BACKGROUND: The number of patients of doxylamine overdose has increased, but there were little clinical reports. The purpose of this study is review the patients of doxylamine overdose for aid clinical decision making of patients disposition. METHODS: We reviewed medical records of patients who ingested doxylamine succinate retrospectively from Jan. 1, 1996 to Dec. 31. 1996. Data that was recorded were followed: age, sex, psychiatric history, amounts of ingestion, time interval from ingestion to arrival to hospital, initial vital signs and symptoms, EKG, chest PA, Lab. findings, treatment, patients disposition, length of hospital stay, complication. RESULTS : 1) Total number of patients was ninety and average dosage of ingestion was 1062mg. 2) Tachycardia was the most frequent anticholinergic symptom(46%). 3) Routine lab. findings was not abnormal except one patient who was diagnosed as Rhabdomyolysis. 4) Gut decontamination was performed in patients who had arrived at hospital in 2-3 hours, and who had ingested large dose of drug. 5) Five patients were admitted to Psychiatric dept. and one patient was admitted to emergency dept. for treatment of rhabdomyolysis. 6) The mean duration of hospital stay was 6.5 hours. CONCLUSION: The patients who ingested overdose of doxylamine was managed safely in emergency department, but we should warn against the possibility of rhabdomyolysis.
Decision Making ; Decontamination ; Doxylamine* ; Eating ; Electrocardiography ; Emergencies ; Emergency Service, Hospital ; Humans ; Length of Stay ; Medical Records ; Retrospective Studies ; Rhabdomyolysis ; Succinic Acid* ; Tachycardia ; Thorax ; Vital Signs

PURPOSE: The modified subureteral transurethral injection(STING) has been reported to increase the success of endoscopic treatment of high grade vesicoureteral reflux(VUR). This study was performed to assess the efficacy of the modified STING procedure compared to conventional STING in the setting of high grade VUR. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 40 consecutive children(46 ureters) with a median age of 5.32 years (range 1 to 10 years) who underwent endoscopic treatment of grade IV to grade V VUR between February 2004 and December 2006. The modified STING was performed by applying a direct pressure stream of irrigation fluid into the ureter in order to define the injection site within the ureteral submucosa. The needle was then placed in the ureteral tunnel, and a dextranomer/hyaluronic acid copolymer(Dx/HA) was injected into the submucosal intraureteral space, tracking along the entire length of the detrusor tunnel. Modified STING was performed in 27 ureters(grade IV: 13, grade V: 14), and conventional STING was performed in 19 ureters (grade IV: 12, grade V: 7). Follow-up voiding cystourethrography(VCUG) was performed 3 months later. RESULTS: Complete resolution occurred in 82%(22/27 ureters) of the patients undergoing modified STING, including 92%(12/13) of grade IV patients and 71%(10/14) of grade V patients. Three ureters required a second injection to correct VUR. Conventional STING had a success rate of 63%(12/19), [75%(9/12) in grade IV and 43%(3/7) in grade V]. The mean injected volume for the modified STING was 1.23+/-0.3ml, while that for the conventional STING was 0.95+/-0.2ml(p=0.03). Conclusions: The modified STING was markedly more successful in the treatment of high grade VUR and carried no significant adverse effects.
Child ; Male ; Female ; Humans ; Bites and Sting

Nuclear protein-1 (NUPR1) is a small nuclear protein that is responsive to various stress stimuli. Although NUPR1 has been associated with cancer development, its expression and roles in cholangiocarcinoma have not yet been described. In the present study, we found that NUPR1 was over-expressed in human cholangiocarcinoma tissues, using immunohistochemistry. The role of NUPR1 in cholangiocarcinoma was examined by its specific siRNA. NUPR1 siRNA decreased proliferation, migration and invasion of human cholangiocarcinoma cell lines (HuCCT1 and SNU1196 cells). From these results, we conclude that NUPR1 is over-expressed in cholangiocarcinoma and regulates the proliferation and motility of cancer cells.
Cell Line ; Cholangiocarcinoma ; Humans ; Immunohistochemistry ; Nuclear Proteins ; RNA, Small Interfering

Takayasu's arteritis is a chronic inflammatory disease of unknown etiology involving the thoracic and abdominal aorta and its major branches. In some cases other vessel such as renal arteries, coronary arteries, and even pulmonary arteries may be involved. Total aortography is very important, because the clinical features are determined by the extent and severity of the specific artery involved in the occlusive phase of the disease. We report a case of Takayasu's arteritis type IV in a 38 year man with pulmonary arterial involvement and pulmo-nary hypertension.
Aorta, Abdominal ; Aortography ; Arteries ; Arteritis* ; Coronary Vessels ; Hypertension ; Hypertension, Pulmonary* ; Pulmonary Artery ; Renal Artery ; Takayasu Arteritis*

PURPOSE: In the endoscopic treatment of vesicoureteral reflux, the relatively high rate of success, the simplicity of the procedure, high patient compliance, and a lack of complications has led to the increased development of injection materials and techniques. We report a method of identifying and maintaining a clear visual field during ureteral and bladder submucosal wall injection of a dextranomer/hyaluronic acid copolymer (Deflux, Oceana, Therapeutics Inc.) by use of the hydrodistention implantation technique (HIT) with the aid of temporary ureteral catheter insertion. MATERIALS AND METHODS: We prospectively reviewed patients with grade IV or V reflux who received an endoscopic injection of Deflux. Reflux grade was evaluated before and after treatment (3 months) by use of voiding cystourethrograms. Conventional sub-trigonal injection (STING) was performed with injection of Deflux underneath the bladder mucosa at the 6 o'clock position. HIT was performed either with hydrodistention or with guidewire insertion. These techniques increase visualization of the intramural portion of the distal ureteral wall. Patients with treatment failures were offered reinjection up to three times. RESULTS: Sixty-three patients completed endoscopic injection and follow-up of 3 months. The overall resolution rate for conventional STING was 58%, i.e., 67% for grade IV and 43% for grade V. The overall resolution rate for HIT was 80%, i.e., 93% for grade IV and 66% for grade V. The modified methods showed higher resolution rates for overall cure owing to the success in patients with grade IV reflux (p=0.026). Although the success of grade V treatment was higher with the modified method, the success rate was not statistically significant (p=0.27). CONCLUSIONS: HIT with the use of either hydrodistention or a guidewire to aid in visualization of the intramural portion of the distal ureter is an effective treatment for high-grade vesico-ureteral reflux.
Bites and Stings ; Dextrans ; Follow-Up Studies ; Humans ; Hyaluronic Acid ; Mucous Membrane ; Patient Compliance ; Prospective Studies ; Treatment Failure ; Ureter ; Urinary Bladder ; Urinary Catheters ; Vesico-Ureteral Reflux ; Visual Fields

PURPOSE: Postoperative voiding dysfunction is a bothersome complication after mid-urethral sling surgery. The current study presents multiple repeated postoperative voiding trials against a urine load of preoperative functional bladder capacity, as estimated by a preoperative frequency volume chart, to identify the relevance of preoperative and immediate factors to the outcome. METHODS: A total of 180 patients were enrolled from August 2008 to August 2011. Patients received mid-urethral sling surgery with a transobturator tape, with or without concomitant cystocele repair. Patients reported relevant medical histories and a 3-day frequency volume chart and underwent urodynamic studies. After surgery, patients were filled to their maximum bladder capacity as dictated by their frequency volume chart and performed the first voiding trial. Two subsequent voiding trials were performed after natural filling. Failure of any single voiding trial was considered failure. Patients who failed the final voiding trial received intermittent catheterization to follow-up. After screening for relevant factors with the use of univariate analyses, preoperative, surgical, and postoperative factors predicting outcome were estimated by logistic regression analysis. RESULTS: The urine load at the voiding trial and the peak flow rate immediately preceding the voiding trial predicted voiding trial success in the multivariate analysis. Urine load and previous trial peak flow rate were relevant when tested against each individual voiding trial. Preoperative and surgical factors, such as age, parity, and concomitant cystocele repair, showed significance in the univariate analysis. Overall, 16.1% of patients who passed the first voiding trial failed on subsequent trials, whereas 36.8% of patients who failed the first voiding trial succeeded. CONCLUSIONS: Postoperative voiding dysfunction is transient and is associated with the immediate voiding conditions following surgery. Close observation against urine overload in the bladder is important when weaning patients back to normal voiding conditions.
Catheterization ; Catheters ; Cystocele ; Female ; Follow-Up Studies ; Humans ; Logistic Models ; Mass Screening ; Multivariate Analysis ; Parity ; Suburethral Slings ; Urinary Bladder ; Urinary Incontinence ; Urinary Retention ; Urodynamics ; Weaning

Localized scleroderma is a disease of unknown origin and is characterized by circumscribed sclerotic skin changes. When occurring in a linear pattern, it is called linear scleroderma. 'En coup de sabre' is a subtype of linear scleroderma which is characterized by band-like, ivory-colored depressions on the frontoparietal scalp region. Several treatment modalities have been used. However, they have not been effective or safe. We report our experience of two patients with 'en coup de sabre' on the forehead, who were treated successfully with polymethylmethacrylate microspheres (PMMA-NewPlastic(R)).
Depression ; Forehead ; Humans ; Microspheres* ; Polymethyl Methacrylate* ; Scalp ; Scleroderma, Localized* ; Skin

We report of a successfully treated case of fatal bronchospasm, which developed after N-acetylcysteine bolus intratracheal instillation in a 49-year-old female patient with bronchial asthma undergoing laparoscopic cholecystectomy. N-acetylcysteine has been widely used as a potent mucolytic agent since 1963, with few reported adverse reactions. Its mucolytic action is due to the breakage of disulfide bonds in mucus mucoproteins. Most adverse reactions to N-acetylcysteine are usually mild and respond to the termination of the medication and symptomatic treatment with antihistamine. However, several cases of fatal bronchospasm have been reported in asthmatic patients after inhaled or intravenous N-acetylcysteine. N-acetylcysteine induced bronchospasm could be avoided in most asthmatic patients if its concentration is not allowed to exceed 10%, and concomitant beta2-selective bronchodilators are utilized. Nevertheless, asthma is still a potent risk factor and requires special precautions, including careful risk-versus-benefit assessment, close observation and the immediate availability of resuscitation equipment and staff in the event of life-threatening bronchospasm.
Acetylcysteine* ; Asthma* ; Bronchial Spasm* ; Bronchodilator Agents ; Cholecystectomy, Laparoscopic ; Female ; Humans ; Middle Aged ; Mucoproteins ; Mucus ; Resuscitation ; Risk Factors

PURPOSE: The present study was done to define the degree of intravesical prostatic protrusion (IPP) causing bladder outlet obstruction (BOO) in patients with benign prostatic hyperplasia (BPH)/lower urinary tract symptoms. MATERIALS AND METHODS: We retrospectively evaluated 239 patients with BPH, analyzing age, IPP, prostate volume, International Prostate Symptom Score (IPSS), and the results from a pressure-flow study. Urethral resistance was quantified by using the BOO index (BOOI), according to the formula BOOI=PdetQmax-2xQmax (where Pdet is detrusor pressure at the peak flow rate and Qmax is peak flow rate). BOO was defined by a BOOI above 40. Patients with a BOOI below 20 were excluded. Patients were classified into two groups (obstructed and unobstructed groups) by the BOOI. Correlations were determined by logistic regression analysis, and receiver operating characteristic curves were plotted to estimate the optimal cutoff for IPP. RESULTS: There were significant differences in total prostate volume, postvoiding residual urine (PVR), IPP, and Qmax (p<0.001, p<0.001, p<0.001, and p=0.026, respectively) between the obstructed and unobstructed groups, but there were no significant differences in age (p=0.653), IPSS total score (p=0.624), or quality of life score (p=0.138). IPP had a significant prognosis (p<0.001) but was weakly correlated with prostate volume (p=0.026). The correlation coefficients between IPP and Qmax, PVR, prostate volume, and BOO were 0.551, -0.159, 0.225, and 0.391, respectively. For IPP, the area under the curve was 0.759 (95% confidence interval, 0.657 to 0.861) and the cutoff to indicate BOO was 5.5 mm with 66.7% sensitivity and 80.5% specificity. CONCLUSIONS: An IPP exceeding 5.5 mm was significantly associated with BOO.
Humans ; Indoles ; Logistic Models ; Prognosis ; Prostate ; Prostatic Hyperplasia ; Quality of Life ; Retrospective Studies ; ROC Curve ; Urinary Bladder ; Urinary Bladder Neck Obstruction ; Urinary Tract

Renal lymphangiomatosis is a rare developmental malformation of the perirenal lymphatic system, and this can result in the development of cystic masses in the peri-pelvic or peri-renal areas. This is difficult to differentiate from other cystic renal disease on imaging studies. We present here a case of metachronous bilateral renal lymphangiomatosis that was falsely diagnosed as a simple renal cyst. A 47 year-old man was referred for a large amount of drainage after right renal cyst marsupialization. The abdominal computed tomography(CT) findings and fluid analysis were compatible with a lymphangiomatosis. After 6 month, he presented with flank pain on his left side and CT showed intracystic hemorrhage on the left renal lymphangiomatosis. Percutaneus drainage and conservative management were done.
Male ; Humans ; Cysts