Torsade de pointes is a life-threatening, polymorphic ventricular tachycardia associated with prolongation of the QTc interval. Although torsade de pointes is found in many clinical settings, it is mostly drug induced. Similar problems have been described with nonsedating H1-selective antihistamines like terfenadine and astemizole. The increased risks of both H1-antihistamines were associated with exposure to supratherapeutic doses or concomitant exposure to the cytochrome P-450 inhibitors, ketoconazole, erythromycin and cimetidine. We report a 51-year-old woman with torsade de pointes and a long QTc interval caused by the combined use of terfenadine and itraconazole. After discontinuation of these drugs and treatments with electrical cardioversion and magnesium sulfate, torsade de pointes and prolonged QTc interval were no longer observed and she was discharged in good condition with a normal ECG. In conclusion, physicians should be aware that terfenadine and astemizole can cause torsade de pointes in rare cases.
Astemizole ; Cimetidine ; Cytochrome P-450 Enzyme System ; Electric Countershock ; Electrocardiography ; Erythromycin ; Female ; Histamine Antagonists ; Humans ; Itraconazole* ; Ketoconazole ; Magnesium Sulfate ; Middle Aged ; Tachycardia, Ventricular ; Terfenadine* ; Torsades de Pointes*

This randomized control pilot study quantified the efficacy of interactive virtual reality golf training on balance performance among community mobile older person. Eight older women were assigned randomly to a conventional mat exercises program group (n = 4, mean age = 51 ± 1.6 years old) or an experimental group that participated in interactive virtual reality golf (n = 4, mean age = 53.5 ± 1.4 years old). Balance assessments of all participants included Multi-Directional Reach Test (MDRT), Step Up Test (SUT), Double Leg Static Balance (DLSB) with eyes open and closed and excursion of centre of pressure (COP) sway quantified with a force plate. One subject dropped out from the experimental group and three subjects from the conventional mat exercise group due to work commitments to complete the once a week study for four weeks. No significant differences in base-line balance abilities were found between groups. The experiment group did not have significant improvements in balance capability compared with control subjects (MDRT p = 0.16-0.66; SUT p = 0.05; COP during DLSB p = 0.18-0.66). However, virtual reality golf intervention improved medial-lateral sway by 57.24% during DLSB compared to 14.99% after floor-mat exercises. The improvement in COP during DLSB after interactive virtual reality golf hints towards improved postural control. Further studies with a larger population should explore using off-the shelf interactive virtual reality sports for balance training. This novel technology can complement rehabilitation programs.

No abstract available.
Bicuspid* ; Molar*

The left parasternal impulse was evaluated by inspection and palpation, and it's contour was confirmed with graphic display using a pilse pickup in 45 normal subjects and 33 patients with various cardiac disease.Using an upper limit of normal echocardiographic LV end-diastolic dimension insides, 3.7cm/m2, LV mass index, 80g/m2, RV dimension index, 2.9cm/m2, and RV free wall thickness, 0.4cm, the patients were subdivided into four groups. In 9 patients with pure RV hypertrophy or dilation, the hyperdynamic impulse or sustained heave was noticed in 7 cases(sensitivity 78%, specificity 76%). In 12 patients with pure LV hypertrophy or dilation, striking parasternal systolic retraction was noticed in 5 cases(sensitivity 42%, speccificity 86%). But in 7 patient with biventricular hypertrophy or dilation, either striking systolic retraction or hyperdynamic impulse was noticed in 4 cases. These findings suggest that the evaluation of the parasternal movement is helpful for the cardiac examination.
Echocardiography ; Humans ; Hypertrophy ; Palpation ; Sensitivity and Specificity ; Strikes, Employee

The fruit of Corni fructus (CF), a perennial herb, is believed to have anti-allergy effects, but its mechanism is unknown. The purpose of this study is to investigate the inhibitory effect of CF on compound 48/80-induced mast cell activation. For this, the effects of CF on the degranulation, the histamine release, the calcium influx and the change of the intracellular cAMP levels of rat peritoneal mast cells (RPMC) and influences of CF on the compound 48/80-induced cutaneous reaction were studied. The results were as follows; the compound 48/80-induced degranulation, intracelluar calcium influx and histamine release of RPMC was significantly inhibited by pretreatment with CF, the compound 48/80-induced cAMP level of RPMC were significantly increased by pretreatment with CF, CF significantly inhibited compound 48/80-induced vascular permeability of rat cutaneous tissue. From the above results, it is suggested that CF contains some substances which inhibit the compound 48/80-induced vascular permeability and mast cell activation.
Animals ; Calcium ; Capillary Permeability* ; Cornus* ; Fruit ; Histamine Release ; Mast Cells* ; Rats

The fruit of Corni fructus (CF), a perennial herb, is believed to have anti-allergy effects, but its mechanism is unknown. The purpose of this study is to investigate the inhibitory effect of CF on compound 48/80-induced mast cell activation. For this, the effects of CF on the degranulation, the histamine release, the calcium influx and the change of the intracellular cAMP levels of rat peritoneal mast cells (RPMC) and influences of CF on the compound 48/80-induced cutaneous reaction were studied. The results were as follows; the compound 48/80-induced degranulation, intracelluar calcium influx and histamine release of RPMC was significantly inhibited by pretreatment with CF, the compound 48/80-induced cAMP level of RPMC were significantly increased by pretreatment with CF, CF significantly inhibited compound 48/80-induced vascular permeability of rat cutaneous tissue. From the above results, it is suggested that CF contains some substances which inhibit the compound 48/80-induced vascular permeability and mast cell activation.
Animals ; Calcium ; Capillary Permeability* ; Cornus* ; Fruit ; Histamine Release ; Mast Cells* ; Rats

PURPOSE: Laparoscopic gastric resection (LGR) is increasingly being used instead of open gastric resection (OGR) as the standard surgical treatment for gastric submucosal tumors. Yet there are few reports on which technique shows better postoperative outcomes. This study was performed to compare these two treatment modalities for gastric submucosal tumors by evaluating the postoperative outcomes. We also provide an analysis of the learning curve for LGR. MATERIALS AND METHODS: Between 2003.4 and 2008.8, 103 patients with a gastric submucosal tumor underwent either LGR (N=78) or OGR (n=25). A retrospective review was performed on a prospectively obtained database of 103 patients. We reviewed the data with regard to the operative time, the blood loss during the operation, the time to the first soft diet, the postoperative hospital stay, the tumor size and the tumor location. RESULTS: The clinicopatholgic and tumor characteristics of the patients were similar for both groups. There was no open conversion in the LGR group. The mean operation time and the bleeding loss were not different between the LGR group and the OWR group. The time to first soft diet (3.27 vs. 6.16 days, P<0.001) and the length of the postoperative hospital stay (7.37 vs. 8.88 days, P=0.002) were shorter in the LGR group compared to the OGR group. The tumor size was bigger in the OGR group than that in the LGR group (6.44 vs. 3.65 cm, P<0.001). When performing laparoscopic gastric resection of gastric SMT, the surgeon was able to decrease the operation time and bleeding loss with gaining more experience. We separated the total cases into 3 periods to compare the operation time, the bleeding losses and the complications. The third period showed the shortest operation time, the least bleeding loss and the fewest complications. CONCLUSION: LGR for treating a gastric submucosal tumor was superior to OGR in terms of the postoperative outcomes. An operator needs some experience to perform a complete laparoscopic gastric resection. Laparoscopic resection could be considered the first-line treatment for gastric submucosal tumors.
Diet ; Hemorrhage ; Humans ; Laparoscopy ; Learning Curve ; Length of Stay ; Operative Time ; Prospective Studies ; Retrospective Studies

The occurrence of double primary cancer of the esopbagus and duodenum is considered very rare. Moreover, it is difficult to manage this type of double cancer because esophageal cancer has a biologic tendency to early metastasis. We report a case of double primary cancer, which we have synchronously confirmed esophageal squamous cell carcinoma and duodenal adenocarcinoma with gastrofiberscopic biopsy, and then treated them by gastrojejunostomy and systemic chemotherapy.
Adenocarcinoma ; Biopsy ; Carcinoma, Squamous Cell ; Drug Therapy ; Duodenum ; Esophageal Neoplasms ; Gastric Bypass ; Neoplasm Metastasis

This morphometric study of the trachea was performed to provide the basic data necessary for shielding crico-thyroid membrane incision, tracheal intubation and tracheotomy in korean bodies 48 (33 male, 15 female). Tracheal measurement included the number, the length, the anteroposterior and transverse diameters of trachea, and the height of tracheal cartilages, and the inter-rings distances of cartilages. The length of trachea was 104.0+/-1.4 mm in male and 102.3+/-1.9 mm in female, but there was no significance between males and females. All of the anteroposterior and transverse diameters, and the height were longer in males, compared with females, in the first, fifth, tenth and fifteenth tracheal cartilages. The anteroposterior and transverse diameters of the first and fifteenth tracheal rings, and the height of the first tracheal ring differed significantly male's from female's. The distances between posterior end of rings of the first, tenth and fifteenth tracheal cartilages were broader in males. The inter-rings distances of tracheal cartilage were also wider in the male, and showed significant differences in the 1st~2nd and 10~11th. These results suggest that this might be useful as a clinical basic data for the emergency physician, anesthetist, and associated medical doct
Cadaver ; Cartilage ; Emergencies ; Female ; Humans ; Intubation ; Male ; Membranes ; Trachea* ; Tracheotomy

PURPOSE: Various methods are used in clinical crown lengthening procedure. Esthetic is more important in anterior region than in posterior region. Therefore when performing clinical crown lengthening procedure in esthetic region, clinicians should choose method which doesn't impair esthetic. Surgical extrusion could be a good method to achieve esthetic results MATERIAL AND METHODS: Two patients were scheduled to clinical crown lengthening procedure in esthetic region. Teeth were extruded with periotome carefully to the intended level. Extruded teeth were anchored with sutures. Sutures are removed after 7day. Restorations were seated after extruded teeth were stabilized. RESULT: Five to six months later, both cases showed favorable esthetic outcome that were harmonious with adjacent teeth. CONCLUSION: When clinicians are to do clinical crown lengthening procedure in esthetic region, predictable esthetic outcome could be achieved with surgical extrusion.
Crown Lengthening ; Crowns ; Esthetics ; Humans ; Sutures ; Tooth