No abstract available.
Myocardial Infarction*

A 53-year-old male patient presented with quadriparesis during pulmonological hospitalization for the treatment of S. aureus associated necrotizing pneumonia. He was diagnosed with the aquaporin-4 (AQP4) positive longitudinally extensive transverse myelitis from pons to T3 level. Despite the administration of intravenous methylprednisolone and plasma exchange with appropriate antibiotics, the patient's neurological condition deteriorated and he died. Our case implies that an S. aureus associated necrotizing pneumonia can trigger an AQP4 positive neuromyelitis optica spectrum disorder and contribute to the devastating course.
Anti-Bacterial Agents ; Aquaporin 4 ; Hospitalization ; Humans ; Male ; Methylprednisolone ; Middle Aged ; Myelitis, Transverse ; Neuromyelitis Optica ; Plasma Exchange ; Pneumonia ; Pons ; Quadriplegia

No abstract available.
Humans* ; Mesenchymal Stromal Cells*

Not infrequently, we meet urgent situations that emergency cardiac pacing is inevitable. Paricularly, in patients with impending brady-asystole cardiac arrest, we cannot but introduce pacing cartheter without fluroscopic guidance in emergency department if transcutaneous pacing is not available. There is little report about emergency transvenous cardiac pacing without fluoroscopic guidance in patients with impending cardiac arrest in korea. We report our experiences of temporary transvenous pacing by blind approach performed in patients with impending bradyasystolic cardiac arrest in emergency department. Among 10 patients who blind pacing were performed. 7 were successfully paced and 3 were not. 5 of 7 patients with successful pacing died of underlying diseases. 2 patients wiere alive. A hematoma around the puncture site was developed in a patient receiving thrombolytic therapy. We concluded that temporary transvenous pacing withoup fluoroscopy should be tried in the emergency situations if fluoroscopy or transcutaneous pacemaker is not avialable.
Emergencies* ; Emergency Service, Hospital ; Fluoroscopy* ; Heart Arrest* ; Hematoma ; Humans ; Korea ; Punctures ; Thrombolytic Therapy

The most proper antibiotic must be selected after antimicrobial susceptibility test. If difference in antimicrobial susceptibility was significant between oral sampling sites, it is rationale to use the most susceptible antibiotic agent respond to dental procedure and object of treatment. This study examined sampling site variation from saliva, supragingival plaque and subgingival plaque of 16 children's oral microbes. The cultured bacterial isolates, which were Streptococcus viridans and Neisseria, were examined for 10 antimicribial drugs with the Bauer-Kirby agar disk diffusion method. The used drugs were Penicillin, Ampicillin, Oxacillin, Cephalothin, Imipenem, Gentamicin, Erythromycin, Vancomycin, Ciprofloxacin, Clindamycin. There was no significant difference between three sampling sites for antimicrobial susceptibility test of S. viridans and Neisseria and the sequence of susceptibility was agreed among them. In conclusion, it was suggested that antimicrobial susceptibility test from saliva, supragingival plaque and subgingival plaque of children have no significant sampling site variation.
Agar ; Ampicillin ; Cephalothin ; Child* ; Ciprofloxacin ; Clindamycin ; Diffusion ; Erythromycin ; Gentamicins ; Humans ; Imipenem ; Neisseria ; Oxacillin ; Penicillins ; Saliva ; Vancomycin ; Viridans Streptococci

BACKGROUND: In korea, significant proportion of victims with out-of-hospital cardiac arrest have no change to survive because some physicians regard the victim with cardiac arrest outside the hospital as the dead and they do not attempt cardiopulmonary resuscitation(CPR). And we cannot expect bystander-initiated CPR and emergency medical system in resuscitating the victims with cardiac arrest. We studies the outcome of resuscitation attempts and the factor associated with survival in patients with out-of-hospital cardiac arrest in current situation of emegency medical system. Method: We attempted cardiopulmonary resuscitation(by standard guidelines) in 74 consecutive victims with non-traumatic out-of-hospital cardiac arrest in emergency department. RESULTS: Of 74 victims with cardiac arrest 35(47%) had no any restoration of spotaneous circulation(ROSC), 26(35%) had transient ROSC but died within 24 hours,6(8%) survived over 24 hours but died in the hospital, and 7(10%) discharged alive. Factors associated with survival were cardiac origin as a cause of cardiac arrest, ventricular fibrillation as a initial ECG rhythm, and short circulatory arrest time. CONCLUSION: Survival rate of victims with non-traumatic out-of-hospital cardiac arrest was 10%. Considering the feasibility to survive, CPR should be attempted in patients with out-of-hospital cardiac arrest if do-no-resusciate(DNR) is not indicated.
Cardiopulmonary Resuscitation ; Electrocardiography ; Emergencies ; Emergency Service, Hospital ; Heart Arrest ; Humans ; Korea ; Out-of-Hospital Cardiac Arrest* ; Resuscitation* ; Survival Rate ; Ventricular Fibrillation

No abstract available.
Stroke ; Vision Disorders

Delayed anoxic encephalopathy after carbon monoxide (CO) poisoning is characterized by neurological deterioration that occurs after recovery from acute CO intoxication. There has been no established therapy. We report a patient recovered from acute CO intoxication developed various neurological symptoms. After the administration of high dose prednisolone and anticholinesterase inhibitor, the therapeutic effect was remarkable and confirmed by quantitative analysis of diffusion-tensor imaging (DTI). DTI could be used to evaluate the therapeutic effect for delayed anoxic encephalopathy after CO poisoning.
Carbon Monoxide Poisoning ; Carbon Monoxide ; Carbon ; Diffusion Tensor Imaging ; Humans ; Hypoxia, Brain ; Leukoencephalopathies ; Magnetic Resonance Imaging ; Poisoning ; Prednisolone

BACKGROUND: Laparoscopic cholecystectomy and gynecologic pelviscopy need to induce pneumoperitoneum to allow visualization of the operative field, but the former requires a head-up position whereas the latter needs a Lithotomy-Trendelenburg position. The authors observed hemodynamic changes using an esophageal doppler monitor in both cases. METHODS: Eight females planned for laparoscopic cholecystectomy were assigned to Group 1 and 10 females for gynecologic pelviscopy were assigned to Group 2. Thiopental (5 mg/kg) and vecuronium (0.1 mg/kg) were used to induce general anesthesia. 50% O2-N2O and 1.5 vol.% isoflurane were used to maintain anesthesia. Mechanical ventilation was used with a tidal volume of 10 ml/kg and a respiratory rate of 12 breaths per minute. Mean arterial pressure, heart rate, end-tidal CO2 and peak airway pressure were measured and cardiac output, corrected flow time, and peak velocity were monitored using an esophageal doppler monitor in each group after inducing anesthesia, CO2 inflation, position change, and CO2 deflation. RESULTS: Mean arterial pressure increased in each group while changing position. No significant changes in the heart rate were observed in each group. End-tidal CO2 increased in each group after changing position, and remained elevated even with position reversal and deflation. Peak airway pressure was elevated in each group after CO2 inflation and increased more so with changing posture in group 2 (post inflation: 18.5 +/- 1.4 cmH2O, after position change: 21.4 +/- 2.0 cmH2O). Cardiac output and cardiac index were reduced after the induction of pneumoperitoneum in each group, and reduced more on changing posture in group 2 (CO: 5.9 +/- 2.0 L/min vs. 4.4 +/- 1.5 L/min, CI: 3.7 +/- 1.4 L/min/m2 vs. 2.7 +/- 1.1 L/min/m2). Stroke volume also reduced after changing posture in each group. Corrected flow time was not changed, but peak velocity decreased after CO2 inflation in each group (group 1: 97.4 +/- 30.0 cm/s vs. 78.9 +/- 27.3 cm/s, group 2: 111.9 +/- 14.1 cm/s vs. 88.3 +/- 12.6 cm/s). CONCLUSIONS: The Lithotomy-Trendelenburg position can augment the hemodynamic changes resulting from pneumoperitoneum. Therefore, additional caution is required in patients with cardiovascular disease who are undergoing gynecologic pelviscopy.
Anesthesia ; Anesthesia, General ; Arterial Pressure ; Cardiac Output ; Cardiovascular Diseases ; Cholecystectomy, Laparoscopic* ; Female ; Heart Rate ; Hemodynamics* ; Humans ; Inflation, Economic ; Isoflurane ; Pneumoperitoneum ; Posture ; Respiration, Artificial ; Respiratory Rate ; Stroke Volume ; Thiopental ; Tidal Volume ; Vecuronium Bromide

Mass detached partially or completely from left atrial wall, may produce systemic embolus. If embolus is too large and mitral stenosis is coincidentally present, emblous may obstruct inflow tract of the left ventricle and result in rapid decrease of cardiac output and sudden death subsequently. We experienced a 59-year-old male victim with sudden cardiac arrest from obstruction(“hole-in-one embolus”) of stenotic mitral valve by left atrial mass(ball thrombus). which was detected by transesophageal echocardiography during cardiopulmonary resuscitation.
Cardiac Output ; Cardiopulmonary Resuscitation ; Death, Sudden ; Death, Sudden, Cardiac ; Echocardiography, Transesophageal ; Embolism ; Heart Ventricles ; Humans ; Male ; Middle Aged ; Mitral Valve ; Mitral Valve Stenosis