BACKGROUND: Doxylamine succinate(DS) is an antihistamine commonly used as an over-the-counter medication to relieve insomnia and frequently involved in overdoses. Its overdoses are dominated by anticholinergic effect. Recently it was revealed that DS had a direct effect on muscle, while its exact mechanism is not clear yet. We evaluated the patients with rhabdomyolysis induced by DS overdose for patients disposition based upon clinical decision, especially by creatinine phosphokinase(CPK). METHODS: We reviewed retrospectively the medical records of patients admitted by DS overdose from Jan. 1998 to Oct. 1999. Seventy and nine cases of DS overdose were evaluated with respect to age and sex distribution, amount ingested, clinical symptomatology, time from ingestion to visit, pattern of CPK, amount of bicarbonate used as therapy, complication and prognosis, especially in patients complicated rhabdomyolysis. RESULTS: Rhabdomyolysis, diagnosed as more than 1,000I. U/L of CPK, has been noted in 25(31.6%) of 79 cases of DS overdose visited to our emergency department(ED). In patients diagnosed rhabdomyolysis, the number of man was 10 cases(40%) and the number aged between 20 and 40 years was 22 cases(88%). The average time from DS ingestion to ED visit was 459 minutes. The amount of DS ingested was 500-5,000mg(mean, 1,980mg). 13(52%) cases ingested less than 2,250mg of DS. The initial levels of CPK(range, 48-14900I. U/L; normal range, 26-200I. U/L) after admitting to our emergency department were normal in 15 cases(60%) of rhabdomyolysis patients. The range of peak CPK levels after ingestion was 607 to 412,500I. U/L(mean, 33,550I. U/L). Its peak time was 6 to 96 hours(mean, 28.96 hours). In 14 cases(67%) of 21 visiting within 24 hours after ingestion, peak time of CPK ranged 12 to 24 hours after ingestion. The amount of bicarbonate used as therapy of rhabdomyolysis ranged 100 to 2,740mEq(mean, 656mEq) and all patients was discharged after improvement without other complication including acute renal failure. CONCLUSIONS : Although patients ingested less than 2,250mg of DS, emergency physicians should observe them more than 24 hours after DS ingestion with CPK follow-up after gastric irrigation and charcoal administration.
Acute Kidney Injury ; Charcoal ; Creatinine ; Doxylamine* ; Eating ; Emergencies ; Emergency Service, Hospital ; Follow-Up Studies ; Gastric Lavage ; Humans ; Medical Records ; Prognosis ; Reference Values ; Retrospective Studies ; Rhabdomyolysis* ; Sex Distribution ; Sleep Initiation and Maintenance Disorders ; Succinic Acid*

Bacteriologic factors, such as enzymes and toxins produced by microbes, are one of diverse etiologic factors in dry eye syndrome. We investigated the conjunctival bacterial flora in dry eye patients and compared the results between dry eye patients and normal persons. There were no differences in bacterial flora between the two groups.
Dry Eye Syndromes ; Humans

A secondary cleft lip nasal deformity can be corrected by many procedures including central lip tissue transfer, forked flap, nasal floor and alar base advancement, nasal skin flaps and composite graft. These procedures have been applied for many years, but each one has some conspicuous residual problems. We propose triple V-Y advancement flaps, which we have performed on 13 secondary cleft lip and nasal deformity patients over the past 6 years. The W-shaped triple reverse V-shaped incision easily exposed the alar cartilages. We made the advancement and rotation of the nasal skin flap to lengthen the columella and project the nasal tip. Postoperatively, the columella length and nasolabial angle were found to be increased by an average of 3.7 mm and 42 degrees, respectively. In lateral view, a relatively natural nasal line was achieved. The scar in the nasal tip posed few problems. This procedure should be useful for the correction of the secondary cleft lip nasal deformity.
Cartilage ; Cicatrix ; Cleft Lip* ; Congenital Abnormalities* ; Humans ; Lip ; Skin ; Transplants

Hypertrophic scarring is common in burn patients. The treatment of such scarring is difficult, and recurrence of the hypertrophic change after scar revision is not uncommon. It has been done intramarginal excision to diminish the chances of recurrent hypertrophic scarring. Core scars in the auricle are easily separated from auricular cartilage and overlying soft tissue because there is loose areolar tissue between them. We therefore reviewed our experience with core extirpation of post-burn hypertrophic scars in the auricle. Between June 14, 1991, and August 6, 1994, we excised 10 hypertrophic scars in the auricle in 5 burn patients. Core extirpations of hypertrophic scars were performed under local anesthesia with longitudinal incision along long axis of scars. The wounds were closed directly in one layer after marginal trimming. We observed that core extirpation yielded good results in post-burn hypertrophic scars in the auricles.
Anesthesia, Local ; Axis, Cervical Vertebra ; Burns ; Cicatrix ; Cicatrix, Hypertrophic* ; Ear Cartilage ; Humans ; Recurrence ; Wounds and Injuries

There are many problems in treatment of intertrochanteric fractures due to osteoporosis and unstable pattern of fractures in old ages and they are different from those in young ages, for example, type of fracture, degree of osteoporosis, and general condition, ect. Anthors studied about the prognostic factors of 42 cases among 88 patients with intertrochanteric fractures, who were treated and followed up from Jan. 1982 to Dec. 1987. 1. The patients under 50 years old were mainly males(94.4%) and its chief cause of injury was traffic accident or fall down(72.2%). The cause of injury over 50 years old was slip down on ground(62.9%). 2. The osteoporosis was increased according to increased age of patients and then the unstable type of fracture was increased. In yaung patients, the unstable intertrochanteric fracture was rare despite of high violent injury. 3. The bone union of the follow-up patients was gained at average 13.8 weeks. 4. The sliding degree of lag screw was increased with unstable fracture and the incidence of metal protrusion into joint cavity was increased in the patients of eccentric fixation of lag screw into femoral head. 5. The all cases of complication were occured in osteoporotic patients over 50 years old and their causes were inadequate fixation of unstable fracture. 6. The most important factors in prognosis of intertrochanteric fractures are initial pattern of fractures, degree of osteoporosis and adequacy of reduction state(postop.).
Accidents, Traffic ; Follow-Up Studies ; Head ; Hip Fractures ; Humans ; Incidence ; Joints ; Osteoporosis ; Prognosis

Ureteral duplication is the most common developmental abnormality of the upper urinary tract. The upper pole ureter is often associated with a ureterocele and the lower pole ureter, the V-U reflux. A case of bilateral double collecting system associated with bilateral ureteroceles in a 6-month old Korean male is presented with review of literature.
Humans ; Infant ; Male ; Ureter ; Ureterocele* ; Urinary Tract

No abstract available.
Scalp* ; Skin* ; Transplants*

No abstract available.
Cleft Lip* ; Congenital Abnormalities*

Conjunctivochalasis cause epiphora because abnormal redundant conjunctival tissue obstruct the punctum and block the tear outflow. The surgical resection of the redundant conjunctial tussue with scissors has been performed but it has caused such problems as difficult control of bleeding, long surgical time, high incidence of subconjunctival hemorrhage and cosmetic dissatisfaction. Therefore, the authors performed the operation of conjunctivochalasis with bipolar cautery instead of scissors and evalunted the efficacy of this new method. The authors prospectively studied 9 patients(16 eyes) of conjunctivochalasis who complained of epiphora and were found to have redundancy of conjunctival tissue around the punctal area on slit-lamp examination. They have neither lacrimal pathway insufficiency and obstruction, nor facial falsy or lid laxity that impair the lacrimal pump action, and also no anatomical anomaly of the punta was noted. After marking of redundant conjunctival tissue with gentian Violet under the operationg microscope and topiacal anethesia wint 4% lidocaine, redundant conjunctival tissue was removed by bipolar cautery. We also cauterized exposed Tenon`s capsule to contract the wound. Suture was not performed or three interrupted suture were placed. Epiphora was improved after simple cauterization of redundant conjunctiva in 15 eyes out of 16 eyes during at least 2 months of follow-up period. Removal of redundant lower incidence of subconjunctival hemorrhage than resection technique using scissore. We expect that this surgical technique will substitute for established technique with scissors beause bipolar cautery method was simple and showed lower incidence of complications.
Cautery* ; Conjunctiva ; Follow-Up Studies ; Gentian Violet ; Hemorrhage ; Incidence ; Lacrimal Apparatus Diseases ; Lidocaine ; Operative Time ; Prospective Studies ; Sutures ; Wounds and Injuries

The basic technique for total reconstruction of the microtia was established by Tanzer, who utilized autologous rib cartilages for constructing the auricular framework. In order to decrease the number of surgical stages and to achieve maximal convolution, we employed a surgical procedure with simultaneous three layered costal cartilage grafting for the high profiled auricle, concha formation and lobule rotation. However, we performed ear elevation as an additional procedure for some patients who had decreased helical height due to absorption of cartilage framework or postoperative trauma and who had wanted to wear the spectacles or to have more natural appearance of auriculocephalic sulcus. From August 1988 to October 1997 we had performed surgeries for the ear elevation of 58 patients in 177 patients with total ear reconstruction, using various elevation methods; skin graft, local flap, and local with costal cartilage block. When the ear elevation was performed with skin graft, postoperative contraction of the grafted skin was inevitable. In cases with two skin flaps, it was difficult to stabilize and maintain the correct projection of the constructed ear. So we elevated the reconstructed ear by utilizing a costal cartilage block, two skin flaps to cover the posterior region and skin graft. We conclude that the local flap with costal cartilage block is one of the most favorable methods in ear elevation which can maintain the adequate projection and make natural looking auriculocephalic sulcus.
Absorption ; Cartilage ; Ear* ; Eyeglasses ; Humans ; Ribs ; Skin ; Transplants