BACKGROUND: Intermediate myasthenia syndrome(IMS) is thought to have clinical importance because it may cause sudden respiratory failure during the recovery phase of a cholinergic crisis of organophosphate poisoning. We designed this study to identify the prevalence, the inducing agent, clinical predictor, and the proposed treatment of IMS. METHODS: Patients who had admitted with the diagnosis of acute organophosphate poisoning from 1992 to 1998 at two teaching hospitals were enrolled in this study. We selected the cases of IMS based on a review of medical records using modified He's criteria. RESULTS: Twelve(12) out of 110 patients with acute organophosphate poisoning were diagnosed for a prevalence at 10.9%. The drug inducing IMS were identified as dichlorvos, fenthion, EPN, methidathion, and phosphamidon. The occurrence of IMS was not related to either the initial treatment with atropine and pralidoxime, or the level of serum cholinesterase. Complications were pneumonia, sepsis, pancreatitis, and pseudomembranous colitis, etc. Eleven(11) patients were discharged without sequelae, and one patient was discharged as a hopeless care. CONCLUSION: This study suggests that IMS is not rare, so close observation is required to detect IMS in organophosphate-poisoning patients. Also, more studies are required to find predictors and treatments.
Atropine ; Cholinesterases ; Diagnosis ; Dichlorvos ; Enterocolitis, Pseudomembranous ; Fenthion ; Hospitals, Teaching ; Humans ; Medical Records ; Organophosphate Poisoning ; Pancreatitis ; Phosphamidon ; Pneumonia ; Prevalence ; Respiratory Insufficiency ; Sepsis

No abstract available.
Heart Septal Defects, Atrial*

PURPOSE: There are a number of conditions that can lead to a hypercoagulable state, however, protein C and S deficiencies are frequently described as causes of the hypercoagulable states. The aim of this study was to evaluate the clinical features and prognosis of vascular diseases associated with protein C and/or S deficiencies and to determine an adequate treatment modality for such cases. METHODS: We prospectively evaluated 7 cases with vascular disease caused by protein C and/or S deficiencies confirmed with serologic tests. RESULTS: Four patients showed venous thrombosis, 1 peripheral arterial insufficiency, 1 cerebral venous thrombosis and peripheral arterial insufficiency, and 1 portal vein thrombosis. Surgical intervention was required in 5 patients. Full anticoagulation with heparin sodium followed by warfarin sodium was done in all patients. CONCLUSION: Protein C and S deficiencies may influence clinical management. Patients presenting with atypical vascular involvement without evidence of other risk factors should be evaluated for a hypercoagulable state. Once the diagnosis is made, patients should be treated with full anticoagulation.
Diagnosis ; Heparin ; Humans ; Prognosis ; Prospective Studies ; Protein C* ; Risk Factors ; Serologic Tests ; Vascular Diseases* ; Venous Thrombosis ; Warfarin

Dedifferentiated chondrosarcoma is an uncommon bone tumor, defined as a tumor in which two components -a low-grade chondrosarcoma and a high-grade non-cartilaginous sarcoma-coexist with abrupt interface. We report a rare case of giant-cell rich dedifferentiated chondrosarcoma occurred in the right distal femur shaft of a 60 year-old female. The plain X-ray film showed an irregular radiolucent mass. The T2-weighted MRI revealed a heterogeneous high signal intensity. It was an irregular mass composed of bluish-white, translucent chondroid elements and yellowish solid components with extraosseous invasion. Microscopically, a low-grade chondrosarcoma and a giant-cell rich spindle cell sarcoma with areas resembling giant cell tumor were recognized with abrupt transition. Immunohistochemical staining revealed a S100 protein positivity in chondroid cells and a few spindle cells. CD68 was strongly positive in giant cells. Vimentin was positive in both components and smooth muscle actin was positive in some spindle cells. There was no cytokeratin, desmin and myogenin immunopositivity. It is important to be aware of this rare variant of dedifferentiated chondrosarcoma to avoid the misdiagnosis of more common bone tumors including giant cell tumors.
Actins ; Chondrosarcoma* ; Desmin ; Diagnostic Errors ; Female ; Femur ; Giant Cell Tumors* ; Giant Cells* ; Humans ; Immunohistochemistry ; Keratins ; Magnetic Resonance Imaging ; Middle Aged ; Muscle, Smooth ; Myogenin ; Sarcoma ; Vimentin ; X-Ray Film

OBJECTIVE: To investigate nationwide statistics on flow-diverting stent usage for cerebral aneurysm treatment and related mortality data.METHODS: We requested data extraction from the National Health Insurance Service claims database using electronic data interchange codes (J3207064, J3207073). Patient and hospital information as well as death statistics were collected from the database.RESULTS: A total of 169 procedures were performed using flow-diverting stents for cerebral aneurysm treatment from November 2014 to December 2016 in Korea. The majority of primary diagnosis was unruptured intracranial aneurysm. During the study period, nine subjects died, including one patient initially diagnosed with subarachnoid hemorrhage. The crude mortality rate was 5.3%. Five patients died within one month after the procedure; therefore, the estimated periprocedural mortality rate was 3.0±1.3%. The mortality rate as of the last day of 2016 was 6.3±2.1%.CONCLUSION: In a 171 person-year follow-up in a Korean series, nine deaths occurred after flow-diverting stent treatment. The crude mortality rate in Korea (5.3%) was higher than that reported in a previous meta-analysis (3.8%).
Diagnosis ; Follow-Up Studies ; Humans ; Intracranial Aneurysm ; Korea ; Mortality ; National Health Programs ; Stents ; Subarachnoid Hemorrhage

Superior vena cava syndrome (SVCS) is usually caused by extrinsic compression or invasion of the superior vena cava (SVC) by malignant tumors involving mediastinal structures. Although thymomas are well-known causes of SVCS, cases of SVCS caused by malignant thymomas protruding into adjacent vessels draining the SVC with thrombosis have been very rarely reported worldwide. We experienced a 39-year-old female patient with SVCS that developed after the direct invasion of the left brachiocephalic vein (LBCV) and SVC by an anterior mediastinal mass with a high maximum standardized uptake value on the chest computed tomography (CT) and positron emission tomography-CT. Based on these results, she underwent en bloc resection of the tumor, including removal of the involved vessels, and was eventually diagnosed as having a type B2 thymoma permeating into the LBCV and SVC. We present this case as a very rare form of SVCS caused by an invasive thymoma.
Adult ; Brachiocephalic Veins ; Electrons ; Female ; Humans ; Positron-Emission Tomography ; Superior Vena Cava Syndrome* ; Thorax ; Thrombosis ; Thymoma* ; Vena Cava, Superior*

Postoperative leakage is a serious complication in patients after gastric surgery. It can lead to a rapid deterioration in the patient's condition and quality of life. Treatment is guided by the type of anastomosis and the patient's clinical status. The role of interventional radiology in gastrointestinal tract is evolving. Metallic stent placement has shown encouraging results for the palliation of gastrointestinal tract obstruction and fistula in malignant patients. We encountered a case of the leakage of jejunal end of Roux limb after total gastrectomy. This patient required a drainage procedure with long-term parenteral nutrition. We performed peroral placement of a covered metallic stent to avoid surgery and long-term parenteral nutrition, and he resumed adequate oral intake immediately after stent placement. This minimally invasive procedure is very promising for the treatment of a gastrointestinal fistula to avoid surgery and long-term parenteral nutritional support in selected cases.
Aged ; Anastomosis, Roux-en-Y/*adverse effects ; Drainage ; Fistula/etiology/surgery ; Gastrectomy/*adverse effects ; Human ; Jejunal Diseases/*etiology/radiography/surgery ; Jejunum/radiography/*surgery ; Male ; Postoperative Complications ; *Stents

BACKGROUND: The presence of axillary lymph node metastases (ALNM) and tumor size are two most important prognostic factors in breast cancer. An axillary lymph node dissection (ALND) is usually performed in infiltrating breast cancer for the information of therapeutic decision and prediction of prognosis. However this procedure results in lymphedema of the affected upper extremity, increased axillary drainage, sensory abnormality, and pain. If the axillary lymph node status could be predicted accurately prior to an ALND, selected patients with a low probability of ALNM could be spared the procedure. The purpose of this study was to determine the association between the incidence of ALNM and 14 clinico-pathologic factors by using univariate and multivariate analysis and to investigate the possibility of using those factors as predictors for ALNM. METHODS: We reviewed data from 253 patients with breast cancer who had undergone at least a level I/II axillary dissection between 1991 and 1998. The association between the incidence of ALNM and 14 clinico-pathologic factors (age, menstruation, tumor size, palpability of tumor, tumor site, pathologic type, nuclear grade, estrogen receptor status, progesteron receptor status, p53, c-erbB-2, Ki67, Cd34, and Cathepsin D) were analyzed by using univariate and, when significant, multivariate analysis. RESULTS: Approximately 38.7% of the 253 patients with breast cancer had ALNM. Univariate analysis showed that ALNM were associated with tumor size (P<0.01), pathologic type (P<0.001), palpability (P<0.01), and nuclear grade (P<0.01). However, independent predictors of ALNM in the multivariate analysis were tumor size and pathologic type. Among the patients with smaller than 1.0 cm in the tumor size and DCIS in the pathologic type, the ALNM was not founded. CONCLUSIONS: We conclude that the characteristics of primary breast cancer can help assess the risk for ALNM. Selected patients, who are assessed to be minimal risk, might be spared a routine ALND, if the treatment decision would not be influenced by the lymph node status.
Breast Neoplasms* ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Cathepsins ; Drainage ; Estrogens ; Female ; Humans ; Incidence ; Lymph Node Excision ; Lymph Nodes* ; Lymphedema ; Menstruation ; Multivariate Analysis ; Neoplasm Metastasis* ; Prognosis ; Upper Extremity

The purpose of this study was firstly, to evaluate the efficacy of coronary stenting in ESRD patients compared with non uremic patients and secondly, to compare the perioperative mortality of coronary artery bypass grafting(CABG) in ESRD patients with that in non-uremic patients exhibiting a similar degree of left ventricular function. We examined the clinical restenosis of coronary stenting and 30 day mortality rate after CABG in this retrospective, case-controlled study. The case histories of twenty-five ESRD patients with ischemic heart disease(IHD) and twenty-five non-uremic IHD patients matched for age, sex, ejection fraction and number of implanted stents, who had undergone first, elective, primarily successful coronary stenting were reviewed. The case of histories of another sixteen ESRD patients with IHD and sixteen non-uremic IHD patients matched for age, sex, ejection fraction and number of grafted vessels, who had undergone first elective CABG were also reviewed. Clinical restenosis developed in nine of the twenty-five ESRD patients and in eight of the twenty-five non-uremic patients after coronary stenting within follow up periods of 16.9+/-14.5 months and 17.6+/-14.6 months, respectively. There was no significant difference in the cumulative clinical restenosis free curves between the two groups(p=0.79). Three out of sixteen for the ESRD patients and one out of sixteen for the non-uremic patients died in 30 days after CABG, follow up periods being 11.3+/-9.6 months and 11.1+/-8.9 months, respectively. The perioperative mortality did not differ between the two groups(p=0.28). We conclude that coronary stenting in ESRD patients is as effective as in non-uremic patients regarding initial coronary revascularization and perioperative mortality rate of CABG in ESRD patients is not significantly higher compared with non-uremic patients when Left ventricular function is matched.
Case-Control Studies ; Coronary Artery Bypass* ; Coronary Vessels* ; Follow-Up Studies ; Heart ; Humans ; Kidney Failure, Chronic ; Mortality ; Myocardial Ischemia* ; Retrospective Studies ; Stents* ; Transplants ; Ventricular Function, Left

PURPOSE: CPR Anytime(R), a self-instructional video program, has gained popularity amongst CPR instructors for training non-healthcare providers. This instructional kit enables second-tier instruction. The purpose of this study is to determine the status of second-tier instruction CPR by CPR Anytime(R) trainees. METHODS: Questionnaires were sent to 606 CPR Anytime(R) trainees from 12 BLS training sites. The training period was from October 2006 to July 2007. Questionnaires included provider's basic information, post-course self exercise, amount of second-tier instruction, and multiplier status. RESULTS: The response rate of the questionnaire was 53.6%(325). The mean age was 20.4+/-10.3 years old. The professions of respondents were as follows: students (76.3%), office workers(13.2%), teachers(4.4%), and service providers(1.9%). The post-course self exercise rate was 49% with three fourths of those completing the exercises using both the DVD and MiniAnne(R). Second-tier instruction tools use rates(48%) were as follows: DVD and manikin(35%), manikin only(9%), verbal only(2%), and DVD only(1%). The total multiplier effect was 1.77(575/ 325) with the multiplier effect of teachers significantly higher than others. CONCLUSION: This study found that 48% of CPR Anytime(R) providers perform second-tier instruction to family and friends. Amongst them, the total multiplier effect was 1.77 (575/325).
Cardiopulmonary Resuscitation ; Surveys and Questionnaires ; Exercise ; Friends ; Humans ; Manikins