BACKGROUND: This study aimed to investigate bradycardia as an adverse effect after administration of dexmedetomidine during 33degrees C target temperature management. METHODS: A retrospective study was conducted on patients who underwent 33degrees C target temperature management in the emergency department during a 49-month study period. We collected data including age, sex, weight, diagnosis, bradycardia occurrence, target temperature management duration, sedative drug, and several clinical and laboratory results. We conducted logistic regression for an analysis of factors associated with bradycardia. RESULTS: A total of 68 patients were selected. Among them, 39 (57.4%) showed bradycardia, and 56 (82.4%) were treated with dexmedetomidine. The odds ratio for bradycardia in the carbon monoxide poisoning group compared to the cardiac arrest group and in patients with higher body weight were 7.448 (95% confidence interval [CI] 1.834-30.244, p = 0.005) and 1.058 (95% CI 1.002-1.123, p = 0.044), respectively. In the bradycardia with dexmedetomidine group, the infusion rate of dexmedetomidine was 0.41 +/- 0.15 microg/kg/h. Decisions of charged doctor's were 1) slowing infusion rate and 2) stopping infusion or administering atropine for bradycardia. No cases required cardiac pacing or worsened to asystole. CONCLUSIONS: Despite the frequent occurrence of bradycardia after administration of dexmedetomidine during 33degrees C target temperature management, bradycardia was completely recovered after reducing infusion rate or stopping infusion. However, reducing the infusion rate of dexmedetomidine lower than the standard maintenance dose could be necessary to prevent bradycardia from developing in patients with higher body weight or carbon monoxide poisoning during 33degrees C targeted temperature management.
Atropine ; Body Weight ; Bradycardia* ; Carbon Monoxide Poisoning ; Dexmedetomidine* ; Diagnosis ; Emergency Service, Hospital ; Heart Arrest ; Humans ; Hypothermia, Induced ; Logistic Models ; Odds Ratio ; Retrospective Studies

Objectives: Dental caries and periodontal disease are infectious and chronic diseases. The aim of the study was to investigate the antimicrobial effect of mentha extracts against Streptococcus mutans (S. mutans ) and Porphyromonas gingivalis (P. gingivalis ). Methods: This activity of mentha extracts were confirmed by the disk diffusion test and minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC) and colony forming unit (CFU) assays. Results: S. mutans and P. gingivalis showed the highest antimicrobial activity within the inhibition zones. The antimicrobial activity was interrupted as the MIC and MBC of the herbal extracts against the two bacteria were 1 mg/ml and 10 mg/ml, respectively. The antimicrobial effect was determined by the CFU assay. Conclusions Mentha herb extract demonstrated potential antimicrobial activity against S. mutans and P. gingivalis that cause dental caries and periodontal disease.

Tubulointerstitial nephritis and uveitis (TINU) syndrome is defined as the occurrence of tubulointerstitial nephritis and uveitis in the absence of other systemic diseases. Three pediatric cases have been reported in the Republic of Korea, and we now report a fourth case. A 15-year-old girl presented to the ophthalmology department with a 1-week history of bilateral ocular discomfort that worsened on the day of presentation with redness and pain in both eyes. She was diagnosed with bilateral uveitis, and her baseline examination revealed moderate renal dysfunction and mild proteinuria. A renal biopsy was performed and confirmed the diagnosis of TINU syndrome. She was started on steroid eye drops and a 12-week course of oral steroids at a dose of 40 mg/m2/day, which completely resolved the proteinuria and mild renal function to an estimated glomerular filtration rate of 60 mL/min/1.73 m2. However, the uveitis did not improve, and despite the addition of oral methotrexate as a second-line treatment, the uveitis remains unresponsive to treatment over 21 months. Further evaluation and treatment are ongoing, and active therapeutic intervention is suggested even at a pediatric age, considering the lack of improvement in renal function and uveitis to date.

No abstract available.
Gastrointestinal Tract* ; Radionuclide Imaging*

PURPOSE: Brain injury due to hanging leads has a high mortality rate and severe neurological sequelae. Serum S100B for predicting brain injury in hanging injury has not been evaluated. The aim of this study is to review the characteristics and the prognosis of hanging patients and to determine the usefulness of S100B as a predicting factor. METHODS: A single center, retrospective study was conducted from January 2011 to December 2014. A total of 102 patients visited the emergency department (ED) with hanging injuries and 70 resuscitated patients were enrolled. RESULTS: Of all patients, 56 (54.9%) patients were male and 96 (94.1%) patients committed suicide by hanging; 61 (59.8%) patients visited the ED with cardiac arrest. In arrest patients, all survived patients showed a Cerebral Performance Category (CPC) score of 4. Although 16 (39.0%) had the initial mental status as stupor or coma in non-arrest patients, 1 (2.4%) remained as CPC 4. Among the resuscitated patients, comatose mental status, absence of pupil light reflex (PLR), and diffuse swelling on brain computed tomography (CT) tended to show relation to high mortality rate. Only PLR tended to show relation to CPC score in non-arrest patients. The elevated level of serum S100B was related to the mortality in arrest patients, whereas it was not related to CPC score in non-arrest patients. CONCLUSION: The prognosis of hanging patients was related to PLR irrespective of the presence of cardiac arrest. The serum S100B level for prediction of prognosis is not sufficient in non-arrest patients with hanging.
Asphyxia ; Brain ; Brain Injuries ; Coma ; Emergency Service, Hospital ; Heart Arrest* ; Humans ; Male ; Mortality ; Neck Injuries ; Prognosis ; Pupil ; Reflex ; Retrospective Studies ; Staphylococcal Protein A* ; Status Epilepticus ; Stupor ; Suicide

BACKGROUNDS: Recent studies of population trends demonstrate massive increases in both absolute numbers and percentage of our aging population. A large proportion of the population older than 65 years has age-related sensory losses that impair food intakes, overall health, self-sufficiency, and quality of life. Thus, this study was performed investigate the subjective and objective changes of taste perception in Korean elderly. METHODS: The subjects were 22 male and 109 female normal elderly persons aged 55 to 81(mean: 70+4.5) years without diabetes mellitus. They were recruited from senior citizen centers in Northern area of Seoul. The agents used for taste measurements are; sodium chloride for salt taste ; sucrose, for sweet; Glacial acetic acid, for sour; and Quinine hemisulfate for buffer. Taste threshold was measured by determining detection and recognition thresholds for all 4 taste qualities by a forced-choice, three-stimulus drop technique. Taste threshold was obtained by dropping solutions on the right sides of the tip of the tongue for salt taste, anterior lateral side for sweet, posterior lateral side, for sour taste, and back of the tongue for buffer taste. RESULTS: Among subjects, 52(40%) had hypertension, 12(9%) heart disease, and 18(14%) hypercholesterolemia. Male subjects had lower detection threshold for salt taste compared to that of females. The subjects with hypercholestrolemia had higher detection threshold for buffer taste(p<0.05). Male subjects had higher recognition threshold for buffer taste compared to that of females(p<0.05). The subjects with hypertension, heart problems, history of smoking, drinking, or medication had no significant changes in detection and recognition taste threshold of 4 different taste. Twenty one(16%) subjects experienced symptoms of dysgeusia, thirty(23%) hypogeusia. None of them reported symptoms of phantogeusia, cacogeusia, or heterogeusia. The subjects with dysgeusia had higher detection threshold for sweet taste(p<0.05). CONCLUSION: Male subjects had lower detection threshold for salt taste and higher recognition threshold for buffer taste compared to those of females in Korean elderly(p<0.05). The subjects with hypercholesterolemia had higher detection threshold for buffer taste(p<0.05), and the subjects with dysgeusia had higher detection threshold for sweet taste(p<0.05). Thus, sex-related salty and buffer taste perception were observed in the elderly and dysgeusia had an effect on sweet taste. These results suggest that these taste perception changes seem to have an influence on nutritional and health status of the elderly and we should consider these taste perception changes to prepare the dietary guidelines for healthy life of the elderly.
Acetic Acid ; Aged* ; Ageusia ; Aging ; Diabetes Mellitus ; Drinking ; Dysgeusia ; Female ; Heart ; Heart Diseases ; Humans ; Hypercholesterolemia ; Hypertension ; Male ; Nutrition Policy ; Quality of Life ; Quinine ; Seoul ; Smoke ; Smoking ; Sodium Chloride ; Sucrose ; Taste Perception* ; Taste Threshold ; Tongue

PURPOSE: Beta blocker (BB) has been prescribed for anxiety and panic disorder. Patients intoxicated by psychiatric drugs have often been exposed to BB. Moreover, BB overdose has adverse effects including cardiovascular effects, which can be life-threatening. This study was conducted to identify the characteristics of BB intoxication with psychiatric drugs and the adverse effects on the cardiovascular system. METHODS: A single center, retrospective study was performed from January 2010 to December 2015. A total of 4,192 patients visited the emergency department (ED) with intoxication, and 69 with BB intoxication were enrolled. RESULTS: Overall, 64 patients (92.8%) of enrolled patients were intoxicated with drugs prescribed for the purpose of psychiatric disorders. Propranolol was the most common BB (62 cases, 96.2%), and the median dose was 140.0 mg (25%-75% 80.0-260.0). Twenty-four patients (37.5%) had experienced cardiovascular events, and these patients tended to have decreased mentality, hypotension and coingestion with quetiapine. An initial mean arterial pressure (MAP) below 65 mmHg (odds ratio 10.069, 95% confidence interval 1.572-64.481, p=0.015) was identified as a factor of cardiovascular event upon multiple logistic regression analysis. CONCLUSION: Initial MAP below 65 mmHg was a factor of cardiovascular adverse effect in patients of BB intoxication with psychiatric drugs.
Anxiety ; Arterial Pressure ; Cardiovascular System ; Emergency Service, Hospital ; Humans ; Hypotension ; Logistic Models ; Panic Disorder ; Propranolol ; Quetiapine Fumarate ; Retrospective Studies

PURPOSE: Hypoxic myoclonus is usually a sign of favorable prognosis in cardiac arrest survivors. No single specific factor has yet been consistently predictive of myoclonus or status epilepticus accompanying post-cardiac arrest status. The aim of this study was to investigate characteristics and the predicting factors of myoclonus in patients who recovered from cardiac arrest. METHODS: A single center, retrospective study was conducted from January 2011 to December 2013. A total of 174 patients who were over 18 years of age and who survived longer than 72 hours after cardiac arrest were enrolled. Patients were divided into two groups according to the development of myoclonus. Individual characteristics, information related to cardiac arrest and post-cardiac arrest status, method of evaluation and treatment, and the Cerebral Performance Category (CPC) score were collected. RESULTS: Of all patients, 42 were assigned to the myoclonus group and 132 to the non-myoclonic group. Forty patients (95.2%) in the myoclonic group presented with generalized myoclonus. Asphyxia, as a presumed cause of arrest, was a statistically significant variable of myoclonus development after cardiac arrest (p=0.048). Initial arrest rhythm, laboratory test, and therapeutic hypothermia were not associated with development of myoclonus. The myoclonic group showed a significant tendency to increase the rate of poor neurologic outcome (CPC 3 to 5) compared to the non-myoclonic group (p<0.00). CONCLUSION: Asphyxia as a cause of arrest may be the single early predictor for development of hypoxic myoclonus in post-cardiac arrest patients.
Asphyxia ; Heart Arrest* ; Humans ; Hypothermia ; Myoclonus* ; Prognosis ; Retrospective Studies ; Status Epilepticus ; Survivors

OBJECTIVE: Intracavitary injection of beta-emitting radiation source for control of cystic tumors has been tried with a benefit of localized internal radiation. The authors treated cystic brain tumor patients with Holmium-166-chitosan complex (Ho-166-chico), composed of a beta-emitting radionuclide Holmium-166 and biodegradable chit polymer, and evaluated the safety and effective measurement for response. METHODS: Twenty-two patients with recurrent cystic brain tumor and/or located in a deep or eloquent area were enrolled in this pilot study. The cyst volume and wall thickness were determined on CT or MRI to assess radiological response. The activity of Ho-166-chico injected via Ommaya reservoir was prescribed to be 10-25 Gy to the cyst wall in a depth of 4 mm. RESULTS: There was neither complications related to systemic absorption nor leakage of Ho-166-chico in all 22 patients. But, two cases of oculomotor paresis were observed in patients with recurrent craniopharyngioma. Radiological response was seen in 14 of 20 available follow-up images (70%). Seven patients of 'evident' radiological response experienced more than 25% decrease of both cyst volume and wall thickness. Another 7 patients with 'suggestive' response showed decrease of cyst volume without definitive change of the wall thickness or vice versa. All patients with benign tumors or low grade gliomas experienced symptomatic improvement. CONCLUSION: Ho-166-chico intracavitary radiation therapy for cystic tumor is a safe method of palliation without serious complications. The determination of both minimal effective dosage and time interval of repeated injection through phase 1 trial could improve the results in the future.
Absorption ; Brain Neoplasms* ; Brain* ; Chitosan ; Craniopharyngioma ; Follow-Up Studies ; Glioma ; Holmium ; Humans ; Paresis ; Pilot Projects* ; Polymers

PURPOSE: To evauate the effects of postoperative radiotherapy an dchemotherapy on the pattern of failure and survival for locally advanced rectal carcinoma, we analyzed the two groups of patients who received curative resection only and who received postoperative radiochemotherapy retrospectively. MATERIALS AND METHODS: From June 1989 to December 1992, ninety nine patients with rectal cancer were treated by curative resection and staged as B2-3 or C. Group I(25) patients received curative resection only and group II(74) patients postoperative adjuvant therapy. Postoperative adjuvant group received radiation therapy (4500 cGy/ 25fx to whole pelvis)with 5-FU (500 mg/M2 , day 1-3 IV infusion) as radiosensitizer and maintenance chemotherapy with 5-FU(400mg/m2 for 5 days) and leuconvorin (20mg/m2 for 5 days) for 6 cycles. RESULTS: The patients in group I and group II were comparable in terms of age, sex, performance status, but in group II 74% of patients showed stage C compared with 56% of group I. All patients were flowed from 6 to 60 months with a median follow up of 29 months. Three year overall survival rates and disease free survival rates were 68%, 64% respectively in group I and 64%, 61%, respectively in group II. There was no statistical difference between the two treatment groups in overall survival rate and disease free survival rate. Local recurrences occurred in 28% of group I, 21% of group II (>0.05) and distant metastases occurred in 20% of group I, 27% of group II(p>0.05). The prognostic value of several variables other that treatment modality was assessed. In multivariate anaysis for prognostic factors stage and histologic grade showed statistically significant effect on local recurrences, and lymphatic or vessel invasion on distant metastasis. CONCLUSION: This retrospective study showed no statistical difference between two groups on the pattern of failure and survival. But considering that group II had more advanced stage and poor prognostic factors that group I, postoperative adjuvant radiochemotherapy improves the results for locally advanced rectal carcinoma as compared with curative surgery alone.
Chemoradiotherapy ; Chemoradiotherapy, Adjuvant ; Disease-Free Survival ; Drug Therapy* ; Fluorouracil ; Follow-Up Studies ; Humans ; Maintenance Chemotherapy ; Neoplasm Metastasis ; Radiotherapy* ; Rectal Neoplasms ; Recurrence ; Retrospective Studies ; Survival Rate