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

No abstract available.
Brain Stem* ; Evoked Potentials* ; Hallucinations* ; Humans

PURPOSE: Myocardial SPECT is an effective test for detecting coronary artery disease in the general population. But the diagnostic accuracy between sexes is not defined. The purpose of this study is to compare the diagnostic accuracy between males and females. MATERIALS AND METHODS: One hundred and seventy seven male and 98 female patients who underwent myocardial SPECT within 1 month of coronary angiography were studied. Myocardial SPECTs were considered abnormal if fixed or reversible perfusion defects were detected. Stenosis severity of > or = 50% luminal diameter reduction of any artery defined coronary artery disease (CAD). RESULTS: Overall sensitivity for detection of CAD was 98% in men and 97% in women (p=not significant). However, specificities, accuracies, and positive predictive values (PPV) in men and women were 49% vs 31% (p<0.05), 81% vs 57% (p<0.01), 78% vs 48% (P<0.01), respectively Diagnostic accuracies for detection of right coronary artery disease were not different in both sexes, however, accuracies for detection of left anterior descending artery disease and left circumflex artery disease were significantly lower in female (p<0.05). CONCLUSION: A significant difference of diagnostic accuracy between sexes, especially in LAD and LCx disease, was noted. Artifacts from breast attenuation might be a cause for the lower diagnostic accuracy in female.
Arteries ; Artifacts ; Breast ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Female ; Humans ; Male ; Perfusion* ; Phenobarbital ; Tomography, Emission-Computed, Single-Photon*

BACKGROUND: Tc-99m myocardial perfusion imaging agents have recently found wide spread use as detecting agents of coronary diseases. Unfortunately, false positive results are not infrequent. METHODS: We analyzed Tc-99m myocardial perfusion SPECT (Tc-SPECT) findings in angina patients showing normal coronary angiography. Seventy patients who underwent myocardial SPECT wihin one month of coronary angiography which revealed no significant stenosis were studied. RESULTS: Forty six (65.7%) patients showed perfusion defects on Tc-SPECT. Eighteen were due to soft tissue attenuation, thirteen were due to technical problems such as low count rate, six were associated with intraventricular conduction abnormalities, four with coronary spasms, three with old infarctions, and one with slow coronary flow. CONCLUSION: Photon attenuation and inadequate count rates were the main causes of false positive results on myocardial SPECT imaging with Tc-99m agents. However, pathological conditions such as conduction disturbance, coronary spasm or slow coronary flow were also associated with positive SPECT findings in patients with normal coronary angiograms.
Constriction, Pathologic ; Coronary Angiography* ; Coronary Disease ; Humans ; Infarction ; Myocardial Perfusion Imaging ; Perfusion* ; Spasm ; Tomography, Emission-Computed, Single-Photon*

Angiogenesis is a series of processes that include endothelial proliferation, migration and tube formation. Vascular endothelial growth factor (VEGF) is regarded as a potent mediator of angiogenesis, vascular permeability and tumor cell growth in renal cell carcinoma. This study was designed to evaluate the expression of VEGF and the microvessel count (MVC) and to determine their prediction efficacies for prognosis in renal cell carcinoma. The relationship between the expression of VEGF and MVC were evaluated immunohistochemically in 50 patients with renal cell carcinoma who received a radical nephrectomy at Wonju Christian Hospital between 1989 and 1997. Microvessels were identified by immunostaining endothelial cells for CD-31 antigen. The mean follow-up was 96 months (3 - 133 months). Overall 5-year survival rate was 71.5%. VEGF was expressed in the tumor cell cytoplasm. Of the 50 tumors, 23 (46%) were weak to strongly positive for VEGF but 27 (54%) were unreactive. The respective 5-year survival rates for patients with positive and negative expressions of VEGF were 70% and 73% (p > 0.05). The overall mean MVC was 13.4 in a 400x field. Mean MVCs were significantly higher in VEGF-positive tumors (17.6 +/- 12.1) than in VEGF-negative tumors (9.9 +/- 5.4), and the MVCs of the high vascular density group and the low ascular density groups were significantly different. The 5-year survival rates of patients with high vascular density and low vascular density were 59% and 86%. The median survival period for patients with MVCs higher than or equal to 10 vessels/field was 85 months, whereas for those with MVCs lower than 10 vessels/field the median survival time was 102 months. These results suggest that MVC may be a better prognostic factor in renal cell carcinoma than the expression of VEGF.
Adult ; Aged ; Carcinoma, Renal Cell/*blood supply/*metabolism ; Endothelial Growth Factors/*metabolism ; Female ; Human ; Kidney Neoplasms/*blood supply/*metabolism ; Lymphokines/*metabolism ; Male ; Middle Age ; Neovascularization, Pathologic/*pathology ; Prognosis

We report a false positive case of I-131 scan due to a sialolithiasis in right submandibular gland. I-131 images showed not only remnant thyroid tissues and functional metastases in the anterior neck but also a hot uptake near right submandibular gland. We confirmed the sialolithiasis by radiologic studies. Sialolithiasis should be regarded as a false positive cause when I-131 scan shows a hot spot near salivary bed.
Neck ; Neoplasm Metastasis ; Salivary Gland Calculi* ; Submandibular Gland ; Thyroid Gland* ; Thyroid Neoplasms*

As the newly reconstructed nipple tends to be flattened, especially if submitted to pressure, prudent dressings using various protective devices as a physical support against pressure on a new nipple is important. We used a breathing bag connecting tube as a protective device in nipple reconstruction. A breathing bag connecting tube recycled was cut and trimmed at 1cm above the height of the reconstructed nipple. Before stitch out, the newly reconstructed nipple with a local flap was dressed and protected in this way for 10 days after surgery. After stitch out, patients learnt how to manage the new nipple at home. The sole means of nipple dressing was affixing the breathing bag connecting tube with adhesive tape. Two patients had worn the tube for two months with the best compliance. Owing to the soft composition of the tube material, it is possible for a surgeon to have an easy cutting and trimming of the tube at appropriate heights as well as for a patient to show better compliance yielding better results. The cost factor is another advantage.
Adhesives ; Bandages ; Compliance ; Fibrinogen ; Humans ; Nipples* ; Protective Devices ; Respiration*

We report a case of a patient with cystic subdural hygroma who underwent pre-operative Tc-99m DTPA cistrenoscintigraphy to determine the course of operation. A 68-year-old female was admitted to the department of neurosurgery because of acute subarachnoid hemorrhage. After emergency ventricular drainage, the hydrocephalus and cystic subdural hygroma in the right fronto-temporal area developed. She underwent Tc-99m DTPA cisternoscintigraphy to evaluate the type of hydrocephalus, which revealed obstructive communicating hydrocephalus and the communication between the subdural hygroma and the subarachnoid space. As a result of these findings, she underwent the ventriculo-peritoneal shunt operation without removal of the subdural hygroma. Post-operative brain CT showed nearly normalized shape and size of the right ventricle and disappearance of subdural hygroma. We recommend the pre-operative cisternoscintigraphy in patients with complex hygroma to evaluate the communication between subdural hygroma and the subarachnoid space.
Aged ; Brain ; Decision Making* ; Drainage ; Emergencies ; Female ; Heart Ventricles ; Humans ; Hydrocephalus ; Lymphangioma, Cystic ; Neurosurgery ; Pentetic Acid ; Subarachnoid Hemorrhage ; Subarachnoid Space ; Subdural Effusion* ; Ventriculoperitoneal Shunt

The lipid lowering effects of bezafibrate were evaluated in 18 patients with hyperlipidemia, i.e. over 200mg/dl of cholesterol and/or of cholesterol and/or triglyceride before treatment. The materials were 18 patients(male:8, female:10);7 with diabetes mellitus, 8 with congestive cardiomyopathy, 1 with parkinsonism, The serum lipid concents were measured with enzyme method before and 6 weeks after the treatment with daily 600mg of bezafibrate administered per oral and the differences were observed. 1) The level of serum cholesterol was reduced from 262.8mg/dl(+/-58.9SD) before treatment to 191.3gm/dl(+/-31.3SD) after 6 weeks treatment(p<03.005). 2) The level of serum triglyceride was reduced from 231.8mg/dl(+/-104SD) before treatment to 144.4mg/dl(+/-51SD) after 6 weeks treatment(p<0.005). 3) The level of serum HDL increased from 47.2mg/dl(+/-19.7SD) before treatment to 61.3mg/dl(+/-13.9SD) after 6 weeks treatment(p<0.005). 4) The level of serum LDL was reduced from 169.3mg/dl(+/-52.4SD) before treatment to 101.2mg/dl(+/-29.5SD) after 6 weeks treatment(p<0.05). 5) HDL/Cholesterol ratio was increased from 17.8%(+/-5.4SD) before treatment to 32.6%(+/-7.9SD) after 6 weeks treatment(p<0.005). 6) HDL/LDL ratio was increased from 29.2%(+/-10.8SD) before treatment to 67.2%(+/-30.8SD) after 6 weeks treatment(<0.005). The side effects of bezafibrate such as G-I trouble, myositis, hypersensitivity, elevation of BUN and creatinine were not observed.
Bezafibrate* ; Cardiomyopathy, Dilated ; Cholesterol ; Creatinine ; Diabetes Mellitus ; Humans ; Hyperlipidemias* ; Hypersensitivity ; Myositis ; Parkinsonian Disorders ; Triglycerides

PURPOSE: We sought to identify the prevalence of sexual dysfunction and to evaluate the six domains of sexual function in female hemodialysis patients. MATERIALS AND METHODS: We undertook a cross-sectional study based on self-administered questionnaires and reviews of laboratory data that were collected from February to June 2007. A total of 49 women (mean age 52.3 years) from eight dialysis units were enrolled. Sexual function was assessed by the Korean version of the Female Sexual Function Index (FSFI). RESULTS: Forty-one patients (83.7%) reported sexual dysfunction during the prior 6 months. The mean score for sexual function in the sexual dysfunction group was 15.1, much lower than 29.6 for the normal sexual function group (t=10.2, p=0.000). In the six domains of sexual function for the dysfunction group, orgasm (range 0~6.0) was 2.4, desire (range 1.2~6.0) 1.9, and arousal (range 0~6.0) 1.9. The sexual dysfunction group was significantly older in age and lower in serum albumin level as compared with normal sexual function group. CONCLUSIONS: Sexual dysfunction in female patients on hemodialysis was highly prevalent. Interventions to promote orgasm, desire, and arousal in female patients on hemodialysis should be developed.
Arousal ; Cross-Sectional Studies ; Dialysis ; Female* ; Humans ; Orgasm ; Prevalence ; Surveys and Questionnaires ; Renal Dialysis* ; Serum Albumin