A Comparison of Epidural Analgesia using 0.1% Levobupivacaine or 0.2% Levobupivacaine Combined with Sufentanil after Major Abdominal Surgery / 대한마취과학회지

BACKGROUND: Continuous epidural analgesia with an opioid-local anesthetic combination is an effective strategy for postoperative pain relief after abdominal surgery. Levobupivacaine, the pure S (-) enantiomer of racemic bupivacaine, is similar to its native agent for anesthetic efficacy but has less cardiotoxic and neurotoxic potential than the bupivacaine. We compared the efficacy and safety of 0.1% levobupivacaine with sufentanil or 0.2% levobupivacaine with the same dose of suentanil for patient-controlled epidural analgesia after major abdominal surgery. METHODS: Forty patients scheduled for major abdominal surgery under general anesthesia were randomized to receive either 0.1% levobupivacaine with sufentanil 0.75microgram/ml (n = 20) or 0.2% levobupivacaine with sufentanil 0.75microgram/ml (n = 20) for postoperative epidural analgesia using a patient-controlled analgesia pump at a rate of 3 ml/h and bolus dose of 2 ml on demand. Visual analogue scale (VAS) pain scores at rest, on coughing, during mobilization from the supine to the sitting position and on ambulation were assessed during 48 hours following the surgery. In addition, degree of motor block and mobilization, additional analgesic requirements and adverse effects were assessed. RESULTS: There were no significant differences in VAS pain scores at rest, on coughing, during mobilization from the supine to the sitting position and on ambulation. There were no significant differences in mean volume of local anesthetic consumption, additional analgesic requirements, degree of motor block and mobilization and the incidence of adverse effects. CONCLUSIONS: 0.1% levobupivacaine with sufentanil provided comparable postoperative epidural analgesia and incidences of adverse effects to 0.2% levobupivacaine with the same dose of suentanil in patients undergoing major abdominal surgery.

Comparison between Remifentanil and Nicardipine with Esmolol Continuously Infused for Attenuation of Hemodynamic Changes during Total Knee Arthroplasty in Elderly Patient / 대한마취과학회지

BACKGROUND: The use of tourniquet is associated with severe hemodynamic changes, particularly in elderly patients. This study examined the effects of continuously infused remifentanil or nicardipine with esmolol on the attenuation of the hemodynamic changes with enflurane inhalation during total knee arthroplasty in elderly patients. METHODS: Thirty elderly female patients undergoing total knee arthroplasty were enrolled into this randomized, prospective study. Remifentanil (group R) or nicardipine with esmolol (group EN) was infused using a titration method to maintain a mean arterial pressure (MAP) of 90 mmHg to 70 mmHg during tourniquet inflation. In addition, the inhalation of enflurane was adjusted to guarantee a hypnotic state based on entropy. The hemodynamic variables, inhaled concentration of enflurane, recovery time, and postoperative pain characteristics were measured and compared. RESULTS: Following tourniquet inflation, the MAP was increased and maintained in the target since 20 min after that in both group. Following tourniquet deflation the MAP was decreased significantly in both groups and more patients in group R required a vasopressor. Group R inhaled a lower enflurane concentration and showed more rapid recovery than group EN. There were no significant differences in the level of postoperative pain between the two groups. CONCLUSIONS: These results suggest that remifentanil is more likely to be associated with hypotension after tourniquet deflation and require more attention than nicardipine with esmolol.

A Case of Atypical Lipomatous Tumor / 대한피부과학회지

Liposarcoma is the second most common soft tissue sarcoma next to malignant fibrous histiocytoma and occurs almost exclusively in adults. It is thought to originate from primitive mesenchymal cells rather than from mature adipose tissue. Most liposarcomas usually occur in the deep soft tissue of the extremities and the retroperitoneum, and rarely occur in the cutaneous or subcutaneous tissue. We report a case of an atypical lipomatous tumor in a 63-year-old male, who presented with an asymptomatic, subcutaneous mass on his right axilla.

Descriptive Study of Dermatologic Issues Appeared on Television over Seventeen Months (Jan. 2004~May 2005) / 대한피부과학회지

BACKGROUND: Recently, the number of television programs dealing with dermatologic issues has rapidly increased. Since these television programs have great impact on the general public, scientific exactitude of these programs is extremely important. OBJECTIVE: The purpose of this study was to analyze the television programs about dermatologic issues over a 17 months period, form January 2004 to May 2005. METHODS: From all the programs broadcast between January 2004 and May 2005 on the major public and cable television channels such as MBC, KBS, SBS, EBS and MediTV, programs about dermatological issues were selected by internet search and collated. The programs were then categorized and studied by purpose and theme of the programs, running time, and correctness of dermatologic information. RESULTS: The number of programs about dermatologic issues by type were as follows: 80 on news programs (58.0%), 33 on health care programs (23.9%), 19 on daily information programs (13.8%) and 5 on current issues programs (3.6%). Programs dealing with skin cosmetic information were shown most frequently on the television (44 times, 31.9%), followed by those with information about atopic dermatitis (32 times, 28.6%). Of 197 consultants in 138 television programs, dermatologists could account for only 113 (57.4%), and medical specialists of other fields except dermatology as 24 (12.2%). Thirty two percent of dermatology-related television programs were made without the advice of dermatologists. In most cases, information from dermatologists was accurate or reliable (96.5%), however, the information from oriental herbal-medicinal doctors or non-medical specialists was very difficult to check for accuracy. CONCLUSION: Until now, dermatologists have taken the leading role in programs dealing with dermatologic issues. However, the number of unqualified advisors without sufficient dermatologic knowledge in the programs surveyed was found to be surprisingly high. Therefore, we suggest that more dermatologists need to increase their public health role in the mass media.

A Case of Eccrine Porocarcinoma on the Scalp / 대한피부과학회지

Eccrine porocarcinoma is a very rare, locally-aggressive, potentially fatal tumor arising from the intraepidermal ductal portion of the eccrine sweat gland. It develops either spontaneously or from a long standing benign eccrine poroma. It usually affects older people and is located most commonly on the lower extremities. We report a case of eccrine porocarcinoma which developed on the scalp of an 82-year-old woman. There was no evidence of metastasis, and the tumor was successfully removed by Mohs micrographic surgery.

A Statistical Study on Histopathologic Diagnoses of Skin Diseases / 대한피부과학회지

BACKGROUND: Skin biopsy is an effective diagnostic tool commonly used in dermatology practice. Clinicopathologic correlation is important for diagnostic accuracy. OBJECTIVE: The purpose of this study was to investigate the distribution of skin biopsy specimens, and compare the pathologic diagnosis with the final dermatologic diagnosis. METHODS: This study included 4,018 skin biopsy specimens taken during a period of 10 years from June 1995 to May 2005 at the Department of Dermatology, Korea University Anam Hospital. RESULTS & CONCLUSION: Of all biopsy specimens, 61.49% were diagnosed as tumors, and 38.51% were diagnosed as non-tumors. For the tumors, 87.15% were benign, 4.23% were premalignant and 8.62% were malignant. The rate of concordance between pathologic diagnosis and final dermatologic diagnosis was 76.69%, and the rate of discordance between them was 4.18%. The rate of description without a pathologic diagnosis in pathologic reports was 18.94%. The rate of concordance was higher in tumors (89.65%) than in non-tumors (56.00%), and the rate of description in pathologic reports was higher in non-tumors (39.08%) than in tumors (6.32%). There was no significant difference in the rates of discordance between tumors and non-tumors. The rate of concordance was higher in malignant tumors (95.72%) than in benign tumors (89.77%) or premalignant tumors (74.76%). The rate of description in pathologic reports was higher in premalignant tumors (18.45%) than in benign tumors (6.27%) or malignant tumors (0.95%). There was no significant difference in the rates of discordance between the three groups.

A Case of Spitz Nevus on the Ear Helix / 대한피부과학회지

Spitz nevi, benign melanocytic tumors, have some histologic resemblance to malignant melanoma. They usually appear as asymptomatic, solitary, reddish to pinkish, hairless, dome-shaped, round to oval, smooth-surfaced papules or nodules, measuring less than 1.0 cm in diameter. Histologically, these lesions display striking nests of large spindle cells and epithelioid cells, usually extending from the epidermis to the reticular dermis. Here in, we report a case of Spitz nevus on the helix of the right ear of a 23-year-old man which was treated with Er:YAG laser.

Treatment of Keratoacanthoma with 5% Imiquimod Cream

Keratoacanthoma is a rapidly growing tumor that histologically resembles squamous cell carcinoma. Surgical excision is a desirable therapeutic option, but several other treatment modalities are available. We report on two cases of keratoacanthoma that were treated with imiquimod 5% cream. Imiquimod was applied daily for the first 6 or 7 days, and then reduced to alternate days according to the tolerance and erythema severity of the patient. In both patients, the tumors fully regressed after five weeks of treatment.

Entropy Responses to Endotracheal Intubation during Anesthetic Induction Using Thiopental or Propofol and Succinylcholine / 대한마취과학회지

BACKGROUND: Thiopental and propofol are commonly used intravenous induction agents and entropy is a new method of assessing depth of anesthesia. In this study we evaluated the entropy responses to endotracheal intubation during anesthetic induction with thiopental or propofol. METHODS: Forty ASA class I and II adult female patients undergoing elective surgeries were enrolled into this randomized, prospective study. At 1 minute after fentanyl 2 microgram/kg, thiopental 5 mg/kg (group T) or propofol 2 mg/kg (group P) was administered for induction. And endotracheal intubation was performed following succiny choline 1 mg/kg. From pre-induction till post-intubation 10 minutes, the entropy and hemodynamic variables were measured and compared. RESULTS: The entropy following intubation increased significantly in both groups. But entropy changes in group T were greater than those in group P remained below 65. CONCLUSIONS: Our results using the entropy to monitor anesthetic depth during induction and intubation, suggest that thiopental 5 mg/kg is more likely to be associated with lighter planes of anesthesia and consequent risk of arousal reaction following endotracheal intubation than propofol 2 mg/kg.

Three Cases of Lymphangiectatic Pilomatricoma / 대한피부과학회지

Pilomatricoma is a benign adnexal tumor, differentiating towards elements of the hair matrix and shaft. The tumor typically presents as a solitary, deep-seated, firm nodule with overlying normal epidermis. Herein, we report three cases of pilomatricomas with the dermal bullae overlying tumors. Histopathological examination of the lesions showed marked lymphatic dilatations, edema, and attenuated collagen and elastic fibers above the pilomatricomas in the upper dermis. We diagnosed them as lymphangiectatic pilomatricomas.

Three Cases of Lymphangiectatic Pilomatricoma / 대한피부과학회지

Pilomatricoma is a benign adnexal tumor, differentiating towards elements of the hair matrix and shaft. The tumor typically presents as a solitary, deep-seated, firm nodule with overlying normal epidermis. Herein, we report three cases of pilomatricomas with the dermal bullae overlying tumors. Histopathological examination of the lesions showed marked lymphatic dilatations, edema, and attenuated collagen and elastic fibers above the pilomatricomas in the upper dermis. We diagnosed them as lymphangiectatic pilomatricomas.

Three Cases of Basal Cell Carcinoma of the Axilla / 대한피부과학회지

Basal cell carcinoma (BCC) is the most common skin cancer of humans. The incidence of BCC is closely correlated with sun exposure, as well as older age. Because of this, BCCs are frequently found on sun-exposed areas of fair-skinned, older individuals. The axilla is one of the sun-protected sites where BCC rarely develops. We herein report three unusual cases of primary BCC which arose from the axilla.

Comparison of Premixed NaHCO3 and Lidocaine on Rocuronium Injection Pain / 대한마취과학회지

BACKGROUND: Rocuronium administration is associated with a severe burning pain during injection in 50-80% patients. The purpose of this study was to evaluate mixtures of saline, lidocaine, sodium bicarbonate (NaHCO3) and lidocaine-NaHCO3 with rocuronium to reduce injection pain and withdrawal movement. METHODS: One hundred and twenty patients were randomly assigned to one of four groups in a double blinded, prospective study; Group S (0.9% normal saline 5 ml mixed with rocuronium 50 mg/5 ml, n = 30), Group L (2% lidocaine 5 ml mixed with rocuronium 50 mg/5 ml, n = 30), Group B (8.4% NaHCO3 5 ml mixed with rocuronium 50 mg/5 ml, n = 30) and Group LB (4% lidocaine 2.5 ml and 8.4% NaHCO3 2.5 ml mixed with rocuronium 50 mg/5 ml, n = 30). After all patients had received an intubating dose (0.6 mg/kg) of premixed rocuronium over 5 seconds, we investigated the incidence and severity of pain and withdrawal movement. We measured the onset and duration of muscle relaxation using train-of-four (TOF) and the pH values and osmolalities of each mixture. RESULTS: The incidence and severity of pain during injection were significantly reduced in Groups B and LB compared with Group S. The withdrawal movement was observed 8 patients (26.7%) in Group S, but in no patient in Groups B or LB. No significant difference in the incidence of pain or withdrawal response was observed between Groups S and L. CONCLUSIONS: We conclude that premixed NaHCO3 with rocuronium is effective at reducing injection pain and withdrawal movement whereas the addition of lidocaine has little effect.

A Case of Tubular Apocrine Adenoma / 대한피부과학회지

Tubular apocrine adenoma is a well-circumscribed, intradermal benign tumor, with tubular structures showing apocrine differentiation. Histologically, the characteristic features are various-sized dilated tubules with intraluminary papillary projection and apocrine decapitation secretion. It usually presents as a solitary lesion and is sometimes associated with nevus sebaceous and/or syringocystadenoma papilliferum. We have in report a case of tubular apocrine adenoma with epidermal cysts which developed in the right inguinal area of a 37-year-old man.

Two Cases of Congenital Preauricular Fistula / 대한피부과학회지

Preauricular fistula is a congenital malformation that is presented as a small opening on the preauricular region. During embryonic development, six tubercles from the first and second branchial arches form the auricle, and the incomplete fusion of these tubercles results in congenital preauricular fistula. We report two cases of congenital preauricular fistula manifested as soft nodules with external openings on the preauricular area. It is apt to give rise to recurrent inflammation, so total fistulectomy with a curved incision along the crus of the ear helix was performed. Histopathologically, the fistulas were lined with stratified squamous epithelium, and skin adnexa and elastic cartilage were also present.

Reconstruction of Nasal Alar Defect with Transposition of the Island Pedicle Flap / 대한피부과학회지

Transposition of the island pedicle flap is a versatile method of mobilizing tissue from a relatively distant reservoir and moving it across intervening tissue. Advantages are the similar color and texture to those of the affected area, the minimal donor scar, the increased viability with local blood supply, and the potential to camouflage scars into natural skin lines or cosmetic units. In a 73-year-old woman, the lesion of a basal cell carcinoma on her left nasal ala was removed by Mohs micrographic surgery and the resultant defect was reconstructed by transposition of the island pedicle flap. In our case, there were no significant complications and the final result was satisfactory in both functional and cosmetic aspects. Through our experience, we can confirm that transposition of the island pedicle flap is another alternative for the reconstruction of nasal alar defects.