No abstract available.
Nursing Homes* ; Nursing* ; Nutritional Status*

No abstract available.
Humans

No abstract available.
Humans

Syndrome of inappropriate antidiutetic hormone(SIADH) secretion is the most common cause of hyponatremia in clinical medicine. Before diagnosis of the SIADH is made, other causes for a decreased diluting capacity and nonosmotic stimuli for AVP release need to be rule out. Disorders associated with SIADH can be divided into 4 major etiologic groups: malignancies, pulmonary diseases, central nervous disorders, and drugs. A 45-year-old woman was admitted due to maculopapular skin eruption and fever after taking medications for fever and myalgia. Generalized tonic clonic seizure was developed nine days later, and laboratory results showed marked hyponatremia. During the evaluation, treatment, and subsequent follow-up, the diagnosis of SIADH was confirmed, but the definitive cause was obscure. With fluid restriction, sodium replacement and demeclocycline therapy, she recovered completely 6 months later. We suggest that the SIADH might be related to drug-induced generalized maculopapular rash via menmgitis-like reaction in CSF as one of systemic adverse side effects to drugs rather than direct effect of related drugs.
Clinical Medicine ; Demeclocycline ; Diagnosis ; Exanthema* ; Female ; Fever ; Follow-Up Studies ; Humans ; Hyponatremia ; Inappropriate ADH Syndrome* ; Lung Diseases ; Middle Aged ; Myalgia ; Seizures ; Skin ; Sodium

BACKGROUND: Postoperative pain may be severe after open heart surgery (OHS). High thoracic epidural analgesia may reduce postoperative pain and improve the pulmonary function. We investigated the effect of epidural analgesia after median sternotomy METHODS: Fifty-six patients were randomized to epidural patient controlled analgesia (PCA) or conventional analgesia (control). Patients received OHS with standardized general anesthetic technique. The day before surgery, patients allocated to the PCA group had an epidural catheter inserted at level T4-5. Proper placement was tested with small dose of lidocaine and epinephrine. Epidural catheter was removed 3 days after surgery. Patients in control group received conventional nurse controlled analgesia. Postoperative assessment included daily visual analog scoring (VAS) and pulmonary function test 3 days after surgery. Complication and patients satisfaction were also evaluated. RESULTS: The VAS scores did not significantly differ between the groups, except 12 hours after surgery during coughing. Patients with PCA awoke and were extubated significantly earlier than patients in control group. Significantly higher forced expiratory volume in 1s and peak expiratory flow rate were seen in PCA group than in control group. No significant thoracic epidural related complications occurred. CONCLUSIONS: Thoracic epidural PCA provided better analgesia and allowed earlier extubation. Thoracic epidural PCA yields a slight, but significant, improvement in pulmonary function.
Analgesia ; Analgesia, Epidural ; Analgesia, Patient-Controlled* ; Catheters ; Cough ; Epinephrine ; Forced Expiratory Volume ; Heart* ; Humans ; Lidocaine ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Peak Expiratory Flow Rate ; Respiratory Function Tests ; Sternotomy ; Thoracic Surgery*

Brugada syndrome is characterized by an ECG pattern of right bundle branch block and ST segment elevation in right precordial leads (V1 to V3), without structural heart disease. However, these ECG manifestations transiently normalize in up to 40% of cases. Brugada syndrome is responsible for up to one half of all sudden cardiac deaths in young adults and they may be worsened by beta blockers. We present the anesthetic management of a patient with Brugada syndrome without the characteristic ECG pattern.
Anesthesia* ; Brugada Syndrome* ; Bundle-Branch Block ; Death, Sudden ; Death, Sudden, Cardiac ; Electrocardiography* ; Heart Diseases ; Humans ; Young Adult

Advances in genomic processing technology have been applied to the human microbiota and have provided the understanding of the effect of the microbiota in human health and disease. Especially, studies of the gut microbiota have revealed that changes in gut microbiota are related to obesity and the metabolic syndrome. With weight gain, there is an increase in the ratio of Firmicutes to Bacteroidetes. Certain bacteria have increased the ability to ferment dietary substrates, thereby increasing hosts' energy intake and weight gain. After transplantation of microbiota from lean donors, insulin sensitivity of recipients increased along with proliferation of butyrate-producing intestinal microbiota. One important finding after Roux-en-Y gastric bypass is the relative overabundance of Proteobacteria, which is different with the changes seen in weight loss without bypass surgery. Due to the change of microbiota's composition after bypass surgery, the gut environment is changed to unfavorable for energy absorption including decrease of polysaccharide fermentation. Therefore this change may contribute to the improvement of insulin resistance and loss of body weight. According to these results, modifying the gut microbiota through diet, probiotics, fecal transplants, and surgery might be included as therapeutic options for the diseases linked to imbalance in the microbiota.
Absorption ; Bacteria ; Bacteroidetes ; Bariatric Surgery ; Body Weight ; Diabetes Mellitus ; Diet ; Energy Intake ; Fermentation ; Gastric Bypass ; Humans ; Insulin Resistance ; Microbiota* ; Obesity ; Probiotics ; Proteobacteria ; Tissue Donors ; Weight Gain ; Weight Loss

We studied the clinical characteristics, location of epileptogenic regions, and the surgical outcomes in 18 patients with intractable epilepsy associated with previous CNS infections. All patients underwent an extensive presurgical evaluation and 11 patients had intracranial EEG monitoring. On the basis of presurgical evaluation, epileptic regions were localized to the mesial temporal (n = 12) and the neocortical (n = 6) regions. The age of the time of CNS infection was significantly younger and the latent period of non-febrile seizures after CNS infection was longer in patients with mesial temporal lobe epilepsy (MTLE). MRI showed hippocampal atrophy and hippocampal signal changes in 11 of 12 patients with MTLE. Among 6 patients with neocortical epilepsy (NE) 5 patients had normal MRI and one showed cerebral hemi-atrophy. Surgery was successful (class I & II) in all patients with MTLE, however, in the patients with neocortical epilepsy, seizure-free results were not achieved in any patients after resective surgery (6 patients) and only 2 patients achieved Class II outcomes after a second epilepsy surgery consisting of neocortical resection. Patients with MTLE after CNS infection were differentiated from the group of neocortical epilepsy by an earlier onset of CNS infection, a prolonged latent period and a higher frequency of meningitis. The characteristic pathology in this group was hippocampal sclerosis and the surgical result was excellent. Neocortical epilepsy following CNS infection usually had no focal lesion on MRI and was associated with a relatively poor surgical result. This study suggested that the surgical outcome was influenced by the type of epileptic syndromes rather than the etiology of seizures. The association of MTLE with the younger age of CNS infections and with meningitis more frequently suggested that the neocortical neurons during infancy or early childhood may be more resistant to the epileptogenesis, or that the CNS infections in patients with MTLE might be milder in severity to cause selective injuries to the hippocampal neurons during their vulnerable stage.
Adolescence ; Adult ; Encephalitis/surgery* ; Epilepsy/surgery* ; Female ; Human ; Male ; Meningitis/surgery*

Background: Discoid lupus erythematosus (DLE) with alopecia of the scalp can result in permanent hair loss. Therefore, it is important to evaluate skin lesions and establish appropriate treatment plans for scalp DLE with alopecia. Objective: We aimed to investigate the dermoscopic features of scalp DLE with alopecia and to determine the correlation between dermoscopic findings and treatment efficacy. Methods: Thirty-one patients histopathologically diagnosed with scalp DLE and alopecia were included. We reviewed clinical photographs and dermoscopic findings of the patients and evaluated their treatment responses. Results: The most frequent dermoscopic features of DLE with alopecia were follicular keratotic plugs (96.8%), white scales (71.0%), telangiectatic vessels (67.7%), and pigmentation (64.5%); followed by absent follicular openings (48.4%), white structureless areas (35.5%), follicular red dots (16.1%), and perifollicular whitish halo (12.9%). After at least 6 months of treatment, hair regrowth was observed in 22 patients (71.0%). Dermoscopic findings showed that white structureless areas, perifollicular whitish halo, absent follicular openings (especially when the alopecic patch involved ＞25% of the scalp), and moderate to severe telangiectatic vessels were associated with absence of hair regrowth. Conclusion Dermoscopy is a promising tool for evaluating lesions and predicting therapeutic outcomes in scalp DLE with alopecia. It may contribute to the establishment of appropriate treatment plan by determining whether hair loss is reversible.