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*

We reviewed surgical specimens from 11 patients with diffuse neurofibroma to define the specific clinicopathologic characteristics. Ten cases were cutaneous neurofibromas and one case was an uncommon gastrointestinal neurofibroma involving the rectum. The most frequent sites of involvement were the head and neck, especially the eyelids and the periorbital areas. They usually presented as a plaque-like elevation of the skin. They primarily occured in children and young adults and positive family histories of von Recklinghausen's neurofibromatosis were obtained in 45.4%. Pathologically, the involved skin & rectum were diffusely thickened by an infiltrative growing mass, showing proliferation of short fusiform cells in the uniform matrix of fine fibrillary collagen. The characteristic prominence of Wagner-Meissner bodies (45.4%) suggests they could be associated with pathogenesis of diffuse neurofibroma. On the basis of these findings, we could confirm diffuse neurofibroma to be a distinct form of neurofibroma.
Child ; Adult ; Male ; Female ; Humans

It was reported that many adverse effects occurred to the growth areas of the adolescent player due to repititous strain. The injuries mainly involved in the shoulder and elbow, and named as little leaguers Shoulder and Little Leaguers: Elbow in boy baseball player. But the stress fracture of olecranon epiphyseal plate was rare and reported in a few cases. We reported a case observed in an adolescent Judo Player.
Adolescent ; Baseball ; Elbow ; Fractures, Stress ; Growth Plate ; Humans ; Male ; Martial Arts ; Olecranon Process ; Shoulder

OBJECTIVE: We previously described that Diva is highly expressed in matured metaphase II (MII) oocytes compared to immature germinal vesicle (GV) oocytes in mouse.1 We report here that the expression of Diva transcript as well as protein is oocyte-specific. To elucidate its physiological role in oocyte, the binding partner(s) of Diva has been identified by using immunoprecipitation (IP) followed by Mass Spectrometry. METHODS: NIH/3T3 cells were transiently transfected for 24 h with either empty vector for control or FLAG-tagged mouse Diva construct, and IP was performed with anti-FLAG antibody. The immuno-isolated complexes were resolved by SDS-PAGE on a 12% gel followed by Coomassie Blue staining. For in-gel digestion, 15 bands of interest were excised manually and digested with trypsin. All mass spectra were acquired at a positive reflector mode by a 4700 Proteomics Analyzer (Applied Biosystems, Framingham, MA). Proteins were identified by searching the NCBI nonredundant database using MASCOT Peptide Mass Fingerprint software (Matrixscience, London). RESULTS: Diva-associated complexes were formed in FLAG-tagged mouse Diva-overexpressed NIH/3T3 cells via IP using anti-FLAG-conjugated beads. Among the excised 15 bands, actin and actin-binding proteins such as tropomyosin, tropomodulin 3, and alpha-actinin were identified. Binding between Diva and actin or tropomyosin was confirmed by IP followed by Western blot analysis. Both bindings were also detected endogenously in mouse ovaries, indicating that Diva works with actin and tropomyosin. CONCLUSIONS: This is the first report that immuno-isolated Diva-associated complexes are related to actin filament of the cytoskeletal system. When we consider the association of Diva with actin and tropomyosin, oocyte-specific Diva may play a role in modulating the cytoskeletal system during oocyte maturation.
Actin Cytoskeleton ; Actinin ; Actins ; Animals ; Blotting, Western ; Dermatoglyphics ; Digestion ; Electrophoresis, Polyacrylamide Gel ; Female ; Immunoprecipitation ; Mass Spectrometry* ; Metaphase ; Mice ; Microfilament Proteins ; Oocytes ; Ovary ; Proteomics ; Tropomodulin ; Tropomyosin ; Trypsin

Prediction of individual outcome after cardiopulmonary resuscitation is of major medical, ethical, and socioeconomic interest but uncertain. We experienced the case thats the patient got complete neurologic recovery after the 123th day firm cardiac arrest, who had been suspected to go with poor prognosis because she got the findings of Glasgow Coma Scale 4, severe diffuse encephalopathy on encephalogram and generalized tonic-clonic seizure at the 4th day. Recently, a 29 year-old women who sustained from respiratory arrest induced presumably by sedative and anticonvulsant therapy for control of seizure that happened during local lidocaine anesthesia far mamoplasty was transfered to our emergency medical center from local private plastic office. Arrest time was about 20 minutes. On hospital arrival, she had a pulseless bradyasystole and no respiration, but spontaneous circulation was restored at 10 minutes artier CPR started. We started cerebral oriented resuscitation including mild hypothermia(34degrees C), hemodilution, calcium channel blocker infusion. On hospital day 4, patient's glasgow coma scale(GCS) was 4. On hospital clay 7, Brain Magnetic Resonance Imaging(MRI) showed high signal intensity on T2WI, involving the bilateral basal ganglia. After contrast administraton, marked enhancement can be seen at the lesion site. Patient's glasgow coma scale(GCS) increased step by step to 5 on 8th day, 7 on 14th day, 10 on 15th day, 13 on 17th day, 15 on 20th day. 40 days later the patient was discharged with minor neurologic abnormality including hand tremor, dysphonia, amenorrhea and Mini Mental State Examination(MMSE) score(26). Long-term Follow up revealed that all neurologic functional abnormality inducting hand tremor, dysphonia, amenorrhea and MMSE score(26) is completely recovered on 123th day after episode of cardiopulmonary arrest.
Adult ; Amenorrhea ; Anesthesia ; Basal Ganglia ; Brain ; Calcium Channels ; Cardiopulmonary Resuscitation ; Coma ; Dysphonia ; Emergencies ; Female ; Follow-Up Studies ; Glasgow Coma Scale ; Hand ; Heart Arrest* ; Hemodilution ; Humans ; Hypoxia-Ischemia, Brain* ; Lidocaine ; Plastics ; Prognosis ; Respiration ; Resuscitation ; Seizures ; Tremor

A case of extrapulmonary silicosis involving abdominal lymph nodes in a 62-year-old man is presented. The patient underwent subtotal gastrectomy and regional lymph nodes dissection for gastric adenocarcinoma of clinical stage III. On gross examination, two separate gastric adenocarcinomas and multiple enlarged lymph nodes mimicking metastatic lesion were noted. Microscopic examination of the enlaged lymph nodes revealed characteristic sclerohyaline silicotic nodules without metastatic adenocarcinoma. Chest roentgenogram showed diffusely scattered multiple tiny nodular lesions in the entire lung fields, particularly the posterior side of both upper lung fields. He had worked in a mine for 18 years and had been exposed to silica for 5 of those years. We report incidentally found, unusual case of extrapulmonary silicosis.
Adenocarcinoma ; Gastrectomy ; Humans ; Lung ; Lymph Nodes ; Middle Aged ; Silicon Dioxide ; Silicosis* ; Thorax

No abstract available.
Pemphigus

No abstract available.
Humans ; Papilloma* ; Warts*

Hydrogen sulfide poisoning is frequently encountered in the workplace. Two workers lost their consciousness in an underground tank at a factory producing paper. The tank contained liquid mixture of used paper, sodium oxygenate chloride(NaOC1), and sodium thiosulfate pentahydrate(NaSO3 5H90). A worker(worker A; 36-year-old man) entered tank to remove sludge. When worker A lost his consciousness, worker B entered the tank to rescue worker A, however he lost consciousness inside the tank. We discuss in detail the clinical features of this condition. Hydrogen sulfide poisonings have occurred in industries involving petroleum refining, the manufacture of heavy water, tanning of hides, vulcanization of rubber, and the manufacture of rayon. And it is necessary to stress the health education for workers and managers in these industries.
Adult ; Consciousness ; Deuterium Oxide ; Health Education ; Humans ; Hydrogen Sulfide* ; Hydrogen* ; Oxygen ; Petroleum ; Poisoning* ; Rescue Work ; Rubber ; Sewage ; Sodium ; Tanning ; Triacetoneamine-N-Oxyl

No abstract available.
Liver* ; Retrospective Studies*