BACKGROUND: Recently, there are many reports about the association of Diffusion Weighted Imaging (DWI) and the prognosis of hypoglycemic encephalopathy (HE), but those relationships have not yet been completely determined. As such, we researched for prognosis, according to a variety of clinical data, and the lesion's distribution on DWI. METHODS: We retrospectively reviewed 19 patients who were diagnosed as HE. In addition, those prognoses were analyzed by a variety of clinical data and characteristics of lesion's distribution, which were evaluated on DWI and Apparent Diffusion Coefficient (ADC) maps. Three months later, those prognoses were determined by each Modified Rankin Scale. Further, the time-dependent average Glasgow Coma Scale (GCS), among the groups according to the characteristics of lesion's distributions in the initial DWI, was estimated. RESULTS: In this study, the difference of prognosis was not shown, according to all the clinical data, such as the severity or duration of the hypoglycemic state, but the group that did not have any pathologic lesion on the initial DWI demonstrated a better prognosis, in comparison with the groups-that exhibited any positive lesion on the initial DWI (p = 0.006). The group that had a focal pathologic lesion on the initial DWI showed a better prognosis than the diffuse lesion's group (p = 0.045). The groups with no lesion or focal lesion showed a faster recovery of GCS than the other groups with a positive lesion or diffuse lesion within the initial 1 week. CONCLUSIONS: We can identify that the characteristics of the lesion's distribution of DWI can be more helpful to predict of prognosis in HE than a variety of clinical data, such as the severity or duration of the hypoglycemic state.
Diffusion ; Glasgow Coma Scale ; Humans ; Hypoglycemia ; Prognosis ; Retrospective Studies

OBJECTIVE: To validate the Motor Impairment Scale (MIS) of the Korean long-term care insurance (LTCI) system by comparing with the service time offered for aiding activities of daily living (ADL) and the ADL score. METHODS: A total of 407 elderly subjects without dementia who had used LTCI services were included in this study. Spearman correlations and multivariate linear regression models were employed to determine the relationship of the upper and lower limb MIS (U-MIS and L-MIS, respectively) to the service time and ADL. Stratified analyses for the facility group (n=121) and the domiciliary group (n=286) were performed. RESULTS: There were significant differences in characteristics between facility group and domiciliary group. The MIS was significantly correlated with service time in facility group (Spearman p=0.41 for U-MIS, Spearman p=0.40 for L-MIS). After adjusting for age, sex, and cognition score, U-MIS was an independent predictor for service time in facility group (p=0.04). In domiciliary group, no significant correlation was found between the MIS and service time. The MIS correlated with all of the ADL items and total ADL score in both groups. After adjusting for other factors including age, sex, and cognitive score, U-MIS and L-MIS were independent variables for explaining the total ADL score in both groups. CONCLUSION: The validity of the MIS as an evaluation tool in the physically-disabled elderly is higher in facility group than in domiciliary group. As an easy, objective, and simple method, MIS can be a useful tool in the LTCI system of Korea.
Activities of Daily Living ; Aged ; Cognition ; Dementia ; Humans ; Insurance, Long-Term Care ; Korea ; Linear Models ; Long-Term Care ; Lower Extremity

PURPOSE: This study examined the association between the prolongation of heart rate-corrected QT (QTc) and arrhythmia in patients with aconitine intoxication. METHODS: A 13-year retrospective study of patients with aconitine poisoning treated at emergency departments between March 2002 and May 2013 was conducted. The EKGs obtained within 4 hours after the ingestion of aconitine were analyzed to measure the QT and QTc intervals. The QT interval was manually measured and QTc was obtained using Bazett's formula. The patients were divided into a normal QTc group and a prolonged QTc group (prolonged QTc interval defined as >450 ms in men and >470 ms in women). General characteristics, clinical features, laboratory results, and abnormal EKG findings of the two groups were compared. RESULTS: Forty-one patients were enrolled in this study. The mean QTc intervals of the normal QTc group (n=20) and prolonged QTc group (n=21) were 446.4+/-18.2 ms and 500.6+/-18.1 ms, respectively. The prolonged QTc group had a significant presence of arrhythmia compared with the normal QTc group. Arrhythmia occurred in two of the 20 normal QTc group patients and 17 of the 21 prolonged QTc group patients (p<0.001). Premature ventricular contractions were observed in one normal QTc patients and in 17 prolonged QTcpatients (p<0.001). Ventricular arrhythmias were the most common arrhythmia in both groups. A bundle branch block occurred in 12 patients, all from the prolonged QTc group (p<0.001). Eleven of 12 patients with a bundle branch block had their electrocardiogram return to normal. CONCLUSION: A prolonged QTc interval within 4 hours after ingestion of aconitine is a significant predictor of arrhythmia. Serial measuring of the QTc interval is recommended to predict arrhythmia.
Aconitine* ; Arrhythmias, Cardiac* ; Bundle-Branch Block ; Eating ; Electrocardiography ; Emergencies ; Heart ; Humans ; Male ; Poisoning ; Retrospective Studies ; Ventricular Premature Complexes

PURPOSE: This study examined the association between the prolongation of heart rate-corrected QT (QTc) and arrhythmia in patients with aconitine intoxication. METHODS: A 13-year retrospective study of patients with aconitine poisoning treated at emergency departments between March 2002 and May 2013 was conducted. The EKGs obtained within 4 hours after the ingestion of aconitine were analyzed to measure the QT and QTc intervals. The QT interval was manually measured and QTc was obtained using Bazett's formula. The patients were divided into a normal QTc group and a prolonged QTc group (prolonged QTc interval defined as >450 ms in men and >470 ms in women). General characteristics, clinical features, laboratory results, and abnormal EKG findings of the two groups were compared. RESULTS: Forty-one patients were enrolled in this study. The mean QTc intervals of the normal QTc group (n=20) and prolonged QTc group (n=21) were 446.4+/-18.2 ms and 500.6+/-18.1 ms, respectively. The prolonged QTc group had a significant presence of arrhythmia compared with the normal QTc group. Arrhythmia occurred in two of the 20 normal QTc group patients and 17 of the 21 prolonged QTc group patients (p<0.001). Premature ventricular contractions were observed in one normal QTc patients and in 17 prolonged QTcpatients (p<0.001). Ventricular arrhythmias were the most common arrhythmia in both groups. A bundle branch block occurred in 12 patients, all from the prolonged QTc group (p<0.001). Eleven of 12 patients with a bundle branch block had their electrocardiogram return to normal. CONCLUSION: A prolonged QTc interval within 4 hours after ingestion of aconitine is a significant predictor of arrhythmia. Serial measuring of the QTc interval is recommended to predict arrhythmia.
Aconitine* ; Arrhythmias, Cardiac* ; Bundle-Branch Block ; Eating ; Electrocardiography ; Emergencies ; Heart ; Humans ; Male ; Poisoning ; Retrospective Studies ; Ventricular Premature Complexes

No abstract available.
Paralysis* ; Spondylitis*

PURPOSE: This study was conducted to identify predictors of serious poisoning in patients with snake bite based on initial findings. METHODS: We conducted a retrospective study of patients with snake bite who were treated at the emergency department between January 2010 and December 2016. The patients were divided into two groups according to the severity of symptoms based on the traditional snakebite severity grading scale. The mild poisoning group (MP) was classified as those who had a grade I snakebite severity during the hospital stay, and the severe poisoning group (SP) was classified as patients who had grade I at the time of admission, but progressed to grade II-IV during hospitalization. Initial clinical manifestations and laboratory findings of the two groups were compared. RESULTS: Bite to hospital time intervals of SP were longer than those of MP (p=0.034), and the local effect score (LES) was higher in SP (p<0.001). Laboratory analyses revealed that creatine phosphokinase (p=0.044), creatine phosphokinase MB isoenzyme (CK-MB, p=0.011) and serum amylase (p=0.008) were significantly higher in SP. LES, CK-MB and serum amylase were significant prognostic predictors as indicated by univariate logistic regression analysis. Multivariate analysis revealed the following two significant predictors: LES (odds ratio=3.983, p<0.001) and serum amylase (odds ratio=1.020, p=0.017). CONCLUSION: In managing cases of snake bites, clinical manifestations and laboratory findings must be carefully evaluated. LES and serum amylase are predictive factors for severe poisoning, which is especially important to rapid determination of the intensive care of the patient.
Amylases ; Creatine Kinase ; Critical Care ; Emergencies* ; Emergency Service, Hospital* ; Hospitalization ; Humans ; Length of Stay ; Logistic Models ; Multivariate Analysis ; Poisoning ; Retrospective Studies ; Snake Bites* ; Snake Venoms ; Snakes*

PURPOSE: The purpose of this study was to analyze the radiologic findings of primary epiploic appendagitis, with particular attention to the correlation of ultrasonographic, clinical, CT, MR and surgical findings. MATERIALS AND METHODS: Among 14 patients with primary epiploic appendagitis who presented with the rapid onset of a very localized pain and tenderness, we performed ultrasonography in all, CT in eight, and MRI in four of these eight. Surgery was performed in two patients. Follow-up examinations were performed using US, CT and MRI (n=2), US and CT (n=2), US alone (n=2), and with regard to clinical features (n=12). RESULTS: US performed in 14 patients revealed the presence in all of small, well-defined, ovoid, noncompressible hyperechoic (n=12) or isoechoic (n=2) solid masses attached to the colonic wall, without bowel wall change and without communication with bowel lumen. CT performed in 8 patients showed varying hyperattenuating fatty lesions in the same location in the abdomen, without other inflammatory process. MRI findings of four patients were helpful for further evaluation of internal architecture. CONCLUSION: In primary epiploic appendagitis, US findings were sufficiently characteristic to allow accurate diagnosis and valuable for the differential diagnosis of other acute conditions of the abdomen.
Abdomen ; Colon ; Diagnosis ; Diagnosis, Differential ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Ultrasonography

No abstract available.
Blood Cell Count ; Bone Marrow Cells/metabolism/pathology ; Humans ; Leukemia, Promyelocytic, Acute/complications/*diagnosis/pathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Multiple Myeloma/complications/*diagnosis/pathology ; Paraproteinemias/diagnosis ; Syndecan-1/metabolism

It can be difficult for clinicians to distinguish a paradoxical response to antituberculous therapy, worsening of an existing lesion despite adequate treatment, treatment failure, and drug resistance. We report a case of a 69-year-old woman who experienced bilateral lower extremity paralysis secondary to a paradoxical response. She had been suffering for 1 month from low back pain, due to tuberculous spondylitis. Her low back pain improved after antituberculous therapy. The low back pain, however, reappeared 2 months after treatment, accompanied by newly developed lower extremity weakness. Imaging studies showed an increased extent of her previous lesions. Consequently, the patient underwent a vertebral corpectomy with interbody fusion of the thoracolumbar spine. Histopathological examination showed chronic inflamed granulation tissue with no microorganisms. Although the antituberculous medication was not changed, the patient's symptoms and signs, including the paralysis, resolved after surgery.
Aged ; Drug Resistance ; Female ; Granulation Tissue ; Humans ; Low Back Pain ; Lower Extremity ; Paralysis* ; Spine ; Spondylitis* ; Treatment Failure ; Tuberculosis, Spinal

PURPOSE: The purpose of this study was to determine whether immunosuppressant, rapamycin could inhibit corneal angiogenesis induced by angiogenin and to evalutate its role by micropocket assay. METHODS: The rabbit's eye was implanted intrastromally into the superior cornea with pellet for the control group, pellet containing of angiogenin for the angiogenin group, and pellet containing of angiogenin and rapamycin for the angiogenin+rapamycin group. Biomicrographically, corneal angiogenesis was evaluated for 14 days after pellet implantation, based on the number and the length of new vessels. The neovascularized cornea also was examined histologically. RESULTS: We could observe that the angiogenin inducing corneal angiogenesis was inhibited by rapamycin. The score of neovascularization was significantly decreased in the angiogenin+rapamycin group than in the angiogenin group at 3, 7 and 10 days after pellet implantation (p<0.05). Histologically, the cornea of angiogenin+rapamycin group also showed much less new vessels than that of angiogenin group, in which inflammatory cells and edema was observed. CONCLUSIONS: Rapamycin appears to inhibit angiogenin induced angiogenesis in a rabbit corneal micropocket assay and may have therapeutic potential as an antiangiogenic agent.
Cornea ; Corneal Neovascularization* ; Edema ; Rabbits* ; Sirolimus*