Objective: This study classified patients with acute pharmaceutical drug poisoning who visited the emergency department (ED) to identify clinical characteristics that could be used as the foundation for poisoning prevention programs. Methods: Adult patients aged ≥19 years who visited one of the 23 EDs in South Korea between 2011 and 2018 with pharmaceutical drug poisoning were analyzed retrospectively by sex. The data were sourced from in-depth survey data and the ED patient surveillance system managed by the Korea Disease Control and Prevention Agency. Results: A total of 21,620 cases were analyzed. The sample had more female cases, 15,057 (69.6%); the mean age was 48.3±18.7 years for men and 44.7±17.2 years for women. The onset time was mostly between 18:00 and 24:00 hours; most patients visited the ED via 119 or private vehicles; 5,498 (83.8%) men and 13,070 (86.8%) women reported intentional poisoning; the cause being an intention to commit suicide, though most patients had no history of previous suicide attempts. The frequency of intensive care unit admission and mortality were higher in males than females. When a comparison of the type of drug by sex was carried out, it was observed that analgesic and anti-inflammatory drug poisoning were more frequent in females. On the other hand, cardiovascular drug poisoning was more frequent in males. Conclusion There were more women than men among patients with pharmaceutical drug poisoning. Severity was found to be higher in men than women. In most cases, the poisoning was intentional, and the cause of poisoning was a suicide attempt. Sedatives and antipsychotic drugs were the most commonly used drugs in both groups.

Fibrous dysplasia is a benign, bony abnormality that is usually asymptomatic. A 41-year-old male with minimal symptoms presented at this hospital with abnormal findings incidentally seen in his ribs on the chest radiograph. A skeletal survey showed numerous, osteolytic lesions throughout multiple bones. Diagnostic processes for malignancy of undefined primary origin (MUO) were performed in order to identify the underlying primary neoplasm, although abnormal findings were not seen except for multiple bone lesions. A computed tomography guided bone biopsy was performed on his left rib. The final diagnosis was fibrous dysplasia. This case demonstrates that fibrous dysplasia should be considered in the differential diagnosis in young patients with multiple, osteolytic lesions and without a prior history suggesting malignancy.
Adult ; Biopsy ; Bone Neoplasms ; Diagnosis ; Diagnosis, Differential ; Fibrous Dysplasia, Polyostotic* ; Humans ; Male ; Neoplasm Metastasis* ; Radiography, Thoracic ; Ribs

Valaciclovir is metabolized to acyclovir after ingestion and thereafter exerts its antiviral activity. Because of its superior pharmacokinetic profile, it has quickly replaced acyclovir in the treatment of herpesvirus infection. Neurotoxicity caused by valaciclovir has been reported, however, among patients with pre-existing impaired renal function. This paper reports a case of neurotoxicity of valaciclovir in a patient with end-stage renal disease who was undergoing continuous ambulatory peritoneal dialysis (CAPD). A 67-year-old female on CAPD took 500 mg of valaciclovir twice for herpes zoster. After she took her second dose orally, she developed confusion and disorientation, along with involuntary movements. Her mental confusion progressed to a coma. Discontinuation of valaciclovir showed no rapid improvement. There- fore, hemodialysis was started. After two sessions of hemodialysis, the patient became alert; and after four sessions of hemodialysis, her neurological abnormalities were completely reversed. In conclusion, valaciclovir can induce life-threatening neurotoxicity, especially in CAPD patients, even with appropriate dose reduction, which can be effectively managed by hemodialysis.
Acyclovir ; Coma ; Dyskinesias ; Eating ; Female ; Herpes Zoster ; Herpesviridae Infections ; Humans ; Kidney Failure, Chronic ; Neurotoxicity Syndromes ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory ; Renal Dialysis ; Valine

BACKGROUND: Falls from low-height can cause severe injuries in the elderly population. This study was conducted to determine characteristics of injuries from low-height falls. METHODS: We retrospectively review surveillance data on injured patients who presented to six emergency departments from January 2011 to December 2015. Study subjects were divided into severe group and non-severe group based on severity of injury. The general and clinical characteristics were compared between the two groups and analyzed factors related with severe injuries. RESULTS: Of 1,190 elderly patients, severe group comprised 82 patients (7%). The severe group was 2 years younger than the non-severe group. In the severe group, 61% was men and 34% in the non-severe group. In the non-severe, the injuries more commonly occurred at residential facilities and indoors than those in the severe group. Paid work during injury occurrence was 15%, and the more patients presented with non-alert consciousness in the severe group. The most common regions of major injury were head and neck in the severe group. CONCLUSION: Paid work, non-alert consciousness, and major injury to head and neck are relating factors to severe injuries in the elderly population.
Accidental Falls* ; Aged* ; Consciousness ; Emergency Service, Hospital ; Head ; Humans ; Male ; Neck ; Residential Facilities ; Retrospective Studies

A 52-year-old man was presented with a huge left testicular mass and palpable cervical lymphadenopathy with retroperitoneal lymph node enlargement on an abdominal computed tomography. A left radical orchiectomy and an ultrasound-guided neck node biopsy were performed. A pathological examination revealed spermatocytic seminoma with extensive rhabdomyosarcomatous transformation, a condition known to be highly resistant to platinum-based chemotherapy. The patient received four cycles of etoposide, ifosfamide and cisplatin (VIP) chemotherapy. A repeat computed tomography revealed a substantial regression consistent with a partial response. Retroperitoneal lymph node dissection was attempted, which revealed rhabdomyosarcoma; however, complete microscopic resection was not achieved. After surgery, the residual abdominal lymph node progressed and salvage paclitaxel, ifosfamide and cisplatin (TIP) chemotherapy was employed, which again achieved a partial response. Here, we present a first case report of a spermatocytic seminoma with extensive rhabdomyosarcomatous transformation and multiple metastatic lymphadenopathies that showed a favorable response to platinum-based systemic chemotherapy.
Biopsy ; Cisplatin ; Drug Therapy ; Drug Therapy, Combination* ; Etoposide ; Humans ; Ifosfamide ; Lymph Node Excision ; Lymph Nodes ; Lymphatic Diseases ; Middle Aged ; Neck ; Orchiectomy ; Paclitaxel ; Radiotherapy ; Rhabdomyosarcoma ; Seminoma*

Objective: Fall from height (FFH) is a major public health problem that can result in severe injury, disability, and death. This study investigated how the characteristics of jumpers and fallers differ. Methods: This was a retrospective study of FFH patients enrolled in an Emergency Department-based Injury In-depth Surveillance (EDIIS) registry between 2011 and 2018. Depending on whether the injury was intentional, FFH patients who had fallen from a height of at least 1 m were divided into two groups: jumpers and fallers. Patient characteristics, organ damage, and death were compared between the two groups, and factors that significantly affected death were identified using multivariable logistic analysis. Results: Among 39,419 patients, 1,982 (5.0%) were jumpers. Of the jumpers, 977 (49.3%) were male, while 30,643 (81.9%) of fallers were male. The jumper group had the highest number of individuals in their 20s, with the number decreasing as age increased. In contrast, the number of individuals in the faller group rose until reaching their 50s, after which it declined. More thoracoabdominal, spinal, and brain injuries were found in jumpers. The in-hospital mortality of jumpers and fallers was 832 (42.0%) and 1,268 (3.4%), respectively. Intentionality was a predictor of in-hospital mortality, along with sex, age, and fall height, with an odds ratio of 7.895 (95% confidence interval, 6.746–9.240). Conclusion Jumpers and fallers have different epidemiological characteristics, and jumpers experienced a higher degree of injury and mortality than fallers. Differentiated prevention and treatment strategies are needed for jumpers and fallers to reduce mortality in FFH patients.

Objective: Fall from height (FFH) is a major public health problem that can result in severe injury, disability, and death. This study investigated how the characteristics of jumpers and fallers differ. Methods: This was a retrospective study of FFH patients enrolled in an Emergency Department-based Injury In-depth Surveillance (EDIIS) registry between 2011 and 2018. Depending on whether the injury was intentional, FFH patients who had fallen from a height of at least 1 m were divided into two groups: jumpers and fallers. Patient characteristics, organ damage, and death were compared between the two groups, and factors that significantly affected death were identified using multivariable logistic analysis. Results: Among 39,419 patients, 1,982 (5.0%) were jumpers. Of the jumpers, 977 (49.3%) were male, while 30,643 (81.9%) of fallers were male. The jumper group had the highest number of individuals in their 20s, with the number decreasing as age increased. In contrast, the number of individuals in the faller group rose until reaching their 50s, after which it declined. More thoracoabdominal, spinal, and brain injuries were found in jumpers. The in-hospital mortality of jumpers and fallers was 832 (42.0%) and 1,268 (3.4%), respectively. Intentionality was a predictor of in-hospital mortality, along with sex, age, and fall height, with an odds ratio of 7.895 (95% confidence interval, 6.746–9.240). Conclusion Jumpers and fallers have different epidemiological characteristics, and jumpers experienced a higher degree of injury and mortality than fallers. Differentiated prevention and treatment strategies are needed for jumpers and fallers to reduce mortality in FFH patients.

Objective: Fall from height (FFH) is a major public health problem that can result in severe injury, disability, and death. This study investigated how the characteristics of jumpers and fallers differ. Methods: This was a retrospective study of FFH patients enrolled in an Emergency Department-based Injury In-depth Surveillance (EDIIS) registry between 2011 and 2018. Depending on whether the injury was intentional, FFH patients who had fallen from a height of at least 1 m were divided into two groups: jumpers and fallers. Patient characteristics, organ damage, and death were compared between the two groups, and factors that significantly affected death were identified using multivariable logistic analysis. Results: Among 39,419 patients, 1,982 (5.0%) were jumpers. Of the jumpers, 977 (49.3%) were male, while 30,643 (81.9%) of fallers were male. The jumper group had the highest number of individuals in their 20s, with the number decreasing as age increased. In contrast, the number of individuals in the faller group rose until reaching their 50s, after which it declined. More thoracoabdominal, spinal, and brain injuries were found in jumpers. The in-hospital mortality of jumpers and fallers was 832 (42.0%) and 1,268 (3.4%), respectively. Intentionality was a predictor of in-hospital mortality, along with sex, age, and fall height, with an odds ratio of 7.895 (95% confidence interval, 6.746–9.240). Conclusion Jumpers and fallers have different epidemiological characteristics, and jumpers experienced a higher degree of injury and mortality than fallers. Differentiated prevention and treatment strategies are needed for jumpers and fallers to reduce mortality in FFH patients.

Objective: Fall from height (FFH) is a major public health problem that can result in severe injury, disability, and death. This study investigated how the characteristics of jumpers and fallers differ. Methods: This was a retrospective study of FFH patients enrolled in an Emergency Department-based Injury In-depth Surveillance (EDIIS) registry between 2011 and 2018. Depending on whether the injury was intentional, FFH patients who had fallen from a height of at least 1 m were divided into two groups: jumpers and fallers. Patient characteristics, organ damage, and death were compared between the two groups, and factors that significantly affected death were identified using multivariable logistic analysis. Results: Among 39,419 patients, 1,982 (5.0%) were jumpers. Of the jumpers, 977 (49.3%) were male, while 30,643 (81.9%) of fallers were male. The jumper group had the highest number of individuals in their 20s, with the number decreasing as age increased. In contrast, the number of individuals in the faller group rose until reaching their 50s, after which it declined. More thoracoabdominal, spinal, and brain injuries were found in jumpers. The in-hospital mortality of jumpers and fallers was 832 (42.0%) and 1,268 (3.4%), respectively. Intentionality was a predictor of in-hospital mortality, along with sex, age, and fall height, with an odds ratio of 7.895 (95% confidence interval, 6.746–9.240). Conclusion Jumpers and fallers have different epidemiological characteristics, and jumpers experienced a higher degree of injury and mortality than fallers. Differentiated prevention and treatment strategies are needed for jumpers and fallers to reduce mortality in FFH patients.

The coexistence of an epithelial lesion and a subepithelial lesion is uncommon. In almost all such cases, the coexistence of these lesions appears to be incidental. It is also extremely rare to encounter a neoplasm in the surface epithelium that overlies a benign mesenchymal tumor in the esophagus. Several cases of a coexisting esophageal neoplasm overlying a leiomyoma that is treated endoscopically or surgically have been reported previously. Here, three cases of a superficial esophageal neoplasm that developed over an esophageal leiomyoma and was then successfully removed by endoscopic submucosal dissection are described.
Epithelium ; Esophageal Neoplasms* ; Esophagus ; Leiomyoma*