Some species of venomous snakes spit venom in human eyes as a defence mechanism when threatened. If not detected and treated appropriately early, this can result in severe toxic ocular injury leading to potential blindness (snake venom ophthalmia). Not much is known of the clinical course and treatment guidelines due to the rarity of such occurrences. We present a case of isolated severe toxic ocular injury in one eye who reported to us with very poor vision following venom spit, which was promptly treated leading to a successful visual recovery. This is the first documented case of snake venom ophthalmia from Kuala Belait, Brunei Darussalam.
Elapidae ; Snake Venoms ; Corneal Opacity ; Blindness

BACKGROUND: Thyroglobulin (Tg) is the primary biochemical marker used to monitor patients with differentiated thyroid cancer (DTC) for residual or recurrent disease after total thyroidectomy, as only normal or well-differentiated malignant thyroid cells produce Tg. Here, we evaluated the precision and functional sensitivity (FS) of a recently developed highly sensitive Tg (hsTg) electrochemiluminescent immunoassay (ECLIA) and compared it to that of the radioimmunoassay (RIA) method using pooled human serum with low levels of Tg. METHODS: For the ECLIA method, the Elecsys Tg II kit (Roche Diagnostics, Germany) was used with an E170 analyzer (Roche Diagnostics). For the RIA method, the Tg-plus-RIA kit (BRAHAMS, Germany) was used with a Cobra Quantum gamma counter (Packard Instrument Company, USA). The precision and limit of detection (LOD) were determined according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. FS was determined using a modification of the CLSI guideline. RESULTS: The total precision of the hsTg ECLIA and RIA methods was 9.6% and 48.2%, respectively. The manufacturer-reported LOD was verified by the hsTg ECLIA (0.04 ng/mL), but not by the RIA method (>0.08 ng/mL). The hsTg ECLIA showed better FS (0.04 ng/mL at a coefficient of variation [CV] of 10%) than the RIA method (0.37 ng/mL at a CV of 20%). CONCLUSIONS: Thus, the hsTg ECLIA performed better than the RIA method in terms of FS, which is extremely important for the early detection of residual or recurrent disease in DTC patients after total thyroidectomy. The excellent performance of the hsTg ECLIA could allow for clinical Tg measurement without thyroid-stimulating hormone stimulation, in contrast to the insufficient performance of the RIA method.
Biomarkers ; Elapidae ; Humans ; Immunoassay* ; Limit of Detection ; Methods ; Radioimmunoassay* ; Thyroglobulin* ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy ; Thyrotropin

BACKGROUND: Supraglottic airway devices are currently available. We compared the efficacy of the Cobra perilaryngeal airway (CobraPLATM) and the ProSealTM laryngeal mask airway (PLMA) during anesthesia with controlled ventilation for the insertion success rate, hemodynamic stability after insertion, intraoperative ventilatory parameters, and postoperative laryngeal discomfort. METHODS: Forty-three patients received either a CobraPLATM or a PLMA after induction with thiopental 5 mg/kg, fentanyl 1microg/kg and rocuronium 0.6 mg/kg, and manual controlled ventilation with N2O: O2 (1:1) and sevoflurane 5-6 vol% for 2 minutes. Unblinded observers collected the intraoperative data, and blinded observers collected the postoperative data. RESULTS: The two devices were similar for hemodynamic stability after insertion, and for the intraoperative ventilatory parameters. The success rates of first-attempts were similar, but the insertion time was longer for the CobraPLATM. The cuff volume and pressure changes were significantly higher for the PLMA than the CobraPLATM. The cuff pressure was significantly higher for the CobraPLATM than the PLMA from insertion to 10 minutes after insertion, but at 30, 60 and 90 minutes after the insertion, there was no significant difference for the two devices. There were no differences with respect to the incidence of adverse events. CONCLUSIONS: During anesthesia with controlled ventilation, these two devices can be used successfully and effectively. We suggest that the CobraPLATM could be used an alternative device for airway management and further investigation is required.
Airway Management ; Anesthesia* ; Elapidae ; Fentanyl ; Hemodynamics ; Humans ; Incidence ; Laryngeal Masks* ; Masks ; Thiopental ; Ventilation*

Animals ; China ; Elapidae ; Humans ; Male ; Snake Bites ; Snake Venoms ; poisoning ; Young Adult

PURPOSE: This study examined the most effective exercise while performing shoulder abduction below ninety degrees. METHODS: Thirty two healthy individuals (17 males, 15 females) participated and performed four exercises, 1) Posterior fly, 2) Prone row, 3) Modified prone cobra, and 4) External rotation in the prone position. Surface electromyography (sEMG) was used to measure the electrical activities for the lower, middle and upper fiber of trapezius and serratus anterior. RESULTS: A significant difference in the muscle activities of the upper/middle/lower trapezius and serratus anterior was observed among the three different positions in terms of the PF (posterior fly), PR (prone row), and MPC (modified prone cobra) (p<0.05). In post-hoc analysis, the activities of the lower and upper trapezius were significantly higher than those of the upper trapezius and serratus anterior (p<0.05). In addition, in ERP (external rotation in prone), there was a significant difference in each activity of the muscles. Post-hoc results indicated that the upper trapezius showed greater EMG activity than the other three muscles. CONCLUSION: External rotation in the prone position revealed the highest activation of the lower trapezius compared to upper trapezius muscle activity. This may be particularly useful in isolating the lower trapezius in cases where excessive scapular elevation is noted. Therefore, the most effective lower trapezius exercise should be performed below ninety degrees of shoulder abduction.
Adult ; Diptera ; Elapidae ; Electromyography ; Exercise ; Humans ; Male ; Muscles ; Prone Position ; Shoulder ; Superficial Back Muscles

PURPOSE: Prehospital airway management is crucial to emergency healthcare providers, especially for emergency medical technicians (EMTs). In spite of its clinical importance, adequate airway management cannot be guaranteed only with the use of endotracheal intubation. Many supraglottic airway devices have been introduced as substitutes for endotracheal intubation. We compared 3 such devices - LMA Classic(TM), Cobra PLA(TM) and King LT(TM) - using a manikin and recorded performance skill and preference. METHODS: Thirty EMTs participated in the airway management educational program and were enrolled in this study which was held in the Gyeong-Gi Fire Academy. We surveyed the participants general characteristics and experience by e-mail prior to this laboratory study of their skills. The airway management program consisted of a 10 minute lecture followed by 20 minutes of skill training. We observed the success rate, preference among the 3 devices, and the total procedure time of airway device insertion in different rooms. RESULTS: The LMA Classic(TM), Cobra PLA(TM) and King LT(TM) groups succeeded 90%, 76.7%, and 80%, respectively at the first trial. There was no statistically significant difference among the groups (p=0.372). To achieve adequate airway management, the groups spent 28.6+/-7.2, 24.7+/-4.9, and 26.9+/-7.0 seconds, respectively, again with no significant differences (p=0.108). A preference survey performed after the test showed the highest preference for King LT(TM), 57%. CONCLUSION: Three prehospital supraglottic airway devices showed no differences in success rate or procedure time. Despite this result, King LT(TM) was the most preferred.
Airway Management ; Benzeneacetamides ; Elapidae ; Electronic Mail ; Emergencies ; Emergency Medical Technicians ; Fires ; Health Personnel ; Humans ; Intubation, Intratracheal ; Laryngeal Masks ; Manikins ; Piperidones

BACKGROUND: The Cobra Perilaryngeal Airway(TM) (Cobra PLA) and the Proseal Laryngeal Mask Airway(TM) (Proseal LMA) provide higher sealing pressures than the classic LMA. The authors compared the clinical effectiveness of these two airway types for controlled ventilation during laparoscopic cholecystectomy. METHODS: One hundred and twenty patients (ASA physical status I-II, aged 18-65 yrs) scheduled for laparoscopic cholecystectomy were randomly allocated for airway management with the Cobra PLA or the Proseal LMA. Anesthesia was induced and maintained with propofol and remifentanil using a target controlled infusion system. Insertion characteristics, anatomical positions, airway adequacies, ventilation efficacies, degrees of gastric distension, and postoperative adverse events (sore throat, dysphagia, and dysphonia) were noted. RESULTS: The number of insertion attempts, insertion times, airway sealing pressure, and airway positions were similar in the two groups. In one Cobra PLA patient, tracheal intubation was needed due to inadequate ventilation before pneumoperitoneum. During pneumoperitoneum, oxygenation and ventilation were optimal in all patients in both groups, and degrees of gastric distension were similar. Furthermore, no differences were found in terms of the incidences of adverse effects. CONCLUSIONS: Cobra PLA and Proseal LMA were found to have similar insertion characteristics and both provided adequate airways and effective ventilation during laparoscopic cholecystectomy.
Aged ; Airway Management ; Anesthesia ; Cholecystectomy, Laparoscopic ; Deglutition Disorders ; Elapidae ; Humans ; Incidence ; Intubation ; Laryngeal Masks ; Oxygen ; Pharynx ; Piperidines ; Pneumoperitoneum ; Propofol ; Ventilation

This study was aimed to investigate the cytotoxic effect of the Naja Naja Actra Venom Component (NNAVC) combined with activated immune cells on human acute myeloblastic leukemia line KG1a cells. The cytotoxic effects of NNAVC at different concentrations on KG1a cells were measured by CCK-8 method. LDH releasing assay was used to detect the cytotoxic effects of activated immune cells, NNAVC combined with activated immune cells on KG1a cells and the sensitivity of KG1a treated with NNAVC to activated immune cells. The results showed that the inhibitory rate of NNAVC on KG1a cells increased with the concentration enhancement, the cytotoxicity of activated immune cells at the different effector to target (E:T) ratios(6.25:1, 12.5:1, 25:1) on KG1a cells were 12.30%, 24.85% and 52.26%. The cytotoxicity of NNAVC combined with activated immune cells at the different E:T cell ratios (10:1, 20: 1) on KG1a cells were 56.21% and 85.59%, which were higher than that of NNAVC or activated immune cells alone. The cytotoxicity of activated immune cells at the E: T cell ratio of 10:1 on KG1a cells treated with NNAVC at different concentrations were 25.65%, 31.33%, 28.63% and 16.78%, respectively, and that at the E:T cell ratio of 20: 1 were 40.62%, 44.70%, 44.62% and 40.72%. It is concluded that:both of NNAVC and activated immune cells have lethal effect on KG1a cells, and the combination of NNAVC and activated immune cells can strengthen their effect on KG1a.
Animals ; Cell Line, Tumor ; drug effects ; Cytotoxicity, Immunologic ; Elapidae ; Humans ; Immunocompetence ; Leukemia, Myeloid, Acute ; immunology ; pathology ; Venoms ; pharmacology

PURPOSE: To determine, in an experimental study of biliary stent placement, the usefulness and safety of the percutaneous transcholecystic approach and the patency of a newly designed biliary stent. MATERIALS AND METHODS: A stent made of 0.15-mm-thick nitinol wire, and 10 mm in diameter and 2 cm in length, was loaded in an introducer with an 8-F outer diameter. The gallbladders of seven mongrel dogs were punctured with a 16-G angiocath needle under sonographic guidance, and cholangiography was performed. After anchoring the anterior wall of the gallbladder to the abdominal wall using a T-fastener, the gallbladder body was punctured again under fluoroscopic guidance. The cystic and common bile ducts were selected using a 0.035-inch guide wire and a cobra catheter, and the stent was placed in the common bile duct. Post-stenting cholangiography was undertaken, and an 8.5-F drainage tube was inserted in the gallbladder. Two dogs were followed-up and sacrificed at 2, 4, and 8 weeks after stent placement, respectively, and the other expired 2 days after stent placement. Follow-up cholangiograms were obtained before aninmal was sacrificed, and a pathologic examination was performed. RESULTS: Stent placement was technically successful in all cases. One dog expired 2 days after placement because of bile peritonitis due to migration of the drainage tube into the peritoneal cavity, but the other six remained healthy during the follow-up period. Cholangiography performed before the sacrifice of each dog showed that the stents were patent. Pathologic examination revealed the proliferation of granulation tissue at 2 weeks, and complete endothelialization over the stents by granulation tissue at 8 weeks. CONCLUSION: Percutaneous transcholecystic biliary stent placement appears to be safe, easy and useful. After placement, the stent was patent during the follow-up period.
Abdominal Wall ; Animals ; Bile ; Bile Ducts ; Catheters ; Cholangiography ; Common Bile Duct ; Dogs* ; Drainage ; Elapidae ; Follow-Up Studies ; Gallbladder ; Granulation Tissue ; Needles ; Peritoneal Cavity ; Peritonitis ; Stents* ; Ultrasonography

Although the obstruction is potentially reversible with treatment, marked and sometimes prolonged diuresis and natriuresis associated with an impaired ability to concentrate the urine may follow relief of the obstruction. Various factors contributing to the postobstructive diuresis and natriuresis have been suggested, including decreases of tubular sodium reabsorption, retention of urea and expansion of extracellular fluid volume. Tubular damage as a consequence of obstruction may occur one or more nephron segments and may result in decreased reabsorption of filtrate. The discovery of aquaporin (AQP) membrane water channels and sodium (co)transporters and channels provided insight, at the molecular level, into the fundamental physiology and pathophysiology of water and sodium balance. In addition, recent studies have shown that the kidney per se is also a site of production and release of atrial natriuretic peptide (ANP). The locally synthesized ANP may act in a paracrine manner to increase the urinary excretion of sodium and water. In this context, an altered regulation of ANP in the kidney may result in an altered urinary excretion. The combined interactions of multiple independent mechanisms are thought to be involved in the pathogenesis of postobstructive diuresis and natriuresis. We examined the changes of AQP water channels, sodium (co)transporters and natriuretic peptide system in obstructed kidneys. The expression of AQP water channels and sodium transporters was decreased in the obstructed kidneys, which may at least in part account for the urinary concentration defect associated with postobstructive diuresis and natriuresis. In addition, the postobstructive natriuresis was associated with an enhanced renal expression of ANP mRNA and an increased urinary excretion of ANP. The plasma dendroaspis natriuretic peptide (DNP) level was increased following an experimental ureteral obstruction. The urinary excretion of DNP was increased along with the postobstructive diuresis. An enhanced activity of DNP system may in part play a role in mediating the postobstructive diuresis
Animals ; Aquaporins* ; Atrial Natriuretic Factor ; Diuresis* ; Elapidae ; Extracellular Fluid ; Kidney* ; Membranes ; Natriuresis ; Natriuretic Peptides ; Negotiating ; Nephrons ; Physiology ; Plasma ; Rats* ; RNA, Messenger ; Sodium* ; Urea ; Ureteral Obstruction