Industrial exposure to toxic agent may produce a wide variety of respiratory damage. Acetic acid is a colorless liquid with a pungent vingar-like odor. It is a rare case that acute lung injury is caused by inhalation of acetic acid. Acetic acid is miscible with water, and may directly produce damage to mucosa of respiratory tract due to its irritant quality. The outcome of the reaction is dependent on the intensity and duration of exposure and varies from death or pulmonary edema in acute phase to resolution or bronchiolitis obliterans or bronchiectasis. We experienced a rose of acute lung injury due to accidental inhalation of acetic acid. The patient was a 31-year-old male who had developed progressive chest discomfort, chilling sense, and mild dyspnea after accidental inhalation of acetic acid. He had severe hypoxemia and chest radiograph showed diane bilateral alveolar edema. He responded to conservative treatment with oxygen inhalation and was discharged with improved condition on the 7th hospital day.
Acetic Acid* ; Acute Lung Injury* ; Adult ; Anoxia ; Bronchiectasis ; Bronchiolitis Obliterans ; Dyspnea ; Edema ; Humans ; Inhalation* ; Male ; Mucous Membrane ; Odors ; Oxygen ; Pulmonary Edema ; Radiography, Thoracic ; Respiratory System ; Thorax ; Water

The Dichloromethane(methylene chloride) is a highly volatile liquid used as a solvent, extraction medium, and paint remover. The most significant route of intoxication to dichloromethane is generally inhalation at work site or home, but ingestion is rare. The main toxicological harvard insults from in vivo conversion of dichloromethane to carbon monoxide. We present a case of dichloromethane intoxication following ingestion. A 71 years old male patient ingested 60-70cc of dichloromethane was brought to emergency department after stomach washout via nasogastric tube at other hospital. On arrival at emergency department(approximately 19 hours after ingestion), he was stuporous with a blood pressure 140/90mmHg, heart rate of 92 beats/min, dyspneic, respiratory rate of 24/min and body temperature 36.8 degrees C. His Pupils were isocoric, miotic, and sluggishly reactive. There were mucosal bums and significant secretion in oral cavity. On auscultation, breathing sound was coarse without role on both lung field. The COHb levels were 6.3%at 32 hours after ingestion and normalized to 0.6%at 44 hours after ingestion. Patient was transfered to intensive care unit and supportive care was started with 100% oxygen. On ingestion 4th day, chest X-ray showed pulmonary edema and acute respiratory distress syndrome developed. Patient regained the consciousness on the 11th day. On the 30th day, respiratory function improved and the ventilator was removed. Alveolitis and mild pulmonary fibrosis developed and mild dyspnea was continued. On the 36th day, gastroscopic examinations showed ulceration of esophagus and stomach. On the 76th day, patient was discharged after pulmonary rehabilitation.
Aged ; Auscultation ; Blood Pressure ; Body Temperature ; Carbon Monoxide ; Consciousness ; Dyspnea ; Eating* ; Emergencies ; Emergency Service, Hospital ; Esophagus ; Heart Rate ; Humans ; Inhalation ; Intensive Care Units ; Lung ; Male ; Methylene Chloride* ; Mouth ; Oxygen ; Paint ; Pulmonary Edema ; Pulmonary Fibrosis ; Pupil ; Rehabilitation ; Respiratory Distress Syndrome, Adult ; Respiratory Rate ; Respiratory Sounds ; Stomach ; Stupor ; Thorax ; Ulcer ; Ventilators, Mechanical ; Workplace

Sinusitis manifested as symptomatic imflammation of the paranasal sinuses is a common pediatric diagnosis. Many studies have focused more directly on the question of relationship between allergy and sinusitis but the relevance of the relationship between allergy and sinusitis still needs further examination, The purpose of this study is to assess of relationship of allergy to extent or severity of sinusitis. A clinical evaluation was performed on 199 children, age 2 to 15 years, in whom the diagnosis of sinusitis was confirmed by paranasal sinus radiographic assessment at our hospital Pediatric OPD and in the ward from July 1991 to June 1993. The results were as follows: 1) Male was more prominent than female (M:F ratio 1.76:1). The age distribution, 100 cases(55.2%) of the total case were 4-7 year old. 2) The symptoms were coughing, most common (77,9%), rhinorrhea, nasal discharge and nasal stuffiness, in decreasing order. The clinical signs were postnasal drip (62.8%), most common, throat injection, wheezing sound, and allergic shiner in decreasing order. Eighty eight patients were evaluated acute and compared with 111 patients with chronic sinusitis. 3) Comparable study between two groups were summarized as follwos: (1) There was no significant difference in age and sex distribution between acute and chronic group. (2) The lowest seasonal incidence of acute group was seen in summer and autumn but there was no significant variation between both group (p>0.05). (3) Allergc disease was more prevalent in chronc group than acute group (p<0.05). Asthma incidence was higher in chronic group than acute group (p<0.05). (4) The frequency of total IgE level checked by PRIST higher than 200 IU/ml in acute group and chronic group was 23.2% and 42.3%, respectively (p<0.05). The incidence of positive skin prick test in acute group and chronic group was 25.0% and 46.5% respectively (p<0.05). (5) Otitis media, nasal polyp and adenoid hypertrophy incidence were higher in chronic group than acute group (p<0.05). (6) There was no significant difference if ESR between both groups. The eosinophilia in peripheral blood higher than 5% in the acute group and chronic group was 15.9% and 42.3% respectively (p<0.05). (7) The patients with chronic group had more severe involvement of the paranasal sinuses than acute group (p<0.05). (8) There were no significant difference in chest radiographic findings and follow up paranasal sinus radiographic findings after treatment (P>0.05).
Adenoids ; Age Distribution ; Asthma ; Child* ; Cough ; Cyprinidae ; Diagnosis ; Eosinophilia ; Female ; Follow-Up Studies ; Humans ; Hypersensitivity ; Hypertrophy ; Immunoglobulin E ; Incidence ; Male ; Nasal Polyps ; Otitis Media ; Paranasal Sinuses ; Pharynx ; Radiography, Thoracic ; Respiratory Sounds ; Seasons ; Sex Distribution ; Sinusitis* ; Skin

The folling results were obtained through the clinical review and Virology Laboratory of 100 cases of meningitis seen at ward of the pediatric department of Has Sung Hospital during the period from May to June, 1993. 1) Early childhood period was the most frequent age group and male was predominant in aseptic meningitis. 2) The common chief complaints were fever, vomiting, headache in order. 3) On physical examination meningeal irritation signs were not prominent. 4) On admission, leukocytosis (WBC count>10.000/mm(3)) on peripheral blood was showed in 36%. 5) The findings of cerebrospinal fluid showed that cells (Mean WBC count 671.8/mm(3)) were increased in all cases, and protein and sugar were mostly within normal limit. 6) Echovirus 9 was thought to be main causative agent according to the cerebrospinal fluid culture and antibody test. 7) On follow up study 2 months after discharge, 14 cases showed minimal abnormalities of EEG but no abnormal finding in BERA.
Cerebrospinal Fluid ; Echovirus 9 ; Electroencephalography ; Fever ; Follow-Up Studies ; Headache ; Humans ; Leukocytosis ; Male ; Meningitis ; Meningitis, Aseptic* ; Physical Examination ; Virology ; Vomiting

OBJECTIVES: This study was conducted to examine the mental health status of the laid off by comparing the unemployed with the employed. METHODS: A survey questionnaire was used to investigate the mental health status of the laidoff in comparison with that of the employed. The study sample consisted of 247 laid-off people formerly employed in A auto factory and 167 employees working in B auto factory. RESULTS: The proportion exercising regularly was 20.2% for the laid-off and 34.8% for the employed and the proportion having regular meals was 10.9% and 50.6%, respectively. In addition, the frequency and amount of alcohol consumption and smoking of the laid-off were higher than those of the employed. Among the laid-off, 69.4% responded that they spent less time in talking to their spouse, and 65.4% also reported reduced sexual activities with their spouse. Because of unemployment, 41.8% of the laid-off experienced conflicts with their children, and 53.5% also perceived that they were stigmatized and treated badly by their neighbors, friends and relatives. Mean IFR in the laid-off was 22.9, which was much higher than the 15.3 recorded in the employed. The mean PWI-SF was 24.2 for the laid-off and 13.0 for the employed, which indicates the lower psychological health status of the laid-off than that of the employed. Age, annual salary, family relationship, regular exercise, regular diets, possibility to return to work and perception of the future were related to mental health status for the laid-off. Stepwise multiple regression analysis showed that the most important factor influencing mental health status for the laid-off was family relationships. CONCLUSIONS: According to the above results, the mental health of the laid-off is worse than that of the employed. Based on this study, a follow-up study focusing on the mental health status of the reemployed to the same factory, is needed to understand the direct mental health effect on the laid-off.
Alcohol Drinking ; Child ; Diet ; Family Relations ; Friends ; Humans ; Meals ; Mental Health* ; Questionnaires ; Return to Work ; Salaries and Fringe Benefits ; Sexual Behavior ; Smoke ; Smoking ; Spouses ; Unemployment

PURPOSE: We evaluated oncologic outcomes of chondrosarcomas and analyzed the disease-free survival rate of chondrosarcomas according to the various factors. MATERIALS AND METHODS: We performed a retrospective study for the disease-free survival rate of 48 chondrosarcomas, 44 of which underwent surgical treatment and followed up more than 18 months since 1993, and in the remaining 4 cases, the patients died before 18 months after surgery. The vsariables were location, tumor volume, histologic grade, stage, age at presentation and treatment performed. The mean follow up period was 43.8 months (1-196 months). RESULTS: The overall disease-free survival rate was 77.1% at mean 43.8 month follow up. The 5 year- and 10 year disease-free survival rates were 64% and 58% respectively. The histologic grade, stage, age at presentation revealed statistical significance on disease-free survival. All 9 patients treated with extended curettage for grade 1 central chondrosarcomas revealed disease-free survival with excellent functional outcome. CONCLUSION: The disease-free survival rate of chondrosarcomas mainly depended on histologic grade, stage and age at presentation. Local recurrence and distant metastasis also revealed statistically significant differences of disease-free survival rate. Comparing to wide resection, extended curettage for low-grade central chondrosarcomas in extremities were efficient methods with similar survival rate and less functional losses and complications.
Chondrosarcoma ; Curettage ; Disease-Free Survival ; Extremities ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Survival Rate ; Tumor Burden

BACKGROUND: Pulmonary complications including pneumonia and pulmonary edema frequently develop in critically ill surgical patients. Lung ultrasound (LUS) is increasingly used as a powerful diagnostic tool for pulmonary complications. The purpose of this study was to report how LUS is used in a surgical intensive care unit (ICU). METHODS: This study retrospectively reviewed the medical records of 67 patients who underwent LUS in surgical ICU between May 2016 and December 2016. RESULTS: The indication for LUS included hypoxemia (n = 44, 65.7%), abnormal chest radiographs without hypoxemia (n = 17, 25.4%), fever without both hypoxemia and abnormal chest radiographs (n = 4, 6.0%), and difficult weaning (n = 2, 3.0%). Among 67 patients, 55 patients were diagnosed with pulmonary edema (n = 27, 41.8%), pneumonia (n = 20, 29.9%), diffuse interstitial pattern with anterior consolidation (n = 6, 10.9%), pneumothorax with effusion (n = 1, 1.5%), and diaphragm dysfunction (n = 1, 1.5%), respectively, via LUS. LUS results did not indicate lung complications for 12 patients. Based on the location of space opacification on the chest radiographs, among 45 patients with bilateral abnormality and normal findings, three (6.7%) and two (4.4%) patients were finally diagnosed with pneumonia and atelectasis, respectively. Furthermore, among 34 patients with unilateral abnormality and normal findings, two patients (5.9%) were finally diagnosed with pulmonary edema. There were 27 patients who were initially diagnosed with pulmonary edema via LUS. This diagnosis was later confirmed by other tests. There were 20 patients who were initially diagnosed with pneumonia via LUS. Among them, 16 and 4 patients were finally diagnosed with pneumonia and atelectasis, respectively. CONCLUSIONS: LUS is useful to detect pulmonary complications including pulmonary edema and pneumonia in surgically ill patients.
Anoxia ; Critical Care* ; Critical Illness ; Diagnosis ; Diaphragm ; Fever ; Humans ; Lung* ; Medical Records ; Pneumonia ; Pneumothorax ; Pulmonary Atelectasis ; Pulmonary Edema ; Radiography, Thoracic ; Retrospective Studies ; Ultrasonography* ; Weaning

BACKGROUND: It is important to evaluate the patient presenting with non-traumatic chest pain in emergency department, and it is also difficult to classify appropriately. The purpose of this study is to predict probability of acute myocardial infarction(AMI) and assess the group for low probability of AMI that is target for observation-unit of chest pain in emergency department. METHODS: A prospective, clinical study was performed from March 1998 to August 1998 at the department of emergency medicine, Ewha Womans University Mokdong hospital. We classified high-probability group and low-probability group of AMI according to Goldman's algorithm and then compared with the final diagnosis. RESULTS: The study included 218 patients. 84 patients(39%) was the high-probability group and 134 patients(61%) was the low-probability group of AMI. As compared with final diagnosis, AMI was 47 patients(56%) among the high-probability group and 1 patient(0.7%) among the low-probability group. We observed sensitivity of 98%, specificity of 78% in predicting AMI. CONCLUSION: The classification according to Goldman's algorithm may be useful predictor of AMI and improve triage for emergency department patient with chest pain. It is also helpful for management of observation-unit of chest pain in emergency department.
Chest Pain* ; Classification ; Diagnosis ; Emergencies* ; Emergency Medicine ; Emergency Service, Hospital* ; Female ; Humans ; Prospective Studies ; Sensitivity and Specificity ; Thorax* ; Triage

Most ectopic pregnancies occur in the fallopian tubes. There have been numerous theories to explain the occurrence of ectopic pregnancy in fallopian tubes. The most commonly held view is that the passage of the fertilized ovum through the fallopian tube is delayed or hindered by chronic inflammation and its sequelae. We designed a study to evaluate the details of histopathologic changes and the location of implantation and how they relate to the clinical history. 182 fallopian tube specimens from patients who had undergone total or partial salpingectomy were examined. A high incidence of non-specific inflammation of plicae and wall of tube (31.9%) and salpingitis isthmica nodosa (12.6%) were observed. Other associated findings included acute salpingitis, complex plicae or complex hyperplasia of tubal epithelium, fibrous adhesion with ovary, endometriosis, and calcification. History of previous ectopic tubal pregnancy was found in 8 cases. The cases with serum beta-HCG value above 2,500 I.U./L (group I, n=97) were more frequently noted in those exhibiting myosalpingeal invasion of trophoblast (67 cases) than in those without invasion (30 cases). Of the 182 tubal pregnancies, 117 (64.3%) cases were found in the ampulla and 47 (25.8%) cases in isthmic location. In 117 ampullary pregnancies, the products of conception were found intraluminally in 71 cases (60.7%), and extraluminally in 34 (29.1%) cases, of which the products of conception were found entirely extraluminal. The products of conception, found both within and outside the tubal lumen, were found in 12 cases (10.2%). Of 47 tubes with isthmic pregnancies, 33 cases were intraluminal (70.2%), 12 cases were extraluminal (25.5%), and two cases were mixed (4.3%). In conclusion, significant histopathologic abnormalities accompany a majority of ectopic tubal pregnancy, and myosalpingeal invasion of trophoblast is correlated with high serum beta-HCG. Thus, it is necessary to confirm not only the ectopic placental tissue but also the accompanying details of the other histopathologic findings or the pathologic evaluation of ectopic tubal pregnancy.
Endometriosis ; Epithelium ; Fallopian Tubes ; Female ; Fertilization ; Humans ; Hyperplasia ; Incidence ; Inflammation ; Ovary ; Pregnancy ; Pregnancy, Ectopic ; Pregnancy, Tubal* ; Salpingectomy ; Salpingitis ; Trophoblasts ; Zygote

BACKGROUND: This study was aimed to elucidate the effect of thiopental anesthesia on circulatory response to hemorrhage in rats by power spectral analysis of heart rate and blood pressure variability. METHODS: Sixteen male Sprague-Dawley rats weighing 350~475 g were divided into thiopental (50 mg/kg, ip)-anesthetized (T, n=10) and conscious (C, n=6) groups. Hemorrhage was induced with a withdrawal pump from the femoral artery at 3 ml/kg/min for 5 min. Arterial pressure was measured with a pressure transducer connected to the contralateral femoral artery for 5 min before, during and after hemorrhage. The blood pressure signal digitized at 500 Hz through a data acquisition system was analyzed with fast Fourier transform algorithm to yield power spectra of sytolic (SP) and diastolic (DP) blood pressure and instantaneous heart rate (HR). Powers of very low frequency (VLF, 0.02~0.26 Hz), low frequency (LF, 0.26~0.75 Hz) and high frequency (HF, 0.75~5.00 Hz) band were expressed as percent of total power. RESULTS: Before Hemorrhage blood pressure was lower in T (113 6/83 6 mmHg) than in C (157 4/101 2) rats, but was not changed by hemorrhage in both groups. Before Hemorrhage HR was lower in T (331 22 beats/min) than in C (378 27) rats. HR was significantly increased to 412 26 beats/min in C, but was not changed in T during hemorrhage. Total powers of Before Hemorrhage blood pressure and HR variability were lower in T than in C. During hemorrhage, total power of blood pressure variability tended to increase in both groups, and that of DP was significantly increased during hemorrhage in T. Total power of HR was significantly increased in C, but was not changed in T. T rats showed lower LF and higher HF power of blood pressure, and lower VLF and LF and higher HF power of HR than C rats. During hemorrhage, both groups showed no significant change in spectral distribution of HR power, except for a significant increase in LF of HR after hemorrhage in C. Spectral distribution of blood pressure power was not changed by hemorrhage in C. In T rats, VLF of DP was significantly increased and HF of DP was decreased during hemorrhage. CONCLUSIONS: It suggests that autonomic activity, especially cardiac sympathetic activity is increased in response to hemorrhage in C. Thiopental anesthesia depresses overall autonomic activity, especially sympathetic activity, and vasomotor tone. Hemorrhage under thiopental anesthesia induces depression of baroreceptor reflex activity, while increased levels of vasoconstrictor hormones help to maintain the blood pressure.
Anesthesia ; Animals ; Arterial Pressure ; Baroreflex ; Blood Pressure* ; Depression ; Femoral Artery ; Fourier Analysis ; Heart Rate* ; Heart* ; Hemorrhage* ; Humans ; Male ; Rats* ; Rats, Sprague-Dawley ; Thiopental ; Transducers, Pressure