Ischemia causes tissue necrosis in a wide variety of pathologic conditions. Permanent deprivation of blood flow is lethal to any tissue and the prudent therapy for ischemia unquestionably is reperfusion. While reperfusion is necessary to reverse the progression towards ischemic death, reperfusion is also thought to be accompanied by its own component of injury. Oxygen free radicals, formed during ischemia/reperfusion, have been proposed as one of the main causes of reperfusion injury. Free radical attacks on biological membrane, such as mitochondria and endoplasmic reticulum, and can lead to the oxidative destruction of the polyunsaturated fatty acids of the membranes through lipid peroxidation. However, direct association between microsomal lipid peroxidation in vivo after ischemia/reperfusion and changes in secretory function and drug metabolism on the liver have not been established. Therefore, present study was performed to evaluate the hepatic secretory function and the hepatic microsomal drug metabolizing enzyme activity after ischemia/reperfusion preparation in rat liver. Further, the effect of oxygen free radical scavengers was investigated. The animals were divided into sham operation group and ischemia/reperfusion group. The ischemia/reperfusion group was subdivided into non-treated control and treated (with superoxide dismutase, allopurinol, alpha-tocopherol, deferoxamine) groups. Hepatic ischemia was produced by clamping the left branches of portal vein and hepatic artery, resulting in complete ischemia to the median and left lobes while the right lobes remained per Fused to prevent intestinal congestion. Reperfusion was permitted by declamping after 1 hour. After 1 or 5 hours of reperfusion, bile was collected, blood was obtained from abdominal aorta, and liver microsomes were isolated. The results are as follows. Serum aminotransferase was increased 15~20 times by ischemia/reperfusion. However, this increase was attenuated by free radical scavengers, especially 5 hours of reperfusion. The wet weight-to-dry weight ratio of the liver was significantly increased by ischemia/reperfusion. alpha-tocopherol pretreatment minimized the increase of ratio. Malondialdehyde level in the liver microsomal fraction was significantly increased after ischemia/reperfusion, but this increase was attenuated by scavenger pretreatment, especially alpha-tocopherol. Bile flow and cholate output but not the bilirubin output, were decreased after ischemia/reperfusion. The free radical scavenger pretreahnent restored the secretion significantly. Cytochrome P-450 content was significantly decreased after ischemia/reperfusion and ameliorated by free radical scavenger pretreatment. NADPH cytochrome P-450 reductase activity and aminopyrine N-demethylase activity were also decreased and improved by free radical scavengers pretreatment. These results indicate that ischemia/reperfusion deteriorates the hepatic secretory function as well as hepatic microsomal drug metabolizing enzyme activity, and the oxygen free radical scavengers attenuate the functional changes of the liver induced by ischemia/reperfusion.
Allopurinol ; alpha-Tocopherol ; Aminopyrine N-Demethylase ; Animals ; Aorta, Abdominal ; Bile ; Bilirubin ; Cholates ; Constriction ; Cytochrome P-450 Enzyme System ; Endoplasmic Reticulum ; Estrogens, Conjugated (USP) ; Fatty Acids, Unsaturated ; Free Radical Scavengers ; Free Radicals ; Hepatic Artery ; Ischemia ; Lipid Peroxidation ; Liver ; Malondialdehyde ; Membranes ; Metabolism* ; Microsomes, Liver ; Mitochondria ; NADPH-Ferrihemoprotein Reductase ; Necrosis ; Oxygen ; Portal Vein ; Rats* ; Reperfusion ; Reperfusion Injury ; Superoxide Dismutase

Typhlitis or neutropenic enterocolitis is a life-threatening, necrotizing process of the cecum whose incidence is increasing. Typhlitis presents as fever, abdominal pain, and diarrhea in neutropenic patients. As the incidence of typhlitis increases, emergency physicians must be aware of this rapidly progressive and potentially fatal disease. The definitive management of typhlitis is controversial. The most prudent course for the emergency physician is to initiate aggressive medical management early in the ED. We describe a 25-year-old man with severe neutropenia presented to the emergency department with fever, abdominal pain, diarrhea that began 2days earlier. Abdominal computerized tomography(CT) demonstrated diffuse concentric thickening of the cecal wall, intramural edema, inflammatory bowel changes but no free air and abscess formation. He was recovered by early diagnosis and aggressive medical therapy. We report a case of typhlitis with literature reviews.
Abdominal Pain ; Abscess ; Adult ; Cecum ; Diarrhea ; Early Diagnosis ; Edema ; Emergencies* ; Emergency Service, Hospital ; Enterocolitis, Neutropenic ; Fever ; Humans ; Incidence ; Neutropenia ; Typhlitis*

Isolated infernal iliac artery aneurysms and rupture are relatively infrequent, often difficult to detect and therefore rarely considered in the differential diagnosis for abdominal pain. The consequences can be grave, The incidence of isolated iliac artery aneurysm is 1~2% of that of abdominal aortic aneurysm(AAA). The natural history is of gradual enlargement, with rupture the most common clinical presentation. The signs and symptoms of such an aneurysm are influenced by its concealed location within the bony pelvis. Awareness of these special characteristics improves the chances of early diagnosis and proper surgical treatment before possible rupture. Here is a case of ruptured aneurysm of left internal iliad artery. A 73-year-old man was presented to our emergency center with severe abdominal pain and voiding difficulty Abdominal Computed Tomography(Cf) and angiography showed ruptured aneurysm of left infernal iliad artery. Emergency operation was successfully performed for the ruptured internal iliad artery aneurysm.
Abdominal Pain ; Aged ; Aneurysm* ; Aneurysm, Ruptured ; Angiography ; Arteries ; Diagnosis, Differential ; Early Diagnosis ; Emergencies ; Humans ; Iliac Artery* ; Incidence ; Natural History ; Pelvis ; Rupture ; Rupture, Spontaneous*

BACKGROUNDs: A retrospective study was performed to define objective radiologic parameters in diagnosing epiglottitis on soft-tissue lateral neck radiographic study. METHODS: Parameters of soft-tissue structures(epiglottis width, third vertebral body width, ratio of epiglottic width to third vertebral body width) in 30 adult patients compared with those of age and sex-matched controls with foreign body in throat whose radiographic reading was normal. RESULTS: Epiglottis width of more than 11mm, ratio of epiglottis width(EW) to the third vertebral body width(C3W) of more than 0.5 were, respectively, found to be 100% sensitive and specific in differentiating between patients with and without epiglottitis. CONCLUSION: These preliminary results suggest that EW/C3W ratio of more than 0.5, EW of more than 11mm, respectively, may be useful in the diagnosis of epiglottitis in adult patients.
Adult* ; Diagnosis* ; Epiglottis ; Epiglottitis* ; Foreign Bodies ; Humans ; Neck ; Pharynx ; Retrospective Studies

BACKGROUND: Recent ad vances and innovation in laser technology encourages us to learn and use it experimentally and clinically. The pulsed dye laser(Candela SPTL-1) is a flashlamp excited dye laser, using the princ ples of selective photothermolysis that targets the abnormal microvascu lature of cutaneous lesions while sparing adjacent structures including the epidermis. The laseemits a 585nm wavelength, and has a pulse duration of 450 usec. It is now being widely used in the treatment of vascular diseases in the dermatology field. OBJECTIVE & METHOD : Buring the period of about 3 years from August 1994 to March 1992, at the out patient clinin of Department of Dermatology of Yonsei University. 252 patients who were treated with SPTL was analyzed to evaluate the clinical effects of the pulsed dye laser. Patient di@st.ributition f the cutaneous vascular lesions included 1fil pat.ients with nevui flammeus, 68 with telangcetasia, 15 with spider angima, 5 with strawberry hemangiona and 2 with cavernous hemangior ia. RESULTS: The results and summarized as follows : 1. Nevus flammeus 4b.7% of early childhood, 41.5% of late childhood and 47.3% of adults showed excellent or good results. 2. Telangiectasia 78.1% of patients she wed excellent or good results. 3. Spider angioma 66.7% of patients she wed excellent or good results. 4. Strawberry hemangioma and cavernous hemangioma Most, of the patients,howed fair or poor results. 5. Complications included hyperpigmentation(26.5%), hypopigmentation(1.6%) and atrophic scar(4.5% ). CONCLUSION: Our experince with pulsed dye laser during the last 3 years revealed that it was superior in treating vascular disease than other existing lasers.
Adult ; Dermatology ; Epidermis ; Fragaria ; Hemangioma ; Hemangioma, Cavernous ; Humans ; Lasers, Dye* ; Port-Wine Stain ; Spiders ; Telangiectasis ; Vascular Diseases

Acute myocardial infarction after a bee sting is a very rare process. Among proposed mechanisms, vasospasm of the coronary artery is the most probable mechanism. Many mediators are included in the venom of wasps, and those mediators have vasoconstrictive properties and may constrict the coronary artery. Furthemore, those mediators have thrombogenic properties that lead to thrombogenesis in the coronary artery and aggravate myocardial ischemia. Epinephrine, commonly used in the management of anaphylactic shock, may further aggravate myocardial ischemia. We experienced two cases of acute myocardial infarction after a bee sting. In the first case, we could find no underlying abnormalities of the coronary vessel because the patient died during coronary angiography. In the second case, the electrocardiogram showed inferior wall myocardial infarction, but only mild stenosis of the right coronary artery was seen in coronary angiography.
Anaphylaxis ; Bees* ; Bites and Stings* ; Constriction, Pathologic ; Coronary Angiography ; Coronary Vessels ; Electrocardiography ; Epinephrine ; Humans ; Inferior Wall Myocardial Infarction ; Myocardial Infarction* ; Myocardial Ischemia ; Venoms ; Wasps

Erythema multiforme is an episodic, self-limited, mucocutaneous, inflammatory disorder and the disease manifests as severe form is called Stevens-Johnson syndrome. It is most commonly precipitated by herpes simplex infection or drugs and the pathogenesis of the mucocutaneous lesion is thought to be related to immune complexes, cell-mediated immunity, or both. We experienced a case of Stevens-Johnson syndrome in 23-year-old female who had systemic bullous kin lesion and diffue mucopurulent conjunctivitis after use of oral acetazolamide for control of steroid-induced increased intraocular pressure after excimer laser photorefractive keratectomy, which has not been reported in Korea. So, we report this case with a review of the literature.
Acetazolamide* ; Antigen-Antibody Complex ; Conjunctivitis, Bacterial ; Erythema Multiforme ; Female ; Herpes Simplex ; Humans ; Immunity, Cellular ; Intraocular Pressure ; Korea ; Lasers, Excimer ; Photorefractive Keratectomy ; Stevens-Johnson Syndrome* ; Young Adult

BACKGROUND: Hypothermia is a condition that can lead to serious complications and even to death in newborn. Although the temperature control is essential in neonatal care, it is often neglected during urgent transfer from local private hospitals. The purpose of this study is to evaluate the incidence and clinical outcomes of transfer induced neonatal hypothermia. SUBJECTS AND METHOD: In this retrospective study, subject is limited to transferred outborn babies with age less than 24 hours from June 1996 to May 1999. A total of 3,086 patients were admitted in NICU during the study period and inborn and outborn babies were 1,743(56%) and 1,343(44%) respectively. Among the 1,343 outborn babies, 212 babies were transferred from the private hospital within 24 hours of birth and were eligible for the study. Rectal temperature on arrival, transfer time, birth weight, gestational age, initial arterial gas study, and clinical outcome were compared. Statistical analysis has been done with chi-sqaure test and multiple logistic regression analysis. RESULTS: There were 84 cases(39.6%) hypothermia(<36degrees C> among the 212 babies and the rate of hypothermia in transfered babies have not decreased over the study period. There were significantly more hypothermia in lower gestational age (less than 28 weeks) and lower birth weight (less than 2,000gm) caused hypothermia significantly more than normal gestational age or normal range of birth weight. And time interval (less than 12 hour) from birth to arrival at emergency department was also significant factor in hypothermia. The mortality rate was three fold higher in hypothermia than normothermic or hyperthermic babies. CONCLUSION: This study shows that hypothermia during neonate transportation is a major cause of neonatal mortality and morbidity in prehopital care. Body temperature control during transport of neonates under 24 hours of age should be emphasized for the better outcome of treatment.
Birth Weight ; Body Temperature ; Emergency Service, Hospital ; Gestational Age ; Hospitals, Private ; Humans ; Hypothermia* ; Incidence ; Infant ; Infant Mortality ; Infant, Newborn* ; Logistic Models ; Mortality ; Parturition ; Reference Values ; Retrospective Studies ; Transportation*

The case of a patient with acute onset of flank pain is presented. Initial therapy was directed toward relief of pain believed to be caused by renal calculi. The flank pain did not responded to analgesics. An abdominal ultrasonogram showed that multiple hyperechogenic masses were in the parenchyma of both kidney, and an abdominal CT showed that multiple high-density masses, presumed to be angiomyolipomas, were located in both kidneys and in the perirenal hematoma around the left kidney. Vital signs were stable, and there was no evidence of anemia. On the seventh hospital day, angiographic tumor embolization was performed. Cases such as this should remind emergency physicians to carefully consider alternate diagnoses to renal calculi in patients with flank pain who have atypical clinical features or an atypical course.
Analgesics ; Anemia ; Angiomyolipoma* ; Diagnosis ; Emergencies ; Flank Pain ; Hematoma ; Humans ; Kidney ; Kidney Calculi ; Rupture, Spontaneous* ; Tomography, X-Ray Computed ; Ultrasonography ; Vital Signs

Endoscopic injection sclerotherapy(EIS) has been widely used in treating and eradicating acutely bleeding esophageal varies, but may be associated with some undesirable local and systemic complications. Endoscopic variceal ligation(EVL), which consists of mechanicai ligation and thrombosis of varices using elastic o-band, has been recently developed as a non operative alternative to EIS. We performed EVL in 65 patients who had bled from esophageal varices between November 1991 and September 1993. Total 274 sessions were performed and 774 o-bands were used. Six patients were actively bleeding and all of them were successfully controlled by emergency EVL. During the follow-up period, five patients who had combined hepatoma died. Varices were eradicated or reduced grade I in 43(71.6%) of the 60 survivals by 8-36 ligations(mean 15.6 ligation) in 2-13 EVL sessions(mean 5.6 sessions). During follow up period, five patients had recurred from grade 0 to grade 2 or 3 in 106-260 days(mean 182.6 days), and then eradicated by repeated EVL. During or after EVL, there were no complications, except mild substernal distress and mild dysphagia in 17 and 7 patients respectively. These results showed that EVL is a safe and effective method for eradication of bleeding esophageal varices.
Carcinoma, Hepatocellular ; Deglutition Disorders ; Emergencies ; Esophageal and Gastric Varices* ; Follow-Up Studies ; Hemorrhage ; Humans ; Ligation* ; Thrombosis ; Varicose Veins