Rhabdomyolysis is a complex medical condition in which insufficient energy supply to muscles results in the destruction of skeletal muscle and leakage of toxic intracellular substances into the systemic circulation. The common cause of rhabdomyolysis is a direct traumatic injury; however, it can also occur due to non-traumatic factors, including infection, toxins, and drugs. Rhabdomyolysis as an adverse effect of antipsychotic medication is not well understood. Peripheral neuropathy is a rare complication of rhabdomyolysis. Here, we present a case of a 22-year-old woman who presented to the emergency department with right thigh pain following an antipsychotic drug overdose and 3 days of loss of consciousness. There was no history of trauma to her leg. Physical examination, diagnostic testing, and imaging indicated a diagnosis of rhabdomyolysis and peripheral neuropathy. The patient underwent an incision with drainage, a muscle biopsy, and was treated with hydration, after which her condition improved, and she was discharged. Follow-up testing indicated lasting nerve injury. Peripheral neuropathy can occur even in patients with rhabdomyolysis without compartment syndrome. Awareness of this rare complication may help in initiating early interventions to minimize irreversible sequelae.

There are various etilogic factors concerned in the formation of pulmonary edema but it is rare that pulmonary edema is elicited as a consequence of direct current shock. The cause of this complication is unknown. The mechanism of pulmonary edema is suspected that acute alteration or disparities in atrial or ventricular mechanical function of the heart consequent to the application of electrical discharge precipitate pulmonary congestion. A case of acute pulmonary edema following the use of direct current shock during anesthesia for mitral commissurotomy was experienced. The patient was treated with oxygen, diuretics, steroid, continuous positive pressure ventilation and partial cardiopulmonary bypass. The patient recovered without further event.
Anesthesia ; Cardiopulmonary Bypass ; Diuretics ; Estrogens, Conjugated (USP) ; Heart ; Humans ; Oxygen ; Positive-Pressure Respiration ; Pulmonary Edema* ; Shock* ; Thoracic Surgery*

OBJECTIVE: The purposes of this study were to evaluate the causes of intoeing gait and to investigate the association between femoral anteversion and tibial torsion. METHODS: The subjects were 23 children with intoeing gait. The association between increased femoral anteversion and external torsion of the tibia was investigated by computed tomography and 3-dimensional computed tomography. The tibial torsion angle was measured by computed tomography. Femoral anteversion angle was measured by computed tomography and 3-dimensional computed tomography. RESULTS: The intoeing gait was caused by increased femoral anteversion in 67.4% of the cases, by internal tibial torsion in 21.7% and by other factors in 10.9%. There was a clear correlation between the degree of femoral anteversion and the degree of external torsion of the tibia. CONCLUSION: The results of this study indicate that most common cause of intoeing gait is increased femoral anteversion and that in cases of increased femoral anteversion, compensatory external torsion of the tibia develops during growth.
Child ; Gait* ; Humans ; Tibia

Brain Computerized Tomography(CT) and cerebral angiography were reviewed in thirty-six patients with multiple intracranial aneurysms(22.5%) among the 160 consecutive surgical cases of intracranial aneurysms. The prevalent sites of multiple aneurysms were the middle cerebral artery(37.0%), posterior communicating artery(22.2%), and internal carotid artery(14.8%) in sequence. However, the vertebrobasilar system(83.3%), anterior communicating artery(63.6%), and posterior communicating artery(50.0%) had higher probability of rupture than internal carotid artery(8.3%) or middle cerebral artery(33.3%). Based on CT and angiographic information, the site of rupture can be predicted with a high degree of reliability. These factors were the presence of localized hemorrhage on CT, focal vasospasm, size and irregularity of aneurysms, and relative hyperplasia of parent artery.
Aneurysm ; Arteries ; Brain ; Cerebral Angiography ; Hemorrhage ; Humans ; Hyperplasia ; Intracranial Aneurysm ; Parents ; Rupture

Twenty patients with a major thoracolumbar or lumbar spine fractures were treated with various kinds of internal fixation device through anterior or posterior approach during last 2 years. Anterior spinal surgery(10 patients) applied to the patients who had a major fracture of anterior compartment with neural canal impingement and condisted of anterior decompression through vertebrectomy and stabilization with Kaneda device. Posterior spinal surgery(9 patients) applied to mainly posterior compartment injury and consisted of stabilization with Harrington instrument(3 patients) and Roy-Camille plate system(6 patients). The other one patient was treated with a combined approach of anterior decompression and posterior Harrington instrumentation. No patients showed neurological deterioration after surgery and 15 patients(75%) improved postoperatively with entering the next Frankel subgroup. Radiologic evaluation showed the correction of the fracture deformity with satisfactory outcome postoperatively. There was no significant difference between anterior and posterior spinal surgery regarding operative result.
Congenital Abnormalities ; Decompression ; Decompression, Surgical* ; Humans ; Internal Fixators ; Neural Tube ; Spine*

Nonsurgical management of four cases of the parasagittal epidural hematoma were experienced. Patients were mildly symptomatic or minimal neurological disturbances on admission. Patients were treated conservatively because of stable neurologic sign. All patients had who diastatic fracture and / or suture have become a complete neurological recovery with satisfactory absorption of EDH over a period of 5 to 12 weeks.
Absorption ; Hematoma* ; Humans ; Neurologic Manifestations ; Sutures

PURPOSE: In cases of locally advanced non-small cell lung cancer (NSCLC), concurrent chemoradiotherapy (CCRT) is the leading therapeutic modality. However, much controversy exists about the chemotherapeutic regimens and radiation methods. MATERIALS AND METHODS: During concurrent chemoradiotherapy, three or four cycles of gemcitabine (500 mg/m2) and cisplatin (30 mg/m2) were administered every two weeks while 50.4 Gy of irradiation was administered in 28 fractions (once/day, 5 treatment days/week) to the tumor site, mediastinum, and the involved lymph node region. In addition, a booster irradiation dose of 18 Gy in 10 fractions was administered to the primary tumor site unless the disease progressed. Two or three cycles of consolidation chemotherapy were performed with gemcitabine (1,200 mg/m2, 1st and 8th day) and cisplatin (60 mg/m2) every three weeks. RESULTS: A total of 29 patients were evaluable for modality response. Response and treatment toxicities were assessed after concurrent chemoradiotherapy and consolidation chemotherapy, respectively. One patient (4%) achieved a complete response; whereas 20 patients (69%) achieved a partial response after concurrent chemoradiotherapy. Following the consolidation chemotherapy, three patients (10.3%) achieved complete responses and 21 patients (72.4%) achieved partial responses. The median follow-up period was 20 months (range 3m39 months) and the median survival time was 16 months (95% CI; 2.4m39.2 months). The survival rates in one, two, and three years after the completion of treatment were 62.7%, 43.9%, and 20%, respectively. Complications associated to this treatment modality included grade 3 or 4 esophagitis, which occurred in 15 patients (51.7%). In addition, an incidence of 24% for grade 3 and 14% for grade 4 neutropenia. Lastly, grade 2 radiation pneumonitis occurred in 6 patients (22%). CONCLUSION: The response rate and survival time of concurrent chemoradiotherapy with biweekly gemcitabine (500 mg/m2) and cisplatin (30 mg/m2) were encouraging in patients with locally advanced NSCLC. However, treatment related toxicities were significant, indicating that further modification of therapy seems to be warranted.
Incidence ; Chemoradiotherapy ; Lung Neoplasms

Intracranial pressure was monitored in 23 patients, either who exhibited an increase in pressure or who were considered at risk for the developement of intracranial hypertention. The intracranial pressure was measured while the patient was in the position from supine to 50 degree of head elevation. The intracranial pressure was decreased during head elevation, but 8 cases(34.8%) were not changed. The maximal cerebral perfusion pressure was seen at 50 degree of head elevation(52.2%), next 30 degree(21.7%) and 40 degree(7.4%) in orders. The changes of vital sign were not significant during head elevation. To control the intracranial pressure, the patient who were managed in the position of 30degrees and 50degrees head elevation showed most effective cerebral perfusion pressure without any significant changes of the vital sign and central venous pressure.
Central Venous Pressure ; Head* ; Humans ; Intracranial Pressure* ; Perfusion* ; Vital Signs*

Cerebrospinal fluid lactate and intracranial pressure were measured in 24 severely head-injured patients with Glasgow coma scale below 8. Cerebral perfusion pressure, vital sign and CVP were also measured simultaneously. Severely head-injured patients revealed increased CSF lactate and intracranial pressure which have been significantly correlated with outcome. But changes of vital sign, cerebral perfusion pressure and CVP were not correlated with outcome. The elevation of intracranial pressure checked on arrival was statistically significant in correlation to outcome. And the elevation of CSF lactate were correlated with statistically significance in correlation with outcome and lactate level checked on time interval(arrival, 12hr, 24hr, 48hr after trauma). And so CSF lactate levels are statistically more significant than intracranial pressure in predicting prognosis. We will expect good prognosis in severely head-injured patient by reducing intracranial pressure and CSF lactate, oxygenation and increasing cerebral perfusion.
Cerebrospinal Fluid ; Glasgow Coma Scale ; Humans ; Intracranial Pressure ; Lactic Acid* ; Oxygen ; Perfusion ; Prognosis* ; Vital Signs

BACKGROUND: There are many combinations of treatment for locally advanced non-small cell lung cancer (NSCLC). Recent studies have showed the efficacy of concurrent chemoradiotherapy (CCRT) in NSCLC. At present, however, there is no consensus about the optimal dosages and timing of radiation and chemotherapeutic agents. The aims of study were to determine the feasibility, toxicity, response rate, and survival rate in locally advanced NSCLC patients treated with doxetaxel and cisplatin based CCRT. METHOD: Sixteen patients with unresectable stage III NSCLC were evaluated from May 2000 until September 2001. Induction chemoradiotherapy consisted of 3 cycles of docetaxel (75 mg/m2/IV on day 1) and cisplatin (60 mg/m2/IV on day 1) chemotherapy every 3 weeks and concomitant hyperfractionated chest irradiation (1.15 Gy/BID, total dose of 69 Gy) in 6 weeks. Patient who had complete or partial response, and stable disease were applied consolidation chemotherapy of docetaxel and cisplatin. RESULTS: All patients showed response to CCRT. Four patients achieved complete response (25%), partial responses in 12 patients (75%). The major common toxicities were grade III or more of neutropenia (87.3%), grade III esophagitis (68.8%), pneumonia (18.8%) and grade III radiation pneumonitis (12.5%). Thirteen patients were ceased during follow-up period. Median survival time was 19.9 months (95% CI; 4.3-39.7 months). The survival rates in one, two, and three years are 68.7%, 43.7%, and 29.1%, respectively. Local recurrence was found in 11 patients (66.8%), bone metastasis in 2, and brain metastasis in 1 patient. CONCLUSION: The response rate and survival time of CCRT with docetaxel/cisplatin in locally advanced NSCLC were encouraging, but treatment related toxicities were high. Further modification of therapy seems to be warranted.
Brain ; Carcinoma, Non-Small-Cell Lung* ; Chemoradiotherapy ; Cisplatin ; Consensus ; Consolidation Chemotherapy ; Drug Therapy ; Esophagitis ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Neutropenia ; Pneumonia ; Radiation Pneumonitis ; Radiotherapy* ; Recurrence ; Survival Rate ; Thorax