Authors experienced a case of insulinoma which was initially misdiagnosed as idopathic temporal lobe epilepsy with automatism. This patients did not show other hypoglycemic symptoms except seizure. It has been reported that some of the patients with insulinoma are unaware of hypoglycemia and are at increased risk for seizures and coma. These patients would have normal glucose uptake in the brain and consequently no sympathoadrenal activation would begin, resulting in an awareness of hypoglycemia. It this case, abnomal EEG pattern consistent with a complex partial seizure remained after successful operation. Recent reports indicate that hypoglycemia is capable of killing neurons in the brain. An endogenous neurotoxin is produced and is released by the brain into tissue and cere-brospinal fluid. Endogenous excitotoxins produced during hypoglycemia may explain the tendency toward seizure activity often seen clinically. We suggest that persistent abnormalities of EEG in this case may be related to focal neuronal damage in hypoglycemia.
Automatism ; Brain ; Coma ; Electroencephalography* ; Epilepsy, Temporal Lobe* ; Glucose ; Homicide ; Humans ; Hypoglycemia ; Insulinoma* ; Neurons ; Neurotoxins ; Seizures ; Temporal Lobe*

Although shock in sepsis is usually managed successfully by conventional medical treatment, a subset of cases do not respond and may require salvage therapies such as veno-arterial extracorporeal membrane oxygenation (VA ECMO) support as well as an attempt to remove endotoxins. However, there are limited reports of attempts to remove endotoxins in patients with septic shock on VA ECMO support. We recently experienced a case of septic shock with severe myocardial injury whose hemodynamic improvement was unsatisfactory despite extracorporeal membrane oxygenation (ECMO) support. Since the cause of sepsis was acute pyelonephritis and blood cultures grew gram-negative bacilli, we additionally applied polymyxin B direct hemoperfusion (PMX-DHP) to the ECMO circuit and were able to successfully taper off vasopressors and wean off ECMO support. To the best of our knowledge, this is the first adult case in which PMX-DHP in addition to ECMO support was successfully utilized in a patient with septic shock. This case indicates that additional PMX-DHP therapy may be beneficial and technically feasible in patients with septic shock with severe myocardial injury refractory to ECMO support.
Adult ; Cardiomyopathies* ; Endotoxins ; Extracorporeal Membrane Oxygenation ; Hemodynamics ; Hemoperfusion* ; Humans ; Membranes* ; Oxygen* ; Polymyxin B* ; Polymyxins* ; Pyelonephritis ; Salvage Therapy ; Sepsis ; Shock ; Shock, Septic*

Azithromycin* ; Doxycycline* ; Scrub Typhus*

BACKGROUND: Epidural opioids and local anesthetics provide excellent postoperative analgesia. In addition, soft tissue and intra-articular injection of bupivacaine and morphine may have a beneficial analgesic effects after total knee arthroplasty (TKA). This study was designed to assess the additional analgesic effect of combined soft tissue, and intra-articular injection of morphine and bupivacaine in patients undergoing TKA under spinal anesthesia with continuous epidural morphine and bupivacaine injection. METHODS: Forty patients aged 55 to 75 years for a TKA under spinal anesthesia were randomly divided into 2 groups. The both group of patients received a continuous epidural infusion using a two-day infusor containing morphine 5 mg in 100 ml of 0.125% bupivacaine. The experimental group of patients (n = 20) received soft tissue, and intra-articular injection containing 10 mg morphine in 100 ml bupivacaine 0.125%. The control group of patients (n = 20) received soft tissue, and intra-articular injection of 100 ml normal saline. Postoperative pain was assessed using the visual analog scale (VAS) at 1, 2, 4, 8, 12, 24, and 48 h postoperatively and side effects, such as hypotension, nausea, vomiting, pruritus, and respiratory distress were recorded. Whenever patients demanded supplemental analgesia, diclofenac sodium 75 mg was injected intramuscularly and the need for additional analgesic requirement was recorded. RESULTS: The experimental group of patients had significantly lower pain score and analgesic requirements than the control group for 2 days. There was no difference in the incidence of side effects between groups. CONCLUSIONS: Combined soft tissue, and intra-articular injection of morphine and bupivacaine with continuous epidural morphine and bupivacaine infusion reduces postoperative pain and supplementary analgesic requirements than continuous epidural morphine and bupivacaine infusion only in patients undergoing TKA.
Analgesia ; Analgesics, Opioid ; Anesthesia, Spinal ; Anesthetics, Local ; Arthroplasty* ; Bupivacaine* ; Diclofenac ; Humans ; Hypotension ; Incidence ; Infusion Pumps ; Injections, Intra-Articular* ; Knee* ; Morphine* ; Nausea ; Pain, Postoperative ; Pruritus ; Visual Analog Scale ; Vomiting

Uterine serosal pregnancy is an extremely rare form of ectopic pregnancy. This is a report of a 35-year-old primigravida woman who was diagnosed with uterine serosal pregnancy via laparoscopic intervention. A 35-year-old woman (gravida 1, para 0) was referred from a local clinic for a ruptured left tubal pregnancy at amenorrhea 5+0 weeks with elevated serum beta human chorionic gonadotropin (16,618 mIU/mL). A pregnancy on the left posterior wall of the uterine serosa was diagnosed during the operation and successfully treated with laparoscopic surgery as a conservative management strategy to enable fertility preservation. With the advantages of ultrasonography and laparoscopy, an early diagnosis of a primary abdominal pregnancy located on the left posterior wall of the uterine serosa was made, prior to the occurrence of severe intra-abdominal massive hemorrhage, which was then treated laparoscopically as a conservative management strategy enabling the preservation of fertility.
Adult ; Amenorrhea ; Chorionic Gonadotropin ; Early Diagnosis ; Female ; Fertility ; Fertility Preservation ; Hemorrhage ; Humans ; Laparoscopy ; Pregnancy* ; Pregnancy, Abdominal ; Pregnancy, Ectopic ; Pregnancy, Tubal ; Serous Membrane ; Ultrasonography

OBJECTIVES: It was aimed to observe the regional cerebral blood flow (rCBF) response on methamphetamine challenge test in rats which were subjected to repeated administration of methamphetamine, and to investigate the mechanism(s) of changes in rCBF response in relation to the dopaminergic receptors and cyclic AMP. METHODS: Male Sprague-Dawley rats received daily injections of methamphetamine (0.3 mg/kg, i.p.) for 10 days, and were then allowed a 4-day drug-free period. Naive and methamphetamine-pretreated rats were challenged with topical application of methamphetamine on the surface of parietal cortex through a cranial window. The changes in rCBF were measured by laser-Doppler flowmetry. RESULTS: Acute topical application of methamphetamine dose-dependently increased rCBF with little effect on mean arterial blood pressure. The methamphetamine-induced increases in rCBF were significantly blocked by SCH23390, a D1-like receptor antagonist, but not by sulpiride, a D2-like receptor antagonist. Repeated administration of methamphetamine induced progressive augmentation of rCBF in response to the challenge of methamphetamine. Repeated administration of methamphetamine in combination with SKF38393, a D1-like receptor agonist, as well as with SCH23390 significantly attenuated the development of augmentation of rCBF response to methamphetamine. The augmentation of rCBF response was markedly inhibited by pretreatment with 2',3'-dideoxyadenosine, a specific adenylyl cyclase inhibitor, and Rp-cAMPS, a protein kinase A inhibitor, respectively. CONCLUSION: Based on these results, it is suggested that repeated administration of methamphetamine induces an augmentation of rCBF in response to the challenge of methamphetamine, and that D1-like receptor-mediated cyclic AMP plays a critical role in the development of augmentation of methamphetamine-induced rCBF response.
2,3,4,5-Tetrahydro-7,8-dihydroxy-1-phenyl-1H-3-benzazepine ; Adenylyl Cyclases ; Animals ; Arterial Pressure ; Cyclic AMP ; Cyclic AMP-Dependent Protein Kinases ; Dideoxyadenosine ; Humans ; Laser-Doppler Flowmetry ; Male ; Methamphetamine* ; Rabeprazole ; Rats* ; Rats, Sprague-Dawley ; Sulpiride

PURPOSE: We compared the reproducibility of 201Tl and 99mTc-sestamibi (MIBI) gated SPECT measurement of myocardial function using the Germano algorithm. MATERIALS AND METHODS: Gated SPECT acquisition was repeated in the same position in 30 patients who received 201Tl and in 26 who received 99mTc-MIBI. The quantification of end-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction (EF) on 201Tl and 99mTc-MIBI gated SPECT was processed independently using Cedars quantitative gated SPECT software. The reproducibility of the assessment of myocardial function on 201Tl gated SPECT was compared with that of 99mTc-MIBI gated SPECT. RESULTS: Correlation between the two measurements for volumes and EF was excellent by the repeated gated SPECT studies of 201Tl (r=0.928 to 0.986; p<0.05) and 99mTc-MIBI (r=0.979 to 0.997; p<0.05). However, Bland Altman analysis revealed the 95% limits of agreement (2 SD) for volumes and EF were tighter by repeated 99mTc-MIBI gated SPECT (EDV: 14.1 ml, ESV: 9.4 ml and EF: 5.5%) than by repeated 201Tl gated SPECT (EDV: 24.1 ml, ESV: 18.6 ml and EF: 10.3%). The root mean square (RMS) values of the coefficient of variation (CV) for volumes and EFs were smaller by repeated 99mTc-MIBI gated SPECT (EDV: 2.1 ml, ESV: 2.7 ml and EF: 2.3%) than by repeated 201Tl gated SPECT (EDV: 3.2 ml, ESV: 3.5 ml and EF: 5.2%). CONCLUSION: 99mTc-MIBI provides more reproducible volumes and EF than 201Tl on repeated acquisition gated SPECT. 99mTc-MIBI gated SPECT is the preferable method for the clinical monitoring of myocardial function.
Humans ; Perfusion* ; Technetium Tc 99m Sestamibi ; Tomography, Emission-Computed, Single-Photon*

We herein describe a 70-year-old woman who presented with respiratory failure due to extensive lung adenocarcinoma. Despite advanced disease, care in the intensive care unit with ventilator support was performed because she was a newly diagnosed patient and was considered to have the potential to recover after cancer treatment. Because prompt control of the cancer was needed to treat the respiratory failure, empirical treatment with an oral epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor was initiated before confirmation of EGFR-mutant adenocarcinoma, and the patient was successfully treated. Later, EGFR-mutant adenocarcinoma was confirmed.
Adenocarcinoma* ; Aged ; Female ; Humans ; Intensive Care Units ; Lung* ; Protein-Tyrosine Kinases ; Receptor, Epidermal Growth Factor ; Respiration, Artificial ; Respiratory Insufficiency* ; Ventilators, Mechanical ; Erlotinib Hydrochloride

OBJECTIVE: The purpose of this study was to identify the characteristics of school violence, self concept, psychopathology and psychosocial characteristics of male aldolescent delinquency doing school violence. And we hoped to use this result as basic material for prevention of school violence through comparison of those of students group. METHOD: We surveyed 725 male adolescents including 331 deliquents from educational program called "Big Brothers and Sisters" in Pusan. We used self-reporting questionnaire composed of demographic data and attitude to violence. In order to investigate the psychopathology and self-concept, we used Child Behavior Check List, Youth edit, Korean version(CBCL) and the Piers-Harris Children's Self-Concept Scale. Statistical methods employed were Chi-square, t-test, two-way ANOVA. RESULT: The results show that in most demographic and psychosocial factor including age, education, socio-economic condition, religion and relationship with friends, there was no significant difference between delinquent and student group. And there was no significant difference between bully and non-bully in both group. The frequency of alcohol drinking and smoking were higher in bullying groups. For the feeling of watching violent mass-media, bullying delinquents reported more excited state than non-bullying delinquents in both group. On results of CBCL, subscales of delinquent behavior, aggressive behavior, externalizing problem, social scale in delinquent group were higher than those in student group. Subscale of somatic complaints, thought problem, attention problem, delinquent behavior, aggressive behavior, internalizing problem, and externalizing problem in bullying group were higher than those in nonbullying group. In both delinquent and student group, subscale of delinquent behavior, aggressive behavior, and externalizing problem in bullying group were significantly higher than those in nonbully group. In the results of self-concept scale, subscales of behavior, intellectual and school status in delinquent group were lower than those in student group. Subscale of somatic complaints, thought problem, attention problem, delinquent behavior, aggressive behavior, internalizing problem, and externalizing problem in bullying group were higher than those in nonbully group. CONCLUSION: In both delinquent and student groups, most psychosocial factors in bully group were not significantly different with those in nonbully group. Bully group was more influenced by internal psychic state, psychopathology and environmental factor than nonbully group.
Adolescent* ; Alcohol Drinking ; Bullying ; Busan ; Child ; Child Behavior ; Education ; Friends ; Hope ; Humans ; Male ; Psychology ; Psychopathology* ; Surveys and Questionnaires ; Self Concept ; Siblings ; Smoke ; Smoking ; Social Problems ; Violence*

68Ga-DOTATOC PET/CT is widely used as a functional imaging technique in the detection and characterization of neuroendocrine tumors (NETs). Pancreatic NET and intrapancreatic accessory spleen (IPAS) have similar radiologic characteristics in anatomical imaging and usually show high uptake of 68Ga-DOTATOC. Thus, it is challenging to make a differential diagnosis between NET and IPAS when the tumor-like lesion is located in the pancreatic tail. Here, we present a case of 68Ga-DOTATOC PET-positive pancreatic tail lesion with high arterial enhancement on CT and MRI. Since 99mTc-labeled damaged red blood cell does not accumulate on NET, a negative spleen scan finding was a crucial diagnostic step to decide surgical resection, which was histologically proven as insulinoma. Our case shows a promising role of additional use of spleen scan with SPECT/CT for the differential diagnosis of 68Ga-DOTATOC PET-positive pancreatic NET from the accessory spleen.