No abstract available.
Heart Diseases* ; Heart*

Transfusion complications include ABO/Rh incompatibility, sepsis, febrile reaction, immunosuppression, and viral transmission. We experienced a case of anaphylactic reaction in a 40-year-old male scheduled for laminectomy. Anesthesia was induced by intravenous (I.V.) thiopental sodium and maintained with enflurane / N2O / oxygen. Vital signs were stable until 2 hours into surgery, when patient developed sudden profound hypotension (systolic pressure 60 mmHg) with tachycardia, skin flushing and bronchial wheezing shortly after infusion of only a few milliliters of 4th unit of whole blood. Blood transfusion was immediately stopped, anesthetic agents were discontinued, and 100% oxygen was administered. Rapid administration of I.V. fluids was begun and I.V. hydrocortisone along with pheniramine were administered. Patient was successfully treated and eventually discharged from the hospital. In conclusion, besides hemolytic transfusion reaction, anaphylactic transfusion reaction may cause severe hypotension. One should be aware of the potential for adverse effects including anaphylaxis, should recognize them immediately and treat them appropriately.
Adult ; Anaphylaxis ; Anesthesia ; Anesthetics ; Blood Group Incompatibility ; Blood Transfusion ; Enflurane ; Flushing ; Humans ; Hydrocortisone ; Hypotension ; Immunosuppression ; Laminectomy ; Male ; Oxygen ; Pheniramine ; Respiratory Sounds ; Sepsis ; Skin ; Tachycardia ; Thiopental ; Vital Signs

BACKGROUND AND OBJECTIVES: Qualitative oculomotor abnormalities have been reported in parkinsonian patients for many years, but conflicting results have been obtained. This study was performed to evaluate the correlation between the severity of the disease and the abnormalities of the ocular movements in idiopathic parkinson's disease. METHODS: We gave the vestibular function tests in patients with idiopathic parkinson's disease and normal controls. Eye movement recordings were made with automated electronystagmography and rotation test was performed. A total of 46 patients (mean age : 61.2+/-6.7) and 24 controls (mean age : 60.5+/-4.3) were studied. The severity of the disease was divided into two groups by modified Hoehn & Yahr staging ; H-Y stage 1 and 2 as a mild group and stage 3 and 4 as a severe group. RESULTS: Saccadic latency and accuracy, pursuitic gain and velocity, vestibulo-ocular reflex (VOR) suppression by vision were significantly altered in patients, whereas mean velocity of optokinetic nystagmus (OKN) and VOR gain in darkness were normal. Alteration of saccadic latency and accuracy, pursuitic gain and velocity, VOR suppression by vision were profound in the severe group compared with a mild group and controls, but the above parameters did not differ between a mild group and controls. In a hemiparkinson's group, saccadic latency and accuracy, pursuitic gain, OKN mean velocity and gain was not different between the both sides. CONCLUSION: The results indicate that severe Parkinson's disease damages nigrostriatal or other specific pathways which were involved in the regulation of the saccadic, pursuitic and pursuitic-mediated visual fixation system. In a hemiparkinson's group asymmetric damage of dopaminergic innervation which was involved in the regulation of ocular movements was not found.
Darkness ; Electronystagmography ; Eye Movements ; Humans ; Nystagmus, Optokinetic ; Parkinson Disease* ; Reflex, Vestibulo-Ocular ; Vestibular Function Tests

BThere are many materials which can make beautiful, clear eyelid crease with temporary effect. Double fold tape and glue are the most popular materials to make artificial double eye lids. However, the long-term use of these materials seems to make cause many local problems. This study was conducted to identify the long-term side effects of double-fold tape and glue. A total of 191 patients who have experienced double fold tape or glue were enrolled. The information of age, double-fold making product, and side effects were collected, based on medical records and, Patient & Observer scale(1: 'Normal', 5: 'Abnormal/Severe). The mean period of use was 23.7 months. The time required to make double-fold was 5~30 minutes. The most common symptom was itching sense, followed by decrease skin elasticity, skin dryness, and change of skin color. The most common signs was skin laxity, followed by eruption, keratinization, pigmentation, and local inflammation. One patient underwent medical treatment for conjunctivitis after double-fold glue usage. Double fold tape or glue can lead a problem with skin due to lack of oxygen exposure and rubbing eye lids with a stick. Appropriate use of double-fold products and careful monitoring of side effects are needed.
Adhesives ; Blepharoplasty ; Conjunctivitis ; Elasticity ; Eye ; Eyelids ; Humans ; Inflammation ; Keratins ; Medical Records ; Oxygen ; Pigmentation ; Pruritus ; Skin ; Surgical Tape

Solid pseudopapillary tumor (SPT) of the pancreas is a rare tumor that typically affects young women without causing significant clinical symptoms. No case of SPT in an old man has been reported in South Korea, and such cases are very rare worldwide. We report a 70-year-old man with SPT of the pancreas with multiple organ metastasis. Although surgical resection is the treatment of choice for SPT, we decided not to treat, considering his age and the disease severity.
Aged ; Diagnosis ; Female ; Humans ; Korea* ; Neoplasm Metastasis ; Pancreas*

The Iinvolvement of subaortic structures in the aortic valve endocarditis appears more commonly than previously recognized. These subaortic complications are most commonly located in the mitral-aortic intervalvular fibrosa and may be presented as abscess, or as pseudoaneurysm with or without perforation. Perforated pseudoaneurysm can lead to the development of communication between the left ventricular outflow tract and various cardiac chambers, most commonly the left atrium. These complications are related with poor prognosis. Early and precise recognition of these complications is important for optimal treatment. At present, transesophageal echocardiography (TEE) has been validated as the technique of choice. We describe a case of infectious pseudoaneurysm of mitral-aortic intervalvular fibrosa featuring the connection of the fistulous simultaneously to the left atrium and aorta. In our case, accurate interpretation of TEE imaging revealing the subaortic structures was not so easy due to interference of both aortic and mitral prosthetic valves. We expect the further development of (Ed-confirming that here you don't intend, "We expect to further develop") TEE and other imaging modalities to substantially improve the future diagnosis of these undesirable complications.
Abscess ; Aneurysm, False* ; Aorta ; Aortic Valve* ; Diagnosis ; Echocardiography, Transesophageal ; Endocarditis* ; Fistula* ; Heart Atria ; Prognosis

Paralytic pontine extropia(PPE) is a exotropia in contralateral eye of lesion side, associated with one-and- a-half syndrome in acute phase of brainstem infarction and after then, often followed by non-paralytic pontine extropia(NPPE) and medial longitudinal fasciculus (MLF) syndrome in each clinical improvement. NPPE is pontine exotropia without lateral gaze palsy to ipsilateral side and is considered to be due to partial impairment of the unilateral paramedian pontine reticular formation(PPRF). We reported a case, 75 yearold man, of brainstem infarction who initially presented NPPE in acute phase, followed by ipsialteral MLF syndrome after 5th days.
Brain Stem Infarctions* ; Brain Stem* ; Brain* ; Exotropia* ; Paralysis

Electrical stimulation has been used for evaluating central motor system and deep portion of peripheral nerve, but it was painful. And then magnetic stimulation was introduced recently and used widely because it was painless and easily repeated, compared to electrical stimulation. This study was undertaken in order to obtain normal valued of motor evoked potentials by transcranial magnetic stimulation. Ninety-two volunteers, free of neurological disease, were tested with Medelec Magstim model 200 and Medelec MIstral. There were 55 male and 37 female, ranging in height from 130 to 180 centimeter, with a mean height of 165.9 centimeter, in age from 13 to 70 years, with a mean age of 34 years. Transcranial magnetic stimulation cause contralateral hand and foot muscle responses, and the resultant motor evoked potentials can be recorded. Stimulating sites were near vertex in head, Erb's point in cervical region and L45 interspace in lumbar region. Recording sites wre abductor pollicis brevis(APB) in hand and abductor hallucis(AH) in foot. Our results were as follow ; 1) Latency between head and contralateral APB was 20.9+/-1.5ms, latency between cervical region and ipsilateral APB was 11.7+/-1.1ms, and there-by CMCT was 9.2+/-1.1ms. 2) Latency between head and contralateral AH was 39.0+/-2.6ms, latency between lumbar region and ipsilateral AH was 20.9+/-2.1ms, and there-by CMCT was 1.8+/-2.0ms. 3) Latency was statistically well correlated with subject height, but not CMCT. 4) There was no statistical significance, between male and female, right and left side, among age group, in latency and CMCT. 5) By voluntary muscle contractions, latency was shortened and amplitude was increased on vertex stimulation, but not hanged on stimulation of cervical and lumbar region. 6) By incraesing stimulus intensity, latency was shortened and amplitude was increased on vertex stimulation, but amplitude only was increased on stimulation of cervical region.
Electric Stimulation ; Evoked Potentials, Motor* ; Female ; Foot ; Hand ; Head ; Humans ; Lumbosacral Region ; Male ; Muscle, Skeletal ; Peripheral Nerves ; Reference Values* ; Transcranial Magnetic Stimulation* ; Volunteers

PURPOSE: Electrical burn of scalp is uncommon. Much more, chronically exposed dura in unstable burn scar is quite exceptional. Hence, we report a case of chronically exposed dura following electrical burn. METHODS: A 63-year-old man presented with an about 40 years history of an ulcerative lesion arising from electrical burn scar with 'squeeze like sensation' around wound. Wound was about 6 x 8cm. Area in the center was 3 x 3 cm nonviable dura without sequestrum. Tangential excision with an intraoperative neurosurgical consultation and transposition flap under general anesthesia was done. Intraoperative biopsy was done. The wound was diagnosed as chronic osteomyelitis, not Marjolin ulcer. Flap was taken successfully. But after 5 days, infectious discharge had been appeared during 2 weeks, despite irrigation and drainage. As flap was re-evaluated, we could see remnant necrotic dura. After that, latissimus dorsi muscle free flap with meshed split thickness skin graft was transferred without excision of necrotic dura. RESULTS: Flap was taken successfully. Follow-up at 10 weeks has been uneventful, with good and stable coverage of the wound. CONCLUSION: It is true that complete excision of devitalized tissue with sagittal sinus obliteration is prerequisite to flap taken. But necrotic dura was tangentially excised instead of total dura excision, because, posterior two-thirds of the sagittal sinus was involved underneath. Muscle is rich in blood vessels and decrease the recipient-site bacterial count effectively. In this case, muscle flap with skin graft without total dura excision is an alternative treatment.
Anesthesia, General ; Bacterial Load ; Biopsy ; Blood Vessels ; Burns ; Burns, Electric ; Cicatrix ; Drainage ; Dura Mater ; Follow-Up Studies ; Free Tissue Flaps ; Humans ; Middle Aged ; Muscles ; Osteomyelitis ; Scalp ; Skin ; Transplants ; Ulcer

A case of metastatic renal cell carcinoma is reported. The tumor had imaging features of meningioma on brain computerized tomography and magnetic resonance.
Brain ; Carcinoma, Renal Cell* ; Dura Mater* ; Meningioma*