No abstract available.

Acute myocardial infarction after a bee sting is a very rare process. Among proposed mechanisms, vasospasm of the coronary artery is the most probable mechanism. Many mediators are included in the venom of wasps, and those mediators have vasoconstrictive properties and may constrict the coronary artery. Furthemore, those mediators have thrombogenic properties that lead to thrombogenesis in the coronary artery and aggravate myocardial ischemia. Epinephrine, commonly used in the management of anaphylactic shock, may further aggravate myocardial ischemia. We experienced two cases of acute myocardial infarction after a bee sting. In the first case, we could find no underlying abnormalities of the coronary vessel because the patient died during coronary angiography. In the second case, the electrocardiogram showed inferior wall myocardial infarction, but only mild stenosis of the right coronary artery was seen in coronary angiography.
Anaphylaxis ; Bees* ; Bites and Stings* ; Constriction, Pathologic ; Coronary Angiography ; Coronary Vessels ; Electrocardiography ; Epinephrine ; Humans ; Inferior Wall Myocardial Infarction ; Myocardial Infarction* ; Myocardial Ischemia ; Venoms ; Wasps

The importance of tick-borne diseases is increasing because of climate change, with a lack of long-term studies on tick-borne pathogens in South Korea. To understand the epidemiological characteristics of tick-borne diseases, the monthly distribution of field ticks throughout the year was studied in South Korea between May 2014 and April 2018 in a cross sectional study.

PURPOSE: To determine the change of exoangle according to the measure distance and 1-hour occlusion of exotropic eye in intermittent exotropia. METHODS: We prospectively reviewed the records of 60 patients diagnosed with intermittent exotropia. The exoangle was measured at 6 m, 14 m, outdoor 30 m and at 6 m after occlusion of exotropic eye for 1 hour. Refractive error, stereoacuity and suppression were investigated in all subjects. RESULTS: The mean amount of exoangle was 28.2 +/- 5.64 PD at 6 m, 29.7 +/- 6.54 PD at 14 m and 30.3 +/- 2.84 PD at outdoor 30 m. The amounts of exoangle at 14 m and at outdoor 30 m were significantly increased compared with that at 6 m (p=0.009 and p=0.005, respectively). However, there was no significant difference between that at 14 m and at 30 m (p=0.08). The mean amount of exoangle after occlusion of exotropic eye for 1 hour was 29.3 +/- 5.48 PD, which was not statistically different from that at 14 m (p=0.44) and at 30 m (p=0.19). In 31 patients (51.7%) who had an increase of exoangle more than 3 PD at 14 m and 30 m compared to that at 6 m, mean exoangle at 6 m was 31.4 +/- 5.30 PD. In 29 patients (48.3%) who had an increase of exoangle less than 3PD, mean exoangle at 6 m was 26.2 +/- 5.72 PD. Increase of exoangle was prominent in patients with exoangle more than 30 PD at 6 m. There was no correlation in the amount of exoangle according to refractive error, stereoacuity and the presence of suppression (p=0.17, p=0.47, p=1.0, respectively). CONCLUSIONS: The exoangle increased at distances longer than 6 m and after 1-hour occlusion of exotropic eye in intermittent exotropia. The increment of exoangle according to distance was prominent in patients with exoangle more than 30 PD at 6 m.
Exotropia* ; Humans ; Prospective Studies ; Refractive Errors

No abstract available.
Rhinoplasty*

Glioblastoma multiforme (GBM) is a brain tumor notorious for its malignancy. The key reason for the limited efficacy of standard treatment is the high recurrence rate of GBM, even after surgical resection. Hence, intensive postsurgical chemical therapies, such as the systemic delivery of various drugs and/ or drug combinations, are typically followed after surgery. However, overcoming the blood-brain barrier by systemic administration to efficiently deliver drugs to the brain tumor remains a daunting goal. Therefore, various local drug delivery methods showing potential for improved therapeutic efficacy have been proposed. In particular, the recent application of electronic devices for the controlled delivery of chemotherapy drugs to GBM tissue has attracted attention. We herein review the recent progress of local drug delivery strategies, including electronics-assisted strategies, at the research and commercial level. We also present a brief discussion of the unsolved challenges and future research direction of localized chemotherapy methods for GBM.

PURPOSE:We performed this study to evaluate the clinical significance and temporal changes of pleural effusion developed after the resection of hepatoma. MATERIALS AND METHODS: We reviewed retrospectively follow-up chest radiographs of 97 patients who had undergone operation for hepatoma and had no radiologically demonstrable postoperative complications. The duration of pleural effusion was classified into five groups and the amount of pleural effusion at one week after operation was graded into four groups. Statistical significance of the relationship between the duration, amount of pleural effusion and five factors, which are location and size of tumor, age of the patients, methods of operation, and preoperative liver function, was studied respectively. RESULTS:Pleural effusion was developed in 63.9% (62/97) and the mean duration was 2.5 weeks. In 92% (52/56), pleural effusion disappeared spontaneously within four weeks. Patients who had hepatoma in upper portion of the right lobe developed more frequent pleural effusion which persisted longer, and was larger in amount at one week after operation(p<0.05). There were no statistically significant differences between pleural effusion and the other four factors. CONCLUSION:Pleural effusion following hepatoma surgery should not be regarded as a sign of post-operative complication, as it invariably disappears spontaneously within four weeks. Development of pleural effusion is considered to be caused by local irritation and disturbance of lymphatic flow at the diaphragm.
Carcinoma, Hepatocellular* ; Diaphragm ; Follow-Up Studies ; Humans ; Incidence* ; Liver ; Pleural Effusion* ; Postoperative Complications ; Radiography, Thoracic ; Retrospective Studies

We report a rare case of severe hypoglycemia after sunitinib treatment for pancreatic neuroendocrine carcinoma. We describe the initial clinical presentation, laboratory results, pathologic findings, and managment in a patient with a nonfunctioning pancreatic neuroendocrine carcinoma with liver metastases who developed life threatening hypoglycemia after 2 months of sunitinib therapy. A 46-year-old woman presented to the emergency department with loss of consciousness from hypoglycemia. Serum C-peptide and insulin levels at fasting state revealed that the hypoglycemia resulted from endogenous hyperinsulinemia. She had been diagnosed with nonfunctioning pancreatic neuroendocrine carcinoma based on a biopsy of metastatic cervical lymph node and was being treated with sunitinib, a small molecule tyrosine kinase inhibitor. Immunohistochemical stain of the metastatic liver mass demonstrated that the initially nonfunctioning neuroendocrine carcinoma cells had changed into insulin-producing cells after sunitinib therapy. Transarterial chemoembolization of the liver masses and systemic chemotherapy with streptozotocin/adriamycin relieved the hypoglycemia. A nonfunctioning pancreatic neuroendocrine carcinoma was transformed into an insulin-producing tumor after treatment with sunitinib, causing endogenous hyperinsulinemia and severe hypoglycemia.
Biopsy ; C-Peptide ; Carcinoma, Neuroendocrine ; Emergencies ; Fasting ; Female ; Humans ; Hyperinsulinism ; Hypoglycemia ; Indoles ; Insulin ; Insulinoma ; Liver ; Lymph Nodes ; Neoplasm Metastasis ; Protein-Tyrosine Kinases ; Pyrroles ; Unconsciousness

OBJECTIVE: To evaluate the performance and reproducibility of a computer-aided detection (CAD) system in mediolateral oblique (MLO) digital mammograms taken serially, without release of breast compression. MATERIALS AND METHODS: A CAD system was applied preoperatively to the full-field digital mammograms of two MLO views taken without release of breast compression in 82 patients (age range: 33-83 years; mean age: 49 years) with previously diagnosed breast cancers. The total number of visible lesion components in 82 patients was 101: 66 masses and 35 microcalcifications. We analyzed the sensitivity and reproducibility of the CAD marks. RESULTS: he sensitivity of the CAD system for first MLO views was 71% (47/66) for masses and 80% (28/35) for microcalcifications. The sensitivity of the CAD system for second MLO views was 68% (45/66) for masses and 17% (6/35) for microcalcifications. In 84 ipsilateral serial MLO image sets (two patients had bilateral cancers), identical images, regardless of the existence of CAD marks, were obtained for 35% (29/84) and identical images with CAD marks were obtained for 29% (23/78). Identical images, regardless of the existence of CAD marks, for contralateral MLO images were 65% (52/80) and identical images with CAD marks were obtained for 28% (11/39). The reproducibility of CAD marks for the true positive masses in serial MLO views was 84% (42/50) and that for the true positive microcalcifications was 0% (0/34). CONCLUSION: The CAD system in digital mammograms showed a high sensitivity for detecting masses and microcalcifications. However, reproducibility of microcalcification marks was very low in MLO views taken serially without release of breast compression. Minute positional change and patient movement can alter the images and result in a significant effect on the algorithm utilized by the CAD for detecting microcalcifications.
Adult ; Aged ; Aged, 80 and over ; Breast Neoplasms/radiography ; Calcinosis/radiography ; False Positive Reactions ; Female ; Humans ; Mammography/*methods ; Middle Aged ; *Radiographic Image Interpretation, Computer-Assisted ; Reproducibility of Results ; Sensitivity and Specificity

PURPOSE: The aim of the current study was to examine the characteristics of suicidal attempters who visited the emergency department (ED) with a psychiatric diagnosis of adjustment disorder. METHODS: Suicidal attempters who had visited the ED were retrospectively selected between January 2015 and December 2015. Sex, age, marital status, psychiatric diagnosis, causes of suicidal attempt, methods of suicidal attempt, influence of alcohol, and results of ED management were reviewed in the medical records. RESULTS: A total of 468 suicide attempters who had visited the ED were interviewed by psychiatrists, and 323 cases were included. Adjustment disorder is the most common diagnosis among these patients (N=202, 62.5%). There was no statistical difference between the adjustment disorder group and the non-adjustment disorder group with respect to marital status, psychiatric diagnosis, causes of suicidal attempt, methods of suicidal attempt, and results of ED management. The number of patients under the influence of alcohol who visited the ED was higher in the adjustment disorder group (p=0.04). CONCLUSION: Adjustment disorder is the most common diagnosis among suicidal attempters who visit the ED. Suicidal attempt in the adjustment disorder group is likely an impulsive decision, but their admission results are just as poor as the non-adjust disorder group.
Adjustment Disorders* ; Diagnosis ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Marital Status ; Medical Records ; Mental Disorders ; Prognosis ; Psychiatry ; Retrospective Studies ; Suicide*