No abstract available.
Intestinal Obstruction*

Many patients whose chief complaint is headache caused by accident such as traffic accident, falling, or assaults visit to emergency center. Majority of these patients has mild or moderate symptoms, and there is no need to treat surgically. However, the fact that head injury can cause SIADH(syndrome of inappropriate secretion of antidiuretic hormone) is likely to be overseen. Acute hyponatremia might have been associated with death or permanent brain damage. Hyponatremia is best handled by early recognition and correction of a downward trend in the serum sodium. Unfortunately, this is often difficult in the head-injured patient, where hyponatremia may occur fairly rapidly and is confused by symptoms of head injury. when moderate to severe hyponatremia occurs, it is important to determine its etiology and expeditiously initiate corrective action. There has not been any reported case of the occurrence of symptomatic SIADH after mild head injury in Korea yet. The authors report the experience of three cases of symptomatic SIADH after mild head injury with review of the literatures.
Accidents, Traffic ; Brain ; Craniocerebral Trauma* ; Emergencies ; Head* ; Headache ; Humans ; Hyponatremia* ; Inappropriate ADH Syndrome ; Korea ; Sodium

Amicrobial pustulosis of the folds (APF) is a rare pustular eruption, which predominantly involves the cutaneous folds, including the external auditory canals, scalp, and palms. It occurs in patients with a wide spectrum of autoimmune abnormalities. Systemic lupus erythematosus is the autoimmune disorder observed most commonly in patients with APF. The etiology of APF is unclear, but all reported cases have involved women of reproductive age when the eruptions first occurred. This report describes a 34-year-old woman who presented with an acute pustular rash. Her medical history was unremarkable, except for transitory dry eyes, dry mouth, and polyarthralgia for 1 year. Coalescing pustular lesions arising on erythematous skin, forming crusted and eroded plaques, were observed, which predominantly affected the anterior chest, mainly the cutaneous folds. The periorificial regions were also involved, including the nasal alae, mouth angles, and external auditory canals. Our patient had the characteristic clinical and histopathological features of APF, in association with primary Sjogren's syndrome (pSS). In conclusion, we present a patient having APF associated with pSS.
Adult ; Arthralgia ; Cytochrome P-450 CYP1A1 ; Ear Canal ; Exanthema ; Eye ; Female ; Humans ; Lupus Erythematosus, Systemic ; Mouth ; Scalp ; Sjogren's Syndrome ; Skin ; Thorax

BACKGROUND: Puffer fish can be the source of lethal flood poisoning in humans. Tetrodotoxin(TTX) poisonings are not infrequency seen in Korea, but there are few clinical reports. So we reviewed the patients of TTX poisoning and analyzed the clinical characteristics of patients. METHODS: A retrospective study was performed of 40 patients who visited Chung Ang Gil Hospital from Jan. 1, 1995 to May. 31, 1998 with a diagnosis of TTX poisoning by a review of patients' medical records and telephone inquiries, The diagnosis of TTX poisoning was made by causal links between consumption of puffer fish and the development of typical symptoms of tetrodotoxication. The clinical severity of the patients in this study was classified according to the classification of Fukuda. RESULTS: Mean age of the patients was 40 years. The highest incidence was in the 4th decade in 21 patients(52.5%). The ratio of male to female was 3.44:1, Seasonal distribution excluding cases in 1998 was 12 patients in spring, 6 in summer, 5 in autumn and 12 in winter. The mean interval between consumption and symptom onset was 137 minutes. Common initial symptoms were circumoral numbness(32 patients) and paresthesia of extremities(24 patients). Various symptoms were developed after ingestion of puffer flesh such as neuromuscular(39 patients), cardiovascular/pulmonary (23 patients) and gastrointestinal (16 patients) system. Mean recovery time from the onset of symptom was 22.00 hours. All were treated with symptomatic and supportive measures and recovered completely without sequelae. In 2 cases ventilatory supports were applied for 18.5 hours and 31.5 hours respectively.
Classification ; Diagnosis ; Eating ; Female ; Humans ; Incidence ; Korea ; Male ; Medical Records ; Paresthesia ; Poisoning* ; Retrospective Studies ; Seasons ; Telephone ; Tetraodontiformes*

PURPOSE: We wanted to describe the MR imaging findings of endometrial cancer in patients with a history of prior radiation therapy for cervical cancer (ECRT) and we compare them to the MR imaging findings of patients with spontaneously occurring endometrial cancer (SEC). MATERIALS AND METHODS: Twenty-two patients with endometrial cancer that was diagnosed by operation or endometrial biopsy were included in the study. The patients were divided into two groups according to the presence of past RT for cervical cancer: ECRT (n = 4) and SEC (n = 18). The MR images were retrospectively analyzed by consensus of two experienced radiologists. The MR imaging findings were analyzed by the size, shape and signal intensity of the mass, distension of the uterine cavity, the presence of cervical stenosis and the nature of the fluid collection. RESULTS: For the mass shape, all the ECRT lesions were polypoid masses. However, the SEC patients had 5 polypoid masses and 13 wall thickenings. The maximal diameter, signal intensity and enhancement pattern of the masses were not different between the ECRT and SEC patients. The width of the endometrial cavity varied between 3.9 cm in the ECRT patients and 0.4 cm in the SEC patients (p =0.002). All the ECRT patients had cervical stenosis. However, none of the SEC patients had cervical stenosis. CONCLUSION: MR imaging of ECRT patients demonstrated prominent distension of their uterine cavity and cervical stenosis, which may be the result of radiation fibrosis in the uterus.
Biopsy ; Cervix Uteri* ; Consensus ; Constriction, Pathologic ; Endometrial Neoplasms* ; Female ; Humans ; Magnetic Resonance Imaging* ; Radiation Pneumonitis ; Retrospective Studies ; Uterine Cervical Neoplasms* ; Uterus

BACKGROUND: Sitagliptin is a novel antidiabetic agent with a low risk for hypoglycemia. We investigated the efficacy and safety of sitagliptin when patients switched from a sulfonylurea to sitagliptin and identified good candidates for the switch. METHODS: Sixty-one patients with type 2 diabetes switched from glimepiride with metformin to sitagliptin with metformin due to clinical hypoglycemia. Serum glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), and 2-hour postprandial plasma glucose (2h-PPG) before and 12 and 24 weeks after the drug switch were checked. RESULTS: HbA1c and FPG levels did not change 12 or 24 weeks after the switch; however, the 2h-PPG level decreased from 218.0+/-67.5 mg/dL at baseline to 197.1+/-69.9 mg/dL at 12 weeks and 192.3+/-67.4 mg/dL at 24 weeks after switching drugs (P=0.045, P=0.018, respectively). All but one patient no longer experienced hypoglycemia after discontinuing glimepiride. In a multivariate logistic regression analysis, a high homeostasis model assessment of insulin resistance and low baseline HbA1c level were independent predictors of an HbA1c < or =7% after switching to sitagliptin. CONCLUSION: Glycemic control was not aggravated in patients 24 weeks after the drug switch, and symptomatic hypoglycemia decreased significantly. Patients with dominant insulin resistance may be good candidates for switching from a sulfonylurea to sitagliptin to reduce hypoglycemia.
Blood Glucose ; Diabetes Mellitus, Type 2* ; Fasting ; Hemoglobin A, Glycosylated ; Homeostasis ; Humans ; Hypoglycemia* ; Insulin Resistance ; Logistic Models ; Metformin ; Sitagliptin Phosphate

BACKGROUND: The analysis of serological markers for hepatitis B virus (HBV) is a useful tool for the prevention and diagnosis of HBV infection. In this work, we evaluated a newly improved domestic rapid assay, Kobias HBsAg and anti-HBs Window kits (Kobias, Korea) for the detection of HBsAg and anti-HBs in serum. METHODS: A total of 360 sera screened by enzyme immunoassay (EIA) (Enzygnost, DADE Behring, Germany) were included in this study. Each specimen was tested for HBsAg and anti-HBs by Kobias Window kits and Genedia Rapid device (Green Cross, Korea), conventional one step test kits. The results were compared with those of EIA. RESULTS: The sensitivity and specificity of Kobias HBsAg were 99.2% and 96.7%, and those of Kobias Anti-HBs were 95.8% and 96.7%, respectively. The concordance rates between EIA and Kobias HBsAg and Kobias Anti-HBs were 98.3% and 96.1%, and those between Kobias kits and Genedia kits for HBsAg and anti-HBs were 97.8% and 93.9%, respectively. CONCLUSIONS: Kobias HBsAg/Anti-HBs kits are simple, rapid, and low-cost methods for detecting HBsAg and anti-HBs. With comparable results with EIA, the Kobias HBsAg/Anti-HBs kits could be suitable for screening purposes or in emergency situations.
Diagnosis ; Emergencies ; Exercise Test ; Hepatitis B Surface Antigens* ; Hepatitis B virus ; Immunoenzyme Techniques ; Mass Screening ; Sensitivity and Specificity

The most frequent perioperative cardiovascular event is cardiac dysrhythmia, defined as an abnormality of cardiac rate, rhythm or conduction. Although the occurrence of arrhythmia during the perioperative period is not uncommon, a case of newly developed perioperative atrial flutter which spontaneously converts to atrial fibrillation is rare. We report a case of atrial flutter that developed immediately after induction of general anesthesia, in a 70-year-old male patient who previously had a normal sinus rhythm. Atrial flutter changed spontaneously to atrial fibrillation after discharge to the recovery room. Dysrhythmia was unresponsive to drug therapy, and the atrial fibrillation disappeared after electric cardioversion.
Aged ; Anesthesia, General* ; Arrhythmias, Cardiac ; Atrial Fibrillation* ; Atrial Flutter* ; Drug Therapy ; Electric Countershock ; Humans ; Male ; Perioperative Period ; Recovery Room

PURPOSE: To compare the results of two different instruments made of stainless steel and titanium alloy for correction of single thoracic adolescent idiopathic scoliosis (AIS) using pedicle screw instrumentation. MATERIALS AND METHODS: A total of 141 patients with single thoracic AIS treated with pedicle screw instrumentation and selective thoracic fusion were retrospectively reviewed after a follow-up of 2 years. The patients had a main thoracic curve of 40° to 75° and were divided into two groups based on instrument materials; S group (stainless steel, n=90) and T group (titanium alloy, n=51). The diameter of the stainless steel rod used was 7.0 mm while that of the titanium alloy rod was 6.35 mm or 6.0 mm. Standing long-cassette radiographic measurements including various coronal and sagittal parameters for the preoperative, early postoperative and 2-year postoperative follow-up were analyzed. There were no significant differences in the preoperative curve characteristics between the two groups. RESULTS: In the S group, the preoperative main thoracic curve of 51.3°±8.4° was improved to 19.0°±7.6° (63.1% correction) and the lumbar curve of 32.3°±8.4° spontaneously decreased to 12.7°±8.2° (62.9% correction) at 2 years postoperatively. In the T group, the preoperative main thoracic curve of 49.5°±8.4° and the lumbar curve of 30.3°±8.9° was improved to 18.8°±7.4° (62.2% correction) and 11.3°±5.4° (63.3% correction), respectively. The corrections of coronal curves were not statistically different between the two groups (p>0.05). The thoracic kyphosis was changed from 16.8°±8.5° to 24.3°±6.1° in the S group and from 19.6°±11.2° to 26.6°±8.5° in the T group. There were no significant differences in the changes of sagittal curves, coronal and sagittal balances at the 2-year follow-up and the number of fused segments and used screws between the two groups (p>0.05). CONCLUSION: When conducting surgery for single thoracic AIS using pedicles screw instrumentation, two different instruments made of stainless steel and titanium alloy showed similar corrections for coronal and sagittal curves.
Adolescent ; Alloys ; Follow-Up Studies ; Humans ; Kyphosis ; Pedicle Screws ; Retrospective Studies ; Scoliosis ; Stainless Steel ; Steel ; Titanium

Postoperative pyoderma gangrenosum (PPG) is rare, and its diagnosis is often delayed because of its wound infection-mimicking course. A 53-year-old breast cancer patient who underwent breast-conserving surgery of the right breast presented with fever, leukocytosis, C-reactive protein elevation, and redness of the right breast on postoperative day (POD) 3. The breast wound showed desquamation with painful ulcerative changes from POD 6, and fever was sustained under antibiotic administration. Wound irrigation was attempted; however, inflammatory skin damage progressed to involvement of the entire skin overlying the breast. With clinical suspicion of PPG, skin biopsy and systemic corticosteroid initiation were performed on POD 12. Wound damage progression ceased, and the systemic inflammation subsided. The patient underwent split-thickness skin grafting under intravenous corticosteroid administration, and the wound healed after 30 days. PPG is a rare clinical scenario. Early diagnosis is critical to avoid unnecessary treatment and aggravation of the surgical wound.