PURPOSE: To report the long term results of bifocal treatment in nonrefractive accommodative esotropia and to analyze the changes of accommodative convergence to accommodation (AC/A) ratio. METHODS: Sixteen patients treated with bifocal glasses for at least 5 years were evaluated retrospectively. Angle of deviation at near and distance, refractive error, and AC/A ratio by the lens gradient method were analyzed. The changes of AC/A ratios were also compared after dividing the patients according to continuation or cessation of bifocal therapy. RESULTS: Six patients (38%; bifocal stop group, BSG) were able to stop using bifocal glasses at an average age of 10.8 years (range, 6.5 to 15.4 years) during their follow-up. However, the other ten patients (62%; bifocal continue group, BCG) had to continue using bifocal glasses until the final visit, which was 13.8 years on average (range, 11.3 to 18.5 years). The AC/A ratio decreased from time of bifocal prescription to the last visit in both groups, from 4.4 to 2.7 in the BSG and from 5.9 to 4.5 in the BCG. AC/A ratios were significantly higher (p = 0.03) in the BCG than that of the BSG from the beginning of bifocal treatment and this difference was persistent until the final visit (p = 0.03). CONCLUSIONS: The AC/A ratio decreased with age in both groups but was significantly higher throughout the entire follow-up period in the BCG. AC/A ratio at bifocal prescription could be an important factor in predicting response to bifocal treatment.
Accommodation, Ocular/*physiology ; Adolescent ; Child ; Cyclopentolate/administration & dosage ; Esotropia/*physiopathology/*therapy ; *Eyeglasses ; Female ; Humans ; Male ; Phenylephrine/administration & dosage ; Retrospective Studies ; Statistics, Nonparametric ; Tropicamide/administration & dosage

Topical phenylephrine, an agent used to facilitate nasotracheal intubation and prevent nasal mucosal bleeding, can cause severe hypertension in some patients, secondary to its stimulation of alpha-adrenergic receptors. Moreover, a high incidence of pulmonary edema is found in patients whose phenylephrine administration is followed by treatment with beta-blocking agents. We report a case of acute pulmonary edema in a pediatric patient who developed severe hypertension after the inadvertent administration of a large dose of topical nasal phenylephrine, followed by beta-adrenergic antagonists (esmolol).
Administration, Intranasal ; Adolescent ; *Anesthesia, General ; Dentigerous Cyst/surgery ; Humans ; Male ; Phenylephrine/*adverse effects ; Pulmonary Edema/*chemically induced/radiography ; Radiography, Thoracic

PURPOSE: Tribulus terrestris has been used as an aphrodisiac. However, little is known about the effects and mechanism of action of T. terrestris on penile erection. Therefore, the effect of a T. terrestris extract and the mechanism of action of the extract on relaxation of the corpus cavernosum (CC) were investigated. The erectogenic effects of an oral preparation of the extract were also assessed. MATERIALS AND METHODS: The relaxation effects and mechanism of action of the T. terrestris extract on rabbit CC were investigated in an organ bath. The intracavernous pressure (ICP) was calculated after oral administration of the extract for 1 month to evaluate whether the relaxation response of the CC shown in the organ bath occurred in vivo. Additionally, cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP) were measured in the CC by immunoassay. Smooth muscle relaxation was expressed as the percentage decrease in precontraction induced by phenylephrine. The ICP was also assessed in rats after oral administration of the extract for 1 month, and changes in concentrations of cGMP and cAMP were monitored. RESULTS: Concentration-dependent relaxation effects of the extract on the CC were detected in the organ bath study. Relaxation of the CC by the T. terrestris extract was inhibited in both an endothelium-removed group and an L-arginen methyl ester pretreatment group. The ICP measured after oral administration of the T. terrestris extract for 1 month was higher than that measured in the control group, and a significant increase in cAMP was observed in the T. terrestris extract group. CONCLUSIONS: The T. terrestris extract induced concentration-dependent relaxation of the CC in an organ bath. The mechanism included a reaction involving the nitric oxide/nitric oxide synthase pathway and endothelium of the CC. Moreover, in an in vivo study, the T. terrestris extract showed a significant concentration-dependent increase in ICP. Accordingly, the T. terrestris extract may improve erectile function.
Adenosine Monophosphate ; Administration, Oral ; Animals ; Baths ; Endothelium ; Guanosine Monophosphate ; Immunoassay ; Male ; Muscle, Smooth ; Penile Erection ; Phenylephrine ; Rats ; Relaxation ; Tribulus

The syndrome of nonsyphilitic interstitial keratitis associated with vestibulcauditory symptoms (tinnitus, vertigo, nystagmus and progressive deafness) was described by Dr. Cogan in 1945. Since then, numerous cases of this clinical entity have been reported elsewhere in the world. Recently the author experienced one case of Cogan's syndrome in our ophthalmologic OPD for the first time in Korea. The 45 years old male patient, looking very well on gross appearance, was admitted to ENT ward with sudden onset of vertigo, tinnitus and progressive deafness under the diagnosis of Meniere's disease on May 14,1976. Two month later, on July 6, 1976, the visual acuity in his left eye had suddenly deteriorated from 1.2 to 0.6. Under the slit lamp microscopic examination, mild infiltration in the corneal stroma and almost total pcsterior synechia were detected, and a few inflammatory cells were found in anterior chamber but not observed agueous flares. Several fine keratic precipitates were adhered on the lower one half of the posterior corneal surface as a linear apperance. The patient was treated by local instillation of 1% Atropine, 10% Phenylephrine and 3%. Dexamethasone, and also 1% Depomedrol was injected subconjunctivally. Oral administration of Dexamethasone, Vitamine B complex, INH and Chloramphenicol were combined. Thereafter those ocular symptoms had gradually improved, and recently his visual acuity has recovered to normal level (OS 1.2). The vestibuloauditory symptoms just as tinnitus and vertigo were also disappeared, where as moderate deafness has been still remained.
Administration, Oral ; Anterior Chamber ; Atropine ; Chloramphenicol ; Cogan Syndrome* ; Corneal Stroma ; Deafness ; Dexamethasone ; Diagnosis ; Humans ; Keratitis* ; Korea ; Male ; Meniere Disease ; Middle Aged ; Phenylephrine ; Tinnitus ; Vertigo ; Visual Acuity ; Vitamins

PURPOSE: To maximize effective use of mydriatic drugs through comparing the pupillary dilation effects between 1% tropicamide and 2.5% phenylephrine. METHODS: Fifty people requiring pupillary dilation were divided into 3 groups. Group 1 was treated with one drop of 1% tropicamide in the right eye and one drop of 2.5% phenylephrine in the left eye. Group 2 was treated twice during a 5-minute interval with 1% tropicamide in the right eye. Group 3 was treated twice during a 5-minute interval with 2.5% phenylephrine in the right eye. Groups 2 and 3 were treated with 2.5% phenylephrine and 1% tropicamide in the left eye, administered during a 5-minute interval. The pupillary size was measured in all groups for 40 minutes following eye drops administration. RESULTS: The mean patient age was 15.7 years. Group 1 included 10 patients, and groups 2 and 3 included 20 patients each. Eight patients in group 1 and 16 patients in group 2 developed a larger right pupil. Fourteen patients in group 3 developed a larger left pupil. CONCLUSIONS: Our study showed that 1% tropicamide, with its parasympathetic antagonistic mechanism of action, was more effective at inducing pupillary dilation than 2.5% phenylephrine, and the combination of 1% tropicamide and 2.5% phenylephrine was more effective than multiple drops of single eye drops.
Adolescent ; Adult ; Child ; Child, Preschool ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Female ; Follow-Up Studies ; Humans ; Male ; Muscarinic Antagonists/*administration & dosage ; Mydriatics/*administration & dosage ; Ophthalmic Solutions ; Phenylephrine/*administration & dosage ; Pupil/*drug effects ; Refractive Errors/diagnosis/physiopathology ; Retrospective Studies ; Tropicamide/*administration & dosage ; Young Adult

OBJECTIVETo study the effects of dopamine and phenylephrine for treatment of hypotension during cesarean section under combined spinal epidural anesthesia (CSEA) on the stereology of the placenta.

METHODSForty puerperants undergoing cesarean section under CSEA were randomly divided into dopamine group and phenylephrine group. Ropivacaine (16 mg) was administered immediately after spinal anethesia. Blood pressure was maintained near the baseline by adjusting the drug infusion rate. Fetal blood gas, Apgar score, and placental villus microvascular stereological changes were observed during the operation.

RESULTSThe microvascular density was significantly lower in dopamine group than in phenylephrine group (P<0.05). Phenylephrine group showed significantly lower umbilical artery blood pH than dopamine group (P<0.05). The Apgar score and blood pressure were comparable between the two groups (P>0.05). Compared to the baseline, both of the two groups showed significantly lowered heart rate during the operation (P<0.01).

CONCLUSIONDopamine is associated with the risk of fetal acidosis. Phenylephrine is helpful for preventing hypotension by increasing placental blood flow and improving oxygen supply to ensure maternal and fetal safety during cesarean section.

Amides ; administration & dosage ; Anesthesia, Spinal ; Apgar Score ; Blood Gas Analysis ; Blood Pressure ; Cesarean Section ; Dopamine ; administration & dosage ; Female ; Fetal Blood ; Fetus ; Heart Rate ; Humans ; Hypotension ; drug therapy ; Infant, Newborn ; Oxygen ; Phenylephrine ; administration & dosage ; Placenta ; drug effects ; physiology ; Pregnancy ; Vasoconstrictor Agents ; administration & dosage

BACKGROUND: The intravenous administration of indigo carmine has been reported to produce transiently increased blood pressure in patients. The goal of this in vitro study was to examine the effect of indigo carmine on phenylephrine-induced contractions in an isolated rat aorta and to determine the associated cellular mechanism with particular focus on the endothelium-derived vasodilators. METHODS: The concentration-response curves for phenylephrine were generated in the presence or absence of indigo carmine. Phenylephrine concentration-response curves were generated for the endothelium-intact rings pretreated independently with a nitric oxide synthase inhibitor, Nomega-nitro-L-arginine methyl ester (L-NAME), a cyclooxygenase inhibitor, indomethacin, and a low-molecular-weight superoxide anion scavenger, tiron, in the presence or absence of indigo carmine. The fluorescence of oxidized dichlorofluorescein was measured in rat aortic vascular smooth muscle cells cultured in the control, indigo carmine alone and tiron plus indigo carmine. RESULTS: Indigo carmine (10(-5) M) increased the phenylephrine-induced maximum contraction in the endothelium-intact rings with or without indomethacin, whereas indigo carmine produced a slight leftward shift in the phenylephrine concentration-response curves in the endothelium-denuded rings and L-NAME-pretreated endothelium-intact rings. In the endothelium-intact rings pretreated with tiron (10(-2) M), indigo carmine did not alter phenylephrine concentration-response curves significantly. Indigo carmine (10(-5) M) increased the fluorescence of oxidized dichlorofluorescein in the vascular smooth muscle cells, whereas tiron abolished the indigo carmine-induced increase in oxidized dichlorofluorescein fluorescence. CONCLUSIONS: Indigo carmine increases the phenylephrine-induced contraction mainly through an endothelium-dependent mechanism involving the inactivation of nitric oxide caused by the increased production of reactive oxygen species.
1,2-Dihydroxybenzene-3,5-Disulfonic Acid Disodium Salt ; Administration, Intravenous ; Animals ; Aorta ; Blood Pressure ; Contracts ; Fluorescence ; Humans ; Indigo Carmine ; Indoles ; Indomethacin ; Muscle, Smooth, Vascular ; Nitric Oxide ; Nitric Oxide Synthase ; Phenylephrine ; Prostaglandin-Endoperoxide Synthases ; Rats ; Reactive Oxygen Species ; Superoxides

BACKGROUND: Determining the precise magnitude, duration, and mechanism of hypotension caused by intravenous amiodarone could potentially increase the safety of drug administration to critically ill patients. The objective of this study was to characterize the immediate cardiovascular actions of an intravenous loading dose of amiodarone administered using echocardiographic and hemodynamic measurements. METHODS: In a prospective double-blind trial, 20 patients undergoing off-pump coronary artery bypass graft surgery were randomly assigned to receive intravenous amiodarone (n = 10) or placebo (n = 10). Heart rate (HR), arterial blood pressure (systolic, diastolic, mean; SAP, DAP, MAP), pulmonary artery pressure (systolic, diastolic, mean; PSAP, PDAP, PMAP), cardiac output (CO), central venous pressure (CVP), left ventricular ejection fraction (LVEF) were measured. RESULTS: HR, SAP, DAP, MAP, PSAP, PDAP, PMAP, CO by thermodilution method, CVP, LVEF by echocardiographic measurements was not significantly different in both group. Hypotension requiring intervention occurred in 2 of 10 patients after amiodarone administration and in none of 10 patients after placebo. CONCLUSIONS: Hypotension requiring intervention occurred 20% after amiodarone administration, the cause of these hypotension were thought to be arterial dilatation but was not associated with decreased cardiac output or left ventricular ejection fraction and corrected successfully by intravenous administration of phenylephrine.
Administration, Intravenous ; Amiodarone* ; Arterial Pressure ; Cardiac Output ; Central Venous Pressure ; Coronary Artery Bypass, Off-Pump ; Critical Illness ; Dilatation ; Echocardiography* ; Heart Rate ; Hemodynamics* ; Humans ; Hypotension ; Myocardial Ischemia ; Phenylephrine ; Prospective Studies ; Pulmonary Artery ; Stroke Volume ; Thermodilution ; Transplants

AIMTo investigate the inhibitory effects and mechanism of action of isoliensinine (IL) on the proliferation of porcine coronary arterial smooth muscle cells (CASMCs) induced by phenylephrine (Phen) and its mechanisms of action.

METHODSMTT assay, immunohistochemical method and Western blotting were adopted.

RESULTSIL (0.03 - 3 micromol x L(-1)) could inhibit the CASMCs proliferation induced by Phen (0.1 micromol x L(-1)) in a concentration-dependent manner. IL (0.1 micromol x L(-1)) antagonized Phen-induced overexpression of PDGF-beta and bFGF from 0.545 +/- 0.026 and 0.47 +/- 0.03 to 0.458 +/- 0.019 and 0.376 +/- 0.017 (P < 0.01 , P < 0.01). IL (0.1 micromol x L(-1)) also decreased c-fos, c-myc and hsp70 overexpression induced by Phen from 0.57 +/- 0.04, 0.44 +/- 0.04 and (173 +/- 36)% to 0.46 +/- 0.05, 0.372 +/- 0.021 and (115 +/- 35)% respectively (P < 0.01, P < 0.01, P < 0.01).

CONCLUSIONIL exerted antiproliferative effect on CASMCs induced by phenylephrine, and its mechanisms were related to decrease the overexpression of growth factors (PDGF-beta, bFGF), protooncogene (c-fos, c-myc) and hsp70.

Animals ; Cell Proliferation ; drug effects ; Cells, Cultured ; Coronary Vessels ; cytology ; Dose-Response Relationship, Drug ; Fibroblast Growth Factor 2 ; metabolism ; HSP70 Heat-Shock Proteins ; metabolism ; Isoquinolines ; administration & dosage ; isolation & purification ; pharmacology ; Muscle, Smooth, Vascular ; cytology ; Nelumbo ; chemistry ; Phenylephrine ; antagonists & inhibitors ; Plants, Medicinal ; chemistry ; Proto-Oncogene Proteins c-fos ; metabolism ; Proto-Oncogene Proteins c-myc ; metabolism ; Proto-Oncogene Proteins c-sis ; metabolism ; Swine