Heat stroke, a medical emergency, occurs when the body's thermal regulation is upset and unable to dissipate adequate amounts of heat with a rise in body temperature. It is characterized by hyperyrexia, with a core temperature of 40degrees C or more, hot dry skin, and central nervous system disturbance and usually results in rhabdomyolysis and multiorgan failure. Our case, a 43-year-old healthy male, was caused by a marathon, half course, on a sunny day in late summer. He suddenly fell down on the road and was delivered to a nearby hospital, where a seizure developed. He was transfered to our hospital and then displayed Central Nervous System disturbance, hot dry skin, acute liver failure, rhabdomyolysis, anuric acute renal failure, and disseminated intravasculular coagulopathy. He was treated with general supportive care and hemofiltration. Despite the aggressive management, he died of shock on the fifth day after admission.
Acute Kidney Injury ; Adult ; Body Temperature ; Central Nervous System ; Emergencies ; Heat Stroke* ; Hemofiltration ; Hot Temperature* ; Humans ; Liver Failure, Acute ; Male ; Rhabdomyolysis ; Seizures ; Shock ; Skin

Churg and Strauss established the clinicopathologic features of allergic angiitis and granulomatosis. The condition is rare and is characterized by involvement of vessels of all sizes(including veins and venules), especially the pulmonary vessel. intra- and extravascular granuloma formation, eosinophil infiltration of tissue and an association with asthma and peripheral eosinophilia. Churg Strauss syndrome (CSS) involves the GI tract, the skin, the heart, the lungs etc. We report a case of CSS in 38 year old male patient, who presented acute peritonitis and who had had 4-year history of bronchial asthma. An emergency laparotomy revealed multiple impending perforations in small intestine. A skin lesion and neuropathy developed postoperatively. Microscopic exammination of the appendix and the skin lesion showed thrombs in the lumens of vessels, vasculitis and eosinophilic infiltration to the lesion and the vessel wall.
Adult ; Appendix ; Asthma ; Churg-Strauss Syndrome* ; Emergencies ; Eosinophilia ; Eosinophils ; Gastrointestinal Tract ; Granuloma ; Heart ; Humans ; Intestine, Small ; Laparotomy ; Lung ; Male ; Peritonitis ; Skin ; Vasculitis ; Veins

Churg and Strauss established the clinicopathologic features of allergic angiitis and granulomatosis. The condition is rare and is characterized by involvement of vessels of all sizes(including veins and venules), especially the pulmonary vessel. intra- and extravascular granuloma formation, eosinophil infiltration of tissue and an association with asthma and peripheral eosinophilia. Churg Strauss syndrome (CSS) involves the GI tract, the skin, the heart, the lungs etc. We report a case of CSS in 38 year old male patient, who presented acute peritonitis and who had had 4-year history of bronchial asthma. An emergency laparotomy revealed multiple impending perforations in small intestine. A skin lesion and neuropathy developed postoperatively. Microscopic exammination of the appendix and the skin lesion showed thrombs in the lumens of vessels, vasculitis and eosinophilic infiltration to the lesion and the vessel wall.
Adult ; Appendix ; Asthma ; Churg-Strauss Syndrome* ; Emergencies ; Eosinophilia ; Eosinophils ; Gastrointestinal Tract ; Granuloma ; Heart ; Humans ; Intestine, Small ; Laparotomy ; Lung ; Male ; Peritonitis ; Skin ; Vasculitis ; Veins

BACKGROUND: We observed fentanyl known as centrally-acting antitussive agents provoke a cough response in some patients at induction of anesthesia. This may be of clinical importance. METHOD: 121 patients (ASA class I) were assigned randomly to 4 groups. Each group was given different doses of fentanyll Group 1 (n=30); 0.5ug/kg, Group 2 (n=30); 1ug/kg, Group 3 (n=33); 2ug/kg, Group 4 (n=28); 4 g/kgl, within 1 second through a peripheral venous cannula before induction of anesthesia. All patients were observed carefully in order to detect a cough response and any side effects. RESULT: The incidences of FCR (Fentanyl Cough Response) were 0% in Group 1, 10.0% in Group 2, 30.3% in Group 3, and 39.3% in Group 4. The ED50 of FCR was 4.25ug/kg. The mean onset-time from the end of fentanyl administration to the beginning of coughing was 12.5 seconds. FCR was decreased with aging, but not affected by weight, height, or smoking. Other serious side effects were not accompanied. CONCLUSION: Fentanyl can evoke the pulmonary chemoreflex dose-dependently and the ED50 was 4.25 g/kg.
Aging ; Anesthesia ; Antitussive Agents ; Catheters* ; Cough* ; Fentanyl* ; Humans ; Incidence ; Reflex* ; Smoke ; Smoking

Gelastic (laughing) epilepsy characterized as paroxysmal involuntary laughing episodes usually begins in infancy or childhood. It is known to be poorly respond to medical or surgical treatments. This unique seizure is rare and associated with variable etiologies, especially with hypothalamic harmatoma. But still, relationship between harmatoma and seizure is unclear. We presented three cases of gelastic seizures which were diagnosed by clinical history, 24 hour video EEG monitoring and radiological studies. Two of them were associated with hypothalamic harmatoma, but etiology of one case with normal brain structure can not be documented. Anticonvulsant agents were prescribed on all cases and surgical interventions(gamma knife surgery or subtotal resection) were done on harmatoma cases. After medical and surgical treatments, one case showed poor prognosis but two cases showed exellent outcome with seizure free state.
Brain ; Electroencephalography ; Epilepsy ; Prognosis ; Seizures*

PURPOSE: To report three cases of ophthalmoplegic migraine which is a rare condition characterized by the association of headaches with an oculomotor nerve palsy. CASE SUMMARY: A 44-year-old male and two eight-year-old females were presented with diplopia developed after headaches. All of the three patients showed abnormal eye movement and they had past episodes of transient diplopia with headaches. Visual evoked potential (VEP), cerebrospinal fluid (CSF) examination, laboratory findings, and other neurologic tests were all normal, also there was no tumor or cerebrovascular disease on brain MRA & MRI. The symptoms of all patients improved gradually within several weeks from first the visit, with complete recovery seen in all three. CONCLUSIONS: Any patient who has a headache with paresis of the extraocular muscle should be considered for ophthalmoplegic migraine. To diagnose ophthalmoplegic migraine, family history, past medical history, associated symptoms and signs, neurologic examinations and neuroimaging tests are needed.
Adult ; Brain ; Diplopia ; Evoked Potentials, Visual ; Eye Movements ; Female ; Headache ; Humans ; Male ; Migraine Disorders ; Muscles ; Neuroimaging ; Neurologic Manifestations ; Oculomotor Nerve ; Ophthalmoplegic Migraine ; Paresis

PURPOSE: To reassess the diagnostic value of plain radiographs, compared with computed tomography, in thediagnosis of acute traumatic spinal fracture. MATERIALS AND METHODS: Forty-six patients (total 64 cases) withacute traumatic spinal fracture were studied using plain radiographs and computed tomography. Fracture site andtype (according to the three-column theory), classification as major or minor injury, stability of fracture, andthe presence of associated soft tissue change were evaluated on plain radiographs and CT. The results of the twoimaging techniques were compared. RESULTS: Excluding eight cases of C1 and C2 fractures, 41 cases involvedfractures of the vertebral body, and 15 involved only the posterior column. Plain radiographs and CT showed,respectively, 27 and 25 cases of simple compression fracture, 13 and 16 of bursting fracture. One case ofcompression fracture was not detected on plain radiographs. The results of classification as major (43/56) orminor (13/56) injury were equivalent on plain and CT films. For the evalvation of unstable fracture, plainradiographs were superior to CT(stable fracture, 46/64; unstable fracture, 18/64), while for the evaluation ofsoft tissue change, CT was better than plain radiographs. CONCLUSION: If correct procedures are meticulouslyadhered to, plain radiographs of acute traumatic spinal injury provide good information for the diagnosis oftraumatic fracture.
Classification ; Diagnosis ; Fractures, Compression ; Humans ; Spinal Fractures* ; Spinal Injuries

BACKGROUND: Nosocomial urinary tract infection (UTI) is the most frequent nosocomial infection and could be prevented through the intensive nosocomial infection control (NIC) or restricting the use of indwelling urinary catheter. The efficiency of the intensive NIC to prevent UTI for the patients with indwelling urinary catheter was investigated. METHODS: Study population consisted of 296 patients with indwelling urinary catheter in the intensive care unit (lCU) who didn't have UTI on admission. The incidence rates of nosocomial UTI were compared between 146 patients being provided with ordinary NIC from March 15 to July 31, 1995 (control group) and 150 patients being provided with intensive NIC from January 16 to October 31, 1996 (NIC group). RESULTS: There was significant decrease in the incidence of nosocomial UTI in the NIC group (35 UTI among 150 patients, 23.8%) than in me control group (68 UTI among 146 patients, 46.6%) (P<0.01). But there were no differences in age distribution, sex, admission route to the ICU and underlying diagnoses between two groups. Interval between insertion of urinary catheter and development of UTI was significantly prolonged in the NIC group (10.0 +/- 3.5 days) than in the control group(7.6 +/- 3.9 days) (p < 0.01) despite there were no differences in the duration of urinary catheterization in two groups. The most common organism isolated from the urine of the patients was Candida tropicalis in both groups and the other organisms were in the order of Enterococcus faecium, Pseudomonas putida, Staphylococcus epidermidis in the control group and in the order of Staphylococcus aureus, Acinetobacter baumannii, Enterococcus faecalis in the NIC group. Four of five Staphylococcus aureus isolated in NIC group were MRSA. CONCLUSION: This study result confirms the efficiency of intensive NIC fur decrease in the incidence of nosocomial UTI in patients with indwelling urinary catheter. But the incidence of nosocomial UTI should be decreased further through the continuous emphasis on NIC and it seems to be necessary to study the effect of each component of NIC with proper control of the risk factors for the development of nosocomial UTI in the future.
Acinetobacter baumannii ; Age Distribution ; Candida tropicalis ; Cross Infection* ; Diagnosis ; Enterococcus faecalis ; Enterococcus faecium ; Humans ; Incidence ; Intensive Care Units* ; Critical Care* ; Methicillin-Resistant Staphylococcus aureus ; Pseudomonas putida ; Risk Factors ; Staphylococcus aureus ; Staphylococcus epidermidis ; Urinary Catheterization ; Urinary Catheters ; Urinary Tract Infections* ; Urinary Tract*

Myotonic dystrophy is a multisystemic disorder inherited as an autosomal dominant trait. The characteristic clinical features include the presence of myotonia, atrophy of the muscles of the face and the sternocleidomastoids and numerous nonmusclar manifestations such as cataracts, frontal baldness, gonadal dysfunctions and cardiac abnormalities. We experienced one case of myotonic dystrophy with prolonged atrial flutter in 30-year-old male who was admitted because of palpitation. We present this case with reviewing literatures.
Adult ; Alopecia ; Atrial Flutter* ; Atrophy ; Cataract ; Gonads ; Humans ; Male ; Muscles ; Myotonia ; Myotonic Dystrophy*

OBJECTIVE: This study aimed to test the possible association between Cholecystokinin B receptor (CCKBR) promoter gene and panic disorder. METHODS: 262 patients with panic disorder and 76 healthy controls participated in this study. Genotyping was performed by polymerase chain reaction-based method. RESULTS: Allele distribution of CT repeat polymorphism in patients with panic disorder was not different from those of the controls. However, after excluding the patients with panic disorder comorbid with major depressive disorder and other anxiety disorder, we found out the significant association of CCKBR (CT)n repeat with the panic disorder without comorbidities. And we analysed the data as a di-allelic polymorphism with a short (140-162 bp) and a long (164-180 bp) allele. In the di-allelic analysis, there was an excess of the shorter allele in patients with panic disorder. CONCLUSION: The present study suggested that the CCKBR promoter dinucleotide polymorphism may have a potential role for susceptibility to panic disorder in the Korean population and thus calls for consecutive studies in order to pile up the data with larger different ethnic background.
Alleles ; Anxiety Disorders ; Cholecystokinin* ; Comorbidity ; Depressive Disorder, Major ; Diagnosis* ; Drug Therapy* ; Humans ; Panic Disorder* ; Panic* ; Receptor, Cholecystokinin B*