No abstract available.

Acute myocardial infarction after a bee sting is a very rare process. Among proposed mechanisms, vasospasm of the coronary artery is the most probable mechanism. Many mediators are included in the venom of wasps, and those mediators have vasoconstrictive properties and may constrict the coronary artery. Furthemore, those mediators have thrombogenic properties that lead to thrombogenesis in the coronary artery and aggravate myocardial ischemia. Epinephrine, commonly used in the management of anaphylactic shock, may further aggravate myocardial ischemia. We experienced two cases of acute myocardial infarction after a bee sting. In the first case, we could find no underlying abnormalities of the coronary vessel because the patient died during coronary angiography. In the second case, the electrocardiogram showed inferior wall myocardial infarction, but only mild stenosis of the right coronary artery was seen in coronary angiography.
Anaphylaxis ; Bees* ; Bites and Stings* ; Constriction, Pathologic ; Coronary Angiography ; Coronary Vessels ; Electrocardiography ; Epinephrine ; Humans ; Inferior Wall Myocardial Infarction ; Myocardial Infarction* ; Myocardial Ischemia ; Venoms ; Wasps

The importance of tick-borne diseases is increasing because of climate change, with a lack of long-term studies on tick-borne pathogens in South Korea. To understand the epidemiological characteristics of tick-borne diseases, the monthly distribution of field ticks throughout the year was studied in South Korea between May 2014 and April 2018 in a cross sectional study.

PURPOSE: To determine the change of exoangle according to the measure distance and 1-hour occlusion of exotropic eye in intermittent exotropia. METHODS: We prospectively reviewed the records of 60 patients diagnosed with intermittent exotropia. The exoangle was measured at 6 m, 14 m, outdoor 30 m and at 6 m after occlusion of exotropic eye for 1 hour. Refractive error, stereoacuity and suppression were investigated in all subjects. RESULTS: The mean amount of exoangle was 28.2 +/- 5.64 PD at 6 m, 29.7 +/- 6.54 PD at 14 m and 30.3 +/- 2.84 PD at outdoor 30 m. The amounts of exoangle at 14 m and at outdoor 30 m were significantly increased compared with that at 6 m (p=0.009 and p=0.005, respectively). However, there was no significant difference between that at 14 m and at 30 m (p=0.08). The mean amount of exoangle after occlusion of exotropic eye for 1 hour was 29.3 +/- 5.48 PD, which was not statistically different from that at 14 m (p=0.44) and at 30 m (p=0.19). In 31 patients (51.7%) who had an increase of exoangle more than 3 PD at 14 m and 30 m compared to that at 6 m, mean exoangle at 6 m was 31.4 +/- 5.30 PD. In 29 patients (48.3%) who had an increase of exoangle less than 3PD, mean exoangle at 6 m was 26.2 +/- 5.72 PD. Increase of exoangle was prominent in patients with exoangle more than 30 PD at 6 m. There was no correlation in the amount of exoangle according to refractive error, stereoacuity and the presence of suppression (p=0.17, p=0.47, p=1.0, respectively). CONCLUSIONS: The exoangle increased at distances longer than 6 m and after 1-hour occlusion of exotropic eye in intermittent exotropia. The increment of exoangle according to distance was prominent in patients with exoangle more than 30 PD at 6 m.
Exotropia* ; Humans ; Prospective Studies ; Refractive Errors

Glioblastoma multiforme (GBM) is a brain tumor notorious for its malignancy. The key reason for the limited efficacy of standard treatment is the high recurrence rate of GBM, even after surgical resection. Hence, intensive postsurgical chemical therapies, such as the systemic delivery of various drugs and/ or drug combinations, are typically followed after surgery. However, overcoming the blood-brain barrier by systemic administration to efficiently deliver drugs to the brain tumor remains a daunting goal. Therefore, various local drug delivery methods showing potential for improved therapeutic efficacy have been proposed. In particular, the recent application of electronic devices for the controlled delivery of chemotherapy drugs to GBM tissue has attracted attention. We herein review the recent progress of local drug delivery strategies, including electronics-assisted strategies, at the research and commercial level. We also present a brief discussion of the unsolved challenges and future research direction of localized chemotherapy methods for GBM.

No abstract available.
Rhinoplasty*

PURPOSE:We performed this study to evaluate the clinical significance and temporal changes of pleural effusion developed after the resection of hepatoma. MATERIALS AND METHODS: We reviewed retrospectively follow-up chest radiographs of 97 patients who had undergone operation for hepatoma and had no radiologically demonstrable postoperative complications. The duration of pleural effusion was classified into five groups and the amount of pleural effusion at one week after operation was graded into four groups. Statistical significance of the relationship between the duration, amount of pleural effusion and five factors, which are location and size of tumor, age of the patients, methods of operation, and preoperative liver function, was studied respectively. RESULTS:Pleural effusion was developed in 63.9% (62/97) and the mean duration was 2.5 weeks. In 92% (52/56), pleural effusion disappeared spontaneously within four weeks. Patients who had hepatoma in upper portion of the right lobe developed more frequent pleural effusion which persisted longer, and was larger in amount at one week after operation(p<0.05). There were no statistically significant differences between pleural effusion and the other four factors. CONCLUSION:Pleural effusion following hepatoma surgery should not be regarded as a sign of post-operative complication, as it invariably disappears spontaneously within four weeks. Development of pleural effusion is considered to be caused by local irritation and disturbance of lymphatic flow at the diaphragm.
Carcinoma, Hepatocellular* ; Diaphragm ; Follow-Up Studies ; Humans ; Incidence* ; Liver ; Pleural Effusion* ; Postoperative Complications ; Radiography, Thoracic ; Retrospective Studies

We report a rare case of severe hypoglycemia after sunitinib treatment for pancreatic neuroendocrine carcinoma. We describe the initial clinical presentation, laboratory results, pathologic findings, and managment in a patient with a nonfunctioning pancreatic neuroendocrine carcinoma with liver metastases who developed life threatening hypoglycemia after 2 months of sunitinib therapy. A 46-year-old woman presented to the emergency department with loss of consciousness from hypoglycemia. Serum C-peptide and insulin levels at fasting state revealed that the hypoglycemia resulted from endogenous hyperinsulinemia. She had been diagnosed with nonfunctioning pancreatic neuroendocrine carcinoma based on a biopsy of metastatic cervical lymph node and was being treated with sunitinib, a small molecule tyrosine kinase inhibitor. Immunohistochemical stain of the metastatic liver mass demonstrated that the initially nonfunctioning neuroendocrine carcinoma cells had changed into insulin-producing cells after sunitinib therapy. Transarterial chemoembolization of the liver masses and systemic chemotherapy with streptozotocin/adriamycin relieved the hypoglycemia. A nonfunctioning pancreatic neuroendocrine carcinoma was transformed into an insulin-producing tumor after treatment with sunitinib, causing endogenous hyperinsulinemia and severe hypoglycemia.
Biopsy ; C-Peptide ; Carcinoma, Neuroendocrine ; Emergencies ; Fasting ; Female ; Humans ; Hyperinsulinism ; Hypoglycemia ; Indoles ; Insulin ; Insulinoma ; Liver ; Lymph Nodes ; Neoplasm Metastasis ; Protein-Tyrosine Kinases ; Pyrroles ; Unconsciousness

In 1992, Brugada described clinical features of patients with aborted sudden cardiac death who showed no demonstrable heart disease and a peculiar ECG pattern consisting of right bundle branch block and ST-segment elevation in right precordial leads. Recently, We experienced two cases with aborted sudden cardiac death and similar ECG pattern. Physical examination, routine laboratory tests including serum electrolytes, echocardiography, myocardial thallium SPECT, MRI and MIBG scans were within normal limit. Arrhythmias were not induced in treadmill exercise test, and signal averaged ECGs revealed positive late potentials. Coronary angiography showed normal coronary artery with no evidence of induced vasospasm. Polymorphic ventricular tachycardia and ventricular fibrillation were induced by ventricular stimulation. Intravenous administration of flecainide, procainamide augmented ST segment elevation in one patient, and isoproterenol reduced ST segment elevation in the other patient. For prevention of sudden death, ICDs were implanted in the two patients. Ventricular fibrillations occurred in one patient 12 and 13 months after the implantation and were successfully terminated by ICD.
3-Iodobenzylguanidine ; Administration, Intravenous ; Arrhythmias, Cardiac ; Bundle-Branch Block* ; Coronary Angiography ; Coronary Vessels ; Death, Sudden ; Death, Sudden, Cardiac* ; Echocardiography ; Electrocardiography ; Electrolytes ; Exercise Test ; Flecainide ; Heart Diseases ; Humans ; Isoproterenol ; Magnetic Resonance Imaging ; Physical Examination ; Procainamide ; Tachycardia, Ventricular ; Thallium ; Tomography, Emission-Computed, Single-Photon ; Ventricular Fibrillation

Schwannomas are benign neoplasms arising from the sheath of myelinated nerve fibers and may occur in any part of the body. They mostly occur in the head and neck region, accounting for about 25% to 45% of all cases. The eighth cranial nerve is the most common site of origin. About 4% of all head and neck schwannomas originate in the nasal cavity and paranasal sinuses. The best treatment of schwannomas is surgical excision. Since it is an encapsulated tumor, difficultly is rarely encountered in its complete removal, and recurrence is unlikely. We present a unique and rare case of a 71-year-old man with a recurrent septal mass, finally diagnosed as a schwannoma, with a review of the literature.
Aged ; Head ; Humans ; Nasal Cavity ; Nasal Septum ; Neck ; Nerve Fibers, Myelinated ; Neurilemmoma* ; Paranasal Sinuses ; Recurrence ; Vestibulocochlear Nerve