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: To describe the technical features of CT-guided percutaneous ethanol injection therapy (PEIT) for hepatic tumors that are undetectable or inaccessible under ultrasound guidance, to analyze its short-term therapeutic results, and to discuss its feasibility and limitations with a review of the related literature. MATERIALS AND METHODS: During a 22-month period, 17 patients with 28 hepatic tumors (27 hepatocellular carcinomas and one metastasis) underwent 38 sessions of CT-guided PEIT. Follow-up CT scanning was also performed. All tumors were undetectable or inaccessible under ultrasound guidance. The quantity of ethanol injected depended on their maximum diameter, which was 0.9 -5.1 (mean, 2.2) cm. To determine the puncture site and direction of the needle, the graduated grid system was used. A 21 or 22-G PEIT needle was introduced into the tumor stepwise, with intermittent CT monitoring, and if the CT images obtained immediately after initial injection demonstrated incomplete perfusion, an additional dose of ethanol was administered. During the follow-up period of 28 -619 (mean, 261) days, three-phase spiral CT scans were obtained. We focused on whether or not a viable portion of ablated tumor was present, and if so, the interval during which the extent of viable portion had changed, as well as the CT findings which suggested a predisposition to incomplete ablation. RESULTS: PEIT was successfully performed in all patients. During each session, 3 -30 (mean, 12.1) mL of ethanol was injected for 35 -115 (mean, 85) mins, with 1 -7 (mean, 3.7) trials to determine the puncture site and needle direction. The follow-up CT results showed that 20 tumors (71.4%) contained no viable portion, that this portion had decreased in four (14.3%), and was unchanged or had increased in four (14.3%). In the eight tumors for which multiple sessions were required, follow-up CT showed that the viable portion was absent or had decreased in size in all except one. In five of the patients with a tumor containing a viable portion at follow- up CT, the procedure was incomplete because of unendurable pain (n = 2) or noncooperation (n = 3). A CT finding which suggested a predisposition to incomplete ablation was a poor margin (n = 3). Complications included severe pain (n = 6) and scanty peritoneal hemorrhage (n = 1). CONCLUSION: Despite several limitations of our study, the therapeutic results of CT-guided PEIT appeared to be similar to or slightly worse than those of well-established ultrasound-guided PEIT with the former procedure, however, intermittent CT monitoring indicates whether perfusion is complete, and for this reason, CT-guided PEIT is believed to be an effective treatment modality when a hepatic tumor is undetectable or inaccessible under ultrasound guidance.
Carcinoma, Hepatocellular ; Ethanol* ; Follow-Up Studies ; Hemorrhage ; Humans ; Needles ; Perfusion ; Punctures ; Tomography, Spiral Computed ; Tomography, X-Ray Computed ; Ultrasonography

This is the first report of a case of painless moving toes syndrome with radiculopathy. The patient presented with bilateral painless moving toes and unilateral subclinical sacral (S1) radiculopathy. Bilateral movements with the unilateral lesion, and fluctuation with postural changes and distant muscle contraction suggest that the underlying pathomechanism was a central reorganization in the spinal level.
Humans ; Muscle Contraction ; Radiculopathy ; Toes

Cerebral venous thrombosis (CVT) is a multifactorial disease characterized by various clinical manifestations and predisposing factors. The association of CVT with hyperthyroidism has been suggested and the high plasma level of factor VIII in hyperthyroidism has been hypothesized to increase the risk of recurrent thromboembolism. We report a 30-year-old man who presented with headache. He was diagnosed with CVT and concomitant hyperthyroidism with increased factor VIII.
Adult ; Causality ; Factor VIII* ; Headache ; Humans ; Hyperthyroidism* ; Plasma ; Thromboembolism ; Venous Thrombosis*

Intermittent fasting has become an increasingly popular strategy in losing weight and associated reduction in obesity-related medical complications. Overwhelming studies support metabolic improvements from intermittent fasting in blood glucose levels, cardiac and brain function, and other health benefits, in addition to weight loss. However, concerns have also been raised on side effects including muscle loss, ketosis, and electrolyte imbalance. Of particular concern, the effect of intermittent fasting on hormonal circadian rhythms has received little attention. Given the known importance of circadian hormonal changes to normal physiology, potential detrimental effects by dysregulation of hormonal changes deserve careful discussions. In this review, we describe the changes in circadian rhythms of hormones caused by intermittent fasting. We covered major hormones commonly pathophysiologically involved in clinical endocrinology, including insulin, thyroid hormones, and glucocorticoids. Given that intermittent fasting could alter both the level and frequency of hormone secretion, decisions on practicing intermittent fasting should take more considerations on potential detrimental consequences versus beneficial effects pertaining to individual health conditions.

Objectives: This study evaluates soft tissue changes of the upper lip and nose after maxillary setback with orthognathic surgery such as Le Fort I or anterior segmental osteotomy. Materials and Methods: All 50 patients with bimaxillary protrusion and skeletal Class II malocclusion underwent Le Fort I or anterior segmental osteotomy with backward movement. Soft and hard tissue changes were analyzed using cephalograms collected preoperatively and 6 months postoperatively. Results: Cluster analysis on the ratios shows that 2 lines intersected at 4 mm point. Based on this point, we divided the subjects into 2 groups: Group A (less than 4 mm, 27 subjects) and Group B (more than 4 mm, 23 subjects). Also, each group was divided according to changes of upper incisor angle (≥4°=A1, B1 or <4°=A2, B2). The correlation between A and B groups for Aʼ/ANS and Ls/Is (P<0.001) was significant; Aʼ/A (P=0.002), PRN/A (P=0.043), PRN/ANS (P=0.032), and St/Is (P=0.010). Variation of nasolabial angle between the two groups was not significant. There was no significant correlation of vertical movement and angle variation. Conclusion The ratio of soft tissue to hard tissue movement depends on the amount of posterior movement in the maxilla, showing approximately two times higher rates in most of the midface when posterior movement was greater than 4 mm. The soft tissue changes caused by posterior movement of the maxilla were little affected by angular changes of upper incisors. Interestingly, nasolabial angle showed a different tendency between A and B groups and was more affected by incisal angular changes when horizontal posterior movement was less than 4 mm.

Purpose: This study aimed to evaluate the cost-effectiveness of treatment with retrograde intrarenal surgery (RIRS) versus repeated shock wave lithotripsy (SWL) in patients with renal calculi. Materials and Methods: The non-retreatment rates (NRRs) and their respective real-world costs for RIRS and SWL were derived through retrospective analysis of health insurance claims data from 2015 to 2017. Decision tree modeling was performed to demonstrate the cost-effectiveness of RIRS. Furthermore, sensitivity analysis was performed to examine the robustness of the results. Results: Analysis of the obtained data showed that NRRs of single SWL ranged from 46% to 56%, whereas NRRs of single RIRS ranged from 75% to 93%. Introducing RIRS early in the treatment sequence was observed to be favorable for the reduction of overall failure (overall NRR, 0.997) compared to the results of repeated SWL (overall NRR, 0.928). The implementation of decision tree modeling revealed that the cost per retreatment-avoided increased with the introduction of RIRS at an earlier time (first line, second line, third line, fourth line: 18640 USD, 10376 USD, 4294 USD, 3377 USD, respectively). Probabilistic modeling also indicated that the introduction of RIRS as the first line of treatment was least likely to be cost-effective, when compared to other options of introducing RIRS as the second, third, or fourth line of treatment. Conclusion Performing RIRS as early as possible

BACKGROUND: In vitro detection of the allergen-specific IgE antibody (sIgE) is a useful tool for the diagnosis and treatment of allergies. Although multiple simultaneous allergen tests offer simple and low-cost screening methods, these platforms also have limitations with respect to multiplexibility and analytical performance. As an alternative assay platform, we developed and validated a microarray using allergen extracts that we termed “GOLD” chip. METHODS: Serum samples of 150 allergic rhinitis patients were used in the study, and the diagnostic performance of the microarray was compared with that of AdvanSure (LG Life Sciences, Daejun, Korea) and ImmunoCAP (Phadia, Uppsala, Sweden). Standard IgE samples were used for the quantitative measurement of sIgEs. RESULTS: The microarray-based assay showed excellent performance in the quantitative measurement of sIgEs, demonstrating a linear correlation within the range of sIgE concentrations tested. The limit of detection (LOD) was lower than 0.35 IU/mL, which is the current standard for the LOD cut-off. The assay also provided highly reproducible sets of data. The total agreement percentage of positive and negative calls was 92.2% compared with ImmunoCAP. Moreover, an outstanding correlation was observed between the microarray and the ImmunoCAP results, with Cohen's kappa and Pearson correlation coefficient values of 0.80 and 0.79, respectively. CONCLUSIONS: The microarray-based in vitro diagnostic platform offers a sensitive, reproducible, and highly quantitative method to detect sIgEs. The results showed strong correlations with that of ImmunoCAP. These results suggest that the new allergen microarray can serve as a useful alternative to current screening platforms, ultimately becoming a first-line screening method.
Biological Science Disciplines ; Diagnosis ; Humans ; Hypersensitivity* ; Immunoglobulin E ; In Vitro Techniques* ; Limit of Detection ; Mass Screening ; Methods ; Rhinitis, Allergic

A fine needle aspiration biopsy specimen of a retroperitoneal mass in a 26-year-old man who had had an orchiectomy for seminoma was submitted for cytologic evaluation. Cytologic features of the specimen included uniform neoplastic cells found singly or in groups of several cells intermingled with lymphocytes in a characteristic foamy, lacelike background. These cells varied from 10 to 20 m in diameter. The nuclei were round to ovoid with fine or reticular chromatin and one or more prominent nucleoli. The poorly defined cytoplasm stained pale-blue or blue with cytoplasmic vacuoles. The cytologic appearance was consistent with seminoma. Documented reports of the cytological appearance of seminoma are rare. The diagnosis of primary gonadal seminoma by fine needle aspiration biopsy is probably not indicated since the treatment of a primary gonadal tumor, regardless of its histogenesis, requires surgical resection. However, fine needle aspiration biopsy is extremely valuable in the diagnosis of extragonadal as well as metastic and recurrent seminoma.
Adult ; Biopsy ; Biopsy, Fine-Needle ; Chromatin ; Cytoplasm ; Diagnosis ; Gonads ; Humans ; Lymphocytes ; Neoplasm Metastasis ; Orchiectomy ; Seminoma* ; Vacuoles

Objectives: This study evaluates soft tissue changes of the upper lip and nose after maxillary setback with orthognathic surgery such as Le Fort I or anterior segmental osteotomy. Materials and Methods: All 50 patients with bimaxillary protrusion and skeletal Class II malocclusion underwent Le Fort I or anterior segmental osteotomy with backward movement. Soft and hard tissue changes were analyzed using cephalograms collected preoperatively and 6 months postoperatively. Results: Cluster analysis on the ratios shows that 2 lines intersected at 4 mm point. Based on this point, we divided the subjects into 2 groups: Group A (less than 4 mm, 27 subjects) and Group B (more than 4 mm, 23 subjects). Also, each group was divided according to changes of upper incisor angle (≥4°=A1, B1 or <4°=A2, B2). The correlation between A and B groups for Aʼ/ANS and Ls/Is (P<0.001) was significant; Aʼ/A (P=0.002), PRN/A (P=0.043), PRN/ANS (P=0.032), and St/Is (P=0.010). Variation of nasolabial angle between the two groups was not significant. There was no significant correlation of vertical movement and angle variation. Conclusion The ratio of soft tissue to hard tissue movement depends on the amount of posterior movement in the maxilla, showing approximately two times higher rates in most of the midface when posterior movement was greater than 4 mm. The soft tissue changes caused by posterior movement of the maxilla were little affected by angular changes of upper incisors. Interestingly, nasolabial angle showed a different tendency between A and B groups and was more affected by incisal angular changes when horizontal posterior movement was less than 4 mm.