PURPOSE: To compare the safety and efficacy of tamsulosin and tamsulosin with the phosphodiesterase-5 inhibitor tadalafil in combination with prednisolone as medical expulsive therapies for lower ureteric stones. MATERIALS AND METHODS: Between July 2011 and December 2012, 62 adult patients presenting with distal ureteric stones sized 5 to 10 mm were randomized equally to treatment with tamsulosin (group A) or tamsulosin with tadalafil (group B). Therapy was given for a maximum of 6 weeks. In addition, patients in groups A and B were given 5-mg prednisolone once daily (maximum 1 week). The stone expulsion rate, time to stone expulsion, analgesic use, number of hospital visits for pain, follow-up and endoscopic treatment, and adverse effects of the drugs were noted. Statistical analyses were done by using Student t-test and chi-square test. RESULTS: There was a higher expulsion rate (83.9% in group B and 74.2% in group A) and a lower time to expulsion in both treatment groups than in historical controls used in earlier studies. However, these results were not statistically significant (p=0.349, p=0.074, respectively). Statistically significant differences were noted in hospitalization for colic and analgesic requirement, which were less in group B than in group A. There were no serious adverse events. Another important finding was improvement in erectile function in group B. CONCLUSIONS: Medical expulsive therapy for distal ureteric stones using tamsulosin and tadalafil with prednisolone is safe and efficacious. Also, the prescription of tadalafil in cases of erectile dysfunction with the development of lower ureteric stones may provide additional advantages.
Adult ; Colic ; Cyclic Nucleotide Phosphodiesterases, Type 5 ; Erectile Dysfunction ; Follow-Up Studies ; Hospitalization ; Humans ; Male ; Prednisolone* ; Prescriptions ; Ureter* ; Urinary Calculi

Clozapine is a gold standard medication and drug of choice in refractory schizophrenia. Among many of its fatal side effects, delirium is less reported and inconsistently recognized by clinicians. We here present a case of delirium which emerged during retreatment with clozapine in a patient of paranoid schizophrenia. A patient diagnosed with paranoid schizophrenia, was restarted on clozapine after he left medications and became symptomatic. He was delirious on 22nd day after clozapine was restarted. Clozapine was stopped and the patient was managed with standard treatment for delirium. After one week interval, clozapine was restarted. Delirium was not noted till 6 weeks of his hospital stay. Clozapine induced central anticholinergic toxicity or clozapine induced seizure might cause delirium in index case. Limited literature exist delirium with clozapine. Clinicians must have high index of suspicion to detect delirium during clozapine therapy. More researches should focus to explore the association between delirium and clozapine.
Clozapine* ; Delirium* ; Humans ; Length of Stay ; Retreatment ; Risk Factors ; Schizophrenia ; Schizophrenia, Paranoid ; Seizures

BACKGROUND: The prevalence of os acromiale has been documented to be between 1% and 15% and is known to be clinically associated with subacromial impingement or rotator cuff tear. However, the prevalence of os acromiale in Korea has not yet been determined. The purpose of this study is to evaluate the prevalence of os acromiale in Korean patients who visited shoulder clinics and to investigate the correlations with rotator cuff tear. METHODS: We retrospectively reviewed the X-rays of patients visiting a shoulder clinic at a tertiary hospital in Korea from January 2011 to January 2012 to determine the frequency of os acromiale. X-ray findings were confirmed with magnetic resonance imaging (MRI) for patients who had these images available. MRI was also used to assess the status of the rotator cuff. The correlation between the presence of os acromiale either with gender, hand dominance or rotator cuff tear was analyzed statistically. RESULTS: A total of 2,946 shoulders from 1,568 patients were analyzed with X-rays. Thirteen cases out of 1,568 patients had an os acromiale; and there were five and eight cases of pre-acromiale and meso-acromiale, respectively. Thus, the prevalence of os acromiale in this study population was found to be 0.7 (7 cases per 1,000 patients). Bilaterality was found in two cases. Os acromiale was not more frequent according to gender (five males versus eight females, p = 0.525) and hand dominance was not associated with frequency of os acromiale (seven dominant arms versus six non-dominant arms, p = 0.631). A sub-analysis of shoulders with available MRIs (1,074 shoulders) revealed that there were two rotator cuff tears (40%) out of five cases of os acromiale, whereas 607 rotator cuff tears were observed (57%) among 1069 cases without os acromiale. This difference was not statistically significant (p = 0.656). CONCLUSIONS: The identified prevalence of os acromiale in Korean patients who visited shoulder clinics is 0.7%, which is much lower as compared with the prevalence of general population from other ethnic groups. No correlation was observed between rotator cuff tears and os acromiale in this study population.
Acromion/*pathology/*radiography ; Adult ; Aged ; Ambulatory Care Facilities ; Female ; Humans ; Joint Diseases/*epidemiology/pathology/radiography ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Prevalence ; Republic of Korea/epidemiology ; Retrospective Studies ; Rotator Cuff/*pathology/*radiography ; Shoulder Impingement Syndrome

Purpose: To evaluate the clinical presentation, management, and outcome of eyes with an inadvertent globe perforation during peribulbar or retrobulbar block. Methods: This retrospective study evaluated the eyes which had an accidental globe perforation during local ocular anesthesia from 2012 to 2020. The patients were divided into three groups: group 1, Clear media with no rhegmatogenous retinal detachment (RRD); group 2, significant vitreous hemorrhage (VH) precluding the retinal view without RRD; and group 3, RRD with/without VH. Results: Twenty-five patients were included in the study. The mean axial length (AL) was 24.7 ± 2.7 mm (range, 20.9–31.2 mm). The most common presenting feature was VH (n = 14). The treatment included retinal laser barrage (n = 7) and vitrectomy (n = 17). Retinal breaks were identified in all the eyes (total breaks = 37). The mean presenting best-corrected visual acuity in groups 1, 2, and 3 were logarithm of the minimum angle of resolution 0.79 ± 0.73, 1.82 ± 0.78, and 2.13 ± 0.59 respectively. All the treated patients had an attached retina at the last follow-up. The mean final best-corrected visual acuity for each group was logarithm of the minimum angle of resolution 0.59 ± 0.79, 0.48 ± 0.26, and 1.25 ± 0.64, respectively (p = 0.006). The development of RRD was associated with a larger AL (p = 0.015); while the development of significant VH associated with the superior location of the perforation (p = 0.015), late recognition of the perforation (p = 0.004), and multiple perforations (p = 0.015). Conclusions Early recognition and intervention in eyes with an inadvertent perforation can lead to a good outcome. Eyes with a longer AL, superior, and multiple perforations are at higher risk of developing complications like RRD and VH. Complications like RRD, macular injury, and vascular occlusion are risk factors for poor prognosis.

PURPOSE: Liver is the most frequently injured organ in abdominal trauma. Today non-operative management (NOM) is considered as the standard of care in hemodynamically stable patients, with or without the adjunct of angioembolisation (AE). This systematic review assesses the incidence of complications in patients who sustained liver injuries and were treated with simple clinical observation. Given the differences in indications of treatment and severity of liver trauma and acknowledging the limitations of this study, an analysis of the results has been done in reference to the complications in patients who were treated with AE. METHODS: A systematic literature review searched "liver trauma", "hepatic trauma", "conservative management", "non operative management" on MEDLINE (via PubMed), Cochrane Central Register of Controlled Trials databases, EMBASE, and Google Scholar, to identify studies published on the conservative management of traumatic liver injuries between January 1990 and June 2020. Patients with traumatic liver injuries (blunt and penetrating) treated by NOM, described at least one outcome of interests and provided morbidity outcomes from NOM were included in this study. Studies reported the outcome of NOM without separating liver from other solid organs; studies reported NOM complications together with those post-intervention; case reports; studies including less than 5 cases; studies not written in English; and studies including patients who had NOM with AE as primary management were excluded. Efficacy of NOM and overall morbidity and mortality were assessed, the specific causes of morbidity were investigated, and the American Association for the Surgery of Trauma classification was used in all the studies analysed. Statistical significance has been calculated using the Chi-square test. RESULTS: A total of 19 studies qualified for inclusion criteria were in this review. The NOM success rate ranged from 85% to 99%. The most commonly reported complications were hepatic collection (3.1%), followed by bile leak (1.5%), with variability between the studies. Other complications included hepatic haematoma, bleeding, fistula, pseudoaneurysm, compartment syndrome, peritonitis, and gallbladder ischemia, all with an incidence below 1%. CONCLUSION NOM with simple clinical observation showed an overall low incidence of complications, but higher for bile leak and collections. In patients with grade III and above injuries, the incidence of bile leak, collections and compartment syndrome did not show a statistically significant difference with the AE group. However, the latter result is limited by the small number of studies available and it requires further investigations.
Abdominal Injuries/complications* ; Compartment Syndromes ; Humans ; Injury Severity Score ; Liver/injuries* ; Retrospective Studies ; Wounds, Nonpenetrating/complications*