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

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

The authers reported one case of manic episode that occured after retirement in a 63 year old male patient. There was no psychiatric past history and family history. Also there was no abnormal finding on laboratory examination. This patient had received small doses of antidepressants anxiolytic and hypnotic (amitriptyline 10 mg, lorazepam 0.5 mg, triazolam 0.25 mg) to control insomnia since 3 months ago before admission. This patient showed manic symptoms such as grandious idea, expansive and irritable mood, increased psychomotor activity and insomnia after retirement. Pharmacotherapy (lithium and chloropromazine) supportive psychotherapy and family therapy were administered. Excessive motivation for work after retirement and small dose of antidepressant were suspected to trigger a manic episode in this elderly patient. We also reviewed literatures about pathophysiology of elderly manic disorder.
Aged* ; Antidepressive Agents ; Bipolar Disorder ; Drug Therapy ; Family Therapy ; Humans ; Irritable Mood ; Lorazepam ; Male ; Middle Aged ; Motivation ; Psychotherapy ; Retirement* ; Sleep Initiation and Maintenance Disorders ; Triazolam

BACKGROUND: Although one hair usually arises from a single follicular opening in normal healthy subjects, we can see two or more hairs emerging from the single opening through close inspection. The latter is called "compound hair", described by Lowenthal in 1946, however, few reports on this have been made since. Histopatholoigcally two or more hairs which have an independant external root sheath arise from one follicular opening like its clinical appearance. We examined the distribution and density of compound hair in order to define its difference according to anatomical sites and aging process. OBJECTIVE AND METHOD: We counted the number of hairs in the circle(2 cm in diameter) at te frontal, temporal and occipital scalp of 24 old young men(22.5+/-2.0 years old) and 24 old men(64.4+/-12.9 years old), respectively. RESULTS: The summated number of grouped hair, which was mostly regarded at compound hair, was greater in the young group than in old group in the frontal area, but was smaller in young group than in old group in from the temporal and occipital areas. The proportion of grouped hair to total hair in the older group was lower in the frontal area, but higher in the temporal and occipital areas(p<0.05, p<0.01) according to aging process, however, no significant change was seen between the frontal area and the sum of single hair to compound hair was significantly decreased in the temporal and occipital areas(p<0.05, p<0.01) according to aging process, however, no significant change was seen between the frontal area and the sum of the three tested areas. CONCLUSION: Compound hairs are observed frequently on the scalp of normal healthy subjects and are most frequently seen on the occipital scalp in both of the young and old.
Aging ; Hair* ; Scalp* ; Tuberculosis, Cutaneous

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*

We report a patient with pachydermoperiostosis accompanied by hypertrophic gastritis. A 26-year-old man showed deep folds and furrows of the face and scalp, and terminal spade-like expansion of fingers and toes. Physical examination revealed no abnormalities except a grotesque appearance. Results of routine laboratory tests were unremarkable. Mild periosteal reactoins of both femurs and humeri were noted on long bone series, and hypertrophic gastritis on fibroscopic examination drew our attention. The relationship between pachydermoperiostosis and hypertrophic gastritis is uncertain. However it is probable that hypertrophic gastritis may be the endodermal counterpart of the ectodermal manifestations of pachydermoperiostosis.
Adult ; Ectoderm ; Endoderm ; Femur ; Fingers ; Gastritis, Hypertrophic* ; Humans ; Osteoarthropathy, Primary Hypertrophic* ; Physical Examination ; Scalp ; Toes

Pneumomediastinum is a relatively uncommon, infrequently reported entity, In the evaluation of these entity, it is important to exclude pathological causes, including Boerhaave's syndrome which carries a high mortality. Spontaneous pneumomediastinum is related to excessive intraalveolar pressure leading to rupture of perivascular alveoli in the setting of a Valsalva maneuver without communication to gut material. So, it has a benign self-limited course and rarely requires medical intervention. On the contrary, secondary pneumomediastinum caused by instrumental, traumatic, and spontaneous perforation of esophagus. Although the prognosis have been improved since the advent of broad-spectrum antibiotics and nutritional support, pneumomediastinum due to esophageal perforation still has a high morbidity and mortality. The most important prognostic factor is the time interval between perforation and initiation of therapy, and an awareness and a high clinical suspicion is critical in the early diagnosis and treatment. Recently, we have experienced 2 cases of pneumomediastinum, one case was spontaneous pneumomediastinum and the other may be caused by instrumental esophageal perforation. We report the clinical course of the patients with a current literature review.
Anti-Bacterial Agents ; Early Diagnosis ; Esophageal Perforation ; Esophagus ; Fibrinogen ; Humans ; Mediastinal Emphysema* ; Mortality ; Nutritional Support ; Prognosis ; Rupture ; Valsalva Maneuver

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

BACKGROUND: Tramadol is a centrally acting analgesic with weak opioid agonist properties and has effect on the spinal inhibition of pain. This study was designed to evaluate the efficacy of tramadol in the treatment of postanesthetic shivering. METHODS: Sixty patients (ASA class I/II) who showed postanesthetic shivering were randomly assigned into three groups (n=20): Normal saline group; normal saline 10 ml, tramadol (TRD) 0.5 mg/kg group; tramadol 0.5 mg/kg, TRD 1.0 mg/kg group; tramadol 1.0 mg/kg. And all patients received standard postoperative management in the recovery room. Evaluation of the grade of shivering was done at 30 seconds, 2, 5 and 10 minutes from the beginning of the treatment by the same investigator who had injected the drug. The age, sex, weight, duration of anesthesia and axillary temperature were recorded. RESULTS: By 30 seconds, 2 minutes, 5 minutes, and 10 minutes, 0, 4, 9, 9 patients of the 0.5 mg/kg tramadol group (n=20) and 7, 18, 19, 19 patients of the 1.0 mg/kg tramadol group (n=20) stopped the shivering respectively. But in 3 patients of 0.5 mg/kg tramadol group who stopped shivering by 5 minutes, shivering was recurred within 10 minutes and in 3 patients who had not stopped shivering by 5 minutes, shivering stopped by 10 minutes. In the placebo group, only 1 patient stopped shivering by 5 minutes. CONCLUSION: 1.0 mg/kg of tramadol was effective for the treatment of postanesthetic shivering but 0.5 mg/kg of tramadol was ineffective.
Anesthesia ; Humans ; Recovery Room ; Research Personnel ; Shivering* ; Tramadol*