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*

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

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*

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.

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

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

BACKGROUND: The survival rate of grafted fat is difficult to predict, and repeated procedures are frequently required. In this study, the effects of the freezing period of harvested adipose tissue and the addition of human adipose tissue-derived stem cells (ASCs) on the process of fat absorption were studied. METHODS: Adipose tissue was obtained from patients who underwent a lipoaspirated fat graft. The fat tissue was cryopreserved at -20degrees C in a domestic refrigerator. A total of 40 nude mice were used. The mice in the experimental group received three different subcutaneous injections in the back: an injection of fresh fat and ASCs, an injection of fat that had been frozen for one month and ASCs, and an injection of fat that had been frozen for two months and ASCs. The control mice received fat grafts without ASCs. The mice were sacrificed at four or eight weeks after the procedure, and the grafted fat tissues were harvested. The extracted fat was evaluated using photographic analysis, volume measurements, and histological examination. RESULTS: In the control group, the fat resorption rates four weeks after transplantation in the grafts of fresh fat, fat that had been frozen for one month, and fat that had been frozen for two months were 21.14%, 22.46%, and 42.56%, respectively. In the experimental group, the corresponding resorption rates were 6.68%, 13.0%, and 33.9%, respectively. CONCLUSIONS: ASCs can increase the fat graft survival rate. The use of ASCs in fat grafting can reduce the need for repeated fat grafts and provide good long term results.
Absorption ; Adipose Tissue ; Animals ; Cryopreservation ; Freezing ; Graft Survival ; Humans* ; Injections, Subcutaneous ; Mice ; Mice, Nude ; Stem Cells* ; Survival Rate* ; Transplants

Phospholipase C(PLC) plays a central role in signal transduction and it is important in cellular growth, differentiation and transformation. There are currently ten known mammalian isozymes of PLC identified and cloned. However, there are no report of PLC distribution in human lung tissue or their significances in pulmonary diseases. Presence of various PLC isozymes in normal human lung tissue was studied from surgical specimens. PLC isozymes in tissue extracts of the lung were partially purified by successive chromatographic steps on heparin-sepharose CL-6B conventional and TSKgel heparin-5PW HPLC columns and their activities were assayed. PLC activity peaks identified in the chromatography were immunoblotted with specific antibodies against ten known mammalian PLC isozymes(PLC-beta 1-4, -gamma 1-2, and -delta 1-4). In addition, immunohistochemical staining of the lung tissue was performed to determine subcellular and histological localization of PLC isozymes. The results indicate that normal human lungs contain beta 1, beta 3, gamma 1, and delta 1, isozymes of PLC. The order of amount present in the lung tissue was PLC-delta 1 > gamma 1 >beta 1 >> beta 3, in descending order. On immunohistochemistry, PLC-gamma 1 was most widely distributed and was present in bronchiolar epithelium, in type I and type II pneumocytes as well as in fibroblasts of the interstitial tissue. PLC-delta 1 was present in the cytoplasm of the bronchiolar epithelium whereas PLC-beta 1 was localized to the apical membranous portion of the same epithelium. PLC-beta 3 was seen in the nucleus of the respiratory and alveolar lining epithelium as well as in the nucleus of lung fibroblasts.
Adult ; Chromatography, Agarose ; Female ; Heparin/chemistry ; Human ; Immunohistochemistry ; Isoenzymes/isolation & purification/*metabolism ; Lung/*enzymology/pathology ; Male ; Phospholipase C/isolation & purification/*metabolism