As the elderly population continues to grow, the number of geriatric patients reported to poison centers continues to increase. Older poisoned patients are at an increased risk of death compared to younger adult patients. The purpose of this paper is to report a case of hydrofluoric acid poisoning along with a discussion of poisoning characteristics. A 79 year-old male with dementia visited emergency department presenting epigastic discomfort after ingestion of 50% hydrofluoric acid solution. At admission, he presented with a stable vital sign but progressed to pulseless electrical activity. In spite of advanced resuscitation efforts and administration of calcium gluconate, he rapidly detoriated and died 3 hours after the ingestion.
Adult ; Aged ; Calcium Gluconate ; Dementia ; Eating ; Emergencies ; Gluconates ; Humans ; Hydrofluoric Acid ; Male ; Resuscitation ; Vital Signs

Cyclooxygenase-2 (COX-2)-mediated prostaglandin E₂ (PGE₂) plays a key role in development and progression of inflammatory responses and Porphyromonas gingivalis is a common endodontic pathogen. In this study, we investigated induction of COX-2 and PGE₂ by P. gingivalis in human dental pulp cells (HDPCs). P. gingivalis increased expression of COX-2, but not that of COX-1. Increased levels of PGE₂ were released from P. gingivalis-infected HDPCs and this PGE₂ increase was blocked by celecoxib, a selective COX-2 inhibitor. P. gingivalis activated all three types of mitogen-activated protein kinases (MAPKs). P. gingivalis-induced activation of nuclear factor-κB (NF-κB) was demonstrated by the results of phosphorylation of NF-κ B p65 and degradation of inhibitor of κB-α (IκB-α). Pharmacological inhibition of each of the three types of MAPKs and NF-κB substantially attenuated P. gingivalis induced PGE2 production. These results suggest that P. gingivalis should promote endodontic inflammation by stimulating dental pulp cells to produce PGE₂.
Celecoxib ; Cyclooxygenase 2 ; Dental Pulp* ; Dinoprostone ; Humans* ; Mitogen-Activated Protein Kinases ; Phosphorylation ; Porphyromonas gingivalis* ; Porphyromonas* ; Pulpitis

We have previously shown that the specific phosphatidylinositol 3-kinase inhibitor LY294002 (LY29), and its inactive analog LY303511 (LY30), inhibit a monocyte chemoattractant protein-1 (MCP-1) expression in human umbilical vein endothelial cells; these results suggest the potential of LY30 as an anti-inflammatory drug. In this study, we determined the effects of LY30 on the production of various inflammatory cytokines in human macrophagic THP-1 cells which were stimulated with lipopolysaccharide (LPS). LY30 selectively suppressed the mRNA expression of IL-12 p40, TNF-α, and MCP-1 without affecting the expression of IL-1α, IL-6, and IL-8. Inhibition of the production of IL-12 and TNF-α by LY30 was also demonstrated using ELISA assays. In order to elucidate the mechanisms of the action of LY30, we examined the role played by the mitogen-activated protein kinases and the key transcription factors, AP-1 and NF-κB in LPS-stimulated THP-1 cells. The results revealed that LY30 inhibited LPS-induced activation of ERK, but not p38 or JNK. Furthermore, the AP-1 DNA binding activity was suppressed by LY30 based upon the dosage, whereas NF-κB DNA binding was not affected. These results suggest that LY30 selectively inhibits cytokine production in the LPS-stimulated macrophagic THP-1 cells by downregulating the activation of ERK and AP-1.
Chemokine CCL2 ; Cytokines ; DNA ; Enzyme-Linked Immunosorbent Assay ; Human Umbilical Vein Endothelial Cells ; Humans* ; Interleukin-12 ; Interleukin-6 ; Interleukin-8 ; Mitogen-Activated Protein Kinases ; Phosphatidylinositol 3-Kinase ; RNA, Messenger ; Transcription Factor AP-1 ; Transcription Factors

A 47-year-old woman ingested about 12 mg of colchicine with suicidal intent. Colchicine, a highly poisonous alkaloid, is a commonly used treatment for gout, Bechet's disease, and familial Mediterranean fever. Despite the knowledge of its side effects, the risk of a significant overdose is under-appreciated. She suffered from acute multisystem toxicity, including gastrointestinal disorders, bone marrow suppression, alopecia, and probable pancreatitis, but she ultimately recovered with supportive therapy. We report a case of acute colchicine toxicity from a single overdose with a review of the literature.
Alopecia ; Bone Marrow ; Colchicine ; Familial Mediterranean Fever ; Female ; Gastroenteritis ; Gout ; Humans ; Middle Aged ; Pancreatitis

PURPOSE: Treatment of ovarian metastasis from colorectal cancer has been controversial, and only limited data on ovarian metastasis have been reported. We reviewed the clinical features of patients with ovarian metastasis from a colorectal carcinoma. METHODS: From 1993 to 2002, 568 women were treated for colorectal cancer. Of those, 17 cases were diagnosed as ovarian metastasis. We reviewed the 17 cases retrospectively. RESULTS: The incidence of ovarian metastasis was 3.0% (17/568). The number of cases involving synchronous ovarian metastasis was 7 (1.2%). Those 7 patients also had another metastasis including ovarian metastasis. Ten cases (1.8%) involved metachronous ovarian metastasis. Of those 10 patients, 8 had ovarian metastasis in combination with other organ metastasis. The median disease-free interval from the diagnosis of the primary colorectal cancer to the diagnosis of ovarian metastasis was 9.8 months, and the median survival after the diagnosis of ovarian metastasis was 17.2 months. The median survival after the diagnosis of ovarian metastasis was 23.4 months in the ovarian- metastasis-only group, compared with 10.1 months in the group with ovarian and other metastasis. The difference in survival between the two groups was statistically significant. CONCLUSIONS: The incidence of ovarian metastasis from colorectal cancer was low. When such an event occurred, it was frequently associated with widespread disease and resulted in a poor prognosis. However, patients having only ovarian metastasis had a higher survival rate.
Colorectal Neoplasms ; Female ; Humans ; Incidence ; Neoplasm Metastasis ; Prognosis ; Retrospective Studies ; Survival Rate

Myxedema coma is the extreme form of untreated hypothyroidism. In reality, few patients present comatose with severe myxedema. We describe a patient with myxedema coma which was initially misdiagnosed as a brain stem infarct. She presented to the hospital with alteration of the mental status, generalized edema, hypothermia, hypoventilation, and hypotension. Initially her brain stem reflexes were absent. After respiratory and circulatory support, her neurologic status was not improved soon. The diagnosis of myxedema coma was often missed or delayed due to various clinical findings and concomitant medical condition and precipitating factors. It is more difficult to diagnose when a patient has no medical history of hypothyroidism. A high index of clinical suspicion can make a timely diagnosis and initiate appropriate treatment. We report this case to alert clinicians considering diagnosis of myxedema coma in patients with severe decompensated metabolic state including mental change.
Aged ; Brain Stem Infarctions/diagnosis/radiography ; Diagnosis, Differential ; Diagnostic Errors ; Echocardiography ; Female ; Humans ; Hypothyroidism/complications/drug therapy ; Myxedema/*diagnosis/etiology/radiography ; Republic of Korea ; Thyroxine/therapeutic use ; Tomography, X-Ray Computed

Neurofibromatosis type 1 (NF1) is an autosomal dominant hereditary disorder. The pathogenesis of NF1 is suggested to be an alteration of the NF-1 gene, which normally functions as a tumor suppressor. A mutation of NF-1 causes the development of viable tumors in various sites. On the other hand, the synchronous manifestation of a gastrointestinal stromal tumor (GIST) and neuroendocrine tumor (NET) in the background of NF1 is extremely rare. This paper reports three cases treated with surgical intervention along with the long-term follow-up results. Three patients showed synchronous ampullary NET and GIST in association with NF1 supported by postoperative histopathologic analysis. Surgical treatments, such as pancreatoduodenectomy and local excision were applied. No recurrence occurred during the postoperative follow-up period of 10, 9, and 2.7 years. Synchronous GIST and NET in the background of NF1 is extremely rare, but the possible coexistence of other tumors in NF1 patients is relatively higher than that in the general population. Furthermore, both NETs and GISTs occurring in NF1 patients tend to be smaller in size compared to that in the general population. Therefore, when NF1 patients present with vague abdominal discomfort, close attention must be paid to identifying the coexistence of other neoplasms.
Follow-Up Studies ; Gastrointestinal Stromal Tumors ; Hand ; Humans ; Neuroendocrine Tumors ; Neurofibromatoses ; Neurofibromatosis 1 ; Pancreaticoduodenectomy ; Recurrence

Neurofibromatosis type 1 (NF1) is an autosomal dominant hereditary disorder. The pathogenesis of NF1 is suggested to be an alteration of the NF-1 gene, which normally functions as a tumor suppressor. A mutation of NF-1 causes the development of viable tumors in various sites. On the other hand, the synchronous manifestation of a gastrointestinal stromal tumor (GIST) and neuroendocrine tumor (NET) in the background of NF1 is extremely rare. This paper reports three cases treated with surgical intervention along with the long-term follow-up results. Three patients showed synchronous ampullary NET and GIST in association with NF1 supported by postoperative histopathologic analysis. Surgical treatments, such as pancreatoduodenectomy and local excision were applied. No recurrence occurred during the postoperative follow-up period of 10, 9, and 2.7 years. Synchronous GIST and NET in the background of NF1 is extremely rare, but the possible coexistence of other tumors in NF1 patients is relatively higher than that in the general population. Furthermore, both NETs and GISTs occurring in NF1 patients tend to be smaller in size compared to that in the general population. Therefore, when NF1 patients present with vague abdominal discomfort, close attention must be paid to identifying the coexistence of other neoplasms.
Follow-Up Studies ; Gastrointestinal Stromal Tumors ; Hand ; Humans ; Neuroendocrine Tumors ; Neurofibromatoses ; Neurofibromatosis 1 ; Pancreaticoduodenectomy ; Recurrence

PURPOSE: The aim of this study was to review our experience with neuroendocrine carcinoma (NEC) of the colon and rectum to highlight the clinical and pathological characteristics in this relatively uncommon malignancy. METHODS: From December 1995 to December 2006, 11 patients with NEC were identified from our database of 6,143 colorectal cancer patients (0.18%), which does not include carcinoid tumors. The pathology was retrospectively reviewed and the tumors were categorized as pure NEC, including well-differentiated NEC (n=3), poorly-differentiated (n=3) and mixed endocrine/exocrine tumor (n=5) on the basis of the histology and immunohistochemical findings. RESULTS: The mean age of the patients was 57 yr (range, 37 to 69 yr). The tumors were located as follows: 8 in the colon and 3 in the rectum. The diagnosis of NEC was suggested preoperatively from the tissue biopsy in 2 of 9 patients (22.2%). The tumors were advanced at the time of diagnosis, with American Joint Committee on Cancer Stage III (n=7) and Stage IV disease (n=4). Most tumors stained positive by immunohistochemistry for neuroendocrine markers, including synaptophysin (7/9, 77.8%); however, chromogranin was expressed in 4 of 9 NEC tumors (44.4%). Metastatic disease was detected at the time of diagnosis in 36.4% (4/11) of the patients. The median survival for NEC was 16 mo (3.6-67.4 mo), and for pure NEC and mixed endocrine/exocrine tumor was 4.1 mo and 23.6 mo, respectively. CONCLUSION: NEC had distinctive cytoarchitectural features and was often immunoreactive for neuroendocrine markers. Our findings showed that pure NEC had aggressive behavior and a poor prognosis.
Biopsy ; Carcinoid Tumor ; Carcinoma, Neuroendocrine ; Colon ; Colorectal Neoplasms ; Humans ; Immunohistochemistry ; Joints ; Prognosis ; Rectum ; Retrospective Studies ; Synaptophysin

PURPOSE: Barriers to cardiopulmonary resuscitation (CPR) education are magnified by relative cost and course availability. E-learning has emerged as a viable solution for continuous, on-demand training and organizational learning. We assessed the hypothesis that E-learning is a viable strategy for CPR training of the general public and sought to evaluate its effects on CPR quality compared to traditional classroom-based methods. METHODS: The E-learning program was specifically designed to teach basic life support skills, and consisted of 50 minutes internet lectures and simulation videos. The training session was freely available to twenty two officers in rural South Korea. The trainees were able to practice with a mannequin and an automated external defibrillator (AED) trainer at their place of employment over the course of 3 days. The control group was trained at a hospital by certified instructors using the same equipment during a 2 hour period. At the end of the course, the participant's skills were evaluated using a checklist and a skill performance test. RESULTS: Forty two subjects were enrolled finally with 19 and 23 belonging to the E-learning and the control groups, respectively. One E-learning trainee was excluded because he was absent from the skills test. The mean time to learn CPR and AED techniques was 29.0+/-24.5 minutes in the elearning group. The mean age of the E-learning group was significantly older than that of the control group (32.4+/-4.0 vs. 26.0+/-1.5, p<0.001). However, we did not find any significant differences in their weight, height or CPR educational status. Before the education sessions, the willingness to perform CPR and their confidence in performing CPR were not significantly different among the two groups. Regarding skill performance, there were no significant differences between the groups except the volume of ventilation. The control group showed a higher volume of ventilation than the elearning group (1,031.7+/-521.6 vs. 548.8+/-303.3, p=0.004). CONCLUSION: E-learning accompanied with appropriate practice can be a helpful tool for public CPR training. The demand for E-learning will increase, and this study shows that e-learning programs can be successful, yielding similar results as traditional, classroom-based training.
Cardiopulmonary Resuscitation ; Checklist ; Defibrillators ; Education, Distance ; Educational Status ; Employment ; Hypogonadism ; Internet ; Learning ; Lectures ; Life Support Care ; Manikins ; Mitochondrial Diseases ; Ophthalmoplegia ; Republic of Korea ; Ventilation