No abstract available.
Disabled Persons* ; Female ; Humans ; Menarche*

BACKGROUND: Syncope is both one of the most common and one of the most challenging problems seen in medical practice. In spite of intensive medical evaluation, the cause of syncope remains unknown in a significant number of patients. In recent years, head-up tilt test has been of increasing interest as a diagnostic aids in patients with unexplained syncope. This study investigated the clinical utility of this technique in te evaluation of patients with vasovagal syncope. METHODS: Seven patients with unexplained syncope were evaluated with a 60 degree or 80 degree head-up tilt test with or without intravenous infusion of isoproterenol(1-4ug/min) in an attempt to provoke bradycardia, hypotension or both. There were 4 males and 3 females with a mean age of 35+/-8 years. RESULTS: 1) During head-up tilt test, vasovagal responses were provoked in 5 of 7 patients(71.4%) with syncope of unknown origin. During the test, there was no complication associated with the test. 2) During tilt-induced vasovagal reponse, mean systolic blood pressure decreased to 84+/-12mmHg from supine control of 125+/-21mmHg(p<0.01) and mean diastolic blood pressure decreased to 50+/-17mmHG from supine control of 76+/-14mmHg(p<0.01). 3) Five patients with positive results of the tests were followed up for 12months and they had a good outcome free of recurrence. CONCLUSION: Head-up tilt test appeared safely applicable test in patients with suspected vasovagal syncope and good prognosis was expected in the patients.
Blood Pressure ; Bradycardia ; Female ; Follow-Up Studies* ; Humans ; Hypotension ; Infusions, Intravenous ; Male ; Prognosis ; Recurrence ; Syncope ; Syncope, Vasovagal*

BACKGROUND: Management of massive rotator cuff tears can be challenging because of the less satisfactory results and a higher retear rate regardless of the use of open or arthroscopic repair technique. METHODS: We retrospectively analyzed 102 cases of massive rotator cuff tear treated with either open or arthroscopic repair. Open repair was performed in 38 patients; and arthroscopic repair, in 64 patients. The mean age at the time of surgery was 59.7 years in the open group and 57.6 years in the arthroscopic group. RESULTS: The Constant score increased from the preoperative mean of 55.9 to 73.2 at the last follow-up in the open repair group and from 53.8 to 67.6 in the arthroscopic repair group (p<0.001 and <0.001, respectively). The University of California at Los Angeles (UCLA) score increased from a preoperative mean of 17.7 to 30.8 at the last follow-up in the open group and from 17.5 to 28.7 in the arthroscopic group (p<0.001 and <0.001, respectively). No statistically significant difference in the Constant and UCLA scores was observed between the two groups at the last follow-up (p=0.128 and 0.087, respectively). Retear was found in 14 patients (36.8%) in the open group and 39 patients (60.9%) in the arthroscopic group (p=0.024). CONCLUSIONS: Open and arthroscopic repairs of massive rotator cuff tears may provide satisfactory clinical results with no significant difference. However, a significantly lower retear rate was observed for the open repair group compared with the arthroscopic repair group.
Arthroscopy ; California ; Follow-Up Studies ; Humans ; Retrospective Studies ; Rotator Cuff* ; Shoulder ; Tears* ; Tendon Injuries

PURPOSE: This study evaluates the effect of behavioral relaxation training on distress and cancer screening intention of patients with upper gastrointestinal endoscopy.METHODS: The research was conducted in a non-equivalent control group posttest design. Data were collected from endoscopy subjects in B city from October to November of 2018. Fifteen minutes of behavioral relaxation training were provided to the experimental group (n=40) and traditional relaxation therapy methods were provided to the control group (n=40). Outcome measures were distress and cancer screening intention of patients with upper gastrointestinal endoscopy. Data were analyzed with a χ²-test, independent t-test, Fisher's exact test with SPSS/PC version 23.0.RESULTS: The objective discomfort (t=8.81, p<.001) of the experimental group was lower than that of the control group; there were no significant differences in the subjective discomfort (t=1.73, p=.088). The cancer screening intention (t=−5.85, p<.001) of the experimental group was significantly higher than that of the control group.CONCLUSION: Behavioral relaxation training was effective in heightening cancer screening intention. Therefore it can be usefully applied to increase cancer screening intention.
Early Detection of Cancer ; Education ; Endoscopy ; Endoscopy, Gastrointestinal ; Humans ; Intention ; Outcome Assessment (Health Care) ; Relaxation Therapy ; Relaxation

MELAS syndrome is a rare but distinct clinical entity belonging to a group of mitochondrial encephalomyopathies characterized by the tetrad of mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes. We experienced a case of MELAS syndrome in an 8 year-old boy who showed headache, pain of the eyeball, vomiting, stroke-like episodes such as visual disturbance and dysarthria, myoclonic seizure, confusion, and walking disturbance. His serum lactate level was elevated up to 48 mg/dl. MRI findings showed high signal intensities T2-weighted image and low signal intensities in T1-weighted image in the right thalamus and parietooccipital lobe and bilateral symmetric high signal intensity in T1-dweighted image in the basal ganglia. We have seen the dispersed ragged-red fibers with modified Gomori trichrome staining on light microscope, and abundant and dysmorphic mitochondria on electon microscope in the specimen of muscle biopsy. esis of SLE.
Basal Ganglia ; Biopsy ; Child ; Dysarthria ; Headache ; Humans ; Lactic Acid ; Magnetic Resonance Imaging ; Male ; MELAS Syndrome* ; Mitochondria ; Mitochondrial Encephalomyopathies ; Seizures ; Thalamus ; Vomiting ; Walking

No abstract available.
Gelatin* ; Hemorrhagic Fever with Renal Syndrome*

Vascular injury during lumbar disc surgery is a rare but potentially life-threatening complication. It has been managed by open vascular surgical repair. With recent technologic advance, endovascular treatment became one of effective treatment modalities. We present a case of a 32-year-old woman who suffered with common iliac artery injury during lumbar disc surgery that was treated successfully by endovascular repair with temporary balloon occlusion and subsequent insertion of a covered stent. Temporary balloon occlusion for 1.5 hours could stop bleeding, but growing pseudoaneurysm was identified at the injury site during the following 13 days. It seems that the temporary balloon occlusion can stall bleeding from arterial injury for considerable time duration, but cannot be a single treatment modality and requires subsequent insertion of a covered stent.
Adult ; Aneurysm, False ; Balloon Occlusion ; Female ; Hemorrhage ; Humans ; Iliac Artery ; Stents ; Vascular System Injuries

Titanium miniscrews are being used increasingly as an anchorage for tooth movement, because they are easy to place and to remove, increase the number of sites available, give minimum strain to patients regarding surgical procedures, and offer uneventful healing after removal. The use of titanium miniscrews as an orthodontic anchorage has been reported in clinical case reports, but clinicians have experienced screw loosening when using such screws. To our knowledge, there are no published reports evaluating the stability of miniscrews. Information about the length of miniscrews used in relation to the location is of some importance, as stability will vary depending on bone quality. The purpose of this study was to evaluate a variety of lengths of miniscrews (diameter: 2mm) which were inserted in maxilla or mandible and to demonstrate in a dog model which miniscrew provides fundamental stability in the jaws. 10 mm long miniscrews in the maxilla and 8mm long miniscrews in the mandible showed no clinical mobility and retained their position throughout an 8 weeks force (200g) application. The mucosal condition around the screws was healthy in cases in which miniscrews were inserted in the alveolar bone between the roots and the head of the screws emerged into the attached gingiva. When the force application was terminated, radiographic analysis revealed neither root resorption nor periodontal pathology around the miniscrews that remained stable during the entire treatment period. This study suggests that if titanium miniscrews with adequate length are properly used depending on the location, they provide sufficient stability for orthodontic anchorage.
Animals ; Dogs* ; Gingiva ; Head ; Humans ; Jaw ; Mandible ; Maxilla ; Pathology ; Root Resorption ; Titanium* ; Tooth Movement

Acute necrotizing esophagitis (AEN), also called "black esophagus," is a rare disorder with an unknown pathogenesis. Endoscopic findings generally show black pigmentation throughout the esophagus. This case also offered rare views of the gross anatomy of this disorder. Histological examination revealed that the mucosal and submucosal layers of the esophagus were involved in the severe necrotizing inflammation. The chief manifestation of this disease is hematemesis from hemorrhage of the upper gastrointestinal tract with a typically multifactorial etiology. AEN is also characterized by a clear boundary at the gastroesophageal junction where the necrosis stops. In this study, we report an autopsy case of a 61-year-old man with necrotizing inflammation throughout the esophagus and esophageal necrosis from the laryngopharynx to the gastroesophageal junction. The patient was a disabled person with a history of alcohol abuse who was also diagnosed with mild coronary arteriosclerosis and fatty liver on the basis of the underlying diseases. In this case, the main etiology for poor perfusion from the distal esophageal area was likely underlying illness, history of alcoholism, and malnutrition.
Alcoholism ; Autopsy* ; Coronary Artery Disease ; Disabled Persons ; Esophagitis* ; Esophagogastric Junction ; Esophagus ; Fatty Liver ; Hematemesis ; Hemorrhage ; Humans ; Hypopharynx ; Inflammation ; Malnutrition ; Middle Aged ; Necrosis ; Perfusion ; Pigmentation ; Upper Gastrointestinal Tract

Although complex fractionated electrogram (CFE) is known to be a target for catheter ablation of fibrillation, its physiological meaning in fibrillation wave-dynamics remains to be clarified. We evaluated the spatiotemporal relationships among the parameters of fibrillation wave-dynamics by simulation modeling. We generated maps of CFE-cycle length (CFE-CL), local dominant frequency (LDF), wave break (WB), and phase singularity (PS) of fibrillation in 2-dimensional homogeneous bidomain cardiac modeling (1,000 x 1,000 cells ten Tusscher model). We compared spatiotemporal correlations by dichotomizing each maps into 10 x 10 lattice zones. In spatial distribution, WB and PS showed excellent correlation (R = 0.963, P < 0.001). CFE-CL had weak correlations with WB (R = 0.288, P < 0.001), PS (R = 0.313, P < 0.001), and LDF (R = -0.411, P < 0.001). However, LDF did not show correlation with PS or WB. PSs were mostly distributed at the periphery of low CFE-CL area. Virtual ablation (5% of critical mass) of CFE-CL < 100 ms terminated fibrillation at 14.3 sec, and high LDF ablation (5% of critical mass) changed fibrillation to organized tachycardia, respectively. In homogeneous 2D fibrillation modeling, CFE-CL was weakly correlated with WB, PS, and LDF, spatiotemporally. PSs are mostly positioned at the periphery of low CFE-CL areas, and virtual ablation targeting low CFE-CL regions terminated fibrillation successfully.
Algorithms ; Atrial Fibrillation/*physiopathology ; Body Surface Potential Mapping ; Catheter Ablation ; *Electrocardiography ; Electrodes ; Heart Atria/physiopathology ; Humans ; *Models, Biological