BACKGROUND AND OBJECTIVES: The Romberg test is a simple, inexpensive modality to test the vestibulo-spinal reflex. However, it is not a quantitative measure and has low sensitivity and specificity. We investigated the effectiveness of the modified Romberg test in evaluating equilibrium ability in dizzy patients by comparing it with the computerized dynamic posturography. MATERIALS AND METHODS: The study was conducted on 63 patients with various degrees of dizziness. Computerized dynamic posturography(CDP) was performed and equilibrium ability was measured with the modified Romberg test. Modifications were made in two ways : heel-to-toe standing(test 1) and standing on sponge(test 2). RESULTS: Correlation coefficients between the modified Romberg test and the vestibular dysfunction score of CDP were 0.62 and 0.52, respectively, and they were statistically significant(P<0.01). The Receiver Operating Characteristics(ROC) curve showed that the area index of tests 1 and 2 were 0.86 and 0.78, respectively. CONCLUSIONS: The modified Romberg tests showed fairly good correlation with the vestibular dysfunction score of CDP. Further modifications are required to use the modified Romberg test as an accurate diagnostic tool in the evaluation of dizzy patients.
Cytidine Diphosphate ; Dizziness ; Humans ; Posture ; Reflex* ; Sensitivity and Specificity ; Vestibular Function Tests

PURPOSE: Patent ductus arteriosus, derived left to right shunt flows, elevate the pulmonary artery pressure in infants and children and may alter right ventricular afterload thereby right ventricular function. Therefore, we examined the effects of patent ductus arteriosus on the right ventricular systolic time interval in premature infants by non-invasive Doppler echocardiography. METHODS: Tweleve premature infants with patent ductus arteriosus were studied by M-mode and Doppler echocardiography before and after treatment with mefenamic acid. Heart rate (HR), ratio of left atrium/aorta (LA/AO), right ventricular preejection period (RVPEP), right ventricular ejection time (RVET) and right ventricular systolic time interval (RVSTI : ratio of RVPEP/RVET), both corrected or uncorrected for heart rate were measured. RESULTS: After mefenamic acid treatment, in infants showing clinical response, right ventricular preejection period (RVPEP) and right ventricular systolic time intetrval (RVSTI), both corrected or uncorrected for heart rate, decreased significantly following ductal closure (RVPEP : 70.3msecc +/- 14.5 vs 54.3msec +/- 10.9, P<0.01, RVPEPc : 129.2msec +/- 13.5 vs 111.7msec +/- 8.4, P<0.01, RVSTI : 0.38 +/- 0.09 vs 0.28 +/- 0.05, P<0.05, RVSTIc : 0.31 +/- 0.04 vs 0.27 +/- 0.03, P<0.01). CONCLUSION: Premature infants with patent ductus arteriosus exhibit echocardiographic evidence of increased RVSTI as a result of increased right ventricular afterload. This results suggest that we have to make every effort to prevent the ductal reopening or early closure of ductus arteriosus in premature infants.
Child ; Ductus Arteriosus ; Ductus Arteriosus, Patent* ; Echocardiography ; Echocardiography, Doppler* ; Heart Rate ; Heart Ventricles* ; Humans ; Infant ; Infant, Newborn ; Infant, Premature* ; Mefenamic Acid ; Pulmonary Artery ; Systole ; Ventricular Function, Right

Diffuse or focal white matter hyperintensity lesions on MRI have been reported in only a few patients with Hashimoto's encephalopathy (HE), and anti-TPO antibody level is high in most cases. We report a 59-year-old woman who presented with acute onset of disorientation with confusion. Anti-thyroglobulin antibody was detected in high titer, although anti-TPO antibody titer was not high. Thyroid sonography and biopsy revealed Hashimoto's thyroiditis. Initial fluid-attenuated inversion recovery (FLAIR) image and diffusion-weighted imaging (DWI) revealed ill-defined, diffuse, high-signal intensity lesions on the deep white matters and globus pallidus. Brain SPECT showed significant hypoperfusion in both basal ganglia (especially globus pallidus), frontal and temporal lobes. With the impression of HE, the patient was treated on a high-dose steroid. Over the next 15 weeks, her cognition improved to a nearly normal state and the MRI findings on DWI and FLAIR showed resolution paralleling her clinical improvement. Our case illustrates the peculiar changes in the MR findings, especially in DWI, with hypoperfusion on brain SPECT in patients with HE and allows for a greater understanding of the pathophysiology of HE.
Autoantibodies ; Basal Ganglia ; Biopsy ; Brain ; Brain Diseases ; Cognition ; Female ; Globus Pallidus ; Hashimoto Disease ; Humans ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Temporal Lobe ; Thyroid Gland ; Thyroiditis ; Tomography, Emission-Computed, Single-Photon

Phenobarbital is a long-acting barbiturate causing generalized depression of neuronal activity in the brain. Its effect is primarily achieved through enhanced GABA-mediated synaptic inhibition. Its use as an antiepileptic agent was first described in 1912. Before the introduction of phenytoin, phenobarbital is used as sedative-hypnotics. It is used for the treatment of epilepsy and status epilepticus. All barbiturates, including phenobarbital, have a high potential far abuse. They were frequently used for suicide attempts in the past, but they have in large part been replaced by benzodiazepines. the onset of symptoms depends on the drug and the route of administration. Mild to moderate barbiturate intoxication resembles ethanol inebriation with slurred speech, ataxia, and lethargy. Severe acute barbiturate intoxication is life threatening. Early deaths are generally cardiovascular-related. Hypotension, shock, pulmonary edema, and cardiac arrest that occurs with large doses are caused by depression of central sympathetic tone and as well as by direct depression of cardiac contractility. The potentially fatal oral dose of phenobarbital is 6-l0g. We describe an 23-year-old woman with pulmonary edema and cardiac arrest after ingestion of 18 grams of phenobarbital. She was completely recovered by successful cardiopulmonary resuscitation and hemoperfusion. We report a case with literature review.
Ataxia ; Barbiturates ; Benzodiazepines ; Brain ; Cardiopulmonary Resuscitation ; Depression ; Eating ; Epilepsy ; Ethanol ; Female ; Heart Arrest* ; Hemoperfusion ; Humans ; Hypotension ; Lethargy ; Neurons ; Phenobarbital* ; Phenytoin ; Pulmonary Edema* ; Shock ; Status Epilepticus ; Suicide ; Young Adult

BACKGROUND: Poly (ADP-ribose) polymerase (PARP) has been described as an important candidate for mediation of neurotoxicity after brain ischemia. This study was purposed to evaluate the effects of a PARP inhibitor on hypoxic-ischemic injury in the neonatal rat brain. In this study, a highly potent inhibitor of PARP, 3, 4-Dihydro-5-[4-(1-piperidinyl) butoxy]-1 (2H)-isoquinolinone (DPQ) was investigated. METHODS: Seven-day old Sprague-Dawley rat pups were used. The right common carotid artery was ligated under halothane anesthesia. After a recovery period of 3 hours, they were exposed to 8% oxygen at 37degreesC for about 120 minutes. The animals were divided into four groups: the pre-treatment group (n = 13) and post-treatment group (n = 21) were given DPQ 10 mg/kg and the pre-control group (n = 7) and post-control group (n = 14) were given a vehicle for controls. Pre-treatment and pre-control groups were injected 30 minutes prior to the hypoxic injury while post-treatment and post-control groups were injected 30 minutes after the hypoxic period intraperitoneally. The right cerebral hemisphere of the rats were examined with localized (1)H magnetic resonance spectroscopy on day 1 and 7 after the hypoxic insult. Lipid/N-acetyl aspartate (Lip/NAA) and lipid/creatine (Lip/Cr) ratios were used as apoptotic markers. On day 14, the degree of brain injury was scored by morphological changes. RESULTS: In the DPQ treated groups, the Lip/NAA and Lip/Cr ratios were lower than those of the control groups on day 1 after the hypoxic-ischemic injury (P < 0.05). However on day 7, only the ratios of the pre-treatment group were lower than those of the control group (P < 0.05). The degree of morphological changes of the brain injury on day 14 were lower in the DPQ treated groups (P < 0.05). CONCLUSIONS: These results suggest that DPQ exerts a neuroprotective effect in cerebral hypoxic-ischemic injury probably by inhibiting apoptosis especially in the early stage after an insult. Acute inhibition of PARP can have a therapeutic value in preventing ischemic brain injury.
Anesthesia ; Animals ; Apoptosis ; Aspartic Acid ; Brain Injuries ; Brain Ischemia ; Brain* ; Carotid Artery, Common ; Cerebrum ; Halothane ; Magnetic Resonance Spectroscopy ; Negotiating ; Neuroprotective Agents ; Oxygen ; Rats* ; Rats, Sprague-Dawley

BACKGROUND: Flood is the most common natural disaster in our country. Lots of victims occurred during the period of flood in the northern territory of Kyoungkido on August 5, 1998. We tried to describe the characteristics of the flood-related injury and illness, management and medical requirements. METHODS: We interviewed the patients admitted to 8 hospitals in Ujungbu and reviewed medical records from aug 5 to Aug 14, 1998. RESULTS: There were total 102 patients, male were 52%and women were 48% Most of patients were between 30's and 60's. Most of them were minor, and less than 3%of them needed critical care. The diagnosis were laceration(39.2%, contusion(22.5%, fracture(13.7%, infectious disease(7.8%, ligament rupture(7.8%, aggravation of chronic illness(5.9%, dermatitis(2.0% and traumatic hyphema(1.0%. The laceration occurred in the foot(37.9%, lower leg(27.0%, thigh(16.2%, hand(10.8% and head(8.1%. The location of ligament injury were achilless tendon(62.5%, hand(25% and knee(12.5%. The 67.5%of flood-related laceration patients progressed cellulitis, especially in sutured wound and a typical tetanic patient was developed. Of hospitalized patients, 2 patients showed evidence of post-traumatic stress disorder(PTSD). CONCLUSION: During flood, civils have better to be educated about prevention of injury, such as wearing of shoes and clothes. Although laceration was minor, lacerated wounds should be thoroughly irrigated, debrided the margin and considered delayed closure, tetanus immunization. Reportedly, there is an increased prevalance of PTSD and depression after disasters. Therefore mental health care will be required in the future.
Cellulitis ; Critical Care ; Depression ; Diagnosis ; Disasters ; Female ; Gyeonggi-do ; Humans ; Immunization ; Lacerations ; Ligaments ; Male ; Medical Records ; Mental Health ; Northern Territory ; Shoes ; Stress Disorders, Post-Traumatic ; Tetanus ; Wounds and Injuries

BACKGROUND: Electrical breathing pacing has many advantages over mechanical ventilation. However, clinically permanent diaphragmatic pacing has been applied to limited patients and few temporary pacing has been reported. Our purpose is to investigate the feasibility of temporary electrical diaphragm pacing in explothoracotomy canine cases. METHODS: Five dogs were studied under the general anesthesia. Left 5th intercostal space was opened. Self designed temporary pacing leads were placed around the left phrenic nerve and connected to the myostimulator. Chest wall was closed after tube insertion with underwater drainage. Millar catheter was introduced to the aorta and right atrium. Swan-Ganz catheter was introduced to the pulmonary artery. When the self respiration was shallow with deep anesthesia, hemodynamic and tidal volume were measured with the stimulator on. RESULTS: Tidal volume increased from 143.3 +/- 51.3 ml to 272.3 +/- 87.4 ml(p=0.004). Right atrial diastolic pressure decreased from 0.7 +/- 4.0 mmHg to -10.5 +/- 4.7 mmHg(p=0.005). Pulmonary arterial diastolic pressure decreased from 6.1 +/- 2.5 mmHg to 1.2 +/- 4.8 mmHg(p<0.001). The height of water level in chest tube to show intrathoracic pressure change was from 10.3 +/- 6.7cmH2O to 20.0 +/- 5.3 cmH2O. CONCLUSION: Temporary electrical diaphragmatic pacing is a simple method to assist respiration in explothoracotomy canine cases. Self designed pacing lead is implantable and removable. Negative pressure ventilation has favorable effects on the circulatory system. Therefore, clinical application of temporary breathing pacing is feasible in thoracotomy patients to assist cardiorespiratory function.
Anesthesia ; Anesthesia, General ; Animals ; Aorta ; Blood Pressure ; Catheters ; Chest Tubes ; Diaphragm ; Dogs ; Drainage ; Heart Atria ; Hemodynamics ; Humans ; Phrenic Nerve ; Pulmonary Artery ; Respiration ; Respiration, Artificial ; Thoracic Wall ; Thoracotomy ; Tidal Volume ; Ventilation ; Water

PURPOSE: Management of cardiovascular risk factors is of major importance in renal transplant recipients to determine long-term outcomes. While calcineurin inhibitors improve the clinical course after kidney transplantation, they have been implicated in contributing to increased cardiovascular risk. This study investigated the influence of conversion from cyclosporine to tacrolimus on cardiovascular risks and graft function in renal allograft recipients with hyperlipidemia. METHODS: Twenty three adult renal recipients who were receiving cyclosporine-based regimen for more than one year after transplantation and had hyperlipidemia (serum total cholesterol > or =200 mg/dL) were enrolled. The effect of conversion from cyclosporine to tacrolimus was evaluated with blood pressure, fasting lipid profile, glucose and HbA1c. They were measured at baseline and at 1, 3, 6 and 12 months after conversion. The change in estimated glomerular filtration rate (eGRF) was also compared between before and after conversion. RESULTS: Though conversion from cyclosporine to tacrolimus did not cause significant differences in the serum triglyceride level, there was a noticeable decline in total cholesterol level (213.78+/-16.28 to 185.96+/-38.62 mg/dL, p<0.01). Conversion did not trigger new onset or worsening of diabetes mellitus with no meaningful differences in fasting blood glucose and HbA1c levels. The eGFR stabilized with Tacrolimus in comparison with the cyclosporine (-2.9+/-13.4 mL/min vs. -7.3+/-13.8 mL/min). CONCLUSION: Conversion to tacrolimus would be preferable to cyclosporine for maintenance immunesuppression in renal recipient with hyperlipidemia, as it meliorates hyperlipidemia and leads to stabilization of allograft function.
Adult ; Blood Glucose ; Blood Pressure ; Calcineurin ; Cardiovascular Diseases ; Cholesterol ; Cyclosporine ; Diabetes Mellitus ; Dyslipidemias ; Fasting ; Glomerular Filtration Rate ; Glucose ; Humans ; Hyperlipidemias ; Kidney Transplantation ; Risk Factors ; Tacrolimus ; Transplantation, Homologous ; Transplants

OBJECTIVES: The investigation of the prevalence of pleural diseases in regards to those living within 1 km of 14 asbestos mines in Chungnam province. METHODS: We enrolled 4,057 residents (male: 1,887, female: 2,170) living within 1km of asbestos mines in Chungcheong province. They received checkups from Soonchunhyang Environmental Health Center for asbestos related diseases between March 2009 and December 2009. Chest X-rays were taken from all subjects and read by two experts according to International Labor Organization guidelines. Those subjects suspected of asbestos related lesions were further checked with HRCT(high-resolution computed tomography). The determination was done by two experts after reviewing the resulting data. RESULTS: The 4,057 exposed residents underwent the checkup, 859 of whom further underwent the HRCT(high-resolution computed tomography) check. The prevalence of pleural plaque was found to be 11.3% (29.2% non-occupational, 8.0% occupational) from the chest X-rays. The HRCT(high-resolution computed tomography) results revealed that 227 subjects (26.4%) out of the 859 positive subjects (110 (18.8%) non-occupational, 117 (42.9%) occupational) showed evidence of pleural plaque. The statistical analysis showed that the prevalence of pleural plaque increased with increases in age, residence time, and occupational family exposure to asbestos (p<0.05). CONCLUSIONS: We recommend better control of asbestos in the soil and mines. We also recommend that all affected residents living near asbestos mines receive medical checkups as mandated by the asbestos health damage relief policy.
Asbestos ; Environmental Exposure ; Environmental Health ; Humans ; Korea ; Pleural Diseases ; Prevalence ; Soil ; Thorax

Ethylene glycol is a sweet-tasting liquid with industrial use as a solvent or as a starting reagent in chemical processes. Physicians are familiar with ethylene glycol because it is the major component of many antifreeze solutions and is taken in suicide attempts or, more often inadvertency. its metabolites may cause severe intoxication. Unfortunately, its metabolites are highly toxic and require rapid treatment Treatment involves correction of metabolic acidosis, ethanol administration and enhancement of elimination. The most commonly used elimination technique is hemodialysis We describe an 21-year-old man with acute renal failure due to ingestion of antifreeze that contained ethylene glycol. He was transferred to our hospital because of aggressive management The recovery of our patient with severe ethylene glycol intoxication illustrates that aggressive and early treatment can prevent mortality and morbidity.
Acidosis ; Acute Kidney Injury* ; Chemical Processes ; Eating ; Ethanol ; Ethylene Glycol* ; Humans ; Mortality ; Renal Dialysis ; Suicide ; Young Adult