BACKGROUND: The use of intraoperative brainstem auditory evoked potential (BAEP) has reduced the incidence of sensorineural hearing loss (SNHL) after microvascular decompression (MVD). This complication occurs due to direct compressive and/or stretching injury of the cochlear nerve or to indirect compression of the perineural vasculature during cerebellar retraction. The aim of this study was to evaluate the effect of thiopental sodium on SNHL after MVD for hemifacial spasm. METHODS: 94 hemifacial spasm patients with normal hearing function preoperatively and who underwent MVD under intraoperative BAEP monitoring were enrolled in this study. Patients were randomly divided into two groups. 52 patients were administered placebo (control group) and 42 patients were administered thiopental sodium 5 mg/kg intravenously 5 minutes before cerebellar retraction (thiopental group). The effects of thiopental on intraoperative BAEP changes and postoperative hearing functional outcomes were sought. Incidence and degree of postoperative SNHL were evaluated by pure tone audiometry threshold analysis. RESULTS: Maximal changes in intraoperative BAEP parameters did not differ between the two groups, and neither did the incidence nor degree of SNHL. In the control group, 4 transient and 4 permanent postoperative SNHL, including 2 deaf patients, occurred with an overall incidence of 15.4%. In the thiopental group, 2 transient and 1 permanent postoperative SNHL occurred, with an overall incidence of 7.1%. CONCLUSIONS: Thiopental sodium administered prior to cerebellar retraction might reduce the incidence of postoperative hearing loss.
Audiometry ; Cochlear Nerve ; Evoked Potentials, Auditory, Brain Stem ; Hearing Loss ; Hearing Loss, Sensorineural ; Hearing* ; Hemifacial Spasm ; Humans ; Incidence ; Microvascular Decompression Surgery* ; Thiopental*

BACKGROUND: Although lidocaine seems to be one of the most suitable spinal anesthetics for ambulatory surgery, the safety of lidocaine for spinal anesthesia has been called into question by report of transient neurologic toxicity. So diluted bupivacaine with opioids or adrenergic receptor agonist can replace spinal lidocaine, but delayed awakening, pruritis, intraoperative weak motor block are unsolved problems. This study explored the possibility of solving the unmerited problem to mix bupivacaine and plain lidocaine in spinal anesthesia for transurethral surgery. METHODS: Fifty patients presented for transurethral resection of bladder or prostate. The duration was expected to less one hour. All patients were randomized to two groups receiving the following spinal anesthetics: Group I (7.5 mg bupivacaine), 1.5 ml of 0.5% spinal bupivacaine in 8% dextrose + 0.6 ml saline; Group II (7.5 mg bupivacaine + 6 mg lidocaine), 1.5 ml of 0.5% spinal bupivacaine in 8% dextrose + 0.6 ml 1% plain lidocaine. The sensory and motor block level were checked via pinprick test and modified Bromage score. RESULTS: The highest level of sensory block was not different in group I and group II [median (range): T8 (T5-T9) vs. T8 (T5-T10)]. Onset time to peak block was similar in both groups (11+/-2 vs. 11+/-4 min). Time to two-segment regression (49+/-10 vs. 42+/-10 min; P < 0.05), L1 regression (139+/-27 vs. 113+/-24 min; P < 0.01), S2 regression (200+/-41 vs. 158+/-38 min; P < 0.01) were significantly reduced in group II. No clinical evidence of transient neurologic toxicity was found. Modified Bromage score to evaluate for motor block was not different at the same sensory block level. CONCLUSIONS: Bupivacaine and lidocaine mixture as spinal anesthetics provided the combination of adequate depth of anesthesia and rapid recovery.
Adrenergic Agonists ; Ambulatory Surgical Procedures ; Analgesics, Opioid ; Anesthesia ; Anesthesia, Spinal* ; Anesthetics ; Bupivacaine* ; Glucose ; Humans ; Lidocaine* ; Prostate ; Pruritus ; Urinary Bladder

PURPOSE: To estimate annual health care and productivity loss costs attributable to overweight or obesity in working asthmatic patients. MATERIALS AND METHODS: This study was conducted using the 2003–2013 Medical Expenditure Panel Survey (MEPS) in the United States. Patients aged 18 to 64 years with asthma were identified via self-reported diagnosis, a Clinical Classification Code of 128, or a ICD-9-CM code of 493.xx. All-cause health care costs were estimated using a generalized linear model with a log function and a gamma distribution. Productivity loss costs were estimated in relation to hourly wages and missed work days, and a two-part model was used to adjust for patients with zero costs. To estimate the costs attributable to overweight or obesity in asthma patients, costs were estimated by the recycled prediction method. RESULTS: Among 11670 working patients with a diagnosis of asthma, 4428 (35.2%) were obese and 3761 (33.0%) were overweight. The health care costs attributable to obesity and overweight in working asthma patients were estimated to be $878 [95% confidence interval (CI): $861–$895] and $257 (95% CI: $251–$262) per person per year, respectively, from 2003 to 2013. The productivity loss costs attributable to obesity and overweight among working asthma patients were $256 (95% CI: $253–$260) and $26 (95% CI: $26–$27) per person per year, respectively. CONCLUSION: Health care and productivity loss costs attributable to overweight and obesity in asthma patients are substantial. This study's results highlight the importance of effective public health and educational initiatives targeted at reducing overweight and obesity among patients with asthma, which may help lower the economic burden of asthma.
Adult ; Asthma/*economics/epidemiology/therapy ; *Cost of Illness ; *Efficiency ; *Employment ; Female ; *Health Care Costs ; Health Expenditures ; Humans ; Male ; Middle Aged ; Obesity/*economics/epidemiology/therapy ; Overweight/economics/epidemiology/therapy ; United States/epidemiology ; Young Adult

Hereditary fructose intolerance(HFI) is an autosomal recessive disease caused by catalytic deficiency of aldolase B in which affected homozygotes develop hypoglycemia and abdominal symptoms after taking foods containing fructose. Chronic exposure to fructose may lead to progressive hepatic injury, renal injury, growth retardation, and ultimately to liver and kidney failure. Herein, we report a case of HFI with presentation of episodic vomiting, diarrhea, cold sweating, abnormal liver function and failure to thrive after 12 months of her age. She developed an aversion to fruits and sweet-tasting foods. When she was admitted to hospital at the age of 30 months, hepatomegaly, and dysfunction of proximal renal tubule with renal tubular acidosis were noted. We confirmed the diagnosis via enzyme assay on biopsied liver and intestine. A fructose restrictied diet was recommended. The patient has been symptom free with normal liver functions since then.
Acidosis, Renal Tubular ; Diagnosis ; Diarrhea ; Diet ; Enzyme Assays ; Failure to Thrive ; Fructose ; Fructose Intolerance* ; Fructose-Bisphosphate Aldolase ; Fruit ; Hepatomegaly ; Homozygote ; Humans ; Hypoglycemia ; Intestines ; Kidney Tubules, Proximal ; Liver ; Renal Insufficiency ; Sweat ; Sweating ; Vomiting