BACKGROUND: This study aimed to investigate bradycardia as an adverse effect after administration of dexmedetomidine during 33degrees C target temperature management. METHODS: A retrospective study was conducted on patients who underwent 33degrees C target temperature management in the emergency department during a 49-month study period. We collected data including age, sex, weight, diagnosis, bradycardia occurrence, target temperature management duration, sedative drug, and several clinical and laboratory results. We conducted logistic regression for an analysis of factors associated with bradycardia. RESULTS: A total of 68 patients were selected. Among them, 39 (57.4%) showed bradycardia, and 56 (82.4%) were treated with dexmedetomidine. The odds ratio for bradycardia in the carbon monoxide poisoning group compared to the cardiac arrest group and in patients with higher body weight were 7.448 (95% confidence interval [CI] 1.834-30.244, p = 0.005) and 1.058 (95% CI 1.002-1.123, p = 0.044), respectively. In the bradycardia with dexmedetomidine group, the infusion rate of dexmedetomidine was 0.41 +/- 0.15 microg/kg/h. Decisions of charged doctor's were 1) slowing infusion rate and 2) stopping infusion or administering atropine for bradycardia. No cases required cardiac pacing or worsened to asystole. CONCLUSIONS: Despite the frequent occurrence of bradycardia after administration of dexmedetomidine during 33degrees C target temperature management, bradycardia was completely recovered after reducing infusion rate or stopping infusion. However, reducing the infusion rate of dexmedetomidine lower than the standard maintenance dose could be necessary to prevent bradycardia from developing in patients with higher body weight or carbon monoxide poisoning during 33degrees C targeted temperature management.
Atropine ; Body Weight ; Bradycardia* ; Carbon Monoxide Poisoning ; Dexmedetomidine* ; Diagnosis ; Emergency Service, Hospital ; Heart Arrest ; Humans ; Hypothermia, Induced ; Logistic Models ; Odds Ratio ; Retrospective Studies

No abstract available.
Chylothorax* ; Lymphangiectasis*

OBJECTIVES: The aims of this study were to know the prevalence of cognitive disorders in patients with thyroid cancer, and identify related variables to them. METHODS: Subjects were consisted of fourty-two patients with thyroid cancer, who were admitted for radioiodine ablative therapy at 6-12 months after total thyroidectomy. The data were obtained from interviews about history and assessments of depression and cognitive function(Korean Version of the Montreal Cognitive Assessment, MoCA-K). RESULTS: 1) Among subjects, those with below 22 of total score of the MoCA-K were twenty-one(50.0%). 2) Upon age, education, Pre-radioiodine therapy thyroid stimulating hormone(TSH), there were statistically significant difference between subgroup with above 23 of the total MoCA-K score and those below 22. 3) The total scores of the MoCA-K in subjects had significant correlation with age, education, comorbidity, Pre-radioiodine therapy TSH, total score of the HDRS-17. CONCLUSIONS: Cognitive disorders were more prevalent among patients with thyroid cancer before radioiodine therapy. Therefore, further study should be needed to clarify the mechanism for the cognitive disorders in thyroid cancer. Furthermore, physicians should pay attention to the cognitive function and prepare preventative measures for cognitive disorder during management of thyroid cancer.
Carcinoma, Papillary* ; Comorbidity ; Depression ; Education ; Humans ; Prevalence ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroidectomy ; Thyrotropin

Wernicke encephalopathy is usually accompanied with peripheral neuropathy, known as dry beriberi. In contrast, wet beriberi presenting as cardiovascular symptoms rarely occurs. The acute type of wet beriberi can be fatal, if untreated quickly. It is reported that the cerebellar vermis has a role of the coordination and control of cardiovascular and autonomic reflex activities. We report a 58-year-old man showing acute wet beriberi in Wernicke encephalopathy with cerebellar vermis lesion.
Beriberi* ; Cerebellar Vermis ; Humans ; Middle Aged ; Peripheral Nervous System Diseases ; Reflex ; Wernicke Encephalopathy*

BACKGROUND AND OBJECTIVES: Ventricular assist device(VAD) was developed for the bridge to cardiac transplantation, but the current research trends proceed to the purpose of bridge to cardiac recovery. We investigated the effects of long-term VAD implantation on the hemodynamic parameters related to the prognosis of heart failure by simulation to provide the preclinical and clinical applicability. MATERIAL AND METHODS: A moving-actuator type artificial heart developed by Seoul National University Artificial Heart Laboratory was used as a model of biventricular assist device. We set initial values of hemodynamic parameters according to the guideline of VAD implantation, and performed simulation of the change of hemodynamic variables related to successful device weaning and the prognosis of heart failure. RESULTS: Cardiac indices (CIs) at 1 hour and 6 months after VAD implantation were 2.98 l/min/m2 and 2.60 l/min/m2, respectively. Systolic/diastolic/mean aorta pressure were 121/84/99 mmHg at 6 months after VAD implantation. During pump-off state at 6 month, each value of hemodynamic parameters were as follows: CI 2.53 l/min/m2, pulmonary capillary wedge pressure 10 mmHg, left ventricular end-diastolic volume 105 ml, left ventricular ejection fraction 0.58, mean aorta pressure 84 mmHg, end-systolic wall stress 108 kdyn/cm2. Peak rate of change of power(peak dPWR(t)/dt) was 5.62x108 dyneXcm/s2 after 6-month VAD implantation. In a real VAD-implanted patient, simulation data were partly compatible with real hemodynamic data, especially in the aspects of predicting VAD weaning. CONCLUSION:Long-term VAD implantation partially improved the values of hemodynamic parameters related to the prognosis, and this simulation results will provide the basic concept and applicability of clinical trial for end-stage heart failure.
Aorta ; Heart Failure* ; Heart Transplantation ; Heart* ; Heart, Artificial ; Heart-Assist Devices ; Hemodynamics* ; Humans ; Prognosis ; Pulmonary Wedge Pressure ; Seoul ; Stroke Volume ; Weaning

It is very useful to evaluate the content and 3D distribution of extracellular matrix non-destructively in tissue engineering. This study evaluated the feasibility of using micro-computed tomography (µCT) with Hexabrix to measure quantitatively sulfated glycosaminoglycans (GAGs) of engineered cartilage. Rabbit chondrocytes at passage 2 were used to produce artificial cartilages in polyglycolic acid scaffolds in vitro. Engineered cartilages were incubated with Hexabrix 320 for 20 min and analyzed via µCT scanning. The number of voxels in the 2D and 3D scanning images were counted to estimate the amount of sulfated GAGs. The optimal threshold value for quantification was determined by regression analysis. The 2D µCT images of an engineered cartilage showed positive correlation with the histological image of Safranin-O staining. Quantitative data obtained with the 3D µCT images of 14 engineered cartilages showed strong correlation with sulfated GAGs contents obtained by biochemical analysis (R² = 0.883, p < 0.001). Repeated exposure of engineered cartilages to Hexabrix 320 and µCT scanning did not significantly affect cell viability, total DNA content, or the total content of sulfated GAGs. We conclude that µCT imaging using Hexabrix 320 provides high spatial resolution and sensitivity to assess the content and 3D distribution of sulfated GAGs in engineered cartilages. It is expected to be a valuable tool to evaluate the quality of engineered cartilage for commercial development in the future.
Cartilage* ; Cell Survival ; Chondrocytes ; DNA ; Extracellular Matrix ; Glycosaminoglycans* ; In Vitro Techniques ; Ioxaglic Acid ; Polyglycolic Acid ; Tissue Engineering

Cerebellar ataxia with neuropathy and vestibular areflexia syndrome (CANVAS) is a slowing progressive ataxic disorder characterized by bilateral vestibulopathy, cerebellar ataxia and somatosensory impairment. Autonomic dysfunction is recently considered as a core feature in CANVAS in addition to these symptoms. In most cases, patients with CANVAS show cerebellar atrophy in brain imaging, but some cases show minimal or no atrophy of cerebellum. Brain (18F)-fluoro-2-deoxy-D-glucose positron emission tomography (¹⁸F-FDG PET) study can be a complimentary tool to diagnosis CANVAS in cases of no structural abnormality such as cerebellar atrophy. Hereby, we present a case of CANVAS with minimal atrophy of cerebellum but showing a prominent hypometabolism in cerebellum, thalamus and posterior cingulate cortex in ¹⁸F-FDG PET.
Atrophy ; Brain ; Cerebellar Ataxia ; Cerebellum ; Diagnosis ; Gyrus Cinguli ; Humans ; Neuroimaging ; Positron-Emission Tomography ; Primary Dysautonomias ; Thalamus ; Vestibular Neuronitis

Focal subarachnoid hemorrhage occasionally presents as transient focal neurologic episodes mimicking transient ischemic attack (TIA). Unless properly diagnosed, it may aggravate cerebral hemorrhage by administering antithrombotic agents. Therefore, clinicians need to be aware that such focal subarachnoid hemorrhage sometimes cannot be detected on noncontrast computed tomography and blood-sensitive magnetic resonance imaging can detect even a small amount of hemorrhage. We describe an 85-year-old woman with focal subarachnoid hemorrhage and possible cerebral amyloid angiopathy who presented transient left arm weakness recurrently, which mimicked TIA.
Aged, 80 and over ; Arm ; Cerebral Amyloid Angiopathy ; Cerebral Hemorrhage ; Female ; Fibrinolytic Agents ; Hemorrhage ; Humans ; Ischemic Attack, Transient ; Magnetic Resonance Imaging ; Subarachnoid Hemorrhage

BACKGROUND: Such screening tools for alcoholism as MAST, NAST, CAGE focused on the alcohol-related psyhosocial problems. But some men can be exduded in a study using these tools whereas they might be at risk for alcohol related physical problems. From this perspective the new tools focusing under quantity and frequency of intake for detection of early-stage drinkers not yet manifesting evident psychosocial problems but having alcohol- related potential harms, are being developed. With focus on these aspects, 10 itemed AUDIT was developed by WHO and this study was developed to provide standard points for screening alcohol problems in Korea with cultural difference through AUDIT. METHOD: The subjects were 85 drinking men and 11 male alcohol dependents who visited Kangmung hospital af Asan foundation from July until August 1998. The team composed of 2 family physicians and 1 psychiatrist, who delivered structured interviews based on DSM-IV criteria in terms of psychosocial problems, and examined them and reviewed the patient records in terms of alcohol-related physical problems. Accordingly the subjects were classified into 'normal', 'physical problems-related drinkers' without psychosocial problems, and 'alcohol abuser' and 'alcohol dependent' according to DSM-IV criteria. Aside from physicians diagnostic procedures, they were again made to complete a questionnaire induding all the items of AUDIT, MAST, NAST and CAGE. RESULTS: As regards physicians' diagnostic results, 31 were normal, 8 had physical problems without psychosocial problems, 36 abused alcohol, and 21 were alcohol-dependent. The mean AUD1T scores of all the sub were 17.5(+/-9.5) and the mean AUDIT scores of each group were 7.1(+/-4.3), 16.6(+/-3.4), 19.9(+/-5.0), 29.3(+/-5.1), respectively and revealed significant difference among them AUDlT scores were significantly correlated with those marked from physicians' diagnostic results and also significantly correlated with MAST, NAST and CAGE, respectively. After consideration of mean AUDIT scores and standard deviations of each group according to diagnostic results, the preliminary standard AUDIT scores for detection of a broader sense of 'problem drinker' including physical as well as psychosocial problems were most possibly 12, 13, 14 points. Their sensitivity and specificity were 96.9% and 87.1% in 12 points, 92.3% and 90.8% and 90.3% in 14 points, respectively. The preliminary standard AUDIT scores concerning alcohol use disorders hased on DSM IV criteria were most possibly 14, 15, 16 with its sensitivity and specificity of 91.2% and 74.4% in 14 points, 89.5% and 79.5% in 15 points, and 84.2% and 84.6% in 16 points. The preliminary standard AUDIT scores for 'alcohol dependence' were most possibly 25, 26, 27 with its sensitivity and specificity of 85.7% and 90.7% in 25 points, 85.7% and 93.3 in 26 points, and 71.4% and 94.7% in 27 points. CONCLUSIONS: The authors recommend AUDIT cut-off scores of 12 points as the standard value for a broader sense of problem drinking including physical as well as psychasocial problems, 15 for 'alcohol use disorders' based on DSM IV criteria, and 26 for 'alcohol dependence' in Korea.
Alcoholism* ; Chungcheongnam-do ; Diagnostic and Statistical Manual of Mental Disorders ; Drinking ; Humans ; Korea* ; Male ; Mass Screening* ; Physicians, Family ; Psychiatry ; Sensitivity and Specificity ; Surveys and Questionnaires

BACKGROUND AND OBJECTIVES: Congenital nystagmus (CN) is an ocular oscillation that usually manifests during early infancy. To report a novel mutation in FERM domain containing 7 (FRMD7) gene in a Korean family with CN. MATERIALS AND METHODS:Genomic DNA was prepared from peripheral blood leukocytes and direct sequencing of the entire coding and adjacent intronic regions was performed to detect sequence variation of FRMD7 gene, where mutations were found recently in patients with familial CN. The family showed an X-linked pattern of inheritance without father-to-son transmission. RESULTS: Three family members with CN exhibited two sequence variations which were a novel mutation (c. 875T>C; Leu292Pro) and a polymorphism (c. 1403G>A; Arg468His, dbSNP rs#6637934). The proband was hemizygous for both variations and his mother and maternal grandmother were heterozygous carriers. CONCLUSION: This study provides an additional evidence for mutations in FRMD7 as a common cause of X-linked CN and expands its mutation spectrum.
Clinical Coding ; DNA ; Humans ; Introns ; Leukocytes ; Mothers ; Nystagmus, Congenital* ; Wills