Neuroleptic malignant syndrome is a rare, but potentially life-threatening adverse event associated with the use of neuroleptic agents. We describe the case of a 47-year-old schizophrenic woman who was treated with clozapine for years. The patient developed acute renal failure with pulmonary edema, and underwent mechanical ventilation and hemodialysis.
Acute Kidney Injury ; Antipsychotic Agents ; Clozapine* ; Female ; Humans ; Middle Aged ; Neuroleptic Malignant Syndrome* ; Pulmonary Edema ; Renal Dialysis ; Respiration, Artificial ; Rhabdomyolysis

PURPOSE: This study evaluated the clinical and radiological outcomes of unstable distal clavicular fractures treated with an AO Hook plate. MATERIALS AND METHODS: From March 2009 to October 2010, sixteen patients with distal clavicular fractures underwent open plating using an AO Hook plate. The clinical outcomes were assessed by measuring the UCLA scores and KSS sores, and the radiological outcomes were evaluated using simple radiographs at the final follow-up. RESULTS: Fracture union was obtained in all patients at an average of 13.9 weeks (range, 9~20 weeks). The UCLA scoring system showed excellent results in 9 cases and good results in 7. The average KSS scores of distal clavicular fractures were 95.5. At the final follow-up, subacromial osteolysis developed in 11 cases (68.7%) of whom 3 suffered from pain around the acromion. Other complications occurred in 4 patients: one had a fracture adjacent to the plate proximally, two had a stiff shoulder with subacromial impingement, and one had hypoesthesia around the surgical wound. CONCLUSION: Unstable distal clavicular fractures treated with a Hook plate provided rigid fixation and satisfactory outcomes considering the high union rate. Nevertheless, potential postoperative complications related to morphometric properties of the plate should be considered.
Acromion ; Clavicle ; Follow-Up Studies ; Humans ; Hypesthesia ; Osteolysis ; Postoperative Complications ; Shoulder

BACKGROUND: Stellate ganglion block, which is one of the effective therapeutic tools for treating herpes zoster has been advocated by many investigators. However its efficacy is controversial at present. OBJECTIVE: This study was conducted to examine the role of stellate ganglion block in the prevention of postherpetic neuralgia and relationships between the time of this treatment and the outbreak of postherpetic neuralgia. METHODS: Twenty patients over the age of fifty with herpes zoster were included in this study. Before treatment, we randomly divided patients into two groups, A and B. Group A was treated with stellate ganglion block and acyclovir and group B was treated with acyclovir alone. Also we subdivided each group by starting treatment time into group 1 and 2. Group 1 was defined as the patients who began treatment within 2 weeks of the onset of the skin lesion. We observed the severity of pain and the incidence of postherpetic neuralgia according to each group.
Acyclovir ; Herpes Zoster* ; Humans ; Incidence ; Neuralgia, Postherpetic ; Research Personnel ; Skin ; Stellate Ganglion*

Changes in the number, the immunoreactivities and the ultrastructures of sero- tonin immunoreactive mucosal mast cells[MMCs] in rat gastrointestinal tracts after vagus nerve stimulation were investigated by using light and electron microscopic immunocytochemical methods. The vagus nerves were electrically stimulated with a square wave pulse generator for a duration of 5 minutes each, a total of 8 times at 2 minute intervals. Serotonin immunoreactive cells of the connective tissues of the gastrointestinal tract were mainly located in the lamina propria, and a small number of the cells were also scattered in the submucosa. By using electron microscopic immunocytochemistry and Wright stain, the serotonin immunoreactive cells of the lamina propria and the submucosa were identified to be MMCs. A few large-sized serotonin immunoreactive connective tissue mast cells [CTMCs], showing strong metachromasia with the Wright stain, were located together with the MMCs in the submucosa of the stomach. In most of the gut regions of the control group, the majority of the MMCs did not show any serotonin immunoreactivities and only a few MMCs showed weak serotonin immunoreactivities. After stimulation of the vagus nerves, the number and the immnu- noreactivities of the serotonin immunoreactive MMCs dramatically increased in all gut regions observed, especially in the small intestines. In the samples treated with the electron microscopic immnunocytochemical methods, hardly any serotonin immunoreactivities were detected in the MMCs of the control group. However, the serotonin imrnunoreactivities of the MMCs were significantly increased after vagus nerve stimulation. The serotonin immnunoreactive products were localized, following vagal stimulation, both in the peripheral matrix of the granules and in the cytoplasm. Also, it was confirmed ultrastructurally that the Golgi complexes were expanded in the MMCs of the vagal stimulation group. The above results suggest that vagus nerve stimulation may activate serotonin biosynthesis in MMCs.
Animals ; Connective Tissue ; Cytoplasm ; Gastrointestinal Tract* ; Golgi Apparatus ; Immunohistochemistry ; Intestine, Small ; Mast Cells* ; Mucous Membrane ; Rats* ; Serotonin* ; Stomach ; Vagus Nerve Stimulation* ; Vagus Nerve*

This study was undertaken to investigate the ultrastructure of the neurons, neuroglial cells and capillaries in the area postrema[AP] of the Oriental discolured bat, Vespertilio superans. The AP of the bat was a single midline structure at the most caudal portion of the fourth ventricle. Most neurons in the AP were small cells, but their ultrastructure were similar to the typical neurons located elsewhere in the central nervous system. Astroglial cells and oligodendrocytes were also observed and showed their typical ultrastructure. Ultrastructural features of neurons, astroglial cells and oligodendrocytes were not changed during hibernating cycles. However, microglial cells were only found in the hibernating AP ; these cells were located in the parenchyma and near the blood vessels of the AP. Since the microglial cytoplasm was filled with phagocytotic inclusions, the nuclei of the these cells were eccentrically located. Phagocytotic cytoplasmic inclusions were shown to be composed of a dense irregular peripheral region and the pale round central region. A Large vacant space was often found in the electron lucent central region. Continuous and fenestrated capillaries surrounded by pericytes were found in the bat`s AP. Especially, Phagocytotic inclusions were found in the pericyte cytoplasm of the hibernating AP, and this result supports suggestion that pericytes might be phagocytotic cells. On the basis of the distributions of phagocytotic tells[pericytes and microglial cell], ultrastructure of these cells, morphology of their cytoplasmic inclusions, and the appearance of phagocytotic activity of the pericytes during the hibernating stage when microglial cells were observed, it can be concluded that pericytes may also participates in the formation of rrlicroglial cells. Tanycytes were also found in the bat AP.
Area Postrema* ; Blood Vessels ; Capillaries ; Central Nervous System ; Cytoplasm ; Ependymoglial Cells ; Fourth Ventricle ; Inclusion Bodies ; Microglia ; Neuroglia ; Neurons ; Oligodendroglia ; Pericytes

BACKGROUND: Activated coagulation time (ACT) is commonly used to guide heparin and protamine dosing during cardiovascular surgery. There are many factors that influence the ACT such as time of test, hemodilution, temperature, aprotinin and etc. We considered the other factor that influence the ACT, the route of blood sample. METHODS: This study included 40 patients who were scheduled for cardiac surgery. Whole blood was sampled through arterial and central venous line at 10 minutes after surgical incision and heparin administration. The ACT was measured with Hemochron 801 blood coagulation timer with 12 mg of celite surface activator. RESULTS: At 10 minutes after surgical incision and heparin administration, arterial blood and venous blood ACTs were 127 20, 537 214 seconds and 118 18, 496 145 seconds respectively (p<0.05). CONCLUSIONS: We conclude that the venous blood ACT is more less than arterial blood ACT during cardiovascular surgery.
Aprotinin ; Blood Coagulation ; Diatomaceous Earth ; Heart* ; Hemodilution ; Heparin ; Humans ; Thoracic Surgery*

No abstract available.
Orientia tsutsugamushi* ; Rickettsia* ; Ulsan*

The report on compression neuropathy of the ulnar nerve at the elbow was first submitted by Panas in 1878. Therafter many authors have reported on etiology, pathoanatomy, method of treatment and prognosis of tardy ulnar nerve palsy. But there are some controversies about method of treatment and prognosis. We reviewed 15 patients of tardy ulnar nerve palsy resulted from the fracture of the lateral condyle of the humerus during the growing period. The result obtained are as follows. 1. All 15 patients with tardy ulnar nerve palsy were resulted from non-union of lateral condyle and cubitus valgus deformity. 2. Average carrying angle was 28 degrees. 3. Intial symptoms were pain and paresthesia of the hand in all 15 patients. Eight of them also had atrophy of intrinsic muscle and seven patients had clawing deformity of fingers. 4. Preoperative severity of ulnar neuritis according to Osborne's classification was Grade I; 1 case, Grade lI; 6 case, Grade III; 8 cases. 5. Submuscular transposition of ulnar nerve was performed in 11 and subcutaneous in the other 4 patients. 6. In all patient, pain was markedly improved within a few months after transposition of nerve. Improvement of hypothenar atrophy was obtained in 5 out of 8 and interosseous atropy in 3 out of 7 cases. Clawing was improved in 5 out of 8 cases. 7. Postoperative status of ulnar neuritis by Osborne's criteria was Normal; 1, Grade I; 4, Grade II; 7, Grade III; 3 cases. 8. Postoperative complications were decreased sensation in the medial aspect of forearm in 3 cases and recurrence of nerve compression symptom in 1 csse. 9. Internal neurolysis with anterior transposition of nerve would be recommandable in Grade III severe ulnar neuritis and in case of firm consistency of nerve at the operative field.
Animals ; Atrophy ; Classification ; Congenital Abnormalities ; Elbow ; Fingers ; Forearm ; Hand ; Hoof and Claw ; Humans ; Humerus ; Methods ; Paresthesia ; Postoperative Complications ; Prognosis ; Recurrence ; Sensation ; Ulnar Nerve ; Ulnar Neuropathies

BACKGROUND AND OBJECTIVES: Spontaneous progression of severe congestive heart failure is structurally characterized by cellular degeneration and multiple foci of myocardial cell death. The cardiac troponin I (cTnI), one of the subunits of the troponin regulatory complex, binds to actin and inhibits interaction between actin and myosin. cTnI is uniquely expressed in the adult human myocardium, and an increase in its circulating levels is highly indicative of myocardial injury. In this study, we addressed the usefulness of cTnI as a sensitive and specific molecular marker for severity in patients with congestive heart failure. MethodscTnI, creatinin kinase-MB (CK-MB), and myoglobin were assessed in 59 patients with severe congestive heart failure diagnosed by the echo-cardiography and gated equilibrium blood pool heart scan. Also we assesed cTnI, creatinin kinase-MB (CK-MB), and myoglobin in 25 persons without cardiac disease in echocardiography. RESULTS: 1) The cTnI con-centration was 89.6+/-69.3 pg/mL in patients with congestive heart failure and its level was greater than that of the control group (22.4+/-17.1, p=0.001). 2) The cTnI level differed significantly according to left ventricular ejection fraction (EF), 117.3+/-73.8 pg/mL in patients with EF\<40% (28 patients), 66.3+/-44.5 pg/mL in patients with EF> or =40% (31 patients), 22.4+/-17.1 pg/mL in the control group (25 persons) (p=0.001). CONCLUSION: cTnI was useful as a specific and sensitive serum molecular marker in patients of congestive heart failure. And its level reflected the severity of congestive heart failure.
Actins ; Adult ; Cell Death ; Echocardiography ; Equidae ; Estrogens, Conjugated (USP)* ; Heart ; Heart Diseases ; Heart Failure* ; Humans ; Myocardium ; Myoglobin ; Myosins ; Stroke Volume ; Troponin I* ; Troponin*

Orthostatic headache after suboccipital craniectomy has been rarely reported. A 32-year-old man underwent emergent suboccipital craniectomy due to acute bilateral cerebellar infarctions with massive brain edema. Although his neurological deterioration halted after the craniectomy, he still suffered from a severe disabling orthostatic headache. We performed two epidural blood patches at the levels of the lumbar and thoracic spine. He improved considerably a few days after the repetitive epidural blood patches. Epidural blood patches may be a useful treatment modality for post-craniectomy postural headaches.
Adult ; Blood Patch, Epidural* ; Brain Edema ; Headache* ; Humans ; Infarction ; Spine