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: 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

No abstract available.
Pulmonary Atelectasis*

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

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

Actinomycosis is a slowly progressive chronic suppurative infection noted for forming characteristic sulfur granule by an anaerobic gram-positive bateria. Pelvic actinomycosis occurs most commonly in association with IUD and has variable nonspecific symptoms that make an initial diagnosis difficult. Colonization of lower genital tract by Actinomyces occurs most often in IUD users and increases with the duration of IUD use. We experienced a case of actinomycotic pelvic abscess associated with IUD and report it with a brief review of concerned literature.
Abscess ; Actinomyces ; Actinomycosis* ; Colon ; Diagnosis ; Intrauterine Devices* ; Sulfur

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*

PURPOSE: Fournier's disease is polymicrobial necrotizing fasciitis of the perineal, perianal, or genital areas. The objective of this study was to investigate patients with Fournier's gangrene and to determine risk factors that affect mortality. METHODS: This study was a retrospective clinical study. Clinical presentations and outcomes of surgical treatments were evaluated in 27 patients with Fournier's gangrene that were treated in a single institution from January 2000 to March 2009. RESULTS: The mean age of patients was 52.8+/-14.4 yr, and the male-to-female ratio was 25:2. Among the predisposing factors, diabetes mellitus was the most common (n=8, 29.6%). The most common infection source was anorectal (n=16, 59.3%). Sepsis on admission was detected in 16 cases (59.3%). Four patients died during treatment, for an overall mortality of 14.8%. A logistic regression test showed a Fournier's gangrene severity index greater than 9 and sepsis on admission to be prognostic factors. CONCLUSION: The mortality rate was higher in patients with sepsis on admission and with a Fournier's gangrene severity index greater than nine.
Diabetes Mellitus ; Fasciitis, Necrotizing ; Fournier Gangrene ; Humans ; Logistic Models ; Retrospective Studies ; Risk Factors ; Sepsis

Various treatment modalities are available for mycosis fungoides including topical steroids, topical chemotherapy, phototherapy, and spot radiation therapy. However, these modalities do not always result in optimal effects, with efficacy depending on lesion size, number, and location. Photodynamic therapy (PDT) is a recently introduced therapeutic modality that proved effective in patients with unilesional mycosis fungoides. A 58-year-old woman presented with a seven-year history of a pruritic erythematous scaly patch on her right thigh. Through skin biopsy, we verified the lesion as mycosis fungoides. The lesion did not respond well to a topical steroid. We opted for topical PDT with methyl-aminolevulinate (MAL). MAL cream was applied for 4 hours following irradiation with a red light. Four sessions were administered, separated by five weeks. The lesion clinically improved after treatment without severe side effects. PDT using MAL could be considered an effective and tolerable treatment for mycosis fungoides.
Biopsy ; Drug Therapy ; Female ; Humans ; Middle Aged ; Mycosis Fungoides* ; Photochemotherapy* ; Phototherapy ; Skin ; Steroids ; Thigh