The field of forensic toxicology faces significant challenges when assessing toxic substances whose blood concentrations do not correlate proportionally with toxicity. A representative example of such substances is uncouplers, which induce apoptosis via mitochondrial dysfunction, leading to delayed toxicity. In this study, we examined domestic intoxication cases involving uncouplers, with particular focus on chlorfenapyr, a widely recognized uncoupler. Symptoms observed in poisoning cases included initial vomiting, abdominal pain, and diarrhea, followed by hyperthermic episodes, rhabdomyolysis, optic nerve damage, pancreatitis, brain damage, and, ultimately, death occurring days to weeks later. In fatal cases, the blood concentration of chlorfenapyr was found to be below 1 ppm (ranging from tens to hundreds of ppb), making it easily overlooked in routine toxicological screenings. Furthermore, due to its delayed toxic effects, chlorfenapyr may not be detected in gastric contents, necessitating careful forensic evaluation. In negative chlorfenapyr cases presenting with hyperthermic episodes and signs of cell death, exposure to other uncouplers should be considered. Clinical cases reviewed in this study suggest that ingesting as little as 20 mL of pesticide products containing chlorfenapyr can lead to death weeks later, highlighting the severe delayed toxicity of this compound. Therefore, regulatory policies governing its use should be reinforced, and the development of alternative pesticides should be considered to mitigate fatal risks.

The field of forensic toxicology faces significant challenges when assessing toxic substances whose blood concentrations do not correlate proportionally with toxicity. A representative example of such substances is uncouplers, which induce apoptosis via mitochondrial dysfunction, leading to delayed toxicity. In this study, we examined domestic intoxication cases involving uncouplers, with particular focus on chlorfenapyr, a widely recognized uncoupler. Symptoms observed in poisoning cases included initial vomiting, abdominal pain, and diarrhea, followed by hyperthermic episodes, rhabdomyolysis, optic nerve damage, pancreatitis, brain damage, and, ultimately, death occurring days to weeks later. In fatal cases, the blood concentration of chlorfenapyr was found to be below 1 ppm (ranging from tens to hundreds of ppb), making it easily overlooked in routine toxicological screenings. Furthermore, due to its delayed toxic effects, chlorfenapyr may not be detected in gastric contents, necessitating careful forensic evaluation. In negative chlorfenapyr cases presenting with hyperthermic episodes and signs of cell death, exposure to other uncouplers should be considered. Clinical cases reviewed in this study suggest that ingesting as little as 20 mL of pesticide products containing chlorfenapyr can lead to death weeks later, highlighting the severe delayed toxicity of this compound. Therefore, regulatory policies governing its use should be reinforced, and the development of alternative pesticides should be considered to mitigate fatal risks.

The field of forensic toxicology faces significant challenges when assessing toxic substances whose blood concentrations do not correlate proportionally with toxicity. A representative example of such substances is uncouplers, which induce apoptosis via mitochondrial dysfunction, leading to delayed toxicity. In this study, we examined domestic intoxication cases involving uncouplers, with particular focus on chlorfenapyr, a widely recognized uncoupler. Symptoms observed in poisoning cases included initial vomiting, abdominal pain, and diarrhea, followed by hyperthermic episodes, rhabdomyolysis, optic nerve damage, pancreatitis, brain damage, and, ultimately, death occurring days to weeks later. In fatal cases, the blood concentration of chlorfenapyr was found to be below 1 ppm (ranging from tens to hundreds of ppb), making it easily overlooked in routine toxicological screenings. Furthermore, due to its delayed toxic effects, chlorfenapyr may not be detected in gastric contents, necessitating careful forensic evaluation. In negative chlorfenapyr cases presenting with hyperthermic episodes and signs of cell death, exposure to other uncouplers should be considered. Clinical cases reviewed in this study suggest that ingesting as little as 20 mL of pesticide products containing chlorfenapyr can lead to death weeks later, highlighting the severe delayed toxicity of this compound. Therefore, regulatory policies governing its use should be reinforced, and the development of alternative pesticides should be considered to mitigate fatal risks.

The field of forensic toxicology faces significant challenges when assessing toxic substances whose blood concentrations do not correlate proportionally with toxicity. A representative example of such substances is uncouplers, which induce apoptosis via mitochondrial dysfunction, leading to delayed toxicity. In this study, we examined domestic intoxication cases involving uncouplers, with particular focus on chlorfenapyr, a widely recognized uncoupler. Symptoms observed in poisoning cases included initial vomiting, abdominal pain, and diarrhea, followed by hyperthermic episodes, rhabdomyolysis, optic nerve damage, pancreatitis, brain damage, and, ultimately, death occurring days to weeks later. In fatal cases, the blood concentration of chlorfenapyr was found to be below 1 ppm (ranging from tens to hundreds of ppb), making it easily overlooked in routine toxicological screenings. Furthermore, due to its delayed toxic effects, chlorfenapyr may not be detected in gastric contents, necessitating careful forensic evaluation. In negative chlorfenapyr cases presenting with hyperthermic episodes and signs of cell death, exposure to other uncouplers should be considered. Clinical cases reviewed in this study suggest that ingesting as little as 20 mL of pesticide products containing chlorfenapyr can lead to death weeks later, highlighting the severe delayed toxicity of this compound. Therefore, regulatory policies governing its use should be reinforced, and the development of alternative pesticides should be considered to mitigate fatal risks.

This report is concerned with our clinical experience of 150 cases of anesthesia for open heart surgery at department of anesthesiology, In chon Gil hospital from Februry, 1990 to April, 1993. The results were as follows ; 1) Among 150 cases, 68 cases (45.3%) were congenital heart disease and 82 cases (54.7%) were acquired heart disease. 62 cases (41.3%) were males and 88 cases (58.7%) were females. 2) Glycopyrrolate, diazepam, morphine, were used as premedicants. 3) Fentanyl, ketamine, diazepam, thiopental sodium were used as induction agents and injected singly or in combination. 4) In congenital cyanotic heart diseases, ketamine was used as main anesthetic agent. In other heart diseases, fentanyl, isoflurane, diazepam were used. 5) Vecuronium was used for intubation and maintenance of muscle relaxation. 6) Overall mortality rate was 3.3% (5 cases) and the causes of death were low cardiac output, respiratory insufficiency, mediastinal infection.
Anesthesia ; Anesthesiology ; Cardiac Output, Low ; Cause of Death ; Diazepam ; Female ; Fentanyl ; Glycopyrrolate ; Heart Defects, Congenital ; Heart Diseases ; Heart* ; Humans ; Incheon ; Intubation ; Isoflurane ; Ketamine ; Male ; Morphine ; Mortality ; Muscle Relaxation ; Respiratory Insufficiency ; Thiopental ; Thoracic Surgery* ; Vecuronium Bromide

Intraspinal(intrathecal, epidural) narcotics administration had been widely used and well estabilished for pain control. The action mechanism of intraspinal narcotics has been well defined, and meperidine and pentazocine have been reported to be used as a sole agent for spinal anesthesia. The authors have already reported good loeal anestheticlike effets of meperidine and pentazocine clinically in patients scheduled for various surgeries, followed by experimen- tal evaluation of toxic effects of two drugs on the sciatic nerve of rats and dogs. This investigation was primarily undertaken to examine the difference in neurophysiological action between meperidine and morphine and also to evaluate early histological changes on aciatic nerve of rabbits within one week after injection of the each narcotics. Adult Korean rabbits were chosen as experimental animals because it is easy to observe neurophysiological activity with responses and to avoid of manipulating trauma. The rabbits were anesthetized using ketamine 10 mg/kg intramuscularly. The sciatic nerve of the rabbits was exposed and stimulated by a nerve stimulator to observe myoneural response as a control and then injected with 0.1% morphine 0.2 mg(Group I), 0.5% meperidine 10 mg(Group 2) and 0.3 % pentazocine 6 mg(Group 3). The sciatic nerve was stimulated for 20 minutes at 5 minutes interval and gait changes were carefully observed in the recovery room to see the myoneural activity, A specimen was taken at 4 and 24 hours, and 1 week after injection. The results were as follows, When the sciatic nerve was stimulated by a nerve stimulator, the normal muscle twitch was observed clearly in Group I with the morphine injection. However, in Group 2 with meperidine and Group 3 with pentazocine injection, muscle twitching decreased gradually and finally disappeared about after 10 minutes, Complete motor paralysis ceased after 60 minutes and muscle reaction returned to normal about 90 minutes after injection, Therafter, myoneural complications were not noticed in the 3 groups for a period of I week. All specimens of the 3 groups were inyestigated under light and with electron microscopic examination and they revealed mild vacuolziations scattered in axons of myelinated and unmyelinated nerves of some of the specimens but these were not significant. As a result of this investigation, we concluded that neurophysiologically, meperidine and pentazocine have local anesthetic-like effect, such as motor paralysis, but not with morphine, and neurohistologically, the above three norcotics have no significant toxic effects on nervous tissues.
Adult ; Anesthesia, Spinal ; Animals ; Axons ; Dogs ; Gait ; Humans ; Ketamine ; Meperidine* ; Morphine* ; Myelin Sheath ; Narcotics ; Paralysis ; Pentazocine* ; Peripheral Nerves ; Rabbits* ; Rats ; Recovery Room ; Sciatic Nerve*

BACKGROUND: Infants are very different from children and adults in the point of anatomy, physiology, pharmacology and psychology. The mortality rate of infant anesthesia is higher than that of child and adult. So that this study is to analyze the infant's operation and to recognize the tendency and problems of infant's anesthesia and also to improve the outcome. METHODS: A retrospective analysis was performed on 1436 infants who had operations from april 1987 to february 1995 according to age, sex, department, disease, operation time, postoperative complications, mortality rate and anesthetic method. RESULTS: Total number of operation tend to increase annually. The male to female ratio was 67.5% to 32.5%. The distribution of patients by department was 60.6% of general surgery, 21.0% of plastic surgery and small percentage of other department. The distribution of disease was the following : inguinal hernia - the most common; cleft lip and palate, intussusception and others. The postoperative complications developed in 98 of 1436. The most common complication was the respiratory problems, the others were sepsis, electrolyte unbalance, gastrointestinal and CNS problems. The total mortality rate was 3.6%. The emergency operation case was 17.9%. CONCLUSIONS: The most common distribution of age was neonate and the most commm department was general surgery and the most common disease was inguinal hernia. The most common postoperative complication was respiratory problems and the second was infection and sepsis. The mortality rate in preterm infant, neonate, emergency operation and long duration operation was higher than total motality rate.
Adult ; Anesthesia* ; Child ; Cleft Lip ; Emergencies ; Female ; Hernia ; Hernia, Inguinal ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Intussusception ; Male ; Mortality ; Palate ; Pharmacology ; Physiology ; Postoperative Complications ; Psychology ; Retrospective Studies* ; Sepsis ; Surgery, Plastic

BACKGROUND: Infants are very different from children and adults in the point of anatomy, physiology, pharmacology and psychology. The mortality rate of infant anesthesia is higher than that of child and adult. So that this study is to analyze the infant's operation and to recognize the tendency and problems of infant's anesthesia and also to improve the outcome. METHODS: A retrospective analysis was performed on 1436 infants who had operations from april 1987 to february 1995 according to age, sex, department, disease, operation time, postoperative complications, mortality rate and anesthetic method. RESULTS: Total number of operation tend to increase annually. The male to female ratio was 67.5% to 32.5%. The distribution of patients by department was 60.6% of general surgery, 21.0% of plastic surgery and small percentage of other department. The distribution of disease was the following : inguinal hernia - the most common; cleft lip and palate, intussusception and others. The postoperative complications developed in 98 of 1436. The most common complication was the respiratory problems, the others were sepsis, electrolyte unbalance, gastrointestinal and CNS problems. The total mortality rate was 3.6%. The emergency operation case was 17.9%. CONCLUSIONS: The most common distribution of age was neonate and the most commm department was general surgery and the most common disease was inguinal hernia. The most common postoperative complication was respiratory problems and the second was infection and sepsis. The mortality rate in preterm infant, neonate, emergency operation and long duration operation was higher than total motality rate.
Adult ; Anesthesia* ; Child ; Cleft Lip ; Emergencies ; Female ; Hernia ; Hernia, Inguinal ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Intussusception ; Male ; Mortality ; Palate ; Pharmacology ; Physiology ; Postoperative Complications ; Psychology ; Retrospective Studies* ; Sepsis ; Surgery, Plastic

The diagnosis of acute inflammation of the placenta, represented as acute chorioamnionitis, is important in that it is associated with a poor clinical outcome for both the mother and the fetus, including major perinatal morbidities such as sepsis, respiratory distress syndrome, and CNS damage. However, current medical trends in Korea seem to overlook the significance of a histopathological diagnosis of acute placental inflammation, mainly due to the indifferences of clinicians and pathologists. Since late 1993, histopathological examinations have been performed on preterm placentas at Seoul National University. These examinations have demonstrated acute placental inflammation in a significant number of cases. In the present study the incidence of acute placental inflammation was analyzed in 521 placentas which were submitted for pathological examinations in 1995. Examinations were performed to provide basic information on the incidence and profile of acute placental inflammation in this hospital and, thereby, to emphasize the significance of histopathological examinations of the placenta in the routine surgical pathology service. Among the 521 placentas, acute inflammation was found in 194 cases (37.2%). In preterm placentas acute inflammation was found in 39.6% of the cases (67/169), while 36.1% (127/352) of term placentas showed acute inflammation. Taking the delivery mode into account, 26.3% (49/186) of the placentas delivered by cesarean section showed acute inflammation, while 43.3% (145/335) of the transvaginally delivered placentas showed inflammation. The present analysis demonstrates the existence of acute inflammation in a significant proportion of placentas with different clinical settings. The importance of a histopathological examination in routine hospital practice should be emphasized.
Incidence

OBJECTIVE: We evaluated the effects and toxicities of docetaxel-carboplatin combination chemotherapy against recurrent or persistent ovarian cancer who were previously heavily treated with one or more lines of chemotherapy. METHODS: Sixteen patients with a recurrent or persistent ovarian cancer, previously received first or more line chemotherapy, had been treated with docetaxel-carboplatin combination chemotherapy at Kosin Medical Center from December 2001 to May 2003. The docetaxel-carboplatin combination chemotherapy consists of docetaxel 75 mg/m2 and carboplatin 450 mg/m2 given i.v. every 3-4 weeks. The response of patients was evaluated with the tumor marker (serum CA-125) and imaging studies (ultrasonogram, CT, MRI). The toxicities were defined according to the WHO toxicity criteria. RESULTS: The overall response rate was 50% (8/16). Eight patients were evaluable for response by WHO criteria. The response rate by WHO criteria was 37.5% (3/8). In detail, complete response was 12.5%, partial response was 25%, stable disease was 37.5% and progressive disease was 25%. The serologic CA-125 response rate was 50% (8/16), in detail serologic partial response was 50%, and serologic stable disease was 31% and serologic progressive disease was 19%. The median response duration was 10 months (3 to 17 months), the median time to response was 1 month (1/2 to 2 months) and the median time to re-progression was 5 months (3 to 7 months). The most common toxicity was gastrointestinal toxicity and the bone marrow suppression was proved as a most serious side effect. CONCLUSION: The docetaxel-carboplatin chemotherapy as a 2nd or more lines regimen against heavily pre-treated recurrent or persistent ovarian cancer is considerable but was associated significant gastrointestinal and bone marrow side effects. Routine premedication is recommended.
Bone Marrow ; Carboplatin* ; Drug Therapy* ; Drug Therapy, Combination* ; Humans ; Ovarian Neoplasms* ; Premedication