The highly toxic sodium monofluoroacetate (SMFA) was banned as a rodenticide in this country in the 1980s. The fluoroacetate metabolite, fluorocitric acid blocks cellular metabolism by inhibiting the Klebs cycle, producing widespread clinical effects including respiratory, neurologic, cardiologic, and fluid-electrolyte abnormalities. We report the case of intentional ingestion of a derivative product, beta-fluoroethyl acetate. A 79-yr-old female was brought to the emergency room without any problem. At 2hours post ingestion, she had a generalized tonic-clonic seizure and then, was unresponsive to painful stimuli. At 6hours post ingestion, she died from refractory ventricular fibrillation. We report this patient to increase awareness of beta-fluoroethylacetate toxicity.
Eating* ; Emergency Service, Hospital ; Female ; Humans ; Metabolism ; Poisoning ; Seizures ; Sodium ; Ventricular Fibrillation

Purpose: This study aimed to analyze the prognosis of implant placement after maxillary sinus perforation repair using a collagen membrane during sinus elevation surgery.Materials and Methods: The radiographic and clinical data of 27 patients who underwent simultaneous or delayed implant placement with perforation repair (using collagen membranes) were retrospectively analyzed. The patients were divided into the following three groups: group 1: perforation repair, bone grafting, and simultaneous implant placement (nine patients, 19 implants); group 2: perforation repair, no bone grafting, and simultaneous implant placement (11 patients, 19 implants); group 3: perforation repair, bone grafting, and delayed implant placement (seven patients, 15 implants). The follow-up period was at least 2 years for all patients. Results: No significant differences in implant survival rates were observed between groups. Marginal bone loss was minimal in all groups with some exceptions. The thickness of the maxillary sinus measured on the day of surgery differed significantly between the groups, potentially attributed to the variations in the surgical materials employed. However, the thickness normalized in all groups at 1-year follow-up. Conclusion This study suggests that simultaneous and delayed implant placement in cases of perforated maxillary sinus membranes repaired with collagen membranes during sinus elevation surgery can achieve favorable long-term outcomes. In certain cases, simultaneous implant placement without bone grafting is a viable option.

Purpose: This study aimed to analyze the prognosis of implant placement after maxillary sinus perforation repair using a collagen membrane during sinus elevation surgery.Materials and Methods: The radiographic and clinical data of 27 patients who underwent simultaneous or delayed implant placement with perforation repair (using collagen membranes) were retrospectively analyzed. The patients were divided into the following three groups: group 1: perforation repair, bone grafting, and simultaneous implant placement (nine patients, 19 implants); group 2: perforation repair, no bone grafting, and simultaneous implant placement (11 patients, 19 implants); group 3: perforation repair, bone grafting, and delayed implant placement (seven patients, 15 implants). The follow-up period was at least 2 years for all patients. Results: No significant differences in implant survival rates were observed between groups. Marginal bone loss was minimal in all groups with some exceptions. The thickness of the maxillary sinus measured on the day of surgery differed significantly between the groups, potentially attributed to the variations in the surgical materials employed. However, the thickness normalized in all groups at 1-year follow-up. Conclusion This study suggests that simultaneous and delayed implant placement in cases of perforated maxillary sinus membranes repaired with collagen membranes during sinus elevation surgery can achieve favorable long-term outcomes. In certain cases, simultaneous implant placement without bone grafting is a viable option.

Purpose: This study aimed to analyze the prognosis of implant placement after maxillary sinus perforation repair using a collagen membrane during sinus elevation surgery.Materials and Methods: The radiographic and clinical data of 27 patients who underwent simultaneous or delayed implant placement with perforation repair (using collagen membranes) were retrospectively analyzed. The patients were divided into the following three groups: group 1: perforation repair, bone grafting, and simultaneous implant placement (nine patients, 19 implants); group 2: perforation repair, no bone grafting, and simultaneous implant placement (11 patients, 19 implants); group 3: perforation repair, bone grafting, and delayed implant placement (seven patients, 15 implants). The follow-up period was at least 2 years for all patients. Results: No significant differences in implant survival rates were observed between groups. Marginal bone loss was minimal in all groups with some exceptions. The thickness of the maxillary sinus measured on the day of surgery differed significantly between the groups, potentially attributed to the variations in the surgical materials employed. However, the thickness normalized in all groups at 1-year follow-up. Conclusion This study suggests that simultaneous and delayed implant placement in cases of perforated maxillary sinus membranes repaired with collagen membranes during sinus elevation surgery can achieve favorable long-term outcomes. In certain cases, simultaneous implant placement without bone grafting is a viable option.

PURPOSE: This study was performed to evaluate the changes in the IL-1beta and the IL-6 concentrations in cerebrospinal fluid (CSF) after initial successful cardiopulmonary resuscitation (CPR), to examine the difference in the IL-1beta and the IL-6 concentrations in CSF between the cerebral performance category (CPC) 1-2 group and CPC 3-5 group after successful CPR, and to identify early makers predicting the outcome after successful CPR. METHODS: We studied prospectively 10 patients with spontaneous circulation after CPR. Samples of CSF were taken at 20 min, 4 hr, 24 hr, and 48 hr after restoration of spontaneous circulation. The control group was consisted of the nonspecific 6 patients in brain computed tomography and CSF finding among the visited patients in emergency department with complaints of headache. The CSF IL-1beta and IL-6 were measured by using enzyme-linked immunosorbent assays. RESULTS: 1) The concentrations of CSF IL-6 for CPC 3-5 were higher in the successful CPR group than in the control group. 2) In the severely neurologically disabled group (CPC 3-5), the concentrations of CSF IL-6 were significantly higher at 20 min 4 hr, 24 hr and 48 hr after successful CPR than they were in the mildly neurologically disabled group(CPC 1-2). 3) The concentrations of CSF IL-6 in the severely neurologically disabled group (CPC 3-5) reached peak levels at 24 hours after successful CPR. 4) The concentrations of CSF IL-1beta did not differ between the two groups. CONCLUSION: Our study indicates that CSF IL-6 is increased more in the severely neurologically disabled group (CPC 3-5) than it is in the mildly neurologically disabled group (CPC 1-2) after successful CPR. We found a significant relationship between the concentration of CSF IL-6 and initial outcome for the CPR patient. Thus, we suggest that CSF IL-6 might play a role in brain ischemic-reperfusion injury and might be used as a prognostic marker after successful CPR.
Brain ; Cardiopulmonary Resuscitation ; Cerebrospinal Fluid ; Emergency Service, Hospital ; Enzyme-Linked Immunosorbent Assay ; Headache ; Heart Arrest* ; Humans ; Hypoxia-Ischemia, Brain* ; Interleukin-1beta ; Interleukin-6 ; Prospective Studies

PURPOSE: Intra-abdominal leiomyosarcoma is an uncommon malignant tumor, and its standard treatment is surgical resection. However, there is no generally preferred treatment for its metastatic mass, especially in the liver.METHODS: According to the sarcoma registry, 476 patients were diagnosed as leiomyosarcoma and received treatment in Asan Medical Center, Seoul, Korea. And from 2003 to 2015, surgical resections of liver metastases were performed in 10 patients with leiomyosarcoma. The characteristics and short-term results were documented.RESULTS: Of the 10 patients, the median age was 48 years and the median survival period was 34.2 months. The mean period from primary resection to liver metastasis was 12.9 months. Six patients had a single metastatic mass, and four had multiple nodules. One patient had an additional distant metastasis outside of the liver. Eight patients had a partial hepatectomy, and the others were treated using segmentectomy or lobectomy. Two patients (20%) died during follow-up. Four patients showed metastasis to other organs after surgical resection of the liver.CONCLUSION: Intra-abdominal leiomyosarcoma with liver metastasis is a very rare disease. Long-term survival can be achieved after surgical resection and should be considered for all patients.
Chungcheongnam-do ; Follow-Up Studies ; Hepatectomy ; Humans ; Korea ; Leiomyosarcoma ; Liver ; Mastectomy, Segmental ; Neoplasm Metastasis ; Rare Diseases ; Sarcoma ; Seoul

Peri-implantitis, in which inflammation caused by plaque and biofilm on the implant surface spreads to the hard tissue, can be treated by decontamination of the implant surface and reconstruction of the lost hard tissue through surgical methods. We have described the management of 3 peri-implantitis cases by decontamination of the implant surface using a round titanium brush and regenerative therapy. All cases showed clinical improvements, and no further radiographic bone loss was observed during a 2-year follow-up. This treatment method can be effective for clinical improvement and bone regeneration. However, a longer follow-up period is necessary to support these outcomes.

PURPOSE: Vitamin D deficiency is reported to be more common in type 1 diabetes patients and might be associated with the increased urinary loss of vitamin D binding protein (VDBP) consequent to impaired 25-hydroxyvitamin D (25(OH)D) circulation. We aimed to evaluate the possible increased urinary loss of VDBP, a correlation between VDBP and circulating 25(OH)D level, and risk factors influencing low vitamin D level in pediatric type 1 diabetes patients without microalbuminuria. METHODS: This is a cross-sectional study of subjects who visited Seoul National University Children’s Hospital between January and March 2013. Forty-two type 1 diabetes patients and 29 healthy controls were included. Biochemical parameters including serum and urine VDBP concentrations were analyzed. RESULTS: There was no significant difference in the frequency of vitamin D deficiency or serum 25(OH)D level between the 2 groups. The serum and urine VDBP concentrations did not show any difference between the 2 groups. Serum 25(OH) D level did not correlate with serum or urine VDBP. Multivariate regression analysis revealed that daylight outdoor hours (β=2.948, P=0.003) and vitamin D intake (β=2.865, P=0.003) affected the 25(OH)D level; the presence of type 1 diabetes or urinary VDBP excretion was not significant. CONCLUSIONS: In pediatric type 1 diabetes patients, urinary VDBP excretion did not contribute to low serum 25(OH)D level in the setting of normoalbuminuria. The factors associated with 25(OH)D level during winter periods were daylight outdoor hours and vitamin D intake. Further studies including both micro- and macroalbuminuria patients with type 1 diabetes are warranted.
Albuminuria ; Child ; Cross-Sectional Studies ; Diabetes Mellitus, Type 1 ; Ergocalciferols ; Humans ; Risk Factors ; Seoul ; Vitamin D ; Vitamin D Deficiency ; Vitamin D-Binding Protein* ; Vitamins*

Rhabdoid transformation is an extremely rare occurrence in sarcomatoid cholangiocarcinoma. Only two cases have been reported in the medical literature worldwide, and its clinical and pathological characteristics remain unknown. Published case reports indicate that rhabdoid cholangiocarcinoma grows rapidly, with early metastasis and a particularly poor prognosis. Here, we report a case of rhabdoid transformation in sarcomatoid cholangiocarcinoma that exhibited aggressive behavior and resulted in a devastating prognosis.
Cholangiocarcinoma ; Neoplasm Metastasis ; Prognosis

A retroperitoneal ectopic pregnancy is a very rare form of extrauterine pregnancy and is a potentially life threatening variation of ectopic gestation within the retroperitoneal cavity. In fact, the clinical history, physical examination, laboratory and vaginal ultrasonographic findings are non specific. It is a surgical emergency because of high maternal and fetal morbidity and mortality. Early diagnosis is essential. Surgical intervention is indicated as soon as the diagnosis is made. We report our experience with one retroperitoneal ectopic pregnancy with a brief review of the literature
Diagnosis ; Early Diagnosis ; Emergencies ; Female ; Mortality ; Physical Examination ; Pregnancy ; Pregnancy, Ectopic* ; Retroperitoneal Space