BACKGROUND: Electroconvulsive therapy (ECT) that works by electrically inducing grand mal seizure is an effective therapy for patients with major psychosis and affective disorders. But ECT may produce intense stimulation of the central nervous system resulting in hypertension and tachycardia. Such an acute hyperdynamic state may be undesirable because of possible cardiovascular complications. We compared the ability of different bolus doses of esmolol to blunt the hemodynamic effects of ECT. METHODS: Twenty ASA physical status 1~2 patients were enrolled in a crossover design study to determine the effects of two standard esmolol bolus doses (0.5 mg/kg and 1.0 mg/kg) on the hemodynamic response and seizure duration during ECT. In each patients receiving esmolol or placebo, arterial pressure, heart rate, seizure duration and peripheral oxygen saturation (SpO2) were recorded. RESULTS: The seizure duration with placebo was 43 +/- 9 sec, esmolol 0.5 mg/kg bolus dose was 39 +/- 14 sec and esmolol 1.0 mg/kg bolus dose was 39 +/- 12 sec, but it was not significant. Compared with esmolol 0.5 mg/kg bolus dose, esmolol 1.0 mg/kg bolus dose decreased blood pressure and heart rate during ECT more effectively. CONCLUSIONS: Esmolol 1.0 mg/kg bolus dose was considered to be the better dose in blunting the hyperdynamic response during ECT without shortening of seizure duration.
Arterial Pressure ; Blood Pressure* ; Central Nervous System ; Cross-Over Studies ; Electroconvulsive Therapy* ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Hypertension ; Mood Disorders ; Oxygen ; Psychotic Disorders ; Seizures ; Tachycardia

Dysplasia epiphysialis punctata is a rare congenital disorder of infancy affecting in particular cartilage, muscle, jointtcapsules and the eyes. A case of dysplasia epiphysialis punctata with involvement of all epiphyses of extremities, spine and pelvis in 2 days old male is to be reported with review of literature.
Cartilage ; Chondrodysplasia Punctata ; Congenital, Hereditary, and Neonatal Diseases and Abnormalities ; Epiphyses ; Extremities ; Humans ; Male ; Pelvis ; Spine

Verrucous carcinoma, also known as oral florid papillomatosis, is characterized by relentless local persistence, little tendency to metastasis and failure to respond to treatment. The disease is encountered in dermatological clinic as well as dental or otolaryngological clinics. The present case, a 57-year-old man, was first diagnosed as oral lichen planus and eventually developed verrucous carcinoma involving most of the oral mucous membrane including the lower lip and entire gum. Various treatment modalities were done only to result in failures. The overall course of the case for 10 years is reported.
Carcinoma, Verrucous* ; Gingiva ; Humans ; Lichen Planus, Oral ; Lip ; Middle Aged ; Mucous Membrane ; Neoplasm Metastasis ; Papilloma

Twenty-four factories registered at the Ministry of Labor as factories using or producing cadmium in 1991 were investigated to know the present state of occupational exposure to cadmium in 1992. Nine factories among 24 stopped using or changed to other substances and 1 factory didn't produce any more, but delivered it to other factories through imports. Therefore, only 14 factories were producing or using cadmium. But, alloying materials were uspplied to about 20 and more factories, however, they couldn't be investigated because of limited information. Three factories had less than 50 workers were 3, 6 had 50-300 and 5 had more than 300. About 167 workers were exposed to cadmium. According to the classification by process, there were 4 alloy processes, 2 refinary, 2 elctroplating, 2 dry cell making, 1 industrial battery and 1 copper refinary. 8 factories used metal cadmium, 3 cadmium oxide, 2 cadmium sulfide, and 1 cadmium hyroxide. One factory was importing cadmium stearates only and supplying them to the PVC making factories. The amount of metal cadmium producing in 2 refinary factories was about 50-65 ton per month. The other cadmium compounds were imported. According to exposure level of cadmium in air of the 10 factories examined, each factory could be divided into high, moderate and low exposure groups. 1 battery recycling factory and 3 alloy factories were in the high exposure group and their mean air concentrations were 0.06679, 0.05481, 0.02492, and 0.003mg/m3, respectively. Refinary and industrial battery making factories were in the middle exposure group and their mean air concentrations were 0.00773 and 0.00613 mg/m3, respectively. Finally, low exposure group were copper smelting, dry cell case making, duplicator drum making and electroplating factory and their mean air concentrations were 0.00096, 0.00071, 0.00057 and 0.00054 mg/m3 respectively.
Alloys ; Cadmium Compounds ; Cadmium* ; Classification ; Copper ; Electroplating ; Korea* ; Occupational Exposure* ; Osmeriformes ; Recycling ; Stearates

Untill now occasional cases of jellyfish stings have been reported in Korean literatures but all of the reported patients contracted the stings abroad out of the country. Recently we have found a case of the jellyfish stings first in Korean coastline. The patient was an 11-year-old girl, who got the sting while she was swimming in the southern west coast of the country. The initial skin lesions showed typically whipped appearance and subsided in a month after taking both courses of the immediate toxic reaction and the late allergic reaction. Considering the ecological changes of the sea waters of the Korea, we think the jellyfish stings would occur more frequently also in the country and dermatologists should be familiar with the dermatitis.
Bites and Stings* ; Child ; Dermatitis ; Female ; Humans ; Hypersensitivity ; Korea ; Seawater ; Skin ; Swimming

A 78-year-old man was diagnosed with renal cell carcinoma, and left nephrectomy was performed. He started pazopanib. One month later, he visited our hospital because of general weakness and dyspnea. His oxygen saturation was low. A chest X-ray showed pulmonary edema and bilateral pleural effusion. An echocardiogram showed a larger left ventricle and lower ejection fraction than observed at the previous examination. The patient discontinued pazopanib and started diuretics and digoxin. His symptoms improved and a follow-up X-ray showed improvement in the pulmonary edema with bilateral pleural effusion.
Aged ; Carcinoma, Renal Cell* ; Digoxin ; Diuretics ; Dyspnea ; Follow-Up Studies ; Heart Failure* ; Heart Ventricles ; Heart* ; Humans ; Nephrectomy ; Oxygen ; Pleural Effusion ; Pulmonary Edema ; Thorax

The incidence of ischemic heart disease has been increased rapidly in Korea. However, the clinical effects of antecedent hypertension on acute myocardial infarction have not been identified. We assessed the relationship between antecedent hypertension and clinical outcomes in 7,784 patients with acute myocardial infarction in the Korea Acute Myocardial Infarction Registry during one-year follow-up. Diabetes mellitus, hyperlipidemia, cerebrovascular disease, heart failure, and peripheral artery disease were more prevalent in hypertensives (n=3,775) than nonhypertensives (n=4,009). During hospitalization, hypertensive patients suffered from acute renal failure, shock, and cerebrovascular event more frequently than in nonhypertensives. During follow-up of one-year, the incidence of major adverse cardiac events was higher in hypertensives. In multi-variate adjustment, old age, Killip class > or =III, left ventricular ejection fraction <45%, systolic blood pressure <90 mmHg on admission, post procedural TIMI flow grade < or =2, female sex, and history of hypertension were independent predictors for in-hospital mortality. However antecedent hypertension was not significantly associated with one-year mortality. Hypertension at the time of acute myocardial infarction is associated with an increased rate of in-hospital mortality.
Acute Disease ; Age Factors ; Aged ; Cerebrovascular Disorders/etiology ; Diabetes Mellitus/etiology ; Female ; Heart Failure/etiology ; Hospital Mortality ; Humans ; Hyperlipidemias/etiology ; Hypertension/*complications ; Male ; Middle Aged ; Myocardial Infarction/complications/*mortality/therapy ; Peripheral Vascular Diseases/etiology ; Predictive Value of Tests ; Registries ; Sex Factors

This study was performed to evaluate the effects of diabetes on short- and mid-term clinical outcomes in patients with acute myocardial infarction (AMI). Between October 2005 and December 2009, a total of 22,347 patients with AMI from a nationwide registry was analyzed. At the time point of the day 30 after AMI onset, landmark analyses were performed for the development of major adverse cardiovascular events (MACEs), including death, re-infarction and revascularization. In this cohort, 6,131 patients (27.4%) had diabetes. Short-term MACEs, which occurred within 30 days of AMI onset, were observed in 1,364 patients (6.1%). Among the 30-day survivors (n = 21,604), mid-term MACEs, which occurred between 31 and 365 days after AMI onset, were observed in 1,181 patients (5.4%). After adjustment for potential confounders, diabetes was an independent predictor of mid-term MACEs (HR, 1.25; 95% CI, 1.08-1.45; P = 0.002), but not of short-term MACEs (HR: 1.16; 95% CI: 0.93-1.44; P = 0.167). Diabetes is a poor prognostic factor for mid-term clinical outcomes but not for short-term outcomes in AMI patients. Careful monitoring and intensive care should be considered in diabetic patients, especially following the acute stage of AMI.
Acute Disease ; Aged ; Cardiovascular Diseases/etiology ; Cohort Studies ; Diabetes Mellitus, Type 2/complications/*diagnosis ; Diagnosis, Differential ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Myocardial Infarction/*diagnosis/epidemiology/mortality ; Prognosis ; Proportional Hazards Models ; Registries ; Survival Analysis ; Time Factors

BACKGROUND AND OBJECTIVES: Recently, the prognostic value of N-terminal brain natriuretic peptide (NT-proBNP) in acute coronary syndrome has been demonstrated in many studies. However, NT-proBNP levels are influenced by various factors such as sex, age, renal function, heart failure severity, and obesity. NT-proBNP concentrations tend to decrease with higher body mass index (BMI). The aim of this study was to examine the influence of obesity on NT-proBNP as a predictive prognostic factor in acute myocardial infarction (AMI) patients. SUBJECTS AND METHODS: Using data from the Korea Acute Myocardial Infarction Registry (January 2005 to September 2008), 2,736 AMI patients were included in this study. These patients were divided into men (n=1,972, 70%) and women (n=764, 30%), and were grouped according to their BMIs. Major adverse cardiac events (MACE) during 1 year clinical follow-up were evaluated. RESULTS: NT-proBNP was significantly higher in lower BMI (p<0.001). Mean NT-proBNP levels of each obesity group were 2,393+/-4,022 pg/mL in the lean group (n=875), 1,506+/-3,074 pg/mL in the overweight group (n=724) and 1,100+/-1,137 pg/mL in the obese group (n=1,137) (p<0.01). NT-proBNP was an independent prognostic factor of AMI in obese patients by multivariative analysis of independent risk factors of MACE (p=0.01). CONCLUSION: NT-proBNP is lower in obese AMI patients than in non-obese AMI patients, but NT-proBNP is still of independent prognostic value in obese AMI patients.
Acute Coronary Syndrome ; Body Mass Index ; Brain ; Female ; Follow-Up Studies ; Heart Failure ; Humans ; Korea ; Male ; Myocardial Infarction ; Natriuretic Peptide, Brain ; Obesity ; Overweight ; Peptide Fragments ; Risk Factors

BACKGROUND: The number of immunocompromised hosts has been increasing steadily and a new pulmonary infiltrate in these patients a potentially lethal condition which needs rapid diagnosis and treatment. In this study we sought to examine the clinical manifestations, radiologic findings, and therapeutic outcomes of pulmonary mycoses presenting as a new pulmonary infilrate in immunocompromised hosts. METHOD: All cases presenting as a new pulmonary infilrate in immunocompromised hosts and confirmed to be pulmonary mycoses by pathologic examination or by positive culture from a sterile site between October of 1996 and April of 1998 were included in the study and their chart and radiologic findings were retrospectively reviewed. RESULTS: In all, 14 cases of pulmonary mycoses from 13 patients(male : female ratio = 8 : 5, median age 47yr) were found. Twelve cases were diagnosed as aspergillosis while two were diagnosed as mucormycosis. Major risk factors for fungal infections were chemotherapy for hematologic malignancy (10 cases) and organ transplant recipients(4 cases). Three cases were receiving empirical amphotericin B at the time of appearance of new lung infiltrates. Cases in the hematogic malignancy group had more prominent symptoms : fever(9/10), cough(6/10), sputum(5/10), dyspnea(4/10), chest pain(5/10). Patients in the organ transplant group had minimal symptoms(p<0.05). On simple chest films, all of the cases presented as single or multiple nodules (6/14) or consolidations(8/14). High resolution computed tomograph showed peri-lesional ground glass opacities(14/14), pleural effusions(5/14), and cavitary changes(7/14). Definitive diagnostic methods were as follows : 10 cases underwent minithoracotomy, 2 underwent video-assisted thoracoscopic surgery, 1 underwent percutaneous needle aspiration and 1 case was diagnosed by culture of abscess fluid. All cases received treatment with amphotericin B with 1 case each being treated with liposomal amphotericin B and itraconazole due to renal toxicity. Lung lesion improved in 12 of 14 patient but 4 patients died before completing therapy. CONCLUSION: When a new lung infiltrate develops presenting either as a nodule or consolidation in a neutropenic patient with hematologic malignancy or in a transplant recipient, you should always consider pulmonary mycoses as one of the differential diagnosis. By performing aggressive work up and early treatment, we may improve prognosis of these patients.
Abscess ; Amphotericin B ; Aspergillosis ; Diagnosis ; Diagnosis, Differential ; Drug Therapy ; Female ; Fungi ; Glass ; Hematologic Neoplasms ; Humans ; Immunocompromised Host* ; Itraconazole ; Lung ; Mucormycosis ; Mycoses* ; Needles ; Prognosis ; Retrospective Studies ; Risk Factors ; Thoracic Surgery, Video-Assisted ; Thorax ; Transplantation ; Transplants