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Chai H, Russ J, Vardhaman S, Lim CH, Zhang Y. A Bilayer Method for Measuring Toughness and Strength of Dental Ceramics. J Dent Res 2024; 103:419-426. [PMID: 38410925 DOI: 10.1177/00220345231225445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Abstract
The ever-increasing usage of ceramic materials in restorative dentistry necessitates a simple and effective method to evaluate flexural strength σF and fracture toughness KC. We propose a novel method to determine these quantities using a bilayer specimen composed of a brittle plate adhesively bonded onto a transparent polycarbonate substrate. When this bilayer structure is placed under spherical indentation, tunneling radial cracks initiate and propagate in the lower surface of the brittle layer. The failure analysis is based on previous theoretical relationships, which correlate σF with the indentation force P and layer thickness d, and KC with P and mean length of radial cracks. This work examines the accuracy and limitations of this approach using a wide range of contemporary dental ceramic materials. The effect of layer thickness, indenter radius, load level, and length and number of radial cracks are carefully examined. The accuracy of the predicted σF and KC is similar to those obtained with other concurrent test methods, such as biaxial flexure and 3-point bending (σF), and bending specimens with crack-initiation flaws (KC). The benefits of the present approach include treatment for small and thin plates, elimination of the need to introduce a precrack, and avoidance of dealing with local material nonlinearity effects for the KC measurements. Finally, the bilayer configuration resembles occlusal loading of a ceramic restoration (brittle layer) bonded to a posterior tooth (compliant substrate).
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Affiliation(s)
- H Chai
- School of Mechanical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - J Russ
- School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - S Vardhaman
- Department of Preventive and Restorative Sciences, University of Pennsylvania, School of Dental Medicine, Philadelphia, PA, USA
- College of Dental Medicine, Columbia University, New York, NY, USA
| | - C H Lim
- Department of Preventive and Restorative Sciences, University of Pennsylvania, School of Dental Medicine, Philadelphia, PA, USA
| | - Y Zhang
- Department of Preventive and Restorative Sciences, University of Pennsylvania, School of Dental Medicine, Philadelphia, PA, USA
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Ko E, Kwak JS, Park H, Lim CH. Limited effect of sugammadex on postoperative pulmonary complications in patients undergoing spine surgery in prone position intraoperatively: A retrospective analysis of matched cohort data. Medicine (Baltimore) 2023; 102:e35858. [PMID: 37933001 PMCID: PMC10627630 DOI: 10.1097/md.0000000000035858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/09/2023] [Indexed: 11/08/2023] Open
Abstract
Postoperative pulmonary complications (PPCs) increase postoperative mortality, hospital stays, and healthcare costs. Whether the use of sugammadex could reduce PPCs remains controversial. This study aimed to determine if sugammadex could more effectively reduce PPCs than acetylcholinesterase inhibitor (AChEi) in patients who had undergone spine surgery, in prone position intraoperatively. From March 2019 to February 2021, adult patients who underwent elective spine surgery were eligible. Primary outcomes were PPCs (including atelectasis on chest radiograph, pneumonia, acute respiratory distress syndrome, and aspiration pneumonitis) and respiratory failure that occurred within 28 days after surgery. Secondary outcomes were length of hospital stay, in-hospital death, and readmission rate within 30 days. Patients were divided into 2 groups (Sugammadex group and AChEi group) and compared by 1:1 propensity score matching. Of a total of 823 patients who underwent spinal surgery, 627 were included. After 1:1 propensity matching, 142 patients were extracted for each group. PPCs occurred in 9 (6.3%) patients in both groups (P = 1.000). Respiratory failure occurred in 7 (4.9%) patients in the Sugammadex group and 5 (3.5%) patients in the AChEi group (P = .77). There was no significant difference in secondary outcomes between the 2 groups. Although there have been some evidences showing that the use of sugammadex can attenuate the development of PPCs, this study did not show positive effects of sugammadex on patients who underwent spine surgery in the prone position.
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Affiliation(s)
- Eunji Ko
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Seoul, South Korea
| | - Ji Soo Kwak
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Seoul, South Korea
| | - Heechan Park
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Seoul, South Korea
| | - Choon Hak Lim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Korea University, Seoul, South Korea
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Seong H, Jang Y, Ko E, Lee J, Kim T, Lim CH, Shin HJ, Kim YH, Kim DS. Impact of preoperative red blood cell transfusion on long-term mortality of liver transplantation: A retrospective cohort study. Medicine (Baltimore) 2023; 102:e34914. [PMID: 37713857 PMCID: PMC10508566 DOI: 10.1097/md.0000000000034914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/03/2023] [Indexed: 09/17/2023] Open
Abstract
Preoperative red blood cell (RBC) transfusion can induce immune modulation and alloimmunization; however, few studies have investigated the effect of preoperative transfusion and hemoglobin levels that need to be corrected before surgery, especially in critically ill patients such as those with end-stage liver disease who undergo liver transplantation (LT). This study aimed to investigate the effects of preoperative RBC transfusion on long-term mortality in LT recipients. A total of 249 patients who underwent LT at a single center between January 2012 and December 2021 were included in this study. The patients were divided into 2 groups: preoperative transfusion and preoperative non-transfusion. Since the baseline characteristics were significantly different between the 2 groups, we performed propensity score matching, including factors such as the Model for End-Stage Liver Disease score and intraoperative RBC transfusion, to exclude possible biases that could affect prognosis. We analyzed the 5-year mortality rate as the primary outcome. The preoperative transfusion group showed a 4.84-fold higher hazard ratio than that in the preoperative non-transfusion group. There were no differences in 30-day mortality, duration of intensive care unit stay, or graft rejection rate between the 2 groups. Preoperative transfusion could influence long-term mortality in LT, and clinicians should pay attention to RBC transfusion before LT unless the patient is hemodynamically unstable. A large-scale randomized controlled trial is needed to determine the possible mechanisms related to preoperative RBC transfusion, long-term mortality, and the level of anemia that should be corrected before surgery.
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Affiliation(s)
- Hyunyoung Seong
- Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Yookyung Jang
- Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Eunji Ko
- Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Jaehee Lee
- Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Taesan Kim
- Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Choon Hak Lim
- Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Hyeon Ju Shin
- Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Yun-Hee Kim
- Department of Anesthesiology and Pain Medicine, Changwon Hanmaeum Hospital, Changwon, South Korea
| | - Dong-Sik Kim
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery Anam Hospital, Korea University College of Medicine, Seoul, South Korea
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Ko E, Yoo KY, Lim CH, Jun S, Lee K, Kim YH. Is atelectasis related to the development of postoperative pneumonia? a retrospective single center study. BMC Anesthesiol 2023; 23:77. [PMID: 36906539 PMCID: PMC10007747 DOI: 10.1186/s12871-023-02020-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/14/2023] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND Atelectasis may play a substantial role in the development of pneumonia. However, pneumonia has never been evaluated as an outcome of atelectasis in surgical patients. We aimed to determine whether atelectasis is related to an increased risk of postoperative pneumonia, intensive care unit (ICU) admission and hospital length of stay (LOS). METHODS The electronic medical records of adult patients who underwent elective non-cardiothoracic surgery under general anesthesia between October 2019 and August 2020 were reviewed. They were divided into two groups: one who developed postoperative atelectasis (atelectasis group) and the other who did not (non-atelectasis group). The primary outcome was the incidence of pneumonia within 30 days after the surgery. The secondary outcomes were ICU admission rate and postoperative LOS. RESULTS Patients in the atelectasis group were more likely to have risk factors for postoperative pneumonia including age, body mass index, a history of hypertension or diabetes mellitus and duration of surgery, compared with those in the non-atelectasis. Among 1,941 patients, 63 (3.2%) developed postoperative pneumonia; 5.1% in the atelectasis group and 2.8% in the non-atelectasis (P = 0.025). In multivariable analysis, atelectasis was associated with an increased risk of pneumonia (adjusted odds ratio, 2.33; 95% CI: 1.24 - 4.38; P = 0.008). Median postoperative LOS was significantly longer in the atelectasis group (7 [interquartile range: 5-10 days]) than in the non-atelectasis (6 [3-8] days) (P < 0.001). Adjusted median duration was also 2.19 days longer in the atelectasis group (β, 2.19; 95% CI: 0.821 - 2.834; P < 0.001). ICU admission rate was higher in the atelectasis group (12.1% vs. 6.5%; P < 0.001), but it did not differ between the groups after adjustment for confounders (adjusted odds ratio, 1.52; 95% CI: 0.88 - 2.62; P = 0.134). CONCLUSION Among patients undergoing elective non-cardiothoracic surgery, patients with postoperative atelectasis were associated with a 2.33-fold higher incidence of pneumonia and a longer LOS than those without atelectasis. This finding alerts the need for careful management of perioperative atelectasis to prevent or reduce the adverse events including pneumonia and the burden of hospitalizations. TRIAL REGISTRATION None.
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Affiliation(s)
- Eunji Ko
- grid.411134.20000 0004 0474 0479Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841 Republic of Korea
| | - Kyung Yeon Yoo
- grid.411597.f0000 0004 0647 2471Department of Anesthesiology and Pain Medicine, Chonnam National University Hospital, 42 , Jebong-ro, Dong-gu, Gwangju, 58128 Republic of Korea
| | - Choon Hak Lim
- grid.222754.40000 0001 0840 2678Department of Anesthesiology and Pain Medicine, College of Medicine, Korea University, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841 Republic of Korea
| | - Seungwoo Jun
- grid.411134.20000 0004 0474 0479Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841 Republic of Korea
| | - Kaehong Lee
- grid.411134.20000 0004 0474 0479Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841 Republic of Korea
| | - Yun Hee Kim
- grid.49606.3d0000 0001 1364 9317Department of Anesthesiology and Pain Medicine, Hanyang University Changwon Hanmaeum Hospital, 57, Yongdong-Ro, Uichang-Gu, Gyeongsangnam-Do, Changwon-Si, 51139 Republic of Korea
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Ko E, Kim YH, Song YJ, Choe K, Heo J, Moon DE, Lim CH. Reliability of Marked Scales on Intravenous Fluid Plastic Bags. J Korean Med Sci 2022; 37:e345. [PMID: 36536546 PMCID: PMC9763708 DOI: 10.3346/jkms.2022.37.e345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 09/28/2022] [Indexed: 11/25/2022] Open
Abstract
Precise fluid administration is important to prevent hypo- or hypervolemia. However, the accuracy of scales marked on intravenous (IV) fluid plastic bags had remained unknown. Ten 1 L sized IV crystalloids were prepared from each of three manufacturers (H, J, and D). At each scale, the actual volume of the IV fluid was measured. Differences with the measured volumes for each scale were investigated between the three manufacturers. All initial total volume was greater than 1 L. Except for the full-filled level, H overfilled, whereas J and D filled less. For J and D, the maximal differences between the scale and the measured volume were about 200 mL. Fluid volumes of each scale were significantly different among the three manufacturers (P < 0.001). It is inaccurate to measure the amount of fluid depending on the IV bag scales. Clinicians must use electronic infusion pumps for accurate fluid administration.
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Affiliation(s)
- Eunji Ko
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Yun Hee Kim
- Department of Anesthesiology and Pain Medicine, Changwon Hanmaeum Hospital, Changwon, Korea
| | | | | | - Junghyun Heo
- Department of Commercialization of Biomedical Technology, Viva Innovation Co., Ltd., Seoul, Korea
| | - Dae Eun Moon
- Department of Commercialization of Biomedical Technology, Viva Innovation Co., Ltd., Seoul, Korea
| | - Choon Hak Lim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Korea University, Seoul, Korea.
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Zulkufli NS, Ting HY, Mat Salleh MJ, Lim CH, Che Muda NB. Clinical utility of Pandy test in the face of quantitative CSF total protein and albumin: A retrospective study and literature review. Malays J Pathol 2022; 44:253-260. [PMID: 36043588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Qualitative Pandy test has long been used to indicate raised globulins in the cerebrospinal fluid (CSF). Despite its shortfalls and the availability of quantitative CSF protein assays, Pandy test continues to be performed in clinical laboratories across Malaysia. OBJECTIVES (1) Compare diagnostic performance of Pandy test to CSF total protein and albumin; (2) Conduct literature review on clinical utility of Pandy test. MATERIALS AND METHODS This is a retrospective, cross-sectional study involving 890 inpatients of all ages with CSF biochemistry analysed in Hospital Pulau Pinang over a period of 7 months. Patient demographics, clinical diagnosis and CSF total protein, albumin and Pandy results were collected and analysed using Mann-Whitney U test, Spearman rank-order correlation coefficient, Chi Square test and receiver operating characteristic (ROC) curve analysis. RESULTS CSF total protein, CSF albumin, CSF protein-albumin difference and age showed significantly higher median values in patients with positive Pandy compared to negative Pandy. Significant associations were found between positive Pandy test with clinical diagnosis (Cramers V 0.443, p<0.01), sample haemolysis (Phi 0.326, p<0.01), CSF protein-albumin difference (Spearman 0.727, p<0.001), CSF total protein (Spearman 0.710, p<0.001) and CSF albumin (Spearman 0.662, p<0.01). All three quantified CSF parameters showed comparably good sensitivity and specificity in determining positive Pandy. DISCUSSION AND CONCLUSION Good correlation with CSF proteins, analytical issues and reagent hazards indicate no added clinical value of Pandy test in the face of quantified CSF total protein and albumin. Abolishing the test saves resources, reduces occupational hazards and shortens turnaround time without compromising diagnosis.
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Affiliation(s)
- N S Zulkufli
- Hospital Pulau Pinang, Department of Pathology, Chemical Pathology & Integrated Unit, Penang, Malaysia.
| | - H Y Ting
- Hospital Miri, Department of Pathology, Chemical Pathology Unit, Sarawak, Malaysia
| | - M J Mat Salleh
- Hospital Seberang Jaya, Department of Pathology, Chemical Pathology Unit, Penang, Malaysia
| | - C H Lim
- Hospital Pulau Pinang, Department of Pathology, Chemical Pathology & Integrated Unit, Penang, Malaysia
| | - N B Che Muda
- Hospital Pulau Pinang, Department of Pathology, Chemical Pathology & Integrated Unit, Penang, Malaysia
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Ko E, Song YJ, Choe K, Park Y, Yang S, Lim CH. The Effects of Intravenous Fluid Viscosity on the Accuracy of Intravenous Infusion Flow Regulators. J Korean Med Sci 2022; 37:e71. [PMID: 35257526 PMCID: PMC8901879 DOI: 10.3346/jkms.2022.37.e71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/02/2022] [Indexed: 11/20/2022] Open
Abstract
Intravenous infusion flow regulators (IIFRs) are widely used devices but it is unknown how much the difference between the IIFR scale and the actual flow rate depends on the viscosity of the intravenous (IV) fluid. This study evaluated the effects of viscosity on the flow rate of five IV fluids (0.9% normal saline, Hartmann's solution, plasma solution-A, 6% hetastarch, and 5% albumin) when using IIFRs. The viscosity of crystalloids was 1.07-1.12 mPa·s, and the viscosities of 6% hetastarch and 5% albumin were 2.59 times and 1.74 times that of normal saline, respectively. When the IIFR scales were preset to 20, 100, and 250 mL/hr, crystalloids were delivered at the preset flow rate within a difference of less than 10%, while 6% hetastarch was delivered at approximately 40% of the preset flow rates and 5% albumin was approximately 80% transmitted. When delivering colloids, IIFRs should be used with caution.
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Affiliation(s)
- Eunji Ko
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Seoul, Korea
| | | | | | - Yongdoo Park
- Department of Biomedical Engineering, College of Medicine, Korea University, Seoul, Korea
| | - Sung Yang
- Department of Biomedical Science and Engineering, School of Mechanical Engineering, Gwangju Institute of Science and Technology, Gwangju, Korea
| | - Choon Hak Lim
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Seoul, Korea.
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Shin HJ, Ko E, Jun I, Kim HJ, Lim CH. Effects of perioperative erythropoietin administration on acute kidney injury and red blood cell transfusion in patients undergoing cardiac surgery: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e28920. [PMID: 35244046 PMCID: PMC8896477 DOI: 10.1097/md.0000000000028920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 02/07/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The renoprotective effects of erythropoietin (EPO) are well-known; however, the optimal timing of EPO administration remains controversial. Red blood cell (RBC) transfusion is an independent risk factor for cardiac surgery-associated acute kidney injury (CSA-AKI). We aimed to evaluate the efficacy of EPO on CSA-AKI and RBC transfusion according to the timing of administration. METHODS We searched the Cochrane Library, EMBASE, and MEDLINE databases for randomized controlled trials. The primary outcome was the incidence of CSA-AKI following perioperative EPO administration, and the secondary outcomes were changes in serum creatinine, S-cystatin C, S-neutrophil gelatinase-associated lipocalin, urinary neutrophil gelatinase-associated lipocalin, length of hospital and intensive care unit (ICU) stay, volume of RBC transfusion, and mortality. The subgroup analysis was stratified according to the timing of EPO administration in relation to surgery. RESULTS Eight randomized controlled trials with 610 patients were included in the study. EPO administration significantly decreased the incidence of CSA-AKI (odds ratio: 0.60, 95% confidence interval [CI]: 0.43-0.85, P = .004; I2 = 52%; P for heterogeneity = .04), intra-operative RBC transfusion (standardized mean difference: -0.30, 95% CI: -0.55 to -0.05, P = .02; I2 = 15%, P for heterogeneity = .31), and hospital length of stay (mean difference: -1.54 days, 95% CI: -2.70 to -0.39, P = .009; I2 = 75%, P for heterogeneity = .001) compared with control groups. Subgroup analyses revealed that pre-operative EPO treatment significantly reduced the incidence of CSA-AKI, intra-operative RBC transfusion, serum creatinine, and length of hospital and ICU stay. CONCLUSION Pre-operative administration of EPO may reduce the incidence of CSA-AKI and RBC transfusion, but not in patients administered EPO during the intra-operative or postoperative period. Therefore, pre-operative EPO treatment can be considered to improve postoperative outcomes by decreasing the length of hospital and ICU stay in patients undergoing cardiac surgery.
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Affiliation(s)
- Hyeon Ju Shin
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Eunji Ko
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Injae Jun
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyun Jung Kim
- Department of Preventive Medicine, Institute for Evidence-based Medicine Cochrane Korea, Republic of Korea
| | - Choon Hak Lim
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
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Choi SU, Rho JH, Choi YJ, Jun SW, Shin YJ, Lee YS, Shin HJ, Lim CH, Shin HW, Kim JH, Lee HW, Lim HJ. Postoperative hypoalbuminemia is an independent predictor of 1-year mortality after surgery for geriatric intertrochanteric femoral fracture: A retrospective cohort study. Medicine (Baltimore) 2021; 100:e28306. [PMID: 34941120 PMCID: PMC8701452 DOI: 10.1097/md.0000000000028306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/26/2021] [Indexed: 01/05/2023] Open
Abstract
Preoperative hypoalbuminemia from malnutrition is associated with increased morbidity and mortality after geriatric hip fracture surgery. However, little is known regarding the correlation between postoperative hypoalbuminemia and mortality. This study aimed to evaluate whether postoperative hypoalbuminemia could predict 1-year mortality after intertrochanteric femoral fracture surgery in elderly patients.The medical records of 263 geriatric patients (age ≥65 years) who underwent intertrochanteric femoral fracture surgery between January 2013 and January 2016 in a single hospital were reviewed retrospectively. The patients were allocated to 2 groups based on lowest serum albumin levels within 2 postoperative days (≥3.0 g/dL [group 1, n = 46] and <3.0 g/dL [group 2, n = 217]. Data between the non-survival and survival groups were compared. Multivariable logistic regression analysis was conducted to identify the independent predictor for 1-year mortality.The 1-year mortality rate was 16.3% after intertrochanteric femoral fracture surgery. Multivariable logistic regression analysis revealed that postoperative hypoalbuminemia was significantly associated with 1-year mortality (adjusted odds ratio, 8.03; 95% confidence interval, 1.37-47.09; P = .021). The non-survival group showed a significantly increased incidence of postoperative hypoalbuminemia (95.4% vs 80.0%, P = .015) and intensive care unit admission (11.6% vs 2.7%, P = .020), older age (82.5 ± 5.8 years vs 80.0 ± 7.2 years, P = .032), lower body mass index (20.1 ± 3.2 kg/m2 vs 22.4 ± 3.8 kg/m2, P < .001), and increased amount of transfusion of perioperative red blood cells (1.79 ± 1.47 units vs 1.43 ± 2.08 units, P = .032), compared to the survival group.This study demonstrated that postoperative hypoalbuminemia is a potent predictor of 1-year mortality in geriatric patients undergoing intertrochanteric femoral fracture surgery. Therefore, exogenous albumin administration can be considered to improve postoperative outcomes and reduce the risk of mortality after surgery for geriatric hip fracture.
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Affiliation(s)
- Sung Uk Choi
- Department of Anesthesiology and Pain Medicine, Anam Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Jeong Ho Rho
- Department of Anesthesiology and Pain Medicine, Okcheon St. Mary’ Hospital, Chungcheongbuk-do, Republic of Korea
| | - Yoon Ji Choi
- Department of Anesthesiology and Pain Medicine, Ansan Hospital, College of Medicine, Korea University, Ansan, Republic of Korea
| | - Seung Woo Jun
- Department of Anesthesiology and Pain Medicine, Anam Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Young Jae Shin
- Department of Anesthesiology and Pain Medicine, Anam Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Yoon Sook Lee
- Department of Anesthesiology and Pain Medicine, Ansan Hospital, College of Medicine, Korea University, Ansan, Republic of Korea
| | - Hyeon Ju Shin
- Department of Anesthesiology and Pain Medicine, Anam Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Choon Hak Lim
- Department of Anesthesiology and Pain Medicine, Anam Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Hye Won Shin
- Department of Anesthesiology and Pain Medicine, Anam Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Jae Hwan Kim
- Department of Anesthesiology and Pain Medicine, Ansan Hospital, College of Medicine, Korea University, Ansan, Republic of Korea
| | - Hye Won Lee
- Department of Anesthesiology and Pain Medicine, Anam Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Hye Ja Lim
- Department of Anesthesiology and Pain Medicine, Anam Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
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Ita MI, Wang JH, Fanning N, Kaar GF, Lim CH, Redmond HP. O52 Plasma circulating cell-free messenger RNA as a potential biomarker of melanoma. Br J Surg 2021. [DOI: 10.1093/bjs/znab282.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Blood-borne cell-free nucleic acids are increasingly emerging as significant non-invasive adjuncts to current methods of disease status evaluation in cancer patients. In this study, we sought to examine whether significant differences exist in the plasma transcriptomic profile of advanced melanoma patients with a high disease burden compared to patients with therapeutic response.
Method
Plasma circulating cell-free messenger ribonucleic acid (ccfmRNA) was extracted from twenty patients with stage IV melanoma receiving immunotherapy. Pathway focused gene expression analysis was performed. Patients were assessed with paired blood sample collection and CT scan assessments at baseline and at 3 months follow up. Response Evaluation Criteria in Solid Tumours (RECIST 1.1) was used for tumour burden estimation.
Result
In stage IV melanoma patients, CCL5, GZMB and MYD88 genes were significantly over-expressed (P < 0.05 versus healthy controls). In patients with high disease burden or progressive disease, CCL18, CCR1, CCR4, CD274, CSF2, and GBP1 genes were significantly over-expressed (P < 0.05 versus patients with therapeutic response). Finally, in stage IV melanoma patients with brain metastases, CCL18, CCR1, CCR4, CD274, CSF2, EGF, GBP1, and PTGS2 genes were significantly over-expressed (P < 0.05, versus patients without brain metastasis).
Conclusion
Significant differences were observed in the plasma transcriptomic profile between the various melanoma patient groups, and we postulate that these differences may be exploited to identify novel therapeutic targets or biomarkers relevant to melanoma. CCL4 and CCL5 are prognostic in melanoma, both genes had significantly higher expressions in low disease burden patients compared to patients with a high disease burden.
Take-home Message
CCL4 and CCL5 ccfmRNA transcripts are prognostic in melanoma. High expression of both genes is favourable in melanoma patients.
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Ita MI, Wang JH, Toulouse A, Lim CH, Fanning N, O’Sullivan MGJ, Nolan Y, Kaar GF, Redmond HP. O51 The utility of plasma circulating cell-free messenger RNA as a biomarker of glioma: a pilot study. Br J Surg 2021. [DOI: 10.1093/bjs/znab282.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Research into the potential utility of plasma-derived circulating cell-free nucleic acids as non-invasive adjuncts to radiological imaging has been occasioned by the invasive nature of brain tumour biopsy. Circulating-cell-free messenger RNAs are short fragments of RNA present in blood. The objective of this study was to determine whether significant differences exist in the plasma transcriptomic profile of glioma patients relative to differences in their tumour characteristics, and also whether any observed differences were representative of synchronously obtained glioma samples and TCGA glioma derived RNA.
Method
Blood samples were collected from twenty-nine patients prior to tumour resection. Plasma ccfmRNA and glioma derived RNA were extracted and profiled.
Result
BCL2L1, CXCL5, GZMB, HLA-A, HLA-C, IRF1, MYD88, TGFB1, TLR2, and TP53 genes were significantly over-expressed in glioma (high-grade-glioma-HGG and low-grade-glioma-LGG) patients (P < 0.05, versus control). BCL2L1, GZMB and HLA-A genes were significantly over-expressed in HGG patients (P < 0.05, versus LGG patients). There was positive correlation between the magnitude of fold change of differentially expressed genes in plasma and glioma derived RNA (Spearman r = 0.6344, n = 14, P = 0.017), and with the mean FPKM of TCGA glioma derived RNA samples (Spearman r = 0.4614, n = 19, P = 0.047). There was positive correlation between glioma radiographic tumour burden and the magnitude of fold change of CSF3 gene (r = 0.9813, n = 20, P < 0.001).
Conclusion
We identified significant differential expression of genes involved in cancer inflammation and immunity among patients with different glioma grades, and we identified positive correlation between the plasma transcriptomic profile and tumour samples, and with TCGA glioma derived RNA.
Take-home Message
The plasma transcriptomic profile of glioma patients appears to be representative of synchronously obtained glioma samples.
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Yum HK, Lim CH, Park JY. Medicosocial Conflict and Crisis due to Illegal Physician Assistant System in Korea. J Korean Med Sci 2021; 36:e199. [PMID: 34254477 PMCID: PMC8275465 DOI: 10.3346/jkms.2021.36.e199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 11/20/2022] Open
Abstract
The Korean Medical Association opposes the illegal attempt to implement the physician assistant (PA) system in Korea. The exact meaning of 'PA' in Korea at present time is 'Unlicensed Assistant (UA)' since it is not legally established in our healthcare system. Thus, PA in Korea refers to unlawful, unqualified, auxiliary personnel for medical practitioners. There have been several issues with the illegal PA system in Korea facing medicosocial conflicts and crisis. Patients want to be diagnosed and treated by medically-educated, licensed and professionally trained physicians not PAs. In clinical settings, PAs deprive the training and educational opportunities of trainees such as interns and residents. Recently, there have been several attempts, by CEO or directors of major hospitals in Korea, to adopt and legalize this system without general consensus from medical professional associations and societies. Without such consensus, this illegal implementation of PA system will create new and additional very serious medical crises due to unlawful medical, educational, professional conflicts and safety issues in medical practice. Before considering the implementation of the PA system, there needs to be a convincing justification by solving the fundamental problems beforehand, such as the collapsed medical delivery system, protection and provision of optimal education program and training environment of trainees, burnout from excessive workloads of physicians with very low compensational system and poor conditions for working and education, etc.
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Affiliation(s)
- Ho Kee Yum
- Respiratory and Critical Care Medicine, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Choon Hak Lim
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Jung Yul Park
- Department of Neurosurgery, Korea University Anam Hospital, Seoul, Korea.
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Lee MG, Shin YJ, You HS, Lim CH, Chang YJ, Shin HJ. A Comparison of Anesthetic Quality Between Interscalene Block and Superior Trunk Block for Arthroscopic Shoulder Surgery: A Randomized Controlled Trial. Pain Physician 2021; 24:235-242. [PMID: 33988942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Interscalene block is the most commonly used nerve block for shoulder surgery, and superior trunk block has been investigated as a phrenic-sparing alternative. This randomized controlled trial compared ultrasound-guided interscalene block and superior trunk block as anesthesia for arthroscopic shoulder surgery. OBJECTIVES Our aims were to determine the superiority of anesthesia quality and compare the risk of hemidiaphragmatic paralysis between these 2 blocks. STUDY DESIGN A randomized, controlled trial. SETTING Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital. METHODS Forty-eight patients undergoing elective arthroscopic shoulder surgery under an ultrasound guided brachial plexus block were randomized to receive either an interscalene block (ISB group, n = 24) or a superior trunk block (STB group, n = 24) for surgery. Ten milliliters of 2% lidocaine and 10 mL of 0.75% ropivacaine were used as local anesthesia in both brachial plexus block groups (total 20 mL). In the ISB group, the local anesthesia was injected between the C5-C6 root and at the upper part of C5 with equally divided doses. In the STB group, the local anesthesia was injected into the anterior and posterior parts of the superior trunk with equally divided doses. Sensory blockade of each trocar's insulting site (supraclavicular, axillary, and suprascapular nerve areas) and motor blockade of the axillary nerve (shoulder abduction) and the suprascapular nerve (shoulder external rotation) were assessed by a blinded observer at 5-minute intervals for 30 minutes after the block. Anesthesia quality was assessed using 3 grades (excellent/insufficient/failure). The blinded investigator also assessed the grade of hemidiaphragmatic paralysis (normal/partial/complete) by comparing pre- and postoperative chest radiographs. Primary outcome variables were anesthesia grade and rate of hemidiaphragmatic paralysis. Secondary outcome variables were performance time and anesthesia onset time. RESULTS The anesthetic grade was significantly different between the 2 groups (22/2/0 in the ISB group vs. 16/3/5 in the STB group, P = 0.046). Both groups displayed equivalent incidence of hemidiaphragmatic paralysis (12/6/6 in the ISB group vs. 7/14/3 in the STB group, P = 0.063). No intergroup differences were found in terms of performance time and anesthesia onset time. LIMITATIONS Our sensory and motor function test was not applied to the subscapular nerve, which serves internal rotation of the humeral head so may be difficult to evaluate in patients with rotator cuff tears. We assessed the diaphragmatic movement by chest radiographs instead of by ultrasound. CONCLUSIONS The superior trunk block provided lower quality of surgical anesthesia than the interscalene block and did not effectively decrease the risk of hemidiaphragmatic paralysis during arthroscopic shoulder surgery for rotator cuff syndrome.
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Affiliation(s)
- Mi Geum Lee
- Department of Anesthesiology and Pain Medicine, Gachon University, Gil Medical Center, Incheon, South Korea
| | - Young Jae Shin
- Korea University College of Medicine, Anam Hospital, Seoul, Korea
| | - Hae Sun You
- Korea University College of Medicine, Anam Hospital, Seoul, Korea
| | - Choon Hak Lim
- Korea University College of Medicine, Anam Hospital, Seoul, Korea
| | - Young Jin Chang
- Department of Anesthesiology and Pain Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon, South Korea
| | - Hyeon Ju Shin
- Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, Seoul
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Ita M, Nolan Y, Toulouse A, Wang JH, Lim CH, O'sullivan MGJ, Kaar GF, Redmond HP. O9: DETECTION OF RELEVANT GENE MUTATIONS IN GLIOMA USING PLASMA CELL FREE DNA. Br J Surg 2021. [DOI: 10.1093/bjs/znab117.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Background
Comprehensive molecular profiling of gliomas provide information essential for accurate biological classification beyond traditional histopathology. Genomic profiling utilizing tumour tissue samples inevitably involves obtaining tissues through potentially hazardous surgical procedures or stereotactic biopsies carrying risks of morbidity and mortality. Tissues from biopsies may also be insufficient or fail to capture a comprehensive picture of the tumours genetic profile due to tumour heterogeneity. In these contexts, complementary minimally invasive strategies are needed for molecular profiling of gliomas. Cell free DNA (cfDNA) has emerged as an easily accessible biomarker containing fragments of circulating tumour DNA (ctDNA) released into plasma through apoptosis. We explored its potential utility in genomic profiling of brain tumours.
Method
Plasma cfDNA from patients with radiographically suspected brain malignancies were extracted and quantified before planned surgical interventions. Cell free DNA was extracted using a QIAamp Circulating Nucleic Acid Kit (Qiagen), and was quantified (ng cfDNA/mL) using a DS-11 FX Spectrophotometer (DeNovix). Pathway focused profiling of somatic mutation status was performed using QBiomarker Somatic Mutation PCR Arrays for human brain cancers (Qiagen) through real time PCR (Roche).
Result
Somatic mutations in human brain cancer were evaluated in the following genes; BRAF, CTNNB1/beta-catenin, EGFR, IDH1, IDH2, KRAS, NF2, NRAS, PIK3CA, and PTEN. A total of 14 (70%) patients had greater than 1 somatic mutation detected in their plasma cfDNA.
Conclusion
We postulate that glioma derived circulating tumour DNA occur in plasma, and genomic analysis using cell free DNA may complement current methods of glioma genomic characterisation.
Take-home message
Glioma derived circulating tumour DNA occur in plasma.
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Affiliation(s)
- M Ita
- Cork University Hospital, University College Cork
| | - Y Nolan
- Cork University Hospital, University College Cork
| | - A Toulouse
- Cork University Hospital, University College Cork
| | - JH Wang
- Cork University Hospital, University College Cork
| | - CH Lim
- Cork University Hospital, University College Cork
| | | | - GF Kaar
- Cork University Hospital, University College Cork
| | - HP Redmond
- Cork University Hospital, University College Cork
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15
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Lim CH, Hyun SH, Cho YS, Choi JY, Lee KH. Prognostic significance of bone marrow 2-[ 18F]-fluoro-2-deoxy-d-glucose uptake in diffuse large B-cell lymphoma: relation to iliac crest biopsy results. Clin Radiol 2021; 76:550.e19-550.e28. [PMID: 33762136 DOI: 10.1016/j.crad.2021.02.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 02/11/2021] [Indexed: 11/24/2022]
Abstract
AIM To investigate the prognostic significance of bone marrow (BM) 2-[18F]-fluoro-2-deoxy-d-glucose (FDG) uptake in relation to posterior iliac crest BM biopsy (BMB) results in diffuse large B-cell lymphoma (DLBCL). MATERIALS AND METHODS Pretreatment integrated positron-emission tomography(PET)/computed tomography (CT) images of 512 DLBCL patients who underwent BMB and received rituximab combined with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy were analysed retrospectively. BM uptake was assessed visually and by maximum standard uptake value (SUVmax). Associations with lymphoma-specific survival (LSS) were assessed using Kaplan-Meier and Cox regression analyses. RESULTS FDG(+) BM was observed in 64 cases (41 focal, 12 heterogeneous, 11 diffuse). This finding distinguished iliac crest involvement (positive in 59 and negative in 453) with 89.6% accuracy (459/512) and 93.6% specificity (424/453). In BMB(+) patients, BM-to-liver SUVmax ratio >1.8 concurred perfectly with FDG(+) BM. During 52 months of follow-up, there were 156 lymphoma-related deaths. In the entire population, multivariate analysis revealed high International Prognostic Index (IPI; p<0.001), old age (p=0.003), bulky disease (p=0.011), BMB(+) (p=0.028), and FDG(+) BM (p=0.019) as independent predictors of worse LSS. In the BMB(+) subgroup, high National Comprehensive Cancer Network-revised IPI (NCCN-IPI; p=0.029) and FDG(+) BM (p=0.008) were significant independent predictors. Among BMB(+) patients with low to low-intermediate NCCN-IPI, FDG(+) BM was associated with significantly worse 2-year LSS (33.3% versus 100%; p=0.017). The same was true among those with high-intermediate NCCN-IPI (34.7% versus 76.9%.; p=0.026). CONCLUSION Increased BM FDG in DLBCL is a predictor of worse LSS independent of BMB results and other prognostic variables including IPI/NCCN-IPI.
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Affiliation(s)
- C H Lim
- Department of Nuclear Medicine, Soonchunhyang University Hospital, Seoul, South Korea
| | - S H Hyun
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, South Korea
| | - Y S Cho
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, South Korea
| | - J Y Choi
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, South Korea
| | - K-H Lee
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, South Korea.
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Ng BH, Tan YS, Pavitratha P, A Hing C, Zainul NH, Lim CH. Angiosarcoma - a rare fatal cause of recurrent pericardial effusions. Med J Malaysia 2020; 75:759-761. [PMID: 33219196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A 40-year-old man presented to the Hospital Sultanah Bahiyah, Alor Setar, Kedah, with constitutional and respiratory symptoms. Physical examination and echocardiogram demonstrated massive pericardial effusion. Patient required multiple attempts of pericardiocentesis due to recurrent pericardial effusion. Initial workup including pericardial fluids examination and computed tomography imaging did not reveal any apparent cause. Magnetic resonance imaging showed a suspicious mass infiltrating into the right atrium. Autoimmune screening was negative. Patient was subsequently treated as having tuberculous pericarditis. However, his disease progressed rapidly and he eventually passed away due to right atrial rupture. Postmortem revealed a ruptured right atrial tumour leading to massive haemothorax. Histopathological examination confirmed the diagnosis of primary pericardial angiosarcoma.
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Affiliation(s)
- B H Ng
- Hospital Raja Permaisuri Bainun, Department of Internal Medicine, Ipoh, Perak Darul Ridzuan, Malaysiaa.
| | - Y S Tan
- Hospital Sultanah Bahiyah, Department of Internal Medicine, Alor Setar, Kedah Darul Aman, Malaysia
| | - P Pavitratha
- Hospital Sultanah Bahiyah, Department of Pathology, Alor Setar, Kedah Darul Aman, Malaysia
| | - C A Hing
- Hospital Sultanah Bahiyah, Department of Internal Medicine, Alor Setar, Kedah Darul Aman, Malaysia
| | - N H Zainul
- Hospital Sultanah Bahiyah, Department of Internal Medicine, Alor Setar, Kedah Darul Aman, Malaysia
| | - C H Lim
- Hospital Sultanah Bahiyah, Department of Internal Medicine, Alor Setar, Kedah Darul Aman, Malaysia
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17
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Huh H, Park SH, Yu JH, Hong J, Lee MJ, Cho JE, Lim CH, Lee HW, Kim JB, Yang KS, Yoon SZ. Quantifying the depth of anesthesia based on brain activity signal modeling. Medicine (Baltimore) 2020; 99:e18441. [PMID: 32000357 PMCID: PMC7004717 DOI: 10.1097/md.0000000000018441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Various methods of assessing the depth of anesthesia (DoA) and reducing intraoperative awareness during general anesthesia have been extensively studied in anesthesiology. However, most of the DoA monitors do not include brain activity signal modeling. Here, we propose a new algorithm termed the cortical activity index (CAI) based on the brain activity signals. In this study, we enrolled 32 patients who underwent laparoscopic cholecystectomy. Raw electroencephalography (EEG) signals were acquired at a sampling rate of 128 Hz using BIS-VISTA with standard bispectral index (BIS) sensors. All data were stored on a computer for further analysis. The similarities and difference among spectral entropy, the BIS, and CAI were analyzed. Pearson correlation coefficient between the BIS and CAI was 0.825. The result of fitting the semiparametric regression models is the method CAI estimate (-0.00995; P = .0341). It is the estimated difference in the mean of the dependent variable between method BIS and CAI. The CAI algorithm, a simple and intuitive algorithm based on brain activity signal modeling, suggests an intrinsic relationship between the DoA and the EEG waveform. We suggest that the CAI algorithm might be used to quantify the DoA.
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Affiliation(s)
- Hyub Huh
- Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine
| | - Sang-Hyun Park
- Medical Device Innovation Center, Korea University Medical Center
| | - Joon Ho Yu
- Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine
| | - Jisu Hong
- Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine
| | - Mee Ju Lee
- Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine
| | - Jang Eun Cho
- Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine
| | - Choon Hak Lim
- Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine
| | - Hye Won Lee
- Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine
| | - Jun Beom Kim
- KM Fundamental Research Division, Korea Institute of Oriental Medicine, Daejeon
| | - Kyung-Sook Yang
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seung Zhoo Yoon
- Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine
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18
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Lee S, Kim WJ, Jeon Y, Lim CH, Sun K. Specification of Subject Sex in Oncology-Related Animal Studies. Acute Crit Care 2018; 33:178-184. [PMID: 31723882 PMCID: PMC6786696 DOI: 10.4266/acc.2017.00444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 12/12/2017] [Accepted: 04/30/2018] [Indexed: 11/30/2022] Open
Abstract
Background Growing evidence for clinically significant differences between the sexes has attracted the attention of researchers. However, failures to report a test animal sex and balance the sex ratios of study samples remain widespread in preclinical investigations. We analyzed the sex-reporting rate and sex distributions of test animals in published oncology studies. Methods We selected five oncology journals included in the Scientific Citation Index (SCI) based on impact factors. We identified preclinical investigations with in vivo mouse experiments published in 2015 for inclusion in our study sample. We classified each article by whether or not it reported test subject sex, and by which sex was included. We also recorded whether there were justifications for using one particular sex in single-sex studies (e.g., anatomical reasons) and whether sex-based analyses were conducted for both-sex studies. Results We surveyed a total of 382 articles. Half (50.3%) failed to report test animal sex. Among articles that did report sex, 91.7% were single-sex studies, of which 69.4% did not provide any justifications for using the sex included in the study. Relatively few studies 15.7 studies included animals of both sexes, and only 2.3 studies conducted sex-based analyses. These findings are consistent with those of previous research that used other methods to collect data from the literature such as text mining, but our analysis of the provision of justifications for using one sex versus the other is a novel feature. Conclusions Many researchers overlook test subject sex as a factor, but test animal sex should be reported in all preclinical investigations to enhance the reproducibility of research and avoid faulty conclusions drawn from one-sided studies.
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Affiliation(s)
- Sukyo Lee
- Korea University College of Medicine, Seoul, Korea
| | - Won Jun Kim
- Korea University College of Medicine, Seoul, Korea
| | - Yeong Jeon
- Korea University College of Medicine, Seoul, Korea
| | - Choon Hak Lim
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Kyung Sun
- Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Seoul, Korea.,Osong Medical Innovation Foundation, Cheongju, Korea
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19
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Choi YJ, Huh H, Bae GE, Ko EJ, Choi SU, Park SH, Lim CH, Shin HW, Lee HW, Yoon SZ. Effect of varying external pneumatic pressure on hemolysis and red blood cell elongation index in fresh and aged blood: Randomized laboratory research. Medicine (Baltimore) 2018; 97:e11460. [PMID: 29995802 PMCID: PMC6076149 DOI: 10.1097/md.0000000000011460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND External applied pneumatic pressure is usually used for rapid transfusion of red blood cells (RBCs). However, increased shear stress can cause increased hemolysis and decreased RBC elongation indices. Therefore, the purpose of this study was to measure the degree of hemolysis and the alteration of RBC elongation indices under varying external pressure in fresh and aged blood. METHODS Venous blood samples were obtained from 20 healthy human volunteers. Each blood bag was divided into 2 subgroups (5 or 35 days of storage), and 5 levels of pressure were applied: 0, 150, 200, 250, and 300 mmHg. After infusion, a laboratory study was conducted. The percentages of irreversibly changed cells were evaluated using Bessis classification. RBC elongation indices were measured using a microfluidic ektacytometer. RESULTS There were no significant differences in the percentage of irreversibly changed RBCs between the pressures of 0 and 300 mmHg. Moreover, there were no significant differences in laboratory test results or elongation indices among all levels of pressure. Irreversibly changed RBCs and hemolysis were increased depending on the storage period. CONCLUSION Irreversible changes in RBCs did not occur as a result of external pressure. The hemolysis and elongation indices of fresh RBCs were not influenced by external pneumatic pressure up to 300 mmHg. Only the storage period affected the irreversible changes in RBCs and hemolysis. Therefore, the application of external pressure to RBCs in variously aged blood is likely to be a safe procedure.
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Affiliation(s)
- Yoon Ji Choi
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Gyeongsangnam-do
| | - Hyub Huh
- Department of Anesthesiology and Pain Medicine, College of Medicine, Korea University
| | - Go Eun Bae
- Maypure Clinic, Uijeongbu-si, Gyeonggi-do
| | - Eun Ji Ko
- Department of Anesthesiology and Pain Medicine, College of Medicine, Korea University
| | - Sung-uk Choi
- Department of Anesthesiology and Pain Medicine, College of Medicine, Korea University
| | - Sang-Hyun Park
- Biomedical Center, Korea University Medical Center, Seoul, Republic of Korea
| | - Choon Hak Lim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Korea University
| | - Hye Won Shin
- Department of Anesthesiology and Pain Medicine, College of Medicine, Korea University
| | - Hye-won Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, Korea University
| | - Seung Zhoo Yoon
- Department of Anesthesiology and Pain Medicine, College of Medicine, Korea University
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20
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Koh KH, Park MK, Choi SU, Huh H, Yoon SZ, Lim CH. Dantrolene treatment in a patient with uncontrolled hyperthemia after general anesthesia: a case report of suspected malignant hyperthermia - A case report -. Anesth Pain Med (Seoul) 2018. [DOI: 10.17085/apm.2018.13.2.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Kyung Hee Koh
- Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Min Kyung Park
- Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sung Uk Choi
- Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hyub Huh
- Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seung Zhoo Yoon
- Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Choon Hak Lim
- Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, Seoul, Korea
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21
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Huh H, Jung JS, Park SJ, Park MK, Lim CH, Yoon SZ. Successful early application of extracorporeal membrane oxygenation to support cardiopulmonary resuscitation for a patient suffering from severe malignant hyperthermia and cardiac arrest: a case report. Korean J Anesthesiol 2017; 70:345-349. [PMID: 28580087 PMCID: PMC5453898 DOI: 10.4097/kjae.2017.70.3.345] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 12/08/2016] [Accepted: 12/12/2016] [Indexed: 12/12/2022] Open
Abstract
Malignant hyperthermia (MH) may lead to metabolic crisis of skeletal muscle in susceptible individuals following exposure to triggering agents such as volatile anesthetics or depolarizing muscle relaxants. MH is a rare and a potentially lethal disease, which can lead to cardiac arrest. We report a case of severe MH, in which the rapidly evolving signs of hypermetabolism eventually resulted in cardiac arrest. Despite conventional treatments following cardiopulmonary resuscitation, the patient's vital signs did not improve. Therefore, we applied extracorporeal membrane oxygenation for providing hemodynamic support.
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Affiliation(s)
- Hyub Huh
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jae Seung Jung
- Department of Thoracic and Cardiovascular Surgery, Korea University College of Medicine, Seoul, Korea
| | - Sang Jae Park
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Korea
| | - Min Kyung Park
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Korea
| | - Choon Hak Lim
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Korea
| | - Seung Zhoo Yoon
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Korea
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22
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Lim CH, Benjamin NHS, Kan FK. Upper gastrointestinal haemorrhage in severe dengue: To scope or not to scope? Med J Malaysia 2017; 72:55-57. [PMID: 28255142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Upper gastrointestinal haemorrhage (UGIH) in severe dengue represents a clinical dilemma in term of management. The recommended treatment in dengue with UGIH involves blood product transfusion support and proton pump inhibitor (PPI) infusion. Despite being the mainstay of treatment in non-dengue UGIH, the role of endoscopic haemostatic intervention in severe dengue remains controversial. In the present report, we present a case of severe dengue complicated with upper gastrointestinal haemorrhage successfully underwent early therapeutic endoscopic intervention in a district hospital.
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Affiliation(s)
- C H Lim
- Hospital Segamat, Department of Surgery, KM 6, Jalan Genuang, 85000 Segamat, Johor, Malaysia.
| | | | - F K Kan
- Hospital Sultanah Aminah, Medical Department, Infectious Disease Unit, Johor Bahru, Johor, Malaysia
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Jang J, Lim HH, Bae G, Choi SU, Lim CH. Operation room management in Korea: results of a survey. Korean J Anesthesiol 2016; 69:487-491. [PMID: 27703630 PMCID: PMC5047985 DOI: 10.4097/kjae.2016.69.5.487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 05/24/2016] [Accepted: 05/24/2016] [Indexed: 11/16/2022] Open
Abstract
Background The current state of general hospital operation room (OR) in Korea and how these ORs are being operated remain unclear. Therefore, the aim of this study was to investigate and assess the current state of OR management and surgical scheduling in general hospitals of Korea. Methods A total of 92 anesthesiology training hospitals and 2 equivalent hospitals in Korea were targeted for the survey. Anesthesiologists in hospitals received questionnaires for OR, anesthetic managements and surgical scheduling directly or by phone from the beginning of October 2015 to the end of December 2015. Results Of the 94 hospitals that were targeted, 59 hospitals (62.7%) responded to the survey. Of the 59 hospitals, 40 (67.8%) had 500–1,000 beds, 36 (61.0%) had 11–20 ORs. Most OR arrangements were made by residents and specialists in Anesthesiology Department (90%). Most hospitals (47.4%) in the response set performed total surgeries in the range of 10,000 to 20,000 annually. The proportion of emergency surgeries in the total surgeries was 2.8–55.0%. Methods for predicting expected surgery time were arbitrarily decided by surgeons (61%), anesthesiologist's experience (20%), or by analyzing historical data using software (5%). Conclusions This survey study could trigger active operational researches for OR efficiency. It might help hospital policy makers manage OR resources more efficiently.
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Affiliation(s)
- Joonchul Jang
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hyong Hwan Lim
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Goeun Bae
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sung Uk Choi
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Choon Hak Lim
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
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Myung J, Park SJ, Lim J, Kim YH, Shin S, Lim CH. Effects of lipopolysaccharide on changes in red blood cells in a mice endotoxemia model. Clin Hemorheol Microcirc 2016; 63:305-312. [DOI: 10.3233/ch-152017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jeihak Myung
- Department of Medicine, School of Medicine, Korea University, Seoul, Korea
| | - Seol Ju Park
- Department of Anaesthesiology and Pain Medicine, Korea University, Korea
| | - Jaekwan Lim
- Korea Artificial Organ Center, Korea University, Seoul, Korea
| | - Yun Hee Kim
- Department of Anaesthesiology and Pain Medicine, Korea University, Korea
| | - Sehyun Shin
- School of Mechanical Engineering, Korea University, Seoul, Korea
| | - Choon Hak Lim
- Department of Anaesthesiology and Pain Medicine, Korea University, Korea
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Choi SU, Lim CH, Lee HW, Lee SH, Sun K, Lim HJ, Yoon SM, Chang SH. Thoracic Epidural Clonidine Attenuates Haemodynamic Responses Induced by Endobronchial Intubation. J Int Med Res 2016; 34:565-72. [PMID: 17294988 DOI: 10.1177/147323000603400601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Laryngoscopy and endobronchial intubation usually cause transient hypertension and tachycardia. We investigated whether thoracic epidurally injected 3 μg/kg clonidine attenuates cardiovascular responses to intubation compared with 2 μg/kg fentanyl and 1 mg/kg lidocaine. Epidural catheterization was performed at the T6–T7 or T7–T8 intervertebral space, and saline or clonidine in saline was injected 20 min before anaesthetic induction. Anaesthesia was induced using 5 mg/kg thiopental sodium and 0.1 mg/kg vecuronium. Laryngoscopy and endobronchial intubation were performed 2 min later. Mean blood pressure and heart rate were measured throughout anaesthetic induction. In the control group and the fentanyl group, mean blood pressure and heart rate 3 min after endobronchial intubation were elevated significantly compared with baseline. In the clonidine group, however, mean blood pressure and heart rate did not increase compared with baseline. The control group had higher mean blood pressure and heart rate than the clonidine group 3 min after endobronchial intubation. Thoracic epidural clonidine may attenuate the haemodynamic response to endobronchial intubation.
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Affiliation(s)
- S U Choi
- Department of Anaesthesiology and Pain Medicine, Korea University Medical Center, Sungbuk-gu, Seoul, South Korea
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26
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Ahn CB, Kang YJ, Kim MG, Yang S, Lim CH, Son HS, Kim JS, Lee SY, Son KH, Sun K. The Effect of Pulsatile Versus Nonpulsatile Blood Flow on Viscoelasticity and Red Blood Cell Aggregation in Extracorporeal Circulation. Korean J Thorac Cardiovasc Surg 2016; 49:145-50. [PMID: 27298790 PMCID: PMC4900855 DOI: 10.5090/kjtcs.2016.49.3.145] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 09/23/2015] [Accepted: 09/30/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Extracorporeal circulation (ECC) can induce alterations in blood viscoelasticity and cause red blood cell (RBC) aggregation. In this study, the authors evaluated the effects of pump flow pulsatility on blood viscoelasticity and RBC aggregation. METHODS Mongrel dogs were randomly assigned to two groups: a nonpulsatile pump group (n=6) or a pulsatile pump group (n=6). After ECC was started at a pump flow rate of 80 mL/kg/min, cardiac fibrillation was induced. Blood sampling was performed before and at 1, 2, and 3 hours after ECC commencement. To eliminate bias induced by hematocrit and plasma, all blood samples were adjusted to a hematocrit of 45% using baseline plasma. Blood viscoelasticity, plasma viscosity, hematocrit, arterial blood gas analysis, central venous O2 saturation, and lactate were measured. RESULTS The blood viscosity and aggregation index decreased abruptly 1 hour after ECC and then remained low during ECC in both groups, but blood elasticity did not change during ECC. Blood viscosity, blood elasticity, plasma viscosity, and the aggregation index were not significantly different in the groups at any time. Hematocrit decreased abruptly 1 hour after ECC in both groups due to dilution by the priming solution used. CONCLUSION After ECC, blood viscoelasticity and RBC aggregation were not different in the pulsatile and nonpulsatile groups in the adult dog model. Furthermore, pulsatile flow did not have a more harmful effect on blood viscoelasticity or RBC aggregation than nonpulsatile flow.
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Affiliation(s)
- Chi Bum Ahn
- Department of Molecular Medicine, Gachon University Graduate School of Medicine
| | - Yang Jun Kang
- Department of Mechatronics, Gwangju Institute of Science and Technology
| | - Myoung Gon Kim
- Department of Mechatronics, Gwangju Institute of Science and Technology
| | - Sung Yang
- Department of Mechatronics, Gwangju Institute of Science and Technology
| | - Choon Hak Lim
- Department of Anesthesiology and Pain Medicine, Korea University Medical Center
| | - Ho Sung Son
- Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center
| | - Ji Sung Kim
- Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine
| | - So Young Lee
- Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine
| | - Kuk Hui Son
- Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine
| | - Kyung Sun
- Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center
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Shin HW, Kim DH, Yoo HS, Lee DK, Yoo YD, Lim CH. Changes in cuff pressure and position of cylindrical-cuff and tapered-cuff tracheal tubes during laparoscopic abdominal surgery. J Int Med Res 2015; 43:544-54. [DOI: 10.1177/0300060515581670] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 03/20/2015] [Indexed: 11/16/2022] Open
Abstract
Objectives To evaluate changes in cuff pressure and position of tapered-cuff and cylindrical-cuff tracheal tubes (TTs) during laparoscopic cholecystectomy; to compare the frequency of endobronchial intubation and airway complaints with the two types of TT. Methods Patients were randomly assigned to intubation with a TT with a cylindrical cuff (group C) or a tapered cuff (group T). Anaesthesia was maintained with sevoflurane, O2 and N2O after intubation. TT cuffs were inflated to 20 cm H2O; changes in cuff pressure and volume were measured up to 30 min after the start of N2O use. Distance between the TT tip and the carina was measured before and after pneumoperitoneum and position change. Frequency of sore throat, dysphagia and hoarseness in the two groups was recorded. Results Cuff volume and pressure were significantly lower in group T than in group C ( n = 32 per group). Cuff pressure and volume significantly increased 30 min after start of N2O use in both groups. Distance from the TT tip to the carina decreased during surgery in both groups. There were no cases of endobronchial intubation, and there were no between-group differences in the frequency of airway complaints. Conclusions The tapered cuff was associated with a smaller change in cuff pressure during laparoscopic cholecystectomy than the cylindrical cuff, and therefore may be associated with increased preservation of tracheal mucosal perfusion.
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Affiliation(s)
- Hye Won Shin
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Dong Hwan Kim
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Hae Seun Yoo
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Dong Kyu Lee
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Young Dong Yoo
- Department of Surgery, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Choon Hak Lim
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
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28
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Cheng ML, Ling DY, Nanu P KP, Nording H, Lim CH. Factors influencing late stage of breast cancer at presentation in a district Hospital - Segamat Hospital, Johor. Med J Malaysia 2015; 70:148-152. [PMID: 26248776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION In Malaysia, late stage presentation of breast cancer (stage III or IV) has been a healthcare problem that varies geographically throughout the country. This study aims to understand the factors influencing late stage of breast cancer at presentation among Malaysian women in Segamat Hospital, Johor, which is a district hospital. METHODS A retrospective descriptive study was conducted on secondary data of all newly diagnosed breast cancer women from 1st August 2011 to 28th February 2014. Secondary data includes age, ethnicity, marital status, family history, education level, occupation, presenting symptom, duration of symptom, tumour size, tumour pathology, tumour grading, oestrogen, progesterone and HER-2 receptor status were collected and analysed using SPSS version 20.0.0. RESULT In total, data from 52 women was analysed and two women were excluded for incompleteness as these women defaulted. Late stage at presentation was 59.6% of all new cases (17.3% stage III and 42.3% stage IV). The commonest age group of all women diagnosed with breast cancer was in the 5th decade. Majority of them were Malay, married and housewives with no family history of breast cancer. The statistically significant factors associated with late stage at presentation include Malay ethnicity (p=0.019), presenting symptoms other than breast lump (p=0.047), and duration of breast lump more than 3 months (p=0.009). DISCUSSION/CONCLUSION The study demonstrated presentation at late stage of breast cancer is a major health concern among Malaysian women in district hospital. This may be attributed to different sociocultural beliefs, strong belief in complementary and alternative medicine, lack of awareness, and difficult accessibility to healthcare services.
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Affiliation(s)
- M L Cheng
- Hospital Segamat, Department of Surgery, KM 6, Jalan Genuang, 85000 Segamat, Johor, Malaysia.
| | - D Y Ling
- Hospital Segamat, Department of Surgery, KM 6, Jalan Genuang, 85000 Segamat, Johor, Malaysia
| | - K P Nanu P
- Hospital Segamat, Department of Surgery, KM 6, Jalan Genuang, 85000 Segamat, Johor, Malaysia
| | - H Nording
- Hospital Segamat, Department of Surgery, KM 6, Jalan Genuang, 85000 Segamat, Johor, Malaysia
| | - C H Lim
- Hospital Segamat, Department of Surgery, KM 6, Jalan Genuang, 85000 Segamat, Johor, Malaysia
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Nam MJ, Lim CH, Kim HJ, Kim YH, Choi H, Son HS, Lim HJ, Sun K. A Meta-Analysis of Renal Function After Adult Cardiac Surgery With Pulsatile Perfusion. Artif Organs 2015; 39:788-94. [PMID: 25865900 DOI: 10.1111/aor.12452] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The aim of this meta-analysis was to determine whether pulsatile perfusion during cardiac surgery has a lesser effect on renal dysfunction than nonpulsatile perfusion after cardiac surgery in randomized controlled trials. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were used to identify available articles published before April 25, 2014. Meta-analysis was conducted to determine the effects of pulsatile perfusion on postoperative renal functions, as determined by creatinine clearance (CrCl), serum creatinine (Cr), urinary neutrophil gelatinase-associated lipocalin (NGAL), and the incidences of acute renal insufficiency (ARI) and acute renal failure (ARF). Nine studies involving 674 patients that received pulsatile perfusion and 698 patients that received nonpulsatile perfusion during cardiopulmonary bypass (CPB) were considered in the meta-analysis. Stratified analysis was performed according to effective pulsatility or unclear pulsatility of the pulsatile perfusion method in the presence of heterogeneity. NGAL levels were not significantly different between the pulsatile and nonpulsatile groups. However, patients in the pulsatile group had a significantly higher CrCl and lower Cr levels when the analysis was restricted to studies on effective pulsatile flow (P < 0.00001, respectively). The incidence of ARI was significantly lower in the pulsatile group (P < 0.00001), but incidences of ARF were similar. In conclusion, the meta-analysis suggests that the use of pulsatile flow during CPB results in better postoperative renal function.
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Affiliation(s)
- Myung Ji Nam
- School of Medicine, Korea University, Seoul, Korea
| | - Choon Hak Lim
- Anesthesiology and Pain Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Hyun-Jung Kim
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Yong Hwi Kim
- Anesthesiology and Pain Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Hyuk Choi
- Department of Medical Science, Graduate School of Medicine, Korea University, Seoul, Korea
| | - Ho Sung Son
- Thoracic and Cardiovascular Surgery, Korea University, Seoul, Korea
| | - Hae Ja Lim
- Anesthesiology and Pain Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Kyung Sun
- Thoracic and Cardiovascular Surgery, Korea University, Seoul, Korea
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Baeg MK, Park JM, Ko SH, Min GJ, Lee KJ, Yang JH, Lim CH, Kim SW, Choi MG. Seizures due to hyponatremia following polyethylene glycol preparation; a report of two cases. Endoscopy 2014; 45 Suppl 2 UCTN:E269-70. [PMID: 24008460 DOI: 10.1055/s-0033-1344568] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- M K Baeg
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Soh J, Shin HW, Choi SU, Lim CH, Lee HW. Easy airway management using the i-gel™ supraglottic airway in a patient with Treacher Collins syndrome. Korean J Anesthesiol 2014; 67:S17-8. [PMID: 25598889 PMCID: PMC4295963 DOI: 10.4097/kjae.2014.67.s.s17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Jungsub Soh
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hye Won Shin
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sung Uk Choi
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Korea
| | - Choon Hak Lim
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hye Won Lee
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Korea
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Park HN, Chung BH, Pyun JE, Lee KC, Choung JT, Lim CH, Yoo Y. Idiopathic acute eosinophilic pneumonia in a 14-month-old girl. Korean J Pediatr 2013; 56:37-41. [PMID: 23390444 PMCID: PMC3564029 DOI: 10.3345/kjp.2013.56.1.37] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 04/23/2012] [Accepted: 07/09/2012] [Indexed: 11/28/2022]
Abstract
Idiopathic acute eosinophilic pneumonia (IAEP), characterized by acute febrile respiratory failure associated with diffuse radiographic infiltrates and pulmonary eosinophilia, is rarely reported in children. Diagnosis is based on an association of characteristic features including acute respiratory failure with fever, bilateral infiltrates on the chest X-ray, severe hypoxemia and bronchoalveolar lavage fluid >25% eosinophils or a predominant eosinophilic infiltrate in lung biopsies in the absence of any identifiable etiology. We present a 14-month-old girl who was admitted to our pediatric intensive care unit because of acute respiratory distress. She had a fever, dry cough, and progressive dyspnea for 1 day. Chest X-ray showed multifocal consolidations, increased interstitial markings, parenchymal emphysema and pneumothorax. IAEP was confirmed by marked pulmonary infiltrates of eosinophils in the lung biopsy specimen. Most known causes of acute eosinophilic pneumonia, such as exposure to causative drugs, toxins, second-hand smoking and infections were excluded. Her symptoms were resolved quickly after corticosteroid therapy.
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Affiliation(s)
- Ha Neul Park
- Department of Pediatrics, Korea University Anam Hospital, Seoul, Korea
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Chung HG, Myung SA, Son HS, Kim YH, Namgung J, Cho ML, Choi H, Lim CH. In vitro effect of clinical propofol concentrations on platelet aggregation. Artif Organs 2012; 37:E51-5. [PMID: 23145919 DOI: 10.1111/j.1525-1594.2012.01553.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The inhibitory effect of propofol on platelet aggregation remains unclear, and studies on the subject disagree. Furthermore, although propofol infusions are widely used for general anesthesia and as sedatives for patients in intensive care units, little information is available on its concentration- and time-related effects on platelet aggregation. Here, the authors investigated the in vitro effect of propofol, at concentrations required for sedation and general anesthesia, on platelet aggregation after 1, 2, or 3 h. Blood from healthy volunteers (n = 9) was incubated at propofol plasma concentrations of 0, 2, 4, and 10 μg/mL in a water bath at 37°C. Platelet aggregation was measured using a platelet function analyzer (PFA-100) after 1, 2, or 3 h of incubation. Times to occlude collagen/epinephrine (CEPI) or collagen/adenosine 5'-diphosphate (CADP)-coated membranes (closure times, CTs) were measured. The CEPI and CADP CTs of non-incubated blood were 125.6 ± 19.5 s and 93.0 ± 12.2 s, respectively, and no significant difference in CEPI CTs was observed at propofol plasma concentrations of 0, 2, 4, and 10 μg/mL after incubation for 1, 2, or 3 h. CADP CTs were comparable at propofol concentrations of 0, 2, 4, and 10 μg/mL at each incubation time. These findings suggest that propofol at concentrations required for sedation and general anesthesia has no inhibitory effect on platelet aggregation after 3 h of incubation.
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Affiliation(s)
- Hye Gyo Chung
- Department of Medicine, School of Medicine, Korea University, Seoul, Korea
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Kim YH, Chung HG, Myung SA, Rha JH, Yang S, Nam MH, Shin SH, Lim CH. In vitro effect of clinical propofol concentrations on red blood cell aggregation and deformability. Clin Hemorheol Microcirc 2012; 51:287-92. [PMID: 22387482 DOI: 10.3233/ch-2012-1535] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This in vitro study investigated time-related effects of propofol at the plasma concentrations required for sedation and general anaesthesia, on RBC aggregation, deformability, and morphology. Blood containing propofol at plasma concentrations of 0, 2 and 4 μg ml-1 was incubated in a water bath at 37°C for 1, 2, or 4 hours. RBC elongation indices (EIs) and aggregation indices (AIs), which represent RBC deformability and aggregation, respectively, were measured. Also, RBC morphological indices (MIs), which represent RBC morphology, were calculated. EIs and AIs were similar at propofol concentrations of 0, 2, or 4 μg ml-1 after 1, 2, or 4 hours of incubation. MIs at propofol plasma concentrations 0 or 2 μg ml-1 were similar after 1, 2, and 4 hours of incubation, however, MI at a propofol concentration of 4 μg ml-1 after 4 hours of incubation was higher than its value after 1 or 2 hours of incubation. No significant difference was observed between MIs at propofol plasma concentrations 0, 2, or 4 μg ml-1 after 1, 2, and 4 hours of incubation. At clinical doses, propofol has no direct effects on RBC deformability, aggregation, or morphology over a 4 hours incubation period.
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Affiliation(s)
- Yun Hee Kim
- Department of Anaesthesiology and Pain Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
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Lim CH, Tassone C, Liu XC, Thometz JG, Lyon R. Correlation of idiopathic scoliosis assessments between newly developed Milwaukee Topographic Scanner and Quantec. Stud Health Technol Inform 2012; 176:255-258. [PMID: 22744503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The Milwaukee Topographic Scanner (MTS) is a newly developed system, which utilizes laser technology to obtain three-dimensional topographic evaluation of the spine. The goal of this study was to determine the correlation of topographic measurements between MTS and Quantec Spinal Imaging System. Twelve parameters generated by the MTS and Quantec Spinal Imaging System was compared to each other using the Pearson Coefficient. Twenty patients between the ages 16-18 with scoliosis were evaluated with the MTS and Quantec. There were several parameters, which showed high correlations especially back height (0.972), coronal curve (0.952), and left trunk volume (0.905). MTS is a reliable three-dimensional topographic alternative to radiographs without the exposure to radiation.
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Affiliation(s)
- C H Lim
- Department of Orthopaedic Surgery, Children's Hospital of Wisconsin, Milwaukee, WI, USA
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Chung BH, Nam HK, Rhie YJ, Lee KC, Choung JT, Lim CH, Yoo Y. Pneumocystis jiroveciPneumonia in a 5-month-old Boy with Agammaglobulinemia - A Case Report -. Korean J Crit Care Med 2012. [DOI: 10.4266/kjccm.2012.27.4.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Bo Hyun Chung
- Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea
| | - Hyo-Kyoung Nam
- Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea
| | - Young Jun Rhie
- Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea
| | - Kwang Chul Lee
- Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea
| | - Ji Tae Choung
- Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea
| | - Choon Hak Lim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Young Yoo
- Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea
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Ch'ng JK, Soon JL, Lim CH. Paradoxical emboli from left superior vena cava causing recurrent brain abscess. Singapore Med J 2012; 53:e21-e23. [PMID: 22252194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Persistent left superior vena cava is a rare but well-recognised condition. We describe a case of persistent left superior vena cava draining directly into the left atrium, with a fixed anatomical right-to-left shunt and paradoxical embolic events causing recurrent brain abscess. Surgical ligation was curative.
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Affiliation(s)
- J K Ch'ng
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, 17 Third Hospital Avenue, Singapore.
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Shin HJ, Ahn JH, Jung HI, Lim CH, Shin HW, Lee HW, Lim HJ, Yoon SM, Chang SH. Feasibility of ultrasound-guided posterior approach for interscalene catheter placement during arthroscopic shoulder surgery. Korean J Anesthesiol 2011; 61:475-81. [PMID: 22220224 PMCID: PMC3249569 DOI: 10.4097/kjae.2011.61.6.475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 01/12/2011] [Accepted: 01/19/2011] [Indexed: 11/22/2022] Open
Abstract
Background Continuous interscalene block has been known to improve postoperative analgesia after arthroscopic shoulder surgery. This was a prospective study investigating the ultrasound-guided posterior approach for placement of an interscalene catheter, clinical efficacy and complications after placement of the catheter. Methods Forty-two patients undergoing elective arthroscopic shoulder surgery were included in this study and an interscalene catheter was inserted under the guidance of ultrasound with posterior approach. With the inplane approach, the 17 G Tuohy needle was advanced until the tip was placed between the C5 and C6 nerve roots. After a bolus injection of 20 ml of 0.2% ropivacaine, a catheter was threaded and secured. A continuous infusion of ropivacaine 0.2% 4 ml/hr with patient-controlled 5 ml boluses every hour was used over 2 days. Difficulties in placement of the catheter, clinical efficacy of analgesia and complications were recorded. All patients were monitored for 48 hours and examined by the surgeon for complications within 2 weeks of hospital discharge. Results Easy placement of the catheter was achieved in 100% of the patients and the success rate of catheter placement during the 48 hr period was 92.9%. Postoperative analgesia was effective in 88.1% of the patients in the post anesthetic care unit. The major complications included nausea (7.1%), vomiting (4.8%), dyspnea (4.8%) and unintended vascular punctures (2.4%). Other complications such as neurologic deficits and local infection around the puncture site did not occur. Conclusions The ultrasound-guided interscalene block with a posterior approach is associated with a success high rate in placement of the interscalene catheter and a low rate of complications. However, the small sample size limits us to draw definite conclusions. Therefore, a well-designed randomized controlled trial is required to confirm our preliminary study.
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Affiliation(s)
- Hyeon Ju Shin
- Department of Anesthesiology and Pain Medicine, College of Medicine, Korea University, Seoul, Korea
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Lee SY, Lim CH, Pasupathy S, Poopalalingam R, Tham KW, Ganguly S, Wai CHD, Wong WK. Laparoscopic sleeve gastrectomy: a novel procedure for weight loss. Singapore Med J 2011; 52:794-800. [PMID: 22173248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Morbid obesity is associated with increased morbidity and mortality. Bariatric surgery offers morbidly obese individuals substantial and sustainable weight loss and reduction in obesity-related comorbidities. Laparoscopic sleeve gastrectomy (LSG) is a new restrictive procedure in bariatric surgery. We aimed to evaluate our experience with LSG with regard to its safety and feasibility and early weight loss. METHODS The surgical outcome, complications and early clinical results of all patients who underwent LSG at Singapore General Hospital were studied. RESULTS 30 patients underwent LSG between December 2008 and October 2010. The mean preoperative weight of the patients was 113.4 (range 91.0-170.0) kg, while the mean body mass index (BMI) was 42.6 (range 33.0-60.0) kg/m². Diabetes mellitus was present in 39 percent of the patients, hypertension in 43 percent, hyperlipidaemia in 35 percent, obstructive sleep apnoea in 30 percent and osteoarthritis in 22 percent. The majority of patients had two or more obesity-related comorbidities (52 percent). Mean operative time was 142 (range 80-220) minutes and median duration of postoperative stay was three days. At two weeks, one, three and six months post operation, the mean BMI was 38.6 kg/m², 37.8 kg/m², 34.5 kg/m² and 30.8 kg/m², the mean percentage of excess weight loss was 17.7 percent, 23.3 percent, 40.9 percent and 56.7 percent, and absolute weight loss was 8.00 kg, 11.52 kg, 18.77 kg and 26.85 kg, respectively. CONCLUSION LSG is a promising procedure for surgical treatment of obesity, with good early weight loss and low morbidity.
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Affiliation(s)
- S Y Lee
- Department of General Surgery, Singapore General Hospital, Outram Road, Singapore 169608
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Kim YH, Namkung J, Lim BG, Min SH, Shin HW, Lim CH. Pleural effusion after microtia reconstructive surgery -A case report-. Korean J Anesthesiol 2011; 61:166-8. [PMID: 21927690 PMCID: PMC3167139 DOI: 10.4097/kjae.2011.61.2.166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Revised: 02/15/2011] [Accepted: 02/16/2011] [Indexed: 11/24/2022] Open
Abstract
Microtia reconstructive surgery is usually a multi-stage repair procedure that involves the use of cartilage and skin grafts. Complications can arise at both ear reconstruction sites and cartilage donor sites. In particular, pneumothorax, atelectasis, chest scars, and chest deformities are known to be associated with the harvesting of costal cartilage. However, delayed pleural effusion can also develop. Our patient complained of a cough and chest pain at 5 days postoperatively, and pleural effusion was detected by chest radiography. However, thoracentesis was not performed and the effusion resolved spontaneously and completely.
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Affiliation(s)
- Yun Hee Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Korea University, Seoul, Korea
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Choi H, Lee HM, Nam KW, Choi J, Lee JJ, Kim HC, Song SJ, Ahn CB, Son HS, Lim CH, Son KH, Park YD, Jeong GS, Sun K. A durability study of a paracorporeal pulsatile electro-mechanical pneumatic biventricular assist device. Artif Organs 2011; 35:614-24. [PMID: 21535444 DOI: 10.1111/j.1525-1594.2010.01187.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In 2002, the paracorporeal pulsatile electro-mechanical pneumatic ventricular assist device (VAD) began to be developed by the Korea Artificial Organ Center at Korea University under a Health & Medical Technology Research and Development program which finished in 2008. In vitro durability testing was conducted on the paracorporeal pulsatile pneumatic VAD to determine device durability and to evaluate device failures. The 1- and 2-year reliability of the paracorporeal pulsatile pneumatic VAD was shown to be 91.2% and 54.9%, respectively, with an 80% confidence level. Failure modes were analyzed using fault tree analysis, with customized software continuously acquiring data during the test period. After this period, 21 in vivo animal tests were done, with 14 cases of left atrium to left ventricle (LV) inflow cannulation (36Fr)/outflow grafting to descending aorta, and seven cases of apex cannulation of LV to descending aorta (12 mm). The longest postoperative day (182 days) in Korea was recently recorded in in vivo animal testing (bovine, 90 kg, male, 3.5-4.0 L/min flow rate, and 55 bpm).
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Affiliation(s)
- Hyuk Choi
- Department of Biomedical Engineering, College of Medicine, Korea University, Seoul, Korea
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Paik CN, Choi MG, Lim CH, Park JM, Chung WC, Lee KM, Jun KH, Song KY, Jeon HM, Chin HM, Park CH, Chung IS. The role of small intestinal bacterial overgrowth in postgastrectomy patients. Neurogastroenterol Motil 2011. [PMID: 21324050 DOI: 10.1111/j.1365-2982.2011.01686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Small intestinal bacterial overgrowth (SIBO) is expected in postgastrectomy patients; however, its role has not been clarified. This study was to estimate the prevalence of SIBO and investigate the clinical role of SIBO in postgastrectomy patients. METHODS This prospective study involved 76 patients who underwent gastrectomy for early gastric cancer with no evidence of recurrence. An H(2)-CH(4) breath test with oral glucose challenge test was performed to diagnose SIBO and dumping syndrome. Sigstad dumping questionnaires, serum glucose, hematocrit and pulse rate were simultaneously monitored for every 30 min for 3 hours. KEY RESULTS There were significant differences in SIBO between the postgastrectomy patients and controls (77.6%vs 6.7%, P < 0.01). Abdominal fullness or borborygmus during oral glucose load were more common in SIBO-positive than in negative patients (50.8%vs 17.6%, P = 0.03), and were the independent factors for predicting SIBO in postgastrectomy patients (P = 0.02). The prevalences of dumping syndrome and hypoglycemia after oral glucose were 35 (46.1%) and 19 (25.0%), and were not different between both groups. However, the plasma glucose was significantly lower in SIBO-positive than in SIBO-negative patients at 120 and 150 min after oral glucose load (P < 0.05). No significant differences were observed in pulse rate and hematocrit in both groups. CONCLUSIONS & INFERENCES SIBO is common among postgastrectomy patients. It appears to be associated with postprandial intestinal symptoms and might aggravate late hypoglycemia. SIBO could be a new therapeutic target for managing intestinal symptoms in postgastrectomy patients.
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Affiliation(s)
- C N Paik
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
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Paik CN, Choi MG, Lim CH, Park JM, Chung WC, Lee KM, Jun KH, Song KY, Jeon HM, Chin HM, Park CH, Chung IS. The role of small intestinal bacterial overgrowth in postgastrectomy patients. Neurogastroenterol Motil 2011; 23:e191-6. [PMID: 21324050 DOI: 10.1111/j.1365-2982.2011.01686.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Small intestinal bacterial overgrowth (SIBO) is expected in postgastrectomy patients; however, its role has not been clarified. This study was to estimate the prevalence of SIBO and investigate the clinical role of SIBO in postgastrectomy patients. METHODS This prospective study involved 76 patients who underwent gastrectomy for early gastric cancer with no evidence of recurrence. An H(2)-CH(4) breath test with oral glucose challenge test was performed to diagnose SIBO and dumping syndrome. Sigstad dumping questionnaires, serum glucose, hematocrit and pulse rate were simultaneously monitored for every 30 min for 3 hours. KEY RESULTS There were significant differences in SIBO between the postgastrectomy patients and controls (77.6%vs 6.7%, P < 0.01). Abdominal fullness or borborygmus during oral glucose load were more common in SIBO-positive than in negative patients (50.8%vs 17.6%, P = 0.03), and were the independent factors for predicting SIBO in postgastrectomy patients (P = 0.02). The prevalences of dumping syndrome and hypoglycemia after oral glucose were 35 (46.1%) and 19 (25.0%), and were not different between both groups. However, the plasma glucose was significantly lower in SIBO-positive than in SIBO-negative patients at 120 and 150 min after oral glucose load (P < 0.05). No significant differences were observed in pulse rate and hematocrit in both groups. CONCLUSIONS & INFERENCES SIBO is common among postgastrectomy patients. It appears to be associated with postprandial intestinal symptoms and might aggravate late hypoglycemia. SIBO could be a new therapeutic target for managing intestinal symptoms in postgastrectomy patients.
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Affiliation(s)
- C N Paik
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
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Ahn JH, Lim CH, Chung HI, Choi SU, Youn SZ, Lim HJ. Postoperative renal function in patients is unaltered after robotic-assisted radical prostatectomy. Korean J Anesthesiol 2011; 60:192-7. [PMID: 21490821 PMCID: PMC3071483 DOI: 10.4097/kjae.2011.60.3.192] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Revised: 10/08/2010] [Accepted: 10/12/2010] [Indexed: 11/18/2022] Open
Abstract
Background Pneumoperitoneum with an intra-abdominal pressure (IAP) of 14 mmHg is known to decrease renal function. Robotic-assisted radical prostatectomy (RARP) requires an IAP of more than 15 mmHg for operation. Therefore, we retrospectively investigated whether patients who underwent RARP experienced renal insufficiency during the postoperative period (at postoperative days 7 and 30). Methods One hundred patients who underwent RARP were enrolled in this study. Preoperative serum blood urea nitrogen (BUN) and serum creatinine (Cr) levels were measured. Creatinine clearance (CrCl) was calculated using the Cockcroft and Gault formula. CrCl was calculated at 1 day before surgery (baseline), 2 hr postoperatively, and at 1, 3, 7, and 30 days postoperatively (POD 1, POD 3, POP 7, and POD 30). Patients were assigned to abnormal CrCl (n = 52) or normal CrCl groups (n = 48) on the basis of these measurements. Results Significant inter-group differences in BUN, Cr, and CrCl were observed at all postoperative time points. BUN and Cr decreased significantly at postoperative 2 hr and POD 1, 3, and 7 versus baseline in both groups, whereas CrCl increased significantly at postoperative 2 hr and POD 1, 3, and 7 versus baseline in both groups. However, BUN, Cr, and CrCl were similar at POD 30 and preoperatively in the two groups. Conclusions RAPR, which requires an IAP of 15-20 mmHg for more than 4 hr, does not induce renal dysfunction during the postoperative period, and even in those patients with an abnormal CrCl.
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Affiliation(s)
- Jae Hyun Ahn
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Korea
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Yoon JR, Jeon Y, Yoo Y, Shin HJ, Ahn JH, Lim CH. The analgesic effect of remifentanil on prevention of withdrawal response associated with the injection of rocuronium in children: no evidence for a peripheral action. J Int Med Res 2011; 38:1795-800. [PMID: 21309495 DOI: 10.1177/147323001003800526] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Remifentanil pre-treatment has been reported to decrease the incidence of rocuronium injection-associated withdrawal movement. This study was designed to explore the site of action of remifentanil for reducing withdrawal response during rocuronium injection in children. Ninety-six paediatric patients were randomly assigned to three groups. After induction of anaesthesia with 5 mg/kg 2.5% thiopental sodium, 2 ml saline (placebo group) or 0.5 microg/kg remifentanil (group R), was injected intravenously 1 min before 0.6 mg/kg rocuronium. In a third group (group R'), the venous retention of 0.5 microg/kg remifentanil was maintained for 30 s followed by tourniquet release and injection of 0.6 mg/kg rocuronium. Withdrawal response was graded using a four-point scale. The incidence of withdrawal movement after rocuronium administration was 94%, 22% and 81% in the placebo, R, and R' groups, respectively. This study demonstrated that the pre-treatment effect of remifentanil for reducing rocuronium-associated withdrawal response occurs mainly through a central action.
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Affiliation(s)
- J R Yoon
- Department of Anaesthesiology and Pain Medicine, St. Mary's Hospital, The Catholic University of Korea, Bucheon, Republic of Korea
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Marriott AJ, Hwang NC, Lai FO, Tan CK, Tan YM, Lim CH, Boey SK, Tay SM, Cheow PC, Lim YP, Chan T, Loh K, Kwok B, Chung A, Sivathasan C. Combined heart-liver transplantation with extended cardiopulmonary bypass. Singapore Med J 2011; 52:e48-e51. [PMID: 21451915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We report a case of combined heart and liver transplantation for familial amyloid polyneuropathy. This is the first such combined transplant performed in Asia, and differs from previously described cases, in that cardiopulmonary bypass was continued at partial flow during liver transplantation in our case. This was done in order to provide haemodynamic support to the cardiac graft and to protect it from the impending reperfusion insult that frequently accompanies liver transplantation. The utility of this management course is discussed, along with its actual and potential complications. We also describe the impact of a lung-protective ventilation strategy employed during cardiac transplantation.
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Affiliation(s)
- A J Marriott
- Department of Anaesthesiology, Singapore General Hospital, Outram Road, Singapore 169608
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Kim JY, Lim CH, Go WH, Lee KH, Kim JW. Distal oesophageal stricture after transoesophageal echocardiography in a cardiac surgical patient. Eur J Echocardiogr 2010; 11:889-91. [PMID: 20562114 DOI: 10.1093/ejechocard/jeq080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Transoesophageal echocardiography (TEE) is an important tool for diagnosis and monitoring during anaesthesia in cardiac operation. TEE is generally considered a safe and minimally invasive technique. However, adverse events may occur during probe insertion or manipulation. We report a case of delayed distal oesophageal stricture with an associated scarring probably due to TEE during a cardiac operation. The patient, a 75-year-old female, underwent coronary artery bypass graft, mitral valve replacement, and tricuspid valve annuloplasty. Seven days after surgery, the patient complained of dysphagia without haemoptysis and drop of haematocrit. At 24 days after surgery, severe stricture of distal oesophagus with scarring was observed by oesophagography and stent insertion was done.
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Affiliation(s)
- Ji Yeon Kim
- Department of Anesthesiology and Pain Medicine, Ilsan Paik Hospital, Inje University, Goyang, South Korea
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Abstract
BACKGROUND Hemorheologic factors such as red blood cell (RBC) aggregation and deformability differ according to species. In many comparative hemorheologic studies, only venous blood samples have been used for measurements. There is little published information comparing arterial and venous blood differences between species. We compared hemorheologic factors in arterial and venous blood in rats, dogs and humans. METHODS Nineteen dogs and 12 rats were used. Human blood was obtained from 12 healthy volunteers. Blood gas analysis, hematocrit and elongation index which represents RBC deformability were measured in arterial and venous blood samples. The critical shear stress and aggregation index, both of which represent RBC aggregation, were also measured in arterial and venous blood. RESULTS There were no arterial or venous differences in hematocrit, critical shear stress, or elongation index in dogs. In rats, RBC aggregation was not measurable. The hematocrit and elongation index of arterial blood were significantly lower than those of venous blood in rats. There were no arterial or venous differences in hematocrit, aggregation index, or elongation index in humans. CONCLUSION Arterial and venous hemorheologic factors differed depending on the species. Further standardization is necessary for the measurement of hemorheologic variables.
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Affiliation(s)
- Kuk Hui Son
- Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center, Seoul, Korea
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Kang YJ, Kim MG, Son KH, Lim CH, Son HS, Yoon SY, Kwon HS, Yang S. Experimental Investigation of Pulsatility Effect on the Deformability and Hemolysis of Blood Cells. Artif Organs 2010; 34:E103-9. [DOI: 10.1111/j.1525-1594.2009.00974.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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