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*

Illumination and access of instruments to peripheral fundus are limited by lens in phakic vitrectomy. The purpose of this study was to determine if curved endoilluminator could enhance visibility of peripheral fundus in phakic virectomy. Ten consecutive cases of pars plana vitrectomy were done for vitreous opacity. Indirect laser photocoagluation was done to make four reference points of distance from optic disc to nasal ora serrata. We evaluated the respective extent of nasal peripheral view with the use of curved or straight endoilluminator which was inserted through temporal scleral port. When compared with the straight endoilluminator, the curved endoilluminator enhanced the visualization of peripheral fundus(p<0.05). A curved endoilluminator may be a useful surgical adjunct during the phakic vitrectomy and other advantages and disadvantages of its use are discussed.
Lighting* ; Retinaldehyde* ; Vitrectomy*

Massive subretinal hemorrhage may develop secondary to choroidal neovascularization. The poor visual prognosis associated with submacular hemorrhage can be explained by preexisting abnormality of photoreceptorretinal pigment epithelium-Bruch's membrane complex and fibrin-mediated injury to the outer segment of photoreceptor. An animal experiment showed that subretinal fibrin induced irreversible damage to the retina within 24 hours. We use recombinant tissue plasminogen activator(rt-PA), at doses(3 microgram substantially lower than previously reported, to aid in the surgical evacuation of massive subretinal hemorrhage within 2 days of its development. The subretinal hemorrhage in both patients developed in association with age-related macular degeneration. Postoperative corrected visual acuity improved from counting fingers to 0.3 in one patient and from hand motion to 0.04 in the other. There has been no complication except ocular hypertension which is medically controllable. Subfoveal neovascularization explains poor postoperative vision in one case. It seems that visual recovery is facilitated by early evacuation of massive subretinal hemorrhage and by using low-dose rt-PA. Low-dose rt-PA may minimize the risks of intraocular hemorrhage and retinal toxicity.
Animal Experimentation ; Choroidal Neovascularization ; Fibrin ; Fingers ; Hand ; Hemorrhage* ; Humans ; Macular Degeneration ; Membranes ; Ocular Hypertension ; Plasminogen ; Prognosis ; Retina ; Retinaldehyde ; Tissue Plasminogen Activator* ; Visual Acuity

Choroidal detachment after retinal detachment surgery is relatively common but preoperative choroidal detachment is very rare. We reviewed three cases of choroidal detachment associated with primary rhegmatogenous retinal detachment to see whether there were common features that may be of help in early diagnosis and treatment. The patients were elderly and presented with markedly decreased vision, profound hypotony and inflammatory cells in anterior chamber. Indirect ophthalmoscopy revealed rhegmatogenous retinal detachment with choroidal detachment and proliferative vitreoretinopathy. They were treated with preoperative and postoperative steroid and undergone surgery including vitrectomy. The follow-up periods were 8, 6 and 2 months respectively. Choroidal detachment disappeared, successful reattachment of retina was achieved and corrected visual acuity was improved in all cases. Choroidal detachment associated with rhegmatogenous retinal detachment seems to be associated with hypotony, intraocular inflammation and unstable vascular system. Careful assessment and proper management including surgical procedure seem to improve its prognosis.
Aged ; Anterior Chamber ; Choroid* ; Early Diagnosis ; Follow-Up Studies ; Humans ; Inflammation ; Ophthalmoscopy ; Prognosis ; Retina ; Retinal Detachment* ; Retinaldehyde* ; Visual Acuity ; Vitrectomy ; Vitreoretinopathy, Proliferative

Purpose: This study aimed to identify the effects of nurse’s knowledge and self-efficacy on nursing performance in pediatric intravenous fluid management and provide the primary data necessary for the efficient intravenous injection management of hospitalized children. Methods: This study was a descriptive study design with 141 nurses who perform pediatric intravenous therapy care at eight hospitals in the S, C, D, and S regions. Data were collected from September 1, 2023, to September 30, 2023. Results: Nursing performance of pediatric intravenous injection management was significantly positively correlated with knowledge (r=.44, p<.001) and self-efficacy (r=.19, p=.022). Nurses’ knowledge (β=.42, p<.001) and self-efficacy (β=.22, p=.004) of pediatric intravenous injection management and care were identified as significant predictors of nursing performance thereof, with these two factors explaining 21.9% of the variance. Conclusion This study found that knowledge and self-efficacy of pediatric intravenous injection management are significant predictors of the practice of intravenous care among pediatric nurses. Therefore, considering these factors, education and intervention programs should be developed to enhance pediatric nurses' knowledge and self-efficacy regarding intravenous injection management.

The objectives of this study were to investigate the prevalence and risk factors of occupationally related carpal tunnel syndrome (CTS) among workers employed in services and manufacturing industries analysing the sensitivity and specificity of clinical symptoms and signs. Three surveys were made for this study. The first survey was done for 1,447 workers employed by 25 companies. The jobs of the employees were repetitive works at VDT and assembly lines. Therefore, employees could be divided to two groups, doing repetitive works and non repetitive works. The second survey was made for 189 workers who were randomly selected from 517 workers complained some symptoms at their hands and wrists. We examined their symptoms and carried out neurological examinations for CTS (Tinel's sign, Phalen's sign, pin prick test, carpal compressive test, toniquet compression test). The third survey was made for nerve conduction study (NCS) for 57 workers who had shown positive signs for CTS. The main results of this study were as follows: 1. From the first survey, we have found that there were significant statistical differences in getting uncomfortable neuromuscular symptoms by sex, job type, total working hours during a week, duration of current work, and kinds of work. Odds ratio in male vs female, repetitive vs non repetitive, service vs manufacturing companies, total working hours during a week, and duration of current work were 1.867(95% CI=1.467-2.377), 1.680 (95% CI=1.121-2.279), 1.663(95% CI=1.213-2.279), 1.016(95% CI=1.006-1.027) and 1.283 (95% CI=1.097-1.501) respectively. 2. From the second survey, we have found that 46 peoples (25.0%) were positive for one or more than one signs in neurological examinations of NIOSH criteria. Positive findings from neurological examinations were high among workers of low level of education (p-value=0.008), manufacturing jobs (p-value=0.00), long hours a week (p-value=0.028), and long duration of current work (p-value=0.00). 3. From the third survey, we diagnosed 35 peoples (61.4%) had CTS by NCS. They had abnormally delayed latent period or velocity in median nerve conduction velocity.
Carpal Tunnel Syndrome* ; Education ; Female ; Hand ; Humans ; Male ; Median Nerve ; National Institute for Occupational Safety and Health (U.S.) ; Neural Conduction ; Neurologic Examination ; Occupations ; Odds Ratio ; Prevalence ; Risk Factors ; Sensitivity and Specificity ; Wrist

An infant presented with persistent epiphora after successful probing of the lacrimal system. Examination of the nose showed a cystic structure occluding lower portion of the lacrimal drainage system. In cases of recurrent obstruction, nasal examination and endoscopic marsupialization may help guide the clinician towards the most appropriate treatment.
Cysts/*complications/surgery ; Dacryocystitis/*complications/surgery ; Endoscopy ; Female ; Humans ; Infant ; Lacrimal Apparatus Diseases/*complications/surgery ; *Nasolacrimal Duct ; Recurrence

To simulate the posterior vitreous detachment (PVD) in the rabbit, 1 IU hyaluronidase and/or 0.2 ml of perfluoropropane gas was intravitreally injected. Ophthalmoscopic, light microscopic examination prepared by cryotechnique, electron microscopic examination, and electroretinogram were done on the 3rd and 28th postoperative days. As a result, the eyes undergone simultaneous intravitreal injection of 1 IU hyaluronidase and 0.2 ml perfluoropropane gas showed membranous structure split from the internal limiting membrane of the superior retina in 3 days after injection. The eyes also demonstrated membranous structure separated from the superior retina after 28 days, simulating vitreous detachment. On the contrary, neither agent alone induced vitreous detachment. No toxic retinal changes associated with simultaneous intravitreal injection of 1 IU hyaluronidase and 0.2 ml perfluoropropane gas were observed. Therefore, with a future support by histologic examination other than cryotechnique and by immunohistochemical analysis, the simultaneous intravitreal injection of perfluoropropane gas and hyaluronidase would be a promising method to induce vitreous detachment in non-vitrectomized eye.
Animals ; Drug Combinations ; Electroretinography ; Eye Diseases/chemically induced/pathology ; Fluorocarbons/*toxicity ; Hyaluronoglucosaminidase/*toxicity ; Injections ; Rabbits ; Retina/drug effects/physiology ; Vitreous Body/*drug effects/pathology

The purpose of this study was to define a one portion size of food frequently consumed by Korean children aged 6-11 for convenient use in food selection, diet planning, nutritional evaluation, and nutrition education. We analyzed using the original data on 889 persons (9.96%) aged 6-11 years among 8,930 persons to whom NHANES 2005 and selected food items consumed by the intake frequency of 10 or higher among the 500 most frequently consumed food items. A total of 172 varieties of food items of regular use were selected. Also the portion size of food items was set on the basis of the median (50 percentile) of the portion size for a single intake by a single person was analyzed. The portion size of cereals was 5 g for prosomillet to 120 g for hamburger. As for vegetables, it posted 1 g for red pepper to 50 g for nabakkimchi. The portion size of meats and products was 15 g for luncheon meat to 120 g for beef feet soup. In comparison of children's portion size with adults', the children's portion sizes of every food groups, with the exception of meats and eggs, were lower than those of adults. The portion size of the regular food items of children in this study will be conveniently and effectively used by children, children's diet planners and researchers in selecting food items for a nutritionally balanced diet and in assessing the children's diet intake.
Adult ; Aged ; Capsicum ; Edible Grain ; Child ; Diet ; Eggs ; Food Preferences ; Foot ; Humans ; Korea ; Meat ; Nutrition Surveys ; Ovum ; Single Person ; Vegetables

It is a well-known clinical fact that contrast-enhanced magnetic resonance angiography exaggerates vertebral arterial ostial stenosis and sometimes shows pseudostenosis. Considering the clinical significance of a lesion in the posterior circulation ischemia, the importance of an accurate imaging diagnosis of ostial stenosis should not be underestimated. We were able to differentiate pseudostenosis of the ostium from true stenosis using thin-slab maximum-intensity-projection(MIP) images which are thought to be helpful for minimizing standard full thickness MIP images.
Constriction, Pathologic ; Ischemia ; Magnetic Resonance Angiography ; Vertebral Artery