OBJECTIVE: The purpose of this study is to evaluate the efficacy of ferritin-folate-cyanocobalamin supplementation for prevention of anemia during pregnancy. METHODS: The authors conducted a clinical investigation on 50 pregnant women from 20th to 36th gestational weeks. The cobination of cyanocobalamin coenzyme 500mg, folic coenzyme 800mcg, and ferritin 20mg constituted the supplementation. The parameters examined in first trimester as baseline, before treatment(at 20th weeks), and after treatment(at 36th weeks) were : hemoglobin, hematocrit, ferritin, mean corpuscular hemoglobin(MCH), mean corpuscular hemoglobin concentration(MCHC), mean corpuscular volume(MCV), red blood cell count(RDW), folic acid, and vit. BPaired sample t-test was used for comparison. RESULTS: The results indicated a significant increase in the value of hemoglobin(p<0.05) and hematocrit(p<0.01) in comparison to before and after the treatment. The values of serum ferritin, folic acid, vitamin Bwere increased after the treatment compared to those of before the treatment, though there was no statistical significance. The results of MCV, MCH, MCHC, and RDW showed no statistically significant in comparison to before and after the treatment. CONCLUSIONS: These data indicate that supplementing ferritin 20mg-folate 800mcg-cyanocobalamine 500mcg per day from 20th to 36th weeks' gestation can increase values of hemoglobin, hematocrit, and ferritin concentration and can be cosidered as an appropriate method to prevent iron deficient anemia. It also might increase the value of folic acid and vitamin B12, concentration, but further study is stiU needed to determine whether the supplementation of folate and cyanocobalamine in combination with iron can have better eflicacy than iron alone in prevention of iron deficiency anemia.
Anemia* ; Anemia, Iron-Deficiency ; Erythrocyte Indices ; Erythrocytes ; Female ; Ferritins* ; Folic Acid* ; Hematocrit ; Humans ; Iron ; Pregnancy Trimester, First ; Pregnancy* ; Pregnant Women ; Vitamin B 12* ; Vitamins

PURPOSE: The aim of this study was to understand the pathogenesis of the enophthalmos of Horner's syndrome. METHODS: We performed right cervical sympathectomy in 10 Sprague-Dawley rats weighing 200~300 grams at 8 weeks of age. We obtained bilateral extraocular muscle and fat from all 10 rats. These tissues were observed under light and electron microscopy. RESULTS: After 8 weeks, ptosis and enophthalmos were seen in the right eye in all rats. We found no change bilateral fat, but the right extraocular muscle fibers had smaller diameters than the left. The right intermuscular distance was longer than the left upon light microscopy and the right extraocular muscle contained fewer and smaller mitochondria than the left extraocular muscle upon electron microscopy. CONCLUSIONS: Based on these results, it is believed that enophthalmos resulted from extraocular muscle atrophy that resulted from decreasing metabolism of mitochondria in Horner's syndrome. However, enophthalmos in Horner's syndrome requires more intensive study.
Animals ; Enophthalmos ; Eye ; Horner Syndrome ; Light ; Microscopy ; Microscopy, Electron ; Mitochondria ; Muscles ; Muscular Atrophy ; Rats ; Rats, Sprague-Dawley ; Sympathectomy

Pulmonary artery aneurysms are extremely rare. Even though their etiology or mechanism remain uncertain, congetial anenrysms follow the congenital heart defects which elevate the pulmonary artery pressure or increase the pulmonary blood flow and acquired aneurysms are developed by syphilis, mycotic change and atherosclerosis. Pulmonary artery aneurysms involve the artery trunk rupture and exanguination if untreated, there has been an emphasis in the need for surgical intervention whenever the diagnosis is made regardless of the presence or absence of symptoms. Here we report a case of patient ductus arterious associated with main pulmonary artery aneurysm in 39 year old female patient with review of literatures.
Adult ; Aneurysm* ; Arteries ; Atherosclerosis ; Diagnosis ; Ductus Arteriosus, Patent* ; Female ; Heart Defects, Congenital ; Humans ; Pulmonary Artery* ; Rupture ; Syphilis

BACKGROUND: induction of analgesia is frequently required during undergoing reduction of fractures or dislocation in the emergency department. METHODto induce analgesia should be easy, convenient, and safe because patients are not always in fasting state. Nitrous oxide inhalation has been known as a good method of analgesia in emergency patients. PURPOSE: This study was aimed to evaluate the efficacy and safety of nitrous oxide analgesia in the emergency department. METHOD: We prospectively studied 34 patients undergone reductions of fractures in the emergency department. Nitrous-oxide was the sole source of analgesia. The Visual Analogue Scale(VAS) was rated by the emergency physician before nitrous oxide inhalation,5 minutes after inhalation and reduction procedures. RESULTS: No complication such as vomiting, respiratory depression, or a change in oxygen saturation resulted from the use of nitrous-oxide. Ninety one percent of patients obtained an analgesic effect. However, 9% of patients did not experience any analgesic effect after inhalation of nitrous oxide. In subgroup analysis for analgesic effect of nitrous-oxide, nitrous oxide provided only partial analgesia for acute pain in open fracture group. VAS was significantly lower after inhalation than before inhalation of nitrous oxide in simple fracture group. However, VAS of simple fracture group was increased during closed reductions, which indicated incomplete relief of pain by nitrous oxide. Nitrous oxide inhalation foiled to relieve pain during reduction in patients with open fracture or dislocation. CONCLUSION: Administration of nitrous-oxide, when used as the sole source of analgesia, is not the ideal method of analgesia during reduction of fractures or dislocations.
Acute Pain ; Analgesia ; Dislocations ; Emergencies* ; Emergency Service, Hospital* ; Fasting ; Fractures, Open ; Humans ; Inhalation ; Nitrous Oxide* ; Oxygen ; Prospective Studies ; Respiratory Insufficiency ; Vomiting

Transcutaneous cardiac pacing(TCP) is a rapid, safe, noninvasive and easily utilized form of emergency cardiac pacing, with hemodynamically similar to transvenous cardiac pacing. This paper reports the result of transcutaneous pacing in a series of patients in emergency department.32 patients with bradyanhythmia were enrolled during the study period. TCP was successful in 29(91%) patients. No evidence of electrical capture was seen in two patients in asystole and a patient with ventricular escape rhythm. Mean capture threshold was 66 mA. Transvenous pacemaker was inserted in 18(56%) of the 32 patients during transcutaneous cardiac pacing. Twenty(61%) of the 32 patients survived and eventually discharged. Ten patients(31%) were died of uncorrectable underlying disease in spite of successful ECG capture and palpable pulse by TCP. In conclusion, TCP is a reliable, noninvasive method that offers the possibility to initiate pacing within seconds and can be used by any emergency medical staff. In our opinion, it should be considered as the first choice of emergency treatment of hemodynamically unstable bradyarrhythmia.
Bradycardia* ; Electrocardiography ; Emergencies* ; Emergency Service, Hospital* ; Emergency Treatment ; Heart Arrest ; Humans ; Medical Staff ; United Nations

There have been a few reports on rhabdomyolysis caused by thyroid storm, but no cases of thyrotoxicosis related rhabdomyolysis have been reported until now. Here, a rare case of rhabdomyolysis, accompanied by thyrotoxicosis, is reported. A 21-year-old man was admitted to our hospital with severe pain and weakness in both legs. The initial laboratory findings revealed a high muscle enzyme level and severe hypokalemia. In evaluation of the rhabdomyolysis, the thyroid function test was compatible with that of Graves' disease, with the rhabdomyolysis subsequently diagnosed, presenting as thyrotoxicosis. The possible mechanisms for this complaint were hypokalemia-induced muscle ischemia, a thyrotoxicosis-induced excessive hypermetabolic state and pressure-induced muscle ischemia. Therefore, the work up for the cause of rhabdomyolysis should include thyrotoxicosis. The management of rhabdomyolysis is hydration, prevention of acute renal failure, correction of aggravating factors and treatment of the underlying cause, for example, thyrotoxicosis.
Acute Kidney Injury ; Graves Disease ; Humans ; Hypokalemia ; Ischemia ; Leg ; Rhabdomyolysis* ; Thyroid Crisis ; Thyroid Function Tests ; Thyrotoxicosis* ; Young Adult

BACKGROUND/AIMS: Type 2 diabetes with microvascular complications is often accompanied by macrovascular complications. However, the relationship between the two complications is unclear. In this study, we determined the relationship between diabetic retinopathy and morphological changes of the carotid artery. METHODS: We analyzed the presence of plaque and mean carotid intima-media thickness (CIMT) in patients with type 2 diabetes (n = 133) using high-resolution ultrasound. The presence and severity of retinopathy were graded according to fundus photographs. RESULTS: The mean CIMT of the diabetic retinopathy (DR) group (0.111 +/- 0.048 cm) was significantly greater than that of the nondiabetic retinopathy (No DR) group (0.074 +/- 0.039 cm, p = 0.007). An abnormal mean CIMT (> 0.08 cm) was more frequently observed in the DR group (76%) than that in the No DR group (23.1%; odds ratio, 10.609; 95% confidence interval, 3.072-36.639; adjusted by age, body mass index, hypertension, and diabetes duration). Although the mean CIMT in patients with plaque was significantly greater than that of patients without plaque, no significant difference was observed between the DR (36%, 17 patients) and NoDR (18.5%, 20 patients) groups in the presence of plaque. CONCLUSIONS: Diabetic retinopathy was associated with an increased CIMT but not with atherosclerotic plaques. However, the increases in IMT were associated with the presence of plaques, which predispose patients to cardiovascular disease. These results imply that the microvascular complications of diabetes have indirect relationships with the cardiovascular complications of diabetes.
Atherosclerosis ; Body Mass Index ; Cardiovascular Diseases ; Carotid Arteries ; Carotid Intima-Media Thickness ; Diabetes Mellitus ; Diabetic Retinopathy ; Humans ; Hypertension ; Odds Ratio ; Plaque, Atherosclerotic

Intraoperative transesophageal echocardiography (IOTEE) is an invaluable diagnostic method for management of cardiac surgical patients, including patients undergoing valve replacement surgery. We report a patient who underwent reoperation for mitral valve replacement due to intravalvular regurgitation following mitral valve replacement with a bioprosthetic valve. The condition was detected by IOTEE and caused by suture entrapment.
Echocardiography, Transesophageal ; Humans ; Mitral Valve ; Reoperation ; Sutures

Arterial thrombosis is relatively rare compared with venous thrombosis in nephrotic syndrome. However, the assessment of its pathogenesis and risk factors in individual patient with nephrotic syndrome is necessary to allow appropriate prophylactic management because it is a potentially serious problem. Hereby, with review of the literature, we report a case of a 53 yr-old man with cerebral infarction associated with nephrotic syndrome due to focal segmental glomerulosclerosis during the course of treatments with diuretics and steroid. It reveals that the hypercoagulable state in nephrotic syndrome can be associated with cerebral infarction in adults. Prophylactic anticoagulants can be considered to reduce the risk of serious cerebral infarction in nephrotic patients with risk factors such as severe hypoalbuminemia and on diuretics or steroid treatment, even in young patients regardless of types of underlying glomerular diseases.
Cerebral Infarction/epidemiology/*etiology/pathology ; Human ; Male ; Middle Aged ; Nephrotic Syndrome/*complications/epidemiology ; Risk Factors

Anticonvusant therapy with any of several agents, especially phenytoin, phenobarbital, and primidone causes disturbances in bone mineral metabolism. Anticonvulsants stimulate the hepatic microsomal mixed-oxidase enzymes and hence increase the rate of clearance of vitamin D and its metabolism. The severity of clinical manifestations in any given individual appears to be a function of the combined effects of variety of factors including drug type and total drug dose, dietary vitamin D intake, sunlight exposure, and physical activity level. We report a case of osteomalacia associated with long term carbamazepine therapy in a 21-year-old male with less exposure to sunlight.
Anticonvulsants ; Carbamazepine* ; Humans ; Male ; Metabolism ; Motor Activity ; Osteomalacia* ; Phenobarbital ; Phenytoin ; Primidone ; Sunlight ; Vitamin D ; Young Adult