STUDY OBJECTIVE: We evaluate the clinical characteristics and natural history of patients presenting with spontaneous pneumomediastinum (SPNM) . DESIGN: A retrospective case series was conducted to identify patients diagnosed with SPNM. ICD-7(J98.2) discharge codes were used for Jan. 1993 to Aug. 1996 at four institutions , and emergency department(ED) records and admission charts were reviewed. Clinical features, interventions, complications, setting, etiology, symptoms, and length of hospital stay were recorded. PARTICIPANTS: All ED patients more than 12 years old with a diagnosis of SPNM. RESULTS: Thirteen cases were identified. Age range was 14 to 58 years(mean 24 years). Presenting symptoms were chest pain in eight(62%), dyspnea in six(46%), both symptoms in three(23%), no complaints in three(23%). Seven(54%) patients complained only of throat discomfort. Seven(54%) had subcutaneous emphysema, and two(15.3%) had a small pneumothorax. Two(15.3%) were smokers. Three(23%) had normal esophagograms and another three had normal chest CT findings. Two cases(15.3%) were associated with inhalational drug use and three cases were due to exercise. Nine cases(69%) had a history of "Valsalva-type" maneuver. Two patients(15%) had a history of antituberculous treatment and one(7.7.%) had suffered from bronchial asthma. Mean hospital days were 7.3 days(range 3 to 14), none of all needed any intervention. Specifically, no patient developed a subsequent pneumothorax or airway compromise. Seven cases(54%) were received prophylactic antibiotics. CONCLUSION: Most simple SPNM cases are benign disease and most of them(78%) had shown typical chest pain, dyspnea and subcutaneous emphysema. Inhalational drug use is not a main cause of SPNM yet, but increase in use of bronchoinhalers is a suspicous cause of SPNM.
Anti-Bacterial Agents ; Asthma ; Chest Pain ; Child ; Diagnosis ; Dyspnea ; Emergencies ; Humans ; Length of Stay ; Mediastinal Emphysema* ; Natural History* ; Pharynx ; Pneumothorax ; Retrospective Studies ; Subcutaneous Emphysema ; Tomography, X-Ray Computed

BACKGROUND: Hepatic necrosis after acetaminophen overdose results from the increased formation of a highly toxic intermediatc(N-acetyl-p-benzoquinoneimine), produced by acetaminophen metabolism through the cytochrome P450 mixed function oxidase system. N-acetyl-p-benzoquinoneimine is normally detoxified by endogenous glutathione, but the increased production induced by an acetaminophen overdose may depletc glutathione stores, allowing the intermediate to react with and to destroy hepatocytes. METHOD & MATERIAL: We have estimated the hepatoprotective effects of 4-methylpyrazole(500mg/kg and 50mg/kg), inhibitor of cytochrone P450 isoenzyme, when given at two hours after single oral overdose of acetaminophen(2,000mg/kg) in rats. RESULTS: As far as overall protective effect of 4-methylpyrazole on hepatic necrosis score concerned, seam transaminase(AST, ALT) level were found to be decreased in 4-methylpyrazole-treated group compared to untreated group after acetaminophen overdose. No consistent difference in hepatoprotective effect was demonstrated between rats with high dose of 4-methylpyazole(500mg/kg) and rats with lower dose of 4-methylpyrazole(50mg/kg). CONCLUSION: We concluded that oral administration of 4-methylpyrazole apperas to protect hepatotoxicity effectively to acetaminophen overdose.
Acetaminophen* ; Administration, Oral ; Animals ; Cytochrome P-450 Enzyme System ; Glutathione ; Hepatocytes ; Metabolism ; Models, Animal* ; Necrosis ; Oxidoreductases ; Rats*

BACKGROUND: Two major events occurring in the cerebral hemodynamics after successful resuscitation from cardiac arrest are reactive hyperemia and postischemic hypoperfusion. In this study, we examined the effect of Pentoxifylline(PTX) on the rat brain following cardiac arrest. METHODS: Fourteen rats were anesthetized and artificially ventilated. Cardiac angst was produced by chest compression and clamping of tracheal tube far 3 minutes in ketamine anesthetized rats. Circulation was restored by standard cardiopulmonary resuscitation methods. In 7 rats, PTX 10mg/kg was infused at 10min after cardiac angst(PTX group). In the other 7 rats, same amount of normal saline was infused(control group). RESULTS: In both groups, hemodynamic variables, neurologic deficit(ND) score and histopathologic findings of hippocampal CA1 neurons were observed. Hemodynamic variables and ND score were not significandy different between two groups. Delayed ischemic neurons of hippocampal CA1 were decreased in PTX group(2.2+/-2.4%) compared with control group(9.1+/-1.2%). CONCLUSIONS : We conclude that PTX prevented development of delayed ischemic neurons in hippocampal CA1 after cardiac arrest. PTX may be useful in emergency situations following cardiac arrest.
Animals ; Brain* ; Cardiopulmonary Resuscitation ; Constriction ; Emergencies ; Heart Arrest* ; Hemodynamics ; Hyperemia ; Ketamine ; Neurons ; Pentoxifylline* ; Rats* ; Reperfusion Injury* ; Resuscitation ; Thorax

BACKGROUND: Diabetes is a major risk factor for restenosis and high mortality after percutaneous coronary intervention. The impact of coronary stenting on the clinical outcome of diabetic patients remains controversial. METHOD: The in-hospital and long-term clinical outcomes of 104 consecutive diabetic (60+/-8 year-old, 74 male) and age-matched 193 control (57+/-10 year-old, 162 male) patents underwent coronary stenting between January 1998 and March 1999 at Chonnam National University Hospital were compared. RESULTS: 1) Coronary stenting was successful in 98% of diabetic patients and 97% of non-diabetic patients. Post-procedural minimal luminal diameter (MLD) was not different between two groups(2.89+/-0.42 vs. 2.95+/-0.62 mm), but follow-up MLD was lower in diabetics than that in non-diabetics (1.70+/-0.96 vs. 2.05+/-0.72 mm, P < 0.05). 2) Restenosis rate on follow-up coronary angiograpy was not different between two groups (40.7% in diabetics and 32.0% in non-diabetics. 3) In-hospital outcome was not different between two groups. Long-term clinical follow-up (16+/-11 months) revealed higher overall major adverse cardiac events in diabetics than in non-diabetics (38.7 vs. 30.7 %, P < 0.05). CONCLUSION: Coronary stenting in diabetics can be performed with acceptable short-term results. However, long-term clinical outcome in diabetic patients was worse than in non-diabetics.
Follow-Up Studies ; Humans ; Jeollanam-do ; Mortality ; Percutaneous Coronary Intervention ; Phenobarbital ; Risk Factors ; Stents*