A 47-year-old male patient in whom atrial septal defect (ASD) had been diagnosed 15 years previously was admitted for cardiac catheterization. He had definite cyanotic lips and nail beds and severe pulmonary arterial hypertension (PAH). He had received medical treatment only for the last few years after being diagnosed with Eisenmenger syndrome. After cardiac catheterization, he received iloprost inhalation therapy pre and postoperation and was discharged after successful surgical closure of the ASD.
Cardiac Catheterization ; Cardiac Catheters ; Eisenmenger Complex ; Heart ; Heart Diseases ; Heart Septal Defects, Atrial ; Humans ; Hypertension ; Hypertension, Pulmonary ; Iloprost ; Lip ; Male ; Middle Aged ; Nails ; Respiratory Therapy

Congenital long QT syndrome is a rare but potentially lethal disease, characterized by a corrected QT interval of at least 440 msec, ventricular arrhythmia, recurrent syncope, and sudden death. We experienced a case of sudden cardiac arrest during general anesthesia in a child who was later documented to have congenital long QT syndrome. We report this experience with a brief review of literature.
Anesthesia* ; Anesthesia, General ; Arrhythmias, Cardiac ; Child* ; Death, Sudden ; Death, Sudden, Cardiac ; Heart Arrest* ; Humans ; Long QT Syndrome* ; Syncope

BACKGROUND: The purpose of this study was to evaluate the gender-related changes in the function and distribution of alpha1-adrenoceptors in the distal mesenteric artery of streptozotocin (STZ)-induced diabetic rats at the level of alpha1-adrenoceptor subtypes. METHODS: Diabetes was induced by intravenous injection of STZ in a dose of 60 mg/kg through the tail vein in 8 week-old male or female Sprague-Dawley rats (n = 13/group). Age-matched normal rats (n = 15) were used as a control group. Four weeks after STZ injection, the change in mean arterial pressure caused by a 45degrees tilting was recorded. The alpha1-adrenoceptor subtypes mediating contractions of the distal mesenteric artery were investigated using the agonist, phenylephrine as well as subtype-selective antagonists including prazocin, 5-methylurapidil, and BMY 7378. The expression of alpha1-adrenoceptor subtypes of each artery was examined by immunofluorescence staining and western blotting using subtype selective antibodies. RESULTS: Compared with normal male rats, the contractile response to phenylephrine was decreased in the distal mesenteric artery in normal female rats. Moreover, a decrease in contractile force was observed in STZ-induced diabetic rats compared with age-matched controls. Western blotting revealed that there was the difference between normal male and female rats in manifestation of the alpha1D-adrenoceptor. In STZ-induced male and female diabetic rats, all alpha1-adrenoceptor subtypes were decreased in distal mesenteric arteries, compared with normal rats. CONCLUSIONS: There was the gender-related functional difference of alpha1-adrenoceptors in normal rats. In both male and female rats, diabetes decreased the contractile response in mesenteric arteries, which might be caused by the overall change in alpha1-adrenoceptor.
Animals ; Arterial Pressure ; Arteries ; Blotting, Western ; Contracts ; Diabetes Mellitus, Experimental ; Female ; Fluorescent Antibody Technique ; Humans ; Injections, Intravenous ; Male ; Mesenteric Arteries ; Negotiating ; Phenylephrine ; Piperazines ; Rats ; Rats, Sprague-Dawley ; Receptors, Adrenergic, alpha-1 ; Streptozocin ; Veins

PURPOSE: To determine the major reasons that diabetics decide to undergo their first fundus examination, and the factors influencing such reasons. METHODS: Of the patients with type II diabetes who presented to the Department of Ophthalmology in Gachon University Gil Medical Center, 164 patients who underwent their first fundus examination after being diagnosed with diabetes were included in the study. Face-to-face and phone interviews with these patients were conducted. RESULTS: The average prevalence period from the diagnosis of diabetes to the first fundus examination was 8.3 ± 7.5 years. Of the diabetics who underwent their first fundus examination, 52.4% had diabetic retinopathy, with no significant difference in prevalence between the male and female patients (p = 0.118). The most common reason for deciding to undergo the first fundus examination was recommendation by a doctor (53.7%). For those patients who received their first fundus examination after recommendation by a doctor, the prevalence period from diabetes was the shortest among all patients (p < 0.001), and the prevalence and severity of diabetic retinopathy were the lowest (p < 0.001 and p = 0.017, respectively). The number of fundus examinations conducted following recommendation by a doctor was significantly higher in secondary and tertiary hospitals than in primary hospitals (p < 0.001). Education on diabetes and knowledge of diabetic ocular complications were found to be significantly correlated (p < 0.001). CONCLUSIONS: For patients who are diagnosed with diabetes and treated in primary hospitals, who are older, or who did not receive education on diabetes, recommendation by a doctor for early fundus examination is particularly important regardless of subjective visual disturbance. Moreover, patient education should be offered and ophthalmic examination should be recommended in primary hospitals.
Diabetic Retinopathy ; Diagnosis ; Education ; Female ; Humans ; Male ; Ophthalmology ; Patient Education as Topic ; Prevalence ; Tertiary Care Centers

BACKGROUND: Capsular contracture is the most frequently reported complication after implant-based breast reconstruction. This study was first undertaken to present our experience with acellular dermal matrix for prevention of capsular contracture in implant-based immediate breast reconstruction with latissimus dorsi flap, and to assess the final aesthetic outcome. METHODS: We performed a retrospective review of all patients who underwent immediate latissimus dorsi flap breast reconstruction in combination with implant and acellular dermal matrix from January 2014 to December 2015. Demographics and clinical characteristics and postoperative complications, especially focused on capsular contracture, were assessed. They were also analyzed as the potential risk factors for the development of capsular contracture. The aesthetic outcome of the overall reconstruction and the final outcome of the inframammary fold were evaluated. RESULTS: During the study period, a total of 30 patients (30 breasts) were reviewed. The mean Baker grades for all 29 breasts (one breast was dropped out due to implant loss), evaluated at one year after reconstruction, was 1.21±0.49 capsular contracture. None of risk factors except seroma/hematoma (P=0.033) were significantly associated with the development of capsular contracture. Overall aesthetic outcome was 8.2±1.2 and aesthetic outcome of the inframammary fold was 3.5±0.6 for physician and 3.4±0.6 for patients. CONCLUSIONS: In this study, we have shown the ability of acellular dermal matrix to prevent capsular contracture observed in implant-based immediate breast reconstruction with latissimus dorsi flap and its use was proven to create superior aesthetic results.
Acellular Dermis* ; Breast Implants ; Breast* ; Contracture ; Demography ; Female ; Humans ; Mammaplasty* ; Postoperative Complications ; Retrospective Studies ; Risk Factors ; Superficial Back Muscles* ; Surgical Flaps

PURPOSE: This study was performed to investigate whether rebamipide is useful in the treatment of male infertility due to oxidative damage. MATERIALS AND METHODS: 50 infertile males with elevated reactive oxygen species (ROS) in their semen were enrolled. All patients were given an oral daily dose of 900mg rebamipide for at least 3 months. The concentrations of rebamipide and ROS, and the levels of lipid peroxidation, sperm motility, vitality and fertilizing capacity were measured by a high-performance liquid chromatography (HPLC) fluorescent method, chemiluminescence, the thiobarbituric acid method, a computer assisted semen analyzer, eosin-nigrosin staining and hypo-osmotic swelling test, respectively. Additionally, the clinical outcomes, including pregnancy and delivery, were observed at the gynecology outpatient and IVF clinics. RESULTS: The rebamipide concentration in semen after medication was 220.77+/-327.84ng/ml (SD), with a large deviation, but this was higher than the level found in the serum, which was 126+/-76ng/ml (SD). The levels of seminal ROS and lipid peroxidation were significantly decreased according to the duration of treatment (p<0.05). The sperm vitality and fertilizing capacity were also significantly improved at 2-3 months post treatment (p<0.05). Out of the 41 cases with trial pregnancies, 20 (48.8%) became pregnant, consisting of childbirth, miscarriage or ongoing in 17, 2 and 1 case, respectively. Side effects were observed in only 1 case (2%) with self-limits. CONCLUSIONS: These results suggest that rebamipide is an effective free radical scavenger, which may be useful as an oral antioxidant in patients with male infertility due to oxidative damage caused by high tissue affinity to the male accessory organ, antioxidant effect and the improving effect of seminal parameters.
Abortion, Spontaneous ; Antioxidants ; Chromatography, Liquid ; Female ; Gynecology ; Humans ; Infertility, Male ; Lipid Peroxidation ; Luminescence ; Male ; Outpatients ; Oxidative Stress* ; Parturition ; Pregnancy ; Reactive Oxygen Species ; Semen ; Sperm Motility ; Spermatozoa

No abstract available.
Catheters ; Pulmonary Artery

BACKGROUND AND OBJECTIVES: Epistaxis is often regarded as trivial disease, but it may cause serious situation and requires hospital admission. With the advent of nasal endoscopy, localizing the precise location of nasal bleeding is possible in most cases and enables direct treatment rather than simple nasal packing. We analyzed the epistaxis patients who require hospital admission during recent 10 years. MATERIALS AND METHODS: One hundred and one patients who required hospital admission from January 1990 to December 1999 due to intractable or recurrent epistaxis were included in this study. Records of the hospital admission were reviewed and analyzed retrospectively. RESULTS: Male patients were predominant (72.1%) and the highest age distribution was in the 50's. Intervals between the initial attack of epistaxis and medical attention was 2-5 days (60.4%). The mean duration of hospital stay was 5-10 days (49.5%). The precise localization of bleeding point was possible in 98 cases (81.6%), whereas some sites of bleeding revealed Little's area (35.0%) and nasal turbinates (28.3%). The most frequent preexisting structural abnormality and systemic illness were nasal septal deviation and hypertension. In hypertension patients, the predominant age distribution was in the 60's (28.6%), and there was no difference in the bleeding frequency and the mode of management. CONCLUSION: We analyzed the epistaxis patients who required hospitalization. Nasal endoscopy enabled precise localization of the epistaxis and prompt focused management rather than conservative management.
Age Distribution ; Endoscopy ; Epistaxis* ; Hemorrhage ; Hospitalization ; Humans ; Hypertension ; Length of Stay ; Male ; Retrospective Studies ; Turbinates

Purpose: To report a rare case of bilateral optic nerve sheath meningocele diagnosed in a patient with exophthalmos.Case summary: A 33-year-old male visited our clinic with bilateral exophthalmos for 6 months. The patient had been diagnosed with hypertension 3 years previously; however, the condition had been poorly controlled. He also had a history of treatment associated with retinal vein occlusion, macular edema, and papilledema 2 years earlier. There was no limitation in his ocular movement. A Hertel exophthalmometry test showed bilateral exophthalmos of 20 mm in both eyes. Visual field tests showed an inferior arcuate visual field defect in the right eye and a superotemporal peripheral field defect in the left eye. In orbital magnetic resonance imagery, cerebrospinal fluid space widening along the optic nerve and flattening of the bilateral posterior pole of the eye were evident. The patient was diagnosed with optic nerve sheath meningocele. Conclusions Optic nerve sheath meningocele should be considered as a differential diagnosis of exophthalmos patients. Because it is a disease that can affect visual function in a manner similar to that of a visual field defect, rapid diagnosis through imaging study and thorough regular follow-up examinations are essential.

Purpose: To report a rare case of bilateral optic nerve sheath meningocele diagnosed in a patient with exophthalmos.Case summary: A 33-year-old male visited our clinic with bilateral exophthalmos for 6 months. The patient had been diagnosed with hypertension 3 years previously; however, the condition had been poorly controlled. He also had a history of treatment associated with retinal vein occlusion, macular edema, and papilledema 2 years earlier. There was no limitation in his ocular movement. A Hertel exophthalmometry test showed bilateral exophthalmos of 20 mm in both eyes. Visual field tests showed an inferior arcuate visual field defect in the right eye and a superotemporal peripheral field defect in the left eye. In orbital magnetic resonance imagery, cerebrospinal fluid space widening along the optic nerve and flattening of the bilateral posterior pole of the eye were evident. The patient was diagnosed with optic nerve sheath meningocele. Conclusions Optic nerve sheath meningocele should be considered as a differential diagnosis of exophthalmos patients. Because it is a disease that can affect visual function in a manner similar to that of a visual field defect, rapid diagnosis through imaging study and thorough regular follow-up examinations are essential.