PURPOSE: Pneumonia is a common complication of organophosphate poisoning and increases the incidence of respiratory failure and the duration of mechanical ventilator support. Therefore, we investigated the clinical characteristics of pneumonia as a complication of organophosphate insecticide poisoning and then determined the factors related to the development of pneumonia. METHODS: A retrospective study was performed on patients with organophosphate insecticide poisoning, who were treated at our hospital with medical records and chest radiograph of patients. From January 1, 2001, to July 31, 2004, eighty five patients were included in this study. RESULTS: 1) Thirty-two (71% of the patients developing pneumonia) patients developed pneumonia later than 48 hours from admission and twenty-five (55.6% of the patients developing pneumonia) patients developed pneumonia later than 48 hours after mechanical ventilatory support. 2) The mean onset of pneumonia resistant to initial empirical antibiotics was 4.8 days from admission, and that of susceptible pneumonia was 3.7 days from admission. 3) Patients with pneumonia as a complication needed larger doses of atropine and more 2-pralidoxime injections, as well as longer mechanical ventilatory support, ICU admission, and total hospital admission. CONCLUSION: Most Pneumonia in organophosphate poisoning patients were nosocomial pneumonia & ventilator-associated pneumonia. Thus, to reduce the incidence of pneumonia complication in organophosphate poisoning patients, Physicians must take measures, such as hand-washing and careful periodic drainage of tubing condensate, etc., to reduce the incidence of nosocomial pneumonia. In selecting empirical antibiotics for pneumonia complicating organophosphate poisoning patients, physicians should take regional prevalence of nosocomial pathogens into consideration. In late-onset ventilator-associated pneumonia, physicians must consider pneumonia caused by organisms resistant to commonly used empirical antibiotics.
Anti-Bacterial Agents ; Atropine ; Drainage ; Humans ; Incidence ; Medical Records ; Organophosphate Poisoning ; Pneumonia* ; Pneumonia, Aspiration* ; Pneumonia, Ventilator-Associated ; Poisoning* ; Prevalence ; Radiography, Thoracic ; Respiratory Insufficiency ; Retrospective Studies ; Ventilators, Mechanical

No abstract available.
Syringomyelia*

Hemifacial spasm is a relatively uncommon but distressing condition characterized by insiduous development of paroxysmal, involuntary, unilateral hyperkinetic facial movement. In patients with hemifacial spasm, there is an abnormality in the facial nerve or its nucleus which allows the stimulus applied to one branch of the facial nerve to spread to other branches of that same nerve. This lateral spread response is presumed to be due to cross transmission of the antidromic activity in the branch of the facial nerve, and intraoperative monitoring of lateral spread responses provides a useful way of confirming complete facial nerve decompression. In 17 consecutive patients, intraoperative electromyographic(EMG) recordings were made from facial muscles during microvascular decompression for hemifacial spasm. At the beginning of the operation, electrical stimulation of the temporal or zygomatic branch of the facial nerve gave rise to electrically recordable activity in the mentalis muscle(lateral spread), with a latency of about 10msec, that in ten patients, lasted until the facial nerve was decompressed; In seven patients, however, it disappeared when the arachnoid membrane was opened. Early disappearance of lateral spread was frequently occurred in single offending vessel or cases where there was loose compression. Postsurgically the 16 patients in whom the lateral spread response disappeared totally were free from spasm after the operation and in the remaining patient, there was much improvement. These results support the use of lateral spread response monitoring during decompression surgery for hemifacial spasm, and provide strong circumstantial evidence that vascular cross-compression is an important etiologic factor in hemifacial spasm. During a decompression operation for hemifacial spasm, the authors now routinely monitor facial EMG response.
Arachnoid ; Decompression* ; Electric Stimulation ; Facial Muscles ; Facial Nerve ; Hemifacial Spasm* ; Humans ; Membranes ; Microvascular Decompression Surgery ; Monitoring, Intraoperative ; Spasm

Microsurgical clipping is considered the treatment of choice for ruptured intracranial aneurysms. However, ruptured posterior circulation aneurysms remain technically difficult to expose or clip and outcomes in these cases are poorer than those seen in cases of anterior circulation aneurysms. Therefore, endovascular treatment becomes another treatment option in cases of ruptured posterior circulation aneurysms. But, the vertebral artery may not be selected due to luminal narrowing, which are atherosclerotic stenosis clinically, congenital anomalies, or acquired kinking, and structural problem of angle between aorta, subclavian artery and vertebral artery. In these cases, other approaches can be used through, for example, subclavian, axillary, or brachial artery approach. But sometimes such prcedures may be also inappropriate. One other approach is direct percutaneous vertebral artery approach. Though this one also doesn't overcome many clinical and anatomical problems. The authors present two cases of ruptured basilar tip aneurysms which was treated with endovascular Guglielmi detachable coil embolization with open surgery and catheterization, because the one had anatomical problem, and the other had structural problem.
Aneurysm* ; Aorta ; Brachial Artery ; Catheterization ; Catheters ; Constriction, Pathologic ; Embolization, Therapeutic ; Intracranial Aneurysm ; Phenobarbital ; Subclavian Artery ; Vertebral Artery*

BACKGROUND: Subjects with growth hormone-deficiency (GHD) have increased cardiovascular mortality, and growth hormone (GH) replacement may modulate cardiovascular disease risk. Therefore, we evaluated the effects of GH administration on the markers of cardiovascular disease in subjects with GHD. METHODS: 37 subjects (12 men and 25 women) with GHD and 65 normal subjects were enrolled in this study. GH or placebo were given for 3 months at a dose adjusted for normal serum insulin-like growth factor-I (IGF-I) level. Height, weight, waist circumference, hip circumference, lean body mass, fat mass, blood pressure, fasting blood glucose, IGF-I, lipid profile, uric acid, C-reactive protein (CRP), plaminogen activator inhibitor-1 (PAI-1), apolipoprotein AI, and quality of life-assessment of growth hormone deficiency in adults (QoL-AGHDA) were measured at baseline and month 3. RESULTS: Subjects with GHD showed higher levels of triglyceride, CRP, and PAI-1, but lower level of fasting glucose than normal subjects. Fat mass, CRP, and PAI-1 levels decreased in GH recipients (fat mass; 21.9+/-6.6 to 21.3+/-6.7%, p<0.05, CRP; 2.73+/-2.11 to 1.47+/-1.29 mg/L, p<0.001, PAI-1; 48.9+/-33.2 to 31.6+/-28.5 ng/mL, p<0.05). Fasting blood glucose and total cholesterol levels increased in GH recipients (fasting blood glucose; 4.58+/-0.46 to 4.81+/-0.36 mmol/L, p<0.05, total cholesterol; 5.36+/-1.31 to 6.17+/-1.12 mmol/L, p<0.01). Placebo recipients showed decrease in waist-hip ratio (0.93+/-0.05 to 0.92+/-0.04, p<0.05) and increase in fasting blood glucsoe (4.63+/-0.38 to 4.89+/-0.45 mmol/L, p<0.05) and uric acid (319.6+/-89.2 to 335.6+/-89.2 micro mol/L, p<0.05). QoL-AGHDA score improved in both groups (GH recipients; 10.0+/-6.0 to 7.4+/-5.5, p<0.01, placebo recipients; 9.8+/-4.4 to 6.7+/-3.4, p<0.05). CONCLUSION: Our results demonstrated favourable effects of GH on cardiovascular disease through modulating CRP and PAI-1 plasma level in subjects with GHD.
Adult* ; Apolipoprotein A-I ; Blood Glucose ; Blood Pressure ; C-Reactive Protein ; Cardiovascular Diseases* ; Cholesterol ; Fasting ; Glucose ; Growth Hormone* ; Hip ; Humans ; Insulin-Like Growth Factor I ; Male ; Mortality ; Plasma ; Plasminogen Activator Inhibitor 1 ; Triglycerides ; Uric Acid ; Waist Circumference ; Waist-Hip Ratio

Percutaneous vertebroplasty is a safe and effective procedure for the treatment of benign and malignant lesions of the spine, but has been associated with some known complications. Most complications are related to the percutaneous approach, but more severe complications related to the unwanted migration of acrylic cement can occur. We report an unusual case of a fatal pulmonary embolism caused by acrylic cement. Known factors related to cement leakage are incorrect needle position, the consistency of the cement, and the vascularity of the lesion. Emergency physicians should consider acute pulmonary embolism as a diagnosis when evaluating a patient who is suffering from dysnea or chest pain after an orthopedic procedure performed with cement.
Chest Pain ; Diagnosis ; Emergencies ; Humans ; Needles ; Orthopedic Procedures ; Pulmonary Embolism* ; Spine ; Vertebroplasty*

OBJECTIVE: To assess the capability of phosphodiesterase type IV inhibitor (rolipram) to suppress IL-12 in human decidua and the subsequent changes of Th-2 cytokine (IL-10) and Th-1 cytokine (TNF-alpha). METHODS: Decidual tissues of 10 first-trimester pregnant women and 10 first-trimester pregnant women diagnosed as missed abortion were collected by dilatation and currettage. The decidual tissues were treated with rolipram for 6 hours. Protein and mRNA expression in the tissues were analysed by western blotting, immunohistochemistry and reverse transcription-polymerase chain reaction. RESULTS: Rolipram, in the concentration above 1 microgram/ml, could decrease the expression of IL-12p35 (control: 46.37+/-7.38, rolipram: 24.34+/-8.46) and IL-12p40 mRNA (control: 31.7+/-5.8, rolipram: 14.9+/-4.6) and protein (control: 52.4+/-8.9, rolipram: 40.9+/-12.1). However, the expression of IL-10 and TNF-alpha mRNA and protein did not changed by rolipram. There was no difference in the cytokine expression pattern between the decidual tissues of normal pregnancy and missed abortion. CONCLUSION: Rolipram, the phosphodiesterase type IV inhibitor, could induce the decrease of IL-12 in human decidua. In human decidual tissue, unlike other human tissues, the decrease of IL-12 by rolipram did not modulate other Th-1/Th-2 cytokines. Inability of IL-12 to modulate other Th-1/Th-2 cytokines might be related with unique cytokine network in human decidua rather than its small extent of decrease.
Abortion, Missed ; Blotting, Western ; Cyclic Nucleotide Phosphodiesterases, Type 4* ; Cytokines* ; Decidua ; Dilatation ; Female ; Humans* ; Immunohistochemistry ; Interleukin-10 ; Interleukin-12 Subunit p35 ; Interleukin-12 Subunit p40 ; Interleukin-12* ; Pregnancy ; Pregnant Women ; RNA, Messenger ; Rolipram ; Tumor Necrosis Factor-alpha

PURPOSE: Paraquat is widely used non-selective contact herbicide. In spite of efforts to improve the outcome in paraquat poisoning, the mortality rate still remains high. The purpose of this study is to assess the predictive factors of prognosis by investigating initial laboratory data on paraquat poisoning. METHODS: The author retrospectively analyzed the clinical features, laboratory data, and outcomes for 130 paraquatpoisoning patients treated from June 1997 to September 2003 at the emergency medical center of Chonnam National University Hospital. RESULTS: The results were as follows: 1) The mortalities were significantly older than the survivors (49.3 years vs 37.6 years, p<0.05). Among the total 130 cases, the survivors numbered 50, and the deceased numbered 80. The mean age of all 130 cases was 44.8+/-16.9 years. 2) The white blood cell count and the levels of serum AST and ALT in the deceased were significantly higher than they were in the survivors. The levels of arterial pH, PaCO 2, base excess, HCO3 -, and serum potassium in the survivors were significantly higher than they were in the deceased. 3) A multivariate Cox-Regression analysis revealed that sex, serum potassium, and arterial HCO3 - were associated with the mortality rate. CONCILUSION: The above data reveal that the ingested amount, the result of the urine sodium dithionite test, and the initial state of laboratory parameters, including the white blood cell count, ABGA (pH, PaCO2, HCO3 -, base excess), serum potassium, AST, and ALT, can be used to predict the outcome of paraquat poisoning.
Dithionite ; Emergencies ; Humans ; Hydrogen-Ion Concentration ; Jeollanam-do ; Leukocyte Count ; Mortality ; Paraquat* ; Poisoning* ; Potassium ; Prognosis* ; Retrospective Studies ; Survivors

Pseudomembranous colitis (PMC) is a nosocomial and opportunistic infection caused by Clostridium difficile. PMC is related to the use of antibiotics leading to intestinal dysbiosis and an overgrowth of C. difficile. Metronidazole or vancomycin is considered to be the standard therapy for the management of PMC. However, PMC has a 15%-30% recurrence rate and can be refractory to standard treatments, resulting in morbidity and mortality. Here we describe a patient who experienced refractory PMC who was treated with fecal microbiota transplantation. A 69-year-old woman was admitted to the hospital with consistent abdominal pain and diarrhea, which had been present for 5 months. She was diagnosed with PMC by colonoscopy and tested positive for C. difficile toxin. Even though she took metronidazole for 10 days, followed by vancomycin for 4 weeks, her symptoms did not improve. Because of her recurrent and refractory symptoms, we decided to perform fecal microbiota transplantation. Fifty grams of fresh feces from a donor were obtained on the day of the procedure, mixed with 500 mL of normal saline, and then filtered. The filtered solution was administered to the patient's colon using a colonoscope. After the procedure, her symptoms rapidly improved and a follow-up colonoscopy showed that the PMC had resolved without recurrence.
Abdominal Pain ; Aged ; Anti-Bacterial Agents ; Clostridium difficile ; Colon ; Colonoscopes ; Colonoscopy ; Diarrhea ; Dysbiosis ; Enterocolitis, Pseudomembranous* ; Feces ; Female ; Follow-Up Studies ; Humans ; Metronidazole ; Microbiota ; Mortality ; Opportunistic Infections ; Recurrence ; Tissue Donors ; Vancomycin

This study was conducted to determine the nutritional characteristics of horsemeat and bone meal in comparison with those of beef and pork presented by Dietary Reference Intakes For Koreans. Longissimus muscle and large metacarpal bone samples were collected from 20 fattened Jeju horses. Muscle samples were subjected to proximate analysis, assays for fatty acid profile and minerals, and bone samples to mineral assays. Horsemeat had similar levels of protein (21.1 vs 21.0 or 21.1%) and lower levels of fat (6.0 vs 14.1 or 16.1%) compared with beef or pork, respectively. Horsemeat had much higher levels of palmitoleic (8.2 vs 4.4 or 3.3%) and alpha-linolenic (1.4 vs 0.1 or 0.6%) acids than beef or pork, respectively. Linoleic acid was much higher in horsemeat (11.1%) and pork (10.1%) than in beef (1.6%). PUFA:SFA and n-6:n-3 ratios in horsemeat were 0.29 and 10.2, respectively. There were no big differences in mineral contents between horsemeat, beef and pork. For daily recommended mineral intakes of male adults (Dietary Reference Intakes For Koreans), phosphorus, sodium, potassium, iron, zinc and copper can be provided up to 24, 2.5, 6.7, 21, 26 and 40%, respectively, by 100 g raw horsemeat, but calcium and manganese levels are negligible. Horse cannon bone had much higher mineral contents especially in calcium (10,193 mg/100 g), phosphorus (5,874 mg/100 g) and copper (0.79 mg/100 g). Thiamin, riboflavin, niacin and retinol contents were 0.20, 0.21, 1.65 mg/100 g and 30 microgram/100 g, respectively. But ascorbic acid and beta-carotene were not detected. Our data demonstrated that higher levels of palmitoleic and alpha-linolenic acid in horsemeat than in beef and pork may be beneficial for human health. Horsemeat and bone meal are a good source of some minerals and vitamins.
Adult ; alpha-Linolenic Acid ; Ascorbic Acid ; beta Carotene ; Calcium ; Copper ; Horses ; Humans ; Iron ; Linoleic Acid ; Male ; Manganese ; Meals ; Minerals ; Niacin ; Phosphorus ; Potassium ; Recommended Dietary Allowances ; Riboflavin ; Sodium ; Vitamin A ; Vitamins ; Zinc