OBJECTIVES: Hemodynamic measurements of chronic portal hypertension were done to study the mechanisms that maintain high portal pressure despite well developed collateral circulations. METHODS: A prehepatic portal hypertensive rat model was produced by partial portal vein ligation. Cardiac output, organ blood flow and porto-systemic shunt were measured by radioisotope labeled microsphere methods, and vascular resistance was calculated by standard equation. RESULTS: There was a significant reduction in the weight of the liver and increase in the weight of the spleen in the portal stenotic rats. Porto-systemic shunting, representing development of the collateral circulations, was 96.7+/-0.6% in the portal stenosis group compared with 0.9+/-0.2% in the control group (p<0.01). Portal pressure was significantly increased in the portal stenosis group compared with the control group(12.8+/-1.4 vs. 6.5+/-0.6mmHg; p<0.01). Mean arterial pressure was significantly decreased in portal stenosis group compared with control group(101.4+/-2.5 vs, 129.9+/-3.9mmHg; p<0.01). In the portal stenosis group, cardiac output(135.7+/-8.0 vs. 111.0+/-4.2ml/min; p<0.01) and splanchnic organ blood flow (28.97+/-2.03 vs. 17.90+/-1.27ml/min, p<0.01) were significantly increased, with concomitant decrease in total peripheral vascular resistance(58.0+/-3.3 vs. 88.2+/-4.8 dyne sec/cm5 X 105; p<0.01) and splanchnic vascular resistance(2.54+/-0.20 vs. 5.47+/-0.33 dyne sec/cm5 X 105; p<0.01), However, the portal venous resistance was not significantly different in both groups of rats (3.57+/-0.31 vs. 3.03+/-0.38 dyne sec/cm5 X 105; p>0.05). CONCLUSION: The hemodynamic results of this study indicate that hyperdynamic status of systemic and splanchnic circulation was present in chronic portal hypertension and that the primary factor contributing to the persistently elevated portal venous pressure was the markedly increased portal venous inflow.
Animals ; Arterial Pressure ; Cardiac Output ; Collateral Circulation ; Constriction, Pathologic ; Hemodynamics* ; Hypertension, Portal ; Ligation ; Liver ; Microspheres ; Models, Animal* ; Portal Pressure ; Portal Vein* ; Rats* ; Splanchnic Circulation ; Spleen ; Vascular Resistance

From January 1988 to December 1994, endoscopic sphincterotomy with stone extraction was attempted in 395 patients with common duct stones at Yeungnam University Hospital. Endoscopic sphincterotomy was successful in 389 patients(98.5 %), and clearance of the duct was achieved in 364 patients with an overall success rate of 92.2%. After sphincterotomy, stone extraction by basket or balloon was undertaken in 298 patients without lithotripsy, and stones could be extracted after fragmentation of stones in 19 patients. In 47 patients, stones were passed into duo denum spontaneously. There were 6 cases of sphincterotomy failure due to large periampullary diverticulum or previous gastrojejunostomy. In patients with success ful sphincterotomy, endoscopic stone extraction was failed in 25 cases due to 14 large stones, 5 bile duct strictures, 4 impacted stones, and 2 cases of technical fail ure. Complications were developed in 13 patients(3.3%); 8 pancreatitis and 5 bleedings. All of them were improved with medical therapy only. Despite relatively high success rate and low complications of the endoscopic management of choledocholithiasis, there were significant difficulties in removing large stones. Developement of more effective and inexpensive methods of lithotripsy, and the search for rapidly effective solvent dissolving stones were needed.
Bile Ducts* ; Bile* ; Cholangiopancreatography, Endoscopic Retrograde ; Choledocholithiasis ; Constriction, Pathologic ; Diverticulum ; Gastric Bypass ; Humans ; Lithotripsy ; Pancreatitis ; Sphincterotomy, Endoscopic

PURPOSE: This study was performed to determine the usefulness of blood culture in the management of febrile immunocompetent patients presenting emergency department. METHODS: We prospectively analysed the medical characteristic and the result of blood culture of febrile immunocompetent patients who presented to Chonnam National University Hospital emergency center form April 2005 to October 2005. RESULTS: The study included 182 patients. The characteristic associated with the positive result of blood culture on multivariate analysis was the low initial level of albumin. Of the 182 culture, only 26 were true positive(14.3%). Of them, the result of blood culture influenced management in five patients (2.7%). CONCLUSION: The blood cultures has usually been ordered in febrile immunocompetent patients at emergency department has the limited usefulness. The emergency physician who initially treats them has to consider this limitation of it.
Emergencies* ; Emergency Service, Hospital* ; Fever ; Humans ; Jeollanam-do ; Multivariate Analysis ; Prospective Studies

N-acetylcysteine (NAC) is widely recognized as the antidote of choice for acetaminophen overdose. Acetaminophen is a commonly used analgesic and antipyretic agent, and its use is one of the most common causes of poisoning worldwide. Acetaminophen toxicity may occur acutely when supratherapeutic amounts are ingested purposefully or unintentionally. Liver failure may occur in severe toxicity. However, if treated early, patients with acetaminophen poisoning generally recover uneventfully. Acetaminophen is metabolized to N-acetyl-p-benzoquinone imine (NAPQI), which is detoxified by conjugation with glutathione. In overdose, hepatic stores of glutathione are depleted and NAPQI binding to hepatocytes induces cell death and hepatic necrosis. NAC replenishes hepatic glutathione and may also act as a glutathione substitute, combining directly with the toxic metabolite. Intravenous NAC is indicated in patients who present with a history of acetaminophen overdose within the previous 8 to 10 hours, patients unable to tolerate oral NAC, and patients who present with evidence of fulminant hepatic failure. However, caution should be used in patients who have experienced previous hypersensitivity or anaphylactoid reactions to intravenous NAC, as well as in patients with asthma. The most common anaphylactoid reactions include rash, flushing, and bronchospasm. Adults should receive 150 mg/kg administered for 45 minutes, followed by 50 mg/kg administered for 4 hours, followed by 100 mg/kg administered for 16 hours. The total dose is 300 mg/kg delivered over 21 hours. Additionally, caution should always be used when intravenous NAC is prescribed and the amount of diluent is calculated. Monitoring of patients with a should include repeated neurologic and hemodynamic assessment.
Acetaminophen* ; Acetylcysteine* ; Adult ; Antidotes ; Asthma ; Benzoquinones ; Bronchial Spasm ; Cell Death ; Exanthema ; Flushing ; Glutathione ; Hemodynamics ; Hepatocytes ; Humans ; Hypersensitivity ; Imines ; Liver Failure ; Liver Failure, Acute ; Necrosis ; Poisoning*

Fentanyl is a selective and pure agonist to the micron receptor and is about 100 times more potent than morphine. It has been used through intravenously to control acute pain, such as postopreative pain, for a long time. A transdermal fentanyl system, a fentanyl patch, composed of four layers of functional reserviors of fentanyl and one protective layer, delivers a constant amount of fentanyl to systemic circulation thorough passive diffusion for up to 3 days after application on the skin. Due to its pharmacokinetic properties, including delayed onset, relatively constant effect for 3 days, and to the relatively short duration and variable change of acute pain, we recommend that the transdermal fentanyl system should be used to control chronic pain in patients who do not response to lower analgesic agents. However, because of misperception of health care providers, its noninvasive and simple method of administration, and the absence of laws to regulate its usage, abuses of the transdermal fentanyl system have been reported a lot. In conclusion, we reported the cases of two patient who experienced fatal effects after abuse of fentanyl patch, we analyse the pharmacokinetic properties of the fentanyl patch and previous reported cases. We also discuss the appropriate use and regulation of the transdermal fentanyl system by primary health care provider.
Acute Pain ; Analgesics ; Chronic Pain ; Diffusion ; Fentanyl* ; Health Personnel ; Humans ; Jurisprudence ; Morphine ; Primary Health Care ; Respiratory Insufficiency ; Skin

Sodium hypochlorite is commonly used as a household bleaching agent (for example, the Clorox brand). Sodium hypochlorite poisoning with ingestion of a bleaching agent is often observed in clinical practice.Current Concepts: Ingestion (intentional or accidental) is the most common route of exposure to household bleaching agents. Accidental ingestion of household bleaching agents is rarely clinically important. However, ingestion of a large amount of a dilute formulation or a high-concentration preparation of bleaching agents can result in severe and rarely fatal corrosive injury. Therefore, prompt supportive care is essential because a specific antidote is currently unavailable. Severe poisoning requires hospital admission. Emergency endoscopy and thoracic and abdominal computed tomography are warranted to aid with diagnosis and management of hypochlorite-induced corrosive injury in patients with severe poisoning, who develop clinical features suggestive of corrosive injury.Discussion and Conclusion: Intentional poisoning, which accounts for most cases of household bleaching agent poisonings in Korea, is likely to cause severe corrosive injuries. Therefore, it is necessary to gain deeper and accurate understanding of the clinical aspects and treatment of poisoning by household bleaching agents.

BACKGROUND/AIMS: Acute suppurative cholangitis is associated with significant mortality. It is best managed by drainage of biliary tree such as endoscopic, percutaneous or surgical, We evaluated the role of emergency endoscopic nasobiliary drainage(ENBD) in the acute suppurative cholangitis. METHODS: For 55 patients with acute calculous cholangitis, who did not respond to conservative management and the stone could not be removed from bile duct by endoscopic papillotomy due to poor condition or bleeding tendency, ENBD tube(7.5Fr) was inserted at proximal side of obstruction. ENBD was done at 39.4 hours (mean) after arrival to hospital. RESULTS: ENBD was successful in all patients (100%). All patients responded with striking improvement of the abdominal pain, fever and stabilized vital signs within 3 days. After patients conditions were stabilized clinically, common bile duct stones were removed successfully by endoscopic sphincterotomy or surgery. No patients died of acute suppurative cholangitis. CONCLUSION: These results show that ENBD is a simple, safe, and effective measure for the initial control of acute suppurative cholangitis due to cholelithiasis.
Abdominal Pain ; Bile Ducts ; Biliary Tract ; Cholangitis* ; Cholelithiasis ; Common Bile Duct ; Drainage* ; Emergencies* ; Fever ; Hemorrhage ; Humans ; Mortality ; Sphincterotomy, Endoscopic ; Strikes, Employee ; Vital Signs

PURPOSE: Seizures can be detrimental to recovering brain in patients that are resuscitated after cardiac arrest. Early diagnosis and appropriate treatment of seizures may be important to improve prognosis. Therefore, we tried to determine factors that predict seizures and their characteristics in patients after cardiopulmonary resuscitation (CPR). METHODS: Sixty eight patients who were over 18 years of age and who presented at Chonnam National University hospital in a post-resuscitative state after cardiac arrest between April 2007 and April 2010 were enrolled. These patients were divided into two groups according to the development of seizure during hospitalization. Baselines characteristics, information related to cardiac arrest and CPR, results of laboratory tests, the method of treatment, and the neurologic state at discharge were collected. RESULTS: Twenty six patients experienced a seizure during hospitalization and it progressed to status epilepticus in 16 of them. The results of initial laboratory tests, baseline characteristics, and time variables related to CPR were not associated with the development of seizure. Half of seizures, with or without progression to status epilepticus, developed within 12 hours after return of spontaneous circulation. There was no significant difference in the two groups according to progression to status epilepticus. CONCLUSION: There are no predictable variables for development of seizures and progression to status epilepticus in patients after cardiac arrest. However, seizure usually occurs within 12 hours after the return of spontaneous circulation. The physician should consider these characteristics of seizures when he decides to use EEG monitoring to patients in a post-resuscitative state.
Brain ; Cardiopulmonary Resuscitation ; Early Diagnosis ; Electroencephalography ; Heart Arrest ; Hospitalization ; Humans ; Prognosis ; Seizures ; Status Epilepticus

PURPOSE: Many studies have examined the mechanisms of impaired glucose homeostasis after organophosphate (OP) exposure, however no study has evaluated the clinical utility of blood glucose measurements in patients with OP poisoning. The current study was conducted to evaluate the initial glucose level at presentation and the glycemic variables during the first 3 days after admission as a predictor of mortality. METHODS: This retrospective observational case series included 228 patients with a history of OP poisoning. Among other clinical data, information on the initial glucose level at presentation and mean glucose level, delta glucose level, and the presence of a hypoglycemic event during the first 3 days of admission, was collected. RESULTS: Survivors had lower initial glucose levels at presentation and glucose variability during the first 3 days of admission compared to non-survivors. The frequency of hypoglycemic events was higher in non-survivors. In multivariate analysis, the initial glucose level (> 233 mg/dl) was an independent predictor of mortality, along with age. CONCLUSION: The initial glucose level at presentation can be helpful in prediction of mortality in cases of OP intoxication at bedside. The physician should pay attention to patients with a glucose level >233 mg/dl at presentation after ingestion of OP.
Blood Glucose* ; Eating ; Glucose ; Homeostasis ; Humans ; Mortality ; Multivariate Analysis ; Organophosphates ; Poisoning* ; Retrospective Studies ; Survivors

PURPOSE: Paraquat (PQ) increases the level of toxic reactive oxygen species in humans. Various endogenous antioxidant mechanisms against PQ exist in humans. The aim of the present study was to assess lipid peroxidation and antioxidative defenses of humans exposed to acute PQ poisoning over time. METHODS: The medical records of patients who presented to the emergency department (ED) within 6 hours after PQ poisoning were reviewed. Patients were classified into three groups based on the severity index of paraquat poisoning (SIPP) using the serum level of PQ and time interval from exposure to ED arrival. The serum level of malondialdehyde (MDA) and the activities of antioxidative enzymes were compared between groups at baseline, 12 hours, 24 hours and 48 hours after presentation. RESULTS: The mean age of enrolled patients was 51.0+/-15.9 years and they ingested 143.3+/-144.4 ml of 24.5% liquid PQ accidently or as an attempted suicide. The baseline MDA level, and the activities of superoxide dismutase (SOD) and glutathione peroxidase (GPx) in the three groups were similar. In the SIPP >50 group, the serum MDA level and the SOD activity significantly increased from baseline, peaking at 24 hours. In the 10< or =SIPP< or =50 group, serum MDA level and SOD activity displayed a smooth and steady increase. In the SIPP <10 group, serum MDA level steadily decreased but SOD activity increased. GPx activity did not show any changes. CONCLUSION: PQ changes serum levels of MDA and SOD activity depending on the severity of PQ intoxication, but serum GPx activity does not significantly change.
Emergencies ; Glutathione Peroxidase ; Humans ; Lipid Peroxidation ; Malondialdehyde ; Medical Records ; Paraquat ; Reactive Oxygen Species ; Suicide, Attempted ; Superoxide Dismutase