PURPOSE: Tetanus is difficult for emergency physician to diagnosis at an early stage because of its low incidence and atypical initial clinical features. Therefore, we reviewed the clinical features of 54 tetanus cases and attempted to identify factors associated with prognosis in order to improve early diagnosis and treatment. METHODS: We carried out a retrospective chart review of 54 adult tetanus patients who presented to the ED of Chonnam National University Hospital between January 1996 and December 2005. We collected information on demographics, SAPS II score, clinical feature, course of infection and prognosis. We divided the patients to two groups according to the survival and compared their data statistically. RESULTS: Fifty four patients, 33 men and 21 women, were included in the study. The mean age was 50.97+/-15.95. The most common initial diagnosis in ED were electrolyte imbalance (n=15), neck and facial dystonia (n=9). The mean incubation period was 10.27+/-6.47 days. The initial SPAS II score 17.29+/-8.45 and the Wood score was 3.12 +/-1.47. Most commonly symptom was dyspnea and dysarthria. Twenty one patients were supported by mechanical ventilation, and the duration of mechanical ventilation was 5.92+/-4.52 days. On multivariate logistic regression analysis, four variables were found to be associated with the prognosis: incubation period, Wood score, Time interval from initial symptom to mechanical ventilation, initial SAPS II. CONCLUSION: Four variables correlated well with the prognosis: Incubation period, Wood score, Time interval from initial symptom to mechanical ventilation, initial SAPS II score.
Adult ; Demography ; Diagnosis ; Dysarthria ; Dyspnea ; Dystonia ; Early Diagnosis ; Emergencies* ; Emergency Service, Hospital* ; Female ; Humans ; Incidence ; Jeollanam-do ; Logistic Models ; Male ; Neck ; Prognosis ; Respiration, Artificial ; Retrospective Studies ; Tetanus* ; Wood

PURPOSE: Paraquat is a chemical which causes death in 30~80% of patients even after ingestion of small quantities. In spite of much studies, there are no successful treatment modalities or predictive parameters for determining the prognosis of the poisoning. The aims of this study were to evaluate plasma-paraquat concentration and initial laboratory and clinical data as prognostic parameters in patients with paraquat poisoning. METHODS: A retrospective analysis by chart review was done on 168 patients over three years who had ingested paraquat. The patients were divided into two subgroups based on survival and evaluated for ingested amounts of paraquat, the time between ingestion and treatment, urine dithionite test, and plasma paraquat concentration at the time of emergency department (ED) visit. Other clinical and laboratory factors such as age, sex, serum biochemical parameters, and severity index of paraquat poisoning (SIPP) were also analyzed. RESULTS: The plasma paraquat concentrations in the mortality group were higher than in the survival group (51.59+/-55.07 vs. 1.09+/-3.09 microgram/mL, p<0.001). The SIPP was higher in the mortality group as well (173.87+/-219.67 vs. 5.18+/-13.51 microgram/mL/hour). Among the laboratory data obtained in the ED, s-Potassium, s-Protein, arterial pH, PaCO2, bicarbonate, s-Albumin, s-Amylase, AST, BUN, s-Creatinine, and s-Glucose were significant factors which could affect the prognosis for paraquat poisoning. A Cox regression analysis revealed that plasma paraquat concentration, SIPP, s-Creatinine, s-Protein, s-Potassium and bicarbonate were associated with mortality. In addition, SIPP was more significantly correlated with mortality than plasma paraquat concentration (OR 1.362 vs. 1.011, p<0.001 vs. 0.019). CONCLUSION: Initial laboratory parameters including s-creatinine, s-protein, s-potassium, bicarbonate, plasma Paraquat concentration, and SIPP were significant prognostic factors. In addition, the author suggests that SIPP is a better index than plasma paraquat concentration for predicting the outcome of patients admitted for ingestion of paraquat.
Dithionite ; Eating ; Emergencies ; Humans ; Hydrogen-Ion Concentration ; Paraquat ; Plasma ; Prognosis ; Retrospective Studies ; Severity of Illness Index

PURPOSE: There have been few studies concerned with the hiccup patients who visit the emergency department. The purpose of this study is to investigate the epidemiology and clinical characteristics of hiccup patients. METHODS: We retrospectively reviewed 60 hiccup patients who visited the emergency departments of Chungbuk National University Hospitals, Chungnam National University Hospital and Chonnam National University Hospital in Korea from January 2005 to December 2007. We categorized the patients into 2 groups of the discharged and the admitted and also into groups of patients who had different types of treatments. We compared clinical outcomes and characteristics of the groups. RESULTS: A total of 60 cases of hiccup patients visited the emergency department from January 2005 to December 2007. There was a significant difference in the recovery rate from hiccups between the discharged group and the admission group (72.4% & 100.0%, p=0.04). The 3 major drugs used for treatment were metoclopramide, chlorpromazine, and benzodiazepine. The patients showed a broad spectrum for the final diagnosis, from the benign hiccups to ischemic stroke in the pons area. CONCLUSION: In this study, the hiccup patients who visited the ED showed simple temporal signs to various severe diseases such as the ischemic stroke in the pons. These findings can be useful reference for the decision making at admission or discharge and for predicting the prognosis of the hiccup patients who visit the emergency department.
Benzodiazepines ; Chlorpromazine ; Decision Making ; Emergencies ; Hiccup ; Hospitals, University ; Humans ; Korea ; Metoclopramide ; Pons ; Prognosis ; Retrospective Studies ; Stroke

Synovial sarcomas is a mesenchymal tumor that usually occurs in the extremities. Fewer than 100 cases of synovial sarcoma have been reported in the head and neck lesion. We experienced 2 cases of synovial sarcoma of neck, and so reported with a review of literature.
Extremities ; Head ; Neck* ; Sarcoma, Synovial*

Damages on the recurrent laryngeal nerve (RLN) during thyroid surgery is the most common iatrogenic cause of vocal cord paralysis. Identification of the recurrent laryngeal nerve and meticulous surgical techniques can significantly decrease the incidence of this complication. The nonrecurrent inferior laryngeal nerve is an exceedingly rare anomaly of the recurrent laryngeal nerve. The nonrecurrent inferior laryngeal nerve is associated with abnormal development of the aortic arch, where the innominate (brachiorephalic) artery is not found and the right common carotid artery rises directly from the aortic arch. The aberrant right subclavian artery can always be felt against the vertebral column behind the esophagus. Surgeons need to be aware of the positions of these arteries to avoid damaging them. We experienced a case of nonrecurrent inferior laryngeal nerve in the right side with the aberrant right subclavian artery. The patient received a total thyroidectomy with neck dissection for thyroid carcinoma with nodal metastasis. Incidentally, we also found nonrecurrent inferior laryngeal nerve, and also found an aberrant right subclavian artery by the computed tomography scan. The patient presented transient vocal cord paralysis but gained complete recovery of vocal cord mobility after one and a half month later.
Aorta, Thoracic ; Arteries ; Carotid Artery, Common ; Esophagus ; Humans ; Incidence ; Neck Dissection ; Neoplasm Metastasis ; Recurrent Laryngeal Nerve* ; Spine ; Subclavian Artery ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy ; Vocal Cord Paralysis ; Vocal Cords

BACKGROUND AND OBJECTIVES: Previous studies have shown that uptake of 18Fluoro-2-deoxy-glucose in head and neck cancer, as determined by the standardized uptake value (SUV) on positron emission tomography scan (PET scan), is associated with the biology of tumor. The aims of this study were to confirm the association with the biology of tumor and to establish whether a high SUV had prognostic significance. MATERIALS AND METHOD: Thirty patients with the head and neck cancer diagnosed as squamous cell carcinoma underwent a PET scan before treatment. SUVs were analyzed for possibility correlated with diseasefree survival. RESULTS: In univariate survival analysis, when patients were divided into two groups based on the SUV cut-off value of 8, the group whose SUV was greater than 8 in the pre-treatment PET scan showed significantly worse outcome (p=0.029). Correlation analysis demonstrated that SUV provided prognostic information independent of the tumor size, pathologic differentiation and stage. CONCLUSION: We conclude that high FDG uptake on PET (SUV >8 in pre-treatment PET scan) is an important prognostic indicator for poor outcome. Identified patients are thought to require intensive treatment protocol and more careful follow up.
Biology ; Carcinoma, Squamous Cell ; Head and Neck Neoplasms* ; Head* ; Humans ; Positron-Emission Tomography*

PURPOSE: Pralidoxime(2-PAM) is the mainstay of organophosphate intoxication management as an antidote. We investigated the usefulness of high-dose pralidoxime therapy. METHODS: From January 2000 to July 2003, 86 patients presented with organophosphate insecticide intoxication to the emergency medical center of Chonnam National University Hospital. They were randomized into two groups: Group I was given continuous IV infusion of pralidoxime in dose of 500 mg/hr after an initial bolus dose of 2 g and Group II was given continuous IV infusion of pralidoxime in dose of 1000 mg/hr after an initial bolus dose of 2 g. Both groups were given same therapeutic interventions, including the duration of atropine administration. The plasma cholinesterase activites were monitored at admission and at 24 hr and 48 hr after infusion of pralidoxime. The effectiveness of the two treatment modalities were gauged by comparing the durations of mechanical ventilation and intensive care unit (ICU) stay. RESULTS: The mean durations of mechanical ventilation were 9.82+/-6.45 days in group I and 6.51+/-4.50 days in group II. The mean durations of ICU stay were 12.82+/- 7.69 days in group I and 9.15+/-5.38 days in group II. group I showed that longer durations of mechanical ventilation (p=0.03) and ICU stay( p<0.001). The plasma cholinesterase reactivation rate were higher in group II than in group I. CONCLUSION: The results suggest that continuous high-dose pralidoxime therapy may be helpful in the treatment of organophosphate intoxication.
Atropine ; Cholinesterases ; Emergencies ; Humans ; Intensive Care Units ; Jeollanam-do ; Plasma ; Respiration, Artificial

OBJECTIVES: This study aims to confirm the reliability and validity of the GMS-AGECAT(Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy in a Korean elderly population. METHODS: Translation committee developed Korean version GMS translating GMS-A3 after preliminary studies. Few changes from the original English version were necessary. A random sample(N= 1256 of the elderly(65+ years in Asan, community was assessed for diagnostic validity. A two-phase study was designed: Korean version of GMS-AGECAT, MMSE and GDS rated by lay interviewer and clinical assessment by psychiatrists according to DSM-IV. A consecutive hospital sample(N=28 of the elderly(65+ years admitted in Hangang Sacred Heart Hospital was assessed for reliability, concurrent & procedural validity. RESULTS: Reliability coefficients of GMS-AGECAT diagnosis were Inter-rater kappa 0.78 and test-retest kappa 0.56. Correlation coefficients for concurrent validity were 0.76 with MMSE and 0.73 with GDS. Procedural validity of psychiatrist's GMS-AGECAT diagnosis and lay-interviewers' were as follow: case/ no case distinction sensitivity 95.5%, specificity 75%; organicity distinction sensitivity 100%, specificity 83.3% and depression distinction, sensitivity 92.3%, specificity 100%. Diagnostic validity of DSM-IV diagnoses and GMS-AGECAT diagnoses were: case/ no case distinction sensitivity 92.7%, specificity 81%, dementia distinction sensitivity 77.3%, specificity 92.1% and depression distinction sensitivity 83.6%, specificity 84.1%. CONCLUSIONS: This study confirms the reliability and validity of the GMS-AGECAT in Korean elderly. Korean version GMS can be used in the international comparison studies.
Aged ; Chungcheongnam-do ; Classification ; Dementia ; Depression ; Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Heart ; Humans ; Psychiatry ; Reproducibility of Results* ; Sensitivity and Specificity ; Translating

Hydrogen sulfide is a by-product of decayed organic material and is ubiquitously found as an ingredient of manufacturing reagents or as an undesirable by-product of the manufacturing or industrial processing. Hydrogen sulfide is a chemical asphyxiant and interferes with cytochrome oxidase and aerobic metabolism. It has thus been deemed an important cause of work-related sudden death. This gas is particularly insidious due to the unpredictability of its presence and concentration and its neurotoxicity at relatively low concentrations, causing olfactory nerve paralysis and loss of the warning odor. Here, we report two cases of comatose patients presenting after accidental exposure to hydrogen sulfide gas.
Coma ; Death, Sudden ; Electron Transport Complex IV ; Humans ; Hydrogen ; Hydrogen Sulfide ; Indicators and Reagents ; Occupations ; Odors ; Olfactory Nerve ; Paralysis ; Prognosis

PURPOSE: Vibrio vulnificus, one of the most invasive and rapidly fatal human pathogens known is a free-living inhabitant of estuarine and marine environments throughout the world. Vibrio septicemia usually present with a sudden onset of fever, chills, vomiting, diarrhea, abdominal pain, pain in the extremities, and cutaneous lesions. There are many microbiologic studies of V. vulnificus, but few clinical and prognostic studies are reported. We performed a study in 81 clinically suspected V. vulnificus cases to analyze the clinical characteristics of and the prognosis for V. vulnificus septicemia. METHODS: The study included 81 clinically suspected cases V. vulnificus septicemia at the emergency department from 1997 to 2003. We retrospectively analyzed the clinical features and the laboratory data, and measured the simplified acute physiologic score (SAPS II). RESULTS: The overall fatality was 39.5%. The monthly incidence was high in July and August. Almost all cases were primary septicemia (92.6%). Many patients had underlying disease; such as liver disease (66.6%), and diabetes mellitus (18.5%). Alcohol drinking habits were observed in 61.7% of the cases. There were significant difference between non-survivors and survivors in the extent of skin manifestations, respiration rate, leukocyte count, platelet count, albumin, PT, PTT, creatinine, pH, HCO(3-), and SAPS II. CONCLUSION: The platelet count, PT, PTT, creatinine, pH, H CO3-, the leukocyte count, albumin, SAPS II, and the extent of skin manifestations can be used as severity indicators in V. vulnificus septicemia. Especially, the SAPS II on hospital day 2 and the extent of skin manifestations can be used as prognostic factors.
Abdominal Pain ; Alcohol Drinking ; Chills ; Creatinine ; Diabetes Mellitus ; Diarrhea ; Emergency Service, Hospital ; Extremities ; Fever ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Leukocyte Count ; Liver Diseases ; Platelet Count ; Prognosis* ; Respiratory Rate ; Retrospective Studies ; Sepsis* ; Skin Manifestations ; Survivors ; Vibrio vulnificus* ; Vibrio* ; Vomiting