Although liver metastasis is commonly found in cancer patients, fulminant hepatic failure secondary to diffuse cancer infiltration into the liver is rare. Liver metastasis-induced fulminant hepatic failure has been reported in patients with primary cancer of the gastrointestinal tract, breast and uroepithelium, and in patients with melanoma and hematologic malignancy. Small cell lung cancer is so highly invasive that hepatic metastasis is common, but rapid progression to fulminant hepatic failure is extremely rare. We report here on a case of a patient who died because of rapid progression to fulminant hepatic failure as a result of hepatic metastasis of small cell lung carcinoma.
Aged ; Carcinoma, Small Cell/complications/pathology/*secondary ; Female ; Humans ; Liver Failure, Acute/diagnosis/*etiology ; Liver Neoplasms/complications/pathology/*secondary ; Lung Neoplasms/complications/*pathology ; Neoplasm Invasiveness ; Tomography, X-Ray Computed

Percutaneous vertebroplasty consists of the percutaneous injection of polymethylmethacrylate (PMMA) cement into a collapsed vertebral body in order to obtain pain relief and mechanically strengthen the vertebral body. This procedure is now extensively used in treating osteoporotic vertebral compression fracture. It is an efficient treatment, but it is not free of complications. Most complications after vertebroplasty are associated with PMMA leakage. Pulmonary embolism of PMMA is rare, but this can occur when there is a failure to recognize venous migration of cement early during the procedure. We encountered a case of a patient with asymptomatic pulmonary embolism because of PMMA after percutaneous vertebroplasty. Chest X-ray and CT scanning revealed numerous tubular branching opacities that corresponded to the pulmonary vessels at the segmental and subsegmental levels.
Fractures, Compression ; Humans ; Polymethyl Methacrylate* ; Pulmonary Embolism ; Thorax ; Tomography, X-Ray Computed ; Vertebroplasty*

BACKGROUND/AIMS: Polyethylene glycol (PEG)-based gut lavage solutions are safe and effective, but require the intake of large volumes of fluid. The use of 2 L PEG plus 45 mL sodium phosphate (PEG2 plus NaP) was compared with 4 L PEG (PEG4) for bowel cleansing before colonoscopy. METHODS: Patients were randomized to the PEG2 plus NaP group or PEG4 group between January 1, 2009 and March 31, 2010. One hundred and thirty patients were included in the PEG2 plus NaP group, and 141 patients in the PEG4 group. RESULTS: The qualities of the bowel preparation, based on the Ottawa scale were not significantly different between the groups (4.8+/-2.25 for the PEG2 plus NaP group vs. 5.11+/-2.26 for the PEG4). In addition, there were no significant differences in side effects. Laboratory findings after bowel preparation, including electrolyte, phosphorus and creatinine levels, were within the normal ranges in both groups. CONCLUSIONS: PEG2 plus NaP provides good cleansing that is similar to PEG4, but with a lower volume. However, because PEG2 plus NaP can cause serious side effects such as calcium deposition in the kidneys (i.e., nephrocalcinosis), this solution might be considered for the outpatients who cannot tolerate PEG4.
Calcium ; Cathartics ; Colonoscopy ; Creatinine ; Humans ; Kidney ; Outpatients ; Phosphates ; Phosphorus ; Polyethylene ; Polyethylene Glycols ; Prospective Studies ; Reference Values ; Sodium ; Therapeutic Irrigation

Pancreatic arteriovenous malformations (AVM) are extremely rare diseases frequently complicated by gastrointestinal hemorrhage. While surgical resection of affected lesion is preferred for the treatment of pancreatic AVM, angiographic intervention can be used as an alternative treatment, especially in surgically high-risk patients. We experienced a patient with pancreatic AVM manifested by hemobilia and biliary sepsis. Superior mesenteric and common hepatic arteriography showed pancreaticoduodenal AVM composed of nidus supplied by numerous fine feeding arteries and of draining veins encircling the common bile duct (CBD). Hemobilia was controlled by transportal coil embolization of draining veins of AVM around the CBD. Herein, we report this case with the review of literatures.
Arteriovenous Malformations/pathology/*therapy ; Duodenoscopy ; *Embolization, Therapeutic ; Hemobilia/etiology/pathology/*therapy ; Humans ; Male ; Middle Aged ; Pancreas/*blood supply ; Pancreaticoduodenectomy ; Tomography, X-Ray Computed

BACKGROUND: Although organotin compounds are widely used as PVC stabilizers, catalysts and biocides, their effects on humans are not well known. However, their acute intoxication is known to cause neurotoxicity in the central nervous system, renal toxicity, and hepatotoxicity. As there has been no previously published case of organotin intoxication in Korea, we report here the first Korean case of acute exposure to organotin. CASE REPORT: A 43-year-old male with disorientation and behavioral change was admitted to a hospital. He had been working as a tank cleaner for several different companies in the previous 8 years and a week before admission, he had cleaned a tank containing dimethyltin (DMT) for 4 days. A day after finishing the job, he suffered decreased memory, behavioral change and progressive mental deterioration when he arrived at the emergency room. The result of spinal tapping was negative but on the 4th day of admission he deteriorated into a state of coma along with metabolic acidosis and severe hypokalemia. High levels of DMT and trimethyltin (TMT) were detected in a highly sensitive urine analysis. After conservative treatment and chelation therapy, the patient showed some clinical improvement but the neurological defects persisted. CONCLUSION: The patient appeared to have been intoxicated from the acute exposure to a high level of organotin while cleaning the tank.
Acidosis ; Adult ; Central Nervous System ; Chelation Therapy ; Coma ; Disinfectants ; Emergency Service, Hospital ; Humans ; Hypokalemia ; Korea ; Male ; Memory ; Organotin Compounds ; Poisoning* ; Spinal Puncture

Objective: This study examined the characteristics of the patients taking poison intentionally at the pre-hospital stage to prevent it at the community level. Methods: We retrospectively reviewed the data that had been reported to fire stations from January 2017 to December 2018. This data included sex, age, occupation, the season of the year, time, place, methods, alcohol ingestion, transferred to the hospital or not, and we examined how taking poison had an effect on the suicide success rate. Results: The subjects were a total of 1,356 patients who had been reported to fire stations due to intentionally taking poison. Forty-five point five percent of them were male, and 54.5% were female. The most common method of intentional taking poison was sedatives (58.3%), followed by pesticides (24.6%), antidepressants (19.0%), and other methods (12.6%). The home place was preferred more than any other places. The suicide success rate was 2.1% in males and 1.4% in females. For the age groups, those patients 40-64 years old tried taking poison much more than the other age groups. In the aspect of the season of the year, summer was the highest season for taking poison, at 30.3%. The daytime was more preferred than the night time. Conclusion In this study, we analyzed the characteristics of the pre-hospital intentional poisoning cases according to gender, age, occupation, season of the year, time, and between the transferred and the untransferred groups. Efforts should be made in cooperation with the community to prevent suicide attempts by intentionally taking poison.