Cardiac arrest associated with hyperkalemia during red blood cell transfusion is a rare but fatal complication. Herein, we report a case of transfusion-associated cardiac arrest following the initiation of extracorporeal membrane oxygenation support in a 9-month old infant. Her serum potassium level was increased to 9.0 mEq/L, soon after the newly primed circuit with pre-stored red blood cell (RBC) was started and followed by sudden cardiac arrest. Eventually, circulation was restored and the potassium level decreased to 5.1 mEq/L after 5 min. Extracorporeal membrane oxygenation (ECMO) priming is a relatively massive transfusion into a pediatric patient. Thus, to prevent cardiac arrest during blood-primed ECMO in neonates and infants, freshly irradiated and washed RBCs should be used when priming the ECMO circuit, to minimize the potassium concentration. Also, physicians should be aware of all possible complications associated with transfusions during ECMO.
Blood Transfusion ; Death, Sudden, Cardiac ; Erythrocyte Transfusion ; Erythrocytes ; Extracorporeal Membrane Oxygenation* ; Heart Arrest* ; Humans ; Hyperkalemia* ; Infant* ; Infant, Newborn ; Potassium

PURPOSE: To evaluate the associations between components of metabolic syndrome and retinal vascular changes in a Korean population based on data collected at health check-ups. METHODS: Fundus photographs of 381 patients participating in a health check-up were examined to identify central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE), and arteriovenous ratio (AVR) by IVAN software. Retinal hemorrhage, arteriovenous nicking, and retinal exudate were also noted. The association between metabolic syndrome and each component was then analyzed. RESULTS: Significant associations were shown between metabolic syndrome and CRAE (p = 0.032), central obesity and CRAE (p = 0.037), triglyceride and CRAE (p = 0.011), and triglyceride and AVR (p = 0.005), in addition to central obesity and arteriovenous nicking (odds ratio [OR] = 2.68, p = 0.013), central obesity and retinal exudate (OR = 2.30, p = 0.038), serum glucose and retinal hemorrhage (OR = 8.06, p = 0.030), and blood pressure and arteriovenous nicking (OR = 2.78, p = 0.007). CONCLUSIONS: Metabolic syndrome showed a significant relationship with retinal artery diameter. Central obesity showed the greatest relationship with retinal vascular changes among each of the components of metabolic syndrome.
Blood Glucose ; Blood Pressure ; Exudates and Transudates ; Humans ; Obesity, Abdominal ; Retinal Artery ; Retinal Hemorrhage ; Retinal Vein ; Retinaldehyde* ; Triglycerides

PURPOSE: To evaluate the effectiveness of radioiodine treatment for metastatic thyroid carcinoma, we reviewed results of radioactive iodine treatment in patients with functional lung or bone metastases. MATERIALS ANF METHODS: Of 760 patients who were treated for differentiated thyroid cancer between 1984 and 1998, we detected pulmonary metastases and bone metastases in 76 patients (10.0%) and 20 patients (2.6%), respectively. Among them, we could evaluate the effectiveness of I-131 therapy in 53 patients with lung metastases and 15 patients with bone metastases. RESULTS:Of 53 patients who received I-131 therapy with a mean cumulative dose of 26.2 GBq (1.1-84.4 GBq) for pulmonary metastases, metastatic lung lesions completely resolved in 19 patients (35.8%) and improved in 22 patients (41.5%). In 13 of 19 patients with complete remission of pulmonary metastases, the total accumulated dose of I-131 was less than 18.5 GBq. We found 43 sites of metastatic bone lesions in 15 patients with bone metastases. Of 29 lesions which received I-131 therapy, metastatic lesions improved in 14 sites (48.3%), but did not change or progress in 15 sites (51.7%) despite the I-131 therapy. Three lesions were completely cured with a combination treatment of surgery(+/- external radiotherapy) and I-131 therapy, and the other 11 lesions improved. CONCLUSION: Radioactive iodine treatment gives favorable results for pulmonary metastases. However, for bone metastases, there might be a need to use combination therapy including I-131 and surgery or external irradiation.
Atrial Natriuretic Factor ; Humans ; Iodine ; Lung ; Neoplasm Metastasis* ; Thyroid Gland* ; Thyroid Neoplasms*

Bochdalek hernia through Bochdalek foramen, defect at the posterolateral side of the diaphragm is one of the congenital diaphragmatic hernias. It usually occurs in infants, but very rare in old age and also on the right side. We experienced the right-side Bochdalek hernia including kidney herniation in 68 years old man man ifested by hemoptysis. CT scan revealed diaphragmatic defect and herniated liver, colon and kidney. Thoracotomy was performed and the 10 cm-sized large defect was closed with patch. After then, the patient has been well without symptom.
Aged ; Colon ; Diaphragm ; Hemoptysis ; Hernia* ; Hernia, Diaphragmatic ; Humans ; Infant ; Kidney* ; Liver ; Thoracotomy ; Tomography, X-Ray Computed

PURPOSE: To report a case involving an unexpected increase in intraocular pressure (IOP) and acute angle closure after oral administration of methazolamide. CASE SUMMARY: A 38-year-old male visited the emergency department complaining of decreased visual acuity (VA) and ocular pain. These symptoms developed after he took two tablets of 50 mg methazolamide because his IOP was above normal after a short course of systemic steroid treatment. His uncorrected VA dropped to 0.04 and the refractive error was −6.5 diopters in both eyes. The anterior chamber was very shallow, and the IOPs were 46 mmHg in the right eye and 42 mmHg in the left eye. Macular retinal folds were observed in both eyes in infrared fundus images. The patient was instructed not to take methazolamide, which was suspected as the cause of this idiosyncratic drug reaction. He was prescribed topical anti-glaucoma medications and cycloplegics to relieve the acute angle closure, and all symptoms disappeared after these treatments. CONCLUSIONS: Methazolamide is a sulfa derivative like topiramate, which can cause acute angle closure involving edema of the ciliary body and anterior displacement of the lens-iris diaphragm. Clinicians should consider this possible IOP increase before prescribing methazolamide.
Administration, Oral ; Adult ; Anterior Chamber ; Ciliary Body ; Diaphragm ; Edema ; Emergency Service, Hospital ; Humans ; Intraocular Pressure* ; Male ; Methazolamide* ; Mydriatics ; Refractive Errors ; Retinaldehyde ; Tablets ; Visual Acuity

PURPOSE: Using a visual analogue scale, patients pain was compared according to injection site during intravitreal injection. METHODS: A prospective, clinical trial was conducted on 171 eyes of patients experiencing age-related macular degeneration, diabetic retinopathy, retinal vein occlusion, or central serous chorioretinopathy. After determining the anatomic quadrant of the injection site, patients were randomized to receive intravitreal bevacizumab, aflibercept, ranibizumab, or dexamethasone injection. Fifteen minutes after the injection, patients completed a survey about pain using a visual analogue scale from 0 (no pain) to 10 (unbearable pain). RESULTS: According to the visual analogue scale, pain score was 3.20 at the superotemporal site, 3.03 at the superonasal site, and 2.35 at the inferonasal site. Pain was lowest when injected in an inferotemporal site (p = 0.012). CONCLUSIONS: Intravitreal injection at an inferotemporal site can help reduce patient pain.
Bevacizumab ; Central Serous Chorioretinopathy ; Dexamethasone ; Diabetic Retinopathy ; Humans ; Intravitreal Injections* ; Macular Degeneration ; Pain Measurement ; Prospective Studies ; Ranibizumab ; Retinal Vein Occlusion

Cardiac arrest associated with hyperkalemia during red blood cell transfusion is a rare but fatal complication. Herein, we report a case of transfusion-associated cardiac arrest following the initiation of extracorporeal membrane oxygenation support in a 9-month old infant. Her serum potassium level was increased to 9.0 mEq/L, soon after the newly primed circuit with pre-stored red blood cell (RBC) was started and followed by sudden cardiac arrest. Eventually, circulation was restored and the potassium level decreased to 5.1 mEq/L after 5 min. Extracorporeal membrane oxygenation (ECMO) priming is a relatively massive transfusion into a pediatric patient. Thus, to prevent cardiac arrest during blood-primed ECMO in neonates and infants, freshly irradiated and washed RBCs should be used when priming the ECMO circuit, to minimize the potassium concentration. Also, physicians should be aware of all possible complications associated with transfusions during ECMO.
Blood Transfusion ; Death, Sudden, Cardiac ; Erythrocyte Transfusion ; Erythrocytes ; Extracorporeal Membrane Oxygenation ; Heart Arrest ; Humans ; Hyperkalemia ; Infant ; Infant, Newborn ; Potassium

In accordance with the aged society, oral health care for the elderly is considered important to maintain general health. Although the role of dental hygienists is essential for proper health management of the oral cavity, research on the care system for the elderly people's oral health and on the role of dental hygienists in the field of elderly welfare is still insufficient. Hence, the aim of this study is to investigate the status of Korean elderly welfare system and dental hygienists by comparing them with those in Japan, a precedent of aged society. First, we compared and investigated the Japanese long-term insurance system, which provides an institutional basis for a long-term care system for the elderly in Korea. Second, the elderly welfare law and care system, focusing on oral care, were examined. Lastly, in elderly care, we analyzed the distinctions between Korea and Japan regarding dental hygienists' role and scope of work. Taken together, as a precedent of aged society, Japan has shown well-specialized and systematic welfare for the elderly compared with Korea. With the development of the welfare system for the elderly in Japan, the role and the workscope of dental hygienists have been expanded to improve quality of life of elderly people, as a key professional for elderly oral care. Therefore, we should perceive the need for improvement of long-term care insurance and the expansion of dental hygienists' work in Korea. In conclusion, these results could be used as basic data for improving the elderly welfare system and developing dental hygienists in Korea.
Aged* ; Asian Continental Ancestry Group ; Dental Hygienists* ; Humans ; Insurance ; Insurance, Long-Term Care ; Japan* ; Jurisprudence ; Korea* ; Long-Term Care ; Mouth ; Oral Health ; Quality of Life

Betulinic acid (3-beta-hydroxy-lup20[29]-en-28-oic acid) has attracted significant attention due to its diverse biological and pharmacological activities, including anti-inflammatory, antimicrobial, antiviral, antidiabetic, antimalarial, anti-human immunodeficiency virus, and antitumor effects. However, its effectiveness against oral cancer remains unknown. This study aimed to evaluate the effect of betulinic acid on the induction of apoptosis in FaDu human pharyngeal carcinoma cells by performing 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide (MTT) assay, LIVE/DEAD stain, 4',6-diamidino-2-phenylindole (DAPI) stain and western blot. In the MTT assay, LIVE/DEAD stain, and DAPI stain analyses, betulinic acid increased FaDu cell apoptosis in a concentration-dependent manner. Apoptosis induced by betulinic acid in FaDu cells was mediated by the expression of Fas and the activation of caspase-8, caspase-3, and poly (ADP-ribose) polymerase. Western blotting revealed that B-cell lymphoma 2 (Bcl-2) and B-cell lymphoma-extra large were downregulated, while Bcl-2-associated death promoter and Bcl-2-associated X protein were upregulated by betulinic acid in FaDu cells. These findings indicate that betulinic acid inhibits cell proliferation in FaDu human pharyngeal carcinoma cells and induces apoptosis through both apoptotic receptor-mediated exogenous apoptosis and mitochondrialmediated endogenous apoptosis pathways.

Betulinic acid (3-beta-hydroxy-lup20[29]-en-28-oic acid) has attracted significant attention due to its diverse biological and pharmacological activities, including anti-inflammatory, antimicrobial, antiviral, antidiabetic, antimalarial, anti-human immunodeficiency virus, and antitumor effects. However, its effectiveness against oral cancer remains unknown. This study aimed to evaluate the effect of betulinic acid on the induction of apoptosis in FaDu human pharyngeal carcinoma cells by performing 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide (MTT) assay, LIVE/DEAD stain, 4',6-diamidino-2-phenylindole (DAPI) stain and western blot. In the MTT assay, LIVE/DEAD stain, and DAPI stain analyses, betulinic acid increased FaDu cell apoptosis in a concentration-dependent manner. Apoptosis induced by betulinic acid in FaDu cells was mediated by the expression of Fas and the activation of caspase-8, caspase-3, and poly (ADP-ribose) polymerase. Western blotting revealed that B-cell lymphoma 2 (Bcl-2) and B-cell lymphoma-extra large were downregulated, while Bcl-2-associated death promoter and Bcl-2-associated X protein were upregulated by betulinic acid in FaDu cells. These findings indicate that betulinic acid inhibits cell proliferation in FaDu human pharyngeal carcinoma cells and induces apoptosis through both apoptotic receptor-mediated exogenous apoptosis and mitochondrialmediated endogenous apoptosis pathways.