Polyethylene glycol (PEG)-3350 is the most frequently used lavage solution for bowel cleansing prior to colonoscopy or elective surgery because its large molecular weight means that it is poorly absorbed. However, if it leaks into the peritoneal cavity, complications may arise. Few published studies have assessed the absorption, distribution, metabolism and excretion of PEG. Moreover, no published clinical data regarding complications due to the intra-peritoneal leakage of PEG-3350 could be found. We report on an elderly patient who developed the poisoning caused by leaking of PEG-3350 during bowel preparation. It resulted in severe metabolic acidosis, hypernatremia, hyperosmolality and a high anion gap, but it was effectively treated with early continuous renal replacement therapy after surgery.
Absorption ; Acid-Base Equilibrium ; Acidosis ; Aged* ; Colonoscopy ; Humans ; Hypernatremia ; Metabolism ; Molecular Weight ; Peritoneal Cavity ; Poisoning* ; Polyethylene Glycols* ; Renal Replacement Therapy ; Therapeutic Irrigation

BACKGROUND: Abdominal pain is one of the most common complaints in the emergency department and the evaluation presents an extraordinary challenge to the emergency physician's skill. C-reactive protein, an acute phase protein which is increased in the presence of inflammation in various clinical conditions, has been proven useful in assessing disease severity, in monitoring the development of complications, and in evaluating the response to specific treatments. So we tried to determine whether CRP offers an advantage over other clinical or laboratory variables for decision-making in the management of acute abdominal pain in the emergency department. METHOD: Patients who came to a University Hospital ED with acute abdominal pain, between september 1, 1998 and November 30, 1998, were included in this study, Data collection included age, sex, duration of symptom, location of pain, and laboratory dta(white blood cell count, portion of neutrophils, ESR, CRP, amylase). RESULT: This study included 85 patients, 34 of whom were men. The mean age was 36.9+/-19.1 years. CRP might be useful to detect the serious condition, sensitivity 81%, but more useful to differentiate normal condition from serious condition in acute abdominal pain patients, specificity 83%. CONCLUSION: CRP is an useful indicator of decision-making to abdominal patients in the emergency department. Hospitalization or operation is very unlikely when CRP value is normal.
Abdominal Pain* ; Acute-Phase Proteins ; Blood Cell Count ; C-Reactive Protein* ; Data Collection ; Emergencies ; Emergency Service, Hospital ; Hospitalization ; Hospitals ; Humans ; Inflammation ; Male ; Neutrophils ; Sensitivity and Specificity

The principal mode of the transmission of Legionnaires disease is an inhalation of the cooling tower water droplets in which Legionellae exist. As a central cooling system is popularized in many public buildings and large buildings nowadays, the number of cooling towers in rapidly increasing. Therefore the possibility of an outbreak of Legionnaires disease is likely increased. To determine the presence of Legionella in cooling tower water as the first step for the prevention of Legionnaires disease, 48 samples of cooling tower water were taken from 24 buildings in Taegu city in July and September 1987. Three samples out of 24 water samples in September yielded Legionella but it was not isolated in the samples of July. Isolated 3 Legionellas were identified as Legionella peumophila. It seems that Legionella from the cooling tower will be isolated more frequently in late summer than early because central cooling system is stopped operation during winter season which in cool. As based on our survey, Legionnaires disease can occur in Taegu city and if it happens it is most likely due to L. pneumophila.
Daegu ; Inhalation ; Legionella* ; Legionnaires' Disease ; Seasons ; Water*

The proliferating activity of the cancer cells was estimated in 67 superficial bladder tumors (26 pTa and 41 pT1) by the silver-binding nucleolar organizer regions(AgNORs), proliferating cell nuclear antigen(PCNA) and flow cytometric DNA analysis. the clinical variances, AgNORs count, PCNA positivity and the incidence of aneuploidy showed no correlation with recurrence statistically. But cytology, grade and PCNA positivity had statistical significance for progression (p<0.0.05). Especially cytology and PCNA positivity showed independent predictive values in multiple logistic regression analysis. We analyzed the values with above mentioned method including intravesical chemotherapy. None of above showed correlation with recurrence statistically. Cytology, grade, BCG therapy and PCNA positivity had statistical significance for progression( p <0.05). But none of those showed statistical significance in multiple logistic regression analysis. In summary, AgNORs count, PCNA positivity and the incidence of aneup1oidy may not have the value of prognostic factor to predict recurrence and/or progression if include intravesical chemotherapy.
Aneuploidy ; DNA* ; Drug Therapy ; Incidence ; Logistic Models ; Mycobacterium bovis ; Nucleolus Organizer Region* ; Proliferating Cell Nuclear Antigen* ; Recurrence ; Urinary Bladder Neoplasms* ; Urinary Bladder*

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

We performed this study to analyse the morbidity and mortality of stoma formation in infants and children over a 17-year period. Thirty-seven stoma formations were performed in 37 patients: 21 for anorectal malformation, 9 for Hirschsprung's disease, 3 for necrotizing enterocolitis, 2 for multiple ileal atresia, 1 for volvulus neonatorum with perforation, and 1 for diaphragmatic hernia with colon perforation. There were 26 boys and 11 girls with a mean age of 0.4 years. Complications after stoma formation were encountered in 12 patients(32.4%) and included stomal prolapse, stenosis, retraction, dysfunction, skin excoriation and parastomal hernia. Four patients(10.8%) required stomal revision. The incidence of complications was neither related to the age nor to the primary indication for the stoma formation, but sigmoid colostomy was associated with a lower complication rate compared to transverse colostomy(22.1% versus 42.1%, P<0.05). Five patients died, but only one(2.7%) was dead, which was directly related to stoma formation. Eighteen of these children subsequently underwent stoma closure which was associated with complications in six patients(33.3%). The most common complication after stoma closure was wound sepsis in 4 children. In conclusion, because the significant morbidity of stoma formation still exists the refinements in surgical technique may help in reducing the incidence of complications and a sigmoid loop colostomy should be used whenever possible.
Child* ; Colon ; Colon, Sigmoid ; Colostomy ; Constriction, Pathologic ; Enterocolitis, Necrotizing ; Female ; Hernia ; Hernia, Diaphragmatic ; Hirschsprung Disease ; Humans ; Incidence ; Infant* ; Intestinal Volvulus ; Mortality ; Prolapse ; Sepsis ; Skin ; Wounds and Injuries

The transesophageal echocardiography (TEE) has been used for the assessment of right and left ventricular function, valvular structure and function, regional wall motion abnormalities and localization of intravascular catheters, cannular and prosthesis. We inserted the pulmonary artery catheter (PAC) under the guidance of intraoperative TEE because of the difficulty of placing PAC with the pressure tracing method in two patients. The PAC was inserted from right atrium to right ventricle with the basal four chamber view and advanced to pulmonary artery through pulmonary valve with the longitudinal view of TEE. We observed typical pulmonary arterial wave form to confirm the correct position. We suggest that the TEE can be used for successful placement of a PAC to facilitate manipulation of the catheter as an alternative method in the patients whose PAC can not be positioned with the pressure tracing method.
Catheters* ; Echocardiography, Transesophageal* ; Heart Atria ; Heart Ventricles ; Humans ; Prostheses and Implants ; Pulmonary Artery* ; Pulmonary Valve ; Ventricular Function, Left

We performed this study to evaluate the quantitative three-dimensional measurements of neurosensory retinal detachment in central serous chorioretinopathy and the correlation among the type of leakage points on fluorescein angiography, initial visual acuity, the area and height of neurosensory retinal detachment. Types of leakage point were classified into ink-blot type (A) and smokestack type (B). Horizontal and vertical diameters, area, and maximal height of retinal detachment were measured by HRT (Heidelberg Retina Tomograph). Mean horizontal diameter was 3.69+/-1.00mm(range, 1.87~5.30mm), mean vertical diameter was 3.52+/-0.87mm(range, 1.77~4.88mm), mean area was 10.89+/-5.11 mm2(range, 4.29~21.50 mm2), and mean maximal height was 0.24+/-0.07mm(range, 0.10~0.36mm). Initial visual acuity of smokestack type was 0.39+/-0.25, and that of ink-blot type was 0.66+/-0.29. Initial visual acuity of smokestack type was statistically lower than that of ink-blot type. Area and maximal height or retinal elevation were 9.45+/-4.87 mm2, 0.23+/-0.08mm in type A and 13.41+/-4.77 mm2, 0.26+/-0.07mm in type B. The difference in area and maximal height of retinal elevation between type A and type B was not statistically significant. In smokestack type, initial visual acuity was significantly lowered as the area or the maximal height of retinal elevation increased, but the correlation was not statistically significant. In ink-blot type, no correlation was found between initial visual acuity and area or maximal height of retinal elevation.
Central Serous Chorioretinopathy ; Fluorescein Angiography ; Retina ; Retinal Detachment* ; Retinaldehyde* ; Visual Acuity

In order to assess the physical growth of primary school student in the rural area, body height, weight, chest circumference and sitting height of 923 students (469 males, 454 females) in the town of Angang, Kyungpook province, Korea, were measured from April to May, 1988. The most growth age of boy height was 10-11 years old in both sex and the growth curves were crossed at 9-11 years old. The most rapid growth age of body weight was 10-11 years old and growth curves were crossed at 9-11 years old. The most rapid growth age of chest circumference was 10-11 years old in female, whereupon female outgrows male by contrast with male's slow and linear growth. The most rapid growth age of sitting height was 10-11 years old and the growth curves were crossed at 9-10 years old. The Rother index was 1.17-1.30 in male, 1.16-1.29 in female, and male's index was in general superior to female's.
Body Height ; Body Weight ; Female ; Gyeongsangbuk-do ; Humans ; Korea ; Male ; Thorax

PURPOSE: We investigated whether myocardial SPECT had additional usefulness to clinical, functional or surgical indices for the preoperative evaluation of cardiac risks in noncardiac surgery. MATERIALS AND METHODS: 118 patients (M: F=66:52, 62.7+/-10.5 years) were studied retrospectively. Eighteen underwent vascular surgeries and 100 nonvascular surgeries. Rest T1-201/stress Tc-99m-MIBI SPECT was performed before operation and cardiac events (hard event: cardiac death and myocardial infarction; soft event: ischemic ECG change, congestive heart failure and unstable angina) were surveyed through perioperative periods (14.6+/-5.6 days). Clinical risk indices, functional capacity, surgery procedures and SPECT findings were tested for their predictive values of perioperative cardiac events. RESULTS: Peri-operative cardiac events occurred in 25 patients (3 hard events and 22 soft events). Clinical risk indices, surgical procedure risks and SPECT findings but functional capacity were predictive of cardiac events. Reversible perfusion decrease was a better predictor than persistent decrease. Multivariate analysis sorted` out surgical procedure risk (p=0.0018) and SPECT findings (p=0.0001) as significant risk factors. SPECT could re-stratify perioperative cardiac risks in patients ranked with surgical procedures. CONCLUSION:: We conclude that myocardial SPECT provides additional predictive value to surgical type risks as well as clinical indexes or functional capacity for the prediction of preoperative cardiac events in noncardiac surgery.
Death ; Electrocardiography ; Heart Failure ; Humans ; Multivariate Analysis ; Myocardial Infarction ; Myocardial Ischemia ; Perfusion ; Perioperative Period ; Retrospective Studies ; Risk Factors ; Tomography, Emission-Computed, Single-Photon*