Acute organophosphate (OP) poisoning produces cholinergic symptoms resulting from the inhibition of cholinesterase, and the overstimulation of muscarinic and nicotinic receptors in the synapses. The dominant clinical features of acute cholinergic toxicity include bradycardia, miosis, lacrimation, salivation, bronchorrhea, and bronchospasm. All symptomatic patients should receive therapy with oxygen, atropine, and pralidoxime. Atropine works as a physiologic antidote by competitively occupying muscarinic receptor sites, reducing the effects of excessive acetylcholine. Atropine should be immediately administered, and the dose can be titrated according to the severity of OP poisoning. A large dose may be necessary to overcome the excessive cholinergic state in case of severe poisoning. Pralidoxime is a biochemical antidote that reactivates acetylcholinesterase by removing OP from it. It is effective in treating both muscarinic and nicotinic symptoms. After some period of time, the acetylcholinesterase-OP compound undergoes a conformational change, known as aging, which renders the enzyme irreversibly resistant to reactivation by a pralidoxime. There has been a great deal of controversy over the effectiveness of pralidoxime in acute OP poisoning. However, it may be beneficial to administer pralidoxime for a sufficient period in case of severe poisoning with a large quantity of OP, which is common in Korea.
Acetylcholine ; Acetylcholinesterase ; Aging ; Atropine* ; Bradycardia ; Bronchial Spasm ; Cholinesterases ; Humans ; Korea ; Miosis ; Oxygen ; Poisoning* ; Pralidoxime Compounds ; Receptors, Muscarinic ; Receptors, Nicotinic ; Salivation ; Synapses

No abstract available.
Bone Density* ; Female ; Lactation*

No abstract available.
Bone Density* ; Female ; Lactation*

BACKGROUND: Coronary artery bypass graft (CABG) surgery is performed more frequently than before in Korea. Central nervous system (CNS) complications are often the major prognostic determinants following the surgery. We carried out a prospective study to clarify the incidence and risk factors of neurologic complications after CABG surgery. METHODS: A consecutive series of 150 patients undergoing 152 CABG operations from March 1995 to July 1997 by one cardiac surgeon was evaluated by a team of neurologists before and after the surgery. The patients received extensive preoperative examinations including the evaluation of intracranial & extracranial cerebral artery disease. RESULTS: In 44 operations (28.9%), we detected various neurologic complications, including encephalopathy (36 operations, 23.7%), cerebral infarction (5 operations, 3.3%), and seizure (7 operations, 4.6%). Eight patients died postoperatively including one due to neurologic complication. On univariate analysis, age, degree of intracranial artery disease (ICAD), duration of bypass time, hypotension index, duration of ventricular assistant device (VAD), intraoperative event, intra- or postoperative arrhythmia, reoperation, and postoperative bleeding were statistically significant risk factors of CNS complications (p< 0.05). After multivariate analysis, however, age alone remained significant (p=0.02). The degree of ICAD showed marginal significance (p=0.06). CONCLUSIONS: The incidence of CNS complication in the patients undergoing CABG surgery was 28.9%. Our results showed that age was an independent risk factor of CNS complications. And the possibility of ICAD as a risk factor was suggested. Further study with a large number of patients would be necessary to prove the above suggestion.
Arrhythmias, Cardiac ; Arteries ; Central Nervous System* ; Cerebral Arterial Diseases ; Cerebral Infarction ; Coronary Artery Bypass* ; Coronary Vessels* ; Hemorrhage ; Humans ; Hypotension ; Incidence ; Korea ; Multivariate Analysis ; Prospective Studies ; Reoperation ; Risk Factors ; Seizures ; Transplants

Three cases of cerebrospinal fluid (CSF) rhinorrhea and anterior skull base defects were successfully treated by applying mucoperichondrial free graft through the endonasal endoscopic technique. The causes of the skull base defects were trauma in two cases and endoscopic sinus surgery in one case. The defects were located in the sphenoid sinus in one case and the fovea ethmoidalis in two cases. In these cases, contralateral side septal mucoperichondrial free grafts were used to seal the defects and were supported with fibrin glue and Spongostan(R). Endoscopic repair with mucoperichondrial free graft appeared to be a safe and successful approach to the treatment of the anterior skull base defects.
Cerebrospinal Fluid Rhinorrhea* ; Cerebrospinal Fluid* ; Fibrin Tissue Adhesive ; Skull Base ; Sphenoid Sinus ; Transplants*

No abstract available.
Pregnancy, Heterotopic*

No abstract available.
Pregnancy, Heterotopic*

A 39-year-old woman has had several episodes of transient right hemiplegia. On neurological examination during the ictal period she had alert consciousness with aphasia, head and eyeball deviation to the right side, and right hemiplegia. Brain MRI was normal. EEG-video monitoring of ictal period showed continuous ictal discharge in the midline frontocentral area coincided with right hemiplegia. After injection of diazepam, the ictal discharge and right hemiplegia disappeared. We report a case of status epilepticus characterized by ictal hemiplegia.
Adult ; Aphasia ; Brain ; Consciousness ; Diazepam ; Female ; Head ; Hemiplegia* ; Humans ; Magnetic Resonance Imaging ; Neurologic Examination ; Status Epilepticus*

Malignant leptomeningeal metastases involving both internal auditory canals (IACs) are rare and can mimic neurofibromatosis type 2 (NF2). Rapid progression of symptoms and involvement of facial nerve are characteristic clinical courses in contrast to the slow progression of symptoms in NF2. We report a rare case suspected to be metastatic tumor involving bilateral IACs, and presenting sudden bilateral hearing loss in a patient who was previously treated for adenocarcinoma of lung.
Adenocarcinoma ; Facial Nerve ; Hearing Loss, Bilateral ; Humans ; Lung ; Lung Neoplasms ; Neoplasm Metastasis ; Neurofibromatosis 2

PURPOSE: Well differentiated thyroid carcinomas are mostly curable diseases. Invasion of aerodigestive tract by thyroid carcinoma is rare. However, it is considered as a poor prognostic indicator of survival. Some studies showed that local invasion of thyroid carcinoma was the cause of death in many patients. Therefore, adequate local control of the tumor is critical to avoid the mortality as well as the morbidity of the disease. To find proper and adequate treatment modality of locally invasive thyroid carcinoma, we evaluated treatment modalities and outcomes in the patients with thyroid carcinoma with invasion of aerodigestive tract. METHODS: Forty patients with thyroid carcinoma invading aerodigestive tract who were treated from July 1989 through July 2002 were reviewed retrospectively. RESULTS: Direct intraluminal invasion of the thyroid carcinoma requires definitive resection of the aerodigestive tract. In case that the extent of tumor was thought to be limited to perichondrium or extraluminal invasion, tracheal shaving procedure was performed. Five-year and 10-year local control rates were 81.6% and 57.4%, respectively. Disease-specific survival rates of 5-year and 10-year were 90.1% and 81.1%, respectively. CONCLUSION: For the successful treatment of invasive thyroid carcinoma, the resection of the functional structures or the aerodigestive tract should be determined prudently according to the presence of the intraluminal invasion.
Cause of Death ; Humans ; Mortality ; Retrospective Studies ; Survival Rate ; Thyroid Gland* ; Thyroid Neoplasms*