No abstract available.

PURPOSE: Epinephrine itself exhibits some cardiotoxicity. However, it rarely induces cardiomyopathy when used in standard doses during surgery for local hemostasis. This paper reports a rare case of stress-induced cardiomyopathy in a young woman after the local infiltration of epinephrine. METHODS: Corrective rhinoplasty was planned in a 20-year-old woman. Lidocaine mixed with epinephrine 1:100,000 was injected around the skin of the nose and nasal septum after inducing anesthesia, which resulted in sinus tachycardia and hypotension. Postoperative ECG showed a T wave inversion in the lead V2 and echocardiography revealed transient hypokinesia in the cardiac apex. Cardiac enzyme was mildly elevated. RESULTS: Symptoms and laboratory findings improved considerably, and the patient was discharged from hospital without complications on the sixth day after surgery. CONCLUSION: The prognosis of catecholamine-induced cardiomyopathy is generally favorable. However, it is important to be aware of the possible adverse effects of local epinephrine infiltration. This case highlights the need for caution when using epinephrine.
Anesthesia ; Cardiomyopathies ; Echocardiography ; Electrocardiography ; Epinephrine ; Female ; Hemostasis ; Humans ; Hypokinesia ; Hypotension ; Lidocaine ; Nasal Septum ; Nose ; Prognosis ; Rhinoplasty ; Skin ; Surgery, Plastic ; Tachycardia, Sinus ; Young Adult

Intensive care unit (ICU) is an area which promotes feeling of high anxiety. And patients in ICU suffered from physical and psychological discomforts. These physical and psychological discomforts are varied according to patients themselves, age, character, illness and environment such as ICU structure, staff, operating system. Physical and psychological discomforts can affect treatment and prognosis of disease. Several reports have appeared of adverse psychological and psychiatric effects of intensive therapy. On the other hand, some patients may be reassuered by continuous surveillance and exhibit emotional reactions and increased cathecholamine production on returning to a general ward". It may be possible to have considerable influence on these effects by improving the environmental factors. We evaluated the recall of 300 patients after ICU discharge, and 609o of the patients had unpleasant experiences in ICU admission. The most frequently reported unpleasant experiences were pain(18.6%), family worries(15.6%), tracheal suction(5.0%), blood sampling(5.0%), sleep deprivation(4.6%), noise(3.3%), limit of motion and posture (3.0%), unkindness(2.6%) and others(1.0%). We asked about fear for dying in their ICU stay, and 106(35.3%) of 300 patients responded yes. There was no difference in APACHEII score between fear for death and not. Therefore we must try to reduce patient's various painful stimli by more careful and kind treatments. Medical staff should remember that their trivial behavior could stimulate patients and should try to control their patients by heartful experiencing about the prognosis.
Anxiety ; Hand ; Heart ; Humans ; Intensive Care Units* ; Critical Care* ; Medical Staff ; Posture ; Prognosis

PURPOSE: Prompt initiation of effective cardiopulmonary resuscitation (CPR) and defibrillation is underlined in the guideline. Many people search health-related information on the internet. The objective of this study was to evaluate the content and quality of videos for adult basic life support (BLS) on the internet. METHODS: We searched 'Daum' for the term 'CPR' in Korean. Videos dealing with BLS over 5 sequences were included. Videos inserted in the news and drama or used for advertisement or entertainment, or which only contained pediatric BLS were excluded. Two emergency physicians analyzed videos using a standardized checklist. RESULTS: Of 1,600 videos, 32 met the inclusion criteria, except for duplicate videos. More than 90% of videos showed appropriate demonstration for check response, activate emergency response system, correct hand placement, minimize interruptions in chest compression, 30:2 compression to ventilation ratio, open airway, and deliver rescue breath; 13 (40.6%) and 12 (37.5%) videos demonstrated 'call for automated external defibrillator (AED)' and 'apply AED', respectively; 25 (78.1%), 23 (71.9%), and 27 (84.4%) videos showed correct demonstration for chest compression rate and depth, and complete chest recoil, respectively; 6 (18.8%) and 10 (31.3%) videos contained instructions for 'complete chest recoil' and 'minimize interruptions in chest compression', respectively. Only 2 (6.3%) videos dealt with hands-only CPR. CONCLUSION: A large proportion of educational videos for adult BLS contained basic sequence of BLS, except for 'call for AED' and 'apply AED'. There is a lack of instruction for high-quality CPR, particularly for minimizing interruptions in chest compression and complete chest recoil, and hands-only CPR.
Adult* ; Cardiopulmonary Resuscitation ; Checklist ; Defibrillators ; Drama ; Emergencies ; Hand ; Humans ; Internet ; Korea ; Out-of-Hospital Cardiac Arrest ; Thorax ; Ventilation

PURPOSE: Malignant peripheral nerve sheath tumor without neurofibromatosis type 1 is very rare neoplasm. Development in the superficial soft tissue is exremely rare. Authors experienced one rare case of primary malignant peripheral nerve sheath tumor developed on abdomen. The clinical and histologic findings were described. METHODS: An 83-year-old man visited hospital with an 11x6.5x4.5 cm sized ulcerated and hemorrhagic mass on abdomen. The tumor was localized in abdominal skin and started growing 3 years ago. RESULTS: Wide excision with safety margin of 2cm and limberg flap was done. The postoperative biopsy revealed a malignant peripheral nerve sheath tumor. There was no evidence of recurrence of tumor for 16 months. CONCLUSION: Malignant peripheral nerve sheath tumor is an aggressive malignant tumor. An abrupt enlargement of size, ulceration and bleeding are suggestive of malignant chnages of the tumor. We recommand early wide excision with enough safety margin as treatment of malignant peripheral nerve sheath tumor.
Abdomen ; Aged, 80 and over ; Biopsy ; Hemorrhage ; Humans ; Neurofibromatosis 1 ; Peripheral Nerves ; Recurrence ; Skin ; Ulcer

PURPOSE: Retinal nerve fiber layer (RNFL) thickness and optic nerve head (ONH) in diabetic patients with normal tension were analyzed using optical coherence tomography (OCT), which revealed that diabetes induce morphologic changes in optic disc and RNFL thickness. METHODS: A total of 192 patients with type 2 diabetes were analyzed with fundus examination and classified as having normal retina, mild - moderate, severe nonproliferative retinopathy (NPDR), or proliferative retinopathy (PDR). These patients were evaluated with OCT and compared with normal control group. RESULTS: The mean average thickness and nasal average thickness of RNFL in mild-moderate, and severe NPDR groups decreased compared with those of the other groups. There was an increase in the temporal average thickness of RNFL in the PDR group. As the duration of diabetes increased, the mean average and nasal average of RNFL thickness also decreased. The severity of diabetic retinopathy didn't show statistically significant differences in a topographic analysis of the optic nerve head. CONCLUSIONS: The mean average thickness and nasal average of RNFL decreased in NPDR groups. Diabetic changes should be considered when diabetes patients are diagnosed with glaucoma or glaucoma progression.
Diabetic Retinopathy ; Glaucoma ; Humans ; Nerve Fibers ; Optic Disk ; Optic Nerve ; Retina ; Retinaldehyde ; Tomography, Optical Coherence

Tracheomalacia is an uncommon disease but an important cause of respiratory distress in children. Tracheomalacia is often associated with other defects, such as esophageal atresia, tracheoesophageal fistula or paratracheal tumor. Rigid bronscopy is used to confirm tracheomalacia, and aortopexy may be applied for surgical intervention. We experienced a case of a 10 month old male infant with tracheomalacia who had undergone tracheoesophageal fistula correction 2 days after birth. Tracheomalacia was diagnosed under rigid bronchoscopy, and the tracheal wall was compressed in accordance with respiration. After aortopexy, the patient breathed smoothly and was discharged after 9 days uneventfully. Aortopexy does not seem to be familiar with pediatric anesthesiologists. We report this case with references as we were unable to find any case report about this maneuver.
Bronchoscopy ; Child* ; Esophageal Atresia ; Humans ; Infant ; Male ; Parturition ; Respiration ; Tracheoesophageal Fistula ; Tracheomalacia*

A statistical study was done on the feeding trends of 2,965 children who had visited both the out-patient clinic and the well-baby clinic of Padiatric Department, St. Benedict Hosp., from Sept., 1979 to Aud., 1980. 1) Among the total 2,965 children, the distribution according to age was about the same. The percentage of male and female was 58.5% respectively. As for geographical area of the cases, the majority were from Busan City Kyung Nam Province and the percentage was 96% and 3% respectively. 2) As for the methods of feeding, breast-feeding was 65%, artificial-feeding 18% and mixed-feeding 15%. 81% among the total cases had been on breast-feeding at one time or another. 3) As for feeding trends according to age, the younger the chile was, the more frequent the chance of artificial feeding. 4) Breast-feeding was less common in the children of premature delivery than children of full-term delivery. 5) Breast-feeding was less common among children with difficult delivery than children with easy delivery. 6) Breast-feeding was less common among children of hospital delivery than children of home delivery. 7) The higher the education level of the mother, the less common breast-feeding was. 8) Breast-feeding was less common among children from Busan City than children from Kyung Nam Province. 9) As for the beginning of feeding, in case of breast-feeding 56% were from 3rd day after bitrh and also in case of mixed-feeding 56% were from 3rd day after birth. 10) As for the duration of breas-feeding children with more than 12months of breast-feeding were most common(48%) and children with less than 6months of breast-feeding least common(8%). 11) The reasons for breast-feeding or mixed-feeding were not enough breast-milk 59%), mother's job 8%), baby's illness 8%), mother's illness 6%) and mother's breast problem 4%) by its frequency.
Breast ; Busan ; Child ; Chile ; Education ; Female ; Humans ; Male ; Mothers ; Nutritional Support ; Outpatients ; Parturition ; Statistics as Topic*

PURPOSE: To report a case of Enterococcus faecalis endophthalmitis which occurred two days after phacoemulsification and posterior chamber intraocular lens implantation. A vitrectomy performed during the early stage of infection showed retinal and vitreous presentation. We report the clinical manifestation, operative findings, and treatment of this pathogen. METHODS: A healthy, 71-year-old female, presented with a sudden loss of vision and eyeball pain two days after phacoemulsification and intraocular lens implantation. As inflammation of the anterior chamber and vitreous cavity progressed rapidly, we performed intravitreal antibiotics injection (Amikacin, 0.4 mg/0.1 ml, Vancomycin, 1 mg/0.1 ml). Since this was ineffective, pars plana vitrectomy, silicone oil tamponade, and intravitreal antibiotics injection (Vancomycin, 1 mg/0.1 ml) were performed. During the procedure, we noted that the vitreous humor was cloudy and apparently filled with pus. We also noted an edematous retina with hemorrhages and necrotic changes. Enterococcus faecalis was identified on vitreous and aqueous fluid culture. RESULTS: Twelve weeks after vitrectomy, her corrected visual acuity was hand motion and there was no evidence of recurrence.
Aged ; Anterior Chamber ; Anti-Bacterial Agents ; Endophthalmitis* ; Enterococcus faecalis* ; Enterococcus* ; Female ; Hand ; Hemorrhage ; Humans ; Inflammation ; Lens Implantation, Intraocular ; Phacoemulsification* ; Recurrence ; Retina ; Retinaldehyde ; Silicone Oils ; Suppuration ; Vancomycin ; Visual Acuity ; Vitrectomy ; Vitreous Body

PURPOSE: Parotid gland can be considered as a risk organ in whole brain radiotherapy (WBRT). The purpose of this study is to evaluate the parotid gland sparing effect of computed tomography (CT)-based WBRT compared to 2-dimensional plan with conventional field margin. MATERIALS AND METHODS: From January 2008 to April 2011, 53 patients underwent WBRT using CT-based simulation. Bilateral two-field arrangement was used and the prescribed dose was 30 Gy in 10 fractions. We compared the parotid dose between 2 radiotherapy plans using different lower field margins: conventional field to the lower level of the atlas (CF) and modified field fitted to the brain tissue (MF). RESULTS: Averages of mean parotid dose of the 2 protocols with CF and MF were 17.4 Gy and 8.7 Gy, respectively (p < 0.001). Mean parotid dose of both glands > or =20 Gy were observed in 15 (28.3%) for CF and in 0 (0.0%) for MF. The whole brain percentage volumes receiving >98% of prescribed dose were 99.7% for CF and 99.5% for MF. CONCLUSION: Compared to WBRT with CF, CT-based lower field margin modification is a simple and effective technique for sparing the parotid gland, while providing similar dose coverage of the whole brain.
Brain ; Humans ; Parotid Gland ; Xerostomia