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 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*

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

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

Boerhaave's syndrome, spontaneous esophageal rupture, is lethal and associated with a 70% survival rate despite emergent surgical management in recent reports. Early diagnosis and management is critical for more favorable outcome. But, it is difficult to diagnose early because of the low incidence and lack of specific symptoms and signs. We experienced 37 year-old male patient with Boerhaave's syndrome who was heavy drinker, and suffered from chronic renal failure. He visited a hospital because of hematemesis and severe back pain. He was transferred to our hospital with a nasogastric tube insertion, which was penetrating the distal esophagus. A radiologic examination revealed that the distal tip was located in the left pleural cavity. It was assumed that the tube had passed through the preexisting perforation site. Operation was not performed emergently due to delay in diagnosis and severe hyperkalemia. The patient was in a septic condition, but had recovered slowly after systemic broad spectrum antibiotic therapy, pleural drainage and intrapleural antibiotic injections. An esophagography revealed no leakage of gastro-grafin on the 14th hospital day, and he later completely recovered from sepsis.
Adult ; Back Pain ; Diagnosis ; Drainage ; Early Diagnosis ; Esophageal Perforation ; Esophagus ; Hematemesis ; Humans ; Hyperkalemia ; Incidence ; Kidney Failure, Chronic ; Male ; Pleural Cavity* ; Rupture ; Sepsis ; Survival Rate

Intrahepatic arterioportal fistulae are rare, but can induce serious complications such as portal hypertension. We present a patient who developed portal hypertension secondary to an intrahepatic arterioportal fistula which was successfully embolized with occlusive balloon and microcoils. A 47-year-old previously healthy male was admitted to our hospital following an episode of melena and abdominal distension. The noteworthy feature in his previous medical history was a hepatic injury caused by a traffic accident when he was aged 9. He didn't drink liquor at all. General appearance was pale and acutely ill. The abdomen was markedly distended and a very noisy bruit over the liver area was continously heard. Laboratory findings, including liver function tests were completely normal except for anemia (Hb 5.7g/dL) and hepatitis viral markers were all negative. Endoscopy demonstrated gastroesophageal varices as the source of bleeding which was treated with variceal ligation. Computed tomography showed a dilated vascular structure in the periphery of the liver at the arterial phase, which suggested a intrahepaic arterioportal fistula. The fistula was also subsequently identified with duplex ultrasound and angiography. Occlusion of the right hepatic artery was performed with occlusive balloon and microcoils. Ascites was rapidly corrected in accordance with a large amount of diuresis and gastroesophageal varices were also completely disappeared whithin a month. On follow-up examination 18 months after hepatic embolization, duplex ultrasound and selective angiography revealed a minute flow of blood through this fistula, but the patient remains well with no recurrence of signs of portal hypertension.
Abdomen ; Accidents, Traffic ; Anemia ; Angiography ; Ascites ; Biomarkers ; Diuresis ; Endoscopy ; Fistula* ; Follow-Up Studies ; Hemorrhage ; Hepatic Artery ; Hepatitis ; Humans ; Hypertension ; Hypertension, Portal* ; Ligation ; Liver ; Liver Function Tests ; Male ; Melena ; Middle Aged ; Recurrence ; Ultrasonography ; Varicose Veins

PURPOSE: Hyponatremia is the most common electrolyte imbalance encountered in the hospital, there have been few studies about the clinical characteristics of hyponatremia in emergency patients. This study was performed to evaluate the causes and the initial symptoms of hyponatremia in emergency patients, the relationship between their ages and their initial symptoms and the relationship between the causes and the recovery time. METHODS: A total of 42 patients with hyponatremia, who were treated in the Emergency Department of Chonnam National University Hospital from 2000 to 2001, were studied by chart review. RESULTS: The initial symptoms were generalized weakness (33.3%), seizure (28.6%), mental change (21.6%), confusion (9.5%), dizziness (4.8%), and non-specific (2.4%). There was a significant difference in the initial symptoms between children and older. The initial symptom for younger patients was usually seizure. The most common causes of hyponatremia were dehydration and sodium loss (52.4%), other causes were hypothyroidism (11.9%), SIADH (7.1%), heart failure (7.1%), adrenal insufficiency (4.8%), polydypsia (4.8%), CRF (2.4%), nephrotic syndrome (2.4%) and unidentified causes (7.1%). There were significant differences in the recovery times among the causes of hyponatremia. CONCLUSION: The initial symptoms of hyponatremia in emergency patients were usually generalized weakness in older patients and seizure in the young. There were significant differences in the recovery times among the causes of hyponatremia. There were many more incidences of hypovolemic hyponatremia of emergency patients than normovolemic hyponatremia.
Adrenal Insufficiency ; Child ; Dehydration ; Dizziness ; Emergencies* ; Emergency Service, Hospital ; Heart Failure ; Humans ; Hyponatremia* ; Hypothyroidism ; Hypovolemia ; Inappropriate ADH Syndrome ; Incidence ; Jeollanam-do ; Nephrotic Syndrome ; Seizures ; Sodium