No abstract available.
Chylothorax* ; Lymphangiectasis*

No abstract available.
Diabetes Mellitus* ; Hearing* ; Humans

No abstract available.
Lymphoma, T-Cell* ; Nasal Cavity* ; T-Lymphocytes*

PURPOSE: Antivenin is a standard therapy in snakebite victims. While the required antivenin dose can be easily estimated, based on the initial symptoms, this strategy may be unsuccessful if the initial symptoms progressively worsen. The purpose of this study was to identify the progression rate of the initial symptoms following snakebite and its associated factors. METHODS: The medical records of 44 patients treated for snakebite from give the actual dates of the study period were retrospectively examined. Thirty-two of these patients were enrolled. Demographic data, local wound grade and local effect score at initial presentation (G-0 and LES-0, respectively) and 12 hours after admission (G-12 and LES-12, respectively) were reviewed, along with laboratory data. RESULTS: The 32 patients had an average age of 54.0+/-14.5 years and were predominantly male (n=26) and presented mainly during summer. Compared to G-0 and LES-0, re-evaluated G-12 and LES-12 were significantly increased despite initial administration of proper antivenin dosage (p=0.001 and p=0.000, respectively). Total amounts of antivenin correlated with LES-12 (correlation co-efficiency 0.558, p<0.05). However, factors associated with symptom progression were not revealed. CONCLUSION: Initial snakebite symptoms might progressively worsen within hours despite acceptable initial antivenin therapy. Therefore, re-evaluation within several hours must be considered if when the initial snakebite symptoms are minimal or mild.
Antivenins ; Chronology as Topic ; Disease Progression ; Humans ; Male ; Medical Records ; Retrospective Studies ; Snake Bites

BACKGROUND: Though caudal block is a relative simple technique, it has not been widely used in adults because of a high failure rate. We assumed that any tests to quantify the changes of sympathetic tone in the affected areas would be excellent indicators of successful block. We tested the usefulness of two candidates (pulse oximetry plethysmographic waveform amplitude measured at 5th toe and calf minus 5th toe skin temperature gradient) as indicators of successful caudal block. METHODS: In 45 adult patients undergoing anal surgery with caudal block, these two variables were simultaneously measured at 2-min intervals for 20 min. A two-fold increase in the plethysmographic waveform amplitude from baseline and skin temperature gradient of 0oC were predefined as test criteria of successful block. RESULTS: While the sensitivity, specificity, positive predictive value, and negative predictive value of the skin temperature gradient test were 45.9%, 100%, 100%, and 9.1%, those of the plethysmographic waveform test were 86.5%, 100%, 100%, and 28.6%. The plethysmographic waveform test showed a significantly higher discriminative capacity than the skin temperature gradient test (94.9% vs. 48.7%, P < 0.05) CONCLUSIONS: Unlike the skin temperature gradient test, the plethysmographic waveform test showed a considerably high validity in detecting successful block. Considering its simple and real time monitoring potentials together with a high failure rate of caudal block in adults, we cautiously recommend it as a supplemental diagnostic tool to predict successful block, especially when verbal communication with patient is difficult.
Adult ; Humans ; Oximetry* ; Sensitivity and Specificity ; Skin Temperature* ; Skin* ; Toes

Indoxacarb is an oxadiazine insecticide with selective lethality through blockade of neuronal voltage-dependent sodium channels. It has a low mammalian toxicity, and few cases of human toxicity after indoxacarb ingestion can be found in the literature. A 36 year-old male patient visited our ED after a generalized tonic clonic seizure, which was witnessed by his mother. His past medical history was nonspecific. On initial presentation, he showed a decreased level of consciousness with a Glasgow coma score of 5/15 (E1V1M3), unprotected airway, hypoxia, and cyanosis. The saturation gap and cyanosis after intubation and mechanical ventilation was strongly suggestive of methemoglobinemia due to poisoning. Finally, the methemogobin (metHb) level was 27.4%. Therefore, the patient received 100 mg of methylene blue (2 mg/kg, 1% solution) and 50 g of charcoal. The insecticide was found to be ingested xenobiotic (Steward Gold(R); 5% indoxacarb; 95% inert ingredients and other components). On the second hospital day, the patient became alert. The patient's metHb level was 0.1%. The endotracheal tube was removed. On the fifth hospital day, he was discharged in good condition. Herein we present a case of indoxacarb poisoning with methemoglobiemia and seizure, which are unusual presentations.
Anoxia ; Charcoal ; Coma ; Consciousness ; Cyanosis ; Eating ; Humans ; Intubation ; Male ; Methemoglobinemia ; Methylene Blue ; Mothers ; Neurons ; Oxazines ; Respiration, Artificial ; Seizures ; Sodium Channels ; Wit and Humor as Topic

BACKGROUND: Flood is the most common natural disaster in our country. Lots of victims occurred during the period of flood in the northern territory of Kyoungkido on August 5, 1998. We tried to describe the characteristics of the flood-related injury and illness, management and medical requirements. METHODS: We interviewed the patients admitted to 8 hospitals in Ujungbu and reviewed medical records from aug 5 to Aug 14, 1998. RESULTS: There were total 102 patients, male were 52%and women were 48% Most of patients were between 30's and 60's. Most of them were minor, and less than 3%of them needed critical care. The diagnosis were laceration(39.2%, contusion(22.5%, fracture(13.7%, infectious disease(7.8%, ligament rupture(7.8%, aggravation of chronic illness(5.9%, dermatitis(2.0% and traumatic hyphema(1.0%. The laceration occurred in the foot(37.9%, lower leg(27.0%, thigh(16.2%, hand(10.8% and head(8.1%. The location of ligament injury were achilless tendon(62.5%, hand(25% and knee(12.5%. The 67.5%of flood-related laceration patients progressed cellulitis, especially in sutured wound and a typical tetanic patient was developed. Of hospitalized patients, 2 patients showed evidence of post-traumatic stress disorder(PTSD). CONCLUSION: During flood, civils have better to be educated about prevention of injury, such as wearing of shoes and clothes. Although laceration was minor, lacerated wounds should be thoroughly irrigated, debrided the margin and considered delayed closure, tetanus immunization. Reportedly, there is an increased prevalance of PTSD and depression after disasters. Therefore mental health care will be required in the future.
Cellulitis ; Critical Care ; Depression ; Diagnosis ; Disasters ; Female ; Gyeonggi-do ; Humans ; Immunization ; Lacerations ; Ligaments ; Male ; Medical Records ; Mental Health ; Northern Territory ; Shoes ; Stress Disorders, Post-Traumatic ; Tetanus ; Wounds and Injuries

Phenobarbital is a long-acting barbiturate causing generalized depression of neuronal activity in the brain. Its effect is primarily achieved through enhanced GABA-mediated synaptic inhibition. Its use as an antiepileptic agent was first described in 1912. Before the introduction of phenytoin, phenobarbital is used as sedative-hypnotics. It is used for the treatment of epilepsy and status epilepticus. All barbiturates, including phenobarbital, have a high potential far abuse. They were frequently used for suicide attempts in the past, but they have in large part been replaced by benzodiazepines. the onset of symptoms depends on the drug and the route of administration. Mild to moderate barbiturate intoxication resembles ethanol inebriation with slurred speech, ataxia, and lethargy. Severe acute barbiturate intoxication is life threatening. Early deaths are generally cardiovascular-related. Hypotension, shock, pulmonary edema, and cardiac arrest that occurs with large doses are caused by depression of central sympathetic tone and as well as by direct depression of cardiac contractility. The potentially fatal oral dose of phenobarbital is 6-l0g. We describe an 23-year-old woman with pulmonary edema and cardiac arrest after ingestion of 18 grams of phenobarbital. She was completely recovered by successful cardiopulmonary resuscitation and hemoperfusion. We report a case with literature review.
Ataxia ; Barbiturates ; Benzodiazepines ; Brain ; Cardiopulmonary Resuscitation ; Depression ; Eating ; Epilepsy ; Ethanol ; Female ; Heart Arrest* ; Hemoperfusion ; Humans ; Hypotension ; Lethargy ; Neurons ; Phenobarbital* ; Phenytoin ; Pulmonary Edema* ; Shock ; Status Epilepticus ; Suicide ; Young Adult

Isoniazid(Isonicotinic acid hydrazide) is an antimicrobial drug used since 1952 as a fast line agent for the prophylaxis and treatment of tuberculosis. Isoniazid is well known for problems in population having a high prevalence of isoniazid use for prophylaxis or treatment of tuberculosis. But intentional or accidental isoniazid overdose is uncommon. The ingestion of toxic amounts of isoniazid causes recurrent seizures, profound metabolic acidosis, coma and even death. In adults, toxicity can occur with the acute ingestion of as little as 1.5g of isoniazid. Doses larder than 30mg per kg often produce seizures. When ingested in amounts of 80-150mg per kg or more, isoniazid can be rapid fatal. 40-year-old woman having previous pulmonary tuberculosis ingested 7 gram of isoniazid(140mg/kg) to attempt suicide approximately 30 minutes prior to visit to our emergency medical center. She had recurrent generalized tonicclonic seizures and metabolic acidosis. We report one patient treated with pyridoxine, which was equivalent to the amount of isoniazid ingested and administered as a intravenous dose and oral dose.
Acidosis ; Adult ; Coma ; Eating ; Emergencies ; Female ; Humans ; Isoniazid* ; Prevalence ; Pyridoxine ; Seizures* ; Suicide ; Tuberculosis ; Tuberculosis, Pulmonary

PURPOSE: It is known that aspiration pneumonitis is associated with high mortality and morbidity following overdose. However, until now, few domestic studies on this subject have been conducted. The main aim of this study is to investigate the risk factors associated with aspiration pneumonitis in intubated patients following overdose. METHODS: Among 654 adult overdosed patients who visited our institution from Jan. 2006 to June 2008, we enrolled 70 intubated patients within 24 hours after their overdose, and we reviewed the medical records to collect the data. This data was processed by univariate analysis, followed by multiple logistic regression analysis. P values <0.05 were deemed statistically significant. RESULTS: In our study, a high incidence of pneumonitis was seen in the patients with an older age, a lower GCS and a high poisoning severity score or a high comorbidity score (p<0.05). Compared with the non-pneumonitis group, the pneumonitis group had a higher incidence of intubation (6% vs 61.8%, respectively, p<0.05). The main cause of intubation was a decreased mentality (68.6%). Older age, a high comorbidity score, irrigation without airway protection, relative hypoxemia and hyperkalemia were the risk factors of aspiration pneumonitis in the intubated overdosed patients (p<0.05). Among these factors, age, a high potassium level and airway protection might be significant predictors of aspiration penumonitis (p<0.05). CONCLUSION: Older age, a high potassium level and irrigation without proper airway protection may be the significant factors that can predict aspiration pneumonitis in patients who are intubated within 24 hours after overdose, although the further investigations on this are needed.
Adult ; Age Factors ; Anoxia ; Comorbidity ; Humans ; Hyperkalemia ; Incidence ; Intubation ; Logistic Models ; Medical Records ; Pneumonia ; Pneumonia, Aspiration ; Potassium ; Risk Factors