Urine discoloration occurs in the intensive care unit (ICU) due to many causes such as medications, metabolic disorders, and infections. Propofol is advocated as one of the first line sedatives in the ICU, but it is not well known to the intensivists that propofol can induce urine color change. We experienced two cases of green urine after propofol infusion. Propofol should be warranted as the cause of urine discoloration during ICU stay.
Hypnotics and Sedatives ; Intensive Care Units* ; Propofol*

Malignant Mixed Mullerian tumors(MMMTs) are unusual neoplasms occumng mostly in the uterus and, ralely, they arise in the ovary. The clinical features of malignant mixed mullerian tumor of the ovary are similiar to other ovarian malignancies. The clinical course is rapidly progressive and fatal. The optimal treatment modalities has remained elusive. The most reliable prognostic criterion is the initial tumor stage and the overall survival was poor. We experienced two cases of malignant mixed miillerian tumor of the ovary, so we report these cases with a brief review of the concerned literatures.
Female ; Ovary* ; Respiratory Sounds ; Uterus

We analyzed the occurrence of enteric viruses and bacteria at 22 places of drinkable groundwater (civil defense emergency water-supply facility), 8 places of the groundwater used for drinking water in group food services, and 10 places of spring-water. When the 40 concentrated samples were analyzed using nested RT-PCR and real-time RT PCR methods, norovirus and other enteric viruses were not detected in all samples tested. The detection percentages for total coliforms, Escherichia coli, Yersinia enterocolitica of fecal indicator were 57.5%, 22.5% and 7.5%, respectively. Colipages were not detected. These results suggest that high levels of fecal indicator bacteria in groundwater and spring-water are not directly related to occurrence of enteric viruses.
Bacteria ; Drinking Water ; Emergencies ; Escherichia coli ; Food Services ; Groundwater ; Norovirus ; Polymerase Chain Reaction ; Yersinia enterocolitica

BACKGROUND & OBJECTIVES: Severe hemispheric infarction(SHI) reportedly has various range of high mortality. Recently it has been reported that more aggressive therapeutic intervention, such as decompressive hemicraniectomy or mild hypothermia might has potential benefits in the management of SHI. However, the mortality and the prognosis of Sill under the conservative treatment were rarely studied yet in Korea. METHODS: Sixty-six patients with CT proven SHI were subjected among 1649 acute stroke patients registered at the Hallym Stroke Data Bank since Jan. 1993. We analyzed the computerized databases for the mortality and compared inclusively demographic features, clinical characteristics, etiology, therapy modalities and CT findings of fatal group with those of survivors. RESULTS: Twenty-five patients were expired among 66 SI-il patients(mean age: 64.9+/-11.5, male to female ratio;37:29). The mean time to expire was 160.4 hours. The fatal group had a significantly higher incidence of cardioembolism. uncontrolled BP during the acute stage, and extensive infarction territory(MCA+ACA). Risk factors for ischemic stroke such as hypertension, hyperlipidemia. smoking, previous stroke history, diabetes mellitus. and old age were not related to mortality low densities and hyperdense MCA signs on brain imaging were not different between two groups. CONCLUSIONS: The early mortality rate of Sill under the conservative care was 38% in a referral hospital of Korea. intractable hypertension in the acute stage, cardioembolism and extent of infarct area may have predictable values of early mortality of SHI.
Diabetes Mellitus ; Female ; Humans ; Hyperlipidemias ; Hypertension ; Hypothermia ; Incidence ; Infarction ; Korea ; Male ; Mortality* ; Neuroimaging ; Prognosis ; Referral and Consultation ; Risk Factors ; Smoke ; Smoking ; Stroke ; Survivors

PURPOSE: Cystoscopy is very common and is one of the major office based procedures used in urologic clinics. However, a majority of patients complain of fear, pain, and discomfort when performing the procedure in an alert state. Routine administration of sedative and analgesic drugs is widely provided for gastorintestinal endoscopy to prevent patient discomfort and increase tolerance. Based on this, we investigated the safety and efficacy of midazolam induced sedative cystoscopy. MATERIALS AND METHODS: One hundred and twenty patients were enrolled in this study. They were divided into two groups; group I (n=80) consisted of patients who were sedated by midazolam 2.5mg IV before cystoscopy, and group II (n=40) consisted of patients who were not sedated and diclopenac 90mg was injected in them intramuscularly before cystoscopy to prevent pain. All patients in group I were reversed from the sedative state by flumazenil 0.5mg IV right after the completion of the cystoscopic procedure. The two groups were not significantly different in their age, sex, and weight distribution (p>0.05). Blood pressure, pulse, and respiratory rates were monitored pre-, intra-, and post procedure. The status of consciousness was monitored every three minutes by the OAA/S (Observer's Assessment of Alertness/Sedation) scale. Pain scale, anxiety scale, satisfaction score from patients and operators were measured using a specified questionnaire. RESULTS: In group I, the pain scale and anxiety scale were significantly reduced compared to group II (p<0.001). There were temporary changes in blood pressure and pulse rate in group I, but they were not clinically significant and no specific management was required. Group I patients were significantly more satisfied with their procedures compared to the patients of group II (p<0.001). CONCLUSIONS: Midazolam induced sedative cystoscopy can be applied safely and effectively as an outpatient base procedure. Further, we expect to apply this sedative procedure to other urologic procedures.
Analgesics ; Anxiety ; Blood Pressure ; Conscious Sedation ; Consciousness ; Cystoscopy* ; Endoscopy ; Flumazenil ; Heart Rate ; Humans ; Midazolam* ; Outpatients ; Surveys and Questionnaires ; Respiratory Rate

Both death certificates and postmortem examination certificates are used as proof of death. These certificates sometimes contain erroneous information but how frequently they do so is unknown. In particular, only a few studies have measured the accuracy of the cause and manner of death on Korea death documents. In this study, we compared the cause and manner of death on both kinds of certificates with those on autopsy reports to determine the frequency of errors, and to identify way to improve the accuracy of these certificates. In 2012, 528 autopsies were requested of out institute, and certificates were submitted in 241 of the cases. The manner of death was classified as natural, unnatural, or unknown. The cause of death in the autopsy report matched that on the death certificate in 37 of 63 cases (58.7%), and the manner of death matched in 40 of 63 cases (63.5%). The cause of death in the autopsy report matched that on the postmortem examination certificate in 62 of 178 cases (34.8%), and the manner of death matched in 74 of 178 cases (41.6%). Death certificates and postmortem examination certificates are important documents. We identified many incorrect reports of causes and manners of death on both kinds of documents, especially the postmortem death certificates. These inaccuracies are presumably due to a lack of forensic information and education, as well as lack of interest on the part of medical doctors.
Autopsy* ; Cause of Death ; Death Certificates* ; Education ; Korea

PURPOSE: To report a case of iridocorneal endothelial syndrome, which overlapped with some of the features of posterior polymorphous corneal dystrophy. CASE SUMMARY: A 61-year-old female presented with tearing pain and blurred vision in her left eye, which was aggravated in the morning. The symptom started approximately 1 year prior to her visit. At the initial visit, the visual acuities were 1.0 in both eyes and the intraocular pressures were normal. On slit-lamp examination, a single pair of horizontal parallel lines was observed at the central corneal endothelial layer in the right eye. In contrast, multiple pairs of oblique parallel lines were observed in the left eye. The lines of the lesions were more prominent and wavier in the left eye than those of the right eye. The overlying cornea was clear, and the corneal thicknesses were in the normal range in both eyes. Using a gonioscopic examination, localized peripheral anterior synechiae were observed only in the left eye. The pupil and iris were normal in both eyes. On specular microscopic examination, the corneal endothelial cell size in the right eye increased and the corneal endothelial density decreased to 668 cells/mm². In the left eye, multiple abnormal endothelial cells with dark-light reversal were observed. In conclusion, the patient was subsequently diagnosed with iridocorneal syndrome, rather than posterior polymorphous corneal dystrophy. CONCLUSIONS: Posterior polymorphous corneal dystrophy and iridocorneal endothelial syndrome may present with many similarities. Therefore, in cases of uncertain diagnosis, an understanding of the clinical features is important for proper diagnosis.
Cornea ; Diagnosis ; Endothelial Cells ; Female ; Humans ; Intraocular Pressure ; Iridocorneal Endothelial Syndrome ; Iris ; Middle Aged ; Pupil ; Reference Values ; Tears ; Visual Acuity

Purpose: To report a case of carotid-cavernous fistula associated with superior ophthalmic vein thrombosis which was misdiagnosedas orbital cellulitis.Case summary: A 72-year-old female was transferred to our hospital because she had been diagnosed with orbital cellulitis atanother hospital due to pain, swelling, and redness of the left eye, which became increasingly severe 3 days prior to her visit. Thepatient had edema and ptosis of the left eyelid, severe chemosis, and congestion of the conjunctiva. The eye movement testshowed limitations in abduction, adduction, and infraduction of the left eye, and the patient complained of diplopia. Paranasal sinuscomputed tomography showed an edema of the left upper eyelid, enlargement of the extraocular muscles, and dilation andthrombosis of the superior ophthalmic vein. On brain magnetic resonance imaging and magnetic resonance angiography, leftcarotid-cavernous fistula was suspected, so she was transferred to neurosurgery and a cerebral angiography was performed.Cerebral angiography showed an indirect carotid-cavernous fistula on the ipsilateral side and a direct carotid-cavernous fistulaon the opposite side. The patient underwent embolization and stenting. Seven days after surgery, the eyelid and conjunctivalswelling and diplopia disappeared and there was no limitation of eye movement in any direction. Conclusions An infectious disease such as orbital cellulitis is the most common cause of superior ophthalmic vein thrombosis.However, as in this patient, carotid-cavernous fistula can be the cause, so thorough imaging is important for rapid improvementof symptoms.

Purpose: This study compared the contrast sensitivity before and after surgery for intermittent exotropia and consecutive esotropia and examined the correlation between contrast sensitivity and other visual function factors. Methods: The medical records of patients who underwent surgery for consecutive esotropia after surgery for intermittent exotropia were analyzed retrospectively. To analyze changes after each surgery, contrast sensitivity was tested before surgery for exotropia, before surgery for consecutive esotropia, and 3 months after surgery for consecutive esotropia. The changes in contrast sensitivity were analyzed, and correlation analyses between contrast sensitivity and the Titmus test and Worth 4 Dot (W4D) test were performed. Results: The study included 14 patients. In consecutive esotropia, the contrast sensitivity was significantly improved at 7.1 and 10.2 cycles per degree (cpd) under mesopic conditions in the presence of glare and at 10.2 cpd under photopic conditions with and without glare after esotropia surgery (p < 0.05). There was a significant negative correlation between contrast sensitivity and stereopsis at 1.1 cpd under photopic conditions without glare before esotropia surgery (p = 0.011). Comparing the contrast sensitivity according to the W4D results, the fusion group had significantly better contrast sensitivity than the non-fusion group at 10.2 cpd under photopic conditions without glare and 2.9, 4.5, and 7.1 cpd with glare before exotropia surgery (p < 0.05). Conclusions The contrast sensitivity at high spatial frequencies improved after surgery for consecutive esotropia and there was a significant negative correlation between the contrast sensitivity and stereopsis in consecutive esotropia. This means that in patients with esotropia, the contrast sensitivity test is an indirect indicator of visual function.

Purpose: This study compared the contrast sensitivity before and after surgery for intermittent exotropia and consecutive esotropia and examined the correlation between contrast sensitivity and other visual function factors. Methods: The medical records of patients who underwent surgery for consecutive esotropia after surgery for intermittent exotropia were analyzed retrospectively. To analyze changes after each surgery, contrast sensitivity was tested before surgery for exotropia, before surgery for consecutive esotropia, and 3 months after surgery for consecutive esotropia. The changes in contrast sensitivity were analyzed, and correlation analyses between contrast sensitivity and the Titmus test and Worth 4 Dot (W4D) test were performed. Results: The study included 14 patients. In consecutive esotropia, the contrast sensitivity was significantly improved at 7.1 and 10.2 cycles per degree (cpd) under mesopic conditions in the presence of glare and at 10.2 cpd under photopic conditions with and without glare after esotropia surgery (p < 0.05). There was a significant negative correlation between contrast sensitivity and stereopsis at 1.1 cpd under photopic conditions without glare before esotropia surgery (p = 0.011). Comparing the contrast sensitivity according to the W4D results, the fusion group had significantly better contrast sensitivity than the non-fusion group at 10.2 cpd under photopic conditions without glare and 2.9, 4.5, and 7.1 cpd with glare before exotropia surgery (p < 0.05). Conclusions The contrast sensitivity at high spatial frequencies improved after surgery for consecutive esotropia and there was a significant negative correlation between the contrast sensitivity and stereopsis in consecutive esotropia. This means that in patients with esotropia, the contrast sensitivity test is an indirect indicator of visual function.