A 49-year-old female presented with bilateral abducens nerve palsies. She had 75 prism diopter esotropia. The extraocular movement of the lateral rectus was -1 limitation for the right eye and -4 limitations for the left. After performing orbital magnetic resonance imaging (MRI), 2 mL of bupivacain (5 mg/mL) was injected into the left lateral rectus (LR). One month after injection, a further orbital MRI was performed. Subsequently, recession of both medial rectus (6 mm) and resection of the left LR (9 mm) were performed. After one month, bupivacaine had no hypertrophic effects. There was little change in angle of deviation. The orbital MRI scan showed a 1.91% increase in volume compared to the muscle prior to the injection. Histological findings showed no muscle fibers of the left LR muscle, only the fiber nucleus and the collagen that replaced the fibers. We report on the changes in stiffness and muscle volume and on the histology of the muscle one month after injecting bupivacaine into the paralyzed left LR muscle combined with standard surgical treatment.
Abducens Nerve/*pathology ; Abducens Nerve Diseases/*drug therapy/pathology ; Anesthetics, Local/*administration & dosage/adverse effects ; Bupivacaine/*administration & dosage/adverse effects ; Female ; Humans ; Magnetic Resonance Imaging ; Middle Aged

PURPOSE: We report a case of asymptomatic unexplained visual field loss diagnosed as early retinitis pigmentosa (RP) without pigmentation. CASE SUMMARY: A 33-year-old woman was referred to us with a constricted visual field (C24-2) before laser-assisted in-situ keratomileusis surgery. The visual field test (C30-2) revealed significantly decreased sensitivity between 15 to 25 degrees in both eyes. Close fundus examination revealed a subtle greyish retinal atrophic lesion along the vascular arcade and fluorescein angiography revealed a window defect in accordance with a retinal atrophic lesion in both eyes. Optical coherence tomography showed decreased retinal thickness around the macula. Electroretinogram revealed decreased b waves in rod response. Based on these findings, we diagnosed the patient with early RP without pigmentation. CONCLUSIONS: The possibility of early RP without pigmentation presenting as slight atrophy around the macula without significant pigmental degeneration should also be considered if a patient presents with peripheral visual field constriction without other symptoms. The ophthalmologist should ensure that the location of the visual field defect matches the location of the lesion. In addition, a detailed fundus examination with macular optical coherence tomography can be helpful to diagnose such a lesion.
Adult ; Atrophy ; Constriction ; Female ; Fluorescein Angiography ; Humans ; Pigmentation* ; Retinaldehyde ; Retinitis Pigmentosa* ; Retinitis* ; Tomography, Optical Coherence ; Visual Field Tests ; Visual Fields*

BACKGROUND: In a rapidly aging population, the importance of the quality of life of the elderly has been emphasized. The need for special care services according to an individual's physical, emotional, and social functions changes with aging. This study was conducted to analyze the needs of home dwellers in terms of health-care services for active aging. METHODS: The study subjects were 869 adults older than 40 years who lived in houses. They responded to a survey that inquired about the importance of each health-care item for active aging at home. The important items for active aging at home were graded by using a 5-point Likert scale. RESULTS: Among the items, "affection" topped the list, with 4.68 points, followed by cognitive function (4.67 points) and "social relations" (4.59 points). The top 3 items had no significant differences between the age groups. However, some items related to activities of daily living (ADL; including bathing, eating, and ambulating.) and instrumental ADL (IADL; including taking medicines and preparing meals) had significant differences between the age groups. Compared with the subjects in the older age groups, the subjects in the forties age group placed less importance on ADL and IADL. CONCLUSION: For the subjects who lived in houses, affection, cognitive function, and social relation are highly important for as active aging, regardless of age. ADL and IADL are regarded as more important in ≥50 years age groups.
Activities of Daily Living ; Adult ; Aged ; Aging* ; Baths ; Delivery of Health Care* ; Eating ; Humans ; Quality of Life

BACKGROUND: We describe the characteristics of malpractice claims related to central venous catheterization and identify causes and potential preventability of such claims. METHODS: A retrospective study was performed by reviewing records at Lawnb and Lx CD-rom. The records on closed malpractice claim related to central venous catheterization were abstracted from the files available for analysis. The records were reviewed and were analysed to determine the factors associated with a successful defense. RESULTS: Twelve closed claim cases, related to central venous cathetertization were reviewed in the data for malpractice. Catheter-related complications were pneumothorax, hemothorax, cardiac tamponade, pyothorax, hematoma due to arterial puncture, pseudoaneurysm. Almost cases resulted in indemnity payment and verdict for patient. CONCLUSIONS: Although malpractice claims related to central venous catheterization were uncommon, they resulted in high rate and amount of indemnity payments. In pediatric patient, catheterization should be performed with attention. Clinicians should consider the underlying disease of patients and do any pretreatment if needed. Post-procedural radiologic confirmation can improve patient outcome and is also associated with decreased indemnity risk. Informed consent is also important.
Aneurysm, False ; Cardiac Tamponade ; Catheterization ; Catheterization, Central Venous* ; Catheters ; CD-ROM ; Central Venous Catheters* ; Empyema, Pleural ; Hematoma ; Hemothorax ; Humans ; Informed Consent ; Malpractice ; Pneumothorax ; Punctures ; Retrospective Studies

PURPOSE: To investigate the effects of the intake of xylooligosaccharide-sugar mixture (XOS) on defecation frequency and symptoms in 56 young women (mean age of 22.1 years old) with constipation. METHODS: Two experiments were conducted. In experiment 1, a randomized double-blind study was performed to evaluate the effect of 6 weeks' intake of 10 g sucrose containing 7% xylooligosaccharide or 10 g sucrose on constipation. In experiment 2, 24 g coffee mixture containing 12.8 g plant cream and 11.2 g xylooligosaccharide-sugar mixture was consumed by the subjects. During the study, the clinical efficacy was assessed by using a daily diary. The subjects indicated the number of frequencies they defecated in a day and the clinical symptom scores. RESULTS: In experiment 1, the mean frequency of defecations was 2.07 in the pretreatment week and increased significantly to 4.05, 4.42, 4.84, 4.84, and 4.05 in weeks 2 to 6 of XOS intake, in comparison with the 3-3.67 with sucrose intake (sucrose, SUC). In experiment 2, the mean frequency of defecations significantly increased from 2.47 in the pretreatment week to 4.11-5.67 in weeks 1-6 of XOS intake. The occurrence of very loose or loose stools in the XOS group was significantly increased in weeks 5 and 6, compared with the pretreatment week and SUC group. XOS intake significantly alleviated the abdominal displeasure and feeling of residual stool leftness in weeks 2, 3, 5, and 6, while SUC did so in weeks 4 and 6 (p < 0.05). The coffee mixture containing xylooligosaccharide-sugar mixture reduced the abdominal displeasure and feeling of residual stool leftness from week 3 until the end of the experiment (p < 0.05). CONCLUSION: Our results suggest that xylooligosaccharide-sugar mixture intake was effective, without adverse effects, for the alleviation of constipation in the young women in this study.
Coffee ; Constipation* ; Defecation* ; Double-Blind Method ; Female ; Humans ; Plants ; Sucrose

Background: and Purpose Perampanel (PER) is an α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid antagonist used to treat focal and generalized epilepsy. Comprehensive data from real-world settings with long-term follow-ups are still scarce. This study aimed to determine the factors related to PER retention and the polytherapy pattern with PER. Methods: We reviewed all patients with epilepsy with a history of PER prescription during 2008–2017 and over a follow-up of >3 years. PER usage patterns and associated factors were analyzed. Results: Among the 2,655 patients in the cohort, 328 (150 females, 178 males) were enrolled.The ages at onset and diagnosis were 21.1±14.7 years and 25.6±16.1 years (mean±standard deviation), respectively. The age at the first visit to our center was 31.8±13.8 years. Seizure types were focal, generalized, and unknown onset in 83.8%, 15.9%, and 0.3% of patients, respectively. The most common etiology was structural (n=109, 33.2%). The maintenance duration of PER was 22.6±19.2 months (range=1–66 months). The initial number of concomitant antiseizure medications was 2.4±1.4 (range=0–9). The most common regimen was PER plus levetiracetam (n=41, 12.5%). The median number of 1-year seizures before PER usage was 8 (range=0–1,400). A seizure reduction of >50% was recorded in 34.7% of patients (52.0% and 29.2% in generalized and focal seizures, respectively). The 1-, 2-, 3-, 4-, and 5-year retention rates for PER were 65.3%, 50.4%, 40.4%, 35.3%, and 21.5%, respectively. A multivariate analysis indicated that lower age at onset was associated with longer retention (p=0.01). Conclusions PER was safely used in patients with diverse characteristics and was maintained for a long time in a real-world setting, especially in patients with a lower age at onset.

PURPOSE: The objective of this study was to investigate the effects of xyloologosaccharide (XOS)-sugar mixture on glycemic index (GI) and blood glucose in human subjects. METHODS: Randomized double-blind cross-over studies were conducted to examine the effect of sucrose with 14% xyloologosaccharide powder (Xylo 14) and sucrose with 20% xylooligosaccharide powder (Xylo 20) on GI and postprandial glucose response at 15, 30, 45, 60, 90, and 120 min. RESULTS: GIs of Xylo 14 and Xylo 20 were 60.0 +/- 23.5 classified within medium GI range, and 54.3 +/- 17.7 within low GI range, respectively. Xylo 14 and Xylo 20 showed significantly lower area under the glucose curve (AUC) for 0-15 min (p = 0.0113), 0-30 min (p = 0.0004), 0-45 min (p < 0.0001), 0-60 min (p < 0.0001), 0-90 min (p < 0.0001), and 0-120 min (p = 0.0001). In particular, compared with glucose, the blood glucose levels of Xylo 14 and Xylo 20 were significantly lower at every time point between 15 and 120 min. CONCLUSION: The results of this study suggested that Xylo 14 and Xylo 20 had an acute suppressive effect on GI and the postprandial glucose surge.
Adult* ; Blood Glucose* ; Cross-Over Studies ; Glucose ; Glycemic Index* ; Humans ; Sucrose

Dermatofibroma is a common benign fibrohistiocytic tumor. It can occur anywhere on the body surface, but it has a propensity for the extremities. However, dermatofibroma may show a wide variety of clinicopathologic variants and so it is often misdiagnosed. Our case was a 13-year-old male who presented with a 1-year history of a solitary skin-colored hyperkeratotic nodule on the right sole. The nodule had recurred after topical therapy for viral wart. Histopathologic examination of the patient's lesion revealed a poorly circumscribed nodular tumor composed of collagen bundles, fibroblasts and histocytes, which was all consistent with plantar dermatofibroma.
Adolescent ; Collagen ; Extremities ; Fibroblasts ; Histiocytoma, Benign Fibrous ; Humans ; Male ; Warts

Granular parakeratosis is a recently recognized disorder of keratinization that is usually confined to intertriginous areas. The histopathologic features are distinctive and diagnostic. Rarely, histopathologic variants such as follicular granular parakeratosis and granular parakeratosis of eccrine ostia have been described. In this report, we describe a rare case of granular parakeratosis mostly confined to eccrine ostia.
Eccrine Glands ; Keratins ; Neck ; Parakeratosis

There have been no long-term complications or life-threatening adverse effects related to botulinum toxin treatment for any cosmetic indications. Nevertheless, there are well-known, mild side effects of botulinum toxin treatment on the upper face, though most of them are self limited with time. However, excluding brow ptosis, reports about site specific side effects are few and anecdotal. We experienced cases of exaggeration of wrinkles after botulinum toxin injection for forehead horizontal lines, and report them here. In our cases, new appearance of a noticeable glabellar protrusion following botulinum toxin injection on the forehead was observed in 2 patients. Also, a new deep wrinkle on one side of the forehead just above the eyebrow appeared in another 2 patients. The exaggerated wrinkles nearly disappeared without treatment by week 4 in all subjects. These exaggerations of wrinkles may be caused by hyperactivity and overcompensation of untreated muscles. With the increasing availability of diverse botulinum toxin for cosmetic purposes, physicians and patients should be aware of this temporary change after therapeutic injections. We recommend explaining this possible effect prior to injection, for better understanding of treatment for cosmetic indications.
Botulinum Toxins ; Cosmetics ; Eyebrows ; Forehead ; Humans ; Muscles