Successful Anesthetic Management of Myotonic Dystrophy Type I Using Sugammadex: A Case Report

Myotonic dystrophy (DM) is an uncommon inherited disease. Anesthesia for DM patients is tough due to its potency of cardiogenic and pulmonary problems, but a series of studies have shown how to manage and avoid complications and situations. We describe a case of a 33-year-old male patient who was scheduled for an elective excision & biopsy on the left axillae for hidradenitis suppurativa with DM type I. Anesthesia was induced and maintained with propofol, remifentanil, and rocuronium. Sugammadex is used as a reversal agent of neuromuscular blockade. He didn’t show myotonia during surgery and emergence. He also didn’t show postoperative pulmonary complications.

Anesthetic Management for Spine Surgery in a Patient with Left Internal Carotid Artery Occlusion and Penetrating Aortic Ulcer: A Case Report

A key challenge of anesthesia is to provide patients with safe and optimized anesthetic management to improve prognosis and minimize mortality and morbidity. To this end, the anesthesiologist should comprehensively understand the patient’s physical status through pre-anesthetic assessment and carefully monitor the patient during surgery. Several types of novel patient-monitoring devices may be useful to achieve this purpose. We report a case of anesthetic management in a patient with left internal carotid artery occlusion and penetrating aortic ulcer.

Clinical Outcomes of Operative Repair for Patients Who Fail to Conserve the Complete Rupture of the Collateral Ligament in the Proximal Interphalangeal Joint

Objective: The purpose of this study was to compare the preoperative and postoperative outcomes of surgical treatment for patients who fail to conserve the complete rupture of the collateral ligament in the proximal interphalangeal (PIP) joint.Methods: A complete rupture of the collateral ligament was confirmed by a radiologist using ultrasound or magnetic resonance imaging for patients who had symptoms after 4 weeks of conservative treatment. Eleven patients underwent operative collateral ligament repair using an anchor. All patient was followed up for at least 6 months postoperatively. We evaluated clinical outcomes preoperatively and at 6 months follow-up: (1) range of motion of the PIP, (2) joint stability, (3) Visual Analog Scale score, (4) fusiform index of the PIP joint, and (5) functional & cosmetic satisfaction.Results: There was no instability in the lateral stress test at 6-month follow-up. The ranges of motion of the PIP were not statistically different between preoperative and at 6-month follow-up. Patients had less pain but the cosmetic appearance of the PIP joint did not improve. Functional satisfaction differed statistically, but there was no difference in cosmetic satisfaction.Conclusion: Surgical treatment for patients who fail to conserve the complete rupture of the collateral ligament in the PIP joint can provide good joint stability, functional recovery.

Procedural Sedation of Preterm Neonate with Frequent Apnea during Magnetic Resonance Imaging: A Case Report

Magnetic resonance imaging (MRI) is a useful and safe imaging modality for examining preterm infants. However, MRI examination requires careful precautions, and infants and children are likely to require deep sedation or anesthesia to keep them still during the examination. Sedation has various risks and the greatest concern of sedation is cardiorespiratory events. In addition, delicate titration is also necessary for preterm infants because propofol pharmacokinetics is different from those in older children. We successfully completed sedation of a preterm neonate (gestational age, 32+1 weeks; birth weight, 1,970 g) with a history of frequent apnea through careful assessment and continuous monitoring. We want to suggest alternative options for airway management of the high risk of respiratory complications.

Biomedical Ethics for Jehovah’s Witnesses and Patient Blood Management

Jehovah’s Witnesses refuse blood transfusions according to religious beliefs, and for this reason, most hospitals and doctors have refused their treatment. There are more than 100,000 religious people in Korea, but there are few bloodless centers that can receive their treatment. So, the number of Jehovah’s Witnesses patients visiting bloodless centers in Soonchunhyang University Bucheon Hospital has been increasing every year. Despite this situation, no legal or medical countermeasure has yet been proposed against them. Therefore, I would like to take a bioethical approach based on “principles of biomedical ethics” and introduce “patient blood management” which is currently spreading in advanced medical countries.

Analysis of Clinicopathological Features and Risk Factors for Severe Complications after Gastrectomy for Gastric Cancer in Elderly Patients

Objective: As life expectancy is increasing, the number and proportion of elderly patients with gastric cancer are also expanded. This study aimed to investigate the clinicopathological features for elderly gastric cancer patients undergoing gastrectomy and analyze risk factors for developing severe complications.Methods: A total of 514 patients treated surgically for gastric cancer between January 2016 and December 2019 were enrolled in this retrospective study. Patients were divided into two groups: younger group ( ≤ 69 years) and elderly group ( ≥ 70 years). Clinicopathological characteristics and operative outcomes including the complications and mortality were compared between two groups. Risk factors for severe complications in elderly gastric cancer patients were also investigated.Results: Of the 514 patients, 145 (28.2%) were elderly group. Comorbidity (P < 0.001), differentiated histology (P = -0.006), deeper in tumor depth (P = 0.012), and frequent lymph node metastasis (P = 0.028) were observed in elderly group. Overall complications (P = 0.046) and severe complications (P = 0.049) were significantly higher in elderly group. Multivariate analysis indicated that extent of resection (P = 0.044) was associated with severe complications in elderly gastric cancer patients.Conclusion: Elderly patients have a significantly higher probability of complications and severe complications than younger patients after gastrectomy for gastric cancer. Especially, when total gastrectomy was performed in elderly gastric cancer patients, the risk of developing serious complications was significantly higher more than 3 times. Therefore, surgeons should pay attention to gastric cancer patients over the age of 70 who require total gastrectomy.

In-Hospital Cardiac Arrest: Patient Characteristics and Factors Influencing Survival and Neurologic Outcomes

Objective: We aimed to determine the characteristics of in-hospital cardiac arrest (IHCA) patients, as well as the factors influencing survival to discharge and good neurologic outcome.Methods: We examined patients who experienced IHCA from January 1, 2011, to December 31, 2013, in Soonchunhyang University Seoul Hospital. They were divided into a survival group and non-survival group. The patient characteristics, including age, sex, comorbid disease, arrest time, arrest location, witnessed arrest, monitoring, arrest cause, arrest rhythm, and cardiopulmonary resuscitation (CPR) duration, were compared between the groups. Moreover, we assessed the factors associated with survival to discharge and good neurologic outcomes by using multivariate logistic regression analysis.Results: In total, 453 patients of IHCA were observed. The comorbidities in the survival group included neurologic disease (P < 0.001), arrhythmia (P = 0.001), and myocardial infarction (P = 0.032), pneumonia (P = 0.016). Other characteristics included cardiac arrest at daytime (P = 0.032), cardiogenic arrest cause (P = 0.019), and CPR duration < 15 minutes (P < 0.001). The factors associated with survival to discharge included comorbid neurologic disease (odds ratio [OR], 2.191; P = 0.031), arrhythmia (OR, 3.027; P = 0.009), pneumonia (OR, 3.243; P = 0.002), and CPR duration < 15 minutes (OR, 9.638; P < 0.001). The factors influencing good neurologic outcomes included age < 65 years (OR, 3.158; P = 0.007), comorbid disease as arrhythmia (OR, 4.921; P = 0.001), pneumonia (OR, 4.551; P = 0.001), hypotension (OR, 4.264; P = 0.021), and CPR duration < 15 minutes (OR, 6.652; P = 0.001).Conclusion: The factors influencing survival to discharge and good neurologic outcomes among IHCA patients included comorbidities, arrest cause, and CPR duration.

A Case of Transient Neonatal Diabetes Mellitus Attributable to a Nonspecific Mutation in the ABCC8 Gene

Neonatal diabetes mellitus (NDM) is defined as hyperglycemia that persists for more than 2 weeks and requires insulin therapy. NDM principally occurs before 6 months of age. Transient NDM (TNDM) is a clinical form of NDM that persists for a median of 12 weeks and resolves completely by 18 months. However, it may relapse as type 2 DM during early adulthood. The major causes of TNDM are mutations in chromosome 6q24 or the KCNJ11 or ABCC8 genes; the latter encode the two subunits of the pancreatic adenosine triphosphate (ATP)-sensitive potassium channel (KATP-channel). This condition responds well to oral sulfonylurea therapy. Herein, we report a neonate who was small for gestational age and exhibited TNDM symptoms. Genetic analysis revealed a nonspecific mutation in ABCC8; he was successfully treated with oral sulfonylurea.

Regional Anesthesia for Abdominal Surgery in a Patient with Severe Chronic Respiratory Failure: A Case Report

General anesthesia is associated with a risk for postoperative pulmonary complications. The risk is even higher in patients with chronic respiratory failure, and postoperative mortality rates are high. Proper perioperative anesthetic management is important in such patients. Therefore, it is essential to optimize the patient’s physical status before anesthesia and to determine the optimal anesthesia technique based on the pre-anesthesia evaluation of the patient’s pulmonary function. We successfully performed abdominal surgery under spinal anesthesia in a patient with severe chronic respiratory failure.

Eosinophilia in Patients with End Stage Renal Disease Undergoing Hemodialysis

Objective: Eosinophilia in patients on hemodialysis has already been reported. It has been associated with allergy to dialyzers and exaggerated activation of complement during hemodialysis. Its etiology, however, remains unknown. In addition, there are not enough studies on eosinophilia in patients on hemodialysis in Korea. Therefore, we performed this retrospective study to find out the prevalence and possible etiologic factors of blood eosinophilia in patients undergoing hemodialysis.Methods: Between January 2013 to December 2015, the patients hospitalized for hemodialysis at Soonchunhyang University Hospital and National Health Insurance Service Medical Center (Ilsan Hospital) were included in this study. Eosinophilia was defined when absolute eosinophil count was greater than 500/μL, respectively. We retrospectively reviewed the medical records of patients about parasite infection, other malignancies, and history of kidney transplantation.Results: Of the 2,155 patients hospitalized for hemodialysis at two centers, 1,057 patients (49%) were found to have eosinophilia. We investigated 1,199 patients’ information (Soonchunhyang University Hospital) by the medical records. Two hundred two patients (16.8%) had no identifiable and/or possible causes. Only two patients complained of symptoms such as itching. Steroids were administered to control symptoms, and both patients had normal eosinophil levels, and steroids were discontinued. Other patients did not complain of specific symptoms associated with eosinophilia and did not take medication such as steroids. Eosinophilia was improved in 49% of patients without special treatments.Conclusion: We found that the eosinophil counts in patients with end stage renal disease on hemodialysis were frequently elevated. However, in most cases, eosinophilia was not clinically relevant.