The microscope is a surgical instrument with wide use in plastic surgeries more often than other departments due to the high rate of microscopic surgeries. Unfortunately, because the microscope is used mainly for digital replantations and free flaps, the utilization rate is low compared to the price and usability of the microscope itself. From September 2013 to March 2014, a foreign body which was untraceable with radiology in a patient who desired surgical exploration (one case), and a foreign body which was detected but was smaller than 3 mm (two cases) were removed using the microscope. All foreign bodies, which were fish bone, thin metals, or wooden objects, matching the history of the patients, were completely removed without damage. There were no complications and patient satisfaction was high through follow-up. We have described the microscope as the last and optimal examination tool in removal of micro foreign bodies. A simple change of thought, so that the microscope can be used as a second diagnostic tool will decrease complications by foreign bodies.
Follow-Up Studies ; Foreign Bodies* ; Free Tissue Flaps ; Humans ; Metals ; Microscopy ; Patient Satisfaction ; Replantation ; Surgical Instruments

BACKGROUND: Hypotension often occurs after induction of general anesthesia. Although preload status has been considered as an important factor for the occurrence of this hypotension, there have been inconsistent results on this topic. The dynamic preload parameters have not been studied as a predictor of hypotension, and therefore we hypothesized that the passive leg raising (PLR) test, a dynamic preload parameter, could predict anesthesia-induced hypotension and conducted a prospective clinical study. METHODS: In 40 patients undergoing elective cardiac surgery, mean arterial pressure (MAP), stroke volume variation, stroke volume (SV) and cardiac index (CI) were measured using arterial line and FloTrac(TM)/Vigileo(TM) system before, during and after PLR test, respectively. Occurrence of anesthesia-induced hypotension was recorded. The ability of PLR test to predict hypotension was evaluated by receiver operating characteristic (ROC) curve analysis. RESULTS: The incidence of hypotension was 90%, which includes 12.5% of refractory hypotension. Changes in MAP and CI induced by PLR test predicted hypotension (area under ROC curves: 0.722 and 0.788, respectively). Changes in SV and CI induced by PLR test predicted refractory hypotension (area under ROC curves: 0.863 and 0.789, respectively). CONCLUSIONS: Our results suggest that PLR test can predict hypotension and refractory hypotension occurring after induction of anesthesia in patients undergoing cardiac surgery.
Anesthesia ; Anesthesia, General ; Arterial Pressure ; Blood Pressure ; Humans ; Hypotension ; Incidence ; Leg ; Prospective Studies ; ROC Curve ; Stroke Volume ; Thoracic Surgery ; Vascular Access Devices

BACKGROUND: The purpose of this study was to evaluate the gender-related changes in the function and distribution of alpha1-adrenoceptors in the distal mesenteric artery of streptozotocin (STZ)-induced diabetic rats at the level of alpha1-adrenoceptor subtypes. METHODS: Diabetes was induced by intravenous injection of STZ in a dose of 60 mg/kg through the tail vein in 8 week-old male or female Sprague-Dawley rats (n = 13/group). Age-matched normal rats (n = 15) were used as a control group. Four weeks after STZ injection, the change in mean arterial pressure caused by a 45degrees tilting was recorded. The alpha1-adrenoceptor subtypes mediating contractions of the distal mesenteric artery were investigated using the agonist, phenylephrine as well as subtype-selective antagonists including prazocin, 5-methylurapidil, and BMY 7378. The expression of alpha1-adrenoceptor subtypes of each artery was examined by immunofluorescence staining and western blotting using subtype selective antibodies. RESULTS: Compared with normal male rats, the contractile response to phenylephrine was decreased in the distal mesenteric artery in normal female rats. Moreover, a decrease in contractile force was observed in STZ-induced diabetic rats compared with age-matched controls. Western blotting revealed that there was the difference between normal male and female rats in manifestation of the alpha1D-adrenoceptor. In STZ-induced male and female diabetic rats, all alpha1-adrenoceptor subtypes were decreased in distal mesenteric arteries, compared with normal rats. CONCLUSIONS: There was the gender-related functional difference of alpha1-adrenoceptors in normal rats. In both male and female rats, diabetes decreased the contractile response in mesenteric arteries, which might be caused by the overall change in alpha1-adrenoceptor.
Animals ; Arterial Pressure ; Arteries ; Blotting, Western ; Contracts ; Diabetes Mellitus, Experimental ; Female ; Fluorescent Antibody Technique ; Humans ; Injections, Intravenous ; Male ; Mesenteric Arteries ; Negotiating ; Phenylephrine ; Piperazines ; Rats ; Rats, Sprague-Dawley ; Receptors, Adrenergic, alpha-1 ; Streptozocin ; Veins

BACKGROUND: There is no unique guideline as to how to determine the depth of a central venous catheter (CVC). In this study, we inspected the current practice of CVC placement and evaluated insertion depth using the carina as a radiologic landmark in intensive care unit (ICU) patients. METHODS: In 138 ICU patients with a CVC in the right subclavian (SCV group) or internal jugular vein (IJV group), a chest X ray was taken, and the radiographic vertical distance between the catheter tip and the carina level (D-CC) was measured in Picture Archiving and Communication System (PACS) view. The distance between the skin puncture site and the carina level (D-SC) was calculated by adding/subtracting D-CC to/from the actual CVC insertion length. In addition, we surveyed physicians using a questionnaire about the methods they used to determine CVC depth. RESULTS: Mean D-SC was 13.80 +/- 1.69 cm in the SCV group, 14.42 +/- 1.34 cm in the IJV group, but no correlation was found with any measured physical dimension. In males, D-SC was greater, but this difference was not statistically significant. Physicians determined required insertion depths using many different methods (e.g., height, sex......). CONCLUSIONS: Patient height, weight, body mass index (BMI), and sex were not found to be reliable for predicting a safe CVC length. We recommend that after CVC insertion, a chest X ray should be taken and the catheter tip repositioned if necessary to reduce catheter related fatal complications (e.g., cardiac tamponade).
Body Weight ; Catheters ; Central Venous Catheters* ; Humans ; Intensive Care Units ; Jugular Veins ; Male ; Punctures ; Surveys and Questionnaires ; Skin ; Subclavian Vein ; Thorax

The most common developmental anomaly of midgut rotation and fixation is non-rotation. Symptomatic intestinal malrotation is relatively common in infants and children but uncommon in later ages. Most adult cases are silent throughout life and are not discovered unless they cause acute or chronic abdominal pain. Many such patients have ill-defined abdominal complaints and are labeled as having a "functional" disorder since no definite clinical abnormalities are found other than the subjective complaints. The most frequent symptomatic presentation in the adult is midgut volvulus the symptom of which is usually self-limited although often recurrent and sometimes leading to an abdominal catastrophe. The diagnostic means for the adulthood malrotation include simple and contrast radiographic studies and CT scan. Malrotation first detected by cholescintigraphy is rare. We report a case of intestinal non-rotation incidentally discovered on DISIDA hepatobiliary scintiscan.
Abdominal Pain ; Adult ; Child ; Humans ; Infant ; Intestinal Volvulus ; Tomography, X-Ray Computed

OBJECTIVE: This retrospective study was designed to compare the drug usage patterns and clinical outcomes of patients who received either risperidone or olanzapine in a naturalistic setting at a university hospital. METHODS: Inpatients with schizophrenia given either risperidone or olanzapine, as a single oral antipsychotic drug during hospitalization were retrospectively investigated. Data on patients' age, sex, efficacy, duration of hospitalization, dosage, use of antiparkisonian drugs, cost of drugs, weight changes, and hepatotoxicity were collected. RESULTS: Sixty patients, 30 patients for each group, were evaluated. No significant differences were observed between groups for age, sex, the duration of hospitalization, the degree to the improvement of Global Assessment of Functioning and weight gain. The mean daily antiparkinsonian medication use expressed in benztropine equivalents was significantly lower (p<0.001) in the olanzapine group (0.8 mg+/-0.9) than in the risperidone group (2.2 mg+/-0.8). For risperidone, the mean daily dose and associated cost at discharge were 5.6 (+/-1.1)mg and 765.6 (+/-144.9) won per day, whereas those for olanzapine were 15.8 (+/-4.0)mg and 1884.2 (+/-470.9) won per day (p<0.001). A mild increase of liver enzymes was found in both groups. CONCLUSION: It appears from this study that both risperidone and olanzapine are relatively safe and effective in inpatients with schizophrenia. While olanzapine group shows a superior profile in the neurological side effects, risperidone group exhibits better profile in the daily cost of drug. Further controlled studies are recommended to confirm these findings.
Benztropine ; Hospitalization ; Humans ; Inpatients* ; Liver ; Retrospective Studies ; Risperidone* ; Schizophrenia* ; Weight Gain

PURPOSE: Male sexual desire and erection are directly or indirectly affected by hormone and neuroendocrine response. We investigate the changes of the serum dopamine and testosterone level by visual erotic stimulation-induced sexual excitement. MATERIALS AND METHODS: The age of volunteers was ranged from 25 to 65 years, with an average of 45.5years. Serum were collected at rest and after visual erotic stimulation. Sexual excitement induced by erotic film for 30 minutes and erectile status was monitored by Rigiscan. The response of visual erotic stimulation were divided into three groups according to degree of sexual excitement. i.e. no response (Group I), mild excitement(Group II), excitement (Group III). RESULTS: Although some changes were observed in serum dopamine and testosterone level of all 32 patients after visual erotic stimulation, it did not showed statistically signigicant change (p=0.450, p=0.058). According to excitement response, group I and II were not showed statistically significant change in both dopamine and testosterone. Only dopamine of the group III was showed statistically change (dopamine: p=0.041, testosteron: p=0.257) CONCLUSIONS: In this study, serum testosterone level is not showed significant change irrespective of the degree of sexual excitement induced by visual erotic stimulation. However, serum dopamine was changed with statistically significance only in sexual excitement group.
Dopamine* ; Humans ; Male ; Testosterone* ; Volunteers

The sparsity of publication concerning CT findings of tuberculous arthritis prompted authors to retrospectively evaluate 12 patients with tuberculous arthritis for characteristic CT findings. In each patient, the diagnosis of tuberculous arthritis was confirmed by surgery or biopsy. The CT examinations were evaluated by two radiologists retrospectively. Involved joints were the hip joint in seven patients, the sacroiliac joint in three parients, and the shoulder and ankle joint in one patients each. CT features included subchondral bony erosion(12 patients), soft tissue mass in the joint space(nine), widenining of the joint space(eight), ipsilateral muscle atrophy(eight), thickening of the joint capsule(seven), intra-articular effusion(six), soft tissue abscess(five),and bony sclerosis(four). In seven patients with the duration of symptoms less than 1 year, thickening of joint capsule and intra-articular effusion were the predominent findings, while bony sclerosis, gross bone destruction, and soft tissue mass in joint space were seen in five patients with the duration of symptoms longer than 1 year. Our results indicate that CT is useful in the diagnosis of tuberculous arthritis by demonstrating characteristic pathologic changes of the joint space, soft tissue abnormality and bony involvement.
Ankle Joint ; Arthritis* ; Biopsy ; Diagnosis ; Hip Joint ; Humans ; Joint Capsule ; Joints ; Publications ; Retrospective Studies ; Sacroiliac Joint ; Sclerosis ; Shoulder

We performed a study to determine whether clinical history gives a positive or negative influence on X-ray film interpretation. One hundred and nine patient's radiograms, consisting of 55 normal and 54 abnormal cases (136 abnormalities), were interpreted twice by three pairs of residents in radiology and a pair of qualified radiologists, without clinical history first and with clinical history next. The interpreters recorded diagnosis and confidence level of normal or abnormal findings on a six-point scale. Analysis of receiver operating characteristic (ROC) curves showed that knowledge of clinical history improved diagnostic accuracy. Residents, especially beginners, should be advised to obtain clinical history whenever they read radiograms.
Analysis of Variance ; Human ; *Medical Records ; Observer Variation ; Radiography/*standards ; Support, Non-U.S. Gov't