PURPOSE: To determine the plain film findings of acute neuropathic joint in diabetic foot. MATERIALS AND METHODS: Acute neuropathic joint in diabetic foot was considered when fragmentation of the articular ends of bone and subluxation of the affected joint developed within eight weeks after clinical onset of diabetic gangrene. Eight toes of six diabetics were satisfactory to our criteria. We analyzed plain radiographic findings of the affected joint and soft tissue, interval changes in follow-up radiographs, and deformities after healing. RESULTS: The time interval between clinical onset of gangrene and bone destruction ranged from 2 weeks to 4 weeks(mean 2.6 weeks). Plain radiographs showed fragmentation of the articular ends, subluxation, and soft tissue swelling of the metatarsophalangeal joint or interphalangeal joint. The significant feature of these patients was rapid progression of the lesions. Clinically, all patients had diabetic gangrene in affected toes, however, there was no evidence of osteomyelitis in our series. Amputation was done in 2 cases, and lesions in 3 of the remaining 4 cases were repaired spontaneously with regression of gangrene, leaving radiological residua such as pointed-end, tapered-end, and ball and socket deformity. CONCLUSION: Rapid disorganization of the joint with associated evidence of soft tissue gangrene in plain radiograph is believed to be valuable for the diagnosis of diabetic osteoarthropathy.
Amputation ; Congenital Abnormalities ; Diabetic Foot* ; Diagnosis ; Follow-Up Studies ; Gangrene ; Humans ; Joints* ; Metatarsophalangeal Joint ; Osteomyelitis ; Toes

Scrotal leiomyosarcoma arising from dartos layer not involving the testis, epididymis or spermatic cord is very rare tumor. We report a case of scrotal leiomyosarcoma in 29 year old man who present with right scrotal painless growing mass. The lesion had been for 3 months but there was no related symptom such as pain or tenderness. The excised lesion was 3 x 3cm sized ovoid mass with smooth surface and it had no relationship with the testis, epididymis and spermatic cord. Its pathologic finding was compatible with leiomyosarcoma. So additional radical orchiectomy was done.
Adult ; Epididymis ; Humans ; Leiomyosarcoma* ; Male ; Orchiectomy ; Scrotum* ; Spermatic Cord ; Testis

In order to evaluate causes and the effective treatment of postoperative bleeding after open heart surgery, we measured platelet count and plasma fibrinogen levels before, during a 30 and 60-minute, and after a 30, 60 and 90-minute extracorporeal circulation in 5 patients perfused by a bubble and membrane oxygenator, respectively. The results were as follows: 1) The platelet count was reduced significantly by 57.2+/-3.04% during a 30-minute extracorporeal circulation using the bubble oxygenator and by 43.8+/-0.84% using the membrane oxygenator, and these levels were maintained throughout the extracorporeal circulation. 2) The platelet count after a 90-minute extracorporeal circulation increased significantly compared with after a 30-minute extracorporeal circulation (p<0.05) and these effects were more prominent using the bubble oxygenator (p<0.025). 3) The plasma fibrinogen level was reduced by 28.6+/-7.50% during a 30-minute extracorporeal circulation using the bubble oxygenator and by 33.6+/-5.77% using the membrane oxygenator, and these levels were maintained throughout the extracorporeal circulation. 4) The plasma fibrinogen level after a 90-minute extracorporeal circulation increased significantly compared with after a 30-minute extracorporeal circulation (p<0.05).
Blood Platelets* ; Extracorporeal Circulation* ; Fibrinogen* ; Hemorrhage ; Humans ; Oxygen ; Oxygenators ; Oxygenators, Membrane ; Plasma* ; Platelet Count* ; Thoracic Surgery

PURPOSE: Video telemedicine system is efficient method of health care delivery that uses communication technologies via the internet and video-conferring to provide real-time video remote health provider, patient, or both. Video telemedicine system has the potential to improve access to the specialty of emergency medicine, particularly in rural and remote settings. Inadequate maintenance of ongoing health issues can result in high-cost care for both acute illness and long-term complications, whereas prevention of even a small percentage of these costs can pay for the cost of a video telemedicine system. METHODS: We visited a doctorless island on September 8th, 2006 and studied the public health status of the citizens, making charts while giving a free medical examination and treatment. We maintained and analyzed the charts for one year and then surveyed citizens to evaluate the effectiveness of video telemedicine system and to query them regarding future remedies. RESULTS: Out of 178 cases using video telemedicine system, 99 cases were the first medical examination and 12 cases were emergent, with 7 cases resulting in transfer to a mainland hospital. Of the patients transferred to the 3rd grade hospital, 41.4% had a heart problem. Thirty-eight cases were newly diagnosed via video telemedicine system, including 12 cases of vertebral disease (31.5%). 74.0% of citizens were satisfied with the video telemedicine system and among them 45.0% indicated satisfaction with the ease of seeing a doctor. After experiencing video telemedicine system, 100% of the citizens were agreed to continue video telemedicine system on the 'doctorless island', so more support and development is needed. CONCLUSION: Evidence suggests that a variety of video telemedicine system techniques can be applied effectively and safely to deliver emergency medicine across a variety of clinical settings. The utility and efficacy of telemedicine is discussed. Patient satisfaction is generally reported as high.
Delivery of Health Care ; Emergency Medicine ; Heart ; Humans ; Internet ; Patient Satisfaction ; Public Health ; Telemedicine

Hyponatremia is a condition of body fluid and electrolyte imbalance frequently encountered in clinical practice. However, treatment with small amounts of furosemide has in rare instances been reported to be associated with hyponatremia. We report a case of a 50-years-old woman who developed symptomatic hyponatremia after treatment for anaphylaxis and rhabdomyolysis resulting from snake bite. The woman was presented with hypotension and hypersensitivity induced by administration of antivenom after a snake bite. She was treated by fluid therapy and administration of epinephrine. One day after hospitalization, she complained of abdominal pain, and her myoglobin level and creatine phosphokinase concentration had increased. She was treated with hydration and urine alkalization. Renal failure and compartment syndrome were not complications of the clinical course. However, pleural effusion and ascites developed following fluid therapy. A small amount of furosemide was administered for treatment, and one day after administration, hyponatremia was found to have developed. The possibility of prescribing a small amout furosemide should be considered for patients who are treated with fluid therapy and require administration of antivenom for anaphylaxis and rhabdomyolysis resulting from snake bite.
Abdominal Pain ; Anaphylaxis* ; Ascites ; Body Fluids ; Compartment Syndromes ; Creatine Kinase ; Epinephrine ; Female ; Fluid Therapy ; Furosemide ; Hospitalization ; Humans ; Hypersensitivity ; Hyponatremia* ; Hypotension ; Myoglobin ; Pleural Effusion ; Renal Insufficiency ; Rhabdomyolysis* ; Snake Bites* ; Snakes*

No abstract available.
Hepatitis B Surface Antigens* ; Kidney Failure, Chronic* ; Korea* ; Liver Diseases* ; Liver*

Anisakiasis is a disease that often occurs after the ingestion of raw marine fish infected with nematodes of the Anisakis genus. Ingested Anisakis causes a variety of symptoms, including abdominal pain, nausea, and vomiting, when they invade the gastric wall. Although invasion of the gastric wall is common, rare cases of Anisakis invading the small bowel have been reported. These rare cases have resulted in small bowel obstruction and perforation and usually require surgical treatment. A 57-year-old man visited the emergency room suffering from abdominal pain and distension. He ate raw marine fish three days prior and suffered from epigastrium pain a day after this meal. X-ray and computed tomography showed small bowel obstruction without adhesion and required an operation for treatment. A laparotomy revealed dilated and congested jejunum and ileum with perforated distal ileum. We found a small thin long worm, confirmed by histopathology as a member of Anisakis. The patient was discharged after surgery without any complication.
Abdominal Pain ; Anisakiasis ; Anisakis ; Eating ; Emergencies ; Estrogens, Conjugated (USP) ; Humans ; Ileum ; Intestine, Small ; Jejunum ; Laparotomy ; Meals ; Nausea ; Stress, Psychological ; Vomiting

Acute encephalopathies can be defined as an acute central nervous system (CNS) insult, due to an underlying pathology. The clinical symptoms almost always include an acute state of confusion and cognitive impairment. Toxic encephalopathies can occur acutely or chronically depending on the toxic drugs and other substances as well as the individual metabolism of the drug. The organs acutely affected include the heart, lung and kidneys. However, the brain, spinal cord and sympathetic nerves can be affected chronically. If the toxic substance passes through the bloodbrain barrier into the hypothalamus and the posterior pituitary gland, the result can be diabetes insipidus. If the substance affects the anterior pituitary gland, the result can include hormone dysfunction, impaired immune function and altered cognition or personality. We report a patient that developed acute toxic encephalopathy after the prescribed dose of oxycodone was exceeded.
Brain ; Central Nervous System ; Cognition ; Diabetes Insipidus ; Heart ; Humans ; Hypothalamus ; Kidney ; Lung ; Neurotoxicity Syndromes ; Oxycodone ; Pituitary Gland, Anterior ; Pituitary Gland, Posterior ; Spinal Cord

BACKGROUND: The effects of type 1 diabetes mellitus on the metabolism and density of bone in children are still controversial. The aim of this study was to evaluate the effects of type 1 diabetes on markers of bone metaboism and BMD in children by analyzing BMI, HbA1c, biochemical markers, sex hormones, bone metabolism and BMD related factors. MRTHODS: We compared 36 patients (15 males, 21 females) with type 1 diabetes mellitus to 167 healthy children (84 males, 83 females) who lived in Taegu. We measured FBS, serum calcium, phosphorus, HbA1c, osteocalcin, testosterone and estradiol for analyzing the factors which influence on bone metabolism and BMD. BMD was measured at lumbar spine, femur and total body by DEXA. RESULTS: The BMI and serum level of osteocalcin were not different in both groups. Serum calcium level was significantly lower in the diabetic group than that of control group. BMD had no difference in both groups. There was no correlation between BMD and glycemic control (HbA1c) or duration of diabetes. There was good correlation (r=0.78, p<0.01) between serum testosterone level and BMD in male patient group. There was negative correlation (r=-0.4) between serum osteocalcin level and BMD. There was significant correlation (male: r=0.76, female: r=0.66) between lean body mass and BMD in both group. CONCLUSION: The BMD was not decreased significantly and bone turn-over was normal in children with noncomplicated type 1 diabetes mellitus, and BMD was not influenced by the duration or degree of metabolic control of diabetes. But, we need further study including other risk factors that have influences on BMD and bone metabolism in type 1 diabetes mellitu.
Biomarkers ; Calcium ; Child* ; Daegu ; Diabetes Mellitus, Type 1 ; Estradiol ; Female ; Femur ; Gonadal Steroid Hormones ; Humans ; Male ; Metabolism* ; Osteocalcin ; Phosphorus ; Risk Factors ; Spine ; Testosterone

No abstract available.
Drug Therapy, Combination* ; Epirubicin* ; Fluorouracil*