients with a diagnosis of major depressive disorder (DSM-IV) and 18 or over scores of 17-items Hamilton Rating Scale for Depression (HAMD) received treatment with mirtazapine (15-45 mg/day) for 6 weeks. Efficacy was assessed by HAMD, Montgomery and Asberg Depression Rating Scale (MADRS), Beck's Depression Inventory (BDI), and Clinical Global Impression (CGI) scales and statistical analyses were performed on the intent-to-treat sample (143 patients) using the last-observation-carried-forward method. In addition, reported adverse events, routine laboratory parameters, and vital signs were investigated to evaluate the safety of mirtazapine. RESULTS: Mean daily dose of mirtazapine was 28.4 mg. At the end of the study, the response rate (50% or more reduction from baseline in HAMD scores) was 75.5% and the remission rate (7 or less in HAMD score) was 42.7%. Mirtazapine treatment induced significant reduction in depressive symptoms at the 4(th) day and substantial reduction along the treatment period, as assessed by changes in HAMD, MADRS, BDI, and CGI scales. At the 4(th) day and first week of mirtazapine treatment, the mean HAMD-17 total score was significantly reduced compared that of the baseline and the response rates were 11.9% and 28.7%, respectively. Mirtazapine was well tolerated in general, and somnolence and sedation were the most common adverse events reported. In addition, there were no clinically relevant changes in laboratory parameters and vital signs, although body weight was increased. CONCLUSION: Although this trial had many limitations of open non-comparative study, mirtazapine was demonstrated to an effective treatment for moderate to severe major depressive disorder and was well tolerated. A potentially rapid onset of overall therapeutic efficacy of mirtazapine was suggested by significant changes in all major variables of efficacy after 4(th) day of treatment.
Body Weight ; Depression ; Depressive Disorder, Major ; Diagnosis ; Humans ; Outpatients ; Vital Signs ; Weights and Measures

A case with carcinoid tumor of the appendix was encountered incidentally during an elective abdominal surgery for borderline mucinous ovarian tumor in a 16-year old female. Carcinoid tumor of appendix is the most common neoplasm of the gastrointestinal tract in childhood and adolesence. They are usually regarded as a benign neoplasm and an uncommon source of metastasis and recurrence. We report this case with reference to the value of grosss examination of the appendix and incidental appendectomy during gynecologic abdominal operations.
Adolescent ; Appendectomy ; Appendix* ; Carcinoid Tumor* ; Female ; Gastrointestinal Tract ; Humans ; Mucins* ; Neoplasm Metastasis ; Recurrence

Ovarian leiomyoma is a rare mesenchymal tumor, accounting for only 1% of all benign ovarian neoplasm. Most patients are asymptomatic and the tumors are usually found incidentally during operation or at autopsies. Ovarian adenofibroma is a rare benign tumor which originates from the germinal lining and the stroma of the ovary. This tumor may be solid, semisolid or cystic, depending on the relative amount of the epithelial and stromal component. We have experienced a case of ovarian leiomyoma accompanied with ovarian serous adenofibroma in a 42-year-old woman and report this case with a brief review of literature.
Adenofibroma* ; Adult ; Autopsy ; Female ; Humans ; Leiomyoma* ; Ovarian Neoplasms ; Ovary

Uterine lipoleiomyoma are rare benign tumors consisting of smooth muscle and mature adipose tissue. Because of their rarity, fat content, and variable gross morphology, they may be mistaken on radiodiagnosis for the much more common benign cystic ovarian teratoma. The key to differentiate these lesions is the identification of the organ of origin. A mass that arises from the uterus is most likely a lipomatous uterine tumors. Because malignant degeneration occurs in 1-2% of benign cystic ovarian teratomas, their differentiation can be clinically significant. While these tumors are treated by surgical excision, asymptomatic lipomatous uterine tumors and benign pelvic lipomas may require no therapy. The fatty nature of the lipoleiomyoma was demonstrated with standard spin-echo Magnetic resonance imaging (MRI) and further supported using fat- suprressed inversion recovery MRI. MRI also clearly depicted the intrauterine location of the tumor. We report a case in which a preoperative diagnosis of a uterine lipoleiomyoma was made with MRI and fat suppressed MRI.
Adipose Tissue ; Diagnosis ; Lipoma ; Magnetic Resonance Imaging ; Muscle, Smooth ; Teratoma ; Uterus

Total abdominal hystrectomy is the most common surgery of Gynecology. It's complication are taken very important. Although neuropathy, especially femoral nerve injury, is rare, recently we have experienced a case of femoral neuropathy after total abdominal hystrectomy. We present this case with a brief review of literature.
Femoral Nerve* ; Femoral Neuropathy ; Gynecology

In the management of the traumatized gravid and her fetus, diagnostic tests and therapy should be directed primarily at the care of the mother and should not be delayed or compromised because of the pregnancy. Because many factors can damage when the mother is unconscious, fetal well-being should be assessed by serial biophysical profile scoring. If the mother's condition is stable as in the chronic vegetative state, elective delivery might best be performed at a gestational age of 32 to 34 weeks.
Diagnostic Tests, Routine ; Fetus ; Gestational Age ; Humans ; Mothers ; Persistent Vegetative State* ; Pregnancy*

BACKGROUND: Onychomycosis, especially toenail onychomycosis has become one of the common fungal infection and has historically been regarded as a cosmetic rather than medical problem by many patients, even by physicians. Recently, however, there are several reports that this is a refractory disease which may cause a deleterious effect on patients' quality of life (QOL). OBJECTIVE: The purpose of this study was to investigate the impact of toenail onychomycosis on QOL in Korea and to assess the changes of QOL after treatment. METHODS: Total 1004 patients with toenail onychomycosis which was confirmed by clinical findings and KOH preparation were enrolled at 47 dermatologic centers in Korea, and interviewed with standardized QOL questionnaire before and after systemic antifungal treatment. Responses to the questionnaire were scored by f-point scale (0~4) and averaged, and were analyzed for 5 dimensions of emotional impact, social impact, symptom and functional impact, patients' views concerning treatment, and relationship with doctor. RESULTS: 1. Before and after treatment, the most serious impact was emotional dimension showing 1.90 and 1.30 in average score (AS), and social (AS: 1.14 and 0.83) and symptom and functional impact (AS: 1.05 and 0.92) was also affected. 2. In female rather than male, statistically more significant impact on patients' QOL was observed in all dimensions. 3. After treatment, 3 of 5 dimensions were improved significantly - emotional dimension (AS: from 1.90 to 1.30), social dimension (AS: from 1.14 to 0.83), patients' view concerning treatment(AS: from 1.34 to 1.02) 4. The degree of patients' satisfaction at the therapeutic effect was very high - 62.4% (immediately after. treatment) and 65.8% (9 months after initiation of treatment) of patients answered excellent or good. CONCLUSION: This study confirms that toenail onychomycosis has significant Impact on the overall QOL of patients. Also the effect of antifungal therapy on patients' QOL were satisfactory. Therefore, both doctor and patient should pay more attention to the treatment of onychomycosis.
Female ; Humans ; Korea* ; Male ; Nails* ; Onychomycosis* ; Quality of Life* ; Social Change ; Surveys and Questionnaires