BACKGROUND: Quinidine appeared to increase serum digoxin levels when given with quinidine. Therefore elevated serum digoxin concentrations and clinical toxicity have been reported in patient receiving quinidine. Currently, Bayesian method which estimates the most probable parameters of the drug for each patient from population parameters data is useful approach for adjusting digoxin dosage. To increase the accuracy of Bayesian method, it is desirable to use population parameters of Korean. Therefore we evaluated the effect of quinidine on digoxin clearance in Korea. METHOD: Patient's records from 19 adult cardiac disease without CHF having normal renal and liver function from Seoul National University of Hospital respectively wre evaluated. Digoxin pharmacokinetic parameters, CL and Vd, were obtained from serum concentration of digoxin of single and combined therapy at each steady-state by using bayesian method. RESULTS: This study show that quinidine reduced the total body clearance of digoxin from 2.39+/-0.17 to 1.51+/-0.08ml/min/kg(p<0.05) and reduced the digoxin volume of distribution from 8.57+/-0.29 to 4.98+/-0.19L/kg(p<0.05). This results show that digoxin dosage reduced to 40-50% in Korean, if quinidine therapy is initiated.
Adult ; Bayes Theorem ; Digoxin* ; Drug Interactions ; Heart Diseases ; Humans ; Korea ; Liver ; Pharmacokinetics ; Quinidine* ; Seoul

No abstract available.
Osteoarthropathy, Primary Hypertrophic* ; Peptic Ulcer* ; Polyps* ; Stomach*

Background: Although the scallop sign is considered the most important risk factor for extensor tendon ruptures (ETRs) in patients with osteoarthritis of the distal radioulnar joint (DRUJ), previous reports provide a limited understanding of the changes at DRUJ, as risk factors were examined in plain radiographs of the wrist. The aim of this study was to assess the changes of DRUJ using axial images of computed tomography (CT) in patients with DRUJ osteoarthritis and associated ETRs and to evaluate the relationship between the changes of DRUJ and ETRs. Methods: Twelve patients with ETRs due to osteoarthritis of the DRUJ were enrolled. The changes of DRUJ were examined on axial images of CT and the following 8 parameters were measured: width of radius, anteroposterior (AP) length of radius, width of sigmoid notch (SN), AP length of SN, AP length of ulnar head, subluxation length of ulnar head, dorsal inclination of SN, and distance from Lister’s tubercle to SN. Radiological parameters of the DRUJ were measured in 60 control wrists without trauma or osteoarthritis, and the patient and control groups were statistically compared. Results: Statistically significant differences were observed between the patient and control groups in all the radiological parameters except for the AP length of SN and AP length of ulnar head. The width of radius, AP length of radius, width of SN, subluxation length of ulnar head, and dorsal inclination of SN were greater and the distance from Lister’s tubercle to SN was smaller in the patient group than in the control group. The width of SN, dorsal inclination of SN, and distance from Lister’s tubercle to SN were statistically significant risk factors among the 8 parameters. Conclusions ETRs due to osteoarthritis of the DRUJ was related to the changes of DRUJ, especially the changes around SN of the distal radius. In addition to the existing risk factors, a decreased distance from Lister’s tubercle to SN and increased dorsal inclination of SN were identified as new risk factors. Axial images of CT were effective to evaluate degenerative changes at the DRUJ.

Recently, the mathematical analysis of stent simulation has been improved, with the help of development of various tool which measure mechanical property and location of stent in artery. The most crucial part of the stent modeling is how to design ideal stent and to evaluate the interaction between stent and artery. While there has been great deal of researches on the evaluation of the expansion, stress distribution, deformation of the stent in terms of the various parameters, few verification through computer simulation has been performed about deformation and stress distribution of the stent. In this study, we have produced the corresponding results between experimental test using Universal Testing Machine and computer simulation for the ideal model of stent. Also, we have analyzed and compared stress distribution of stent in the cases of that with membrane and that without membrane. The results of this study would provide minimum change of plan and good quality for ideal stent replacing damaged artery through the analysis using computer simulation in the early stage of stent design.
Alloys ; Arteries ; Collodion ; Computer Simulation ; Exercise Test ; Finite Element Analysis ; Membranes ; Stents

Recently, the mathematical analysis of stent simulation has been improved, with the help of development of various tool which measure mechanical property and location of stent in artery. The most crucial part of the stent modeling is how to design ideal stent and to evaluate the interaction between stent and artery. While there has been great deal of researches on the evaluation of the expansion, stress distribution, deformation of the stent in terms of the various parameters, few verification through computer simulation has been performed about deformation and stress distribution of the stent. In this study, we have produced the corresponding results between experimental test using Universal Testing Machine and computer simulation for the ideal model of stent. Also, we have analyzed and compared stress distribution of stent in the cases of that with membrane and that without membrane. The results of this study would provide minimum change of plan and good quality for ideal stent replacing damaged artery through the analysis using computer simulation in the early stage of stent design.
Alloys ; Arteries ; Collodion ; Computer Simulation ; Exercise Test ; Finite Element Analysis ; Membranes ; Stents

Necrobiosis lipoidica (NL) is a chronic granulomatous skin disease typified by indurated plaques on the shin. Although this condition is strongly associated with diabetes mellitus, its etiology and pathogenesis remains unknown. Localization of NL to the lower extremities suggests that local injury may be a contributing factor to the disease. A healthy 38-year-old man presented with localized erythematous to yellowish plaques on his right thigh that developed over several years. The lesion developed in the scar where suture had been done for laceration repair 25 years ago. A biopsy specimen showed degenerated collagen with surrounding palisading granulomas. Numerous lymphocytes and multinucleated giant cells were infiltrated throughout the reticular dermis. Plasma cells aggregation was found at the dermal subcutaneous junction.
Biopsy ; Cicatrix ; Collagen ; Dermis ; Diabetes Mellitus ; Giant Cells ; Granuloma ; Humans ; Lacerations ; Lower Extremity ; Lymphocytes ; Necrobiosis Lipoidica ; Necrobiotic Disorders ; Plasma Cells ; Skin Diseases ; Sutures ; Thigh

OBJECTIVE: The effect of induced hypothermia on severe acute carbon monoxide (CO) poisoning remains to be addressed further. We investigated the effect of induced hypothermia on severe acute CO poisoning. METHODS: Retrospective chart review was conducted for patients who diagnosed as severe acute CO poisoning in emergency department and underwent induced hypothermia from May 2013 to May 2014. Hospital courses with critical medication and major laboratory results were investigated through the chart review. RESULTS: Among total 227 patients with acute CO poisoning during the period of study, patients with severe acute CO poisoning were 15. All patients underwent induced hypothermia with a temperature goal 33°C. Initial and follow-up levels of S100B protein after induced hypothermia were 0.47 μg/L (interquartile range, 0.11 to 0.71) and 0.10 μg/L (interquartile range, 0.06 to 0.37), respectively (P = 0.01). The mean Glasgow Coma Scales at emergency department admission was 6.87 ± 3.36. Except 1 patient who expired after cardiopulmonary resuscitation, Glasgow Coma Scales at 30-day of hospital discharge were 15 in 10 patients (71.4%), 14 in 1 patient (7.1%), 13 in 1 patient (7.1%), and 6 in 2 patients (14.2%). Seven patients (46.7%) developed delayed neurologic sequelae. Four patients showed mild types of delayed neurologic sequelae and 3 showed moderate to severe types of delayed neurologic sequelae. CONCLUSION: Most of patients underwent induced hypothermia had a good recovery from severe acute CO poisoning. Therefore, induced hypothermia may be considered as a possible treatment in severe acute CO poisoning.
Carbon Monoxide Poisoning* ; Carbon Monoxide* ; Carbon* ; Cardiopulmonary Resuscitation ; Coma ; Emergency Service, Hospital ; Follow-Up Studies ; Humans ; Hypothermia, Induced* ; Poisoning ; Retrospective Studies ; Weights and Measures

OBJECTIVE: The purpose of this study was to find out what was the diagnostic usefulness of ultrasonography in carpal tunnel syndrome METHOD: Subjects included 30 hands of 25 carpal tunnel syndrome patients and 20 hands of 17 healthy adults with no electrophysiologic evidence of carpal tunnel syndrome. All subjects were examined with real-time ultrasonography. The ultrasonography was evaluated quantitatively with regard to the cross-sectional area and the flattening ratio of the median nerve and the palmar displacement of the flexor retinaculum. The analysis of difference between normal control group and carpal tunnel syndrome group was done by independent t-test. RESULTS: The carpal tunnel syndrome patients group had significantly increased cross-sectional area of the median nerve at distal radio-ulnar joint, pisiform and hamate. The carpal tunnel syndrome patients group had significantly increased flattening ratio of median nerve at hamate. The carpal tunnel syndrome patients group had significantly increased palmar displacement of the flexor retinaculum. CONCLUSION: Based on the result of this study, the ultrasonography is useful in the diagnosis of the carpal tunnel syndrome.
Adult ; Carpal Tunnel Syndrome* ; Diagnosis ; Hand ; Humans ; Joints ; Median Nerve ; Ultrasonography

Spontaneous intra-abdominal hemorrhage from uterine leiomyomas is rarely encountered. We present a case of a 46-year-old who presented to the emergency room with acute abdominal pain as same as that has experienced for 5-6 times. On examination, the abdomen was diffusely tender, with rebound tenderness in the suprapubic area and in both iliac fossae. Pregnancy test was negative. She had an acute abdomen, dizziness, decreasing hematocrit, and a pelvic mass with free fluid in the pelvic cavity. On transvaginal sonography, 6.3 x 6.1 cm sized hyperechoic mass was visible beside the uterus and CDS. This mass had an ill-defined margin. Large amount of fluid was visible in the CDS and uterovesical pouch. Hemoperitoneum was confirmed by culdocentesis. Magnetic Resonance Imaging revealed a mass with cystic components, diffusely heterogeneous signal intensity and T1 high signal intensity in the left superolateral aspect of uterus. An moderate amount of fluid was found in the pelvic cavity. The patient underwent an exploratory laparotomy. A ruptured, pedunculated, cystic degenerated uterine myoma with active bleeding was found, as well as approximately a liter of free, blood-stained peritoneal fluid and blood-clots. Myomectomy was performed, followed by evacuation of the fluid and clots. The patient's postoperative course was uneventful. In conclusion, preoperative diagnosis of a perforated, uterine fibroid with spontaneous intra-abdominal hemorrhage is difficult; exploratory laparotomy is both diagnostic and therapeutic in this rare, life-threatening condition.
Abdomen ; Abdomen, Acute ; Abdominal Pain ; Ascitic Fluid ; Diagnosis ; Dizziness ; Emergency Service, Hospital ; Female ; Hematocrit ; Hemoperitoneum* ; Hemorrhage ; Humans ; Laparotomy ; Leiomyoma* ; Magnetic Resonance Imaging ; Middle Aged ; Pregnancy ; Pregnancy Tests ; Uterus

Since the first imported case of Middle East respiratory syndrome coronavirus (MERS-CoV) infection was reported on May 20, 2015 in Korea, there have been 186 laboratory-confirmed cases of MERS-CoV infection with 36 fatalities. Ninety-seven percent (181/186) of the cases had exposure to the health care facilities. We are reporting a superspreading event that transmitted MERS-CoV to 81 persons at a hospital emergency room (ER) during the Korean outbreak in 2015. The index case was a 35-yr-old man who had vigorous coughing while staying at the ER for 58 hr. As in severe acute respiratory syndrome outbreaks, superspreading events can cause a large outbreak of MERS in healthcare facilities with severe consequences. All healthcare facilities should establish and implement infection prevention and control measure as well as triage policies and procedures for early detection and isolation of suspected MERS-CoV cases.
Adult ; Coronavirus Infections/*epidemiology/*virology ; Female ; Humans ; Incidence ; Male ; Middle East Respiratory Syndrome Coronavirus/*isolation & purification ; Pandemics/*statistics & numerical data ; Republic of Korea/epidemiology ; Risk Factors