BACKGROUND: Infection, one of the complications associated with procedures, can cause fatal outcomes for patients. Although the local anesthetic agent we use is less susceptible to infection due to its antibacterial action, we performed this study to check the change in the antibacterial effect of lidocaine in various clinical conditions. METHODS: After exposing lidocaine to five contaminated environments, we checked on whether the bacteria could be cultured in blood agar plate (BAP) media. In each contaminated environment, lidocaine was exposed for 4 h (n = 9) and 8 h (n = 9), and the results were compared. Lidocaine was swabbed with chlorhexidine (group A), brought into contact with saliva (group B), skin (group C), an operating room floor and an outpatient room floor (group D), operating room air for 24 h (group A-a), and outpatient room air for 24 h (group A-b). After exposure, the culture was initiated. RESULTS: In 2 of 9 BAP media where lidocaine was exposed to saliva (group B) for 8 h, growth of a colony was observed. In gram staining, it was found to be Streptococcus viridans. No bacteria were found in any other groups. CONCLUSIONS: Though lidocaine has strong antibacterial activity, it has been found that long-term exposure to a contaminated environment reduces its antibacterial activity and that drug contamination can be heavily affected not only by environmental but also human effects. Therefore, the use of aseptic drugs is necessary, and stopping the reuse of the drug is a way to prevent complications, including infection.
Agar ; Bacteria ; Chlorhexidine ; Drug Contamination ; Fatal Outcome ; Humans ; Lidocaine ; Operating Rooms ; Outpatients ; Saliva ; Skin ; Viridans Streptococci

BACKGROUND: Recent studies have shown an association between thyroid hormone levels and metabolic syndrome (MetS) among euthyroid individuals; however, there have been some inconsistencies between studies. Here, we evaluated the relationship between thyroid hormone levels and MetS in euthyroid middle-aged subjects in a large cohort. METHODS: A retrospective analysis of 13,496 euthyroid middle-aged subjects who participated in comprehensive health examinations was performed. Subjects were grouped according to thyroid stimulating hormone, total triiodothyronine (T3), total thyroxine (T4), and T3-to-T4 ratio quartile categories. We estimated the odds ratios (ORs) for MetS according to thyroid hormone quartiles using logistic regression models, adjusted for potential confounders. RESULTS: Of the study patients, 12% (n=1,664) had MetS. A higher T3 level and T3-to-T4 ratio were associated with unfavourable metabolic profiles, such as higher body mass index, systolic and diastolic blood pressure, triglycerides, fasting glucose and glycated hemoglobin, and lower high density lipoprotein cholesterol levels. The proportion of participants with MetS increased across the T3 quartile categories (P for trend <0.001) and the T3-to-T4 ratio quartile categories (P for trend <0.001). The multi-variate-adjusted OR (95% confidence interval) for MetS in the highest T3 quartile group was 1.249 (1.020 to 1.529) compared to the lowest T3 quartile group, and that in the highest T3-to-T4 ratio quartile group was 1.458 (1.141 to 1.863) compared to the lowest T3-to-T4 ratio quartile group, even after adjustment for potential confounders. CONCLUSION: Serum T3 levels and T3-to-T4 ratio are independently associated with MetS in euthyroid middle-aged subjects. Longitudinal studies are needed to define this association and its potential health implications.
Blood Pressure ; Body Mass Index ; Cholesterol, HDL ; Cohort Studies ; Fasting ; Glucose ; Hemoglobin A, Glycosylated ; Humans ; Logistic Models ; Longitudinal Studies ; Metabolome ; Odds Ratio ; Retrospective Studies ; Thyroid Gland ; Thyroid Hormones ; Thyrotropin ; Thyroxine ; Triglycerides ; Triiodothyronine*

Ewing sarcoma/peripheral primitive neuroectodermal tumor (ES/PPNET) arises from bone or soft tissue of many sites of body, but ES/PPNET, as primary lesion, in the soft tissue of neck is very uncommon. The authors experienced a case of ES/PPNET in a 17-year-old girl, which was manifested as isolated cervical mass in the soft tissue without any other suspected primary lesion or metastasis. We report the case with a brief review of the literature.
Adolescent ; Humans ; Neck ; Neoplasm Metastasis ; Neuroectodermal Tumors, Primitive ; Neuroectodermal Tumors, Primitive, Peripheral ; Sarcoma, Ewing

The incidence of serious cardiac complications associated with esophagogastro-duodenoscopic examination is very rare. An episode of cardiac arrest developed in 49-year-old during endoscopic examination. The patient had no history of pulmonary or ischemic heart disease. After cardiopulmonary resuscitation, he recovered completely. In this patient, we were able to demonstrate a focal spasm by coronary angiography.
Cardiopulmonary Resuscitation ; Coronary Angiography ; Coronary Vasospasm* ; Endoscopy, Digestive System* ; Heart Arrest ; Humans ; Incidence ; Middle Aged ; Myocardial Ischemia ; Spasm

The incidence of serious cardiac complications associated with esophagogastro-duodenoscopic examination is very rare. An episode of cardiac arrest developed in 49-year-old during endoscopic examination. The patient had no history of pulmonary or ischemic heart disease. After cardiopulmonary resuscitation, he recovered completely. In this patient, we were able to demonstrate a focal spasm by coronary angiography.
Cardiopulmonary Resuscitation ; Coronary Angiography ; Coronary Vasospasm* ; Endoscopy, Digestive System* ; Heart Arrest ; Humans ; Incidence ; Middle Aged ; Myocardial Ischemia ; Spasm

Waldenstrom's macroglobulinemia is a low- grade lymphoproliferative disorder with monoclonal IgM protein. It is characterized by normocytic, normochromic anemia and lymphoplasmacytic marrow infiltration. Chemotherapy with alkylating agents and steroids has been the standard therapy for patients with symptomatic macroglobulinemia. The purine nucleoside analogues, either alone or in combination with other chemotherapeutic agents are increasingly used, and approximately 40% of patients who have received prior therapy with alkylating agents responded. We experienced a case of Waldenstrom's macroglobulinemia suc-cessfully treated with three courses of cladribine, who had previously received unsuccessful therapy using an alkylating agent, steroid and plasmapheresis. Treatment was well tolerated except for frequent upper respiratory infections with severe pancytopenia. A marked and sustained bone marrow suppression occurred in this patient but resolved in three months without any severe infection.
Alkylating Agents ; Anemia ; Bone Marrow ; Cladribine* ; Drug Therapy ; Humans ; Immunoglobulin M ; Lymphoproliferative Disorders ; Pancytopenia ; Plasmapheresis ; Respiratory Tract Infections ; Steroids ; Waldenstrom Macroglobulinemia*

Ascites is a rare complication of multiple myeloma. When it develops, it is usually associated with extensive liver infiltration with plasma cells, infectious peritonitis or myelomatous peritoneal infiltration. Ascites caused by peritoneal infiltration is even less frequent than others. The majority of previously reported cases were characterized by an IgA paraprotein and lack of skeletal lesions. This rare extramedullary complication of myeloma has been unresponsive to therapy and rapidly fatal. Therefore, it is important to recognize myeloma as a cause of ascites and the presence of ascites heralds a poor prognosis of myeloma. We recently experienced a case of myeloma with ascites and reviewed the relevant literature of human myeloma presenting with the triad of ascites, relative or absolute sparing of the skeleton, and an IgA paraprotein. A 76-year-old man was presented with ascites early in the course of myeloma. He had no evidence of intra-abdominal plasmacytoma and skeletal lesions. Myelomatous ascites was demonstrated by the monoclonal immunoglobulin of IgA type in ascitic fluid. He was treated by plasmapheresis due to hyperviscosity syndrome and VAD combination chemotherapy. He was discharged with the improved clinical condition.
Aged ; Ascites* ; Ascitic Fluid ; Drug Therapy, Combination ; Humans ; Immunoglobulin A ; Immunoglobulins ; Liver ; Multiple Myeloma* ; Paraproteins ; Peritonitis ; Plasma Cells ; Plasmacytoma ; Plasmapheresis ; Prognosis ; Skeleton

Over Past years people have known rich medical information and knowledge through mass-media. It is needed to develop medical database, which makes people get proper medical information, So we made an effort to analysis health and medical consultation data. People easily access internet hospital of Gachon Medial School Gil Medical Center, coorperated with MIDAS Dongailbo. 4020 cases of "Questions and Answers "were conducted to access from March 25th, 1997 to March 25th, 1998. Using Java Servlet, Sybase, and Apache Web Server, we classified data. Those data present over 4000 databases, such as text (3644 cases), image (212 cases), moving picture (21 cases), and medical dictionary (416 dases). People can search symptome, or disease, what they want to know. Our database as a medical service is enhance people know about medical knowledge and information, so that they can take care of their health and prevent illness in advance.
APACHE ; Dictionaries, Medical ; Humans ; Indonesia ; Internet* ; Multimedia*

The adrenal cortical carcinoma is a rare cancer with an estimated incidence of about 1 case per 1,700,000 population. Further development of the tumor thrombi invasion of the inferior vena cava is very rare. The adrenal cortical carcinoma has poor prognosis due to delayed onset of symptoms and signs with regional and metastatic diseases are about 70M at the time of diagnosis. The diagnosis is made by hormonal and imaging studies. Adrenal cortical carcinoma is slightly more frequent in female and hormonally non-functioning tumor is more frequent. Traditionally, surgery and mitotane chemotherapy are known as a valuable therapeutic modality. But recently usefullness of mitotane is questioned due to low response rate and complication such as gastrointestinal trouble and there is not established optimal dosage and duration of treatment. Recently, in metastatic adrenal cortical carcinoma, some literature with combined chemotherapy had tried and reported good response. But, in general, combined chemotherapy has known as ineffective. We experienced and report adrenal cortical carcinoma with inferior vena caval invasion which is diagnosed by computed tomography and magnetic resonance imaging, and we treated surgery and postoperative chemotherapy.
Adrenocortical Carcinoma* ; Diagnosis ; Drug Therapy ; Female ; Humans ; Incidence ; Magnetic Resonance Imaging ; Mitotane ; Prognosis ; Vena Cava, Inferior*

Oral phosphate binders and high calcium dialysate have been used as standard therapies for dialysis patients to prevent renal osteodystrophy. Calcium containing phosphate binders are used to prevent intestinal absorption of dietary phosphate and to avoid aluminum loading by using aluminum containing phosphate binders. The use of calcium products resulted in hypercalcemia in a substantial portion of dialysis population. Calcium carbonate as a phophate binder is widely used in Korea. However, the incidence of hypercalcemia in Korean dialysis patients has not been reported to date. In this study we evaluated the incidence of hypercalcemia in dialysis patients. Patients with associated diseases that may influence serum calcium level were excluded from the study. A total of 180dialysis patients (116 HD patients and 64 CAPD patients) maintained at Soon Chun Hyang University Hospital were included. Three consecutive 2 monthly measurements of serum calcium, phosphate, albumin, alkaline phosphatase, bicarbonate in HD and two consecutive measurements in 3 month interval in CAPD patients were retrospectively evaluated. Ionized calcium and intact parathyroid hormone (N-terminal) were measured every 6 months. Serum total calcium level was corrected by serum albumin level. Three HD patients(2.5%) were hypercalcemic pre-HD while 50(43.1%) hypercalcemic postdialysis. 5 CAPD patients(7.8%) were hypercalcemic. Pre-HD calcium level did not differ from the value in CAPD patients. An average value of pre-and post-HD calcium, and serum albumin levels were significantly higher in HD patients than those values in CAPD patients(p<0.01). Ionized calcium (p<0.01) and serum PTH(p<0.05) levels were significantly higher, while serum bicarbonate level (p<0.01) was significantly lower in HD patients than in CAPD patients. The amount of calcium carbonate used were 2.2g in HD and 2.8g in CAPD. In conclusion, the incidence of hypercalcemia is low in pre-HD (2.5%) and in CAPD patients(7.8%). However, the high incidence of post-HD hypercalcemia observed in this study advocates a future study to evaluate the effect of low calcium dialyste on calcium-phosphate metabolism.
Alkaline Phosphatase ; Aluminum ; Calcium ; Calcium Carbonate ; Dialysis* ; Humans ; Hypercalcemia* ; Incidence* ; Intestinal Absorption ; Korea ; Metabolism ; Parathyroid Hormone ; Peritoneal Dialysis, Continuous Ambulatory* ; Renal Dialysis ; Renal Osteodystrophy ; Retrospective Studies ; Serum Albumin