BACKGROUND: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder that often resolves spontaneously. It was long believed that the condition was caused by inorganic particles in the cupula of the posterior semicircular canal. Management of this condition includes medication, surgery, physical exercise and more recently particle repositioning maneuvers. Among the various therapies, exercise therapy (ET) reported by Brandt-Daroff was based on the theory of cupulolithiasis and is designed to treat BPPV through dispersion of the debris from the cupula. METHODS: Fifty four patients with BPPV were treated with ET to determine the effectiveness. Fifteen additional patients with BPPV were treated with only medication and served as a control group. RESULT: Forty eight of 54 cases (88.9%) treated with ET showed improvement after 2 weeks. With medication alone, 8 of the 15 cases (53.4%) showed improvement after 2 weeks. CONCLUSIONS: The most important benefit of this maneuver seemed to be more expedient recovery than that with medication alone.
Exercise ; Exercise Therapy* ; Humans ; Semicircular Canals ; Vertigo*

No abstract available.
Free Tissue Flaps* ; Hand*

No abstract available.
Intestinal Obstruction* ; Mucocutaneous Lymph Node Syndrome*

Glossopharyngeal neuralgia, first discribed by Labat in 1928, is a very rare disease of unknown cause. This neuralgia is associated with a characteristic sharp pain of the posterior pharynx, tonsils and larynx, and especially triggered by swallowing action. It is said that this pain is more severe than that of trigerminal neuralgia and the pain may last several up to 30 minutes and the attack repeats intermittently. Diagnosis of glosspharyngeal neuralgia is made by the symptoms and by the elongation of the right side of the styloid process in this case. The glossopharyngeal nerve block by the deposition of local anesthetic solution is useful in the accurate diagnosis of the douleureux or neuralgia in which this nerve is involved and in providing anesthesia for operative intervention upon the posterior third of the tongue. This is a report of a case of glossopharyngeal neuralgia, which did not respond to Tegretol and other analgesic drugs and treated by glossopharyngeal nerve block with 0.5% bupivacaine l.5-2.0 ml. The block was performed every day for 15 days and the neuralgia disappeared without complication.
Analgesics ; Anesthesia ; Bupivacaine ; Carbamazepine ; Deglutition ; Diagnosis ; Glossopharyngeal Nerve ; Glossopharyngeal Nerve Diseases* ; Larynx ; Neuralgia ; Palatine Tonsil ; Pharynx ; Rare Diseases ; Tongue

Cardiac resynchronization therapy is effective in selected patients with symptomatic left ventricular dysfunction. Coronary sinus dissection is a relatively uncommon, but much feared, complication that may occur during placement of the left ventricular pacing lead. A 68-year-old man was transferred to our hospital for treatment of severe heart failure. He developed coronary sinus dissection after balloon dilatation during the procedure for cardiac resynchronization therapy. Nevertheless, we successfully placed the left ventricular pacing lead in the coronary vein. We present the case with a review of the literature.
Aged ; Cardiac Resynchronization Therapy ; Coronary Sinus ; Coronary Vessels ; Dilatation ; Heart Failure ; Humans ; Ventricular Dysfunction, Left

No abstract available.
Classification* ; Foot* ; Polydactyly*

No abstract available.
Classification* ; Foot* ; Polydactyly*

No abstract available.

Acute pulmonary edema associated with direct current shock is a rare complication. Pulmonary edema with an increase in heart size following direct current shock have been previously reported and confirmed. The cause of this complication is unknown. This is not due to a sudden increase in the cardiac output with the establishment of sinus rhythm. It has been most commonly noted in the presence of mitral or aortic valvular diseases or ventricular dysfunction. It is likely that acute alteration or disparities in atrial or ventricular mechanical function consequent to electrical discharge precipitate pulmonary congestion. This is a case report of acute pulmonary edema following cardioversion with direct current shock which caused ventricullar fibrillation during tonsillectomy. He was treated with oxygen, iuretics, digitalis, steroid, dopamine and PEEP (positive end expiratory pressure). The patient recovered uneventful ventilation.

Hyperinsullinism and the resultant hypoglycemia are hallmarks of functioning beta islet cell tumors of the pancreas. The management of one case of insulinoma during surgery for the removal of the tumor is described and the available literature on the subject reviewed. The outline of the anesthetic management for the insulinoma is as follows: 1) Anesthetists should understand the signs and the symptoms of hypoglycemia and hyperglycemia. 2) Preoprative management: a) infusion of glucose for avoiding hypoglycemia due to NPO after midnight. b) glucocorticosteroid administration with premedications. 3) Operative management: a) continuous determination of blood glucose level may be helpful. b) Maintenance of the glucose level about 50mg% above symptomatic CNS level have the advantage that exicision of the infulinoma can be immediately judged. c) The use of an agent that decreases CMRO2 and does not affect the insulin-glucose ratio is rational choice when concern about hypoglycemia exists. Thiopental-enflurane anesthesia with controlled ventilation maintaining normocarbia is recommended. d) beta-adrenergic blocker. These drugs must be avoided in the hypoglycemic state.
Adenoma, Islet Cell ; Anesthesia ; Blood Glucose ; Glucose ; Hyperglycemia ; Hypoglycemia ; Insulinoma ; Pancreas ; Premedication ; Ventilation