Tetanus is a rare disease in the developed countries, including Korea, as a result of nearly universal active immunization. Because many physicians have little experience with its diagnosis and management, misdiagnosis and therapeutic delay may result in catastrophic consequences. We report one case of generalized tetanus. A previously healthy 35-year-old man was admitted to the emergency department because of stiffness on jaw and neck. board-like abdomen, extended and rigid both legs, chest tightness, and dyspnea. Seven days before admission, he was injured on the right thing at work. In the emergency department, he was given 5,000 units of human tetanus immunoglobulin intramuscularly, as well as diazepam 2 mg/hr intravenously. On the second hospital day, tracheostomy was performed. Ten days later, his condition was improved. Twenty eight days after admission, he was discharged without any complication.
Abdomen ; Adult ; Developed Countries ; Diagnosis ; Diagnostic Errors ; Diazepam ; Dyspnea ; Emergency Service, Hospital ; Humans ; Immunoglobulins ; Jaw ; Korea ; Leg ; Neck ; Rare Diseases ; Tetanus* ; Thorax ; Tracheostomy ; Vaccination

The intracranial epidural abscess is a not indenpendent disease which is practically always secondary to osteitis or osteomyelitis of overlying bone. Also it was developed from complication of frontal sinusitis, middle ear or mastoiditis, incomplete debridement of compound comminuted depressed fracture and post-operative complications. Occasionally it was derived from dural sinus thrombophlebitis especially cavernous sinus. It was frequently developed frontal and temporal region. We have experienced 5 cases of intracranial epidural abscesses for this one year. Followings are the results ; 1. The causes were complication of compound depressed fracture, chronic osteomyelitis and post-operative complications. 2. The usual symptom was headache, fever and increased lethargy. 3. The laboratory findings of CBC were the increased WBC count and ESR. The CSF findings revealed occasionally increased the cell count and sugar. 4. The pus culture revealed proteus, coliform bacilli and paracolon bacili. 5. Treatment was surgical removal of overlying diseased bone, drainage of the purulent materials and instillation of antibotics irrigation. 6. The prognosis of the 5 cases of the intracranial epidural abscess was good. There was not appeared any complication or sequelae.
Cavernous Sinus ; Cell Count ; Debridement ; Drainage ; Ear, Middle ; Enterobacteriaceae ; Epidural Abscess* ; Fever ; Frontal Sinus ; Frontal Sinusitis ; Headache ; Lethargy ; Mastoid ; Mastoiditis ; Osteitis ; Osteomyelitis ; Prognosis ; Proteus ; Suppuration ; Thrombophlebitis

PURPOSE: To compare the accuracy and reproducibility of central corneal thickness measured by non-contact specular microscopy, ultrasound pachymetry, and Orbscan in the post-penetrating keratoplasty eyes. METHODS: Central corneal thickness was prospectively measured in eyes that had recieved penetrating keratoplasty at least 1 month before. One experienced technician measured all eyes using three methods; non-contact specular microscopy (Topcon SP-2000P; Topcon Corporation, Tokyo, Japan), Orbscan IIz (Orbtek; Bausch & Lomb, Rochester, USA), and ultrasound pachymetry (AL-2000; Tomey, Erlangen, Germany). Three consecutive measurements were performed using each method and the mean values and coefficient of variation were compared. RESULTS: The mean values of central corneal thickness were 550.7+/-63.3 micrometer with specular microscopy, 548.2+/-72.5 micrometer with ultrasound pachymetry, and 472.5+/-151.7 micrometer with Orbscan. There was no significant difference between the measurements obtained by specular microscopy and ultrasound pachymetry (p=0.53), and both methods showed high reproducibility. The corneal thickness measured by Orbscan was remarkably variable and in some patients, Orbscan was unable to measure corneal thickness. CONCLUSIONS: Non-contact specular microscopy appears to be an effective technique, potentially replacing ultrasound pachymetry for measuring central corneal thickness in the post-penetrating keratoplasty eyes.
Corneal Transplantation ; Humans ; Keratoplasty, Penetrating ; Microscopy ; Prospective Studies ; Ultrasonography

Antidepressant prescription for youths has recently been on the increase. There is a growing concern over the increasing off-label usage of antidepressants. Current data on off-label antidepressant usage vary across countries and healthcare systems. Therefore, we examined the extent and pattern of antidepressant prescription for Korean children and adolescents using population-based data. Our data was retrieved from the Korean National Health Insurance Service National Sample Cohort of the year 2013. Among 0.2 million children and adolescents aged 6–18 years from the cohort, subjects who had received any antidepressant medication in the year 2013 were investigated for the prescribed medication, concomitant psychotropic medication, and the associated diagnosis. A total of 2,190 children and adolescents (boys, 55.4%) received antidepressant medication. The most common diagnosis was depressive disorders (n = 469, 21.4%), followed by attention-deficit/hyperactivity disorder (n = 442, 20.2%). Among the prescriptions (n = 3,370), escitalopram (n = 650, 24.1%) and fluoxetine (n = 553, 20.5%) were the two most frequently prescribed drugs. A majority of prescriptions (n = 2,039, 60.5%) included concomitant psychotropic agents, consisting of antipsychotics (n = 901, 26.7%), sedatives (n = 263, 26.3%), medication for attention-deficit/hyperactivity disorder (n = 822, 24.4%), and some others. Our study shows the prescription pattern of antidepressants for children and adolescents in Korea, of which a large proportion is off-label. The results call for close monitoring by clinicians treating this population.
Adolescent* ; Antidepressive Agents* ; Antipsychotic Agents ; Child* ; Citalopram ; Cohort Studies ; Delivery of Health Care ; Depressive Disorder ; Diagnosis ; Fluoxetine ; Humans ; Hypnotics and Sedatives ; Korea* ; National Health Programs ; Off-Label Use ; Prescriptions*

OBJECTIVE: The aim of this study was to develop critical pathway for post operation care of laparoscopic assisted vaginal hysterectomy with time and cost effectiveness using a clinical pathway assistant program (MDCPA(TM), MDware Co.) METHODS: Procedure was done with the following steps; establishment of conceptual framework, development of preliminary critical pathway using CPA program, expert validity test, and confirmation of final critical pathway. RESULTS: Preliminary critical pathway was extracted by CPA program, and this result was verified by expert validity test. The process of data collection and analysis to develop the preliminary critical pathway was accomplished automatically by CPA program. The patients' hospitalization period in the aspect of time and cost effectiveness was confirmed as 6 days, and each item of assessment, test, medication, treatment, diet, activity, and teaching were finalized. CONCLUSION: The CPA program can automate the complicated process, which contains collecting and cleaning the large size EMR data, classifying and confirming the items in critical pathway, so that the time and cost to develop a critical pathway can be reduced. This program is expected to be used for development of critical pathway in a variety of clinical settings in the aspect of time and cost effectiveness.
Cost-Benefit Analysis ; Critical Pathways ; Data Collection ; Diet ; Female ; Glycolates ; Hospitalization ; Hysterectomy ; Hysterectomy, Vaginal ; Medical Records

The majority of metastatic lesions involving the skull arise from carcinoma of the breast and lung. Bone metastass from a wide speculum of malignant neoplasms may be discussed in general as osteoblastic or osteoclastic in type. In osteoblastic from there are carcinoma of the prostate, carcinoma of the breast, carcinoma of the urinary bladder and rarely hypernephroma and cholangiocellular hepatoma. Osteoclastic metastass are characteristically produced by carcinoma of the lung, uterus, gastrointestinal tract, and thyroid and malignant melanoma, and rarely hepatocellular hepatoma, Osteoclastic or osteolytic lesions are much more frequent. Osteolytic metastass to the skull typically present as multiple radiolucenices with ill-defined margin. Metastases may affect any portion of the skull, not only the calvaria but also the base. Recently we experienced a rare case of metastatic hepatocellular carcinoma to the skull. A 51 year old Korean male was admitted to the Dept. of neurosurgery, on Jan. 18, 1975. Patient had complained of headache and mass on the right frontoparietal region for ca 6 weeks and motor weakness on the left extremities for 2 weeks prior to admission. No jaundice and weight loss were complained. The mass on the right frontoparietal region had increased its size gradually and showed adult fist in its size on admission. Neurological examination on admission disclosed that the adult-fist sized mass on the right frontoparietal region was non-tender and palpated soft, and deep tendon reflexes were hyperactive, on the left, and Lt. Superficial reflexes were diminished. No spasticity was noted, and left grasping power was markedly weak. Hypersthesia was felt on the left of the body. No icterus was found. Nor palpable liver neither spleen was found. No tenderness on the abdomen and no palpable masses were noted. Complete blood cell counting was normal. The blood chemistry including the liver function test revealed normal except increased alkaline phosphatase(10.5 Bodansky units). (-feto-protein was negative. Urinalysis and stool examination were normal. X-ray films of simple skull series revealed multiple radiolucencies with ill-defined margins on the right fronto-parietal bone. Right carotid angiograms showed the left square shifting of the right anterior cerebral artery to the left and compressed downward the Rt. Middle cerebral artery, and abnormal vessels in tumor mass were supplied by only the Rt. External carotid artery extracranially and intracranially. Liver scanning was normal. A decompression craniectomy was performed. Extracranially the tumor mass was brownish yellow and soft, which seemed to be the lipoma in character. The skull bone was destroyed multiply. Intracranilly same mass was found. They were removed totally without any bleeding. The operation was finished in usual way, and biopsy was attempted. The post-operative course was usual one except no recovery of the neurologic deficit for 2 weeks. Microscopic examination revealed a metastatic hepatocelluar hepatoma.
Abdomen ; Adult ; Anterior Cerebral Artery ; Biopsy ; Blood Cell Count ; Breast ; Carcinoma, Hepatocellular* ; Carcinoma, Renal Cell ; Carotid Artery, External ; Chemistry ; Decompression ; Extremities ; Gastrointestinal Tract ; Hand Strength ; Headache ; Hemorrhage ; Humans ; Jaundice ; Lipoma ; Liver ; Liver Function Tests ; Lung ; Male ; Melanoma ; Middle Aged ; Middle Cerebral Artery ; Muscle Spasticity ; Neoplasm Metastasis ; Neurologic Examination ; Neurologic Manifestations ; Neurosurgery ; Osteoblasts ; Osteoclasts ; Prostate ; Reflex ; Reflex, Stretch ; Skull* ; Spleen ; Surgical Instruments ; Thyroid Gland ; Urinalysis ; Urinary Bladder ; Uterus ; Weight Loss ; X-Ray Film

BACKGROUND: Administration of anticancer drugs may damage gastrointestinal epithelium, thereby increasing the permeability of the gastrointestinal mucosa. It is known that intestinal permeability test using 51Cr-EDTA is a useful test to assess the damage of intestine. The aim of this study was to evaluate intestinal permeability in patients who were treated with 5-fluorouracil (5-FU) based chemotherapy and to evaluate the relationship between the excretion of 51Cr-EDTA and the grading of mucositis. METHODS: Twenty eight patients who were treated with 5-FU based chemotherapy were chosen as study cases while 18 healthy volunteers as controls. Intestinal permeability was assessed by measurement of the urinary excretion of 51Cr-EDTA after oral challenge, and the National Cancer Institute common toxicity criteria were used for assessing oral mucositis. RESULTS: All except 3 patients in the chemotherapy group experienced grade 1~3 stomatitis. The median value of intestinal permeability test was significantly higher in the chemotherapy group than in control group (7.61%, range 2.10-22.92 vs 2.17%, range 1.16-2.76, respectively, p<0.001). The grading of oral mucositis did correlate with the urinary excretion of 51Cr-EDTA (p<0.001, r=0.867). CONCLUSIONS: The measurement of 51Cr-EDTA excretion after oral challenge may be a useful test for evaluating the intestinal permeability by chemotherapy induced intestinal mucosal damage. Testing of intestinal permeability using 51Cr-EDTA may be applicable to evaluate the effect of therapeutic trials in patients with chemotherapy induced mucositis.
Drug Therapy* ; Epithelium ; Fluorouracil* ; Healthy Volunteers ; Humans ; Intestines ; Mucositis* ; Mucous Membrane ; National Cancer Institute (U.S.) ; Permeability ; Stomatitis

BACKGROUND: Use of corticosteroid appears to increase the risk of upper gastrosintestinal side effects associated with NSAIDs. But, there is no study for the effects of these drugs to NSAID induced small intestinal damage. Therefore, we examed the effects of corticosteroid to NSAID induced enteropathy and bacterial translocation. METHODS: Rat received no drug, NSAID alone (diclofenac 80 mg/kg per os), corticosteroid alone (dexamethasone 5 mg/kg intraperitoneal, 2 times) or NSAID with corticosteroid. Amounts of food intakes, body weight, intestinal permeability, enteric aerobic bacterial counts in small and large intestine, serum biochemical profiles, and pathologic findings of ileum were measured. Cultures of the mesenteric lymph nodes, as well as liver, spleen and systemic blood were taken. RESULTS: Diclofenac or dexamethasone alone administration caused gut barrier damage, enteric bacterial overgrowth and increased bacterial translocation. The supplements with dexamethasone increased NSAID induced gut barrier damage, villous atrophy, enteric bacterial overgrowth and bacterial translocation to mesenteric lymph nodes, liver, spleen and systemic blood. Also, these increased diclofenac induced body weight loss, but not hypoproteinemia. CONCLUSION: Corticosteroid increase NSAID induced body weight loss, gut barrier dysfunction, villous atrophy, enteric bacterial overgrowth and bacterial translocation in experimental animals.
Animals ; Anti-Inflammatory Agents, Non-Steroidal ; Atrophy ; Bacterial Load ; Bacterial Translocation* ; Body Weight ; Dexamethasone ; Diclofenac ; Hypoproteinemia ; Ileum ; Intestine, Large ; Intestine, Small ; Liver ; Lymph Nodes ; Permeability ; Rats* ; Spleen

PURPOSE: Ameloblastomas are rare benign tumors of odontogenic origin, and compose about 1% of all oral and maxillomandibular cysts and tumors. Because this neoplasm has a high rate of local recurrence, segmental mandibulectomy with a 1~2cm safety margin and immediate microsurgical reconstruction is an accepted treatment modality. The authors experienced four mandibular reconstruction cases that underwent secondary dental implantation. Here, the authors describe these cases and their long-term results. METHODS: Four patients with ameloblastoma of the mandible underwent segmental mandibulectomy and reconstruction with a free fibula osseous flap from January 1999 to May 2005, followed by secondary dental implantation. Recurrence, bony union, implant osseointegration, and functional and aesthetic results were evaluated by radiologic imaging, by physical examination, and by using photographs. RESULTS: All free flaps survived with no evidence of flap loss. To date, no recurrence has been noted clinically or radiologically. Imaging after mandibular reconstruction with a free fibular flap revealed satisfactory bony unions and mandibular contours. The patients achieved good aesthetic and functional results after the secondary implantation. CONCLUSION: Mandibular reconstruction using a fibular osseous flap and secondary dental implantation can produce good functional and aesthetic results after segmental mandibulectomy for ameloblastoma.
Ameloblastoma ; Dental Implantation ; Dental Implants ; Fibula ; Free Tissue Flaps ; Humans ; Mandible ; Mandibular Osteotomy ; Mandibular Reconstruction ; Osseointegration ; Physical Examination ; Reconstructive Surgical Procedures ; Recurrence ; Surgical Flaps

Breast cancer is the most common type of female cancer. Tamoxifen, a selective estrogen receptor modulator, is widely used to decrease breast cancer recurrence and mortality among patients. However, it also increases the risk of endometrial cancer. This study aimed to assess knowledge and decisional conflict regarding tamoxifen use. Between June and October 2014, breast cancer patients using tamoxifen were consecutively screened and requested to complete a survey including the EQ-5D, Satisfaction with Decision Scale (SWD), Decisional Conflict Scale (DCS), and a self-developed, 15-item questionnaire measuring tamoxifen-related knowledge. The study sample comprised 299 patients. The mean total knowledge score was 63.4 of a possible 100.0 (range, 13.3-93.3). While 73.9% of the participants knew that tamoxifen reduces the risk of breast cancer recurrence, only 57.9% knew that the drug increases endometrial cancer risk. A higher education level (> or =college) was associated with a higher, total knowledge score (beta = 4.291; P = 0.017). A higher knowledge score was associated with a decreased DCS score (beta = -0.366; P < 0.001). A higher SWD score was also associated with decreased decisional conflict (beta = -0.178; P < 0.001). In conclusion, the breast cancer patients with higher levels of tamoxifen-related knowledge showed lower levels of decisional conflict regarding tamoxifen use. Clinicians should provide the exact information about tamoxifen treatment to patients, based on knowledge assessment results, so as to aid patients' decision-making with minimal conflict.
Adult ; Aged ; Antineoplastic Agents, Hormonal/adverse effects/therapeutic use ; Breast Neoplasms/*drug therapy/epidemiology ; Consent Forms/*statistics & numerical data ; Decision Making ; Endometrial Neoplasms/*chemically induced/epidemiology/prevention & control ; Female ; Health Knowledge, Attitudes, Practice ; Health Surveys ; Humans ; Middle Aged ; Patient Education as Topic/*statistics & numerical data ; Patient Participation/statistics & numerical data ; Prevalence ; Republic of Korea ; Risk Assessment ; Tamoxifen/*adverse effects/*therapeutic use