No abstract available.
Pulmonary Atelectasis*

PURPOSE: The present study investigated whether an autophagic process is involved in the apoptotic death of human tenon's capsule fibroblasts (HTCFs) caused by mitomycin-C. METHODS: An autophagic phenotype was tested using fluorescence microscopy and flow cytometry with specific biological staining dyes including monodansylcadaverine and acridine orange and microtubule-associated protein 1 light chain 3 (LC3). RESULTS: Treatment with mitomycin-C (0.4 mg/ml) increased the acidic vesicular organelles of tenon's capsule fibroblasts in a time dependent manner. Mitomycin-C induced both LC3-II cleavage and beclin-1 expression. 3-MA, a pharmacological inhibitor of autophagy, inhibited the mitomycin-C induced increase of acidic vesicular organelleS. CONCLUSIONS: Autophagy was induced with 0.4 mg/ml mitomycin-C in tenon's capsule fibroblasts. And, autophagic mechanisms may be involved in the early stage of apoptosis of fibroblasts.
Acridine Orange ; Apoptosis ; Autophagy ; Cadaverine ; Coloring Agents ; Fibroblasts ; Flow Cytometry ; Humans ; Light ; Microscopy, Fluorescence ; Microtubule-Associated Proteins ; Mitomycin ; Organelles ; Phenotype ; Tenon Capsule

PURPOSE: We report a case of neurogenic blepharoptosis after reconstruction of a medial orbital wall fracture using the transcaruncular approach. CASE SUMMARY: A 13-year-old girl presented with left eyeball pain and binocular diplopia caused by trauma from falling. Orbital computerized tomography showed a blowout fracture of the left medial orbital wall, herniation of the orbital soft tissue into the ethmoid sinus, and a portion of the medial rectus muscle trapped in the fracture. The patient underwent successful reconstruction of the medial orbital wall using the transcaruncular approach. However, moderate blepharoptosis with functional loss of the levator palpebrae superioris muscle developed immediately after awaking from the anesthesia. The blepharoptosis was presumed to have developed due to postoperative edema; therefore, oral corticosteroid was prescribed. However, the blepharoptosis did not improve. No other ocular signs or symptoms were detected. Because neither the margin reflex distance (MRD1) nor the function of the levator palpebrae superioris muscle recovered after eight weeks of conservative treatment, surgical correction of blepharoptosis was performed under local anesthesia. The preaponeurotic fat, soft tissue, tarsal plate, and aponeurosis of the levator palpebrae superioris all appeared normal. The patient underwent maximal resection of the levator palpebrae superioris muscle and the blepharoptosis was alleviated two weeks after the operation.
Adolescent ; Anesthesia ; Anesthesia, Local ; Blepharoptosis ; Diplopia ; Ethmoid Sinus ; Humans ; Muscles ; Orbit ; Reflex ; Telescopes

PURPOSE: To evaluate the effect of epinephrine on pupil size in reconstruction of an orbital wall fracture. METHODS: The authors of the present study describe 27 patients (27 eyes) who had reconstruction of an orbital wall fracture from January to July of 2009. Patients were divided into two groups according to the use of epinephrine during surgery. Preoperative and postoperative pupil sizes, operation times, and epinephrine dosages were collected. RESULTS: Preoperative pupil sizes were 1.80 +/- 0.37 mm, 1.74 +/- 0.36 mm and postoperative pupil sizes were 1.97 +/- 0.43 mm (p = 0.042), 2.18 +/- 0.52 mm (p = 0.003) in the group with of epinephrine and the group without epinephrine, respectively. Postoperative pupil size significantly increased in all groups. However, no significant difference was found regarding change in pupil size after surgery (p = 0.258). In the group with epinephrine, change in pupil size did not show a significant association with operation time (p = 0.228), nor did change in pupil size and epinephrine dosage (p = 0.922). CONCLUSIONS: The use of epinephrine is an effective modality for bleeding control and securing a clear view in orbital wall fracture reconstruction.
Epinephrine ; Hemorrhage ; Humans ; Orbit ; Pupil

Theophylline has been used for more than 50 years to treat bronchial asthma, and theophylline toxicity continues to be an encountered clinical problem. With suicidal intention, a 61-year-old depressive male patient was sent to the hospital after ingestion of overdose theophylline. He had been followed up for bronchial asthma with about 10 microgram/ mL average plasma theophylline level. On arrival, he complained of dyspnea, palpitation and the plasma theophylline level was 252 microgram/mL. After 2 hours of ingestion, hypotension and tachycardia developed (Systolic blood pressure 50 mmHg, heart rate 190/ min). Other symptoms and signs were stuporous mental state and hypoxemia. Patient's peak plasma theophylline level reached 402 microgram/mL after 3 hours. beta-blocker, dopamine and midazolam were used for control of tachycardia, hypotension and prevention of seizure respectively. After Gastric lavage and administration of charchoal, he was treated with hemoperfusion for 3.5 hours, and serum level decreased. The patient was discharged in good health after 17 days.
Anoxia ; Asthma ; Blood Pressure ; Dopamine ; Dyspnea ; Eating ; Gastric Lavage ; Heart Rate ; Hemoperfusion* ; Humans ; Hypotension ; Intention ; Male ; Midazolam ; Middle Aged ; Plasma ; Seizures ; Stupor ; Tachycardia ; Theophylline*

Although acute acalculous cholecystitis (AAC) accounts for less than 10% of acute cholecystitis in the adult population, gangrene and perforation are much more frequent compared to the usual cases of acute cholecystitis (calculus cholecystitis). However, spontaneous biliary-enteric fistula is well recognized in AAC, 90% of which are cholecystoduodenal fistula (CDF) though it is an uncommon disorder. The majority of the CDF are caused by cholelithiasis. As patients are usually associated with complicated clinical illness, the diagnosis is often difficult to make and required surgery is often delayed. We have studied a rare complication of acute acalculous cholecystitis which was presented as intermittent upper gastrointestinal bleeding. Ulceration of the superficial branch of the cystic artery has been observed due to acalculous cholecystitis associated with a cholecystoduodenal fistula. We have performed a transfixing ligation of the bleeding vessel, cholecystectomy and simple closure of the CDF. We have finally made a diagnosis of early gallbladder cancer through a frozen section. There was no serious complication after the operation and the patient has achieved an uneventful recovery.
Acute Disease ; Cholecystectomy ; Cholecystitis/*diagnosis ; Duodenal Diseases/*complications ; Gallbladder Neoplasms/diagnosis ; Gastrointestinal Hemorrhage/*etiology ; Human ; Intestinal Fistula/*complications ; Male ; Middle Aged

Several cases of ruptured pregnant uterine horn have been documented. However, there have been few reported cases of ectopic tubal pregnancy in a unicornuate with rudimentary horn. So we report this case with a brief review literature.
Animals ; Female ; Horns* ; Pregnancy ; Pregnancy, Tubal* ; Uterus*

Acute embolic occlusion of the common iliac artery is a rare medical emergency that is not only limbthreatening, but also potentially life-threatening. Several treatment options exist for acute limb ischemia, although no treatment is clearly best. We report a case of acute embolic occlusion of the left common iliac artery in a patient with atrial fibrillation who was treated successfully using mechanical thrombectomy following intra-arterial thrombolysis.
Acute Disease ; Arterial Occlusive Diseases/radiography/*therapy ; Combined Modality Therapy ; Embolism/radiography/*therapy ; Female ; Fibrinolytic Agents/*administration & dosage ; Humans ; *Iliac Artery/radiography ; Middle Aged ; *Thrombectomy ; *Thrombolytic Therapy ; Tomography, X-Ray Computed ; Treatment Outcome ; Urokinase-Type Plasminogen Activator/*administration & dosage

PURPOSE: Recently, the change to a more complex social structure has led to an increased frequency of traumas due to violence, accident and so on. In addition, the severity of the traumas and the frequency of penetrating injuries have also increased. Traumas to cervical and abdominal areas, what are commonly seen by general surgeons, can have mild to fatal consequences because in these areas, various organs that are vital to sustaining life are located. The exact location and characteristics of the injury are vital to treating patients with the trauma to these areas. Thus, with this background in mind, we studied, compared, and analyzed clinical manifestations of patients who were admitted to Wonju Christian hospital for penetrating injuries inflicted by themselves or others. METHODS: We selected and performed a retrospective study of 64 patients who had been admitted to Wonju Christian Hospital from January 2005 to December 2009 and who had cervical or abdominal penetrating injuries clearly inflicted by themselves or others. RESULTS: There were 51 male (79.7%) and 13 female (20.3%) patients, and the number of male patients was more dominant in this study, having a sex ratio of 3.9 to 1. The range of ages was between 20 and 86 years, and mean age was 43.2 years. There were 5 self-inflicted cervical injuries, and 19 self-inflicted abdominal injuries, making the total number of self-inflicted injury 24. Cervical and abdominal injuries caused by others were found in 11 and 29 patients, respectively. The most common area involved in self-inflicted injuries to the abdomen was the epigastric area, nine cases, and the right-side zone II was the most commonly involved area. On the other hand, in injuries inflicted by others, the left upper quadrant of the abdomen was the most common site of the injury, 14 cases. In the neck, the left-side zone II was the most injured site. In cases of self-inflicted neck injury, jugular vein damage and cervical muscle damage without deep organ injury were observed in two cases each, making them the most common. In cases with abdominal injuries, seven cases had limited abdominal wall injury, making it the most common injury. The most common deep organ injury was small bowel wounds, five cases. In patients with injuries caused by others, six had cervical muscle damage, making it the most common injury found in that area. In the abdomen, small bowel injury was found to be the most common injury, being evidenced in 13 cases. In self-inflicted injuries, a statistical analysis discovered that the total duration of admission and the number of patients admitted to the intensive care unit were significantly shorter and smaller, retrospectively, than in the patient group that had injuries caused by others. No statistically significant difference was found when the injury sequels were compared between the self-inflicted-injury and the injury-inflicted-by-others groups. CONCLUSION: This study revealed that, in self-inflicted abdominal injuries, injuries limited to the abdominal wall were found to be the most common, and in injuries to the cervical area inflicted by others, injuries restricted to the cervical muscle were found to be the most common. As a whole, the total duration of admission and the ICU admission time were significantly shorter in cases of self-inflicted injury. Especially, in cases of self inflicted injuries, abdominal injuries generally had a limited degree of injury. Thus, in our consideration, accurate injury assessment and an ideal treatment plan are necessary to treat these patients, and minimally invasive equipment, such as laparoscope, should be used. Also, further studies that persistently utilize aggressive surgical observations, such as abdominal ultrasound and computed tomography, for patients with penetrating injuries are needed.
Abdomen ; Abdominal Injuries ; Abdominal Wall ; Female ; Hand ; Humans ; Intensive Care Units ; Jugular Veins ; Laparoscopes ; Male ; Muscles ; Neck ; Neck Injuries ; Retrospective Studies ; Sex Ratio ; Violence

BACKGROUND AND OBJECTIVES: Cilostazol is an anti-platelet and arterial vasodilating drug that inhibits phosphodiesterase type III, an enzyme that breaks down cyclic AMP in platelets, vascular smooth muscle cells, cardiac myocytes and adipocytes. Several animal and human studies have shown that cilostazol has the potential to reduce restenosis after coronary angioplasty, but the precise mechanism by which the inhibition of vascular smooth muscle cell growth occurs from an increase in cyclic AMP is not yet clear. MATERIALS AND METHODS: We investigated the effects of cilostazol on cell proliferation and expression of iNOS and p21 by western blotting with the cultured aortic vascular smooth muscle cells stimulated with platelet-derived growth factor BB. RESULTS: In comparison to the control, treatment with cilostazol significantly inhibited (p<0.05) the increase in cell number. Inducible nitric oxide synthase (iNOS) and p21 expression increased with cilostazol treatment, and these effects of cilostazol were eliminated by simultaneous incubation with the NOS inhibitor, L-NAME. These results indicate that cilostazol increases p21 expression at least partially through an iNOS-dependent pathway in cultured vascular smooth muscle cells stimulated with PDGF-BB. CONCLUSION: These findings suggest that cilostazol has a direct inhibitory effect on abnormal proliferation of vascular smooth muscle cells accompanied by the induction of iNOS-dependent p21 expression, and cilostazol may have potential to prevent restenosis after percutaneous coronary intervention by this mechanism.
Adipocytes ; Angioplasty ; Animals ; Blotting, Western ; Cell Count ; Cell Proliferation ; Cyclic AMP ; Humans ; Muscle, Smooth, Vascular* ; Myocytes, Cardiac ; NG-Nitroarginine Methyl Ester ; Nitric Oxide Synthase ; Nitric Oxide Synthase Type II ; Percutaneous Coronary Intervention ; Platelet-Derived Growth Factor