No abstract available.
Agaricales* ; Morus*

PURPOSE: Ethanol is the most common toxic substance encountered clinically and is becoming increasingly important in forensic medicine. Generally, pre-treatment with an alcohol disinfectant such as isopropyl alcohol for blood sampling could influence evaluations and affect legal evidence. This study was performed to determine whether isopropyl alcohol affects the serum ethanol level. METHODS: Volunteers were prohibited from drinking alcohol and taking medication for 48 hours prior to participating. Pregnant volunteers and volunteers with abnormal liver enzymes or abnormal kidney function were excluded. Enrolled subjects had their blood collected from each arm to measure the alcohol concentration, one side was disinfected with povidone iodine and the other with isopropyl alcohol. After waiting one hour, they ingested 20g of alcohol and waited. After one hour, the serum ethanol levels were measured using the same method as the first sampling. RESULTS: Ten volunteers enrolled for this study. Without the alcohol intake, all serum ethanol levels were in the nondetectable range(<3 mg/dL) for both samples with either isopropyl alcohol or povidone iodine. After drinking alcohol, the serum ethanol level varied among individuals; the mean value of the serum ethanol levels in the alcohol preparation group was 21.08+/-4.85 mg/dL, which was significantly greater than that of the povidone iodine preparation group (19.71+/-5.47 mg/dL) (p=0.006). However, the Bland-Altman analysis showed that the precision of both groups was 1.230 mg/dL, which was less than the measurement error of the equipment (3.48 mg/dL). Therefore, there was no significant difference between the two groups with regard to the measurement error. CONCLUSION: Before alcohol intake, there was no influence on the blood alcohol concentration from the alcohol disinfection, and the result was reliable. After alcohol intake, the possible influence of pre-treatment alcohol on the serum ethanol level was less than the measurement error of the equipment used.
2-Propanol ; Alcohol Drinking ; Arm ; Disinfection ; Drinking ; Ethanol ; Forensic Medicine ; Kidney ; Liver ; Povidone-Iodine

There is a growing interest in the factors related to insufficiency fractures. We are going to report three insufficiency fracture cases which are considered to be caused by osteoporosis, rheumatoid arthritis, steroid use and femoral shaft bowing among the patients not taking bisphosphonate. All cases are caused by low energy trauma and among these cases, one patient is being presented with a prodromal symptom and another patient complains of both prodromal symptoms and bilateral lesions.
Arthritis, Rheumatoid ; Femur ; Fractures, Stress ; Humans ; Osteoporosis ; Prodromal Symptoms

BACKGROUND: Minimum alveolar concentration (MAC) is decreased during pregnancy, but there are no data regarding the requirements for intravenous agents. Recently only one study showed that the requirement for thiopental in pregnant women of 7-13 weeks' gestation was less than the requirement obtained in nonpregnant women. Thus we wanted to determine whether pregnant patients needed less propofol for hypnosis and anesthesia than nonpregnant patients. METHODS: One hundred nonpregnant women having gynecologic surgery and 100 pregnant women of 5-13 weeks' gestation undergoing elective abortions were recruited. They were randomly allocated 10 groups according to the doses of propofol and each group had 10 patients. During a period of 30 seconds, one of the doses of propofol 1.0, 1.25, 1.5, 1.75, 2.0, 2.25, 2.5, 2.75, 3.0 or 3.25 mg/kg was administered. Two minutes later, patients were asked to open their eyes as a test for hypnosis. Patients who did not open their eyes were given a 10 seconds, 50-Hz, 80-mA transcutaneous tetanic electrical stimulus to the ulnar nerve as a test for anesthesia. Estimates of ED50 and ED95 for hypnosis and anesthesia were obtained by logistic regression. RESULTS: In the pregnant women, the median effective doses (ED50) (95% confidence interval) for hypnosis and anesthesia were 1.25 (1.13-1.35) mg/kg and 2.71 (2.49-3.04) mg/kg, the ED95 (95% CI) were 1.51 (1.16-1.87) mg/kg and 3.04 (2.80-3.58) mg/kg respectively. Whereas in the nonpregnant women, the ED50 for hypnosis and anesthesia were 1.27 (1.39-1.90) mg/kg and 4.12 (3.50-6.01) mg/kg, the ED95 were 1.53 (1.41-1.93) mg/kg and 4.35 (3.66-7.26) mg/kg respectively. CONCLUSIONS: In early pregnant women, the doses of propofol for hypnosis and anesthesia were 1.6% and 34.2% less compared with those in nonpregnant women.
Anesthesia ; Female ; Gynecologic Surgical Procedures ; Humans ; Hypnosis ; Logistic Models ; Pregnancy* ; Pregnant Women ; Propofol* ; Thiopental ; Ulnar Nerve

The idiopathic long-QT syndrome is an infrequent inherited disorder, characterized by prolonged QT interval and by the occurrence of life-threatening tachyarrhythmia, particularly in association with emotional or physical stree. In its characteristic presentation, with obvious QT prolongation and stree induced syncope with torsades de points, the diagnosis is straightforward for physicians aware of the disease. But sometimes in cases of borderline QT prolongation and vague symptom, a correct diagnosis is delayed and frequently misdiagnosed as a seizure disorder. The mortality of untreated symptomatic patients with LQTS exceeds 20% in the year after their first syncopal episode and aapproaches 50% within 10 years. But this high mortality rate has been significantly reduced by the use of pharmacological or surgical antiadrenergic therapy or both. So early detection of the disease and antiadrenergic treatment sympathetic innervation to the heart. Second, there was intrinsic gene abnormality in the mechanisms responsible for cardiac repolarization. We report one case of LQTS in a 24 years old female patient who had been suffering from stree related syncope. Her initial EKG had prologed QT interval(588msec) and increased QT intrval dispersion(200msec). In the Holter monitor, long and short cycle sequence induced (pause-dependent) torsades de pointes was detected. She has been treated by beta-blocker and has maintained her condition without recurrence of the symptoms.
Diagnosis ; Electrocardiography ; Epilepsy ; Female ; Heart ; Humans ; Long QT Syndrome ; Mortality ; Recurrence ; Syncope ; Tachycardia ; Torsades de Pointes ; Young Adult

BACKGROUND: Cervical epidural injection, performed via the interlaminar approach, represents a useful interventional pain management procedure indicated in patients with a cervical herniated disk. Due to thedecreased epidural space in the cervical region, cervical epidural injections may result in potentially serious complications, especially during a large volume injection. METHODS: Thirty-four patients with neck pain due to a cervical herniated disk that were referred to the pain clinic for cervical epidural steroid injection were randomized into two groups. One group received a cervical epidural injection of 4 ml drug and the other group received 2 ml drug. The injected mixture included triamcinolon, ropivacaine and omnipaque. Spread levels of the drug after injection were estimated with the use of C-arm fluoroscopy. RESULTS: Spread levels to the cephalad for patients in the two groups were 4.88 +/- 0.78 segments and 4.53 +/- 0.49 segments, respectively. Spread levels to the caudad for patients in the two groups were 4.59 +/- 0.93 segments and 4.47 +/- 0.51 segments, respectively. The results showed no significant difference in the spread level between the two groups. CONCLUSIONS: Use of a small volume of drug (2 ml) can provide a sufficient spread level of the injected drug that is desirable for patients with a cervical herniated disk.
Epidural Space ; Fluoroscopy ; Humans ; Injections, Epidural ; Intervertebral Disc Displacement ; Iohexol ; Neck Pain ; Pain Clinics ; Pain Management

We report a case of recurrent dermatofibrosarcoma in a 30-years-old woman who had undergone operations three times during 60 months and had received post-operative radiotherapy. On neurological examination, no neurological deficits were noticed. In brain magnetic resonance image(MRI), there was right parieto-occipital scalp mass with high signal in T2-weighted image, low signal in T1-weighted image with homogeneous enhancement. The removal was done including about 2cm uninvolved margins and pathologic examination of the lesion revealed dermatofibrosarcoma protuberans(DFSP). The prognostic factors of local recurrence may be related to surgical margins for resection; the length from the grossly intact margins, and the microscopically controlled excision in margins.
Brain ; Dermatofibrosarcoma* ; Female ; Humans ; Neurologic Examination ; Radiotherapy ; Recurrence ; Scalp*

Terminal cancer pain is always a challenge to pain doctors.If the focus of the cancer pain is located in the restricted area, it is easy to control the pain. However, if the focus of cancer pain is widespread, it is very difficult to control the pain and it makes pain doctors embarrassed.Nowadays, the ultrasound-guided nerve block become a popular method. It is easy to find the nerve and helps to insert the catheter around the nerve for the continuous nerve block. We encountered a patient who was 59 years old with a stomach cancer and vertebral metastasis. He complained about the pain in his abdomen, back and left thigh. His abdominal and back pain vanished with the use of continuous lumbar epidural injection. However, the patient still complained about the pain and numbness on the left thigh, because of this, he couldn't get any sleep.We tried a continuous femoral nerve block under the ultrasound guidance, after that his pain was gone.The ultrasound-guided nerve block will be very helpful to control the pain.
Abdomen ; Back Pain ; Catheters ; Femoral Nerve ; Humans ; Hypesthesia ; Injections, Epidural ; Neoplasm Metastasis ; Nerve Block ; Stomach Neoplasms ; Thigh

PURPOSE: An isolated posterior malleolar fracture in the ankle is very rare. We treated eight cases of isolated posterior malleolar fracture, and describe the clinical features and outcomes of treatment. MATERIALS AND METHODS: Between from March 2008 to February 2012, eight cases of isolated posterior malleolar fracture were treated in Ilsan Paik Hospital. The mean age of patients was 30 years (11-49 years); six patients were male and five were right. Slip down (4 cases) was the most common injury mechanism. We treated four cases surgically, three cases by cast and one case by ankle brace. We could not recognize three cases of isolated posterior malleolar fracture at first. The time delay to diagnose unrecognized isolated posterior malleolar fracture was nine days, 56 days and 110 days respectively. We were able to diagnose the unrecognized isolated posterior malleolar fracture using computed tomography (two cases) and magnetic resonance imaging (one case). RESULTS: The main symptom was painful swelling. The average for articular involvement of the posterior malleolar fragment was average 21.4%, and average displacement was 1.25 mm. We treated three cases surgically using a posterior lateral approach and one case using a posterior medial approach. The average American Orthopaedic Foot and Ankle Society score was 92.5 at the last follow-up. CONCLUSION: The isolated posterior malleolar fracture is very rare and if it is neglected, persistent ankle pain can remain. Isolated posterior malleolus fracture should be included as one of the differential diagnoses after ankle trauma.
Ankle Fractures* ; Ankle* ; Braces ; Diagnosis, Differential ; Follow-Up Studies ; Foot ; Humans ; Magnetic Resonance Imaging ; Male

OBJECTIVE: To determine the efficacy and safety of capecitabine in patients with gynecologic cancers as adjuvant chemotherapy or maintenance treatment. METHODS: In this study, patients who were treated with capecitabine between January 2000 and June 2007 at Asan Medical Center, Seoul, Korea were reviewed. Thirty-one patients with gynecologic cancers were included 16 patients with recurrent ovarian cancer, 9 patients with cervical cancer after initial treatment, and 6 patients with recurrent cervical cancer. These patients' data were analyzed by review of medical records and pathologic and laboratory reports retrospectively. Response was assessed by both RECIST criteria for patients with measurable disease and CA 125 criteria in patients with ovarian cancer and National Cancer Institute criteria for progression, response, and toxicity were utilized in cervical cancer. RESULTS: Capcitabine was given at a dosage of 2,000-2,500 mg/m2/day orally in a divided dose daily for 14 days followed by a 7-day rest period in all patients. Nine patients with ovarian cancer were treated with more than 2 cycles and their median age was 49 years (43-67). Two patients showed a partial response and the median progression free survival was 3 months. Nine patients with cervical cancer after initial treatment were in the complete response state and their median progression free survival was 24.5 months. No partial or complete responses were seen in 6 patients with recurrent cervical cancer. There was no severe toxicity. CONCLUSION: Although capecitabine is a well-tolerated regimen, as a single agent, it produces minimal benefit in recurrent ovarian and cervical cancer population.
Chemotherapy, Adjuvant ; Chungcheongnam-do ; Disease-Free Survival ; Humans ; Korea ; Medical Records ; National Cancer Institute (U.S.) ; Ovarian Neoplasms ; Retrospective Studies ; Seoul ; Uterine Cervical Neoplasms ; Capecitabine