BACKGROUND AND OBJECTIVES: Many neurologists are unaware of the drop attack that may occur from an inner ear dysfunction especially in elderly. We performed this study to investigate the clinical features and results of quantitative audiovestibular tests in six elderly patients (> or =65 years of age) who presented with drop attacks attributable to an inner ear pathology. MATERIALS AND METHOD:Group was divided into Meniere's syndrome (4) or non-Meniere peripheral vestibulopathy (2). Standard dizziness questionnaire and quantitative audiovestibular function testing were performed. RESULTS:Episodes were described as a sudden push to the ground in four or a violent illusionary movement of environment leading to a fall in two. All cases gave a history of prior vertiginous episodes and vestibular testing revealed unilateral caloric paresis. Ipsilateral hearing loss was documented in four cases. CONCLUSIONS:Our results suggest that otologic causes should be considered in the differential diagnosis of the drop attack in elderly, even if the symptoms and signs were not consistent with Meniere's syndrome.
Aged* ; Diagnosis, Differential ; Dizziness ; Ear, Inner ; Hearing Loss ; Humans ; Meniere Disease ; Paresis ; Pathology ; Surveys and Questionnaires ; Syncope*

We present two very interesting cases of acute graft-versus-host disease (GVHD), whose skin rashes initially appeared on the localized area of total nodal irradiation (TNI) performed previously to prevent graft rejection and/or GVHD. The histopathologic findings showed some dyskeratotic cells in the epidermis and perivascular mononuclear cell infiltration in the upper dermis. The immunohistochemical studies revealed that HLA-DR was diffusely strongly positive in a number of keratinocytes, whereas both CD4 and CD8 were focally weakly positive in the perivascular lymphocytes in the upper dermis. Later on, liver dysfunction and diarrhea developed and skin rashes began to spread over the other parts of the body in those two patients.
Dermis ; Diarrhea ; Epidermis ; Exanthema ; Graft Rejection ; Graft vs Host Disease* ; HLA-DR Antigens ; Humans ; Keratinocytes ; Liver Diseases ; Lymphocytes ; Skin*

PURPOSE: We report three patients with large angle exotropia had lost medial rectus muscle (MR) and who attained good alignment postoperatively. METHODS: Patient 1 was a 51-year-old female with a history of strabismus surgery done at 10 years of age. Exotropia of 80 prism diopter (PD) gradually developed with limitation of adduction in the right eye. Patient 2 was a 52-year-old male with fixed exotropia of 95 PD in his left eye, which became blind after a severe contusion injury. The third patient was a 46-year-old male who had MR of the right eye cut during endoscopic sinus surgery. Severe limitation of adduction followed with exotropia of 50 PD. We could not find MR in any of the three patients and noted severe adhesion between eyeball and Tenon's capsule. Ocular movement was severely limited horizontally and even vertically. RESULTS: Postoperatively Patient 1 showed orthophoria in follow-up of 2 years. Patient 2 had 16PD of exotropia in follow-up of 13 months, which was cosmetically acceptable. Patient 3 obtained orthophoria after surgery and developed 10 degrees of left head turning to avoid diplopia. CONCLUSIONS: When a patient shows longstanding large angle exotropia with limitation of adduction, we may consider the MR loss. A reasonable treatment may be to align the eyes cosmetically in primary position by weakening the abducting power and suturing the anterior part of nasal Tenon's capsule to the MR insertion site after adhesiolysis.
Contusions ; Diplopia ; Exotropia* ; Female ; Follow-Up Studies ; Head ; Humans ; Male ; Middle Aged ; Strabismus ; Tenon Capsule

This study was undertaken to determine the incidence of the endotrcheal tube contamination by malignant cells in patients with upper respiratory tract cancer undergoing general anesthesia. In 17 patients endotracheal intubation was done and the tube was extubated after completion of the excision of the tumor mass. Following the procedures the outide of the endotracheal tube was swabbed by the cotten tip applicators and the specimens examined cytologically. Two positive cytologic specimens were obtained, they were class III and laryngeal carcinoma in both. This study provides evidence that contamination of the outside of the endotracheal tube can occur when it is passed directly over a carcinoma of the larynx.
Anesthesia, General ; Humans ; Incidence ; Intubation, Intratracheal ; Larynx ; Respiratory System*

Purpose: To evaluate and compare the clinical efficacy of matrix metalloproteinase-9 (MMP-9) immunoassay and tear osmolarity measurement in diagnosing dry eye severity. Methods: Dry eye disease (DED) patients underwent diagnostic tests including MMP-9 assay, tear osmolarity measurement, fluorescein tear breakup time, ocular surface staining, anesthetized Schirmer test, Ocular Surface Disease Index questionnaire, and slit-lamp examination. The dry eye parameters were compared according to positive MMP-9 status and increased tear osmolarity. The correlation between dry eye profiles and MMP-9 positivity and high tear osmolarity was also analyzed. Results: Those who tested positive in MMP-9 immunoassay had significantly higher corneal fluorescein staining score and worse DED severity than those who tested negative. The intensity of MMP-9 positivity showed positive correlation with the corneal staining score and DED severity. However, DED patients with high tear osmolarity above 308 mOsm/L did not show significantly different dry eye signs and symptoms compared to those with lower tear osmolarity values. Tear osmolarity was associated with ocular surface staining score in severe DED patients. Conclusions MMP-9 positivity was associated with ocular surface staining and worse dry eye severity. Therefore, it may be used as a useful indicator of disease severity in conjunction to other diagnostic tests.

The changes of onset and duration of caudal epidural anesthesia had been compared in 54 patients schedulled for perianal surgery at kyungpook National University HospitoL The patients were divided into 3 groups of 18: lidocaine group received 2% lidocaine 20 ml, mixture group received 2% lidocaine 10 ml and 0.5% bupivacaine 10 ml and bupivcaaine group received 0.5% bupivacaine 20 ml. The onsets were as follows. The onsets wiere 3.11+/-0.63 in lidocaine group, 4.83+/-4.17 in mixture group and 8.13+/-3.49 min in bupivacaine group. The onset of bupivacaine group was slower than lidocaine group(p<0.01) and late compared with mixture group(p<0.5). The duration of caudal anesthesia were 192.00+/-62.49 in lidocaine group, 326.72+/-145.28 in mixture group and 419.22+/-125.37min in bupivacaine group. Significant differences were observed between mixture-lidocaine group(p<0.01), bupivacaine-lidocaine group(p<0.01) and bupivacaine-mixture group(p<0.05). Urinary catheteiized patients were 8 in longest duration group of bupivacaine. It is suggested from the above'results that the mixture of lidocaine and bupivacaine during caudal epidural anesthesia can produce rapid onset and long duration.
Anesthesia, Caudal* ; Anesthesia, Epidural ; Anesthetics, Local* ; Bupivacaine ; Gyeongsangbuk-do ; Humans ; Lidocaine

Brachial plexus block, axillary approach appears to be a safe and reliable technique for upper extremity surgery from shoulder to hand. However, the maximum dose of lidocaine that is recommended by the manufactured is 4 mg per kg (approximately 300 mg) regardless of the injection site. The maximum recommended dose for lidocaine with epinephrine is 7 mg per kg (approximately 500 mg). These maximum recommended amounts are insufficient for brachial plexus block. We question the logic behind these recommended dosages and may exceed them. The aim of this study was to determine whether commonly acceptable dosages used in brachial plexus block within a safe range. The time courses of the plasma concentration were observed in 20 healthy patients to whom were axillary injected with 1.5% lidocaine mixed 1: 200,000 epinephrine. The plasma concentrations were measured by immunofluororesence assay at the intervals of 5, 10, 20, 30 and 60 minutes. The values of plasma concentration were 2.65+/-75, 4.29+/-2.75, 5.95 +/-2.02, 4.76+/-1.91 and 4.48+/-1.90 pg/ml in group 1, and 3.71+/-1.68, 4.76+/-1.91, 6.68+/-3.43, 5.57+/-3.08 and 5.56+/-2.86 ug/ml in group 2, and 2.86+/-1.82, 5.08+/-3.74, 5.92+/-3.84, 6.82+/-3.84 and 5.49+/-3.29 ug/ml in group 3 (Mean+SD). The peak plasma concentration was 5.95+/-2.02 and 6.68+/-3.43 ug/ml at 20 minutes in group 1 and 2 respectively and 6.82+/-3.84 ug/ml at 30 minutes in group 3. These results indicated that the lidocaine 750 mg with epinephrine (5 ug/ml) in brachial plexus block is considered to be safe because plasma concentration dose not exceed the toxic level.
Brachial Plexus* ; Epinephrine ; Hand ; Humans ; Lidocaine* ; Logic ; Plasma* ; Shoulder ; Upper Extremity

Diagnostic procedures in pregnant wowen is limited and is usually delayed, especially so if she is on mechanical ventilation. A 28-year-old pregnant woman with severe dyspnea was referred to our hopital under the impression of miliary tuberculosis. The respiratory failure was so severe that patient had to be managed with mechanical ventilator under clinical imression of overwhelming pneumonia or pulmonary tuberculosis. But the patient's conditions deteriorated. Bronchoscopy and blind transbronchial lung biopsy performed to determine the nature of the etiology, and to our surprise, revealed squamous cell carcinoma of the lung.
Adult ; Biopsy ; Bronchoscopy ; Carcinoma, Squamous Cell ; Dyspnea ; Female ; Humans ; Lung Neoplasms* ; Lung* ; Pneumonia ; Pregnancy ; Pregnant Women ; Respiration, Artificial ; Respiratory Insufficiency* ; Tuberculosis, Miliary ; Tuberculosis, Pulmonary ; Ventilators, Mechanical

OBJECTIVES: Copper and Zinc, the trace elements of a living body, take a part in immunologic mechanism and induce the pulmonary fibrosis which is the pathologic progress of pneumoconiosis. This study was performed to assist the identification of the pathologic process of pulmonary fibrosis in pneumoconiosis. METHODS: The subjects of this study was 200 diagnosed persons as pneumoconiosis, of whom 100 persons was the visitors in the outpatients departments of pneumoconiosis and 100 admissive pneumoconiosis patients. The serum copper and zinc are measured and com pared. RESULTS: The mean serum copper concentration of visitor group was significantly higher than that of control group, and that of stage V3 subgroup of visitor group was highest because of their advanced fibrosis. But, there was not the difference of serum copper concentration between patient and control group. We thought that the reason was poor nutritional and health status of the patient. The mean of serum zinc concentration of visitor and patient control was lower than that of control group. As the degree of pulmonary fibrosis was more severe from stage Vl, V2, V3 of visitor to stage Pl, P2, P3 of patient, the mean of serum zinc concentration was lower. The ratio of serum copper/zinc of visitor and patient was higher than that of control, and that of patient was higher than that of visitor. Those results showed that the ratio of serum copper/zinc ratio more greatly expressed the degree of progression of pneumoconiosis than only copper or zinc concentration by adjustment of nutritional and health status of the patient. CONCLUSIONS: As above study results, the degree of pulmonary fibrosis of pneumoconiosis could be estimated by means of serum copper/zinc ratio.
Copper* ; Fibrosis ; Humans ; Outpatients ; Pneumoconiosis* ; Pulmonary Fibrosis ; Trace Elements ; Zinc*

No abstract available.