In this article, the sixth author's affiliation was misprinted unintentionally.

PURPOSE: Ingestion of puffer fish can be poisonous due to the presence of potent neurotoxins such as tetrodotoxin (TTX) found in its tissues. There are few clinical reports related to TTX. We performed this study to evaluate the clinical characteristics of TTX poisoning. METHODS: We conducted a retrospective study of the 41 patients diagnosed with TTX poisoning who visited the Seoul Asan medical center from July 2004 and December 2010. A review of patients'electronic medical records and patient telephone interviews were conducted. Diagnosis of TTX poisoning was confirmed by observing the casual link between puffer fish consumption and the development of typical TTX intoxication symptoms. RESULTS: The mean age of the patients included in the study was 46.6 years. The highest incidence of intoxication was observed in patients in their 50s (10 patients). Seasonal distribution of intoxication events included 10 in spring, 7 in summer, 10 in fall, and 14 in winter. In most cases, symptoms occurred within 1 hour of ingestion. A wide range of symptoms were associated with puffer fish ingestion affecting multiple body systems including neuromuscular (27 patients), gastrointestinal (19 patients), and cardiopulmonary/vascular (19 patients). All patients were treated with symptomatic and supportive therapy and recovered completely, without sequelae, within 48 hours. In three cases, ventilator support was required. CONCLUSION: TTX poisoning is not seasonally related, and patients admitted to the emergency room were observed with a wide range of symptoms. Where TTX poisoning is diagnosed, supportive therapy should be performed. Early intubation and ventilation is important, especially is cases of respiratory failure.
Aluminum Hydroxide ; Carbonates ; Eating ; Emergencies ; Humans ; Incidence ; Interviews as Topic ; Intubation ; Medical Records ; Neurotoxins ; Respiratory Insufficiency ; Retrospective Studies ; Seasons ; Tetraodontiformes ; Tetrodotoxin ; Ventilation ; Ventilators, Mechanical

PURPOSE: Nutrition status is an important factor for perioperative morbidity in cancer surgery. The aim of this study was to evaluate the impact of the malnutrition risk, determined by Seoul National University Hospital-nutrition screening index (SNUH-NSI), on operative morbidity after colorectal surgery for cancer.METHODS: This study enrolled 2,462 patients who had undergone colectomy for initially diagnosed colorectal cancer at Seoul National University Hospital from January 2011 to December 2014. We collected general patient information, SNUH-NSI and prognostic nutritional index (PNI) at administration and related parameters (serum albumin, cholesterol, total lymphocyte counts, hemoglobin and body mass index), operative method, hospital stay and operative morbidity.RESULTS: Patients' mean age was 62.12 years, and 423 patients (17.18%) were rated as severe malnutrition risk. Patients with high risk of malnutrition by SNUH-NSI or PNI, men, higher American Society of Anesthesiologists (ASA) class, palliative operation, and higher stage showed higher operative morbidity (P < 0.05). On multivariate analysis, significant independent risk factors for operative morbidity were severe malnutrition by SNUH-NSI (odds ratio [OR], 1.868; 95% confidence interval [CI], 1.429–2.442; P < 0.001) or PNI (OR, 1.596; 95% CI, 1.258–2.025; P < 0.001), men (OR, 1.483; 95% CI, 1.174–1.876; P=0.001), or high ASA class (OR, 1.782; 95% CI, 1.136–2.795; P=0.012).CONCLUSION: Overall nutritional status, rather than single data, shows significant association with postoperative morbidity in patients who underwent colectomy. Especially severe malnutrition determined by SNUH-NSI, is an independent risk factor for perioperative morbidity. Nutritional support to severely malnourished patient by SNUH-NSI is expected to be effective in preventing complications after colectomy of colorectal carcinoma patients.
Cholesterol ; Colectomy ; Colorectal Neoplasms ; Colorectal Surgery ; Humans ; Length of Stay ; Lymphocyte Count ; Male ; Malnutrition ; Mass Screening ; Methods ; Multivariate Analysis ; Nutrition Assessment ; Nutritional Status ; Nutritional Support ; Risk Factors ; Seoul

PURPOSE: Interstitial cells of Cajal (ICC) play a core function in colonic motility as a pacemaker by regulating the slow wave. We intended to investigate the electrophysiological characteristics of the circular smooth muscle in the human colon, especially in Koreans. METHODS: Colon tissues were obtained from patients undergoing an elective colectomy for non-obstructive lesions. Tissues were immediately stored in oxygenated Krebs-Ringer's bicarbonate solution, and conventional microelectrode recordings of the colonic circular muscle were done from muscle cells. RESULTS: The trans-membrane potentials from 100 tissues were recorded. Regular slow-wave patterns were observed in 36 patients, and 64 patients showed irregular wave patterns. In the tissues exhibiting regular slow-wave patterns, 20 tissues were recorded from the proximal colon and 16 from the distal colon. The frequency of the slow wave from the proximal part was significantly higher than that from the distal part. The resting membrane potential, the upstroke amplitude, the spike amplitude, and the maximal rate of rise showed no significant difference between the two parts, but the time to reach half amplitude did show a significant difference between the two parts. No significant differences in parameters were observed based on the patients' demographics such as sex and age (younger or older than 60). We were able to divide the irregular waves into 3 groups. Irregular slow waves were observed in 35 tissues, irregular slow waves mixed with spike waves were observed in 26 tissues, and spike waves alone were observed in 3 tissues. CONCLUSION: We analyzed the electrophysiological characteristics of the human colonic circular smooth muscle, especially those of the slow wave originating from ICC of patients who had not been pretreated with drugs.
Colectomy ; Colon ; Demography ; Humans ; Interstitial Cells of Cajal ; Membrane Potentials ; Microelectrodes ; Muscle Cells ; Muscle, Smooth ; Muscles ; Oxygen

We report two cases of toxic methemoglobinemia caused by an inert ingredient in pesticide product after intentional ingestion of pesticide. First, 51-year-old male visited to the emergency department (ED) after the ingestion of pesticide in a suicide attempt. Initial methemoglobin (MetHb) level was 25.6%. We did not know the cause of methemoglobinemia at that time. Second, 56-year-old female visited to the ED after the ingestion of the same pesticide in a suicide attempt. MetHb level after 30 minutes was 16.1%. The patients were treated with methylene blue. We contacted to the Korean Rural Development Administration and estimated that magnesium nitrate was more likely to cause methemoglobinemia. This report highlights the importance of considering the possibility of methemoglobinemia caused by inert ingredient in pesticide and early antidotal therapy.
Eating* ; Emergency Service, Hospital ; Female ; Humans ; Magnesium ; Male ; Methemoglobin ; Methemoglobinemia* ; Methylene Blue ; Middle Aged ; Pesticides ; Social Planning ; Suicide

We describe the case of a 19-year-old mentally challenged woman who developed jejuno-jejunal fistula following ingestion of a magnetic necklace. This case report demonstrates the necessity of prompt treatment when the ingested intestinal foreign body is suspected to be multiple magnets, even if there are no sharp edges; and even when it seems the object could be evacuated spontaneously. Ingested magnets are capable of attracting each other across the bowel wall, leading to serious intestinal complications such as pressure necrosis, perforation, fistula formation, or intestinal obstruction.
Eating ; Female ; Fistula ; Foreign Bodies ; Humans ; Intestinal Fistula ; Intestinal Obstruction ; Magnetics ; Magnets ; Necrosis ; Young Adult

PURPOSE: To assess the effectiveness of a care map for a fast-track discharge program after colorectal cancer surgery. METHODS: Ninety-nine patients who underwent colorectal surgery were retrospectively analyzed: 45 patients who were placed in a conventional program (January 3 to March 13, 2013) and 44 patients who were placed in a fast-track program using the care map (July 26 to September 24, 2014). Patients in the fast-track program started eating on postoperative day 1, while those in the conventional program started eating on post-operative day 2. complications, and pain were compared between the two groups. RESULTS: A slight decrease in the average duration of hospitalization was observed for the fast-track group (5.31+/-0.98 days) compared to the conventional group (5.38+/-2.80 days), although this difference was not statistically significant. All other outcomes for the fast-track group were scored as 0. Furthermore, there was no statistically significant differences between pain, narcotics administration, and non-narcotic analgesics (aside from patient-controlled analgesia). CONCLUSION: The care map for the colorectal surgery fast-track program was effective and program validation and supplementation of the active standardization early recovery program should be performed using multi-disciplinary research.
Analgesics, Non-Narcotic ; Colorectal Neoplasms* ; Colorectal Surgery ; Eating ; Hospitalization ; Humans ; Narcotics ; Retrospective Studies

Aconitine is an anti-inflammatory agent with therapeutic uses in oriental medicine as an analgesic and for treatment of stroke. Because of its sodium channel effect, aconitine can promote undesirable, wide complex tachyarrhythmia. If tachycardia develops during use of aconitine, class Ia and class III anti arrhythmic drugs can be utilized for treatment. However there are no single anti-arrhythmia agents which are uniformly effective. We report a case, characterized by wide complex tachyarrhythmia and severe hypotension, which was successfully treated by simultaneous injections of amiodarone and lidocaine. A 59-year-old woman exhibiting clinical signs of drowsiness as a result of ingesting 6 g of aconitine, was admitted to the emergency department. Initially, wide complex tachyarrhythmia (ventricular tachycardia and pulse rate of 180 beats/min) and severe hypotension (blood pressure of 53/26 mmHg) was observed. After simultaneous injection of amiodarone and lidocaine, the patient's rhythm pattern changed to an accelerated junctional rhythm with ventricular premature complex. Two hours later, the patient's heart pattern became a sinus rhythm. As demonstrated by this case, simultaneous injections of amiodarone and lidocaine can be useful in treating ventricular arrhythmia induced by aconitine.
Aconitine ; Amiodarone ; Anti-Arrhythmia Agents ; Arrhythmias, Cardiac ; Emergencies ; Female ; Heart ; Heart Rate ; Humans ; Hypotension ; Lidocaine ; Medicine, East Asian Traditional ; Middle Aged ; Sleep Stages ; Sodium Channels ; Stroke ; Tachycardia ; Tachycardia, Ventricular ; Therapeutic Uses ; Ventricular Premature Complexes

OBJECTIVE: The cerebral cortex can modulate vestibular functions through direct control of neuronal activities in the vestibular nuclei. The purpose of this study was to investigate the effect of unilateral cortical lesion or cortical stimulation on static vestibular symptoms and vestibular nuclear activities at the acute stage of vestibular compensation following unilateral labyrinthectomy (UL) in rats. METHODS: The photothrombic ischemic injury using rose bengal was induced in the primary motor cortex or primary sensory cortex, and electrical stimulation was applied to the primary motor cortex, primary sensory cortex, or sencondary sensory cortex, respectively, in unilateral labyrinthectomized rats. Static vestibular symptoms including ocular movement and postural deficits, and expression of c-Fos protein in the medial vestibular nucleus (MVN) were measured. RESULTS: Lesion of the motor cortex produced a marked postural deficit with paralytic weakness in the hindlimb contralateral to UL. Number of spontaneous nystagmus in animals receiving cortical lesion was significantly increased 2, 6, and 12 hours after UL compared with animals being UL only. Lesion of the primary motor cortex or stimulation of the S2 sensory cortex decreased expression of c-Fos protein in MVN following UL compared with UL only group. Electrical stimulation of S2 sensory areas caused significant reduction of static vestibular symptoms and decreased expression of c-Fos protein in MVN 24 hours following UL. CONCLUSION: The present results suggest that cerebral cortex involves in recovery of static vestibular symptoms during vestibular compensation following UL.
Animals ; Cerebral Cortex ; Compensation and Redress ; Electric Stimulation ; Hindlimb ; Motor Cortex ; Neurons ; Rats ; Rose Bengal ; Vestibular Nuclei

Purpose: Cryptoglandular fistula is one of the common anal diseases requiring surgical treatment. Various surgical techniques have been introduced; however, there is no known standard technique. Coring-out fistulectomy is a surgical technique that accurately resects only the fistula tract. However, only a few cases of this procedure have been reported.We aimed to analyze the surgical outcomes of coring-out fistulectomy for cryptoglandular anal fistulas. Methods: We retrospectively reviewed the medical records of patients who underwent coring-out fistulectomy for a cryptoglandular fistula between 1999 and 2019. Primary outcomes were the treatment success rate (recurrence and healing rates) and incidence of fecal incontinence. Results: A total of 184 patients were included in our study. The average age of the patients was 44 years (range, 16–75 years), and 88.0% were male. Twenty-four (13.0%), 13 (7.1%), and 68 patients (37.0%) underwent operation for recurrent fistula, multiple tracts, and complex type fistula, respectively. The healing rate was 92.4%, and recurrence occurred in 15 of 170 healed patients (8.8%). Thus, the treatment success rate was 84.2%. There was no fecal incontinence except in 1 patient who had preoperative fecal incontinence because of cauda equine syndrome. In multivariable analysis of the factors affecting the treatment success rate, the complex fistula (odds ratio [OR], 14.2; 95% confidence interval [CI], 4.7– 43.0; P < 0.001) and undetected internal opening during the operation (OR, 4.0; 95% CI, 1.4–11.6; P = 0.012) were significant factors. Conclusion Coring-out fistulectomy is a simple and feasible technique for sphincter-preserving anal fistula surgery.