BACKGROUND: Methemoglobinemia(MetHb) induced by dapsone overdose is not uncommon in Korea, especially in rural area. For treatment of dapsone-induced methemoglobinemia, methylene blue(MB) and activated charcoal(AC) should be used. To date, no reports have compared the amount of MB used between MB alone with MB & AC combined group(MB+AC). And also between moderate (MetHb<35%) and severe (MetHb>35%) intoxicated group defined by initial MetHb level. Authors hypothesized that less amount of MB can be used if MB and AC was used together and larger amount of MB is necessary to reduce MetHb level to asymptomatic level in severely intoxicated group. METHODS: From Jan 1990 to Dec 1996, a total of 54 patients who received treatment for dapsone intoxication were subject of study, The study was done retrospective chart analysis for initial MetHb level, total amount of MB and AC. Wilcoxon rank sum test and Chi-sqiare test was used to compare the total dosage of MB used for each group. Linear regression analysis was used between initial MetHb and the total amount of MB. Results were considered statistically significant when p<0.05. RESULTS: For MB alone and MB+AC group, the differences in total amount of MB used were statistically significant with mean dosage of 7.14+/-1.1mg/kg and 4.28+/-0.7mg/kg, respectively. And total amount of MB used between moderate and severe intoxicated group, the differences were statistically significant with mean dosage of 5.16+/-1.1mg/kg vs. 10.98+/-1.9mg/kg, respectively. There was significant correlation between initial MetHb level (X) and the amount of methylene blue (Y), Y=0.3X-2.42 (r2=0.41, p=0.0001) in MB alone, Y=0.186X-1.95(r2=0.21, p=0.034) in MB+AC respectively. CONCLUSION: For methemoglobinemia induced by dapsone, total amount of MB can be reduced especially in severe Intoxicated group if AC use was combined in treatment modality. There was significant correlationship between initial MetHb level and total amount of MB used.
Charcoal* ; Dapsone* ; Humans ; Korea ; Linear Models ; Methemoglobinemia ; Methylene Blue* ; Retrospective Studies

BACKGROUND: The pediatric CPR is rather uncommon practice than adult CPR in emergency room. Therefore, few interest and studies were focused in pediatric CPR. The object of this study is to make an analysis about pediatric CPR performed within hospital setting. METHOD: From January 1. 1990 to December 31. 1996, a total of 59 patients, less than 15-year-old, who received cardiopulmonary resuscitation were subject of this study. The study was done retrospective chart analysis for sex, age, weight, the place of cardiac arrest, initial EKG rhythms, endotracheal tube size, the causes of arrest, CPR time, ROSC, the amount and types of CPR drugs used during resuscitation. Wilcoxon rank sum test and chi2 test were used to compare the dose of drugs during CPR in each group. RESULTS: There were no statistical difference between ROSC and non-ROSC group in place of arrest, initial EKG rhythms, CPR time, dosage of CPR drugs. CONCLUSION: The uniform reporting guideline of pediatric advanced life support should be used for future pediatric CPR study, such as Utstein style guideline in pediatric CPR.
Adolescent ; Adult ; Cardiopulmonary Resuscitation* ; Electrocardiography ; Emergency Service, Hospital ; Heart Arrest ; Humans ; Resuscitation ; Retrospective Studies

PURPOSE: To evaluate the prevalence of the opacification of paranasal sinuses and to correlate the prevalence and severity of the sinus opacification with presence of upper respiratory infection (URI) in infants and children using CT. MATERIALS & METHODS: We analyzed CT scans of 162 children aged under 16 who have no signs and symptoms of paranasal sinusitis. Both sides of maxillary and ethmoidal sinuses were evaluated. We scored from 0 to 3 according to the degree of soft tissue opacification of each sinus and then summed up the scores of each sinus. We divided the children into 5 groups according to their age. We paid particular attention to the following respects: 1) the prevalence of the opacification of the paranasal sinuses in each group; 2) the difference in the prevalence between the children with and without URI ;3) the correlation between the severity of the sinus opacification and the presence of URI. RESULTS: Of 162 children, one or more paranasal sinus opacification was noted in 76(47 %):31(65%) less than 1 year old;11(52%) between 1 and 2 years old;16(53%) between 2 and 6 years old ;15(28%) between 6 and 12 years old;and 3(33%) above 12 years old. In children less than 1 year old, no significant difference in the prevalence of the sinus opacification was found between URI-positive(71%) and URI-negative(58%) subgroups. In chilren between 1 and 12 years old, although the prevalence of the sinus opacification in URI-positive subgroups was much greater than that in URI-negative subgroup, statistically significant difference was noted only in children between 2 and 6 years old. As to the correlation between the severity of the sinus opacification and the presence of URI, these was a statistically significant difference in children between 2 and 6 years old and between 6 and 12 years old. CONCLUSION: Although the exact pathophysiology is not fully understood, the opacification of the paranasal sinuses is not an uncommon finding at CT in children without the signs and symptoms of sinusitis. We think that the clinical correlation is essential in determining the diagnosis and treatment plan in cases that the sinus radiographs or CT scans show the abnormal findings.
Child* ; Diagnosis ; Humans ; Infant* ; Paranasal Sinuses ; Prevalence* ; Sinusitis* ; Tomography, X-Ray Computed

OBJECTS: Event related potential(ERF) has been recently applied to examine the neurophysiological disturbance in attention deficit hyperactivity disorder(ADHD), particularly with regard to N100 and P300 which are known as one of ERP components closely linked with cognitive function. On the basis of these aspects, this study was designed to evaluate electrophysiologic characteristics and its availability for diagnosis and treatment of ADHD children by comparison of ERP between normal controls and ADHD children before and after methylphenidate (MFD) administration. METHODS: We examined the topographic auditory ERF and T.O.V.A.(Test of variables of attention), a standardized computerized visual continuous performance test following administration of stimulant drug, MPD 10mg in 13 ADHD children and compared these results with those of 11 normal controls. RESULTS: The results were as follows: 1) Thought the difference was not spastically significant(P=0.0548), N100 latencies seemed to be longer in ADHD children than in normal controls. N100 amplitudes also seemed to be larger in ADHD children than in normal controls(P=0.0629). 2) The F300 latencies significantly shortened after MFD administration when compared with those before MPD administration in ADHD group(P<0.01). 3) ADHD group performed significantly less well than normal controls in T.O.V.A.(P<0.05). And T.O.V.A. scores significantly improved after MFD administration in ADHD group(P<0.01). 4) The N100 and P300 latencies and the T.O.V.A. scores were significantly correlated before MPD administration in ADHD group(P<0.05). 5) The F300 latencies before MFD administration were significantly correlated with the amplitudes of changes of T.O.V.A. scores after MFD administration(P<0.05). CONCLUSION: It seems that prolonged N100 latency of ADHD children can be regarded as a relatively enduring trait marker and that F300 latency may reflect attentional response ability along with therapeutic effect by stimulant.
Attention Deficit Disorder with Hyperactivity* ; Child* ; Diagnosis ; Evoked Potentials* ; Humans ; Methylphenidate* ; Muscle Spasticity

BACKGROUND: Activated charcoal has been widely used as an adsorbent for the management of drug intoxicated patients in the emergency department(ED). Although there are several commercial ready-mixed charcoal suspension preparations in the market, we are using custom-made suspension from hospital grade bulk charcoal powder. We designed this study to compare the adsorptive capacity of the Actidose Aqua(R), which is a commercial charcoal product, Fuller's earth, and custom-made activated charcoal used in our ED. METHODS: First, we performed modified USP methylene blue adsorption test which is a standard adsorption test for activated charcoal. Then, the drug adsorption test for phenobarbital, acetaminophen, salicylate, and aminophylline was done. Graded amount of three adsorptives were added to the stock solutions of each drugs. The adsorption test were performed as follows: The vials containing drugs and adsorptives were shaken for 30 minutes to ensure adsorption equilibrium, then the suspension was filtered through in-line filter. The filtrates were analyzed by ultraviolet spectroscopy to determine the residual drug concentrations. Finally we examined and compared the surface area and the structure of activated charcoal and Fuller's earth using scanning electron microscopy. RESULTS: In methylene blue adsorption test, the adsorption rate was 60.1% in Actidose Aqua(R) and 59.0% in custom-made charcoal, and 70.2% in Fuller's earth. For the phenobarbital, acetaminophen, and sallcylate, the adsorption rate of Actidose Aqua(R) and custom-made charcoal was greater than 90% with the ratio o adsorptives to drugs over 10:1. For aminophylline, two charcoal products showed excellent adsorption in 5:1 ratio. But Fuller's earth showed poor adsorption in all rages. CONCLUSION: Custom-made activated charcoal showed a comparable adsorption capacity to Actidose Aqua(R). Fuller's earth showed a poor performance to be used as a substitute for activated charcoal in acute drug poisoning otherwise paraquat.
Acetaminophen ; Adsorption ; Aminophylline ; Charcoal* ; Emergencies ; Humans ; Methylene Blue ; Microscopy, Electron, Scanning ; Paraquat ; Phenobarbital ; Poisoning ; Rage ; Spectrum Analysis

BACKGROUND: Tumor recurrence is the most common cause of treatment failure, even after complete resection of early-stage non-small cell lung cancer (NSCLC). In this study, we investigated the prognosis of patients with early recurrence in order to identify independent risk factors related to early recurrence. METHODS: Between February 1995 and December 2012, 242 patients who underwent surgical resection for stage I NSCLC at Dong-A University Hospital were reviewed. The factors predicting overall survival (OS) and early recurrence were investigated. We also investigated the relationship between the patterns and period of recurrence and clinicopathological factors. RESULTS: For patients with stage IA and IB NSCLC, the 5-year OS rate was 75.7% and 57.3% (p=0.006), respectively. A multivariate Cox proportional hazards model demonstrated that gender (p=0.004), comorbidity number (p=0.038), resection type (p=0.002), and tumor size (p=0.022) were the statistically significant predictors of OS. Moreover, the multivariate analysis revealed that smoking history (p=0.023) and histologic grade (p=0.012) were the independent predictors of early recurrence. Additionally, only histologic grade (poor differentiation) was found to be significantly associated with a higher frequency of distant metastasis; there was no relationship between the patterns and period of recurrence and clinicopathological factors. CONCLUSION: The present study demonstrated that smoking history and histologic grade were independent prognostic factors for early recurrence within two years in patients with early-stage NSCLC. Patients with these predictive factors may be good candidates for adjuvant therapy.
Carcinoma, Non-Small-Cell Lung* ; Comorbidity ; Humans ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis* ; Proportional Hazards Models ; Recurrence* ; Risk Factors ; Smoke ; Smoking ; Treatment Failure

No abstract available.
Acute Kidney Injury* ; Fever* ; Nephritis, Interstitial*

To evaluate the normal development of the paranasal sinuses in children with CT, authors prospectively studied with brain CT scans of 260 children without known sinus diseases, ranging in age from 7 days to 16 years. Maximal anteroposterior and transverse diameters(mm) and maximal cross-sectional area(mm2) of both sides of the maxillary sinus were measured with the aid of computer device. As to the ethmoidal and sphenoidal sinuses, we simply documented the presence of the aplastic ethmoidal sinus and calculated the age-incidence of the sphenoidal sinus pneumatization, respectively. There noted three phases in the development of the maxillary sinus. The anteroposterior and transverse diameters of the maxillay sinus increased nearly in parallel. The former was always greater than the latter. In no cases was the ethmoidal sinus aplastic and almost all sinuses were pneumatized even in infants as early as 7 days old. CT identified the conchal pattern of sphenoidal sinus pneumatization in infants as early as 11 days old. Sphenoidal sinus pueumatization was seen in 38% of the children under the age of 1 year, 82% of the children between the age of 1 and 2 years, and almost all children older than 2 years. The anteroposterior and transverse diameters of the maxillary sinus seem to reach the adult size by 8 years of age, and the conchal pattern of sphenoidal sinus pneumatization can be recognized earlier with CT than on the plain radiographs.
Adult ; Brain ; Child* ; Humans ; Infant ; Maxillary Sinus ; Paranasal Sinuses* ; Prospective Studies ; Tomography, X-Ray Computed

Severe hypoglycemia leading to permanent brain damage is rare in non-diabetic population. We present one case where chronic alcoholism combined with prolonged fasting lead to such a state. A 51-year-old male patient, a chronic alcoholic, was found unconscious and brought to the emergency room. At the time of hospitalization, consciousness was stupor and he had a blood glucose of 5 mg/dl and MRI of the brain showed high signal density of the inner temporal gyrus and both hippocampus in T2 weighted imaging. There was no history of diabetes. After two months of rehabilitation, improvements were showed to Rancho Los Amigos recognition scale IV, fair grade of muscular strength in upper and lower limbs, FIM score of 21, and dysphagia was improved and nutrition supply was intaken orally. An alcoholic for a long period of time without adequate nutrient supply was experienced to develop into hypoglycemic encephalopathy and therefore reported.

An university student passed away by an unidentified bullet in a reserve force exercise. An X-ray could not find any bullet from the thorax. The post-mortem examination revealed that the victim had been killed by a 5.56 mm (diameter) bullet. The striation mark of the fatal bullet was coincided with a test fired bullet of a suspect's machine gun. However only blank cartridges had been fired according to the firing range records. Also, the examiner found that the mouth diameter of the fatal blank cartridge case is narrower than the others. In order to explain the strange happening, various situation of blank cartridge firing was considered. The examiner group noticed that the diameter of a blank cartridge mouth fired from an unexpelled bullet including gun may change. The authors test fired a blank cartridge case with a gun including an unexpelled bullet, and compared the shape of the mouth with the fatal blank cartridge case. The mouth shapes of two blank cartridges were coincided. The authors could conclude that the an unidentified suspect charged a bullet in the muzzle of the suspect's gun, and the bullet expelled by the gas pressure of the fatal blank cartridge case.
Autopsy ; Fires* ; Humans ; Mouth ; Thorax