Methylene blue is the first choice antidote for management of methemoglobinemia, however, some patients are refractory to methylene blue and in most cases, methylene blue cannot be available instantly in Korean emergency departments because of import suspension. A 69-year-old woman visited our emergency department for tachypnea and cyanosis after ingesting 30 tablets of dapsone. Because methylene blue was not available, we intravenously administrated 10 g of vitamin C for symptomatic methemoglobinemia. Repeated i.v. administrations of 10 g of vitamin C in patient without preexisting renal insufficiency successfully treated dapsone-induced methemoglobinemia without causing renal complications. Thus, we recommend that if methylene blue is unavailable or methemoglobinemia is refractory to methylene blue, repeated administrations of 10 g of vitamin C may be considered for the treatment of methemoglobinemia in patients without renal insufficiency.
Aged ; Ascorbic Acid* ; Cyanosis ; Dapsone ; Emergency Service, Hospital ; Female ; Humans ; Methemoglobinemia* ; Methylene Blue ; Renal Insufficiency ; Tablets ; Tachypnea

Total abdominal hysterectomy was considered an inadequate treatment method for invasive cervical cancer. Usually the procedure was inadvertently performed on patients who were thought preoperatively to have benign conditions. Survival for patients with gross disease remaining after inappropriate hysterectomy is poor. So, early cancer detection and proper management with precise pretreatment staging is necessary to avoid inadequate hysterectomy, especially in cases of gross residual disease. Cervical cancer typically recurs at the vaginal vault or in the pelvis; however it can recur distantly in the abdomen or lung. Although recurrences have been reported at laparoscopic trocar sites, it is unusual to have recurrence in the abdominal wall after laparotomy. A case of isolated metastasis to the abdominal wall after treatment of unexpected invasive cervical cancer found at total hysterectomy is presented with a brief review of the literature.
Abdomen ; Abdominal Wall* ; Humans ; Hysterectomy* ; Laparotomy ; Lung ; Neoplasm Metastasis* ; Pelvis ; Recurrence ; Surgical Instruments ; Uterine Cervical Neoplasms*

Coronary artery fistula is an unusual anomaly that consists of a communication between one of the coronary arteries and a cardiac chamber or vein. It has hemodynamic significance, complicated by congestive heart failure, bacterial endocarditis, rupture or thrombosis of the fistula or an associated arterial aneurysm, myocardial ischemia, and arrhythmias. It occurs in congenital, traumatic, neoplastic, or artherosclerotic cardiac disorders. It is being diagnosed with increasing frequency with widespread use of selective coronary angiography. However, acquired coronary artery fistula after acute myocardial infarction is a rare clinical entity, and it has not been reported in Korea yet. We observed a 62-year-old male patient with intermittent chest pain at rest, in whom serial coronary angiography showed newly developed communications from the left anterior descending coronary artery to the left ventricular chamber several months after acute myocardial infarction of the anteroseptal wall. The area of communication corresponded to the site of infarction as established by contrast echocardiography.
Aneurysm ; Arrhythmias, Cardiac ; Chest Pain ; Coronary Angiography ; Coronary Vessels* ; Echocardiography ; Endocarditis, Bacterial ; Fistula* ; Heart Failure ; Heart Ventricles* ; Hemodynamics ; Humans ; Infarction ; Korea ; Male ; Middle Aged ; Myocardial Infarction* ; Myocardial Ischemia ; Rupture ; Thrombosis ; Veins

We treated 8 patients with large pituitary adenomas(4 females, 4 males) with bromocriptine. In all patients the level of prolactin was decreased to within the normal range and in most patients the size of tumor was decreased remarkably, high cure rate of large pituitary tumor fallowing operation after pretreated bromocriptine was obtained.
Bromocriptine* ; Female ; Humans ; Pituitary Neoplasms* ; Prolactin ; Reference Values

It is a well-known clinical fact that contrast-enhanced magnetic resonance angiography exaggerates vertebral arterial ostial stenosis and sometimes shows pseudostenosis. Considering the clinical significance of a lesion in the posterior circulation ischemia, the importance of an accurate imaging diagnosis of ostial stenosis should not be underestimated. We were able to differentiate pseudostenosis of the ostium from true stenosis using thin-slab maximum-intensity-projection(MIP) images which are thought to be helpful for minimizing standard full thickness MIP images.
Constriction, Pathologic ; Ischemia ; Magnetic Resonance Angiography ; Vertebral Artery

The second survey which was composed of questionnaires on a variety of ophthalmic topics was made up and sent to members of the Korean Society of Cataract and Refractive Surgery(KSCRS) in March, 1997. The second survey was composed of 80 items, including 8 additional items compare to the first survey in 1996. Forty-three percent(65/150) responded and the results were compared to these of the first survey.Over half of the respondents(64%) were in their forties. Catarct operation accounted for over 60% of the total operations in 75% of KSCRS members which was increased compared to previous survey(45%). The 0-2 days of admission in the cataract surgery was 56% of respondents that was increased than previous survey(36%). Increased preference to 3.5mm incision and 5.5mm incision in cataract operation and increased use of 5.5mm optic size IOL(47%) in phacoemulsification surgery compare to previous survey in that 6.0mm optic size IOL was mostly used were shown which indicate increase of small incision cataract surgery.For radial keratotomy as a means of correcting myopia, 97% of the respondents were not performing the procedure. Fortu-six percent of the respondents have been doing excimer laser photorefractive keratectomy which was decreased than previous survey(54%).For use of foldable IOL. which was one of new question items, 50% of respondents answered they use it in less than 20% of cataract surgery which indicates foldable IOL is not popularly used.These results reflect the present trends of cataract and refractive surgeries in Korea.
Cataract* ; Surveys and Questionnaires ; Keratotomy, Radial ; Korea ; Lasers, Excimer ; Myopia ; Phacoemulsification ; Photorefractive Keratectomy ; Refractive Surgical Procedures*

PURPOSE: Sleep deprivation may exert many negative effects on hippocampus-dependent cognitive function, such as learning and memory. The present study was conducted in order to investigate the effects of repetitive sleep deprivation on cognition, apoptotic neuronal cell death, and cell proliferation in the hippocampus, using mice. METHODS: To induce sleep deprivation, mice were placed in a water cage containing six platforms (3 cm in diameter), surrounded by water up to 1 cm beneath the surface of the platform for 24 h. Mice were randomly divided into four groups (n=20 in each group): control group, 24 h rest after 24 h sleep deprivation group, 48 h rest after 24 h sleep deprivation group, and 72 h rest after 24 h sleep deprivation group. This cycle was continued for 36 days. Novel objective recognition test and immunohistochemistry for 5-bromo-2'-deoxyuridine (BrdU), western blot for expression of Bax, Bcl-2, brain-derived neurotrophic factor (BDNF), and caspase-3 were performed. RESULTS: Results of the novel objective recognition test showed decreased cognition in the 24 h rest after 24 h sleep deprivation group, while a similar effect was observed in other groups, compared to the control group. Increased cell proliferation and enhanced expression of BDNF and Bax protein were observed in the 24 h rest after 24 h sleep deprivation group and the 48 h rest after 24 h sleep deprivation group, compared to the control group. Expression of Bcl-2 showed a decrease in the 24 h and 48 h rest groups, compared to the control group. Expression of caspase-3 in the dentate gyrus of the hippocampus showed a significant increase in the 24 h rest after 24 h sleep deprivation group and in the 48 h rest after 24 h sleep deprivation group, compared to the control group. CONCLUSION: Results of the present study indicate that insufficient rest after sleep deprivation may induce impairment of cognitive function. After sleep deprivation, at least 72 hr of rest time is needed for recovery.
Animals ; Apoptosis ; bcl-2-Associated X Protein ; Blotting, Western ; Brain-Derived Neurotrophic Factor ; Bromodeoxyuridine ; Caspase 3 ; Cell Death ; Cell Proliferation ; Cognition ; Dentate Gyrus ; Hippocampus ; Immunohistochemistry ; Learning ; Memory ; Memory, Short-Term ; Mice ; Neurons ; Sleep Deprivation ; Water

OBJECTIVE: Neurologic complication of extremity is well recognized as a potential complication of procedures performed on patients in the lithotomy position. The goal of this study was to evaluate the incidence and risk factors of this complication. MATERIALS AND METHODS: We retrospectively reviewed the perioperative courses of 322 patients who underwent 1 of 13 surgical procedures performed on patients in the lithotomy position at the A university medical center from 2003 to 2005 inclusive. Neurologic complication was defined as symptoms of paresthesia or dysesthesia (burning) with or without aching pain in the distribution of a extremity nerve or weakness of any extremity muscle, both during postoperative period. RESULTS: Neurologic complications of extremity developed in 5 patients (1.6%). Unilateral nerve affected in patients as follows: sciatic (four patients), radial (one patient). All patients complained motor weakness and paresthesia. 2 patients with suspicious muscle injury due to compartment syndrome had painful swelling. Symptoms were noted at operative day or first and second postoperative day. These symptoms resolved within 5 months in 4 of 5 patients. Multivariate risk factors for development of neurologic complication included perioperative blood transfusion (r=0.128, P<0.05) and duration in lithotomy (r=0.247, P<0.01) CONCLUSIONS: In our data, neurologic complications of extremity were infrequent complications that were noted very soon after surgery and anesthesia. Prognosis often was mild and resolved spontaneous, but they could be severe and associate with prolonged disability. The longer patients were positioned in the lithotomy positions, the greater the chance of development of a neurologic complication. The appropriate positioning and reduction of time in the lithotomy position may reduce the risk of neurologic complication.
Academic Medical Centers ; Anesthesia ; Blood Transfusion ; Compartment Syndromes ; Extremities ; Humans ; Incidence ; Paresthesia ; Postoperative Period ; Prognosis ; Retrospective Studies ; Risk Factors

No abstract available.
Congenital Abnormalities* ; Rhinoplasty*

The authors experienced 4 cases of esophageal perforations following anterior cervical spine surgery. All occurred within a few days in the postoperative period. Diagonosis was made by clinical suspision and confirmed by esophography or reexploration. This complication attributed to sharp blade penetration of a retraction during surgery, infection and use of hardware. 3 cases were successfully treated by drainage, tube feeding and parenteral antibiotics. But unfortunately, 1 case was fatality. Although conservative treatment is required prolonged hospitalization, drainage, tube feeding and parenteral antibiotics are recommended treatment.
Anti-Bacterial Agents ; Diagnosis ; Drainage ; Enteral Nutrition ; Esophageal Perforation* ; Hospitalization ; Postoperative Period ; Spine*