Background: Bupivacaine was introduced to be a long-acting spinal anesthetic agent. It has been argued about whether the addition of epinephrine prolongs the bupivacaine action or not. The aim of this present investigation was to find out the effect of additional epinephrine on spinal anesthesia with bupivacaine. Methods: 47 patients undergoing an operation on lower extremity were randomly allocated to 2 groups. All patients were anesthetized by subarachnoid block with 0.5% bupivacaine in 8% glucose, which was mixed with 0.2 ml of normal saline in group non-E (n=24) and 0.2 ml of 1:1,000 epinephrine in group E (n=23). We evaluated blood pressure and heart rate, the sensory and motor blockade and voiding time after spinal anesthesia. Results: The systolic blood pressure (SBP) at 8 and 10 min after anesthesia were lower in group non-E than in group E (p<0.05). The trend of decreasing diastolic blood pressure was similar in both groups. The heart rate(HR) at 2 min after anesthesia was lower in group non-E than in group E (p<0.05). The sensory block in T10 was produced faster in group non-E (7 min) than in group E (11 min)(p<0.05). And the maximal sensory block level and its reaching time was T7 and 14 min in group non-E, and T8 and 17 min in group E (p=0.12, p=0.11). Two segment regression time was 124 min in group non-E, and 184 min in group E (p=011). The onset time of motor block to Bromage scale 3 was 12 min in group non-E and 16 min in group E (p=0.06). The recovery time from complete motor block to Bromage scale 1 after maximal motor block was 263 min in group non-E, and 278 min in group E. The time at which patients voided after anesthesia was 469 min in group non-E, and 466 min in group E. Three patients urinated by using a urinary catheter in each group. Conclusions: The addition of epinephrine to bupivacaine for spinal anesthesia can slow the decrease in SBP and increase the HR at early stage of anesthesia, and slow the sensory block.
Anesthesia ; Anesthesia, Spinal* ; Blood Pressure ; Bupivacaine* ; Epinephrine* ; Glucose ; Heart ; Heart Rate ; Humans ; Lower Extremity ; Urinary Catheters

No abstract available.
Reye Syndrome*

No abstract available.

No abstract available.
DNA* ; Nucleolus Organizer Region*

This study was conducted to evaluate the effect of a teaching program on patients with myocardial infarction. Forty-five patients were randomly selected 22 were assigned to a teaching group and 23 to a control group. An individualized teaching program was delivered to the teaching group during the hospitalization period. It covered aspects such as: the characteristics of heart disease, the anatomy and physiology of the heart, risk factors of atherosclerosis, medication and diet and exercise therapy. When these subjects were discharged to their homes, they received regular supportive care via telephone or mail for 12 weeks. Atherosclerotic risk factors, including, smoking, exercise, blood lipid profile and BMI were measured before and after the teaching program. Post-testing revealed that the numbers of those who exercised and the number of non-smokers were significantly higher in the teaching group than in the control group. Increased HDL cholesterol (High-Density Lipoprotein cholesterol) was significantly greater in the teaching group than in the control group. The above findings suggest that this individualized teaching program might be helpful at reducing the risk factors of atherosclerosis in myocardial infarction patients.
Adult ; Aged ; Arteriosclerosis/etiology/*prevention & control ; Comparative Study ; Exercise ; Female ; Human ; Lipids/blood ; Male ; Middle Age ; Myocardial Infarction/*prevention & control ; *Patient Education ; Risk Factors ; Smoking

Hashimoto's encephalopathy is a rare autoimmune disease, with symptoms of encephalopathy and high titers of serum anti-thyroid antibodies. Current diagnostic criteria include corticosteroid responsiveness, but in some cases, they are refractory to corticosteroids. In steroid non-responders, other immunomodulatory therapies could be applied. Recently, Rituximab is reported as a safe and effective treatment for Hashimoto's encephalopathy. We report a 50-year-old woman with Hashimoto's encephalopathy presented with confusion and catatonia who was refractory to corticosteroid and immunoglobulin but effectively treated with rituximab.
Adrenal Cortex Hormones ; Antibodies ; Autoimmune Diseases ; Brain Diseases ; Catatonia ; Female ; Glucocorticoids ; Humans ; Immunoglobulins ; Immunomodulation ; Middle Aged ; Rituximab ; Thyroid Hormones

BACKGROUND: The precise measurement of body temperature during anesthesia is important to prevent hypothermia.The aim of this study was to compare the urinary bladder temperature to the esophageal, nasopharyngeal, rectal and skin temperatures, and to compare three heating methods during spine surgery. METHODS: Forty-two patients with ASA physical status I-II, who were scheduled to undergo spine surgery in the prone position, were included in this study.The patients were randomly divided into 4 groups:Group I was treated without any heating methods; group 2, with fluid-warmers; group 3, with forced air-warmers; and group 4, with a combination of both heating methods.After the induction of anesthesia, the esophageal, nasopharyngeal, rectal, urinary bladder and skin temperature was monitored every 15 minute for 3 hours.The urinary bladder temperature was compared to the esophageal, nasopharyngeal, rectal and skin temperatures. RESULTS: The urinary bladder temperature was found to be higher than the esophageal and the nasopharyngeal temperatures (P < 0.01).The urinary bladder temperature of group 3 was higher than that of group 1 at 180 minutes after induction of anesthesia (P < 0.05).The urinary bladder temperature of group 4 was higher than that of group 1 at 150 minutes (P < 0.05), as well as at 165 and 180 minutes (P < 0.05).The skin temperatures of groups 3 and 4 were higher than group 1 (P < 0.001). CONCLUSIONS: The urinary bladder temperature was higher than the esophageal temperature and correlated with the esophageal, nasopharyngeal and rectal temperatures.During spine surgery in the prone position, a forced air-warmer was found to be the most effective but a combination of all the methods tested was found to be even more effective.
Anesthesia ; Body Temperature ; Heating ; Hot Temperature ; Humans ; Prone Position ; Skin ; Skin Temperature ; Spine ; Urinary Bladder

May-Hegglin anomaly (MHA) is a myosin-heavy-chain-9 (MYH9)-related disorder characterized by thrombocytopenia with giant platelets and inclusion bodies in leukocytes. MHA does not require treatment, but it may be misdiagnosed as immune thrombocytopenic purpura (ITP) and inappropriately managed. Reported herein is a case of a 12 year old female patient diagnosed as MHA with laboratory findings of severe thrombocytopenia and giant platelets in peripheral blood morphology, and followed up until 23 years of age. The patient had been diagnosed with ITP and treated with intravenous gamma-globulin therapy at another hospital, and showed no improvements in platelet count. She was then referred to our hospital for further diagnostic workup and followed up for 11 years, showing platelet count of 6,000-20,000/µL and prolonged platelet function test. She was occasionally treated with iron therapy due to iron-deficiency anemia. In 2014, we conducted a DNA analysis that revealed c.4339G>T(p.Asp1447Tyr), a known mutation of MYH9 gene.
Anemia, Iron-Deficiency ; DNA ; Female ; Follow-Up Studies ; gamma-Globulins ; Humans ; Inclusion Bodies ; Iron ; Leukocytes ; Platelet Count ; Platelet Function Tests ; Purpura, Thrombocytopenic, Idiopathic ; Thrombocytopenia

BACKGROUND: To assess the cost-effectiveness of drug therapy to prevent osteoporotic fractures in postmenopausal women with osteopenia in Korea. METHODS: A Markov cohort simulation was conducted for lifetime with a hypothetical cohort of postmenopausal women with osteopenia and without prior fractures. They were assumed to receive calcium/vitamin D supplements only or drug therapy (i.e., raloxifene or risedronate) along with calcium/vitamin D for 5 years. The Markov model includes fracture-specific and non-fracture specific health states (i.e. breast cancer and venous thromboembolism), and all-cause death. Published literature was used to determine the model parameters. Local data were used to estimate the baseline incidence rates of fracture in those with osteopenia and the costs associated with each health state. RESULTS: From a societal perspective, the estimated incremental cost-effectiveness ratios (ICERs) for the base cases that had T-scores between -2.0 and -2.4 and began drug therapy at the age of 55, 60, or 65 years were $16,472, $6,741, and -$13,982 per quality-adjusted life year (QALY) gained, respectively. Sensitivity analyses for medication compliance, risk of death following vertebral fracture, and relaxing definition of osteopenia resulted in ICERs reached to $24,227 per QALY gained. CONCLUSIONS: ICERs for the base case and sensitivity analyses remained within the World Health Organization's willingness-to-pay threshold, which is less than per-capita gross domestic product in Korea (about $25,700). Thus, we conclude that drug therapy for osteopenia would be a cost-effective intervention, and we recommend that the Korean National Health Insurance expand its coverage to include drug therapy for osteopenia.
Bone Diseases, Metabolic* ; Breast Neoplasms ; Cohort Studies ; Cost-Benefit Analysis ; Drug Therapy ; Female ; Global Health ; Gross Domestic Product ; Humans ; Incidence ; Korea ; Medication Adherence ; National Health Programs ; Osteoporotic Fractures* ; Postmenopause ; Quality-Adjusted Life Years ; Raloxifene Hydrochloride ; Risedronate Sodium

PURPOSE: To report 2 cases of WIOL-CF(R) intraocular lens (IOL) (Gelmed International, Kamenne Zehrovice, Czech Republic) dislocation after neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy. CASE SUMMARY: A 78-year-old female was referred for IOL dislocation. She was implanted with WIOL-CF(R) IOL 18 months prior. Two months after WIOL-CF(R) implantation, she received Nd:YAG laser capsulotomy at a local clinic. Pars plana vitrectomy and transscleral fixation of IOL were performed. CONCLUSIONS: This is the first report of WIOL-CF(R) IOL dislocation after Nd:YAG laser capsulotomy in unvitrectomized eyes. When Nd:YAG laser capsulotomy is performed after WIOL-CF(R) IOL implantation, IOL dislocation should be considered even in unvitrectomized eyes.
Aged ; Aluminum ; Dislocations* ; Female ; Humans ; Lenses, Intraocular ; Vitrectomy ; Yttrium