PURPOSE: To report a case of abducens nerve palsy after a percutaneous nerve blocking procedure for trigeminal neuralgia. CASE SUMMARY: A 35-year-old female complaining of stabbing pain in the right maxillary area 4 months in duration was diagnosed with trigeminal neuralgia at a pain clinic. The patient underwent a percutaneous trigeminal nerve blocking procedure using alcohol at the right maxillary nerve. After the procedure, the patient was referred to an ophthalmologic service for horizontal diplopia and abduction defect of her right eye. Her corrected visual acuity, intraocular pressure, pupillary response, anterior segment and fundus were normal bilaterally. The patient had right esotropia of 38 prism diopters in primary gaze (70 prism diopters in right gaze, 20 prism diopters in left gaze) with limited abduction of -3 in the right eye. She was diagnosed with abducens nerve palsy of the right eye. Three months after initial presentation, the patient had intermittent esotropia of 4 prism diopters at right gaze and orthophoria at the other diagnostic gazes; she presented no diplopia. CONCLUSIONS: In the present case study, abducens nerve palsy following a percutaneous trigeminal nerve blocking procedure resolved over 3 months. Because the abducens nerve is adjacent to the trigeminal nerve near the foramen ovale based on anatomical structure, when performing a percutaneous trigeminal blocking procedure, the surgeon should be aware that deep needle puncture could cause abducens nerve palsy.
Abducens Nerve ; Abducens Nerve Diseases ; Diplopia ; Esotropia ; Eye ; Female ; Foramen Ovale ; Humans ; Intraocular Pressure ; Maxillary Nerve ; Needles ; Nerve Block ; Pain Clinics ; Punctures ; Trigeminal Nerve ; Trigeminal Neuralgia ; Visual Acuity

BACKGROUND: An automatic alarm system was developed was developed for unexpected vital sign instability in admitted patients to reduce staffing needs and costs related to rapid response teams. This was a pilot study of the automatic alarm system, the medical emergency system (MES), and the aim of this study was to determine the effectiveness of the MES before expanding this system to all departments. METHODS: This retrospective, observational study compared the performance of patients admitted to the pulmonary department at a single center using patient data from three 3-month periods (before implementation of the MES, December 2013–February 2014; after implementation of the MES, December 2014–February 2015 and December 2015–February 2016). RESULTS: A total of 571 patients were admitted to the pulmonary department during the three observation periods. During this pilot study, the MES automatically issued 568 alarms for 415 admitted patients. There was no significant difference in the rate of cardiopulmonary resuscitation (CPR) before and after application of the MES. The mortality rate also did not change. However, it appeared that CPR was prevented in four patients admitted from the general ward to the intensive care unit (ICU) during MES implementation. The median length of hospital stay and median length of ICU stay were not significantly different before and after MES implementation. CONCLUSIONS: Although we did not find a significant improvement in outcomes upon MES implementation, the CPR rate and mortality rate did not increase despite increased comorbidities. This was a small pilot study and, based on these results, we believe that the MES may have significant effects in longer-term and larger-scale studies.
Cardiopulmonary Resuscitation ; Clinical Alarms ; Comorbidity ; Critical Care ; Emergencies* ; Humans ; Intensive Care Units ; Internal Medicine ; Korea* ; Length of Stay ; Monitoring, Physiologic ; Mortality ; Observational Study ; Patients' Rooms ; Pilot Projects* ; Retrospective Studies ; Vital Signs

This study is to find out changes in medical practice at a university hospital before and after covering intraocular lens (IOL) from the health insurance benefit. The coverage started on March 1, 1993 and a total of 596 cases who were discharged from July 1 to December 31, 1992 and 580 cases who were discharged from July 1 to December 31, 1993 were analyzed. Since the standard reimbursement scheme was changed from March 1, 1993, the charges for 1992 were transformed into 1993 scheme. Major findings are as follows: Average length of stay was statistically significantly decreased from 8.24 days in 1992 to 6 86 days in 1993. Charges except IOL has been statistically significantly decreased from 501,000 won in 1992 to 444,000 won in 1993. Charges for drugs and injection have been reduced. However, charge per day for them was not much different. This is due to decrease in length of stay. Charges for laboratory tests and radiologic examination were quite the same. charges which are not covered by the insurance remained the same. The revenue of the hospital was reduced as expected. However, the hospital reduced the length of stay and increase the turnover rate in order to compensate the potential loss of revenue due to the difference of reimbursement between the out-of-pocket expense and the insurance coverage. By introducing the IOL benefit in the insurance, the insured pays less, hospital generates more revenue through shortening the hospital stay, and the total medical care cost becomes less nationwidely.
Health Care Costs ; Insurance ; Insurance Coverage ; Insurance, Health* ; Length of Stay ; Lenses, Intraocular*

The variations of the occipital sinus were studied in 50 Korean adult cadavers. The morphology of the sinus was classified into 5 types accordingo to its number and the connection with the marginal sinus. These results were compared with the data of the occipital sinus of bones (Sir and Chung, 1907). And the opening of the occipital sinus in the confluens sinuum was observed. 1. A single small occipital sinus was found in 40%. Single occiital sinus with two large marginal sinuses was observed in 8%. The single sinus with a left marginal sinus (6%) and with a right marginal sinus(4%) were present. Double occipital sinuses were observed in 10% of the cadavers. No occipital sinus was discernible in 32%. 2. There were 39 openings of the occipital sinus including the double sinuses. The occipital sinuses communicated with the confluence sinuum in 35 cases (89.7%), with the straight sinus in 5.1% and with the right or left transverse sinus in 1 case, respectively. The openings in the confluens sinuum were found on the left side(51.3%), on the right side (10.3%) and in the center(28.2%). 3. The diameters of the occipital sinus were variable according to the connection with the sigmoid sinus. 4. The difference was found between the data of the morphological types of the occipital sinus that were studied in cadavers and in dry bones.
Adult* ; Cadaver ; Colon, Sigmoid ; Humans

No abstract available.

No abstract available.
Asbestos*

PURPOSE: The purpose of this study was to develop a Critical Pathway for Uterine Artery Embolization patients. METHOD: There were 6 steps that were taken. Step 1 was selecting a diagnosis, and Step 2 was organizing a development team consisting of 7 experts. Step 3 analyzed the medical records, and Step 4 drew up a preliminary Critical Pathway. Step 5 tested the clinical validity of the preliminary Critical Pathway, and Step 6 developed the final Critical Pathway. RESULT: The contents of the medical practices observed in the medical records were investigated in seven areas: monitoring/assessment, treatment, medication, diet, activity, consults, and education/discharge plan; and a total of 73 items was identified. The validity of the 73 items was examined by a group of specialists. 68 items were adopted, 4 items revised, 1 item removed, and 1 item was added. Using the results, a preliminary Critical Pathway was drawn up. According to the results from examining the clinical validity of the preliminary Critical Pathway with five patients for five weeks, 3 items which showed discrepancy were revised and another 3 items were added. Then, the final Critical Pathway was completed. CONCLUSION: This Critical Pathway needs to be clinically applied and continuously to measure its effects in terms of the length of stay, cost?effectiveness, and the patients' and staffs' satisfaction.
Critical Pathways* ; Diagnosis ; Diet ; Humans ; Length of Stay ; Medical Records ; Specialization ; Uterine Artery Embolization* ; Uterine Artery*

No abstract available.

PURPOSE: This study was designed to determine the outcome and safety of intravenous gamma-globulin(IVGG) retreatment in Kawasaki disease. METHODS: A clinical observation of the therapeutic effects, laboratory findings and echocardiograms was carried out on 72 patients with Kawasaki disease in Kosin University Hospital from 1991 to 1999. 27 patients were treated with 1g/kg/day IVGG for 2 days, 45 patients were treated with 2 g/kg for 10hours. The clinical indication for retreatment was fever. Persistent fever was defined as a temperature> or =38.3degrees C persisting beyond 48hrs after the completion of the infusion. Recrudescent fever was defined as a temperature> or =38.3degrees C for 48hrs after the completion of the infusion, followed by a temperature< or =38.3degrees C. Treatment failure was defined as the development of new coronary artery abnormalities after IVCG treatment in a child with normal baseline echocardiogram. RESULTS: The 5 patients(6.94%) were retreated with IVC.G. Two were retreated due to persistent fever and three due to recrudescent fever. Among retreated patients, one was retreated with 1 g/kg and the others with 2g/kg. Nobody had serious complications, and there was no significantly different clinical charicteristics except for CRP between one course IVGG infusion and retreatment group(P=0.003). Treatment failure was not found in either gr<>up. CONCLUSION: We concluded that the IVGG retreatment of Kwasaki disease may improve the clinical course and coronary artery outcome.
Child ; Coronary Vessels ; Fever ; gamma-Globulins* ; Humans ; Mucocutaneous Lymph Node Syndrome* ; Retreatment* ; Treatment Failure

BACKGROUND: Although normal vascular endothelium prevents adhesion and aggregation of platelets by the release of nitric oxide (NO) and prostacyclin, circulating blood cells, such as polymorphonuclear leukocytes (PMNs) and mononuclear leukocytes (ML) may be considered to be also important in modulating platelet aggregation. Recently, nitric oxide synthase (NOS) activity was found in PMNs and ML, so these cells can also release NO to inhibit platelet aggregation. We studied platelet-ML interactions using an experimental model in which isolated ML were placed in the aggregometer in contact with human platelets, stimulated by collagen. METHODS: Platelet count in platelet-rich plasma (PRP) was adjusted to approximately 300x109/L. ML were separated using Ficoll-Hypaque (specific gravity 1.077) and finally resuspended at 1, 3 and 5x109/L, in Tyrode albumin buffer (TAB), respectively. Platelet aggregation was measured with Chrono-Log Aggregometer (USA) after adding variable numbers of the ML, stimulating with 2.5, 5 and 10 microgram/mL of collagen. Mechanisms of ML to inhibit the platelet aggregation were evaluated after incubating the ML with 10 micrometer indomethacin and 300 micrometer NG-monomethyl-L-arginine (L-NMMA). RESULTS: Non-stimulated ML (3x109/L) inhibited (43.2 +/- 19.6 versus TAB control 69.2 +/- 10.7% transmission) the platelet aggregation induced by 2.5 microgram/mL of collagen. The inhibition was not attenuated by increasing the concentration of collagen from 5.0 microgram/ mL (50.1 +/- 18.0% versus TAB control 75.5 +/- 13.1%, P<0.001) to 10 microgram/mL (62.9 +/- 17.3% versus TAB contol 82.3 +/- 12.6%, P<0.01). In addition, it was dependent on the number of ML and incubation time. While preincubation of the ML with indomethcin did not affect the antiaggregating capacity of the ML (63.4 +/- 11.1 versus TAB control 73.3 +/- 7.3%), preincubation of the ML with L-NMMA slightly inhibit the antiaggregating capacity of the ML (86.6 +/- 6.8 versus TAB control 73.3 +/- 7.3%). CONCLUSION: These findings suggest that blood ML inhibited the collagen-induced platelet aggregation, of which mechanism appears to be only partly dependent on NO and to be independent on prostaglandins. Release of other substances affecting platelet aggregation from ML requires to be clarified. Using our experimental model, it has been demonstrated that cell-cell contact may facilitate the exchange of a wide array of mediators between platelets and ML which may influence the cellular responses. This experimental model thus allows to study interactions between platelets and ML.
Blood Cells ; Blood Platelets* ; Collagen ; Endothelium, Vascular ; Epoprostenol ; Gravitation ; Humans ; Indomethacin ; Leukocytes, Mononuclear* ; Models, Theoretical ; Neutrophils ; Nitric Oxide ; Nitric Oxide Synthase ; omega-N-Methylarginine ; Platelet Aggregation* ; Platelet Count ; Platelet-Rich Plasma ; Prostaglandins