Preparation for colonoscopy involves a thorough cleansing of the large bowel. Cleansing is performed using several methods, including ingestion of 4 liters of polyethylene glycol solution. However, these methods can induce hyponatremia by various mechanisms. Severe or rapidly progressing hyponatremia can result in the swelling of the brain, and the symptoms of hyponatremia are mainly neurological. Recently, we encountered a 41-year-old woman who developed acute hyponatremia with encephalopathy after undergoing bowel preparation for colonoscopy. She presented with general weakness, nausea, headache, agitation, delusions, and slurred speech one day after the ingestion of polyethylene glycol solution. Her serum sodium level was very low (110 to 115 mEq/L). Her symptoms pertaining to hyponatremia continued to persist for more than 2 days despite continuous intravenous administration of hypertonic saline for the correction of hyponatremia.
Administration, Intravenous ; Adult ; Brain ; Colonoscopy ; Delusions ; Dihydroergotamine ; Eating ; Female ; Headache ; Humans ; Hyponatremia ; Nausea ; ortho-Aminobenzoates ; Polyethylene ; Polyethylene Glycols ; Sodium

Tuberculous pericarditis is a rare form of tuberculosis usually presenting as pericardial effusion or constrictive pericarditis. But rarely it may present as pericardial mass. We experienced a case of tuberculous pericarditis presenting as pericardial mass which was confirmed by open thoracotomy. The patient was 34-year-old female, who was previously treated for tuberculous pleurisy. She admitted for dyspnea on exertion and imaging study including chest CT and echocardiography showed pericardial mass. Open thoracotomy showed hard adhesive mass lesion around pulmonary artery and pathology showed chronic granulomatous inflammation with caseation necrosis. We report a rare case of tuberculous pericarditis presenting as pericardial mass.
Adhesives ; Adult ; Dyspnea ; Echocardiography ; Female ; Humans ; Inflammation ; Necrosis ; Pathology ; Pericardial Effusion ; Pericarditis, Constrictive ; Pericarditis, Tuberculous* ; Pulmonary Artery* ; Thoracotomy ; Tomography, X-Ray Computed ; Tuberculosis ; Tuberculosis, Pleural

Tuberculous pericarditis is a rare form of tuberculosis usually presenting as pericardial effusion or constrictive pericarditis. But rarely it may present as pericardial mass. We experienced a case of tuberculous pericarditis presenting as pericardial mass which was confirmed by open thoracotomy. The patient was 34-year-old female, who was previously treated for tuberculous pleurisy. She admitted for dyspnea on exertion and imaging study including chest CT and echocardiography showed pericardial mass. Open thoracotomy showed hard adhesive mass lesion around pulmonary artery and pathology showed chronic granulomatous inflammation with caseation necrosis. We report a rare case of tuberculous pericarditis presenting as pericardial mass.
Adhesives ; Adult ; Dyspnea ; Echocardiography ; Female ; Humans ; Inflammation ; Necrosis ; Pathology ; Pericardial Effusion ; Pericarditis, Constrictive ; Pericarditis, Tuberculous* ; Pulmonary Artery* ; Thoracotomy ; Tomography, X-Ray Computed ; Tuberculosis ; Tuberculosis, Pleural

PURPOSE: Compared to urban areas, access to emergency medical services in rural areas is relatively restricted both in quality and quantity. However, based on the aged population model, the need for such services is greater in rural areas, due to accidents and underlying disease. We set out to investigate whether education for emergency medical services would be helpful for utilization of poor resources for emergency medical services in rural areas and how efficient it might be. METHODS: Goheung (n=796) and Haenam (n=819), which appeared to be similar in terms of area, population composition, and quality and quantity of emergency medical services, were selected. While one area received Life Helper for the Village, one of the educational programs for emergency medical services, the other did not. A questionnaire containing items on recognition of emergency medical services and roles of the primary responder was administered. RESULTS: Significant differences were observed in the recognition of emergency medical services and safety awareness in Goheung, to which education for emergency medical services was provided. However, we did not find a relationship between injury or accident development and education for the rural emergency medical service system in two areas. CONCLUSION: Thus, provision of education is needed for development of common residents into primary responders in alienated rural and fishing villages, offering them ongoing and repeating education in order to increase their recognition of emergency medical services and safety awareness, and expand such education to areas that are in a similar situation.
Aged ; Emergencies ; Emergency Medical Services ; Emigrants and Immigrants ; Humans ; Surveys and Questionnaires

Myositis caused by mumps virus is very rare. Mumps virus has been suggested as a causative agent of inclusion body myositis, but there has been no definite evidence. We experienced a case of severe myositis associated with mumps virus infection. A 21-year old man was admitted because of myalgia, headache, fever, and chill for 2 months. The cerebrospinal fluid analysis performed at a local clinic showed findings compatible with viral meningitis. His blood chemistry results revealed elevated levels of serum creatine kinase, lactate dehydrogenase, and serum myoglobin. On the 5th day of admission, the patient showed pain and swelling of parotid gland and scrotum. Electromyography was compatible with inflammatory myopathy. Muscle biopsy of his calf muscle revealed necrotizing (leukocytoclastic) vasculitis and multifocal myolysis with multinucleation. We suspected mumps virus infection because of his symptoms of meningitis, epididymo-orchitis and parotitis. Mumps virus was isolated in throat culture. The past medical history of the patient's mumps virus vaccination was unclear. After 2 weeks of supportive treatment, the patient's condition was improved.
Biopsy ; Cerebrospinal Fluid ; Chemistry ; Creatine Kinase ; Electromyography ; Fever ; Headache ; Humans ; L-Lactate Dehydrogenase ; Meningitis ; Meningitis, Viral ; Mumps virus* ; Mumps* ; Myalgia ; Myoglobin ; Myositis* ; Myositis, Inclusion Body ; Parotid Gland ; Parotitis ; Pharynx ; Scrotum ; Vaccination ; Vasculitis ; Young Adult

BACKGROUND/AIMS: HBeAg-negative chronic hepatitis B (CHB) has a poor long-term prognosis. Since no precise clinically relevant HBV thresholds are known in HBeAg-negative CHB, the decision to treat is difficult. The aim of this study was to evaluate the levels of serum HBV DNA and transaminase and to investigate the correlation of these values in patients with HBeAg-negative CHB. METHODS: The study analyzed the sera from 82 patients with HBeAg-negative CHB, 61 men and 21 women. The mean age was 45 years. The patients were divided into two groups according to serum ALT levels: the patients with lower ALT level (n=52, UNL < ALT < 2 X UNL) and higher level (n=30, ALT >or= 2 X UNL). The level of serum HBV DNA was determined by the Cobas Amplicor HBV Monitor(TM) (Roche). RESULTS: The median serum HBV DNA level was 2.7 X 10(5) copies/mL in patients with HBeAg-negative CHB. The median serum HBV DNA level of patients with a higher ALT level (1.0 X 10(6) copies/mL) was significantly higher than that of patients with a lower ALT level (5.6 X 10(4) copies/mL)(p<0.001). The serum ALT level was correlated with serum HBV DNA levels in patients with HBeAg-negative CHB (r=0.416, p<0.001). The serum level of HBV DNA in patients with cirrhosis (median 2.0 X 10(5) copies/mL) did not differ from patients without cirrhosis (median 4.7 X 10(5) copies/mL). CONCLUSIONS: The level of serum HBV DNA was higher in patients with higher serum ALT level than it was in patients with lower serum ALT, and it was closely correlated with serum ALT levels in HBeAg-negative CHB.
Alanine Transaminase/*blood ; DNA, Viral/*blood ; English Abstract ; Female ; Hepatitis B e Antigens/*blood ; Hepatitis B virus/*genetics/isolation & purification ; Hepatitis B, Chronic/blood/diagnosis/*virology ; Humans ; Lamivudine/*therapeutic use ; Male ; Middle Aged

Therapeutic high-dose radiation can induce atherosclerotic changes of affected arteries. Radiation-associated atherosclerotic diseases of coronary, carotid and subclavian arteries have been demonstrated for years in cancer survivors, but peripheral arterial disease (PAD) associated with radiation is rarely reported. PAD is one of the major macrovascular complications of diabetes and is associated with morbidity and increased mortality. We experienced a case of PAD associated with radiation therapy in a 65-year-old diabetic female patient who had undergone cervical cancer treatment 19 years prior. Computed tomographic angiogram showed occlusion and stenosis from common iliac arteries to superficial femoral arteries. However, both infrapopliteal arteries that are commonly involved in diabetes associated PAD were preserved. She was successfully treated with percutaneous angioplasty combined with femoro-femoral bypass operation. Based on the extent and severity of arterial stenosis in this non-smoking diabetic woman who had a history of high-dose radiation to her pelvis, we concluded that atherosclerotic lesions in this patient were caused by high-dose pelvic irradiation and then exacerbated by diabetes. Therefore, special attention should be given to diabetic patients with history of pelvic irradiation with regard to development of atherosclerosis of peripheral arteries, especially in the pelvic area.
Aged ; Angioplasty ; Arteries ; Atherosclerosis ; Constriction, Pathologic ; Diabetes Mellitus ; Diabetic Foot* ; Female ; Femoral Artery ; Humans ; Iliac Artery ; Mortality ; Pelvis ; Peripheral Arterial Disease* ; Subclavian Artery ; Survivors ; Uterine Cervical Neoplasms

BACKGROUND: Consensus guidelines clearly define how epinephrine is administered during cardiopulmonary resuscitation (CPR). In South Korea, it is not known whether epinephrine is administered in accordance with the current advanced cardiovascular life support (ACLS) guidelines during actual practice. We sought to investigate adherence to ACLS guidelines during actual CPR in terms of the dose of epinephrine and the interval between doses. METHODS: A retrospective review of medical records was performed on 394 adult cardiac arrest patients who received CPR at an emergency room. Data including the duration of CPR, the dose of epinephrine, and the interval between doses was collected from CPR records. RESULTS: Standard-dose epinephrine (1 mg) was used in 166 of 394 patients (42.1%). In 58.8% of patients, the average between-dose interval was within the 3-5 min recommended in the guidelines, whereas it was shorter than 3 min in 31.4% of patients. As a whole, epinephrine was administered in accordance with the current ACLS guidelines in only 96 of 394 patients (24.4%). Logistic regression analysis revealed the duration of CPR to be an independent factor affecting the use of standard-dose epinephrine and the adequate between-dose interval. CONCLUSIONS: Epinephrine was not administered according to the ACLS guideline in most patients. A national multi-center study is required to determine whether the poor adherence to the ACLS guideline is a widespread problem. In addition, efforts to improve adherence to the ACLS guideline are required.
Adult ; Cardiopulmonary Resuscitation ; Compliance ; Consensus ; Emergencies ; Epinephrine ; Heart Arrest ; Humans ; Logistic Models ; Medical Records ; Republic of Korea ; Retrospective Studies

Background: and Objective: The effects of radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) on right ventricular (RV) function are not well known. Methods: Patients who underwent RFCA for AF and underwent pre- and post-procedural echocardiography were enrolled consecutively. Fractional area change (FAC), RV free-wall longitudinal strain (RVFWSL), and RV 4-chamber strain including the ventricular septum (RV4CSL) were measured. Changes in FAC, RVFWSL, and RV4CSL before and after RFCA were compared among paroxysmal AF (PAF), persistent AF (PeAF), and long-standing persistent AF (LSPeAF) groups. Results: A total of 164 participants (74 PAF, 47 PeAF, and 43 LSPeAF; age, 60.8 ± 9.8 years;men, 74.4%) was enrolled. The patients with PeAF and LSPeAF had worse RV4CSL (p<0.001) and RVFWSL (p<0.001) than those with PAF and reference values. Improvements in RVFWSL and RV4CSL after RFCA were significant in the PeAF group compared with the PAF and LSPeAF groups (ΔRV4CSL, 8.4% [5.1, 11.6] in PeAF vs. 1.0% [−1.0, 4.1] in PAF, 1.9% [−0.2, 4.4] in LSPeAF, p<0.001; ΔRVFWSL, 9.0% [6.9, 11.5] in PeAF vs. 0.9% [−1.4, 4.9] in PAF, 1.0% [−1.0, 3.6] in LSPeAF, p<0.001). In patients without recurrence, improvements in RVFWSL and RV4CSL after RFCA were significant in the PeAF group compared to the LSPeAF group. Conclusions RV systolic function is more impaired in patients with PeAF and LSPeAF than in those with PAF. RV systolic function is more improved after RFCA in patients with PeAF than in those with PAF or LSPeAF.

Mucolipidosis II (ML II) or inclusion cell disease (I-cell disease) is a rarely occurring autosomal recessive lysosomal enzyme-targeting disease. This disease is usually found to occur in individuals aged between 6 and 12 months, with a clinical phenotype resembling that of Hurler syndrome and radiological findings resembling those of dysostosis multiplex. However, we encountered a rare case of an infant with ML II who presented with prenatal skeletal dysplasia and typical clinical features of severe secondary hyperparathyroidism at birth. A female infant was born at 37(+1) weeks of gestation with a birth weight of 1,690 g (<3rd percentile). Prenatal ultrasonographic findings revealed intrauterine growth retardation and skeletal dysplasia. At birth, the patient had characteristic features of ML II, and skeletal radiographs revealed dysostosis multiplex, similar to rickets. In addition, the patient had high levels of alkaline phosphatase and parathyroid hormone, consistent with severe secondary neonatal hyperparathyroidism. The activities of beta-D-hexosaminidase and alpha-N-acetylglucosaminidase were moderately decreased in the leukocytes but were 5- to 10-fold higher in the plasma. Examination of a placental biopsy specimen showed foamy vacuolar changes in trophoblasts and syncytiotrophoblasts. The diagnosis of ML II was confirmed via GNPTAB genetic testing, which revealed compound heterozygosity of c.3091C>T (p.Arg1031X) and c.3456_3459dupCAAC (p.Ile1154GlnfsX3), the latter being a novel mutation. The infant was treated with vitamin D supplements but expired because of asphyxia at the age of 2 months.
Acetylglucosaminidase ; Aged ; Alkaline Phosphatase ; Asphyxia ; Biopsy ; Birth Weight ; Dysostoses ; Enzyme Assays ; Female ; Fetal Growth Retardation ; Genetic Testing ; Humans ; Hyperparathyroidism ; Hyperparathyroidism, Secondary ; Infant ; Infant, Newborn ; Leukocytes ; Mucolipidoses ; Mucopolysaccharidosis I ; Parathyroid Hormone ; Parturition ; Phenotype ; Plasma ; Pregnancy ; Rickets ; Trophoblasts ; Vitamin D