Minoxidil is a potent direct-acting peripheral vasodilator indicated in the management of severe or refractory hypertension. Well-known adverse effects include reflex tachycardia, fluid retention and hypertrichosis. This drug has also been reported to cause pericardial effusion in about three percent of nondialyzed patients with compromised renal function and to cause cardiac tamponade less frequently. Many studies have reported that the mean duration of therapy that caused pericardial effusion was about 8 months (range 1 month-53 months). We report a case of cardiac tamponade in nondialyzed patient with chronic renal failure receiving minoxidil for 10 years. A 58-year-old female was admitted to our hospital with dyspnea of NYHA III. She was a chronic renal failure patient without dialysis treatment and received kidney transplantation from cadaver donor and was dignosed chronic rejection in 1994. Minoxidil 10mg has been used for past 10 years. Lasix has been used for past 2 years, with dosage of 40mg to 240mg. On admission, blood pressure was 90/60mm Hg. Cardiomegaly was seen on chest radiograph. The two-dimensional echocardiogram showed a large amount of pericardial effusion. Emergency treatment with pericardiocentesis removed 2500ml of straw- colored pericardial fluid and resulted in marked improvement of dyspnea and stabilized blood pressure. The minoxidil was discontinued. The evidence of pericardial effusion was not seen for 12 months after minoxidil had been discontinued.
Blood Pressure ; Cadaver ; Cardiac Tamponade* ; Cardiomegaly ; Dialysis ; Dyspnea ; Emergency Treatment ; Female ; Furosemide ; Humans ; Hypertension ; Hypertrichosis ; Kidney Failure, Chronic* ; Kidney Transplantation ; Middle Aged ; Minoxidil* ; Pericardial Effusion ; Pericardiocentesis ; Radiography, Thoracic ; Reflex ; Tachycardia ; Tissue Donors

Renal disease is closely associated with hypertension. Hypertension belongs to the clinical picture of chronic kidney disease (CKD). Hypertension associated with renal diseases occurs as a complication of various glomerular and interstitial diseases and may accelerate the decline of renal function if inadequately controlled. The pathophysiology through which the kidney raises blood pressure have been considerably clarified in recent years and it could be shown that "hypertension goes with the kidney" in experimental and clinical studies. The combined interactions of multiple independent mechanisms are thought to be involved in the development of hypertension. Impaired renal sodium handling leads to volume expansion. There is inappropriate activation of the renin-angiotensin system. As only recently documented in detail, renal injury raises the sympathetic tone, even when whole kidney glomerular filtration rate (GFR) is unchanged. This results from stimulating afferent signals coming from the kidney. There also is an evidence of impaired endothelial cell dependent vasodilatation even in very early stages of renal dysfunction. And other factors including uric acid, parathyoid hormone (PTH), and calcium may play a role in concert with other factors in the development of hypertension of renal diseases. Understanding these pathophysiologies is important for appropriate antihypertensive treatment.
Blood Pressure ; Calcium ; Endothelial Cells ; Glomerular Filtration Rate ; Hypertension* ; Kidney ; Kidney Failure, Chronic ; Renal Insufficiency, Chronic ; Renin-Angiotensin System ; Sodium ; Uric Acid ; Vasodilation

No abstract available.
Hypokalemia*

OBJECTIVE: The purpose of this study was to evaluate the effect of interferential current therapy (IFT) of swing pattern frequency alteration on the RIII nociceptive reflex. METHOD: Ten healthy volunteers received IFT of both constant (100 Hz) and swing (20~100 Hz) pattern frequency. Before and after the IFT application RIII nociceptive reflex was evoked by stimulation of sural nerve and recording at biceps femoris muscle. Twenty nine patients with low back pain were treated with IFT of constant or swing pattern frequency and degrees of pain relief were evaluated by Visual Analogue Scale (VAS) and Present Pain Intensity (PPI). RESULTS: The threshold of RIII reflex was increased immediately after both constant and swing frequency, but the increased threshold was lasted for 15 minutes only after swing pattern frequency alteration. Pain relieving effect of IFT evaluated by PPI was also lasted for 15 minutes only after swing frequency alteration. CONCLUSION: These results suggest that IFT of swing pattern frequency alteration had longer lasting effect on the inhibition of RIII nociceptive reflex and the relief of pain than that of constant frequency.
Electric Stimulation Therapy ; Healthy Volunteers ; Humans ; Low Back Pain ; Reflex* ; Sural Nerve

One family with asymmetric septal hypertrophy was reported. The propositus of this family was 31 years old man who was admitted because of transient syncope. His father and one brother were affected but asymptomatic. His sister was suddenly died at age 21 years. The interventricular septal thickness to left ventricular posterior wall thickness ratios were measured using M-mode echocard ogram. In the affected family, echocardiogram revealed asymmetric septal hypertrophy (1.5:1, 2:1, 1.9:1 respectively). In the propositus, cardiac catheterization and simultaneous biventricular cineangiography were performed. Pressure study revealed mild peak systolic pressure gradient within left ventricular apex and left ventricular outflow tract (4mm Hg respectively). Biventricular cineangiogram showed the septal width increased inferiorly, and left ventricular endocardial surface of the septum was straight, while the right ventricular border convex toward the right ventricle.
Adult ; Blood Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Cardiomyopathy, Hypertrophic* ; Cineangiography ; Fathers ; Heart Ventricles ; Humans ; Siblings ; Syncope

No abstract available.
Fractures, Open*

Inhibition of renal prostaglandin synthesis by non-steroidal anti-inflammatory drugs (NSAIDs) causes various electrolyte and acid-base disturbances including sodium retention (edema, hypertension), hyponatremia, hyperkalemia, and decreased renal function. Decreased sodium excretion can result in weight gain, peripheral edema, attenuation of the effects of antihypertensive agents, and rarely aggravation of congestive heart failure. Although rare, NSAIDs can cause hyponatremia by reducing renal free water clearance. Hyperkalemia could occur to a degree sufficient to cause cardiac arrhythmias. Renal function can decline sufficiently enough to cause acute renal failure. NSAIDs associated electrolyte and acid-base disturbances are not uncommon in some clinical situations. Adverse renal effects of NSAIDs are generally associated with prostaglandin dependent states such as volume-contracted states, low cardiac output, or other conditions that tend to compromise renal perfusion. All NSAIDs seem to share these adverse effects. In view of many NSAIDs users' susceptibility to renal adverse effects due to their underlying disease or condition, physicians should be cautious in prescribing NSAIDs to susceptible patients.
Acidosis, Renal Tubular ; Acute Kidney Injury ; Anti-Inflammatory Agents, Non-Steroidal ; Antihypertensive Agents ; Arrhythmias, Cardiac ; Cardiac Output, Low ; Edema ; Heart Failure ; Humans ; Hyperkalemia ; Hyponatremia ; Perfusion ; Sodium ; Water ; Weight Gain

Local anesthesia in strabismus surgery allows for the evaluation of ocular alignment during the operation and enables early postoperative recovery.However, extraocular muscle traction results in decreased heart rate and discomfort for the patient. Therefore, it is our attempt to reveal the degree of of decreased heart rate during extraocular muscle traction and the patient`s pain perception. This was done prospectively on personalities of the patient, preoperative heart rate in the operating room, change of heart rate and pain perception of the patient during surgery. The statistically significant decrease in heart rate due to the ocular cardiac reflex occurs during medial rectus resection, lateral rectus recession, and leads to less satisfaction in the anxious patients. Strabismus surgery under topical anesthesia does not decrease the heart rate significantly, therefore it is relatively safe and the patient`s personality was influence on the intraoperative pain perception of the patients.
Anesthesia* ; Anesthesia, Local ; Heart Rate ; Humans ; Operating Rooms ; Pain Perception ; Prospective Studies ; Reflex ; Reflex, Oculocardiac ; Strabismus* ; Traction

PURPOSE: Study was to evaluate the operative results for tarsal coalition with tarsal tunnel syndrome. MATERIALS AND METHODS: From Jan. 2005 to Mar. 2006, among a number of patients who were diagnosed with tarsal tunnel syndrome caused by tarsal coalition and treated surgically, 5 patients were closely observed for more than 12 months. All cases were talocalcaneal coalition and there were two male and three female patients with a mean age of 36 years (22-50 years). We used the Takakura rating scale as clinical evaluation. RESULTS: All five patients had a burning pain in the sole or extended to toes and showed positive Tinel's sign. Sensory disturbances were observed in the distribution of the medial plantar nerves in four patients and in the area of the medial and lateral plantar nerves in one. Atrophy and weakness of the plantar muscles were seen in two patients. The mean Takakura scale in preoperative and postoperative was 3.4 points (1 to 5 points), 8.6 point (6 to 10 points). The mean follow up was 14.4 months (12 to 16 months). The postoperative results were excellent in two patients, good in two and fair in one. As postoperative complications, there were persistent swelling in one patient and a flexion disturbance of Hallux in one. CONCLUSION: The coalition resection performed on tarsal tunnel syndrome caused by tarsal coalition could improve a level of pains and neurological symptoms significantly. However, since there were some undesirable complications, a detailed explanation to patients is required prior to surgical treatment and study of such complications may be required.
Atrophy ; Burns ; Female ; Follow-Up Studies ; Hallux ; Humans ; Male ; Muscles ; Postoperative Complications ; Tarsal Tunnel Syndrome* ; Tibial Nerve ; Toes

STUDY OBJECTIVE: determine the level of medical care required for mass gatherings and describe the types of medical problems encountered in a religious mass gathered ceremony. DESIGN: Standard charts and a four-tiered triage system(minor, moderate, urgent, and emergent) were developed before the event. The triage system was applied to each chart retrospectively by a single emergency physician. SETTING: Medical staff(10 physicians,13 nurses,1 pharmacist, and 54 first-aid attendants) were based in 8 advanced life support (ALS) clinics. INTERVENTIONS: First-aid attendants referred patients to the clinics, where nurses conducted initial assessments and referred patients to physicians at the venue. Three ambulances were stationed at the venues. RESULT: 22 trauma patients were developed and 183 medical complaints were encountered. Only 7 urgent medical problems were encountered.
Ambulances ; Emergencies* ; Humans ; Pharmacists ; Retrospective Studies ; Triage