Nefazodone, a newer antidepressant is a phenylpiperazine derivative that inhibits the reuptake of both norepinephrine and serotonin, and antagonizes 5-HT2A and alpha1 adrenergic receptors. Compared with SSRIs nefazodone caused the fewer activating symptoms, adverse gastrointestinal effects(nausea, diarrhea, anorexia) and adverse effects of sexual function, but is associated with the more dizziness, dry mouth, constipation, visual disturbances and confusion. We report on 4 cases of visual disturbances and hallucinations in patients taking nefazodone. 1) Nefazodone, as a 5-HT2A antagonist, might induce visual disturbances. 2) mCPP, metabolite of nefazodone might contribute to the hallucination through action on 5-HT receptor. 3) Dopaminergic enhancing activity of nefazodone might cause hallucination. The case report raises the possibility that dose-related perceptual disturbances may exist with nefazodone. The fact emphasizes the need to pay close attention to all possible drug interactions, particularly in patients treated with multiple psychoactive agents, older patients, and patients with decreased hepatic function.
Constipation ; Diarrhea ; Dizziness ; Drug Interactions ; Hallucinations ; Humans ; Mouth ; Norepinephrine ; Psychotropic Drugs ; Receptors, Adrenergic ; Serotonin ; Serotonin 5-HT2 Receptor Antagonists

To overcome the problems of classical pulmonary banding procedure, we developed a percutaneously adjustable pulmonary artery banding device. The banding device consists of banding portion of zig-zag shaped self-expandable stainless steel wire, shaft portion made by a polyvinyl catheter and a screw adjuster which includes a bolt and a nut. As the screw moves, the diameter of banding portion changes. Four Mongrel dogs ranging from 15 kg to 20 kg in weight underwent the banding of the mid portion of descending aorta with this devices through the left thoracotomy. One month after operation, we evaluated the pressure changes by controling the banding with the devices and then the dogs were sacrificed to study the microscopic changes in the aorta. The diameter and circumference of the band could be easily and finely adjustable by the screw control. The pressure recordings revealed a linear increase and decrease in pressure gradient according to percutaneous adjustment of the banding device. Since the banding device can be easily placed and simply adjusted percutaneously, we hope the banding device may be applicable clinically to improving the safety of pulmonary artery banding and debanding procedures in the future.
Animals ; Aorta ; Aorta, Thoracic ; Catheters ; Dogs ; Hope ; Nuts ; Polyvinyls ; Pulmonary Artery* ; Stainless Steel ; Thoracotomy

Recurrent disc herniation and postoperative fibrosis are the main disease entities causing failed back surgery syndrome (FBSS) and magnetic resonance (MR) imaging has become a major diagnostic modality in differentiating the two. To observe the variable entities of FBSS and their MR findings, we retrospectively analyzed 15 MR images in 12 patients. The causes of FBSS were as follows; normal (no organic cause), fibrosis, new or recurrent disc herniation, discitis, osteomyelitis, inflammation at operation site, epidural abscess, arachnoiditis, and hematoma. Except a case of hematoma, gadolinium enhancement scan was necessary and informative in the diagnosis of FBSS and MR imaging only was not enough in the diagnosis of arachnoiditis.
Arachnoid ; Arachnoiditis ; Diagnosis ; Discitis ; Epidural Abscess ; Failed Back Surgery Syndrome* ; Fibrosis ; Gadolinium ; Hematoma ; Humans ; Inflammation ; Magnetic Resonance Imaging ; Osteomyelitis ; Retrospective Studies

Elastofibroma dorsi is a rare, slow-growing, ill defined soft tissue tumor that's typically found between the inferior scapula and chest wall. The characteristic findings on ultrasonography, MRI and CT usually allow the correct diagnosis and so prevent unnecessary surgical procedure. We experienced a case of bilateral elastofibroma dorsi in an 87-year-old man, and we report on this case along with a review of the literature.
Aged, 80 and over ; Diagnosis ; Humans ; Magnetic Resonance Imaging ; Scapula ; Thoracic Wall ; Ultrasonography

The adrenal gland is the second most common site of metastasis from a hepatocellular carcinoma (HCC). Radiofrequency ablation (RFA) for these tumors has been reported to be a potentially effective alternative to an adrenalectomy, especially for inoperable patients. However, for intermediate or large adrenal tumors, combination therapy of transarterial chemoembolization (TACE) and RFA can be attempted as it may reduce the heat sink effect. A 74-year-old patient presented with abdominal discomfort. Abdominal CT images revealed a 5.0 cm sized right adrenal mass. A percutaneous biopsy of the adrenal mass revealed a metastatic hepatocellular carcinoma. TACE was performed on the adrenal mass. However, a one-month follow-up CT image revealed a residual viable tumor. RFA was performed for the adrenal tumor six weeks after the TACE. No procedure-related major complications were noted. The serum alpha-fetoprotein level had also been normalized after the treatment, and 10-month follow-up CT images showed no definite evidence of viable adrenal tumor.
Adrenal Glands ; Adrenalectomy ; Aged ; alpha-Fetoproteins ; Biopsy ; Carcinoma, Hepatocellular* ; Catheter Ablation* ; Follow-Up Studies ; Hot Temperature ; Humans ; Neoplasm Metastasis ; Tomography, X-Ray Computed

To understand the local fluid dynamics for different designs of Fontan operation, five models were made of Pyrex glass to facilitate in vitro study. Models I, II and III had the same position as the center of the anastomosis of the IVC (inferior vena cava) with that of the SVC (superior vena cava), but Models IV and V had 10 mm offset between them. As well, the anastomotic junction angles were different (Models I and IV: 90 degrees, Models II and V: 70 degrees, Model III: 45 degrees). These models were then connected to a flow loop for flow visualization study. In Model I, no dominant vortex was seen in the central region of the junction, but a large unstable vortex was created in Models II and III. In Models IV and V, a significant stagnation region was created in the middle of the offset region. It also showed that the flow distribution from the IVC and SVC to the LPA (left pulmonary artery) and RPA (right pulmonary artery) depends more on the offset of the junction than on the anastomotic junction angle. Generally, as the total flow rates increased, the pressures in the models increased.
Blood Pressure ; Hemodynamics ; Human ; Models, Cardiovascular* ; Regional Blood Flow ; Gov't Venae Cavae/physiology*

Metastatic tumor of the skull base is uncommon. Diagnosis of the tumor is difficult without any associated evidence of another malignancy. It is distinguished from other benign or primary malignant tumor by rapid progression of symptoms, associated neurologic signs, and lytic or infiltrative lesion in imaging work-up study. Recently authors experienced one case of a posterior skull base adenocarcinoma metastasized from the prostate. Patient's initial complaints were hoarseness and aspiration due to vocal cord paralysis. He also complained of longstanding headache. On examination he had multiple cranial nerve paralyses of CN VII, VIII, X, XI, and XII. Radiologic study showed diffuse skull base lesion. Transmastoid biopsy revealed adenocarcinoma. With thorough examination a prostatic mass was found and proved to be the origin of the metastatic adenocarcinoma after transurethral biopsy. The patient was treated with "Flutamide".
Adenocarcinoma* ; Biopsy ; Cranial Nerves ; Diagnosis ; Headache ; Hoarseness ; Humans ; Neoplasm Metastasis ; Neurologic Manifestations ; Paralysis ; Prostate* ; Skull Base* ; Skull* ; Vocal Cord Paralysis

An antimicrobial susceptibility test was conducted to compare the resistance rates among Campylobacter spp. isolates from dogs (n = 50) raised under diverse conditions and humans (n = 50). More than 60% of Campylobacter (C.) jejuni from dogs and humans showed resistance to nalidixic acid, enrofloxacin and ciprofloxacin. C. jejuni isolates from humans showed higher resistance to tetracycline (83.3%) and ampicillin (91.3%) than those from dogs. None of the C. jejuni or Campylobacter coli isolates from humans or dogs were resistant to erythromycin. Overall, 85% of Campylobacter spp. isolates showed a multidrug resistant phenotype. Nucleotide sequencing analysis of the gryA gene showed that 100% of NA(R)/CIP(R) C. jejuni isolates from dogs and humans had the Thr-86th-Ile mutation, which is associated with fluoroquinolone resistance. flaA PCR restriction fragment length polymorphism (RFLP) typing to differentiate the isolates below the species level revealed 12 different clusters out of 73 strains. The human isolates belonged to eight different RFLP clusters, while five clusters contained dog and human isolates.
Ampicillin ; Animals ; Campylobacter coli ; Campylobacter* ; Ciprofloxacin ; DNA Gyrase ; Dogs* ; Drug Resistance, Microbial ; Epidemiological Monitoring* ; Erythromycin ; Humans ; Korea ; Nalidixic Acid ; Phenotype ; Point Mutation ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length* ; Tetracycline

BACKGROUND: To evaluate the utility of additional fixation methods and to suggest a method of reduction in the treatment of unstable pertrochanteric femur fractures with a sliding hip screw (SHS). METHODS: A retrospective study was performed on thirty patients with unstable pertrochanteric femur fractures, who were operated on with a SHS between September 2004 and September 2009 and were followed up for at least 6 months. The additional fixation devices were as follows; antirotation screw (21 cases), fixation of displaced fractures of the posteromedial bone fragment (cerclage wiring, 21 cases and screw, 2 cases) and trochanter stabilizing plate (27 cases). Clinically, the Palmer's mobility score and Jensen's social function group were used. Radiologically, alignment and displacement were observed. The tip-apex distance (TAD) and sliding of the lag screw were measured, and the position of the lag screw within the femoral head was also examined. RESULTS: The mean age at the time of surgery was 76 years (range, 56 to 89 years) and the average follow-up period was 25 months (range, 6 to 48 months). At the last follow-up, the average mobility and social function score was 6.2 (+/- 3.5) and 2.3 (+/- 1.5). Postoperatively, the alignment and displacement indices were adequate in almost all the cases. The mean amount of lag screw sliding and the mean TAD was 5.1 mm (range, 2 to 16 mm) and 6 mm (range, 3 to 11 mm) respectively. The lag screws were located in the center-center zone in 21 cases. The average period to union was 18.7 weeks without any cases of nonunion or malunion. Mechanical failure was noted in one case with breakage of the lag screw and clinical failure was noted in another case with persistent hip pain related to excessive sliding (16 mm). CONCLUSIONS: With additional fixations, the unstable pertrochanteric femur fractures could be well stabilized by SHS until bone union.
Aged ; Aged, 80 and over ; Bone Plates ; *Bone Screws ; Bone Wires ; Female ; Fracture Fixation, Intramedullary/*methods ; Hip Fractures/radiography/*surgery ; Humans ; Male ; Retrospective Studies ; Treatment Outcome

No abstract available.
Kidney Transplantation* ; Lymphocele*