Dermatitis herpetiformis is a chronic, intensely itchy, papulovesicular skin disorder of unknown cause, which is usually symmetrically distributed on extensor surface. Most patients have an associated gluten-sensitive enteropathy which is usually asymptornatic. We report six cases of dermatitis herpetiformis diagnosed by direct immunofluorescence studies. The patients have had characteristic features of dennatitis herpetiformis, such as vesicles, erythernatous papules, urticaria-like plaques, and hypopigmentation or hyperpigmentation, dispersed on the neck, back, and arms. None of the patients had subjective symptoms associated with gluten-sensitive enteropathy. Clinicians should be aware of the clinical features of this disease to avoid possible misdiagnosis, and to provide better therspeutic approaches in time.
Arm ; Celiac Disease ; Dermatitis Herpetiformis* ; Dermatitis* ; Diagnostic Errors ; Fluorescent Antibody Technique, Direct ; Humans ; Hyperpigmentation ; Hypopigmentation ; Neck ; Skin

BACKGROUND: Shivering associated with spinal anesthesia is uncomfortable to the patient and may interfere the monitoring of patient. Hence, we have investigated whether intrathecal meperidine could decrease the incidence and intensity of shivering during spinal anesthesia for unilateral herniorrhaphy. METHODS: Forty ASA class 1 or 2 patients undergoing unilateral herniorrhaphy were randomly allocated into two groups (group C and M). The patients of group C (n = 20) received hyperbaric bupivacaine (0.5%; 13 mg) and normal saline (0.004 ml/kg), and the patients of group M (n = 20) received hyperbaric bupivacaine (0.5%; 13 mg) and meperidine (0.2 mg/kg). After spinal block, the incidence and intensity of shivering were determined objectively by observing involuntary muscle activity. The measurement of the mean arterial pressures and heart rates of the patients, for every two minutes for ten minutes, and subsequently for every five minutes for thirty minutes were carried out. We have also checked the highest sensory block level, and other side effects. RESULTS: There were no significant differences in age, height, weight and duration of surgery between the two groups. Also, the mean arterial pressures, heart rates, and the highest sensory block levels exhibited no differences between the two groups. But, the incidence and intensity of shivering in group M were significantly less than in group C (P<0.05). CONCLUSIONS: Intrathecal meperidine (0.2 mg/kg) was effective in reducing the incidence and intensity of shivering associated with spinal anesthesia for herniorrhaphy.
Anesthesia, Spinal* ; Arterial Pressure ; Bupivacaine ; Heart Rate ; Herniorrhaphy* ; Humans ; Incidence ; Meperidine* ; Muscle, Smooth ; Shivering*

BACKGROUND: It is not clear whether mild hypothermia (34 degrees C) enhances stress hormonal responses during surgery under general intravenous anesthesia. The purpose of this study was determine how mild hypothermia affects hemodymic and stress hormonal responses introperatively and during extubation in patients undergoing cerebral aneurysm surgery under general intravenous anesthesia. METHODS: Anesthesia was induced intravenously with thiopental sodium 5 mg/kg, succinylcholine 1 mg/kg, and maintained with 50% O2, 50% N2O, and propofol using a target controlled system; Diprifusor(R) (3-5 microgram/ml) and muscle relaxation were administered with intravenous vecuronium intermittently. For the normothermia and the hypothermia groups, body temperatures were maintained at 36.9+/-0.3degrees C and 34.2+/-0.2 degrees C, respectively, up to the recovery room. Hemodynamic changes were recorded continuously. Arterial blood gas analysis, glucose, hemoglobin, stress hormones comprising epinephrine, norepinephrine, ADH, ACTH and cortisol were measured at whilst awake, intraoperatively, and just after extubation. RESULTS: Hemodynamic changes from the awake control state to postextubation were not significantly different between the normothermia and hypothermia groups. In the control awake state, all five hormonal concentrations were similar in the two groups. Intraoperatively and during extubation, all hormonal concentrations tended to be lower in the hypothermia group than in the normothermia group, except epinephrine during extubation. During the same period, all except ACTH decreased sufficiently to reach statistical significance (P < 0.05) versus the awake control state. But no significant differents were found between the two groups. CONCLUSIONS: Our data suggest that intraoperative mild hypothermia dose not significantly affect hemodynamic changes or the plasma concentrations of stress hormones.
Adrenocorticotropic Hormone ; Anesthesia ; Anesthesia, Intravenous* ; Blood Gas Analysis ; Body Temperature ; Epinephrine ; Glucose ; Hemodynamics* ; Humans ; Hydrocortisone ; Hypothermia* ; Intracranial Aneurysm ; Muscle Relaxation ; Neurosurgery ; Norepinephrine ; Plasma ; Propofol ; Recovery Room ; Succinylcholine ; Thiopental ; Vecuronium Bromide

BACKGROUND: This study was doned to evaluate the rate of awakening after desflurane or isoflurane anesthesia in pediatric tonsillectomy patients. METHODS: Sixty patients, aged 5 10 years undergoing a tonsillectomy with or without an adenoidectomy were randomly assigned to receive either desflurane-N2O (group D) or isoflurane-N2O (group I). A recovery profile was assessed by a 3 point scale for the first 0, 15 and 30 min in the recovery room. RESULTS: It was statistically significant that group D had a shorter extubation time and eye opening time and a less apprehensive score than group I at 0, 15 and 30 min. CONCLUSIONS: We conclude that desflurane-N2O may offer clinical advantages over isoflurane when used for maintenance of anesthesia during a pediatric tonsillectomy.
Adenoidectomy ; Anesthesia ; Humans ; Isoflurane ; Recovery Room ; Tonsillectomy*

Purpose: To evaluate the proportion of bevacizumab and the reason for its usage in wet age-related macular degeneration (AMD). Methods: Retrospective analysis of medical records was performed for 1,541 patients who received ranibizumab, aflibercept, or bevacizumab injection to treat wet AMD. The proportion of bevacizumab among the entire set of injections was identified. The reason for selecting bevacizumab was additionally identified. Results: During the study period, a total of 2,929 anti-vascular endothelial growth factor (anti-VEGF) injections were performed; 2,236 (76.3%) were ranibizumab or aflibercept injections and 693 (23.7%) were bevacizumab injections. The most common reason for bevacizumab usage was ‘having a 0.1 or worse best-corrected visual acuity or being unable to assure reimbursement due to the development of extensive scarring or geographic atrophy’ (297 bevacizumab injections, 42.9%). The second most common reason was ‘the inability to assure reimbursement such as extrafoveal choroidal neovascularization (CNV) or early CNV without definite fluid in the foveal region’ (201 bevacizumab injections, 29.0%). Conclusions Bevacizumab was used in 23.7% of the anti-VEGF injections to treat wet AMD. When analyzing patients’ treatment burden and financial impact, the results of the present study may provide useful information. Further multi-center studies are required to evaluate more precisely the usage of anti-VEGF drugs.

Purpose: To evaluate the proportion of bevacizumab and the reason for its usage in wet age-related macular degeneration (AMD). Methods: Retrospective analysis of medical records was performed for 1,541 patients who received ranibizumab, aflibercept, or bevacizumab injection to treat wet AMD. The proportion of bevacizumab among the entire set of injections was identified. The reason for selecting bevacizumab was additionally identified. Results: During the study period, a total of 2,929 anti-vascular endothelial growth factor (anti-VEGF) injections were performed; 2,236 (76.3%) were ranibizumab or aflibercept injections and 693 (23.7%) were bevacizumab injections. The most common reason for bevacizumab usage was ‘having a 0.1 or worse best-corrected visual acuity or being unable to assure reimbursement due to the development of extensive scarring or geographic atrophy’ (297 bevacizumab injections, 42.9%). The second most common reason was ‘the inability to assure reimbursement such as extrafoveal choroidal neovascularization (CNV) or early CNV without definite fluid in the foveal region’ (201 bevacizumab injections, 29.0%). Conclusions Bevacizumab was used in 23.7% of the anti-VEGF injections to treat wet AMD. When analyzing patients’ treatment burden and financial impact, the results of the present study may provide useful information. Further multi-center studies are required to evaluate more precisely the usage of anti-VEGF drugs.

Purpose: The effects of dexmedetomidine on locomotor function and thermal hyperalgesia in sciatic nerve crush injury (SNCI) were investigated using rats. Methods: After exposing the right sciatic nerve, the sciatic nerve was crushed for 1 minute by a surgical clip. One day after nerve injury, dexmedetomidine (5, 25, and 50 µg/kg) was directly applied to the injured sciatic nerve once a day for 14 days. Walking track analysis was used to assess locomotor function and plantar test was conducted to assess thermal pain sensitivity. Immunohistochemistry was performed to determine the expression of c-Fos in the ventrolateral periaqueductal gray (vlPAG) and paraventricular nucleus (PVN). Western blot was used to evaluate the expression level of nerve growth factor (NGF) and myelin basic protein (MBP) in the sciatic nerve. Results: SNCI resulted in deterioration of locomotor function and increased thermal pain sensitivity. The level of c-Fos expression in the PVN and vlPAG was increased and the level of NGF and MBP expression in the sciatic nerve was enhanced by SNCI. Dexmedetomidine treatment improved locomotor function and upregulated expression of NGF and MBP in the sciatic nerve of SNCI. Dexmedetomidine treatment alleviated thermal hyperalgesia and downregulated expression of c-Fos in the vlPAG and PVN after SNCI. Conclusions Dexmedetomidine may be used as a potential new treatment drug for recovery of locomotion and control of pain in peripheral nerve injury.

Endoscopic thyroidectomy has been increasingly used because it is minimally invasive, provides better cosmetic results as well as less, post-operative pain. However, the technique is associated with complications that, include subcutaneous emphysema, hypercarbia and pneumothorax. We treated a 45 year-old female patient who had subcutaneous emphysema, hypercarbia and increased peak inspiratory airway pressure due to carbon dioxide administered during the endoscopic thyroidectomy. After the above problems occurred, we increased the minute ventilation with 100% O2. The operation was over after about one hundred twenty minutes and ventilation was adequate so that arterial blood gas findings returned to the normal range in the recovery room. The patient was treated conservatively with oxygen and recovered completely at the time of discharge from the Hospital
Carbon Dioxide ; Female ; Humans ; Middle Aged ; Oxygen ; Pneumothorax ; Recovery Room ; Reference Values ; Subcutaneous Emphysema* ; Thyroidectomy* ; Ventilation

Acupuncture appears to be a clinically effective treatment for acute and chronic pain. A considerable amount of research has been conducted to evaluate the role that acupuncture plays in pain suppression; however, few studies have been conducted to evaluate the side effects of the acupuncture procedure. This case report describes a suspected postdural puncture headache following acupuncture for lower back pain. Considering the high opening pressure, cerebrospinal fluid leakage, and the patient's history of acupuncture in the lower back area, our diagnosis was iatrogenic postdural puncture headache. Full relief of the headache was achieved after administration of an epidural blood patch.
Acupuncture ; Blood Patch, Epidural ; Cerebrospinal Fluid Pressure ; Chronic Pain ; Headache ; Low Back Pain ; Needles ; Post-Dural Puncture Headache

No abstract available.
Bone Matrix* ; DNA* ; Gelatin* ; Osteoblasts*