BACKGROUND: Activated charcoal has been widely used as an adsorbent for the management of drug intoxicated patients in the emergency department(ED). Although there are several commercial ready-mixed charcoal suspension preparations in the market, we are using custom-made suspension from hospital grade bulk charcoal powder. We designed this study to compare the adsorptive capacity of the Actidose Aqua(R), which is a commercial charcoal product, Fuller's earth, and custom-made activated charcoal used in our ED. METHODS: First, we performed modified USP methylene blue adsorption test which is a standard adsorption test for activated charcoal. Then, the drug adsorption test for phenobarbital, acetaminophen, salicylate, and aminophylline was done. Graded amount of three adsorptives were added to the stock solutions of each drugs. The adsorption test were performed as follows: The vials containing drugs and adsorptives were shaken for 30 minutes to ensure adsorption equilibrium, then the suspension was filtered through in-line filter. The filtrates were analyzed by ultraviolet spectroscopy to determine the residual drug concentrations. Finally we examined and compared the surface area and the structure of activated charcoal and Fuller's earth using scanning electron microscopy. RESULTS: In methylene blue adsorption test, the adsorption rate was 60.1% in Actidose Aqua(R) and 59.0% in custom-made charcoal, and 70.2% in Fuller's earth. For the phenobarbital, acetaminophen, and sallcylate, the adsorption rate of Actidose Aqua(R) and custom-made charcoal was greater than 90% with the ratio o adsorptives to drugs over 10:1. For aminophylline, two charcoal products showed excellent adsorption in 5:1 ratio. But Fuller's earth showed poor adsorption in all rages. CONCLUSION: Custom-made activated charcoal showed a comparable adsorption capacity to Actidose Aqua(R). Fuller's earth showed a poor performance to be used as a substitute for activated charcoal in acute drug poisoning otherwise paraquat.
Acetaminophen ; Adsorption ; Aminophylline ; Charcoal* ; Emergencies ; Humans ; Methylene Blue ; Microscopy, Electron, Scanning ; Paraquat ; Phenobarbital ; Poisoning ; Rage ; Spectrum Analysis

BACKGROUND: Alternative medicine is defined as a non-orthodox therapeutic practices including chiropractic, acupunture, herbal medicine, faith, spiritual therapy or as all sorts of medical care that do not follow the medical community standards. Patients do not think of modern medicine as the absolute solution to their health problems and they will sometimes ask for complementary therapy and in want of referral to alternative practitioner. We have investigated the primary physicians' attitude and behavior towards alternative medicine. METHODS: Randomly selected 770 practitioners, in primary care practice in Seoul, were questioned from July to September in 1996 about the attitude to wards alternative medicine, the reasons and symptoms when referring, and experience in alternative medicine practice. RESULTS: 150 questionnaires were returned and among them 139 completed ones (18.1%) were analyzed. Among 770 doctors, 35 (25.2%) have referred patients to alternative practitioner before and more referrals were made when they worked together closely or had some prior training. The belief of special effect of alternative medicine on certain disease was the first reason to refer. Other reasons were for herbal medicine, acupunture, and chiropractice in the order of seguence. The standard way to learn alternative medicine was to attend seminars available through certain institutions. On referral either chronic pain or musculoskeletal disease were the most chief complaints or main diseases of patients. 15 doctors (10.8% ) had some experience in practicing an alternative approach and the patient subjeccts were more likely to be women, and there was increased tendency to be working with another doctor, and to have been trained for such practice. The items used by alternative practitioners were acupunture, herbs in the order of seguence. CONCLUSIONS: Alternative medicine is accepted somewhat by primary physicians in Seoul although the rate of referral and practice is lower than 54% compared to 16% in Canada.
Canada ; Chiropractic ; Chronic Pain ; Complementary Therapies* ; Female ; Herbal Medicine ; History, Modern 1601- ; Humans ; Musculoskeletal Diseases ; Primary Health Care ; Referral and Consultation ; Seoul* ; Surveys and Questionnaires

Eight patients with intracranial tumors or arteriovenous malformation (AVM)s which were less than 3 cm in diameter were treated by a technique of stereotactic radiotherapy during the 4 months period from July 1988 through October 1988 at the Division of Radiation Therapy, Kang-Nam St. Mary's Hospital, Catholic University Medical College. The patients were diagnosed as AVMs in 3 cases, acoustic neurinoma, craniopharyngioma (recurrent), hemangioblastoma, pineocytoma, and pituitary microadenoma in each case. There are several important factors in this procedure, such as localization system, portal, field size, radiation dose, and perioperative supportive care. It is suggested that stereotactic radiotherapy may be performed safely with a radiation dose of 12-30 gy. So this noninvasive procedure can be used to treat unresectable intracranial tumors or AVMs. Of these, clinical symptoms had been regressed in AVMs in 2 cases at 3 months and 2 months after Stereotactic radiotherapy, one of whom was confirmed slightly regressed on the follow-up angiogram. And also craniopharyngioma and pineocytoma was minimally regressed on 3 month follow-up CT.
Arteriovenous Malformations ; Craniopharyngioma ; Follow-Up Studies ; Hemangioblastoma ; Humans ; Neuroma, Acoustic ; Particle Accelerators* ; Pinealoma ; Portal System ; Radiotherapy*