Attending the operation room is an essential part of surgical clerkships. Syncope or presyncopal attacks in the operation room may negatively affect students' learning and career development. This study set out to identify the prevalence of syncope and presyncopal attacks in the operation room during medical students' surgical clerkships. Data from 420 medical students (303 men and 117 women) in their 3rd year of clerkship were collected between 2014 and 2017. An anonymous questionnaire was distributed to assess the prevalence and degree of syncope and presyncopal symptoms. A total of 27% of the respondents had experienced syncope or presyncopal symptoms, 49.6% of the female students and 18.8% of the male students (p < 0.001). Fifty students (43.5%) had been attending as observers at the time of the syncopal attack, while 65 students (56.5%) had been participating as assistants. Thirty-four students (29.6%) had recently eaten at the time of the syncopal attack, while 81 students (70.4%) had not recently eaten. Prodromal symptoms included the urge to sit down (21.2%), sweating (19.3%), nausea (16.9%), a feeling of warmth (13.3%), darkened vision (12.6%), yawning (11.7%), palpitation (11.0%), ear fullness (10.2%), black spots in one's vision (7.6%), and hyperventilation (7.1%). This study showed the prevalence of syncope and presyncopal symptoms in the operation room during surgical clerkships. For students' safety and effective clerkship learning, thorough proactive education on syncopal attacks is required.
Anonyms and Pseudonyms ; Clinical Clerkship ; Ear ; Education ; Female ; Humans ; Hyperventilation ; Learning ; Male ; Nausea ; Operating Rooms ; Prevalence ; Prodromal Symptoms ; Students, Medical ; Surveys and Questionnaires ; Sweat ; Sweating ; Syncope ; Yawning

PURPOSE: Oral naloxone is combined with oxycodone to alleviate or prevent opioid-induced constipation in cancer pain patients. However, there is still concern that oral naloxone may precipitate opioid withdrawal symptoms in patients on opioids. We retrospectively investigated clinical characteristics of cancer patients who experienced opioid withdrawal symptoms. METHODS: We reviewed medical records of all patients who were prescribed with oral oxycodone/naloxone at a tertiary cancer center from January 1, 2012 through December 31, 2016. Eligible patients were screened based on demographics, opioid and naloxone dosages, clinical manifestation and pain intensity. RESULTS: Among a total of 1,641 patients, 10 patients were selected. Seven patients were male, and the average age was 68.1 years. The median dose of naloxone that induced withdrawal symptoms was 20 mg. Most common withdrawal symptom was shivering (seven patients) followed by cold sweating (five), and muscle twitching (five). Other symptoms included restlessness, fever, dizziness, and yawning. Pain was exacerbated from the median intensity of numeric rating scale (NRS) 3 to NRS 6. CONCLUSION: Opioid withdrawal symptoms may occur when switching to oral oxycodone/naloxone for cancer patients who have been treated with other strong opioids. A prospective, multicenter study on this issue should be conducted in future.
Analgesics, Opioid* ; Constipation ; Demography ; Dizziness ; Fever ; Humans ; Male ; Medical Records ; Naloxone ; Oxycodone ; Prospective Studies ; Psychomotor Agitation ; Retrospective Studies ; Shivering ; Substance Withdrawal Syndrome* ; Sweat ; Sweating ; Yawning

Acupuncture Therapy ; Adolescent ; Adult ; Female ; Humans ; Male ; Middle Aged ; Respiration Disorders ; physiopathology ; therapy ; Yawning ; Young Adult

OBJECTIVES: Dislocation of the temporomandibular joint may occur for various reasons. Although different invasive methods have been advocated for its treatment, this study highlights the value of non-invasive treatment options even in chronic cases in a resource-poor environment. MATERIALS AND METHODS: A seven-year retrospective analysis of all patients managed for temporomandibular joint dislocation in our department was undertaken. Patient demographics, risk factors associated with temporomandibular joint dislocation and treatment modalities were retrieved from patient records. RESULTS: In all, 26 patients were managed over a seven-year period. Males accounted for 62% of the patients, and yawning was the most frequent etiological factor. Conservative treatment methods were used successfully in 86.4% of the patients managed. Two (66.7%) of the three patients who needed surgical treatment developed complications, while only one (5.3%) patient who was managed conservatively developed complications. CONCLUSION: Temporomandibular joint dislocation appears to be associated with male sex, middle age, yawning, and low socio-economic status, although these observed relationships were not statistically significant. Non-invasive methods remain an effective treatment option in this environment in view of the low socio-economic status of the patients affected.
Demography ; Dislocations* ; Humans ; Male ; Middle Aged ; Nigeria* ; Retrospective Studies ; Risk Factors ; Temporomandibular Joint* ; Yawning

The temporomandibular joint can be dislocated during anesthesia as a result of excessive oral opening and direct laryngoscope handling. Occasionally, yawning can be observed during the induction of anesthesia with propofol. The forceful and voluntary yawning after a propofol injection can lead to a dislocation of the temporomandibular joint. We report a case of an anterior dislocation of the temporomandibular joint upon induction with propofol, which caused difficulties in mask ventilation and endotracheal intubation. Although intubation had been carried out successfully in this case, an unanticipated difficult airway can be confronted at anytime. Therefore, anesthesiologists should be aware of the management of a difficult airway and practice various methods according to a difficult airway algorithm.
Anesthesia* ; Dislocations ; Intubation ; Intubation, Intratracheal ; Jaw* ; Laryngoscopes ; Masks ; Propofol ; Temporomandibular Joint ; Ventilation ; Yawning

Biological Evolution ; Habits ; Humans ; Yawning ; physiology

Tonsillectomy is one of the most common procedures performed by an otorhinolaryngologist. Postoperative hemorrhage and dehydration are two of the most common complications, but glossopharyngeal neuralgia is an unusual complication encountered in tonsillectomy. Glossopharyngeal neuralgia is characterized by paroxysms of ipsilateral and severe lancinating pain occurring in the distribution of the nerve. The pain may be spontaneous or precipitated by a variety of actions that stimulate the region supplied by the glossopharyngeal nerve namely yawning, coughing, swallowing and talking. The proximity between the glossopharyngeal nerve and the tonsillar fossa suggests that dissection in the correct surgical plane during tonsillectomy is important for avoiding injury to the glossopharyngeal nerve. Glossopharyngeal neuralgia after tonsillectomy is induced by intraoperative cauterization, nerve compression or iatrogenic trauma. Management of glossopharyngeal neuralgia induced by tonsillectomy should be given a trial of anti-convulsant medication like carbamazepine or glossopharyngeal nerve resection. A case of glossopharyngeal neuralgia caused by tonsillectomy was experienced by a 29-year-old man, and this case was reported and its aetiology was discussed.
Adult ; Carbamazepine ; Cautery ; Cough ; Deglutition ; Dehydration ; Glossopharyngeal Nerve ; Glossopharyngeal Nerve Diseases* ; Humans ; Postoperative Hemorrhage ; Tonsillectomy* ; Yawning

We hereupon present a case of injured temporomandibular joint (TMJ) associated with fluoxetine monotherapy-induced repeated yawning. Further information is needed regarding the relationship between fluoxetine administration and clinically significant yawning. Clinicians should be more careful to listen to their patients when they describe unexpected reactions to medications.
Fluoxetine ; Humans ; Rhinitis* ; Temporomandibular Joint ; Yawning

PURPOSE: To establish central control of a penile erection, the centrally elicited erectile effects of apomorphine hydrochloride and various vasoactive agents were investigated after intracerebroventricular administration. MATERIALS AND METHODS: Anesthetized male Sprague-Dawley rats were used for the study. After intracerebroventricular administration of normal saline(NS), apomorphine hydrochloride(AH), prostaglandin E1(PGE1), sodium nitroprusside(SNP), phenylephrine hydrochloride(PE) and phentolamine(PT) under a stereotaxic setting, the intracavernosal pressure(ICP), systolic femoral artery pressure(FAP), heart rate(HR), time to first response, duration and number of erectile response and adverse reactions were evaluated for 60 minutes. To show if the centrally elicited erection by agents in native setting were effective, the above criteria were re-evaluated after a bilateral pelvic neurotomy and bilateral orchiectomy. RESULTS:Cerebral proerectile effects were elicited by AH with no significant changes in the FAP and HR, but with PGE1, SNP, PE and PT significant changes in both the FAP and HR were observed. The ICP/FAP ratio was highest with SNP at 0.75+/-0.08. The mean time to first response was shortest with AH at 18.1+/-5.1min. The mean duration was longest with AH at 39.4+/-10.9min. The number of responses was highest with AH at 2.7+/-1.1. Adverse reactions, such as stretching, yawning and ejaculation, were simultaneously observed during increases in the ICP. In the case of a bilateral pelvic neurotomy or bilateral orchiectomy, these elicited erectile responses disappeared. CONCLUSIONS: Vasoactive agents, such as SNP, PGE1 and PE, had a cerebral proerectile effect, but AH showed more an evidently potent proerectile effect in the aspects of ICP, time to first response and duration of erectile response. Testosterone and the pelvic nerve are suggested to be essential for a central proerectile response.
Alprostadil ; Animals ; Apomorphine* ; Ejaculation ; Femoral Artery ; Heart ; Humans ; Male ; Orchiectomy ; Penile Erection ; Phenylephrine ; Rats* ; Rats, Sprague-Dawley ; Sodium ; Testosterone ; Vasodilator Agents ; Yawning

PURPOSE: To examine the centrally elicited erectile effects of alpha-MSH, oxytocin, prostagladin E1, and anabolic steroids after intracerebroventricular administration. MATERIALS AND METHODS: We used anesthetized male Sprague-Dawley rats. After intracerebroventricular administration of normal saline (NS), alpha-melanocyte stimulating hormone (alpha-MSH), oxytocin acetate (OT), prostaglandin E1 (PGE1), methylprednisolone (MP), testosterone enanthate (TE) or 17beta-estradiol (E2) under stereotaxis, the intracavernosal pressure (ICP), systolic femoral artery pressure (FAP), heart rate (HR), time to first response, duration, and number of erectile responses and adverse reactions were evaluated for 60 minutes. To show whether erections were centrally elicited, the above criteria were re-evaluated after a bilateral pelvic neurotomy and bilateral orchiectomy. RESULTS: A cerebral proerectile effect was elicited only by alpha-MSH and OT with no significant changes of FAP or HR. With PGE1, significant changes in FAP and HR were observed. The ICP/FAP ratio was highest (0.49 0.03) with alpha-MSH. The mean time latency was shortest with OT (20.6 5.6 min). The mean duration was longest in alpha-MSH (11.6 8.7 min). The number of responses was highest with OT (3.6 0.7). Adverse reactions, such as stretching, yawning and ejaculation, were simultaneously observed during increases in ICP. In the cases of a bilateral pelvic neurotomy or bilateral orchiectomy, these elicited erectile responses disappeared. CONCLUSIONS: alpha-MSH had the most potent proerectile effect compared to OT and PGE1 as assessed by highest intracavernosal pressure as well as duration of erectile response. The results suggest that testosterone and the pelvic nerve were essential for the central proerectile response.
alpha-MSH ; Alprostadil ; Animals ; Ejaculation ; Femoral Artery ; Heart Rate ; Humans ; Male ; Methylprednisolone ; Orchiectomy ; Oxytocin ; Penile Erection ; Rats* ; Rats, Sprague-Dawley ; Steroids ; Testosterone ; Yawning