BACKGROUND: Intermediate myasthenia syndrome(IMS) is thought to have clinical importance because it may cause sudden respiratory failure during the recovery phase of a cholinergic crisis of organophosphate poisoning. We designed this study to identify the prevalence, the inducing agent, clinical predictor, and the proposed treatment of IMS. METHODS: Patients who had admitted with the diagnosis of acute organophosphate poisoning from 1992 to 1998 at two teaching hospitals were enrolled in this study. We selected the cases of IMS based on a review of medical records using modified He's criteria. RESULTS: Twelve(12) out of 110 patients with acute organophosphate poisoning were diagnosed for a prevalence at 10.9%. The drug inducing IMS were identified as dichlorvos, fenthion, EPN, methidathion, and phosphamidon. The occurrence of IMS was not related to either the initial treatment with atropine and pralidoxime, or the level of serum cholinesterase. Complications were pneumonia, sepsis, pancreatitis, and pseudomembranous colitis, etc. Eleven(11) patients were discharged without sequelae, and one patient was discharged as a hopeless care. CONCLUSION: This study suggests that IMS is not rare, so close observation is required to detect IMS in organophosphate-poisoning patients. Also, more studies are required to find predictors and treatments.
Atropine ; Cholinesterases ; Diagnosis ; Dichlorvos ; Enterocolitis, Pseudomembranous ; Fenthion ; Hospitals, Teaching ; Humans ; Medical Records ; Organophosphate Poisoning ; Pancreatitis ; Phosphamidon ; Pneumonia ; Prevalence ; Respiratory Insufficiency ; Sepsis

"To evaluate whether different qualifications of a cytologic diagnosis of atypical squamous cells of undetermined significance (ASCUS) predict a greater or lesser likelihood of tissue diagnosis of uterine cervix, we compared different cytologic qualifications of ASCUS with the tissue diagnosis. One hundred twenty-two con- secutive Papanicolaou smears showing ASCUS in women who had undergone cervical biopsy within nearest 30 days were collected. The 122 smears were qualified as ""favor reactive (25%), favor low grade squamous intraepithelial lesion (LSIL) (24%), favor squamous intraepithelial lesion (SIL) (16%), favor high grade squa- mous intraepithelial lesion (HSIL) (16%), and not otherwise specified (19%). Squamous intraepithelial or invasive lesion was pathologically confirmed by cervical biopsy in 13% of the favor reactive, 27% in favor LSIL, 70% in ""favor SIL, 75% in favor HSIL, and 35% in not otherwise specified smears. There were significant associations between the favor reactive smear and the benign biopsy finding and between the favor SIL smear and the biopsy showing a squamous intraepithelial or more severe lesion. Nevertheless, rnost of favor LSIL smears exhibit reactive process in tissue biopsy. Conclusively, qualified ASCUS stratifies women into different risk groups for SIL. The cytopathologist should make the cytologic diagnosis of ASCUS, favor LSIL circumspectly."
Biopsy ; Cervix Uteri ; Diagnosis ; Female ; Humans ; Papanicolaou Test ; Venous Thrombosis*

BACKGROUND: Previous studies indicated that there was important correlation between early patency of infarct-related artery, preservation of ventricular function, and improved survival after thrombolytic therapy for acute myocardial infarction. An increased infusion rate of rt-PA has been shown to result in faster thrombolysis and a high patency rate of occluded vessel in myocardial infarction. Therefore, we evaluated the effect of simplified triple bolus injection of rt-PA on early patency of infarct-related artery and evaluated safety and efficacy of triple bolus injection. METHOD: Patients with acute myocardial infarction presenting up to 6 hour from the onset of chest pain were recruited for the study. Aspring(100-200mg) was given immediately. Total dose for 1.5mg/kg of rt-PA(minimum 75mg, maximum 100mg) was administered as triple bolus intravenous injections. The half of total dose was injected initially, the quarter of total dose was injected at 10 minutes after 1st injection and the remainder was injected at 40 minutes after 1st injection. Five thousand units of heparin was given and 1,000-1,500unit/hr was given continuously. Coronary angiogram was performed at 60 minutes and 7-10 days after the first bolus injection. RESULTS: At 60 minutes, eleven of fourteen patients (78.6%) showed TMI grade-3 of patency in infarct-related coronary artery. There were two patients of hemorrhagic complications. One patient developed cerebellar hemorrhage at third day after rt-PA injection, and the other developed bleeding at femoral sheath site. There was no in-hospital mortality and reinfarction. CONCLUSION: In patients with acute myocardial infarction, the simplified triple bolus injection of rt-PA is associated with high early patency(TMI grade-3) in infarct-related coronary artery, with low risk of major bleeding comlications comparable to other studies.
Arteries ; Chest Pain ; Coronary Vessels ; Hemorrhage ; Heparin ; Hospital Mortality ; Humans ; Injections, Intravenous ; Myocardial Infarction* ; Thrombolytic Therapy ; Tissue Plasminogen Activator* ; Ventricular Function

The authors have studied the findings of radionuclear scanning, inferior vena cavography and ultrasonographyin 2 cases of Budd-chiari Sundrome experienced diffuse inhomogeneous uptake throughout enlarged liver without colddefects. Slightly increased activity in the central portion of liver in case I and markedly increased activity inthe caudate lobe in case II were observed. In inferior vena cavography, the dilated hepatic veins formingintrahepatic collaterals were seen in enlarged caudate lobe. Marked stenosis of I.V.C. at the level of confluenceto right atrium, intraluminal thrombosis of I.V.C., partial obstruction of hepatic veins by thrombi at theconfluent portion and systemic collaterals were noted in case I. In case II, abrupt conical obstruction of I.V.C.at the orgin of hepatic segment, which is consistent with membrane or web. was seen. Prominent systemiccollaterals were developed through the serpinginous margedly dilated azygos and hemiazygos veins, and splenorenalshunt. In ultrasonography, diffuse narrowing and obstruction of hepatic veins at eh confluent level by echogenicnodules were seen in 2 cases. Prominent intrahepatic venous collaterals were observed in case II.
Budd-Chiari Syndrome ; Constriction, Pathologic ; Heart Atria ; Hepatic Veins ; Hepatomegaly ; Liver ; Membranes ; Thrombosis ; Ultrasonography ; Veins

Chronic subdural hematoma (SDH) is a well-known disease entity and is traditionally managed with surgery. However, when associated with spontaneous intracranial hypotension (SIH), the treatment strategy ought to be modified, as classical treatment could lead to unwanted consequences. A 59-year-old man presented with a case of SIH that manifested as a bilateral chronic SDH. He developed fatal extensive pneumocephalus and SDH re-accumulation as a complication of burr-hole drainage. Despite application of an epidural blood patch, the spinal cerebrospinal fluid leak continued, which required open spinal surgery. Chronic SDH management should not be overlooked, especially if the exact cause has not been determined. When chronic SDH assumed to be associated with SIH, the neurosurgeon should determine the exact cause of SIH in order to effectively correct the cause.
Blood Patch, Epidural ; Cerebrospinal Fluid ; Drainage* ; Hematoma, Subdural, Chronic* ; Humans ; Intracranial Hypotension* ; Middle Aged ; Pneumocephalus*

Background: Patient safety has a direct impact on the patient’s health and life, so all members of the hospital should consider it first. Patient safety accidents are often occured by organizational problems rather than individual medical personnel. Therefore, effective interprofessional collaboration(IPC) among experts is essential, so interprofessional education(IPE) is considered important. Methods: : A prospective study method of one-group pretest-posttest design was used that provides IPE using active learning-oriented teaching methods for health workers in various occupations of various hospitals, and evaluates self-efficacy, communication confidence, and attitude toward IPE. Results: : 17 trainees from 8 hospitals were evaluated. First, the average of the awareness of patient safety culture was 3.62 points. Next, the score of each indicators increased in the pre-post evaluation. The average of communication confidence was from 3.73 to 3.95 points, self-efficacy was from 3.99 to 4.11 points, and attitude toward IPE was from 4.44 to 4.52 points, but not significant. Conclusions This study would have a great significance in that it was conducted on health workers in various occupations of various hospitals. As a result of a pre and post education survey conducted with trainees, the score was improved in communication confidence, self-efficacy, and attitude toward IPE. It seems to be due to the use of active learning teaching methods, and the active participation of trainees.

Objective: : Preoperative prediction of the arachnoid membrane descent in pituitary surgery is useful for achieving gross total removal and avoiding cerebrospinal fluid leakage resulting from tearing of the arachnoid membrane in the chiasmatic cistern. In this study, we analyzed the patterns of arachnoid membrane descent during or after pituitary tumor surgery and identified the factors related to this descent. Methods: : Analysis was restricted to pituitary macroadenomas not extending into the third ventricle or over the internal carotid artery. To minimize confounding factors, patients who underwent revision surgery, those who had a torn arachnoid during operation or small medial diaphragma sellae (DS) opening, and subtotal resections were excluded. We enrolled 41 consecutive patients in this retrospective analysis. The degree of arachnoid descent was categorized using intraoperative videos. Preoperative magnetic resonance findings, including tumor height, suprasellar extension, and variables including DS area and medial opening size, tumor composition, and displacement of the pituitary stalk and gland were evaluated to determine their correlations with arachnoid membrane descent. Results: : Arachnoid membrane descent was significantly correlated with DS area and medial opening size. Based on T2-weighted images (T2WI) magnetic resonance (MR) images, tumor composition was significantly associated with arachnoid membrane descent. Other factors were not significantly correlated with arachnoid membrane descent. Conclusion : T2WI of tumor composition and preoperative MR imaging of DS area and medial opening provided valuable information regarding arachnoid membrane descent. These parameters may serve as fundamental measures to facilitate complete resection of pituitary macroadenomas.

OBJECTIVE: To establish a correlation between the modified Ashworth scale (MAS) and amplitude and latency of T-reflex and to demonstrate inter-rater and intra-rater reliability of the T-reflex of the biceps muscle for assessing spasticity after stroke. METHOD: A total of 21 patients with hemiplegia and spasticity after ischemic stroke were enrolled for this study. The spasticity of biceps muscle was evaluated by an occupational therapist using the MAS. The mean value of manual muscle test of biceps muscles was 2.3+/-0.79. Latency and amplitude of T-reflex were recorded from biceps muscles by two physicians. The onset latency and peak to peak amplitude of the mean of 5 big T-reflex were measured. The examinations were carried out by two physicians at the same time to evaluate the inter-rater reliability. Further, one of the physicians performed the examination again after one week to evaluate the intra-rater reliability. The correlations between MAS and T-reflex, and the intra- and inter-rater reliability of biceps T-reflex were established by calculating the Spearman correlation coefficients and the intra-class correlation coefficients (ICCs). RESULTS: Amplitude of the biceps T-reflex increased with increasing level of MAS (rs=0.464 and 0.573, respectively, p<0.01). ICCs of latency and amplitude of biceps T-reflex were 0.914 and 0.822. The Spearman correlation coefficients of latency and amplitude of biceps T-reflex were 0.937 and 0.635, respectively (p<0.01). CONCLUSION: Biceps T-reflex demonstrates a good quantitative measurement and correlation tool with MAS for spasticity, and also shows acceptable inter- and intra-rater reliability, which can be used for patients with spasticity after stroke.
Hemiplegia ; Humans ; Muscle Spasticity ; Muscles ; Reflex, Stretch ; Stroke

PURPOSE: This study was performed to review our experience with deep neck infections (DNI) in an emergency center. METHODS: Over a 60-month period, 32 consecutive patients with DNI were included in the study. Variables included in the data analysis were age, sex, clinical symptoms and signs, and laboratory findings on initial presentation. Both DNI and NDNI (Non-deep neck infections; acute tonsillitis, acute oropharyngitis) groups were examined clinically, and blood samples were taken and studied for several parameters associated with infection, including C-reactive protein levels; the findings were analyzed statistically for differences between the groups. RESULTS: A retrospective review was conducted of 32 patients with deep neck infections. Based on clinical and radiologic findings, these patients were categorized as retropharyngeal space, parapharyngeal space, sublingual space, submandibular space, or multiple space. The most common symptoms were fever (78%) and sore throat (53%), followed by dysphagia (47%), trismus (38%), and neck swelling (31%). No particular background variables were associated with DNI; however, a particularly high CRP level on admission was found to be associated with DNI (p<0.05). CONCLUSION: We should distinguish deep neck infections from non deep neck infections in the emergency department. This study showed that determination of the CRP level may be useful in making a clinical diagnosis of deep neck infections.
C-Reactive Protein ; Deglutition Disorders ; Diagnosis ; Emergencies ; Emergency Service, Hospital ; Fever ; Humans ; Neck* ; Palatine Tonsil ; Pharyngitis ; Retrospective Studies* ; Statistics as Topic ; Tonsillitis ; Trismus

BACKGROUND: Although oral isotretinoin is an effective established therapy for acne, Korean data related with this therapy is very limited. Moreover, there is no published data available on the efficacy of this drug that uses a grading system suitable for Korean acne patients. OBJECTIVE: The purpose of this study is to evaluate the efficacy of oral isotretinoin (Roaccutane?) by using the Korean Acne Grading System (KAGS) and the general satisfaction of patients in treating acne. METHODS: In this multicenter and prospective clinical study, 499 patients with acne, who visited at 5 dermatologic clinics during 11 months, were enrolled. The drug dosage was 0.2~1.0 mg/kg/day over 4 months. The efficacy assessment was performed at baseline and monthly after, with an acne grading based on the KAGS and the patient satisfaction questionnaire. RESULTS: Out of the 499 patients, 435 and 371 have completed the 3-month and 4-month treatments, respectively. After the 4-month treatment, the mean acne grades significantly decreased from 2.71 to 0.68, thus showing a 75.9% reduction in pretreatment scores. The mean patient satisfaction scores improved at the end of 4-month treatment, showing a 4.42 out of 5. CONCLUSION: In this paper, we describe the efficacy of oral isotretinoin by using the KAGS, which has not been previously reported in the Korean literature. Our results show that oral isotretinoin is an effective and satisfactory treatment modality for acnes of all grades in Korean patients, regardless of the dosage.
Acne Vulgaris ; Humans ; Isotretinoin ; Patient Satisfaction ; Prospective Studies