Torsades de pointes, a polymorphic ventricular tachycardia associated with prolonged QT interval, is a well-known life-threatening arrhythmia, which has been found to be induced by various causes such as drugs, electrolyte imbalances, and severe bradycardia. Cisapride is a gastrointestinal prokinetic drug, which is widely used to treat gastroesophageal reflux disease or other functional gastrointestinal disorders. Cisapride can cause torsades de pointes and cases of torsedes de pointes induced by cisapride have been reported in other countries. Cases of torsades de pointes associated with antihistamine drugs have been reported in Korea, however, cisapride-induced torsades de pointes case has not been reported. We report a case of 31 year-old female patient who experienced repeated loss of consciousness due to cisapride-induced torsades de pointes.
Adult ; Arrhythmias, Cardiac ; Bradycardia ; Cisapride* ; Female ; Gastroesophageal Reflux ; Gastrointestinal Diseases ; Humans ; Korea ; Tachycardia, Ventricular ; Torsades de Pointes* ; Unconsciousness

Soft tissue augmentation is a process of implanting tissues or materials to treat wrinkles or soft tissue defects in the body. Over the years, various materials have evolved to correct soft tissue defects, including a number of tissues and polymers. Autogenous dermis, autogenous fat, autogenous dermis-fat, allogenic dermis, synthetic implants, and fillers have been widely accepted for soft tissue augmentations. Tissue engineering technology has also been introduced and opened a new venue of opportunities in this field. In particular, a long-lasting filler consisting of hyaluronic acid filler and living human mesenchymal cells called "injectable tissue-engineered soft tissue" has been created and applied clinically, as this strategy has many advantages over conventional methods. Fibroblasts and adipose-derived stromal vascular fraction cells can be clinically used as injectable tissue-engineered soft tissue at present. In this review, information on the soft tissue augmentation method using the injectable tissue-engineered soft tissue is provided.
Adipocytes/transplantation ; Adipose Tissue/cytology ; Biocompatible Materials ; Connective Tissue/*surgery ; Dermatologic Surgical Procedures/*methods ; Face ; Fibroblasts/transplantation ; Humans ; Hyaluronic Acid/therapeutic use ; Injections, Intradermal ; Mesenchymal Stem Cell Transplantation/*methods ; Mesenchymal Stromal Cells ; Skin ; Skin Aging ; Tissue Engineering/*methods

A 47 year old man gave a history of progressive deterioration of vision in his right eye of more than 8 years duration, which culminated in total blindness. Since 1981 by several ophthalmologists, he had been diagnosed as retinal deta chment, a case of cysticercosis, or choroidal melanoma of the right eye. On admission, ultrasonogram and CT scan for the globe showed choroidal tu mor which entirely filled the vitreous cavity. Cytology for ascites disclosed malignant melanoma cells. Death from metastatic disease occurred four weeks after admission. The diffrentiation between primary and metastatic melanoma may be difficult. The followings are the noted help points: metastatic tumors are typically multiopIe and flat in the uveal tract: multiple tumor emboli are observed in choroid, ciliary body or retinal vessels: associated nevus cells at the base of tumor are lacking: and epitheloid cell types are consistently present. This case might be, morphologically and by his history, originated from a primary choroidal melanoma(epitheloid type).
Ascites ; Blindness ; Choroid* ; Ciliary Body ; Cysticercosis ; DEET ; Humans ; Melanoma* ; Middle Aged ; Neoplasm Metastasis* ; Nevus ; Retinal Vessels ; Retinaldehyde ; Tomography, X-Ray Computed ; Ultrasonography

A 47 year old man gave a history of progressive deterioration of vision in his right eye of more than 8 years duration, which culminated in total blindness. Since 1981 by several ophthalmologists, he had been diagnosed as retinal deta chment, a case of cysticercosis, or choroidal melanoma of the right eye. On admission, ultrasonogram and CT scan for the globe showed choroidal tu mor which entirely filled the vitreous cavity. Cytology for ascites disclosed malignant melanoma cells. Death from metastatic disease occurred four weeks after admission. The diffrentiation between primary and metastatic melanoma may be difficult. The followings are the noted help points: metastatic tumors are typically multiopIe and flat in the uveal tract: multiple tumor emboli are observed in choroid, ciliary body or retinal vessels: associated nevus cells at the base of tumor are lacking: and epitheloid cell types are consistently present. This case might be, morphologically and by his history, originated from a primary choroidal melanoma(epitheloid type).
Ascites ; Blindness ; Choroid* ; Ciliary Body ; Cysticercosis ; DEET ; Humans ; Melanoma* ; Middle Aged ; Neoplasm Metastasis* ; Nevus ; Retinal Vessels ; Retinaldehyde ; Tomography, X-Ray Computed ; Ultrasonography

PURPOSE: Diabetic foot infection is one of the most common and severe complications of diabetes mellitus that delays healing of the wound. Deep tissue biopsy is considered to be the gold standard method for antibiotic selection in treating infected chronic diabetic ulcers. However, swab culture or superficial tissue biopsy is often performed for a microbiologic test since deep tissue biopsy has limitations in application. The purpose of this study is to find out whether microbiologic results of swab culture or superficial tissue biopsy could be used for selection of antibiotics in treating diabetic ulcers. METHODS: This study involved 42 patients with diabetic foot ulcers with negative results in bone probing test. Tissue samples for microbiologic tests were collected from all the patients by using superficial cotton swab, superficial tissue, and deep tissue. The microbiologic results of deep tissue biopsy were compared with swab culture and superficial tissue biopsy statistically. RESULTS: Microbiology of the deep tissue showed the same results with those of the swab culture and superficial tissue in 67% and 71%, respectively. Statistical analysis demonstrated that the microbiology of the swab culture and superficial tissue does not coincide with that of the deep tissue. CONCLUSION: These results suggest that the microbiology of the swab culture and superficial tissue is not concordant with that of the deep tissue in infected chronic diabetic ulcers. To select appropriate antibiotic regimen, the specimen for the microbiologic test should be obtained from deep tissue.
Anti-Bacterial Agents ; Biopsy ; Diabetes Complications ; Diabetic Foot ; Humans ; Ulcer

BACKGROUND AND OBJECTIVES: Even short-term treatment with angiotensin converting enzyme inhibitor in essential hypertension has been known to improve left ventricular (LV) diastolic function, LV hypertrophy (LVH), and aortic stiffness. The purpose of this study was to examine the effects of angiotensin II receptor antagonist (Losartan) on LV diastolic function, LVH, and aortic stiffness in essential hypertension. MATERIALS AND METHODS: Twenty-three hypertensive patients who were aged over 50 years, previously untreated, and without cardiac, renal, neurologic disease, or diabetes, were studied. Before and 12 weeks after monotherapy with Losartan 50 mg q.d., (1) supine arterial blood pressure by sphygmomanometry, (2) interventricular septum and LV posterior wall thickness, and LV end-diastolic dimension by M-mode echocardiography, (3) mitral peak E and A wave velocity by doppler echocardiography, (4) pulse wave velocity (PWV) in the descending aorta from aortic arch to the bifurcation by doppler echocardiography, were done. RESULTS: Twelve weeks after treatment, systolic blood pressure was lowered from 168.2+/-3.5 mmHg to 142.9+/-2.9 mmHg (p<0.05), diastolic blood pressure from 98.52.4 mmHg to 87.51.3 mmHg (p<0.05). Peak E/A ratio was increased from 0.75+/-0.04 to 0.82+/-0.04 (p<0.05). LV mass was decreased from 267.5+/-15.8 g to 235.6+/-12.6 g (p<0.05), and LV mass index from 166.8+/-8.0 g/m2 to 146.9+/-6.0 g/m2 (p<0.05). However, there were no significant change in PWV (from 7.18+/-0.10 m/sec to 7.23+/-0.30 m/sec, p>0.05), compliance (from 1.31+/-0.04 to 1.34+/-0.12, p>0.05), and compliance index (from 0.16+/-0.01 to 0.15+/-0.01, p>0.05). CONCLUSION: Short-term treatment with Losartan decreases blood pressure, improves LV diastolic function and LVH, but not aortic stiffness.
Angiotensin II* ; Angiotensins* ; Aorta, Thoracic ; Arterial Pressure ; Blood Pressure ; Compliance ; Echocardiography ; Echocardiography, Doppler ; Humans ; Hypertension ; Hypertrophy ; Losartan* ; Peptidyl-Dipeptidase A ; Pulse Wave Analysis ; Receptors, Angiotensin ; Vascular Stiffness* ; Ventricular Function, Left*

PURPOSE: Diabetic foot ulcer with osteomyelitis is notorious with its complexity and healing difficulties. Bone biopsy is considered to be the gold standard method of guidance for antibiotic therapy. However, it is often replaced by cultures of ulcer swabs or by superficial samples because of the technical difficulties and possible adverse events. In this study, we compared microbiologic results of bone biopsy with those of superficial tissue biopsy or swab culture to investigate concordance and diagnostic value in bone involved diabetic foot ulcers. METHODS: This study involved 106 patients with diabetic foot ulcers who showed positive results in bone probing test. Tissue samples for microbiologic tests were collected from all the patients by using superficial cotton swab, superficial tissue biopsy, and bone biopsy. The microbiologic results of bone biopsy were compared with swab culture and superficial tissue biopsy statistically. RESULTS: The positive predictive value of bone probing test for underlying osteomyelitis was 82.1%. Microbiology of the bone biopsy showed same results with those of the swab culture and superficial tissue in 64% and 63%, respectively. Statistical analysis demonstrated that the microbiology of the swab culture or superficial tissue did not coincide with that of the bone biopsy. CONCLUSION: These results suggest that the microbiologic results of superficial tissue or swab culture do not coincide with those of bony tissue. To select appropriate antibiotic regimen for diabetic ulcer with bone involvement, the specimen for the microbiologic test should be obtained from involved bone.
Biopsy ; Diabetic Foot ; Humans ; Osteomyelitis ; Ulcer

In a study of intacranial metastases, 46 cases having satisfactory clinical, operative and histological proofswere analyzed by computerized tomography at Presbyterian Medical Center from May, 1982 to February, 1986. Theresults were as follows: 1. The male to female ratio of itracranial metastases were 67:33. The 5th decade group(34.8%) was the most prevalent age group, followed by the 6th decade(21.7%) and 7th decade(21.7%). 2. The numberof lesions was found to be: single-25 cases(54.3%); multiple-21 cases(45.7%). 3. The source of intracranialmetastases found to be: lung 15 cases(32.6%); unknown 12 cases(26.0%); chorioca 3 cases(6.5%); liver 3cases(6.5%); liver 3 cases(6.5%); stomach 2 cases(4.3%); parotid, breast, kidney, prostate, melanoma, rectal ca.rhabdomyosarcoma, nasal ca. lymphoma, testicular ca, cervix, each 1 case(2.2%). 4. The locations of theintracranial metastases were as follows: Cerebral hemisphere 37.7% in parietal region Cerebra hemisphere 15.9% inin frontal region Cerebral hemisphere 13.4% in occipital region Cerebra hemisphere 10.5% in temporal regionCerebellar hemisphere 3.2% Cerebellopontine angle 3.2% Intraventricular 4.8% Meninges 4.8% Skull vault 6.5% 5.Peritumor edema was found to be: Grade II-17 cases(37.0%): Grade III-14 cases(30.4%); Grade I-8 cases(17.4%);Grade 0–7 cases(15.2%) in that order. 6. The chief complaints of intracranial metastases on admission, were asfollows: Headache 30 cases(65.2%); Vomiting 11 casees(23.9%); deteriorated mental state 10 cases(21.6%);Hemiplegia 7 cases(15.2%); visual disturbance 6 cases(13.0%); hemiparesis 4 cases(8.7%); seizure 4 cases(8.7%);other symptoms were less frequent. 7. On pre-contrast scan, hyperdense lesions were present in 18 cases(39.1%);hypodense lesions in 15 cases(32.6%); mixed density in 8 cases(17.4%); isodenisty was present in 5 cases(10.9%).On post-contrast scan, ring enhancement was seen in 19 cases(41.3%); nodular enhancement in 17 cases(37%); mixedring-nodular enhancement in 8 cases(17.4%); only hypodense 2 cases(4.3%).
Breast ; Cerebellopontine Angle ; Cerebrum ; Cervix Uteri ; Edema ; Female ; Headache ; Humans ; Kidney ; Liver ; Lung ; Lymphoma ; Male ; Melanoma ; Meninges ; Neoplasm Metastasis ; Occipital Lobe ; Paresis ; Parietal Lobe ; Prostate ; Protestantism ; Seizures ; Skull ; Stomach ; Vomiting

PURPOSE: To assess the clinical features and outcomes of patients referred for management of dropped lens fragments during cataract surgery. METHODS: The medical records of 22 eyes from 22 patients who were referred to our hospital to undergo pars plana vitrectomy (PPV) for management of dropped lens fragments after phacoemulsification surgery at private clinics were reviewed. Data including patient demographics, preoperative and postoperative visual acuity, factors associated with dropped lens fragment, and postoperative complications were recorded. The factors were compared between 2 patient groups: postoperative Snellen acuity of 0.5 or better and acuity less than 0.5. The statistical significances of differences in factors between the 2 groups were calculated. RESULTS: The mean interval between cataract surgery and PPV was 2.6 +/- 3.7 days. At the final examination, the mean postoperative acuity was 0.57 +/- 0.20, and 16 eyes (72.7%) had a visual outcome of 0.5 or better. After excluding 7 eyes with other pre-existing ocular co-morbidities, 14 eyes (93.0%) achieved a final visual acuity of 0.5 or better. Multivariate analysis showed that the predictor for visual outcomes of 0.5 or better was absence of preoperative eye disease (p = 0.007). Complications after PPV included 2 (9.0%) cases of cystoid macular edema and 1 (4.5%) case of retinal detachment. CONCLUSIONS: Prompt referral and surgical management within 1 week for dropped lens fragments during cataract surgery may achieve a better visual outcome in cases with no pre-existing eye disease.
Cataract ; Demography ; Eye ; Eye Diseases ; Humans ; Macular Edema ; Medical Records ; Multivariate Analysis ; Phacoemulsification ; Postoperative Complications ; Referral and Consultation ; Retinaldehyde ; Visual Acuity ; Vitrectomy

PURPOSE: To assess the influence of body position on intraocular pressure (IOP) in patients who underwent vitrectomy and intraocular gas tamponade. METHODS: Patients who did not undergo any surgery were defined as Group 1. The remaining patients were divided into 3 groups according to the surgery performed (Group 2; cataract surgery, Group 3; vitrectomy and cataract surgery, Group 4; vitrectomy with intraocular gas tamponade and cataract surgery). IOP was measured by a non-contact tonometer, Goldmann applanation tonometer, and Tono-Pen in the sitting, supine, and prone positions. RESULTS: The difference of IOP measured in the sitting position among the 4 groups was not significant. IOP was significantly elevated by 2.04 mm Hg on average when the posture was changed from sitting to supine or prone in all 4 groups. The IOP discrepancy between supine and sitting positions was significantly greater in group 4 by 3.61 mm Hg than the other groups (p = 0.003, ANOVA test). The IOP difference between the prone and sitting position was also significantly higher in group 4 by 3.82 mm Hg than the other groups (p = 0.001, ANOVA test). CONCLUSIONS: The patients with vitrectomized gas tamponade eyes had a mean IOP increase of 3.82 mm Hg when the position was changed from sitting to prone. When performing vitrectomy and intraocular gas tamponade on patients in the prone position, an IOP elevation should be monitored thoroughly.
Cataract ; Humans ; Intraocular Pressure* ; Posture ; Prone Position ; Vitrectomy*