Neuroleptic malignant syndrome is a rare, but potentially life-threatening adverse event associated with the use of neuroleptic agents. We describe the case of a 47-year-old schizophrenic woman who was treated with clozapine for years. The patient developed acute renal failure with pulmonary edema, and underwent mechanical ventilation and hemodialysis.
Acute Kidney Injury ; Antipsychotic Agents ; Clozapine* ; Female ; Humans ; Middle Aged ; Neuroleptic Malignant Syndrome* ; Pulmonary Edema ; Renal Dialysis ; Respiration, Artificial ; Rhabdomyolysis

Holt-Oram Syndrome is an autosomal dominant disorder characterized by the association of upper-limb abnormalities and congenital heart disease. A woman with no family history of genetic disease underwent antenatal sonography at 27 weeks' menstrual age to screen for fetal anomalies. Ultrasonography revealed abnormalities in the upper limbs. The limb abnormalities included abscence of bilateral thumbs and radius: the left humus was short. Pregnancy termination was performed. The postnatal chromosomal analysis revealed a normal 46XX karyotype and the autopsy finding confirmed the Holt-Oram syndrome. We report a case of Holt-Oram Syndrome in fetus with unaffected parents with brief of the literatures.
Autopsy ; Extremities ; Female ; Fetus ; Heart Defects, Congenital ; Humans ; Karyotype ; Parents* ; Pregnancy ; Radius ; Soil ; Thumb ; Ultrasonography* ; Upper Extremity

Calciphylaxis has been described as a rare condition in patients with end-stage renal disease and secondary hyperparathyroidism. Selye et al. first coined the term calciphylaxis to describe soft-tissue calcification and cutaneous necrosis. The common manifestation include painful digital necrosis and medial calcification of small and medium sized vessels. Calciphylaxis is a clinical diagnosis and is characterized by painful, violaceous, mottled skin lesions. Radiographic studies reveal calcification of median and small vessels under the knee but vascular calcification is not specific for calciphylaxis. Histolopathologic findings show a markedly reduced lumen, secondary to the fibrin deposition and inflammation in and around the outer media with an outer ring of calcification which leads to progressive ischemic tissue necrosis. Kidney transplantation and parathyroidectomy is recommened but it is controversial. We present the case of a 64-years-old man with chronic renal failure as well as painful ischemic necrosis on the lower extremity. The pertinets literature is reviewed.
Calciphylaxis ; Diagnosis ; Fibrin ; Humans ; Hyperparathyroidism, Secondary ; Inflammation ; Kidney Failure, Chronic* ; Kidney Transplantation ; Knee ; Lower Extremity ; Necrosis ; Numismatics ; Parathyroidectomy ; Skin ; Vascular Calcification

From May 1, 1993 to May 31 1995, the authers studied retrospectively 211 patients who underwent cardiovascular operation with cardiopulmonary bypass (CPB). Because we were interested in new development of ARF (prevalence, mortality rate, and main risk factors), we performed a multivariate statistical analysis about data of patients with preoperative serum creatinine values of less than 1.5 mg/dL. Normal renal function before operation (serum creatinine level less than 1.5 mg/dL) was registered in 198 (74%) patients. Of these, 27 (14%) patients showed postoperative renal complication, including 20 (10%) patients classified as renal dysfunction (serum creatinine level between 1.5 and 2.5 mg/dL) and 7 (4%) patients as acute renal failure (serum creatinine level higher than 2.5 mg/dL). The mortality rate was 5.8% in normal patients, 5% in patients with renal dysfunction, and 43% when acute renal failure developed (p=0.036). Indeed, the renal impairment proved to be an independent predictor of mortality (odd ratio 2.52~11.25), along with cardiovascular (odd ratio 4.20) and respiratory (odd ratio 2.18) complications. Multivariate analysis identified the following variables as independent risk factors for postoperative renal impairment : advanced age (odd ratio 1), need for emergency operation (odd ratio 3.78), low-output syndrome (odd ratio 3.66), respiratory complication (odd ratio 1.30), need for deep hypothermic circulatory arrest (odd ratio 1.4). The 13 patients (7%) with preoperative renal failure showed a significantly higher morbidity and mortality rate than those without renal complications before operation. We concluded that the likelihood of severe renal complications is resonably low in the patients undergoing cardiac operation without preexisting renal dysfunction, but associated mortality remains high. A prominant role of hemodynamic factor in the development of postoperative acute renal failure must be recognized during preoperative, intraoperative, and postoperative periods.
Acute Kidney Injury* ; Cardiopulmonary Bypass ; Circulatory Arrest, Deep Hypothermia Induced ; Creatinine ; Emergencies ; Hemodynamics ; Humans ; Mortality ; Multivariate Analysis ; Postoperative Period ; Renal Insufficiency ; Retrospective Studies ; Risk Factors

A 56-year old female underwent total aortic arch replacement March 1995, because of an expanding chronic Debakey type I aortic dissection. This aortic dissection had an intimal tear at the origin of the right carotid artery. Retrograde and antegrade propagation of dissection resulted in aortic arch blood flow separation and expanding pseudolumen to the abdominal aorta. Sudden anuria (ARF) developed 3 hours later postoperatively and renal doppler ultrasonography and aortography showed diminished blood flow of renal arteries. We performed balloon aortic dilatation but failed. She could be restored good renal flow after intimal flap fenestration resection and thrombectomy of the abdominal aorta. This patient could be discharged in a state of mild CRF after 2 months of ICU care for respiratory and renal failure.
Acute Kidney Injury* ; Anuria ; Aorta, Abdominal ; Aorta, Thoracic* ; Aortography ; Carotid Arteries ; Dilatation ; Female ; Humans ; Middle Aged ; Renal Artery ; Renal Insufficiency ; Thrombectomy ; Ultrasonography, Doppler

PURPOSE: Midurethral sling procedure is widely used as a primary choice for managing female stress urinary incontinence(SUI) in many countries. But some complications are inevitable, although the incidence is very low. Mesh cutting may be required to correct unwanted problems in some patients. We evaluated the outcome of mesh cutting in patients having mesh-related complications. MATERIALS AND METHODS: Medical records of patients who underwent cutting of midurethral tape from January 2001 to December 2005 were reviewed and a detailed telephone interview was done to see if stress urinary incontinence recurred at least a year after cutting. RESULTS: Eleven patients were included in this study. Mean age was 51.2 ranging from 41 to 70. The reasons why their meshes should be cut were as follows; eight(72.7%) had voiding difficulty, two(18.2%) had a tape erosion and one had voiding difficulty and overactive bladder. These problems were corrected by mesh cutting except one. However, a year after cutting, four out of eleven patients(36.4%) developed recurrent stress urinary incontinence. Recurrence occurred in three out of five patients(60.0%) whose meshes were cut within 1 month after implant, while occurred in 1 out of 6(16.7%) whose meshes were cut after 2 months of implant. Three out of four patients(75.0%) who had mixed urinary incontinence developed recurrence after mesh cutting. In particular, two patients who had detrusor overactivity confirmed by cystometry before surgery showed recurrence of incontinence after mesh cutting. CONCLUSION: A total 36.4% of patients who required mesh cutting developed recurrence of SUI. These data demonstrate that mesh cutting may cause recurrence and urologists should be aware that mesh cutting may be disappointing. Mixed urinary incontinence and duration from implant to mesh cutting seem to be the risk factors of recurrence after mesh cutting.
Female* ; Follow-Up Studies* ; Humans ; Incidence ; Interviews as Topic ; Medical Records ; Recurrence ; Risk Factors ; Suburethral Slings* ; Urinary Bladder, Overactive ; Urinary Incontinence*

No abstract available.
Anesthesia, Epidural*

PURPOSE: Microfat graft is a common procedure for correcting tear trough deformity and dark circle. Because the tissue in this area is very thin, the grafted fat, sometimes, induces palpable lumps and uneven skin contour. When it happens, the surgical removal of the grafted fat is often needed. The authors made attempt of transconjunctival approach for removal, and this made infraorbital fat repositioning possible at the same time. METHODS: 15 female patients with history of microfat graft on lower eyelid, got operation for the grafted fat removal with transconjunctival approach from April of 2009 to July of 2010. The dissection was performed in accordance with infraorbital fat repositioning surgery. Through the transconjunctival incision, knotted fat on orbital septum and orbicularis oculi muscle was removed without damage on skin. After grafted fat removal, subperiosteal space was made 1~2mm below the inferior orbital rim by elevating periosteum. With preserving orbital septum, infraorbital fat was repositioned and anchored to subperiosteal space. Finally, transconjunctival incision was closed with absorbable suture material. RESULTS: 14 patients in the study showed satisfactory results. The problems like uneven skin contour and knotted fat mass, were all solved. In only one patient, incomplete correction was observed, as bulging on her right lower eyelid still remained. One patient complained of transient numbness on lower eyelid, but there was no specific complication other than this. CONCLUSION: The authors attempted the method of transconjunctival approach to remove former grafted fat in lower eyelid and reposition infraorbital fat simultaneously. Since the study brought great results, the method would be helpful to patients and surgeons.
Congenital Abnormalities ; Eyelids ; Female ; Humans ; Hypesthesia ; Muscles ; Orbit ; Periosteum ; Skin ; Sutures ; Transplants

Patient management is considered an important factor in dental field. The aim of this review is to analyze the efficacy of hypnosis to treat fear, anxiety, pain, stress of dental patients, and see how it can be adopted in dentistry for improving patient satisfaction. Medline research was carried out to find the use of hypnosis in dentistry and other aspects of hypnosis in medical area. It can help patient more comfortable, relax, and accordingly reduce patient's negative feelings such as fear, anxiety, pain, stress during dental treatment. Also, it affects patient recovery after surgery by accelerating healing speed and reinforce immune system. When hypnosis is used with other anesthetic method, it can reduce the use of main medication, leading to reduce possibility of side effect. Therefore, using Hypnosis can give patients more comfortable dental experience, both mentally and physically, ultimately making patients more satisfied with the dental treatment.
Anxiety ; Dentistry* ; Humans ; Hypnosis* ; Immune System ; Methods ; Patient Satisfaction*

No abstract available.
Anemia, Refractory* ; Cyclosporine*