Neuroleptic malignant syndrome(NMS) is an uncommon but potentially fatal idiosyncratic reaction to neuroleptics, characterized by muscular rigidity, fever, autonomic dysfunction, and altered consciousness. The major theories to explain NMS is central dopaminergic blockade, but it is unclear. Risperidone is a new antipsychotic drug, a benzisoxazole derivative that blocks dopamine D2 receptor and serotonin type 2 receptor. The comparatively greater serotonin-blocking activity is believed to give risperidone the specific property of not causing any more extrapyramidal side effects than conventional antipsychotics at the optimal dose of 4-8mg/day. It is postulated that risperidone is unlikely to cause NMS. Here, we report a case of risperidone induced neuroleptic malignant syndrome.
Antipsychotic Agents ; Consciousness ; Fever ; Muscle Rigidity ; Neuroleptic Malignant Syndrome* ; Receptors, Dopamine D2 ; Risperidone ; Serotonin

A simple, rapid and selective liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) is developed and validated for quantification of venlafaxine in human plasma with simple liquid-liquid extraction step consisted of extraction with ether and dichloromethane for 10 min and mixing with 1 M sodium acetate in human plasma using fluoxetine as an internal standard (IS). The analyte are separated using an isocratic mobile phase consisted of acetonitrile and 5 mM ammonium formate (4/3, v/v) on a isocratic YMC hydrosphere C18 (2.0x50.0 mm, 3.0 microm) column and analyzed by MS/MS in the multiple reaction monitoring (MRM) mode using the transitions of respective [M+H](+) ions, m/z 278.2-->260.3 and m/z 310.1-->148.1 for quantification of venlafaxine and IS, respectively. The standard calibration curves showed good linearity within the range of 1.0-200.0 ng/mL (r2=0.9986, 1/chi2 weighting). The lower limit of quantification (LLOQ) was 1.0 ng/mL. The retention times of venlafaxine and IS were 0.6 min and 0.7 min that means the potential for the high-throughput potential of the proposed method. In addition, no significant metabolic compounds were found to interfere with the analysis. Acceptable precision and accuracy were obtained for the concentrations over the standard curve range. The validated method was successfully applied to bioequivalence study after 75-mg of venlafaxine sustained-release (SR) capsule in 24 healthy Korean subjects.
Ammonium Compounds ; Calibration ; Chromatography, Liquid ; Ether ; Fluoxetine ; Humans ; Ions ; Liquid-Liquid Extraction ; Methylene Chloride ; Pharmacokinetics ; Plasma* ; Sodium Acetate ; Tandem Mass Spectrometry ; Therapeutic Equivalency* ; Venlafaxine Hydrochloride

To evaluate the degree of competitive exclusion against Salmonella gallinarum(S. gallinarum) of Salmonella enteritidis(S. enteritidis) infected chickens, fifty-six, 4-week old Hyline layer suspected of S. enteritidis infection were challenged with S. gallinarum. All chickens were tested for S. enteritidis isolation using cloacal swabs and serum plate agglutination test using S. enteritidis Ag. before challenge and classified into four groups(SE isolated, SE nonisolated, SE seropositive and SE seronegative). None of the SE isolated and the SE seropositive groups died after challenge and the average weight gains were 245.5g and 254.6g, respectively. But in the SE nonisolated and the SE seronegative groups, mortality was 18.2% and 20.6% and the average weight gains were 150.1g and 111.2g. The incidence of reisolation of S. gallinarum of the SE isolated and the SE seropositive groups were 41.7% and 47.6% from liver, 33.3% and 47.6% from spleen and 8.3% and 14.3% from cecum, respectively, and the SE nonisolated and the SE seronegative group were 63.6% and 64.7% from liver, 84.1% and 88.2% from spleen and 47.7% and 52.9% from cecum. The serological response of the SE isolated and the SE seropositive groups hardly changed from 75.0 and 81.8% before challenge to 75.0 and 85.7% after. But, the other two groups were found to be significantly higher after challenge and increased from 0 and 18.2% to 100%. Consequently, S. enteritidis preinfected chickens were found to be significant different in terms of mortality, weight gain, reisolation of S. gallinarum and serological response compared to noninfected chickens. Moreover, our study shows that S. enteritidis infected chickens appear strong competitive exclusion against the colonization of S. gallinarum.
Animals ; Chickens ; Disease Outbreaks/veterinary ; Korea/epidemiology ; Oviposition ; Poultry Diseases/*microbiology ; Salmonella/*classification/*isolation & purification ; Salmonella Infections, Animal/*microbiology ; Salmonella enteritidis/*classification/*isolation & purification ; Serotyping ; Weight Gain

Due to the instability of intertrochanteric fractures in elderly patients, various methods of reduction and fixation were introduced to obtain stable reduction and solid union, But there have been many controversies regarding advantages between anatomical reduction group and non-anatomical reduction group. The authors analyzed the 68 unstable intertrochanteric fractures out of total 94 cases of intertrochanteric fractures treated from Jan. 1988 to Jan. 1994 with mean follow-up 17 months and evaluated the radiologic and clinical results between those two groups. The results were obtained as follows: 1. The most common cause was low energy injury and according to the Tronzo classification, the type III was most common in 54 cases (79.4%). 2. The average union time was 14.0wks (84%), the union rate was low in the medialized reduction group(A-P) and anterior displaced reduction group(A-P), anterior displaced and anatomical reduction groups(Lateral). 3. The compression length more than 10mm of lag screw was deep in medialized reduction group(A-P), another displaced and anatomical reduction groups(Lateral). 4. The average length of lag screw sliding was 9.2mm and depth sliding of 6.8mm (74%) was occurred within immediate postoperative 1 month.
Aged ; Classification ; Femur ; Follow-Up Studies ; Hip Fractures ; Hip ; Humans

Fractures involving both tibial plataeus result form high energy trauma such as a traffic accidents or falls, and it is frequently accompanied by soft tissue injuries. Thus it is very difficult to treat these fractures satisfactorily and severe complications can be caused. The purpose of study is to analyze the clinical results, complication and factors influencing the results after open reduction and internal fixation of tibial bicondylar fractures. Twenty cases(19 patients) of tibial bicondylar fractures which had been treated by open reduction and internal fixation from January 1989 to December 1994 were analyzed after 1 to 5 years follow-up. The results were as follows. 1. By AO classification, the most common type was C3(13 cases). 2. According to Blokker's criteria, 5 cases was unsatisfactory and all of these cases were C3. 3. Unsatisfactory results were 3 cases of reduction loss(angular deformity), one case of deep infection and one case of unresolved peroneal nerve palsy. 4. Tibial tubercle osteotomy, bone graft and medial buttress plate were important for anatomical reduction and maintenance.
Accidental Falls ; Accidents, Traffic ; Classification ; Follow-Up Studies ; Osteotomy ; Paralysis ; Peroneal Nerve ; Soft Tissue Injuries ; Tibia ; Transplants

From January 1988 to December 1991, 39 fractures of the lateral condyle of humerus in children were treated at the Department of Orthopaedic Surgery, Sung-Ac General Hospital. It was possible to follow up from one year to four years and eleven months. The authors have analyzed the method of treatment on the basis of the degree of displacement in the change of Carrying angle and Baumann's angle. The results were as follows; 1. Of the 39 cases, the age incidence was confined to 2 to 12 years of age and the average age of the patients were 5 years. 2. Most fractures were Milch type II (29 cases) in contrast to Milch type I (10 cases). 3. According to the initial displacement of the fracture, 8 cases were Jokob's stage I, 21 cases of stage II & 10 cases of stage III. 4. There were no significant difference in the range of change of Carrying angle and Baumann's angle according to initial displacement of fracture site. However, significant difference in outcome were noticed from open reduction and internal fixation in comparison to closed reduction and percutaneous pinning. 5. In all 39 cases, lateral condylar overgrowth (10 cases), cubitus varus (1 cases) and cubitus valgus (3 cases) were noticed as complications but clinical significance was not noted. 6. The above results suggest that internal fixation is recommended for firm fixation although displacement is not severe. In case of Jakob's stage III, anatomical reduction is required in order to reduce additional damage on articular surface and epiphyseal plate caused by excessive manipulation.
Child ; Clinical Study ; Follow-Up Studies ; Growth Plate ; Hospitals, General ; Humans ; Humerus ; Incidence ; Methods

Congenital fibrosarcoma of neonate is a very rare malignant tumor prone to behave aggressively with a tendency to local recurrence without metastasis. It is characteristically composed of collagenous fibroblasts and herringbone pattern in histology. We experienced a case of congenital fibrosarcoma on the left thigh and report this case with some review in literature with 1½ year follow up.
Collagen ; Fibroblasts ; Fibrosarcoma ; Follow-Up Studies ; Humans ; Infant, Newborn ; Neoplasm Metastasis ; Recurrence ; Thigh

PURPOSE: To evaluate the clinical effect of intravenous glutamine administration on patients admitted to the intensive care unit in general hospitals. METHODS: Patients with more than 7 days in an intensive care unit were evaluated. The experimental group was the patients who received intravenous glutamine administration for more than 3 days. The laboratory results, intensive care unit length of stay, hospital length of stay, 30 days mortality, and hospital mortality were evaluated with a comparative group. RESULTS: The mean number of administration days of intravenous glutamine was 10.12±8.93 days, and the average daily dose was 0.33±0.10 g/kg/day. No adequate improvement in the laboratory results of glutamine-treated group was observed. The intensive care unit length of stay (21.16±15.83 vs. 16.48±11.06, P=0.007), hospital length of stay (35.94±30.75 vs. 27.34±19.09, P=0.010), 30 days mortality (20.0% vs. 10.0%, P=0.034), and hospital mortality (26.3% vs. 13.0%, P=0.001) were higher in the glutamine-treated group. CONCLUSION: The use of intravenous glutamine on intensive care unit patients did not improve the clinical effect. Further large-scale multi-center studies will be needed to assess the proper administration of intravenous glutamine on intensive care unit patients.
Critical Care ; Glutamine ; Hospital Mortality ; Hospitals, General ; Humans ; Intensive Care Units ; Length of Stay ; Mortality

PURPOSE: To analysis the efficacy of MRI in assessing fracture configuration and frequency of associated soft tissue injuries in tibial plateau fractures. MATERIALS AND METHODS: In the plain films and MRI of 47 cases with tibial plateau fractures,every fracture was classified by findings on plain film and MRI respectively according to the Schatzker system and they were compared with each other. The degree of displacement and depression of the fracture fragments were measured on plain film and MRI. RESULTS: MRI was more accurate in determining the classification of the fracture and measuring the displacement and depression of fragments. Fracture classifications were changed in 12 cases. Especially in Schatzker VI cases, articular step off over 2 mm and articular fragments over 2X2 cm were revealed in detail by MRI. Evidence of internal derangement of the knee was found in 38 (80.8%) cases. CONCLUSION: Most of the cases with acute tibial plateau fracture were commonly associated with ligamentous and meniscal injuries. MRI can aid in accurate evaluation of tibial plateau fracture patterns and decision of treatment plan.
Classification ; Depression ; Knee ; Ligaments ; Magnetic Resonance Imaging* ; Soft Tissue Injuries

Blood gas samples are highly susceptible to preanalytic error due to improper methods of obtaining or handling the sample prior to delivery to the laboratory. The errors in the measurement of blood gas analysis are currently derived from the exposure of sample to atmosphere, effects of anticoagulant itself, temperature difference between the measuring electrode and drawn blood and the delay in running the sample. To study the effects of the delay in measuring the sample and the temperature difference between the measuring electrode and drawn blood on values of blood gases and pH, we analyzed the arterial sampling from the 24 patients who were taking elective surgery or on his/her recovery period with indwelling arterial catheter. The plastic sampling syringes were kept at 4 degrees C (refrigerator) or 22-24 degrees C (room temperature) and analyzed at regular intervals (1, 10, 30, 60,120 min) for 120 minutes. The following results were obtained: 1) When the arterial blood drawn from the anesthetized patients were stored at 4 degrees C, partial pressure of oxygen (PaO2) decreased significantly after 20 min, whereas those stored at room temperature decreased significantly after 10 min. 2) When the arterial blood drawn from the recovery patients were stored at 4 degrees C, PaO2 did not decrease significantly through the experimental period of 120 min. Although those stored at room temperature did not decrease significantly through the period of 120 min. 3) Partial pressure of carbon dioxide in the arterial blood (PaCO2,) drawn from the anesthetized patients increased significantly by 120 min. at 4 degrees C, whereas those at room temperature increased significantly after 20 min. 4) PaCO2, of the recovery patients increased signigicantly by 120 min. at 4 degrees C, whereas those at room temperature increased significantly after 30 min. 5) pH of the arterial blood drawn from either anesthetized or recovery patients decreased significantly by 120 min. at 4 degrees C, whereas those at room temperature decreased significantly after 60 min. 6) No significant changes of arterial oxygen saturation (SaO2) and content (CaO2) were noted in either anesthetized or recovery. patients in accordance with time elapsed at 4 degrees C or room temperature. In summary, as the changes of PO2 in particular higher than physiologic PO2 and PCO2 in the arterial blood stored at room temperature are significant in accordance with the delay in measuring, it would be advisable to analyze the sample in a short period of time or to store it in a cool place when the measuring will be delayed.
Atmosphere ; Blood Gas Analysis ; Carbon Dioxide ; Catheters ; Electrodes ; Gases* ; Humans ; Hydrogen-Ion Concentration* ; Oxygen ; Partial Pressure ; Plastics ; Running ; Syringes