BACKGROUND: The number of patients of doxylamine overdose has increased, but there were little clinical reports. The purpose of this study is review the patients of doxylamine overdose for aid clinical decision making of patients disposition. METHODS: We reviewed medical records of patients who ingested doxylamine succinate retrospectively from Jan. 1, 1996 to Dec. 31. 1996. Data that was recorded were followed: age, sex, psychiatric history, amounts of ingestion, time interval from ingestion to arrival to hospital, initial vital signs and symptoms, EKG, chest PA, Lab. findings, treatment, patients disposition, length of hospital stay, complication. RESULTS : 1) Total number of patients was ninety and average dosage of ingestion was 1062mg. 2) Tachycardia was the most frequent anticholinergic symptom(46%). 3) Routine lab. findings was not abnormal except one patient who was diagnosed as Rhabdomyolysis. 4) Gut decontamination was performed in patients who had arrived at hospital in 2-3 hours, and who had ingested large dose of drug. 5) Five patients were admitted to Psychiatric dept. and one patient was admitted to emergency dept. for treatment of rhabdomyolysis. 6) The mean duration of hospital stay was 6.5 hours. CONCLUSION: The patients who ingested overdose of doxylamine was managed safely in emergency department, but we should warn against the possibility of rhabdomyolysis.
Decision Making ; Decontamination ; Doxylamine* ; Eating ; Electrocardiography ; Emergencies ; Emergency Service, Hospital ; Humans ; Length of Stay ; Medical Records ; Retrospective Studies ; Rhabdomyolysis ; Succinic Acid* ; Tachycardia ; Thorax ; Vital Signs

BACKGROUND: Do-Not-Resuscitate(DNR) order has been used without specific legislation commonly in hospitals of Korea. We designed this study to assess the current use of DNR order in the emergency department and to make a database for establishing a policy for DNR order, especially in ER. METHODS: We retrospectively reviewed medical records of 164 patients who expired in the emergency department of Severance hospital from Sep. 1996 to Aug. 1997. We evaluated age, sex, diagnosis, specific department involved, whether written orders were made and medical care after decision of DNR. The patients were divided into 2 groups : DNR vs CPR. To determine factors influencing DNR decision, we searched for presence of malignancy, irreversible shock, unconsciousness and chronic illness. The logistic regression analysis was used for statistical significance. RESULTS: We found that 102(62.2%) out of 164 expired patients had a DNR order. But only in 59% of cases, were written DNR order on the chart. Factors which had the most influence on decision of DNR were malignancy and age. The sex, chronic illness, irreversible shock, and unconsciousness were not significant factors. CONCLUSION: We found malignancy and old age as an important factor when DNR order had been made. But further evaluation of other factors may be necessary to establish definitely a policy for DNR order.
Cardiopulmonary Resuscitation ; Chronic Disease ; Diagnosis ; Emergency Service, Hospital ; Humans ; Korea ; Logistic Models ; Medical Records ; Retrospective Studies* ; Shock ; Unconsciousness

OBJECTIVE: The continuous synthesis and degradation of proteins in the cell are essential for the maintenance of cellular homeostasis. Intracellular protein degradation largely occurs in the lysosome and cytoplasm. The protein degradation in the cytoplasm (ubiquitin mediated protein degradation) is distinct from the well studied lysosomal protein degradation (nonselective protein degradation) and require energy (ATP), ubiquitin and ubiquitin conjugating enzymes such as E1, E2 and E3. Dementia caused by the deposition of abnormal proteins in brain cells followed by brain cells damage are not fully understood. To better understand the possible mechanism of dementia, we attempted to purify ubiquitin conjugating enzymes (such as E1 and E2 proteins) from the blood of normal persons and patients with dementia and tested their electrophoretic mob)ility on SDS-polyacrylamide gel electrophoresis. METHOD: The E1 and E2 enzymes of the red blood cell lysate fraction from the normal person and the patients with dementia were purified from ammonium sulfate precipitatant of DEAE-cellulose eluate fraction. Following ubiquitin-sepharose column chromatography, the E1 enzyme of the normal and the patients with dementia group showed homogeneous form and various kinds of E2 isoforms were identified by the SDS-polyacrylamide gel electrophoresis. RESULTS: The E1 and E2 enzymes showed no difference on electrophoretic mobility, but the E2 isozyme containing fraction was observed to great difference between the two groups. The 44 kDa protein of E2 isozyme containing fraction was significantly increased in alcoholic dementia and clearly increased in patients with Alzheimer's disease. In addition, another 11 kDa protein was significantly increased in the patients with Alzheimer's disease, but 11 kDa protein of alcoholic dementia was similar to that of the normal person. The 44 kDa and 11 kDa proteins showed a reverse relationship between alcoholic dementia and the patients with Alzheimer's disease. These proteins seems to be different molecules from the well known studied beta-amyloid, presenilin, tau protein and apolipoprotein E (Apo E). CONCLUSIONS: These results might be useful for the elucidation of dementia and the identification of these proteins are now in progress.
Alcoholics ; Alzheimer Disease ; Ammonium Sulfate ; Apolipoproteins ; Brain ; Carrier Proteins* ; Chromatography ; Cytoplasm ; DEAE-Cellulose ; Dementia* ; Electrophoresis ; Erythrocytes* ; Homeostasis ; Humans ; Lysosomes ; Presenilins ; Protein Isoforms ; Proteolysis ; tau Proteins ; Ubiquitin* ; Ubiquitin-Conjugating Enzymes

PURPOSE: Hypertrophic scarring and depression are the principal problems of burn rehabilitation. This study was done to verify the effects of skin rehabilitation massage therapy (SRMT) on pruritus, skin status, and depression for Korean burn survivors. METHODS: A pretest-posttest design using a nonequivalent control group was applied to examine the effects of SRMT for 3 months in a group of 18 burn survivors. The major dependent variables-including pruritus, objective and subjective scar status, and depression-were measured at the beginning and at the end of the therapy to examine the effects of SRMT. RESULTS: Burn survivors receiving SRMT showed reduced pruritus, improved skin status, and depression. The remaining scar also showed improvement in skin pigmentation, pliability, vascularity, and height (compared to the surrounding skin) as measured on the Vancouver Scar Scale (VSS). CONCLUSIONS: The findings demonstrate that SRMT for burn survivors may improve their scars both objectively and subjectively, and also reduce pruritus and depression.
Adult ; Burns/complications/*rehabilitation ; Cicatrix, Hypertrophic/etiology/*prevention & control ; Depressive Disorder/etiology/*prevention & control ; Female ; Humans ; Male ; *Massage ; Pruritus/etiology/*prevention & control

Systemic lupus erythematosus(SLE) is a systemic disease of unknown etiology. Its main pathology is vasculitis and serositis, due to deposition of the immune complex or antibodies. Most findings are nonspecific ; abdominal manifestations include enteritis, hepatomegaly, pancreatic enlargement, serositis, lymphadenopathy, splenomegaly,nephritis, interstitial cystitis, and thrombophlebitis. We described radiologic findings of various organinvolvement of SLE; digestive system, serosa, reticuloendothelial system, urinary system, and venous system.Diagnosis of SLE was done according to the criteria of American Rheumatism Association. Understanding of thevariable imaging findings in SLE may be helpful for the early detection of abdominal involvement andcomplications.
Antibodies ; Antigen-Antibody Complex ; Cystitis, Interstitial ; Digestive System ; Enteritis ; Hepatomegaly ; Lupus Erythematosus, Systemic* ; Lymphatic Diseases ; Mononuclear Phagocyte System ; Pathology ; Rheumatic Diseases ; Serositis ; Serous Membrane ; Thrombophlebitis ; Vasculitis

BACKGROUND: Although a magnetic resonance imaging (MRI) is highly sensitive for changes associated with ischemic stroke, the detection of an acute ischemic lesion is usually impossible within 6 hours of the stroke onset on a conventional MRI. The perfusion MRI is a new imaging technique for diagnosing acute ischemic stroke. We evaluate the clinical usefulness of the perfusion MRI in predicting the final infarct extent in 18 patients with acute middle cerebral artery (MCA) territory ischemic stroke. METHOD: The perfusion MRI was performed within 6 hours after the stroke onset in all patients with a single-section dynamic contrast-enhanced T2*-weighted imaging in conjunction with a conventional routine MRI and MR angiography. Time-concentration curves and cerebral blood volume (CBV) maps were calculated from the dynamic MR imaging data by using numerical integration techniques. We compared findings of CBV maps with infarction on a follow-up CT or MRI. RESULTS: In 14 of 18 patients, the CBV in the occluded MCA territory were decreased. In the remaining 4 patients with a reversible ischemic neurologic deficit (RIND) or transient ischemic attack (TIA), the CBV were increased in 3 and normal in 1. Out of 14 patients with a decreased CBV, two had focal regions of increased CBV within the affected territory, indicating reperfusion hyperemia. The regions of increased or decreased CBV were eventually converted to infarction on follow-up images in all 14 patients. Out of 4 patients with RIND or TIA, one showed focal infarction in centrum semiovale on a follow-up image. CONCLUSIONS: The perfusion MRI was useful for the assessment of hemodynamic change about cerebral perfusion and may predict the extent of final infarction in acute MCA territory ischemic stroke. These results suggest that the perfusion MRI may play an important role in the diagnosis and management of acute ischemic stroke.
Angiography ; Blood Volume ; Diagnosis ; Follow-Up Studies ; Hemodynamics ; Humans ; Hyperemia ; Infarction ; Ischemic Attack, Transient ; Magnetic Resonance Imaging* ; Middle Cerebral Artery* ; Neurologic Manifestations ; Perfusion* ; Reperfusion ; Stroke*

Medulloblastoma is one of the most undifferentiated primitive neuroectodermal tumors and represents about 30% of all posterior fossa tumors in children. Disseminated medulloblastoma, mainly involving cerebral surfaces, ventricles and the subarachnoid space can, in 50% of patients, be identified on intial imaging studies. One thirdof these lesions metastasize to an extracranial site, primarily to bone. Osseous metastases, which occur mainly after craniectomy are typically lytic, but osteoblastic lesions also may occur. We experienced the case of a 14year-old female patient with multiple bone metastases of medulloblastoma after craniectomy. Bone metastaticlesions were present in the right femur and thoracic spine and were osteoblastic or osteolytic
Child ; Female ; Femur ; Humans ; Infratentorial Neoplasms ; Medulloblastoma* ; Neoplasm Metastasis* ; Neuroectodermal Tumors, Primitive ; Osteoblasts ; Spine ; Subarachnoid Space

PURPOSE: To compare the precise roles of high-resolution computed tomography (HRCT) and fiberoptic bronchoscopy (FOB) in the evaluation of patients presenting with hemoptysis and to determine the optimal timing for HRCT. MATERIALS AND METHODS: The results of HRCT and FOB were compared in 23 patients (15 men, 8 women) presenting with hemoptysis. Etiologies included bronchietasis (n=4), parenchymal pulmonary tuberculosis (n=4), lung cancer (n=4), endobronchial tuberculosis (n=2), and broncholithiasis (n=2). Hemoptysis was proved to be due to miscellaneous causes in an additional three cases and to be cryptogenic in four. The diagnostic results of FOB performed before and after HRCT were compared as were those of HRCT performed within and after the first 48 hours of active bleeding. RESULTS: FOB and HRCT offered a correct diagnosis in 39% and 65% of cases, respectively (p=0.005). HRCT demonstrated three cases of bronchiectasis and three of parenchymal pulmonary tuberculosis which were beyond the range of a bronchoscope. In two of five cases in which HRCT findings were nonspecific, chondromatous hamartoma and lung cancer were confirmed by FOB. In cases where HRCT was performed prior to FOB, the latter demonstrated the location and diagnosis in 82% and 47% of cases, respectively (p=0.303) ; when HRCT was performed after FOB, HRCT was correct in 67% and 17% of cases, respectively (p=0.178). In none of three cases (0%) in which HRCT was performed during the first 48 hours of active bleeding did the procedure allow a specific diagnosis. In 15 of 20 (75%) cases in which HRCT was performed after the first 48 hours, however, the diagnosis provided by CT was correct. CONCLUSION: The results of this study suggest that in patients presenting with hemoptysis, both HRCT and FOB should be used for evaluation, since they are diagnostically complementary. FOB is more useful for the diagnosis of endobronchial lesion, and HRCT for bronchiectasis and parenchymal pulmonary tuberculosis. If, in cases of hemoptysis, initial diagnosis is attempted within the first 48 hours of active bleeding, FOB should be the initial step, and HRCT images should not be obtained until active bleeding has been shown on plain chest radiograph to have abated. If this initial approach takes place after the first 48 hours of active bleeding, FOB and HRCT are equally suitable.
Bronchiectasis ; Bronchoscopes ; Bronchoscopy* ; Diagnosis ; Hamartoma ; Hemoptysis* ; Hemorrhage ; Humans ; Lung Neoplasms ; Male ; Radiography, Thoracic ; Tuberculosis ; Tuberculosis, Pulmonary

Magnetic resonance (MR) imaging techniques that measure cerebral perfusion have become increasingly important. It is due to the limitation of other imaging modalities (single photon emission computed tomography, SPECT ; positron emission tomography, PET etc.) and conventional MR imaging to detect cerebral perfusion, and its ability to identify and quantitate changes in cerebral perfusion may have a substantial effect on both the diagnosis and treatment of cerebrovascular disease. We evaluated the cerebral perfusion and arterial recanalization of large territorial infarction in acute, subacute and chronic stage by MR image and MR angiography and tried to correlate with motor improvement. Twenty six patients with large territorial infarction of middle cerebral artery (MCA, n=23) or posterior cerebral artery (PCA, n=3) were included in this study. In conjunction with conventional brain MR imagings, thirty-four dynamic susceptibility contrast-enhanced MR imagings (DSC-MRI) and MR angiography were performed in acute (< lweek, n=22), subacute (1-3 weeks, n=7), and chronic (3-5weeks, n=5) stages of cerebral infarction. Regional cerebral blood volumes (rCBVs) were calculated on a pixel-by-pixel basis and rCBV images were generated. Perfusion of infarcted areas were compared to contralateral normal regions by rCBV ratio (rCBV of infarcted area/that of contralateral), and arterial recanalization of infarcted area were investigated by MR angiographies. Motor power of the hemiparetic side of the patients was observed during the first 5 weeks after the stroke onset. The rCBVs of ischemic regions increased in subacute period than acute period and decreased again in chronic period (p<0.01, Kruskal Wallis one-way ANOVA), and these patterns were also correlated with visual findings of rCBV images. Recanalization of occluded arteries was found on MR angiagraphy in 3 patients (13.69.1) in acute, 6 patients (85.7%) in subacute and 4 patients (80.0%) in chronic infarction. The increase of "rCBV ratio" was more frequently seen in recanalization than no recanalization cases but we could not statistically analyze the difference due to small size of sample. In MCA infarctions, there is no significant relationship between rCBV with motor improvement during first 5 weeks after the onset. DSC-MRI is noninvasive, more widely available than other functional images (SPECT and PET) and easier to perform in an emergency setting. By providing information about hemodynamics, which is not available with conventional T1 or T2-weighted images, DSC-MRI will be helpful in describing the pathaphysiologic characteristics of stroke.
Angiography ; Arteries ; Blood Volume ; Brain ; Cerebral Infarction* ; Diagnosis ; Emergencies ; Hemodynamics ; Humans ; Infarction ; Magnetic Resonance Imaging ; Middle Cerebral Artery ; Perfusion* ; Positron-Emission Tomography ; Posterior Cerebral Artery ; Stroke ; Tomography, Emission-Computed ; Tomography, Emission-Computed, Single-Photon

BACKGROUND: Small deep cerebral infarct can be associated with small-vessel occlusive disease, largevessel disease, low-flow or thrombo-embolic mechanism. This study is designed to investigate ralationship between symptomatic single small deep infarcts ahd vascular diseases. METHODS: We studied 154 patients who had symptomatic, small-sized(<20 mm), single, subcortical infarction(basal ganglia, corona rediata, centrum semiovale) who were admitted to our hospital from jund, 1996 to September, 1999. They were evaluated about the lesion site and vascular status of the carotid system and middle cerebral artery, using MRI, MRA and cervical duplex sonography or conventional angiography. RESULTS: Among 154 patients with single small deep infarction, 100 were related with small artery disease(64.9%), 38 with middle cerebral artery disease(26.7%) and 16 with carotid artery disease(10.4%). The basal ganglia or basal ganglia with corona radiata area were more frequently responsible lesion sites in both small artery disease(n=59, 59%) and middle cerebral artery disese(n=28, 73.7%) than in carotid artery disease(n=1, 6.3%). The centrum ovale or centrum ovale with corona radiata area were frequently involved lesion sites in carotid artery disease (n=10, 67.5%). CONCLUSION: Single small deep infarcts of th basal ganglia with corona radiata were mostly seen in the middle cerebral artery disease or small artery disease, and small deep infarcts of the centrum semiovale with corona radiata were usually assoicated with internal carotid artery disease. In occurrence of single small deep infarcts, middle cerebral artery disease was more frequent than carotid artery disease, which might be associated with intracranial occlusive disease known to be more common in Asians than in Caucasians.
Angiography ; Arteries ; Asian Continental Ancestry Group ; Basal Ganglia ; Carotid Arteries ; Carotid Artery Diseases ; Carotid Artery, Internal ; Cerebral Infarction* ; Ganglia ; Humans ; Infarction ; Magnetic Resonance Imaging ; Middle Cerebral Artery ; Vascular Diseases