Post-traumatic fat embolism was first reported by Zenker in 1862, Von Bergmann reported the first clinical diagnosis of the fat embolism syndrome in 1873. Fat embolism has been associated with traumatic or non-traumatic disorders. Fat embolization after long bone trauma is probably common as a subclinical event. The diagnosis of fat embolism syndrome is based on the patient's history, is supported by clinical signs of pulmonary, cerebral, and cutaneous dysfunction, and is confirmed by the demonstration of arterial hypoxemia in the abscence of other disorders. Two different mechanisms cause fat to embolize: direct entry of deposit fat into the blood stream and agglutination of endogenous or exogenous plasma fat. MRI can detect a cerebral fat embolism with a higher sensitivity than cerebral CT. We report a case of post-traumatic cerebral fat embolism without pulmonary involvement, and we present a review of the literature. A 16-year girl had a traffic accident and pelvic bone fracture. Forty eight hours later severe trauma become stuporous without a focal neurological deficit. The patient received supportive therapy, and her condition improved throughout her hospital course. She was discharged with good condition after a 30-day hospital stay.
Accidents, Traffic ; Agglutination ; Anoxia ; Diagnosis ; Embolism, Fat* ; Female ; Humans ; Length of Stay ; Magnetic Resonance Imaging ; Pelvic Bones ; Plasma ; Rivers ; Stupor

PURPOSE: Neurological outcome prediction is an important aspect of post-resuscitation care in cardiac arrest survivors. The appearance of high serum neuron specific enolase (NSE) is known to be associated with ischemic brain injury and poor neurological outcome. The application of therapeutic hypothermia to cardiac arrest survivors has been shown to improve neurological outcomes. As such, we investigated the predictive value of serial serum NSE levels in patients who were resuscitated from cardiac arrest. METHODS: This study included 123 cardiac arrest survivors who were treated by therapeutic hypothermia from January 2008 to June 2011. Blood samples used for evaluating NSE were collected at return of spontaneous circulation (ROSC) at 6, 24 and 48 hours after initiation of therapeutic hypothermia. Neurological outcome was graded as 'good' or 'poor' at discharge and assessed according to the Cerebral Performance Category scale (CPC). A poor outcome was defined as a CPC value of 3-5. RESULTS: Receiver operating characteristic (ROC) analysis revealed NSE cut-off values of 53.9 microg/L (sensitivity 14.6%), 48.5 microg/L (sensitivity 30.6%), 80.0 microg/L (sensitivity 40.0%), and 52.7 microg/L (sensitivity 55.5%) for poor outcomes with a specificity of 100%, measured at ROSC of 6, 24 and 48 hours after initiation of therapeutic hypothermia, respectively. The poor outcome group showed significant change in NSE concentration over time (p=0.002), while the good outcome group did not. CONCLUSION: Detection of NSE at the cut-off value, 48 hr after initiation of therapeutic hypothermia was a specific but moderately sensitive marker of poor outcome at discharge. Single measurements of NSE should be cautiously interpreted, but NSE change over time was helpful in predicting the neurologic outcome.
Brain Injuries ; Dinucleoside Phosphates ; Heart Arrest ; Humans ; Hypothermia ; Hypothermia, Induced ; Neurons ; Phosphopyruvate Hydratase ; Prognosis ; ROC Curve ; Sensitivity and Specificity ; Survivors

PURPOSE: Neurological outcome prediction is an important aspect of post-resuscitation care in cardiac arrest survivors. The appearance of high serum neuron specific enolase (NSE) is known to be associated with ischemic brain injury and poor neurological outcome. The application of therapeutic hypothermia to cardiac arrest survivors has been shown to improve neurological outcomes. As such, we investigated the predictive value of serial serum NSE levels in patients who were resuscitated from cardiac arrest. METHODS: This study included 123 cardiac arrest survivors who were treated by therapeutic hypothermia from January 2008 to June 2011. Blood samples used for evaluating NSE were collected at return of spontaneous circulation (ROSC) at 6, 24 and 48 hours after initiation of therapeutic hypothermia. Neurological outcome was graded as 'good' or 'poor' at discharge and assessed according to the Cerebral Performance Category scale (CPC). A poor outcome was defined as a CPC value of 3-5. RESULTS: Receiver operating characteristic (ROC) analysis revealed NSE cut-off values of 53.9 microg/L (sensitivity 14.6%), 48.5 microg/L (sensitivity 30.6%), 80.0 microg/L (sensitivity 40.0%), and 52.7 microg/L (sensitivity 55.5%) for poor outcomes with a specificity of 100%, measured at ROSC of 6, 24 and 48 hours after initiation of therapeutic hypothermia, respectively. The poor outcome group showed significant change in NSE concentration over time (p=0.002), while the good outcome group did not. CONCLUSION: Detection of NSE at the cut-off value, 48 hr after initiation of therapeutic hypothermia was a specific but moderately sensitive marker of poor outcome at discharge. Single measurements of NSE should be cautiously interpreted, but NSE change over time was helpful in predicting the neurologic outcome.
Brain Injuries ; Dinucleoside Phosphates ; Heart Arrest ; Humans ; Hypothermia ; Hypothermia, Induced ; Neurons ; Phosphopyruvate Hydratase ; Prognosis ; ROC Curve ; Sensitivity and Specificity ; Survivors

Pulmonary decompression sickness (DCS) is a relatively uncommon form of type II DCS, with a frequency of only 2.4% as averaged from several studies. The deposition of venous gas emboli in the pulmonary arterial circulation produces progressive dyspnea, cough, chest pain and the physical findings of increased central venous pressure and pulmonary arterial pressure, and right-sided strain on an electrocardiogram. We recently experienced a case of pulmonary DCS presenting as interstitial pulmonary edema combined with low central venous pressure. In this case, air bubbles that were trapped in the most nondependent part of the femoral vein were discovered incidentally, on abdominal computed tomography scan, which may mean that the buoyancy of gas bubbles was sufficient to counteract the venous blood flow propelling such bubbles in the direction of blood flow. In addition, we discuss the current availability of recompression facilities in South Korea since some difficulties are anticipated in treating an unstable patient with a monoplace hyperbaric chamber, which is typically the only available type of hyperbaric chamber in South Korea.
Arterial Pressure ; Central Venous Pressure ; Chest Pain ; Cough ; Decompression ; Decompression Sickness ; Diving ; Dyspnea ; Electrocardiography ; Embolism, Air ; Femoral Vein ; Humans ; Hyperbaric Oxygenation ; Pulmonary Edema ; Republic of Korea ; Sprains and Strains

PURPOSE: Organophosphorus (OP) pesticides are differentiated into 3 groups according to their toxicity. The differences in chemical composition of each OP pesticide determines its toxicokinetic characteristics. There are few human studies that address the clinical results of poisoning according to the OP pesticide. In this study, we aimed to examine the differences in clinical features among self-poisoning from 4 highly toxic OP pesticides. METHODS: The 4 kinds of OP poisonings included 17 cases of Dichlorvos, 17 cases of EPN, 17 cases of methidathion, and 13 cases of phosphamidon. We set primary outcomes as GCS, atropine dose required, duration of patient need for atropine, proportion who required ventilation, duration on ventilation, and the interval from ingestion to ventilation. Secondary outcomes were the proportion of OP-induced delayed neuropathy, duration of ICU stay, and proportion who required additional infusion of pralidoxime chloride (PAM). RESULTS: The EPN group required the largest amount of atropine, the longest duration of atropine use, the longest duration for support of mechanical ventilation, and the longest ICU stay. Furthermore the proportion who required additional PAM and neuropathy were in the EPN group. However, the EPN group had the longest interval from ingestion to ventilatory support. Meanwhile, the Dichlorvos group exhibited comparatively mild clinical features. CONCLUSION: Throughout this study, we found different clinical features to each OP pesticide poisoning. It can be explained by differences in chemical composition, which determined the speed of aging, the reactivation rate of OPenzyme, the metabolism, the fat solubility, and other characteristics of the pesticides.
Aging ; Atropine ; Dichlorvos ; Eating ; Humans ; Organophosphorus Compounds ; Organothiophosphorus Compounds ; Pesticides ; Phosphamidon ; Pralidoxime Compounds ; Respiration, Artificial ; Solubility ; Ventilation

Medullary carcinoma of the thyroid gland(MTC) constitutes approximatesly 3% to 10% of all malignant thyroid tumors. It appears in both familial and sporadic forms. Metastases are frequently present at diagnosis and are resistant to chemotherapy and radiotherapy. Surgical resection of the primary tumor and the metastases is the mainstay of treatment. Although MTC can be detected by elevated serum calcitonin, localization of residual or metastatic foci may be difficult. Many scintigraphic methods have been used for identification of the residual tumor or metastasis. However, most of them have either low sensitivity or low specificity. MTC frequently secretes somatostatin and may express somatostatin receptors. Recently, somatostatin-receptor imaging has been known to be useful for the detection of residual and recurrent medullary thyroid carcinoma. A 25 year-old woman who was dignosed as medullary carcinoma by biopsy of thyroid mass is presented. Thirteen years ago, she underwent left thyroidectomy due to thyroid cancer(MTC). Laboratory tests revealed an increase in the levels in serum CEA(CEA=557.6 ng/ml) and calcitonin(calcitonin= 720 pg/ml). The second patient, a 30 year-old female, complained of a palpable mass in the left anterior neck. Ten years ago, she underwent a right lobectomy of thyroid gland due to adenomatous goiter. Laboratory tests revealed an increase in the levels in serum CEA(CEA=617 ng/ml) and Calcitonin (Calcitonin=2,300 pg/ml). In both cases, pre- and postoperative In-111 pentetreotide scintigraphy were done and compared with "'I scintigraphy. In-111 pentetreotide scan may be useful for the localization of residual or metastatic medullary thyroid carcinoma. Further study is warranted to define the sensitivity and specificity of the technique.
Biopsy ; Calcitonin ; Carcinoma, Medullary ; Diagnosis ; Drug Therapy ; Female ; Goiter ; Humans ; Neck ; Neoplasm Metastasis ; Neoplasm, Residual ; Radionuclide Imaging ; Radiotherapy ; Receptors, Somatostatin ; Sensitivity and Specificity ; Somatostatin ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy

In Langerhans cell histiocytosis, diabetes insipidus is the most common endocrinologic complication. We experienced a case of Langerhans cell histiocytosis, involving pituitary stalk and lung. The patient was a 43 year old male with complaint of polyuria and polydipsia. The water deprivation test was carried out to confirm the diagnosis of diabetes insipidus. We found multiple small cysts and nodules in HRCT of lung, and diagnosed Langerhans cell histiocytosis by transbronchial lung biopsy, The patient was managed conservatively with DDAVP nasal spray. The polyuria,polydipsia was relieved completely. After that, we follow up and observe closely the patients lung and pituitary lesion.
Adult ; Biopsy ; Deamino Arginine Vasopressin ; Diabetes Insipidus ; Diagnosis ; Follow-Up Studies ; Histiocytosis, Langerhans-Cell ; Humans ; Lung ; Male ; Pituitary Gland ; Polydipsia ; Polyuria ; Water Deprivation

Down's syndrome (trisomy 21) has been frequently associated with thyroid disease, mainly subclinical hypothyroidism (12.5-32.5%). The occurrence of Downs syndrome in conjunction with hyperthyroidism is rare (0.6-2.5%). The mechanism that Down's syndrome was frequently associated with autoimmune thyroid disease is not clear, but T cell maturation defects and overexpression of chromosome 21 products in Down's syndrome have been suggested. A 19-year-old female was transferred because of generalized weakness. She was born to a 42-year-old mother, She had been suffered from heat intolerance, weight loss, palpitation, dyspnea on exertion and neck swelling and had intermittently taken some medication since her age 9. She had mental retardation (IQ 41) and underdeveloprnent. Exophthalmos, upward-outward slant of palpabral fissures, epicanthal folds, lowset ears, and large, protruding, fissured tongue were identified. Short fifth middle phalanges, clinodactyly and small-sized interventricular septal defect were also detected. Thyroid gland was diffusely enlarged four times the normal size, firm in consistency and had a bruit. Serum T concentration was 7.8ug/dL, T2 306ng/dL, and TSH 0.01ulU/mL. She was positive for thyroid autoantibodies (antimicosomal antibody 1,867 IU/mL, antithyroglobulin antibody 106 IU/mL, and TBII 79.6%). Twenty-four hours radioactive iodine uptake was 64%. Chromosomal analysis with T cell culture stimulated by phytohemagglutinin revealed 47XX, 21 trisomy. Pituitary hormones except TSH were fully stimulated by combined pituitary stimulation. She was finally diagnosed as Down's syndrome with Graves' disease and controlled with use of methimazole.
Adult ; Autoantibodies ; Cell Culture Techniques ; Chromosomes, Human, Pair 21 ; Down Syndrome* ; Dyspnea ; Ear ; Exophthalmos ; Female ; Graves Disease* ; Hot Temperature ; Humans ; Hyperthyroidism ; Hypothyroidism ; Intellectual Disability ; Iodine ; Methimazole ; Mothers ; Neck ; Pituitary Hormones ; Thyroid Diseases ; Thyroid Gland ; Tongue, Fissured ; Trisomy ; Weight Loss ; Young Adult

BACKGROUND: Overt hypothyroidism is well-known cause of secondary hyperlipidemia and atherosclerosis. However, there have been dissenting reports of abnormalities in serum lipid concentrations in patients with subclinical hypothyroidism (SH). Recently, it has been reported that serum Lp (a) concentration, an independent risk factor of atherosclerosis, was increased in patients with SH. Therefore, we analyzed serum Lp (a) and other lipid concentrations to investigate whether they are increased in patients with SH and the correlation between serum Lp (a) and TSH concentrations. METHODS: We undertook this study in 53 patients with SH (TSH > 6 uiU/ml) and 197 age-and sex-matched healthy control subjects, They had no abnormalities in liver function, BUN, creatinine, fasting blood glucose, urinalysis, and past medical histories. Serum T3, T4, and TSH concentrations were measured by RIA using commercial kits. Serum concentrations of Lp (a), total cholesterol, triglyceride (TG), and HDL cholesterol (HDL-C) were measured by rate nephelometry and enzyme assay, respectively. RESULTS: There were no significant differences of serum Lp (a), total cholesterol, LDL cholesterol, TG, and HDL-C concentrations in 53 patients with SH and 197 control subjects (25.6+-3.8mg/dL vs. 25.4+-1.5mg/dL ; 204.0+-4.2mg/dL vs. 204.0+-2.4mg/dL ; 127.0+-3.9mg/dL vs. 125.0+-2.3 mg/dL ; 133.0+-8.5mg/dL vs. 130.0+-6.0mg/dL ; 50.0+-1.5mg/dL vs. 53.0+-0.9mg/dL). There was no correlation between Lp (a) and TSH concentrations in SH (r=0.12, p>0.05). CONCLUSION: Serum Lp (a) concentration as well as total cholesterol, LDL cholesterol, and TG was not increased in patients with SH. There was no correlation between serum Lp (a) and TSH levels in subclinical hypothyroidism.
Atherosclerosis ; Blood Glucose ; Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL ; Creatinine ; Dissent and Disputes ; Enzyme Assays ; Fasting ; Humans ; Hyperlipidemias ; Hypothyroidism* ; Lipoprotein(a)* ; Lipoproteins* ; Liver ; Nephelometry and Turbidimetry ; Risk Factors ; Triglycerides ; Urinalysis

PURPOSE: Management of cardiovascular risk factors is of major importance in renal transplant recipients to determine long-term outcomes. While calcineurin inhibitors improve the clinical course after kidney transplantation, they have been implicated in contributing to increased cardiovascular risk. This study investigated the influence of conversion from cyclosporine to tacrolimus on cardiovascular risks and graft function in renal allograft recipients with hyperlipidemia. METHODS: Twenty three adult renal recipients who were receiving cyclosporine-based regimen for more than one year after transplantation and had hyperlipidemia (serum total cholesterol > or =200 mg/dL) were enrolled. The effect of conversion from cyclosporine to tacrolimus was evaluated with blood pressure, fasting lipid profile, glucose and HbA1c. They were measured at baseline and at 1, 3, 6 and 12 months after conversion. The change in estimated glomerular filtration rate (eGRF) was also compared between before and after conversion. RESULTS: Though conversion from cyclosporine to tacrolimus did not cause significant differences in the serum triglyceride level, there was a noticeable decline in total cholesterol level (213.78+/-16.28 to 185.96+/-38.62 mg/dL, p<0.01). Conversion did not trigger new onset or worsening of diabetes mellitus with no meaningful differences in fasting blood glucose and HbA1c levels. The eGFR stabilized with Tacrolimus in comparison with the cyclosporine (-2.9+/-13.4 mL/min vs. -7.3+/-13.8 mL/min). CONCLUSION: Conversion to tacrolimus would be preferable to cyclosporine for maintenance immunesuppression in renal recipient with hyperlipidemia, as it meliorates hyperlipidemia and leads to stabilization of allograft function.
Adult ; Blood Glucose ; Blood Pressure ; Calcineurin ; Cardiovascular Diseases ; Cholesterol ; Cyclosporine ; Diabetes Mellitus ; Dyslipidemias ; Fasting ; Glomerular Filtration Rate ; Glucose ; Humans ; Hyperlipidemias ; Kidney Transplantation ; Risk Factors ; Tacrolimus ; Transplantation, Homologous ; Transplants