BACKGROUND: Esmolol is a short acting sympathetic beta receptor antagonist, and it was successfully applied to induced hypotension. Esmolol lowers blood pressure by decreasing cardiac output, and does not cause vasodilation. This property of esmolol may help to decrease bleeding during induced hypotension. In this study, we tried to elucidate the effect of esmolol on induced hypotension for total hip arthroplasty. METHOD: Twenty patients receiving total hip arthroplasty were randomly divided to two groups. Esmolol group (10 patients) received esmolol as a hypotensive agent, and sodium nitroprusside (SNP) group (10 patients) received SNP as a hypotensive agent. We measured arterial blood gas analysis, vital sign, amounts of bleeding, amounts of transfusion and administered fluid, and various laboratory findings. RESULTS: Induced hypotension was successfully performed in either esmolol and SNP group. Heart rate increased by SNP, and decreased by esmolol. There were no statistically significant differences between the two groups in amounts of bleeding, amounts of transfusion or administered fluid, and laboratory findings. Arterial oxygen tension was relatively constant in esmolol group, but decreased in SNP group. CONCLUSION: Esmolol can be used as a single hypotensive agent during induced hypotension without significant side effects during total hip arthroplasty.
Arthroplasty, Replacement, Hip* ; Blood Gas Analysis ; Blood Pressure ; Cardiac Output ; Heart Rate ; Hemorrhage ; Humans ; Hypotension* ; Nitroprusside* ; Oxygen ; Sodium* ; Vasodilation ; Vital Signs

Brucellosis is a zoonosis caused by several species of Brucella. Brucellosis is usually an acute or sub-acute febrile illness that histologically develops granulomatous inflammation. Brucella prostatitis is a very rare complication and is usually accompanied by epididymo-orchitis. We now report a case of histologically proven granulomatous prostatitis due to Brucella without clinical evidence of epididymo-orchitis. A 61-year-old farmer presented with myalgia, low back pain, and fever. A needle biopsy of the prostate was performed due to symptoms of urinary frequency and high prostate specific antigen levels (17.3 ng/mL). Histologically, the prostate showed granulomatous inflammation without caseous necrosis. Polymerase chain reaction (PCR) studies of blood and prostatic tissue for Brucella were positive, while a PCR study for Mycobacterium tuberculosis was negative. The patient was treated with doxycycline and rifampin. A possibility of Brucella prostatitis should be considered in the differential diagnosis of granulomatous prostatitis or prostatitis of unknown origin associated with or without epididymo-orchitis.
Biopsy, Needle ; Brucella ; Brucellosis ; Diagnosis, Differential ; Doxycycline ; Fever ; Granuloma ; Humans ; Inflammation ; Korea ; Low Back Pain ; Middle Aged ; Mycobacterium tuberculosis ; Necrosis ; Polymerase Chain Reaction ; Prostate ; Prostate-Specific Antigen ; Prostatitis ; Rifampin

Since the first case of human immunodeficiency virus (HIV) infection was reported in Korea in 1985, the number of HIV patients has risen steadily and reached 5,323 in December 2007. Consequently, multiple opportunistic infections have become a significant clinical problem. Diseases of the gastrointestinal tract are among the most frequent complications of acquired immunodeficiency syndrome (AIDS) and cause morbidity in patients with HIV infection. Opportunistic infections are the leading cause of esophageal complaints. Candida albicans is the most frequently identified cause of esophageal symptoms, followed by herpes simplex virus (HSV) and cytomegalovirus (CMV) infections. Esophageal candidiasis often occurs concurrently with other infectious esophageal disorders. Simultaneous esophageal infection with HSV, CMV, and Candida spp. is rare. We report a case of combined HSV, CMV, and candidal esophagitis in an AIDS patient. He was treated with highly active antiretroviral therapy (HAART) and the appropriate antiviral and antifungal agents.
Acquired Immunodeficiency Syndrome ; Antifungal Agents ; Antiretroviral Therapy, Highly Active ; Candida ; Candida albicans ; Candidiasis ; Cytomegalovirus ; Esophagitis ; Gastrointestinal Tract ; Herpes Simplex ; HIV ; HIV Infections ; Humans ; Korea ; Methylmethacrylates ; Opportunistic Infections ; Polystyrenes ; Simplexvirus

Early and longterm prognosis depended on the extents of acute myocardial infarction and residual myocardial function. Many clinical methods have been evaluated to determine their ability to estimate the size of myocardial infarcts. But because of many disadvantages simplified QRS scoring system, used with standard 12-lead EKG, was developed, which is noninvasive, inexpensive and easily releatible. Therefore, the correlation between QRS and peak CK,killip classification were evaluated in 55 patients with initial acute myocardial infarction at the Chung-Ang University, Yong-San and Pil-Dong Hospital during the period from January 1983 to December, 1986. The results were as follows : 1) The average QRS score of the anterior wall infarction is 7.1 and that of the inferior wall infarction is 4.5 and there is a statistical significance(p<0.01). 2) In the acute myocardial infarction, the correlation coefficeient between the QRS score and the killip classification is 0.66(p<0.05). 3) In the acute myocardial infarction, the average QRS score is 6.3 and the correlation coefficient between the leak CK and the QRS score is 0.52(p<0.05). 4) In the anterior wall infarction, the average QRS score is 7.1 and the correlation coefficient between the peak Ck and QRS score is 0.48(p<0.05). 5) In the inferior wall infarction, the average QRS score is a 4.5 and the correlation coefficient between the leak CK and QRS score is 0.79(p<0.05).
Classification ; Electrocardiography ; Humans ; Infarction ; Myocardial Infarction* ; Prognosis

Esophageal perforation is a rare disease, which require emergent diagnosis and therapeutic procedure. In this paper, we present one case of esophageal perforation by traction of toothbrush which was swallowed during pharyngeal irritation. After the toothbrush was inserted to stomach by gastroscope, gastrostomy was performed for removal of toothbrush and the esophageal perforation was repaired by operation.
Diagnosis ; Esophageal Perforation* ; Gastroscopes ; Gastrostomy ; Rare Diseases ; Stomach ; Traction

An adrenal crisis is a serious medical emergency. Most such crises develop in patients with Addison's disease when they are stressed. However, the clinical features of an impending adrenal crisis are nonspecific, delaying diagnosis and management. Adrenal tuberculosis is very rare among the extrapulmonary forms of tuberculosis. We herein report a case of an adrenal crisis triggered by bilateral adrenal tuberculosis. A 35-year-old man was admitted to our hospital because of drowsiness, fever, and hypotension. Abdominal computed tomography revealed bilateral adrenal enlargement, and computed tomography-guided adrenal gland biopsy allowed us to diagnose adrenal tuberculosis.
Addison Disease ; Adrenal Glands ; Adrenal Insufficiency ; Adult ; Biopsy ; Diagnosis ; Emergencies ; Fever ; Humans ; Hypotension ; Sleep Stages ; Tuberculosis* ; Tuberculosis, Endocrine

Chromobacterium violaceum (C. violaceum) is a gram negative, facultative anaerobe widely distributed in natural aquatic environments and is sensitive to temperature. Its infection has a predilection to tropical or subtropical regions that between latitude 35degrees N and 35degrees S. Infection due to C. violaceum is rare. But human infection with this organism can result in severe, systemic disease with a high fatality rate. C. violaceum infection may rapidly progress to sepsis with multiple organ abscesses, predominantly in lungs, liver, and spleen. The organism is usually resistant to most antibiotics commonly prescribed for gram-negative bacterial infection like aminoglycosides, extended spectrum beta-lactam antibiotics etc. In Korea, two cases of C. violaceum infections were reported in patients injured in a Guam airplane accident, and one case was reported local C. violaceum infection. Here, we report a case of fatal C. violaceum postoperative wound infection in Korea.
Abscess ; Aircraft ; Aminoglycosides ; Ankle Fractures* ; Ankle* ; Anti-Bacterial Agents ; Chromobacterium* ; Gram-Negative Bacterial Infections ; Guam ; Humans ; Korea ; Liver ; Lung ; Sepsis ; Spleen ; Surgical Wound Infection ; Wound Infection* ; Wounds and Injuries*

Primary hyperparathyroicism is a state of hypersecretion of PTH by the parathyroid. The etiology has not been established. The three possible etiologies of piimary hyperparathyroidism and incidences are adencena(83%), hyperplasia(15%), and carcinoma(1~2%). Parathyroid carcinoma usually presents in the fourth decades. The hallmark preoperative signs are hypercalcemia(serum calcium 15mg/dl). Palpable neck mass and bane and renal disease. Patients may present with multiple signs and syrnptoms, including recurrent nephrolithiasis, peptic ulcers, mental change, less frequently, extensive bone resorption. However, with greater awareness of the disease and wider use of screening tests, including blood calcium determinations, the diagnosis is frequently made in patients who have no symptoms and minimal, if any, signs of the disease ather than hypercalcemia and elevated levels of parathyroid Hormone. An 38-years-old woman was admitted to the hospital due to pain on the left knee joint. We experienced full-brown symptom pertaining to hyperpara- thyroidism. Thus we report a case herein and also discuss clinical anifestation, histologic features and treatment.
Bone Resorption ; Calcium ; Diagnosis ; Female ; Humans ; Hypercalcemia ; Hyperparathyroidism ; Incidence ; Knee Joint ; Mass Screening ; Neck ; Nephrolithiasis ; Parathyroid Hormone ; Parathyroid Neoplasms ; Peptic Ulcer ; Thyroid Gland

Formaldehyde is a colorless irritating gas of pungent odor, which is used as a disinfectant, antiseptic, deodorant, tissue fixative and embalming fluid, It is used in the formation of resins, alcohols and acids, and in permanent press processes in the textile industry. If formaldehyde is swallowed, severe abdominal pain and vomiting is immediately noted. Corrosive gastritis can follow with diffuse ulceration, fibrosis and contracture of the stomach, resembling linitis plastica, which may be severe enough to require gastrectomy. We report a case of cicatricial contracted stomach due to the ingestion of formalin.
Abdominal Pain ; Alcohols ; Contracture ; Deodorants ; Eating* ; Embalming ; Fibrosis ; Formaldehyde* ; Gastrectomy ; Gastritis ; Linitis Plastica ; Odors ; Stomach* ; Textile Industry ; Ulcer ; Vomiting

Thrombocytopenia is a common manifestation of rickettsial disease. However, the pathogenesis of thrombocytopenia in many rickettsial diseases is poorly understood. Thrombocytopenia may be associated with consumption due to widespread endothelial damage or disseminated intravascular coagulation, hypersplenism, decreased marrow production, and immune-mediated platelet destruction. Some reports have found anti-platelet antibodies detected in thrombocytopenic patients with rickettsial disease. In addition to thrombocytopenia, facial palsy and Guillain-Barre syndrome were also reported as immune-mediated phenomena in scrub typhus. Here we report a case diagnosed as immune-mediated thrombocytopenia associated with scrub typhus. This is the first report of immune thrombocytopenic purpura (ITP) associated with scrub typhus in Korea. The patient exhibited eschar with a high titer of anti-tsutsugamushi antibody, thrombocytopenia, severe gastrointestinal hemorrhage, and purpura on the lower region of both legs. After steroid treatment, the sustained thrombocytopenia recovered.
Antibodies ; Blood Platelets ; Bone Marrow ; Disseminated Intravascular Coagulation ; Facial Paralysis ; Gastrointestinal Hemorrhage ; Guillain-Barre Syndrome ; Humans ; Hypersplenism ; Korea ; Leg ; Purpura ; Purpura, Thrombocytopenic, Idiopathic* ; Scrub Typhus* ; Thrombocytopenia