BACKGROUND: A number of factors can cause dark circles around the eyes including excessive pigmentation, thin and translucent lower eyelid skin overlying the orbicularis oculi muscle, and shadowing due to skin laxity and tear trough. Autologous fat graft is an effective method for the treatment of lower lid dark circles, but irregularities caused by leaving visible lumps of the fat can occur. Tonnard et al. suggested 'nanofat' grafting and introduced its characteristics and clinical applications. The authors used their nanofat grafting to correct lower eyelid dark circles. METHODS: Nanofat grafting was performed in 19 patients for dark lower eyelids. The grafts were injected into subdermal layer using blunt cannula. Microfat grafting with nasojugal fold was performed to all the patients. Among them, 18 patients received transconjunctival fat removal at the same time. RESULTS: All the patients showed much improvement from preoperative dark coloration. There were no visible lumps of fat, contour irregularities, or fat necrosis. Postoperative edema and ecchymosis were minimal. CONCLUSIONS: Nanofat grafting methods provide a good alternative for correcting dark circles by augmenting thin skin with lower complications. This simple, cost effective procedure is suitable for correction of dark circles and various skin rejuvenation purposes.
Catheters ; Ecchymosis ; Edema ; Eyelids* ; Fat Necrosis ; Humans ; Hyperpigmentation ; Pigmentation ; Rejuvenation ; Shadowing (Histology) ; Skin* ; Transplantation ; Transplants*

The final degrees of education for the third and fourth authors were mutually misplaced.

OBJECTIVE: To determine whether ankle plantar flexors stretching exercise affects functional reach in elderly men. METHOD: Twenty elderly men with an average age of 78.2 years were selected for this study. A active range of motion of ankle dorsiflexion and a functional reach (FR) distance were measured before and after ankle stretching exercise. The ankle dorsiflexion was measured by goniometer in knee extended position. The FR distance was measured in standing position. Ankle plantar flexors stretching exercises were carried out by physical therapist 4 times per week for 4 weeks. At 4 weeks after the stretching exercise, we retested the active range of motion of ankle dorsiflexion and the FR distance using the same method. RESULTS: At 4 weeks after the stretching exercise, the active range of motion of right ankle dorsiflexion was increased from 2.81 +/- 3.26degrees to 5.98 +/- 4.34degrees, and the left ankle dorsiflexion was increased from 3.15 +/- 3.77degrees to 6.35 +/- 2.45degrees. The FR distance was increased form 12.22 +/- 7.54 cm to 19.69 +/- 8.59 cm after the stretching exercise. CONCLUSION: The FR distance was significantly increased after the ankle plantar flexors stretching exercise (p<0.01). This results suggest that the ankle plantar flexors stretching excercise may be capable of increasing the FR distance in elderly.
Aged* ; Ankle Joint ; Ankle* ; Exercise ; Humans ; Knee ; Male ; Physical Therapists ; Range of Motion, Articular

We report a case in which WPW (Wolff-Parkinson-White)-type preexcitation syndrome arose unexpectedly immediately after induction of general anesthesia on a 25-yr-old man who had another rare cardiac arrhythmia, parasystole. His preoperative ECG showed ventricular bigeminy and a delta wave was observed after induction of anesthesia with fentanyl, midazolam and propofol. Anesthesia was maintained with propofol, fentanyl and nitrous oxide. The intraoperative ECG showed varying and temporary responsiveness to drugs such as atropine, lidocaine and ephedrine. After we started to infuse the dobutamine, the delta wave, ventricular bigeminy disappeared on the intraoperative ECG. We should consider the influence of anesthesia-related agents on arrhythmia, and aim to prevent and manage tachyarrhythmias caused by this syndrome.
Anesthesia ; Anesthesia, General* ; Arrhythmias, Cardiac ; Atropine ; Dobutamine ; Electrocardiography ; Ephedrine ; Fentanyl ; Humans ; Lidocaine ; Midazolam ; Nitrous Oxide ; Parasystole* ; Pre-Excitation Syndromes* ; Propofol ; Tachycardia ; Wolff-Parkinson-White Syndrome

No abstract available.
Lipomatosis*

BACKGROUND: Exercise tests (ET), hyperventilation tests (HVT) and cold pressor tests (CPT) have been used to induce coronary artery spasm. However their diagnostic significance and the circadian variation of exercise test response in patients with vasospastic angina are still uncertain. METHODS: To elucidate the circadian variation of ET response and to evaluate the diagnostic significance of non-pharmacological provocation tests, 21 consecutive patients with pure vasospastic angina were studied. Six ETs were performed in the early morning, late morning, and late afternoon in consecutive days, 2 HVTs and 2 CPTs in the early morning. The circadian distribution and types of angina (at rest, on physical activity, or both) from before admission to after discharge (mean follow-up periods 19+/-9 months) were evaluated by clinical history, clinical records and Holter recordings. Circadian distribution of anginal attacks recorded through the all observation periods were classified into 3 patterns (morning and night : MN, morning and afternoon or evening : M+F/E, morning, night and afternoon and/or evening : MN+F/E). RESULTS: One hundred and eleven ETs (39 early morning, 38 late morning, 34 late afternoon tests), 35 HVTs and 33 CPTs were performed. ETs showed 14 positive responses (36%) in the early morning, 14 (37%) in the late morning and 12 (35%) in the late afternoon without any circadian variation. Among the 11 patients who underwent all 6 exercise tests, 3 patients (27%) showed at least one positive response in the early morning, 4 (36%) in the late morning and 4 (36%) in the late afternoon. Subgroups of the subjects according to the types and activity of angina and the numbers of spastic artery also failed to show any circadian variation in ET response, but M+F/E group of circadian pattern of angina showed a peak of positive response in the early morning (p<0.05). HVTs showed significantly higher positive response (23/35, 66%, p<0.05) than ETs (14/39, 36%) and CPTs showed significantly lower positive response (2/33, 6%, p<0.01) than ETs in the early morning. Double tests with more than 1 positive response couldn't increase the positive response in ETs (9/19, 47%), and CPTs (2/14, 14%) but increased significantly in HVTs(15/16, 94%, p<0.05), particularly in the group with low activity (7/8, 86%, p<0.01). ETs showed ST segment elevation in 29 (72%) and depression in 11 (28%) of the 40 positive tests, HVTs in 21 (91%) and 2 (9%) of the 23 positive tests and CPTs in 2 (100%) and 0 (0%) of the 2 positive tests. The ST segment elevation was significantly higher in HVTs than in ET (p<0.05). CONCLUSION: These findings suggest that the exercise test in the early morning do not increase positive response and is not a sensitive diagnostic test associated with occasional depression of ST segment, but hyperventilation test, especially if repeated, is a very sensitive test with predominant elevation of ST segment in patients with vasospastic angina.
Arteries ; Circadian Rhythm ; Coronary Vasospasm ; Coronary Vessels ; Depression ; Diagnostic Tests, Routine ; Exercise Test* ; Follow-Up Studies ; Humans ; Hyperventilation ; Motor Activity ; Muscle Spasticity ; Spasm

Pseudoaneurysm of splenic artery may arise from a vascular erosion by the inflammatory processes around the splenic artery, particularly in acute pancreatitis and chronic pancreatitis, which may cause rupture of pseudoaneurysm and life threatening hemorrhage. Collective experience with this massive hemorrhage is attended by a high mortality rate even with prompt therapy, and conservative management is associated with an almost 100 per cent of mortality rate. Identification of the bleeding site at laparotomy may be exceedingly difficult, which makes the preoperative detection of bleeding source desirable. Peripancreatic vascular lesions can be identified by angiography, and in selected cases the risk of urgent operation to control massive hemorrhage may be obviated by embolization. The authors have recently experienced a case of ruptured splenic artery pseudoaneurysm combined with a pancreatic pseudocyst in a 6 years old boy. A bolus enhanced CT scan and angiography were essential to confirm these complications of pancreatic pseudocyst. We managed this child successfully with an urgent procedure of transcatheter arterial embolization and another elective surgery of pancreatic pseudocyst.
Aneurysm, False* ; Angiography ; Child* ; Hemorrhage ; Humans ; Laparotomy ; Male ; Mortality ; Pancreatic Pseudocyst ; Pancreatitis ; Pancreatitis, Chronic ; Rupture ; Splenic Artery* ; Tomography, X-Ray Computed

No abstract available.
Syncope* ; Urination*

BACKGROUND: In general, the outcomes of arthroscopic repair for superior labrum anterior to posterior lesions (SLAP) are favorable, however, persistent pain and limitation of motion are not rare complications. One of the possible cause is a “knot-ache”. This study evaluated the results of reoperation of symptomatic recurrent SLAP lesions and asked whether the knot is associated with postoperative complications. METHODS: Between 2005 and 2015, a total of 11 patients who had undergone arthroscopic SLAP repair were reoperated for recurrent symptomatic SLAP lesion. By retrospective chart review, operative findings, the visual analogue scale for pain (pVAS), the range of motion (ROM), and functional scores were analyzed. RESULTS: The mean age of the study participants was 38.3 years, and the mean follow-up period was 42.5 months. In the primary operation, there were nine cases of repairs with conventional knot-tying anchors and three cases with knotless anchors. Impingement of the knots during abduction and external rotation of the shoulder was observed in the all cases with knot-tying anchors. The mean pVAS, ROM, and functional scores significantly improved with reoperation. At the final follow-up, the mean satisfaction VAS was 8.3. CONCLUSIONS: The knots of suture anchor maybe a possible etiology of the pain, which we termed a “knot-ache”. Considering that reoperation is performed due to pain after primary repair, the use of knotless suture anchor may have benefits of eliminating one of possible cause, “knot-ache”. Therefore, authors suggest the use of knotless anchors during reoperation for recurrent or recalcitrant pain after primary SLAP repair.

BACKGROUND: The diagnostic significance of ECG ergonovine test and the incidence of vasospastic angina in patients with chest pain are still uncertain. METHODS: From May 1998 to June 1999, 133 consecutive patients with chest pain were admitted for diagnostic coronary angiography. ECG ergonovine provocation tests were performed in 64 patients who have a clinical history suggesting vasospatic angina, including 27 of 28 patients with vasospastic angina documented electrocardiographically, or who's coronary angiographic findings could not be explained by their clinical history. Ergonovine was administered intravenously in incremental dose of 0.05, 0.1, 0.2, 0.3, 0.4 mg up to total cumulative dosage of 1.0mg during coronary angiography(41 cases), in the exercise laboratory(21 cases) or both(2 cases). RESULTS: Of 133 patients with chest pain, vasospastic angina was documented in 32(24%), unstable angina in 52(34%), stable angina in 10(8%), and others in 39(29%). Angiography demonstrated coronary spasm in 4 additional patients as well as 22 patients with vasospastic angina documented electrocardiographically, but ergonovine tests in the exercise laboratory showed positive response in 5 of 6 patients with vasospastic angina documented. Among the 25 patients with coronary spasm proved angiographically during ergonovine test, ECG findings at the time of coronary spasm were ST segment elevation in 21(84%), depression in 1(4%) and no change in 3(12%) patients, who had branch vessel spasm, 3 vessel spasm or incomplete spasm on coronary angiogram. Of the 31 patients with vasospastic angina who underwent ergonovine tests, positive response occurred in 24(77%) after a cumulative dose of < or = 0.4mg and in additional 3(10%) after the higher dose of >0.4mg. However the other 4(13%) had no ECG changes even after the higher dose(>0.4mg) of ergonovine. CONCLUSION: This results suggest that vasospastic angina appear to be a common cause of chest pain, and ECG ergonovine test with high dose can improve diagnostic sensitivity but cannot detect some patients with vasospastic angina.
Angina, Stable ; Angina, Unstable ; Angiography ; Chest Pain ; Coronary Angiography ; Depression ; Electrocardiography* ; Ergonovine* ; Humans ; Incidence ; Spasm