BACKGROUND: Epinephrine used in surgery to provide hemostasis may elicit ventricular arrhythmias. A desirable anesthetic would not sensitize the myocardium to exogenously administered epinephrine. So the effect of sevoflurane, which was introduced to clinical anesthesia recently, on cardiac arrhythmias induced by the infusion of epinephrine was compared with those of halothane which was already known to epinephrine-induced arrhythmia in the 14 mongrel dogs. METHODS: The authors compared the arrhythmogenicity (three or more premature ventricular contractions, PVCs)of intravenously administered epinephrine in 14 mongrel dogs who were randomly assigned to receive sevoflurane (1.7 vol%) or halothane (0.75 vol%) anesthesia equipotently. The arrhythmogenic doses of epinephrine determined in this comparative study were expressed by both infusion rates of epinephrine during sevoflurane and halothane anesthesia. RESULTS: The mean values of the arrythmogenic infusion rates of epinephrine were 27.1 7.6 g/kg for sevoflurane and 2.7 0.8 g/kg for halothane. CONCLUSIONS: We concluded that the arrythmogenic doses of epinephrine during sevoflurane were significantly higher than those during halothane anesthesia.
Anesthesia* ; Animals ; Arrhythmias, Cardiac ; Dogs* ; Epinephrine* ; Halothane* ; Hemostasis ; Myocardium ; Ventricular Premature Complexes

PURPOSE: To investigate the time course and occurrence of foveal retinal detachment presenting with symptoms of metamorphopsia and decreased visual acuity after successful surgery for macula-off retinal detachment. METHODS: This study included 9 eyes of 9 patients who were diagnosed with foveal retinal detachment using optical coherence tomography (OCT) among 198 patients who had decreased visual acuity and metamorphopsia after successful rhegmatogenous retinal detachment surgery. RESULTS: All eyes were diagnosed with foveal retinal detachment by OCT. Foveal retinal detachment occurred after scleral buckling surgery in 8 eyes (88%) and after vitrectomy and pneumoretinopexy in 1 eye. The degree and frequency of foveal retinal detachment was milder and lower after vitrectomy and pneumoretinopexy than after scleral buckling surgery. All foveal retinal detachments were reattached spontaneously after 9 months (range, 5~14 months). In all eyes, the symptom of metamorphopsia was improved and visual acuity increased after the foveal retinal detachment was reattached. CONCLUSIONS: OCT can be used to diagnose foveal retinal detachment in cases when the fundus and fluorescein angiography do not show specific findings but, presenting symptoms of decreased visual acuity and metamorphopsia. In all cases evaluated, the foveal retinal detachment was reattached spontaneously without treatment.
Fluorescein Angiography ; Humans ; Retinal Detachment* ; Retinaldehyde* ; Scleral Buckling ; Tomography, Optical Coherence* ; Vision Disorders ; Visual Acuity ; Vitrectomy

Systemic lupus erythematosus is a connective tissue disease which can affect every organ system. Neurologic abnormalities are common, occuring in approximately half of all patients at some time during the course of their illness. But symptoms of nervous system as the sole presenting symptoms occur in less than 1% of lupus patients. In patients initially presenting with neurologic symptoms and signs, differential diagnosis is difficult and sometimes it may be misdiagnosed. Therefore extensive laboratory investigations should be carried out in all patients with unusual neurological symptoms, since early diagnosis of lupus can help in providing effective treatment. We report a patient with systemic lupus erythematosus who presented with dysarthria and dysphagia resembling multiple sclerosis.
Connective Tissue Diseases ; Deglutition Disorders ; Diagnosis, Differential ; Dysarthria ; Early Diagnosis ; Humans ; Lupus Erythematosus, Systemic* ; Multiple Sclerosis* ; Nervous System ; Neurologic Manifestations

PURPOSE: To investigate long-term visual outcomes and prognostic factors to predict visual outcomes in patients with anatomic success after macular hole surgery. METHODS: Medical records of 36 eyes with successfully repaired stage 3 or 4 idiopathic macular hole and with at least 24 months of follow-up were reviewed. Hole height, stage of macular hole, base diameter, minimum diameter, hole form factor, macular hole index, and hole closure type were measured or calculated, and the correlations of visual outcomes with variables of preoperative optical coherence tomography (OCT) were analyzed. RESULTS: The patients were classified into 3 groups according to the time period necessary to achieve the best corrective visual acuity. The visual acuity of 16 eyes (44.4%) recovered in a mean of 6 months, 13 eyes (36.1%) improved slowly and continuously, and 7 eyes had no improvement despite successful anatomical closure. There were no statistical differences in hole height, base diameter, minimum diameter, hole form factor, macular hole index, or closure type among the 3 groups. CONCLUSIONS: The improvement in visual acuity after successful macular hole surgery persisted at the 24-month follow-up and after. There were no correlations between delayed visual acuity after macular hole surgery and minimum diameter, base diameter, hole height, hole form factor, macular hole index, or closure type.
Eye ; Follow-Up Studies ; Humans ; Medical Records ; Retinal Perforations ; Tomography, Optical Coherence ; Visual Acuity

The primary treatment modality of malignant tumors of the nasopharynx is radiation therapy owing to its inaccessibility to surgical intervention. Over the last two decades there were many changes in techniques of delivery, which include the use of higher doses of radiotherapy, the use of wide radiation field, including the elective radiation of the whole neck, the combined use of brachy- and teletherapy, and the use of split-course therapy. In spite of these advances local and regional recurrences remain the major cause of death. As a boost therapy after external irradiation, high-dose-rate intracavitary irradiation using remote control afterloading system (RALS) was used in two patients. Our results were satisfactory, however, this procedure should only be performed by those who have developed enough expertise in the use of intracavitary techniques for the treatment of nasopharyngeal cancer and have a supportive team including a physicist, dosimetrist, nurse, and trained technologist.
Cause of Death ; Humans ; Nasopharyngeal Neoplasms ; Nasopharynx ; Neck ; Radiotherapy ; Recurrence

Esophageal perforation is a rare disease, which require emergent diagnosis and therapeutic procedure. In this paper, we present one case of esophageal perforation by traction of toothbrush which was swallowed during pharyngeal irritation. After the toothbrush was inserted to stomach by gastroscope, gastrostomy was performed for removal of toothbrush and the esophageal perforation was repaired by operation.
Diagnosis ; Esophageal Perforation* ; Gastroscopes ; Gastrostomy ; Rare Diseases ; Stomach ; Traction

PURPOSE: To evaluate the retinal thickness changes of the macula with age in normal subjects using optical coherence tomography. METHODS: Included were 56 patients with no systemic disease and no ophthalmoscopic evidence of retinopathy and who had a best corrected visual acuity of 1.0 or better. The measurement of the retinal thickness obtained by OCT III was analyzed using the computerized topographic mapping protocol (6 mm diameter map) according to age, refraction error, sex and macular region. We analyzed how they correlated to each other. RESULTS: The mean standard deviations of foveal thickness and retinal thickness within 1 mm diameter of the center were 182 +/- 26 micro meter and 208 +/- 18 micro meter in normal eyes, respectively. There was no statistically significant change with age (p>0.01). But the measurements at 3 and 6 mm from the fovea showed reduced retinal thickness with age (p<0.01). And the retinal thickness in the macular area did not correlate significantly with the refractive error nor with sex (p>0.01). There was a significant difference between the nasal quadrant and temporal quadrant within the 3 mm diameter of the center, and there was also a significant difference between the superior quadrant and inferior quadrant, and between the nasal quadrant and temporal quadrant within the 6 mm diameter of the center (p<0.01). CONCLUSIONS: Retinal thickness around the fovea as measured by OCT showed a decrease with age, although the fovea and the region within 1mm diameter of the center showed no statistical associations with age.
Humans ; Refractive Errors ; Retinaldehyde ; Tomography, Optical Coherence* ; Visual Acuity

PURPOSE: To evaluate the effect of topical cyclosporine 0.05% (Restasis; Allergan, Irving, CA, USA) on tear osmolarity in patients with dry eye disease. METHODS: The present study was a single-center, randomized, prospective, and longitudinal trial. Patients who had been using artificial tears to treat dry eye disease were prescribed cyclosporine 0.05% and evaluated using tear osmolarity, tear break-up time, ocular surface staining score, Schirmer test, and the Ocular Surface Disease Index for symptomatic improvement. Clinical measurements of commonly used objective tests were performed at baseline and after 1, 3, and 6 months. RESULTS: At the end of the study, patients demonstrated statistically significant improvement in tear break-up time (6.26 +/- 1.26 sec at 3 months vs. 4.41 +/- 1.63 sec at baseline, p = 0.022) and OSDI (34.98 +/- 20.19 at 3 months vs. 45.02 +/- 22.38 at baseline, p = 0.032) only at 3 months. Other measures such as Schirmer test, ocular surface grade, and tear osmolarity also showed improvement. However, the differences were not significant. CONCLUSIONS: Over a 6-month period, topical cyclosporine 0.05% showed beneficial effects on symptoms and other commonly used signs of dry eye disease for 3 months; however, the tear osmolarity values were not significantly improved.
Cyclosporine* ; Dry Eye Syndromes* ; Eye Diseases ; Humans ; Ophthalmic Solutions ; Osmolar Concentration* ; Prospective Studies ; Tears*

To check expert opinion about the investigation system of medicine-related death, model for "Death Investigation Center" was suggested and related questionnaire were requested. Between 15 December 2009 and 5 April 2010, we sent e-mails of the questionnaire which asked the opinion for the new postmortem investigation system. We sent the questionnaire to 3,289 lawyers and 4,523 doctors (total 7812), and received 100 replies out of the total. All the lawyers and doctors interviewed knew the importance of the postmortem investigation system. Most of them (87%) agreed to the introduction of the new postmortem investigation system. Some of them thought that protector's agreement was necessary for the postmortem investigation (21%), and more doctors were likely to participate with legal protocol (23%). If the postmortem investigation could not be performed due to the protector's disagreement, another specialized medical investigation should be needed to figure out the cause of death (85%). The new postmortem investigation system should be performed by the specific institution, and supported by the government (44%). In many expert's opinion, nonmedical experts such as lawyers and priests should be included for the institution of investigation for objectivity and neutrality (72%). This sample study finds that the postmortem investigation performed by specialized institution is necessary to determine the cause of death in the hospital. For the operation of the system, neutrality and the operating core would be the most important.
Cause of Death ; Electronic Mail ; Expert Testimony ; Humans ; Lawyers ; Surveys and Questionnaires

To evaluate effects of IPV (Intrapulmonary Percussive Ventilation) on cardiopulmonary hemodynamics and oxygenation, we compared IPV with conventional IPPV (Intermittent Positive Pressure Ventilation} in eight mongrel dogs. After Swan-Ganz catheterization and femoral arterial cannulation, we applied IPPU and IPV for 30 minutes respectively at random order. There were no significant differences in cardiac output (CO), heart rate (HR), mean arterial pressure (MAP), vascular resistance (VR), pulmonary capillary wedge pressure (PCWP), rate pressure product (RPP), coronary perfusion pressure (CPP) and oxygenation-reflecting parameters such as AaDO2, oxygen flux and oxygen consumption (VO2) between IPPV and IPV. A slight increase of diastolic pulmonary arterial pressure (PAP) resulted in increase of pulmonary perfusion pressure (PPP). IPV increases left and right ventricular stroke work index which might be related to slight metabolic acidosis and a little deficient ventilation during IPV. We can conclude that IPV is safe and good in cardiopulmonary hemodynamics and tissue oxygena-tion in dogs, but its better to be cautious in ventilation during IPV.
Acidosis ; Animals ; Arterial Pressure ; Cardiac Output ; Catheterization ; Catheterization, Swan-Ganz ; Dogs* ; Heart Rate ; Hemodynamics* ; Intermittent Positive-Pressure Ventilation ; Oxygen Consumption ; Oxygen* ; Perfusion ; Pulmonary Wedge Pressure ; Stroke ; Vascular Resistance ; Ventilation*