Drugs are important causes of rhabdomyolysis. Opiate drugs are one of the important causes of rhabdomyolysis in foreign countries. In Korea, however, there is no report of opiate-induced rhabdomyolysis. We experienced a case of rhabdomyolysis developed after a morphine overdose for suicidal intent. The patient was a 27-year-old man presenting with comatose mentality. He initially suffered from the manifestations of acute opiate intoxication including central nervous system depression, respiratory depression and hyperthermia. He was treated with intravenous naloxone and mechanical ventilator for one day. Results of further investigations showed evidence of rhabdomyolysis. After he was treated with general supportive care including hydration, urine alkalinization, and cold blanket, his condition was fully recovered. This case highlights the importance of the suspicion of opiate overdose as a cause of rhabdomyolysis in any rhabdomyolysis patient with no definite etiology.
Adult ; Central Nervous System ; Coma ; Depression ; Fever ; Humans ; Korea ; Morphine* ; Naloxone ; Respiratory Insufficiency ; Rhabdomyolysis* ; Ventilators, Mechanical

Median raphe cyst is known as congenital lesion of the perineum and genitalia, but its etiology is unclear. Most investigators believe that the median raphe cyst represent defects in the embryologic developenient bf the male genitalia. Simple surgical excision is effective in most cases. We report our experience with two cases of median raphe cyst without specific symptoms. Even though median raphe cyst is asymptomatic, surgical therapy is worth applicable because it relieve a patient from cosmetic and psychotic problem.
Genitalia ; Genitalia, Male ; Humans ; Male ; Perineum ; Research Personnel

To clarify the mechanism of the protective effect of hemodialysis on lipid peroxidation in RBC membrane structures, the level of malondialdehyde (MDA) which is the lipid peroxidation product, and the activities of antioxidant enzymes such as superoxide dismutase (SOD), catalase, and glutathione peroxidase (GSH-Px) were determined before and after hemodialysis in the RBCs from 20 patients with end stage renal disease (ESRD), and from 14 healthy subjects. Before dialysis, MDA levels in the RBCs from the patients with ESRD were higher than those from healthy controls. SOD and catalase activities in the RBCs were lower. After hemodialysis, MDA, SOD, and catalase in the RBCs from the patients with ESRD were normalized. These results indicate that hemodialysis treatment is helpful to protect the peroxidative darnage through normalizing the activities of antioxidant enzymes.
Catalase ; Dialysis ; Erythrocytes* ; Glutathione Peroxidase ; Humans ; Kidney Failure, Chronic* ; Lipid Peroxidation ; Malondialdehyde* ; Membranes ; Renal Dialysis* ; Superoxide Dismutase

PURPOSE: There are some challenges to accurate diagnosis of ocular myasthenia gravis (MG) in thyroid-associated ophthalmopathy (TAO) patients because the clinical features of these diseases are similar. The aim of this study was to discuss the clinical features and treatment options that may help differentiate these 2 diseases. METHODS: We performed a retrospective analysis using the medical records of patients who visited our clinic and were diagnosed with ocular MG and TAO, from January 2002 to December 2012. The diagnosis of Ocular MG was made on the basis of clinical symptoms and signs with laboratory evaluation, including assays for antithyroid and antiacetylcholine receptor (AchRAb) antibodies, and the Ice, neostigmine, and electromyography tests. RESULTS: Of the 9 ocular MG patients with associated ophthalmopathy, 5 were male and 4 were female. The mean age was 36 +/- 16.0 years and the follow-up period was 45.6 +/- 36.6 months. Graves' disease (8 patients) was predominant and all patients showed abnormal thyroid function. Atypical symptoms and/or mild clinical features were predominant in ocular MG patients with TAO. Positive test results were obtained as follows: Neostigmine test 33.3%, electromyography 44.4%, ice test 77.8% and anti-AchR titer test 77.8%. Thyroid function test results were abnormal in all patients. In 3 patients who were first diagnosed with TAO, symptoms remained persistent despite steroid therapy then improved dramatically by administration of an anti-acetylcholinesterase agent. These patients were diagnosed with ocular MG in conjunction with TAO. CONCLUSIONS: Patients with thyroid disease who show atypical features, symptomatic changes with fatigue, odd appearing ptosis, and who, do not exhibit good response to treatment of TAO need to be examined for ocular MG with additional tests and treatment.
Antibodies ; Diagnosis ; Electromyography ; Fatigue ; Female ; Follow-Up Studies ; Graves Disease ; Graves Ophthalmopathy* ; Humans ; Ice ; Male ; Medical Records ; Myasthenia Gravis* ; Neostigmine ; Retrospective Studies ; Thyroid Diseases ; Thyroid Function Tests ; Thyroid Gland ; Troleandomycin

PURPOSE: To report the clinical features and surgical results for lower lid entropion with kinked tarsus compared with entropion with weakened capsulopalpebral fascia. METHODS: From March 2008 to December 2009, 20 patients (24 eyes) with lower lid entropion were examined. The patients were divided into the aggravated entropion with kinked tarsus group or the weakened capsulopalpebral fascia group based on the height of tarsus, the shapes of the lower lid and tarsus, and conjunctiva changes. For treatment of entropion in the kinked tarsus group, full thickness tarsotomy with rotatory suture (tarsal fracture operation) was performed, and in the weakened CPF group, a CPF tight procedure was performed. The results of the operations were retrospectively evaluated. RESULTS: The mean age of the patients with entropion in the kinked tarsus group (15 cases) was 66.7 +/- 11.4 years, and the mean age of the patients with entropion in the weakened CPF group (9 cases) was 67.2 +/- 6.2 years. The height of the lower lid tarsus of each group was 3.80 +/- 0.39 mm and 5.20 +/- 0.30 mm, respectively. Except for one case of recurrence after tarsal fracture operation in the kinked tarsus group and reoperation with CPF tightening, there were no significant complications or recurrence in either group. CONCLUSIONS: Entropion with kinked tarsus was more common than entropion with weakened CPF in the present study. In addition, surgical treatment based on the shape and cause of entropion showed good results.
Animals ; Ankle ; Conjunctiva ; Entropion ; Eyelids ; Fascia ; Humans ; Recurrence ; Reoperation ; Retrospective Studies ; Sutures

PURPOSE: To evaluate the efficacy of power Doppler ultrasonography (PDUS) in depicting renal infarction inrabbits during experimental renal segmental arterial occlusion, and to compare the results with those of CTscanning. MATERIALS AND METHODS: In 28 rabbits weighing 2.5-4kg, the segmental renal artery was occluded throughthe left main renal artery by embolization with Ivalon (Nycomed, Paris, France). Power Doppler ultrasonography andspiral CT scanning were performed before and at 2, 5, 8, 15, and 24 hours, and 3 and 7 days after occlusion of thesegmental renal artery. The location of infarcted areas and collaterals, as seen on PDUS and CT scans, wasevaluated by two radiologists. RESULTS: In all cases, as seen on power Doppler ultrasonography, infaretedareas-when compared with normal parenchyma, clearly demonstrated wedge-shaped perfusion defects in the kidney. Thelocation of the lesion closely corresponded to the location seen during CT scanning. After renal arterialocclusion, transiently congested capsular arteries, which were named 'capsular sign', were seen in 63% ofrabbits in the two and five-hour groups. No significant cortical rim sign was demonstrated on power Dopplerultrasonography, though it was noted on spiral CT at 15 and 24 hours, and 3 and 7 days after renal arterialocclusion. CONCLUSION: Power Doppler ultrasonography was useful for the diagnosis of renal infarction. Congestedcapsular artery seen in the early stage of renal infarction might be a characteristic finding of this condition,as seen on power Doppler ultrasonography.
Animals ; Arteries ; Diagnosis ; Estrogens, Conjugated (USP) ; Infarction ; Kidney ; Perfusion ; Rabbits ; Renal Artery* ; Tomography, Spiral Computed ; Tomography, X-Ray Computed ; Ultrasonography* ; Ultrasonography, Doppler

Secretory carcinoma is an uncommon type of carcinoma and the only well-documented type that may arise in children and adults of both sexes. Secretory carcinomas do not occur with any particular frequency in any part of the breast. Usually, the primary symptom is a painless mass that may be present for years before biopsy. We encountered a case of a secretory carcinoma of the breast. The patient was a 34-year-old woman. She visited our hospital due to a painless mass located in the upper portion of the left breast in the direction of 11 o,clock and at a distance of 1 cm from the areola. On palpation, it showed a firm and fixed tumor mass. A secretory carcinoma was diagnosed based on excisional biopsy. The patient underwent an Auchincloss, modified radical mastectomy. Multistep cross sections showed an ill-defined brownish, white tumor mass with a gritty sensation and measuring 2.0 1.4 cm in size. Metastasis was found in 1 of 8 axillary lymph nodes. Compared with typical breast cancer, the prognosis is better, but a similar therapeutic strategy may be necessary.
Adult ; Biopsy ; Breast Neoplasms ; Breast* ; Child ; Female ; Humans ; Lymph Nodes ; Mastectomy, Modified Radical ; Neoplasm Metastasis ; Palpation ; Prognosis ; Sensation

PURPOSE: Hydronephrosis constitutes a great portion of fetal anomalies screened by prenatal sonogram. The present authors made an attempt to access its natural courses through follow up neonatal hydronephrosis diagnosed by prenatal sonogram. METHODS: The study was composed of 23 neonates(36 renal units) who were diagnosed with hydronephrosis through prenatal sonogram screening and confirmed 3-7 days after birth with sonographic evaluation at Kyung Hee University Hospital. The neonates were closely monitored for 12-24 months with renal sonogram, diuretic renogram, intravenous pyelography(IVP) and voiding cystoureterography(VCUG). RESULTS: The underlying diseases were composed of 16 cases(44%) of functional abnormalities, 14 cases(39%) of ureteropelvic junction(UPJ) obstruction, three cases(8%) of vesicoureteral reflux (VUR) and on case each of multicystic dysplastic kidney, UPJ obstruction with ureteral stenosis and ureterovesical junction(UVJ) obstruction with VUR. The degree of hydronephrosis was divided into three classes according to its severity. In 30 renal units with UPJ obstruction and functional abnormalities, 26(87%) showed mild hydronephrosis, while four(13%) were moderate. During the follow up period, six cases(20%) showed natural resolution of hydronephrosis, 15 cases(50%) showed improvement while two cases(7%) were aggravated with improvement only after surgery of the underlying disease. The cases which showed natural resolution were all mild hydronephrosis at diagnosis and the cases which underwent surgery due to continuous aggravation were mild one case and moderate one case. CONCLUSION: Those with cases of mild hydronephrosis show rapid natural improvement. On the other hand, in some cases, follow up monitoring reveal aggravation of the situation, emphasizing the necessity for thorough follow up for a long period of time.
Constriction, Pathologic ; Diagnosis ; Follow-Up Studies ; Hand ; Humans ; Hydronephrosis* ; Infant, Newborn ; Mass Screening ; Multicystic Dysplastic Kidney ; Parturition ; Ultrasonography ; Ultrasonography, Prenatal* ; Ureter ; Vesico-Ureteral Reflux

PURPOSE: Combined chemoradiotherapy is standard management for locally advanced non-small cell lung cancer (LA-NSCLC), but standard treatment for elderly patients with LA-NSCLC has not been confirmed yet. We evaluated the feasibility and efficacy of concurrent chemoradiotherapy (CCRT) for elderly patients with LA-NSCLC. MATERIALS AND METHODS: Among patients older than 65 years with LA-NSCLC, 36 patients, who underwent CCRT were retrospectively analyzed. Chemotherapy was administered 3-5 times with 4 weeks interval during radiotherapy. Thoracic radiotherapy was delivered to the primary mass and regional lymph nodes. Total dose of 54-59.4 Gy (median, 59.4 Gy) in daily 1.8 Gy fractions and 5 fractions per week. RESULTS: Regarding the response to treatment, complete response, partial response, and no response were shown in 16.7%, 66.7%, and 13.9%, respectively. The 1- and 2-year overall survival (OS) rates were 58.2% and 31.2%, respectively, and the median survival was 15 months. The 1- and 2-year progression-free survivals (PFS) were 41.2% and 19.5%, respectively, and the median PFS was 10 months. Regarding to the toxicity developed after CCRT, pneumonitis and esophagitis with grade 3 or higher were observed in 13.9% (5 patients) and 11.1% (4 patients), respectively. Treatment-related death was not observed. CONCLUSION: The treatment-related toxicity as esophagitis and pneumonitis were noticeably lower when was compared with the previously reported results, and the survival rate was higher than radiotherapy alone. The results indicate that CCRT is an effective in terms of survival and treatment related toxicity for elderly patients over 65 years old with LA-NSCLC.
Aged ; Carcinoma, Non-Small-Cell Lung ; Chemoradiotherapy ; Disease-Free Survival ; Esophagitis ; Humans ; Lymph Nodes ; Pneumonia ; Retrospective Studies ; Survival Rate

PURPOSE: To determine the correlation of the clinical characteristics and histopathologic findings of lacrimal sac after external dacyrocystorhinostomy (DCR). METHODS: From March 2008 to June 2009, 49 lacrimal sac tissues of 47 patients were obtained after external DCR and divided according to fibrosis and inflammatory findings. The correlation of preoperative duration of symptoms with NLD obstruction, symptoms of recurrence and outcomes of the operation to the histopathologic findings were retrospectively evaluated. RESULTS: The mean age of the patients was 58.83 +/- 11.49 years and the mean duration of preoperative symptoms was 65.2 +/- 69.05 months. Forty-three cases (88%) maintained good openings and 30 cases (61%) had no recurring symptoms over 6 months after the operation. Among the significant symptoms, severe subepithelial inflammations were observed more frequently at shorter duration. However, the fibrosis showed a positive relation with the preoperative duration of symptoms (Spearman correlation test, p<0.05). Most failures were found in the severe inflammation and fibrosis groups and were recovered with anti-inflammatory treatment. CONCLUSIONS: Inflammation and fibrosis of the lacrimal sac could be an important prognostic and predictive factor of outcomes of DCR.
Dacryocystorhinostomy ; Fibrosis ; Humans ; Inflammation ; Recurrence ; Retrospective Studies