PURPOSE: We report a rare case of double depressor palsy after bilateral thalamus infarction. CASE SUMMARY: A 47-year-old male presented with complaints of diplopia upon awakening. He had atrial fibrillation, mitral valve regurgitation, aortic valve regurgitation and a history of spleen infarction 1 year prior. His right eye was hypertrophic and right eye downgaze was limited unilaterally of equal degree in adduction and abduction. Right eye horizontal and upward movements were intact. Left eye movement was intact in all directions. Pupillary light reflex response and convergence test were normal. Nystagmus was not observed. The patient was diagnosed with double depressor palsy of the right eye. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) of the brain showed an old infarction of the left thalamus and diffusion MRI showed acute infarction of the right thalamus. The patient's daily warfarin dose was 2 mg and was increased to 5 mg with cilostazol 75 mg two times a day. Seven weeks later, the patient's ocular movement revealed near normal muscle action and, subjectively, the patient was diplopia-free. CONCLUSIONS: Double depressor palsy is a extremely rare disease and can be caused by bilateral thalamic infarction.
Aortic Valve ; Atrial Fibrillation ; Brain ; Diffusion Magnetic Resonance Imaging ; Diplopia ; Eye Movements ; Humans ; Infarction* ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Mitral Valve Insufficiency ; Paralysis* ; Rare Diseases ; Reflex ; Spleen ; Thalamus ; Warfarin

Malignant hyperthermia is defined as a potentially fatal hypermetabolic syndrome char-acteriged by hyperpyrexia, muscle rigidity, tachycardia, respiratory and metabolic acidosis. cyanosis etc. It ia susceptible in patients with musculoskeletal diaease such as strabismus, kyphosco-liosia, hernia, cleft palate, cryptorchidism, but there is no single diagnostic method to detect a susceptible patient. Fortunately s-CPK is elevated in 70% of carriers, so we checked a-CPK and a-LDH bel- ore operation in patients scheduled for correction of congenital strabismus and classified into group 1 (norirlal a-CPK group) and group 2 (elevated s-CPK group) . We administered Oantrolene sodium to group 2 before operation and compared the changes of s-CPK and s-LDH after operation. The results are as fallows, 1) s-CPK was lowered after administration of Dantrolene sodium in group 2 . (from 76.4 IU/L to 48.5IU/L) 2) s-CPK elevation after operation was much less in group 2 than group 1. (56.1+/-58.7 IU/L vs 164.7+/-127.1 IU/L) In conclusion, it would seem that Dantrelene aodium was affective in prevention of mali-gnant hyperthermia.
Acidosis ; Cleft Palate ; Cryptorchidism ; Cyanosis ; Dantrolene* ; Fever ; Hernia ; Humans ; Male ; Malignant Hyperthermia* ; Muscle Rigidity ; Sodium ; Strabismus ; Tachycardia

Pneumothorax was recognized as a potential hazard of mechanical ventilation shortly after the introduction of the technique of tracheal intubation in the 19th century. Because the gases used in anesthesia are delivered from cylinders and wall outlets at higher than atmoshperic pressure, the possibility of damage to the lung is ever present. Immediate, prompt and adequate management of bilateral tension Pneumothorax are essentil, otherwise the patient dies rapidly. We had a case of bilateral tension Pneumothorax in a 3 year-old boy who underwent a B-E amputation of a severely crushed hand. We report this case along with a review of the literature on Pneumothorax.
Amputation ; Anesthesia ; Anesthesia, General* ; Child, Preschool ; Gases ; Hand ; Humans ; Intubation ; Lung ; Male ; Pneumothorax* ; Respiration, Artificial

PURPOSE: Porous hydroxyapatite is resorbable and osteoconductive, so it is slowly replaced by ingrowing new bone. Optimal pore geometry for osteoconduction, however, has not been determined yet. The objective of this investigation was to assess both the histological response and the reinforcing effects of bone ingrowth within the porous hydroxyapatite implants depending on pore size. MATERIALS AND METHODS: Four kinds of cylindrical types (50, 100, 300, 500 micrometer) of porous hydrox-yapatite were prepared. Fifty-six white rabbits were divided into 4 groups and porous hydroxyapatite block was inserted through the medial cortical window of a proximal tibia. Histomorphological changes were examined using light microscopy and scanning electron microscopy. Biomechanical compression test was performed using a material test machine. RESULTS: Hydroxyapatite implants appeared to have no early adverse effects, such as inflammation and foreign body reaction. Osteoconduction through the pores was found in all four implants and new bone was found on the surface of pores with no histologically demonstrable intervening nonosseous tissue. At four weeks after implantation, new bone was arranged in a concentric pattern around the vessel, similar to osteon. New bone formation through pores was most evident at 300 micrometer-sized type. At 8 weeks, active osteoconduction was also found at 50 micrometer-sized type. Evidence of bone marrow formation within porous hydroxyapatite was found. In a biomechanical study, ultimate compression strength significantly increased in the 300 micrometer-sized type, after 8 weeks implantation compared to preimplantation. CONCLUSIONS: Porous hydroxyapatite implanted into rabbit tibia showed biological fixation and osteointegration. A pore size of 300 micrometer was most effective for bone ingrowth. Osteoconduction also took place in 50 micrometer-sized cylindrical pores.
Bone Marrow ; Bone Regeneration* ; Durapatite* ; Foreign-Body Reaction ; Haversian System ; Inflammation ; Microscopy ; Microscopy, Electron, Scanning ; Osteogenesis ; Rabbits ; Tibia

Peroneal tendon dislocation in association with calcaneal fracture is not common and difficult to diagnose and is often overlooked. It can result in peroneal tendon tear and tenosynovitis which in turn lead to ankle pain and dysfunction. Early detection with through physical examination and CT scan is important to reduce the subsequent tendon dysfunction. We experienced 6 cases of peroneal tendon dislocation associated with calcaneal fracture, and treated 3 of them at the time of fracture operation and treated the other 3 after calcaneal fracture surgery due to sustained pain. We report the results with a review of the literature.
Animals ; Ankle ; Dislocations ; Physical Examination ; Tendons ; Tenosynovitis

BACKGROUND: The incidence of aspergillosis is rising with the increased use of antimicrobial agents and immunosuppressive drugs for the treatment of malignant diseases, acquired immunodeficiency syndrome, or organ transplant recipients. However, treatment failures are also increasing which brings up the need for the development of new and more effective agents and/or compounds which support the activity of common antifungal agents. Apolactoferrin is one of the nonspecific host defence factors present in saliva that exhibit antifungal activity. We studied the in vitro antifungal effect of apolactoferrin in combination with amphotericin-B against Aspergillus fumigatus. METHODS: Preparation of the inoculum and the growth conditions used were those recommended by the National Committee for Clinical Laboratory Standards M38-P (Conidium-forming filamentous fungi: proposed standard). Aspergillus fumigatus test inoculum was prepared to a concentration of 0.4 X 104~5 X 104 cells/mL. Appropriate concentrations of the antifungal agents were added to the wells (50 microliter) and after inoculation, plates were incubated for 48 h at 35Celsius. Turbidity measurement was performed at 48 h at 630 nm and the MIC was defined as the lowest concentration of antifungal agents that inhibited growth of the organism as detected visually. RESULTS: In the combination of experiments, we observed a pronounced cooperative activity against growth of Aspergillus fumigatus by using apolactoferrin and amphotericin-B. The MIC of amphotericin-B was reduced by 1/10 in the presence of apolactoferrin. CONCLUSION: The combined use of apolactoferrin and amphotericin-B against severe infections with Aspergillus fumigatus is an attractive therapeutic option. Clinical studies to further elucidate the potential utility of this combination therapy have been initiated.
Acquired Immunodeficiency Syndrome ; Anti-Infective Agents ; Antifungal Agents ; Aspergillosis ; Aspergillus fumigatus* ; Aspergillus* ; Fungi ; Incidence ; Saliva ; Transplants ; Treatment Failure

Localized Darier's disease (DD) is a rare variant of DD. The disease is characterized by multiple hyperkeratotic papules in a unilateral, linear, zosteriform or Blaschkoid distribution with the histological features of classical DD. Unlike DD, which presents as a generalized condition, localized DD lacks family history and other clinical findings suggestive of DD such as distinctive nail abnormalities and keratotic papules on the palms and soles. Herein, we describe a case of localized DD in a 31-year old Korean man on the perianal area that was treated with topical retinoid cream.
Darier Disease* ; Humans ; Nails, Malformed

BACKGROUND: The effects of the levering laryngoscope (McCoy laryngoscope) on the laryngoscopic view classified by the Cormack and Lehane were investigated in this study. METHODS: The laryngoscopic view with the levering laryngoscope blade in neutral and best position were recorded respectively and analysed statistically. RESULTS: 109 laryngoscopic views were grade 1 or 2 and 12 were grade 3 or 4 in the neutral position with the McCoy blade. Only three patients were grade 3 or 4 in its best position and the others grade 1 or 2. The reduction in the incidence of difficult laryngoscopic view (grade 3 or 4) using the levering laryngoscope in its best position was statistically significant (p<0.01). CONCLUSIONS: Levering laryngoscope improves laryngoscopic view and also reduces the incidence of difficult intubation. So, we suggest that it is an useful instrument for the anesthesiologists in the difficult tracheal intubation.
Humans ; Incidence ; Intubation ; Laryngoscopes*

BACKGROUNDS/AIMS: The purpose of this study was to evaluate the role of peripheral eosinophilia as a predictable factor associated with Eosinophilic cholecystitis (EC) compared with other forms of cholecystitis in patients who underwent a cholecystectomy. METHODS: Between January 2001 and May 2011, the histopathologic features of 3,539 cholecystectomy specimens were reviewed retrospectively. EC was diagnosed in 30 specimens (0.84%). Data from 30 consecutive patients with EC (eosinophilic cholecystitis group [E-group]) were compared with a retrospective control group of 60 patients (other cholecystitis group [O-group]) during the same period. The two groups were matched for age, gender, and the presence of cholelithiasis. RESULTS: The median absolute eosinophil count 1 day post-operatively was 144 cells/mm3 (range: 9-801 cells/mm3) in the E-group and 93 cells/mm3 (range: 0-490 cells/mm3) in the O-group (p=0.036). Pre-operative peripheral eosinophilia was more common in the E-group than the O-group (20% vs. 3.3%, p=0.015). Multivariate analysis revealed that pre-operative peripheral eosinophilia was an independent significant predictable factor associated with EC (odds ratio=7.250, 1.365 <95% confidence interval<38.494, p=0.020). CONCLUSIONS: In the present study, pre-operative peripheral eosinophilia was shown to be an independent predictable factor associated with EC. Further researches seem to be necessary to confirm this finding.
Cholecystectomy ; Cholecystitis ; Eosinophilia ; Eosinophils ; Humans ; Multivariate Analysis ; Retrospective Studies

PURPOSE: Radical lymph node dissection for right-sided colon cancer is technically challenging. No clear guideline is available for surgical resection of clinical stage I right-sided colon cancer. This study was designed to review the pathologic stage of clinical stage I right-sided colon cancer and determine the relevant extent of surgical resection. METHODS: Patients were treated for clinical stage I right-sided colon cancers (cecal, ascending, hepatic flexure, and proximal transverse colon) between July 2006 and December 2014 at a tertiary teaching hospital. Open surgery was not included because laparoscopic surgery is an initial major procedure in the institution. RESULTS: During the study period, 80 patients diagnosed with clinical stage I right-sided colon cancer were classified into 2 groups according to the pathology: stage 0/I and II/III. Tumor sizes were larger in the stage II/III group (P = 0.003). The stage II/III group had higher rates of vascular (P = 0.023) and lymphatic invasion (P = 0.023) and lower rates of well differentiation (P = 0.022). During follow-up, 1 case of local and 4 cases of systemic recurrences were found. Multivariate analysis to confirm odds ratios affecting change from clinical stage I to pathological stage II/III showed that tumor size (P = 0.010) and the number of retrieved lymph nodes (P = 0.046) were risk factors. CONCLUSION For right-sided colon cancer, even with clinical stage I included, radical lymph node dissection should be performed for exact staging with sufficient number of lymph nodes. This will help determine appropriate adjuvant treatment, especially in large tumor sizes.