OBJECTIVES: We report two cases of anosmia that were suspected to be caused by chronic chlorine exposure in cleansing works METHODS: We examined the cases in order to assess the work-relatedness of their anosmia. We conducted olfactory threshold test and olfactory perception test repeatedly at one-month intervals. Using ion chromatography, we analyzed the detergent that the workers had been using for several years before their olfactory function decreased. RESULTS: A 59-year-old male who had worked in a cleansing process for 10 years (1983-1993) and a 58-year-old female who had worked in the same process for 8 years (1987-1995) were diagnosed with anosmia. The cause of the anosmia was presumed to have been the chlorine gas that was generated from the process of heating the detergent-dissolved water, in which chloride was detected. CONCLUSIONS: This is the first report on anosmia due to chronic chlorine exposure. Greater attention needs to be focused on the prevention of anosmia because there are many workers who have been exposed to chlorine gas in chlorine treating and generating processes.
Chlorine* ; Chromatography ; Detergents ; Female ; Heating ; Hot Temperature ; Humans ; Male ; Middle Aged ; Olfaction Disorders* ; Olfactory Perception ; Water

PURPOSE: To evaluate the antiproliferative and antifibrotic effects of alpha-tocotrienols in primary cultured orbital fibroblasts from thyroid-associated ophthalmopathy (TAO) patients. METHODS: Orbital fibroblasts were cultured (5 eyes from TAO patients, 5 eyes from normal patients) and classified into a control group, alpha-tocotrienol group and alpha-tocopherol group. The cell viability was measured using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay. The proliferation of orbital fibroblasts was measured using the Click-iT(TM) assay. The collagen production of the control and alpha-tocotrienol groups was measured using a hydroxyproline assay. RESULTS: The alpha-tocotrienol and alpha-tocopherol groups showed no cytotoxicity up to 150 microm in orbital fibroblasts from TAO and normal patients. The proliferation of orbital fibroblasts from TAO and normal patients was significantly inhibited with alpha-tocotrienol at 80 microm and 120 microm. The collagen production of orbital fibroblasts from TAO patients was significantly inhibited with alpha-tocotrienol at 120 microm. CONCLUSIONS: The results from the present study indicate that non-toxic concentrations of alpha-tocotrienol have significant antiproliferative and antifibrotic effects on orbital fibroblasts from TAO patients.
alpha-Tocopherol ; Cell Survival ; Collagen ; Eye ; Fibroblasts ; Fibrosis ; Graves Ophthalmopathy ; Humans ; Hydroxyproline ; Orbit ; Tetrazolium Salts ; Thiazoles ; Troleandomycin ; Vitamin E

Twenty-one patients undergoing aortic valve replacement for pure aoritic regurgitation were studied retrospectively to evaluate the left ventricular function and internal dimension change before, 1-6 weeks(early postoperative) and 2-36 months after(late postoperative) aortic valve replacement by serial echocardiography. Postoperatively, NYHA function class improved remarkably (from 3.3+/-0.6 to 1.4+/-0.7). Early postoperatively, left ventricular end-diastolic dimension (EDD), left ventricular end-systolic dimension(ESD), left ventricular fractional shortenting(FS) significantly decreased in all patients(7.6+/-1.2cm vs 5.8+/-1.5cm P<0.001, 5.5+/-1.3cm vs 4.7+/-1.3cm P<0.001, 39+/-12% vs20+/-8% P<0.001 respectively). Interventricular septum thickness(IVS) and posterior wall thickness (PW) were slightly thickened before(1.4+/-0.3cm, 1.3+/-0.3cm respectively) and in the early postoperative period (1.3+/-0.4cm, 1.3+/-0.3cm respectively) without significant interval change. Late postoperatively, EDD and ESD decreased significantly (7.8+/-1.2cm vs 5.1+/-0.8cm P<0.01, 5.1+/-1.1cm vs 3.4+/-0.8cm P<0.001. respectively), and FS increased significantly (25+/-9% vs 34+/-9%, P<0.05). Among 3 patients of so called high risk group mentioned by Henry(22,33), ESD and FS improved to normal range in 2 patients, and ESD decreased to 4.4cm and FS increased to 33% in the other one. EDD and ESD decreased significantly in both group I(preoperative ESD<5.5cm) and group II(preoperative ESD<5.5cm), without no decrement difference between two groups, and there was a significant difference of FS decrement between group I and group II at early postoperative period. Preoperative ESD correlated highly with the early postoperative EDD(r=0.89) and ESD(r=0.87) with statistical significance, and moderately high with late postoperative EDD(r=0.45), ESD(r=0.50) and FS(r=0.42) without statistical signiticance. We concluded that there was significant improvement in left ventricular function in pure aortic regurgitation patients postoperatively. Preoperative left ventricular and systolic dimension above 5.5cm and fractional shortenting below 25% are not so reliabel index of poor postoperative prognosis.
Aortic Valve Insufficiency* ; Aortic Valve* ; Echocardiography* ; Humans ; Postoperative Period ; Prognosis ; Reference Values ; Retrospective Studies ; Ventricular Function, Left

To evaluate the change in valvular morphology and occurence and severity of mitral regurgitation produced by PMV, 45 patients(33 women and 12 men,mean age 38+/-10 years) were studied using two-dimensional(2-D) and Doppler echocaediography before and 1-2 days after this procedure. Mitral valve area after PMV increased in all patients, from 0.9+/-0.2 to 1.8+/-0.4cm2(P<0.0001). In valve area estimation, the correlation between Gorlin`s method and 2-Dechocardiography was better(r=0.61, p<0.0001) than that between Gorlin`s method and Doppler pressure halftime(r=0.38, P<0.01) before valvuloplasty, but after the procedure Gorlin`s and 2-D image valve area correlated less well(r=0.33, P<0.05) than Gorlin`s-Doppler pressure halftime correlation(r=0.46, P<0.002). Before PMV, 37 patients had no mitral regurgutation, 7 had grade 1 and 1 had grade 2 mitral regurgutation. After PMV, new mitral regurgutation occurred in 14 patients, increased in severity in 5 patients and so mitral regurgutation newly developed or increased in severity in 19(42%) patients. There were no differences between the patients with and those without an increase in mitral regurgutation after PMV, in age, sex, caediac rhythm, initial mitral valve area, increase in mitral valve area and fluoroscopic calcification. However, morphologic characteristics especially mobility(P<0.01) and thickening(P<0.05) of mitral leaflets were better pressured, and EBDA/BSA(effective balloon dilating area/body surface area) was significantly smaller(P<0.02) in patients without an increase in mitral regurgutation. Thus, an increase in mitral regurgutation after PMV might be related to the features of valve morphology especially and thickand EBDA/BSA.
Female ; Humans ; Mitral Valve ; Mitral Valve Insufficiency* ; Mitral Valve Stenosis

OBJECTIVES: To integrate the results of studies which assess an association between blood lead and blood pressure. METHODS: We surveyed the existing literature using a MEDLINE search with blood lead and blood pressure as key words, including reports published from January 1980 to December 2000. The criteria for quality evaluation were as follows: 1) the study subjects must have been workers exposed to lead, and 2) both blood pressure and blood lead must have been measured and presented with sufficient details so as to estimate or calculate the size of the association as a continuous variable. Among the 129 articles retrieved, 13 studies were selected for quantitative meta-analysis. Before the integration of each regression coefficient for the association between blood pressure and blood lead, a homogeneity test was conducted. RESULTS: As the homogeneity of studies was rejected in a fixed effect model, we used the results in a random effect model. Our quantitative meta-analysis yielded weighted regression coefficients of blood lead associated with systolic blood pressure and diastolic blood pressure results of 0.0047 (95% confidence interval [CI]: -0.0061, 0.0155) and 0.0004 (95% CI: -0.0031, 0.0039), respectively. CONCLUSIONS: The published evidence suggested that there may be a weak positive association between blood lead and blood pressure, but the association is not significant.
Blood Pressure*

To our knowledge, only one case of vaginal cavernous hemangioma in pregnancy has been reported all over the world and there is no report in Korea. The authors have experienced one case of vaginal cavernous hemangioma in pregnancy and report our case with a brief review of literature.
Hemangioma, Cavernous* ; Korea ; Pregnancy* ; Vagina

To our knowledge, implantation into the uterine muscle wall is one of the rare form of ectopic pregnancy, with only 16 cases reported until 1995. The early diagnosis depends upon the sonographic finding of intramural gestational sac-like growth and persistent high beta human chorionic gonadotropin (beta-hCG) levels after dilatation and curettage. But, nobody can't exclude intramural pregnancy in case that associated with adenomyosis in uterus in spite of negative beta-hCG. Hsieh et al. and Dousias et al. mentioned 2 cases of such situation with negative beta-hCG result. And confirmative diagnosis depends upon the pathologic finding for specimen obtained from laparoscopic or explorative hysterotomy. The authors have experienced one case of intramural pregnancy in uterus and report our case with a brief review of literature.
Adenomyosis ; Animals ; Chorionic Gonadotropin ; Diagnosis ; Dilatation and Curettage ; Early Diagnosis ; Female ; Hysterotomy ; Mice ; Myometrium ; Pregnancy* ; Pregnancy, Ectopic ; Ultrasonography ; Uterus*

PURPOSE: Necrotizing fasciitis is a rare, life-threatening, and rapidly progressive soft tissue infection associated with extensive necrosis. Despite recent advances in its management, outcomes have not improved and the mortality rate from this disease is still high. The objective of this study was to identify the predictive factors of mortality for patients diagnosed with necrotizing fasciitis in the ED. METHODS: A total of 38 necrotizing fasciitis cases diagnosed by an emergency department from January 2001 to April 2012 were retrospectively reviewed. RESULTS: Mean serum lactate levels were significantly higher in non-survivors than survivors (8.03+/-4.48 vs. 3.26+/-2.46, p=0.001). Serum glucose levels, arterial pCO2, and HCO3 values were significantly lower in non-survivors than survivors (114.75+/-78.01 vs. 203.92+/-122, p=0.027;25.02+/-6.82 vs. 32.74+/-7.06, p=0.005; 13.76+/-6.08 vs. 20.63+/-5.12, p=0.002, respectively). Microorganisms isolated included coagulase-negative Staphylococci from seven patients (18.4%), Acinetobacter baumannii from six patients (15.8%), Enterococcus faecium from five patients (13.2%), Staphylococcus aureus from five patients (13.2%), Beta-hemolytic Streptococcus from three patients (7.9%), Enterococcus faecalis from three patients (7.9%), Escherichia coli from two patients (5.3%), Pseudomonas aeruginosa from two patients (5.3%), Enterobacter cloaca from two patients (5.3%), Klebsiella oxytoca from two patients (5.3%), and Klebsiella pneumonia from two patients (5.3%). More Acinetobacter baumannii were cultured from the non-survival group than the survival group (p=0.022), while there was no statistical difference from surgical treatment between the survivor and non-survivor group (p=0.460). Interestingly, serum lactate levels above 4.0 mmol/L were a predictor of mortality in the ED (OR, 20.000; confidence interval, 1.796-222.777). CONCLUSION: Initial serum lactate levels above 4 mmol/Larea predictor of mortality in patients diagnosed with necrotizing fasciitis in the ED.
Acinetobacter baumannii ; Blood Glucose ; Cloaca ; Emergencies* ; Enterobacter ; Enterococcus faecalis ; Enterococcus faecium ; Escherichia coli ; Fasciitis, Necrotizing* ; Humans ; Klebsiella ; Klebsiella oxytoca ; Lactic Acid ; Mortality* ; Necrosis ; Pneumonia ; Pseudomonas aeruginosa ; Retrospective Studies ; Soft Tissue Infections ; Staphylococcus aureus ; Streptococcus ; Survivors

PURPOSE: Necrotizing fasciitis is a rare, life-threatening, and rapidly progressive soft tissue infection associated with extensive necrosis. Despite recent advances in its management, outcomes have not improved and the mortality rate from this disease is still high. The objective of this study was to identify the predictive factors of mortality for patients diagnosed with necrotizing fasciitis in the ED. METHODS: A total of 38 necrotizing fasciitis cases diagnosed by an emergency department from January 2001 to April 2012 were retrospectively reviewed. RESULTS: Mean serum lactate levels were significantly higher in non-survivors than survivors (8.03+/-4.48 vs. 3.26+/-2.46, p=0.001). Serum glucose levels, arterial pCO2, and HCO3 values were significantly lower in non-survivors than survivors (114.75+/-78.01 vs. 203.92+/-122, p=0.027;25.02+/-6.82 vs. 32.74+/-7.06, p=0.005; 13.76+/-6.08 vs. 20.63+/-5.12, p=0.002, respectively). Microorganisms isolated included coagulase-negative Staphylococci from seven patients (18.4%), Acinetobacter baumannii from six patients (15.8%), Enterococcus faecium from five patients (13.2%), Staphylococcus aureus from five patients (13.2%), Beta-hemolytic Streptococcus from three patients (7.9%), Enterococcus faecalis from three patients (7.9%), Escherichia coli from two patients (5.3%), Pseudomonas aeruginosa from two patients (5.3%), Enterobacter cloaca from two patients (5.3%), Klebsiella oxytoca from two patients (5.3%), and Klebsiella pneumonia from two patients (5.3%). More Acinetobacter baumannii were cultured from the non-survival group than the survival group (p=0.022), while there was no statistical difference from surgical treatment between the survivor and non-survivor group (p=0.460). Interestingly, serum lactate levels above 4.0 mmol/L were a predictor of mortality in the ED (OR, 20.000; confidence interval, 1.796-222.777). CONCLUSION: Initial serum lactate levels above 4 mmol/Larea predictor of mortality in patients diagnosed with necrotizing fasciitis in the ED.
Acinetobacter baumannii ; Blood Glucose ; Cloaca ; Emergencies* ; Enterobacter ; Enterococcus faecalis ; Enterococcus faecium ; Escherichia coli ; Fasciitis, Necrotizing* ; Humans ; Klebsiella ; Klebsiella oxytoca ; Lactic Acid ; Mortality* ; Necrosis ; Pneumonia ; Pseudomonas aeruginosa ; Retrospective Studies ; Soft Tissue Infections ; Staphylococcus aureus ; Streptococcus ; Survivors

PURPOSE: To report our opinions of management about avascular necrosis following operative treatment of talar fracture and dislocation. MATERIALS AND METHODS: We followed up 5 patients who were diagnosed as talar avascular necrosis after operation of talar fracture and dislocation. Clinical and radiological analysis were performed. The mean age of patients was 36 years. There were 4 males and 1 females. The average follow up was 51 months. Hawkins scoring system was used as clinical evaluation. RESULTS: Regardless of radiological sclerotic finding, all patients showed satisfactory clinical result. Despite arthritic change in one patient, there were no further radiological and clinical deterioration to require salvage procedure. CONCLUSION: Most avascular necrosis after operative treatment of talar fracture and dislocation showed satisfactory result with conservative treatment. Thus, salvage operation such as talectomy or ankle fusion should be reserved in cases of intractable ankle pain and claudication.
Ankle ; Dislocations* ; Female ; Follow-Up Studies* ; Humans ; Male ; Necrosis*