BACKGROUND: Intermediate myasthenia syndrome(IMS) is thought to have clinical importance because it may cause sudden respiratory failure during the recovery phase of a cholinergic crisis of organophosphate poisoning. We designed this study to identify the prevalence, the inducing agent, clinical predictor, and the proposed treatment of IMS. METHODS: Patients who had admitted with the diagnosis of acute organophosphate poisoning from 1992 to 1998 at two teaching hospitals were enrolled in this study. We selected the cases of IMS based on a review of medical records using modified He's criteria. RESULTS: Twelve(12) out of 110 patients with acute organophosphate poisoning were diagnosed for a prevalence at 10.9%. The drug inducing IMS were identified as dichlorvos, fenthion, EPN, methidathion, and phosphamidon. The occurrence of IMS was not related to either the initial treatment with atropine and pralidoxime, or the level of serum cholinesterase. Complications were pneumonia, sepsis, pancreatitis, and pseudomembranous colitis, etc. Eleven(11) patients were discharged without sequelae, and one patient was discharged as a hopeless care. CONCLUSION: This study suggests that IMS is not rare, so close observation is required to detect IMS in organophosphate-poisoning patients. Also, more studies are required to find predictors and treatments.
Atropine ; Cholinesterases ; Diagnosis ; Dichlorvos ; Enterocolitis, Pseudomembranous ; Fenthion ; Hospitals, Teaching ; Humans ; Medical Records ; Organophosphate Poisoning ; Pancreatitis ; Phosphamidon ; Pneumonia ; Prevalence ; Respiratory Insufficiency ; Sepsis

No abstract available.
Animals ; Cerebellum* ; Inositol 1,4,5-Trisphosphate* ; Inositol* ; Rats*

BACKGROUND: Abdominal pain is one of the most common complaints in the emergency department and the evaluation presents an extraordinary challenge to the emergency physician's skill. C-reactive protein, an acute phase protein which is increased in the presence of inflammation in various clinical conditions, has been proven useful in assessing disease severity, in monitoring the development of complications, and in evaluating the response to specific treatments. So we tried to determine whether CRP offers an advantage over other clinical or laboratory variables for decision-making in the management of acute abdominal pain in the emergency department. METHOD: Patients who came to a University Hospital ED with acute abdominal pain, between september 1, 1998 and November 30, 1998, were included in this study, Data collection included age, sex, duration of symptom, location of pain, and laboratory dta(white blood cell count, portion of neutrophils, ESR, CRP, amylase). RESULT: This study included 85 patients, 34 of whom were men. The mean age was 36.9+/-19.1 years. CRP might be useful to detect the serious condition, sensitivity 81%, but more useful to differentiate normal condition from serious condition in acute abdominal pain patients, specificity 83%. CONCLUSION: CRP is an useful indicator of decision-making to abdominal patients in the emergency department. Hospitalization or operation is very unlikely when CRP value is normal.
Abdominal Pain* ; Acute-Phase Proteins ; Blood Cell Count ; C-Reactive Protein* ; Data Collection ; Emergencies ; Emergency Service, Hospital ; Hospitalization ; Hospitals ; Humans ; Inflammation ; Male ; Neutrophils ; Sensitivity and Specificity

BACKGROUND: The pathogenesis of nasal polyp is not well understood, however the common pathway of nasal polyp formation is tissue edema. Factors that are known to predispose tissue edema include histamine, arachidonic acid metabolites, serotonin and peptidergic neuro-transmitters. OBJECTIVES: To elucidate the pathophysiological roles of peptidergic neurotransmitters on the polyp formation, we investigated the distribution of several immunoreactive nerve fibers. MATERIALS AND METHODS: We obtained normal middle turbinate mucosa, edematous middle turbinate mucosa, polypoid middle turbinate mucosa and nasal polyp tissue from 5 patients at the time of surgery and we determined the distribution of substance P(SP) immunoreactive, vasoactive intestinal peptide(VIP) immunoreactive and neuropeptide-Y(NPY) immunoreactive nerve fibers in the above tissues using avidin-biotin complex(ABC) immunohistochemical method. RESULTS: Fine varicose peptidergic nerve fibers were found numerously in normal mucosa and they were decreased in number in the edematous mucosa. However the peptidergic nerve fibers were hardly found in the polypoid mucosa and the pedicle of polyp, and no nerve fibers were found in the apex of polyp except VIP-immunoreactive nerve fibers. CONCLUSION: Decreasing tendency of distribution of these peptidergic nerve fibers in the order of edematous mucosa, polypoid mucosa, and polyp may indicate the denervation of autonomic nervous system. These phenomenon suggests the important role of peptidergic neurotransmitters in the early stage of polyp formation. However, once the polyp has been formed, contribution of the peptidergic neurotransmitters is considered to be negligible.
Arachidonic Acid ; Autonomic Nervous System ; Denervation ; Edema ; Histamine ; Humans ; Mucous Membrane* ; Nasal Polyps* ; Nerve Fibers ; Neuropeptides* ; Neurotransmitter Agents ; Polyps ; Serotonin ; Turbinates

This article was published with an error.

OBJECTIVE: This study aimed to examine the effects of chronic disease management program based on clinics for blood pressure control or glycemic control in patients with hypertension or type 2 diabetes mellitus in Incheon. METHODS: An observational follow up study was done on 11,501 patients registrated at clinics from January 1st to December 31st, 2010 in Incheon. Experience of education and mandatory laboratory tests were assessed with the registration data and income status was identified by National Health Insurance data. The odds ratio and 95% confidence intervals were derived from logistic regression models. RESULTS: The experience of education has a positive effect for blood pressure control in the non-control group with hypertension at the time of registration (Odds ratio 1.357, confidence intervals: 1.112~1.655). The experience of mandatory laboratory tests has a positive effect for blood pressure control in the control group with hypertension at the time of registration (Odds ratio 1.738, confidence intervals: 1.387~2.178). But the effects of the experience of education and mandatory laboratory test in patients with type 2 diabetes mellitus were not identified. CONCLUSIONS: This study revealed the relationship between the experience of education or mandatory laboratory testing and blood pressure control in patients with hypertension.
Blood Pressure ; Chronic Disease ; Diabetes Mellitus, Type 2 ; Follow-Up Studies ; Humans ; Hypertension ; Logistic Models ; National Health Programs ; Odds Ratio

Due to the common use of alkaline disc batteries(e.g. watches, electronic toys and games, calculators, cameras) physicians and the general public should be more aware of this battery foreign body and the peculiarities in their management. Alkaline disc batteries as foreign bodies in the nasal cavities are extremely rare but dangerous because they can cause liquefaction necrosis with subsequent severe local tissue destruction. Batteries found in the nasal cavities should be removed immediately to prevent sequelae such as septal perforations or nasal stenosis. We recently experienced a case of 4-year-old boy who revealed necrotic perforation of nasal septum which was exposed directly to a alkaline disc battery for 20 hours and the special aspects of these foreign body is discussed.
Child, Preschool ; Constriction, Pathologic ; Foreign Bodies* ; Humans ; Male ; Nasal Cavity ; Nasal Septal Perforation* ; Nasal Septum ; Necrosis ; Play and Playthings

Leiomyosarcoma is an uncommon tumor of smooth-muscle origin, and has rarely been described in reference to the head and neck region. There have been 30 previously reported cases of this tumor involving the sinonasal tract in the literature. We present a case of leiomyosarcoma involving the nasal cavity, ethmoid, and sphenoid sinus. We also review here the characteristics, diagnosis and treatment of this tumor.
Diagnosis ; Head ; Leiomyosarcoma* ; Nasal Cavity ; Neck ; Nose* ; Paranasal Sinuses* ; Sphenoid Sinus

As experiences with endovascular aortic devices increases over time, hybrid repair for the treatment of thoracoabdominal aortic aneurysms (TAAA) by using a combination of thoracoabdominal endovascular aneurysm repair and visceral revascularization has been reported with acceptable result. A 55-year-old man with type III TAAA involving visceral arteries has been treated successfully with tube stent-graft followed by right renal revascularization that was facilitated by a rare anatomic configuration. The authors present a type III TAAA patient with rare anatomic configuration of the visceral arteries successfully treated with hybrid endovascular-surgical TAAA repair.
Aneurysm ; Aortic Aneurysm, Thoracic ; Arteries ; Chimera ; Humans

Complicating intramural hematoma is an interesting, relatively unusual condition. Various etiologic factors have been described, with the most common being blunt trauma, anticoagulant therapy, Henoch-Sch nlein purpura and blood dyscrasias. Most intramural hematomas resolve spontaneously with conservative treatment, and the prognosis is good. However, if the abdominal pain or obstruction does not resolve with medical management over seven to ten days, complications such as infarction or peritonitis may occur, and surgical intervention might be required. We report a case of intramural hematoma of duodenum treated with percutaneous drainage and embolization of bleeding focus which was complicated with acute pancreatitis after anticoagulation treatment in a patient with recurrent history of deep vein thrombosis. In addition, we reviewed reports of intramural hematoma of the duodenum and treatment strategies.
Adult ; Anticoagulants/therapeutic use ; Catheterization ; *Drainage ; Duodenal Diseases/*diagnosis/*therapy ; Fluoroscopy ; Hematoma/*diagnosis/*therapy ; Humans ; Male ; Thrombolytic Therapy ; Tomography, X-Ray Computed