Acute dystonic reactions (ADRs) are movement abnormalities characterized by involuntary muscle contractions that typically manifest after exposure to a triggering agent, such as a medication. The specific muscle groups affected determine the type of reaction. For instance, an oculogyric crisis primarily affects the ocular muscles, while oromandibular dystonia involves jaw opening and tongue protrusion. We present the rare case of a 68-year-old man with amyotrophic lateral sclerosis who was successfully treated for an ADR. The patient was admitted with loss of consciousness due to respiratory failure. Tracheostomy was promptly performed under sedation with multiple general anesthetic agents. Immediately after tracheostomy, the patient communicated via eye-blinking without any notable abnormalities, just as before the procedure. However, the following day, he became unresponsive to verbal cues and exhibited a decreased level of consciousness, accompanied by tongue dyskinesia, deviation of both eyes to the left, and loss of visual tracking. The patient’s vital signs remained stable. Brain imaging and an electroencephalogram revealed no abnormalities. Treatment with midazolam produced initial improvement; however, due to a significant side effect of hypotension, the treatment was switched to oral diazepam. The patient’s condition gradually improved, and the medication was eventually discontinued without further ADR episodes.

Acute dystonic reactions (ADRs) are movement abnormalities characterized by involuntary muscle contractions that typically manifest after exposure to a triggering agent, such as a medication. The specific muscle groups affected determine the type of reaction. For instance, an oculogyric crisis primarily affects the ocular muscles, while oromandibular dystonia involves jaw opening and tongue protrusion. We present the rare case of a 68-year-old man with amyotrophic lateral sclerosis who was successfully treated for an ADR. The patient was admitted with loss of consciousness due to respiratory failure. Tracheostomy was promptly performed under sedation with multiple general anesthetic agents. Immediately after tracheostomy, the patient communicated via eye-blinking without any notable abnormalities, just as before the procedure. However, the following day, he became unresponsive to verbal cues and exhibited a decreased level of consciousness, accompanied by tongue dyskinesia, deviation of both eyes to the left, and loss of visual tracking. The patient’s vital signs remained stable. Brain imaging and an electroencephalogram revealed no abnormalities. Treatment with midazolam produced initial improvement; however, due to a significant side effect of hypotension, the treatment was switched to oral diazepam. The patient’s condition gradually improved, and the medication was eventually discontinued without further ADR episodes.

Acute dystonic reactions (ADRs) are movement abnormalities characterized by involuntary muscle contractions that typically manifest after exposure to a triggering agent, such as a medication. The specific muscle groups affected determine the type of reaction. For instance, an oculogyric crisis primarily affects the ocular muscles, while oromandibular dystonia involves jaw opening and tongue protrusion. We present the rare case of a 68-year-old man with amyotrophic lateral sclerosis who was successfully treated for an ADR. The patient was admitted with loss of consciousness due to respiratory failure. Tracheostomy was promptly performed under sedation with multiple general anesthetic agents. Immediately after tracheostomy, the patient communicated via eye-blinking without any notable abnormalities, just as before the procedure. However, the following day, he became unresponsive to verbal cues and exhibited a decreased level of consciousness, accompanied by tongue dyskinesia, deviation of both eyes to the left, and loss of visual tracking. The patient’s vital signs remained stable. Brain imaging and an electroencephalogram revealed no abnormalities. Treatment with midazolam produced initial improvement; however, due to a significant side effect of hypotension, the treatment was switched to oral diazepam. The patient’s condition gradually improved, and the medication was eventually discontinued without further ADR episodes.

Acute dystonic reactions (ADRs) are movement abnormalities characterized by involuntary muscle contractions that typically manifest after exposure to a triggering agent, such as a medication. The specific muscle groups affected determine the type of reaction. For instance, an oculogyric crisis primarily affects the ocular muscles, while oromandibular dystonia involves jaw opening and tongue protrusion. We present the rare case of a 68-year-old man with amyotrophic lateral sclerosis who was successfully treated for an ADR. The patient was admitted with loss of consciousness due to respiratory failure. Tracheostomy was promptly performed under sedation with multiple general anesthetic agents. Immediately after tracheostomy, the patient communicated via eye-blinking without any notable abnormalities, just as before the procedure. However, the following day, he became unresponsive to verbal cues and exhibited a decreased level of consciousness, accompanied by tongue dyskinesia, deviation of both eyes to the left, and loss of visual tracking. The patient’s vital signs remained stable. Brain imaging and an electroencephalogram revealed no abnormalities. Treatment with midazolam produced initial improvement; however, due to a significant side effect of hypotension, the treatment was switched to oral diazepam. The patient’s condition gradually improved, and the medication was eventually discontinued without further ADR episodes.

PURPOSE: To determine, when extracorporeal shockwave lithotripsy is contraindicated, the usefulness and safety of percutaneous management in the removal from the upper urinary tract of foreign bodies and calculi, or small remnants of these, retained affer percutaneous nephrolithotomy. MATERIALS AND METHODS: Between January 1996 and May 2001, we attempted to retrieve foreign bodies or calculi from the upper urinary tract of 20 patients, using various percutaneous techniques. There were eleven foreign bodies, namely fragmented nephrostomy catheters (n=2), migrated ureteric stents inaccessible to retrograde ureteroscopic management (n=8), and one metallic radiopaque marker which was separated from the pusher of the internal ureteral stent. Nine urinary tract calculi were present. These ranged in radiographically measured size from 4 to 8 mm in their largest diameter, and were found in the renal pelvis or calyx (n=5) and ureter (n=4). After percutaneous nephrostomy, all procedures involved the use of a 7-F to 14-F sheath, inserted under fluoroscopic guidance. Devices used for the retrieval of these objects include a stone basket retriever, loop snare, grasping forceps, and balloon catheter. RESULTS: In all cases except one, it was possible to retrieve calculi or other items from the upper urinary tract. No surgical procedure was required and no significant complications were encountered in any of the cases during or after the procedures. CONCLUSION: The percutaneous technique can be useful and safe in the management of foreign bodies or calculi present in the upper urinary tract.
Calculi* ; Catheters ; Foreign Bodies* ; Hand Strength ; Humans ; Kidney Pelvis ; Lithotripsy ; Nephrostomy, Percutaneous ; SNARE Proteins ; Stents ; Surgical Instruments ; Ureter ; Urinary Tract*

The Beckwith-Wiedemann syndrome, which included congenital anomalies such as macroglossia, exomphalos, postnatal somatic gigantism, have a substantially increased risk for the development of tumor. We report a case of testicular yolk sac tumor associated with Beckwith-Wiedemann syndrome, a previously unreported association. Pathologic examination showed Schiller-Duval body with evidence of testicular yolk sac tumor. This finding appears to represent a previously unreported association between Beckwith-Wiedemann syndrome and testicular yolk sac tumor.
Beckwith-Wiedemann Syndrome* ; Endodermal Sinus Tumor* ; Gigantism ; Hernia, Umbilical ; Macroglossia ; Testis ; Yolk Sac*

PURPOSE: The cornea of the keratoconus patient that is one of the contraindications in refractive surgery shows severe topographic asymmetry and the lower curvature is much steeper than the upper one. In this study, we evaluated whether the mild to moderate topographic asymmetry which does not fall under the Rabinowitz-McDonnell's keratoconus criteria(I-S value>3.0 D) would affect the LASIK results. METHODS: The maximal diopter difference in central 3 mm-zone(MDD-3) of the pre-LASIK topography, the postoperative best uncorrected visual acuity(UCVA) and the postoperative best corrected visual acuity(BCVA) were analyzed in 248 eyes of 124 patients retrospectively. We divided the patients into 2 groups according to the magnitude of MDD-3(MDD-3<1.0 D in group 1 and MDD-3> OR =1.0 D in group 2). In the same manner, the patients were divided into 2 groups according to the magnitude of MDD-5(MDD-5<1.0 D in group A and MDD-5> OR =1.0 D in group B) using 5 mm-zone. RESULTS: Between group 1 and 2, statistically significant difference was not observed in postoperative UCVA and BCVA(p>0.05). Between group A and B, statistically significant difference was not observed in postoperative UCVA and BCVA(p>0.05), either. CONCLUSIONS: This suggests that the mild pre-LASIK topographic asymmetry would not affect the visual acuity after LASIK.
Cornea ; Humans ; Keratoconus ; Keratomileusis, Laser In Situ* ; Refractive Surgical Procedures ; Retrospective Studies ; Visual Acuity

PURPOSE: The purpose of this article is to assess the efficacy of a bioabsorbable polylactide (PLA) plate and screw for treating injuries of ankle fractures. MATERIALS AND METHODS:24 patients who underwent an open reduction and internal fixation operation for ankle fractures from July 2005 to March 2007 were enrolled into the study. There were 15 men and 9 women. The average age of the patients was 44 years and the average follow-up period was 16 years and two months (16.2 months). All cases were divided into low grade fracture patient (11) who belongs in type A and B of Danis-Weber classification and high grade fracture patient (13) who belongs in type C1, C2 of Danis-Weber classification, and each groups were analyzed by clinical (Meyer score) and radiological finding at the time of their last follow-up evaluation. RESULTS:The clinical results according to Meyer scoring system, showed that all patient with low grade fracture had good to excellent result, but only 54% of patient with high grade fracture had good to excellent result. According to Cedell's radiologic finding, there were 91% cases above fair in low grade fracture. But there were 62% of patient above fair result in high grade fracture, the reduction losses were seen in 38% of patient with high grade fracture. CONCLUSION: Bioabsorbable PLA plate and screw is good internal fixation device which doesn't have additional operation for removal of implant because of slow absorption within the human body. It showed sufficient strength for acquisition and maintenance of reduction in low grade fracture, but need attention to use because of many cases of reduction loss in high grade fracture. So, it seems to be safe and effective when used in heeling of low grade fracture under considering about type of fracture sufficiently.
Absorption ; Animals ; Ankle ; Female ; Follow-Up Studies ; Heel ; Human Body ; Humans ; Internal Fixators ; Male ; Polyesters

OBJECTIVE: To elucidate interhemispheric asymmetry of the neural generators of somatosensory evoked potential (SEP). METHOD: Median nerve SEP was recorded over 5 sites of each hemisphere in 20 healthy subjects and 23 stroke patients. One electrode was placed over C3'/C4' (position B) and two electrodes were located 2 cm medial (position A) and lateral (position C) to position B, respectively. Additional two electrodes were positioned at 3 cm anterior (position F) and posterior (position P) to position B. The common reference electrode was placed at Fz. RESULTS: In healthy subjects, P22 was more frequently evoked than P27 in position F of the nondominant hemisphere and P27 in position P of the dominant hemisphere. In stroke subjects, fourteen patients demonstrated SEP waveforms over the affected hemisphere. In them, SEP amplitude significantly correlated with proprioception. However, distribution of the recording position showing significant correlation between SEP amplitude and proprioception was different according to dominancy of the affected hemisphere. CONCLUSION: P22 was more dominant in the nondominant hemisphere and P27 in the dominant hemisphere of normal group. Furthermore, clinical correlation of SEP amplitude was affected by the injured hemisphere dominancy in stroke group. These results demonstrate that asymmetry of neural generator distribution can be presumed.
Electrodes ; Evoked Potentials, Somatosensory* ; Humans ; Median Nerve* ; Proprioception ; Stroke

Percutaneous endoscopic gastrostomy is used for long-term nutritional support to the patients who cannot maintain the adequate oral intake and can be performed with relatively few complications. Among the complications, migration of the internal bumper into the abdominal wall, so called "buried bumper syndrome" has been described more recently. We decribed a case of buried bumper syndrome in stroke patient with percutaneous endoscopic gastrostomy. He experienced peritubular leakage, resistance of tubal feeding, and abdominal pain which were developed 4 weeks after percutaneous endoscopic gastrostomy. On endoscopic examination, the gastrostomy lumen coud not be found. The gastrostomy tube was replaced with careful manual traction and replaced to new one with endoscopic technique. No complication was occurred and the function of tube has been well preserved.
Abdominal Pain ; Abdominal Wall ; Gastrostomy ; Humans ; Nutritional Support ; Stroke ; Traction