Traditionally, the Rhododendron species has been used in gastrointestinal disorder or hypertension. Grayanotoxin exists in honey, flowers, pollen, and the nectar of the Rhododendron species. We experienced 3 cases of Grayanotoxin intoxication. The symptoms of intoxication were nausea, vomiting, hypotension, bradycardia, diplopia, dizziness, and chest discomfort. Generally, the treatment for Grayanotoxin intoxication is fluid resuscitation and injection of atropine sulfate. The patients who were intoxicated with Grayanotoxin were discharged without complication after supportive care.
Atropine ; Bradycardia ; Diplopia ; Dizziness ; Flowers ; Honey ; Humans ; Hypertension ; Hypotension ; Nausea ; Plant Nectar ; Pollen ; Resuscitation ; Rhododendron ; Thorax ; Vomiting

OBJECTIVE: To evaluate the effects of piroxicam patch(Trast) in rheumatoid arthritis patients with knee joint pain and swelling and to determine the concentration of plasma and synovial fluid following patch application. METHODS: Twenty-two patients with rheumatoid arthritis participated in a double-blind, placebo-controlled study. The patients were instructed to apply piroxicam or placebo patch at one knee and re-apply it every other day for 2 weeks. They had washout period for 2 weeks and then applied the other patch for 2 weeks at the same joint. The patients recorded knee joint pain using visual analog scale. Knee joint swelling and tenderness were assessed before and after application of piroxicam and placebo patch. Complete blood count, AST, ALT, BUN, creatinine, joint fluid analysis were also done. Piroxicam concentration in plasma and synovial fluid were measured by high performance liquid chromatography(HPLC) after 2 weeks of piroxicam patch application. RESULTS: Knee joint pain improved significantly after the application of piroxicam patch for 2 weeks(visual analog scale, 56. 2+5. 9m vs 48. 2+5. 7mm, p=0. 03 by Wilcoxon signed rank test). There was no significant change in white cell count of synovial fluid, peripheral blood cell count, chemistry, C-reactive protein and erythrocyte sedimentation rate. In terms of adverse effects, mild gastrointesti nal disturbance(8/21 cases, 38%) and local side effects such as pruritus and ery thema(3/21 cases, 14%) were developed, which were insignificant compared with control groups(30%, 15% respectively). Piroxicam concentrations in plasma and synovial fluid after the application of piroxicam patch were 0. 129+0. 04ug/ ml (mean+SE) and 0. 644+0. 202ug/ml respectively. CONCLUSIONS: Piroxicam patch is a safe and effective therapeutic modality for knee joint pain in patients with rheumatoid arthritis. Mild adverse effects such as gastrointestinal disturbance and local side effects were noted. Piroxicam concentration was higher in synovial fluid than in plasma following the application of piroxicam patch.
Arthritis, Rheumatoid* ; Blood Cell Count ; Blood Sedimentation ; C-Reactive Protein ; Cell Count ; Chemistry ; Creatinine ; Humans ; Joints ; Knee ; Knee Joint ; Piroxicam ; Plasma ; Pruritus ; Synovial Fluid ; Visual Analog Scale

OBJECTIVES: The aim of this study is to enhance understanding the clinical features, pathogenesis, diagnosis and treatment of gouty arthritis in Korea by analyzing the clinical manifestations of the patients with urate crystal-proven gouty arthritis. METHODS: 78 cases who had been diagnosed as gouty arthritis by confirming the urate crystals in synovial fluids or tophi in Seoul National University Hospital between January 1, 1989 and July 31, 1995 were analysed for their histories, symptoms, signs, laboratory data, and X-ray findings. RESULTS: 1) Male to female ratio was 18.5:1. The mean age of onset is 49.3 +/- 14.5 years(range 11-83 years); the mean duration of disease 6.5 +/- 7.0 years(range 0-30 years); the mean duration of gouty attack 7.2 +/- 5.5 days(range 1-30 days). 2) The frequent precipitating factors of gouty arthritis were hospitalization(37%) and alcohol drinking(15%). The most frequent accompanying disease was hypertension(24%). Obesity, diabetes, chronic renal failure, hyperlipidemia, ischemic heart diseases, or cerebrovascular diseases were also accompanied by gouty arthritis. 3) The patterns of joint involvement were devided into 3 groups: monoarthritis; 42%, oligoarthritis; 35%, polyarthritis; 23%, The most frequent site of the first gouty attack was the 1st toe(65%). The most frequently involved joint at gouty attack was also the 1st toe(68%). While only lower extremities were involved in most cases with monoarthritis and oligoarthritis(91% and 78%, respectively), both lower and upper extremities were involved in most cases with polyarthritis(78%). 4) Hyperuricemia was found in 74% of the cases at gouty attack. But serum uric acid level was normal in 26%. With respect to pathogenesis of hyperuricemia, 14% of the cases had uric acid overproduction and 86% had uric acid underexcretion. 5) Bony changes in radiologic findings were found in 47% of the cases and tophi in 33%. Bony changes and tophi was significantly related to the younger age of gouty onset and higher serum uric acid level at gouty attack. 6) Acute gouty arthritis responded well to colchicine and NSAIDs. There was no difference in efficacy and the frequency of side effects between them. CONCLUSION: The clinical features of the gouty arthritis in Korea showed no difference from those in foreign studies except higher prevalence of oligo-/polyarthritis and tophi. To be remarkable, 26% of the patients with gouty arthritis did not have hyperuricemia at gouty attack. This finding indicates that urate crystals should be confirmed by synovial fluid examination for diagnosis of gouty arthritis.
Age of Onset ; Anti-Inflammatory Agents, Non-Steroidal ; Arthritis ; Arthritis, Gouty* ; Colchicine ; Diagnosis ; Female ; Gout ; Humans ; Hyperlipidemias ; Hyperuricemia ; Joints ; Kidney Failure, Chronic ; Korea ; Lower Extremity ; Male ; Myocardial Ischemia ; Obesity ; Precipitating Factors ; Prevalence ; Seoul ; Synovial Fluid ; Upper Extremity ; Uric Acid

No abstract available.
Fistula* ; Stomach* ; Tuberculosis*

Myasthenia gravis(MG) is an autoimmune disorder characterized by the presence of anti-acetylcholine receptor antibody and weakness of voluntary muscles. The pathogenesis of MG is decreased numbers of acetylcholine receptors at postsynaptic membranes of neuromuscular junctions. It has been reported that MG often coexists with other autoimmune disorders. This is a case report of systemic lupus erythematosus coexisting with MG in a 23 year old female patient presenting with dysarthria, dysphagia, and limb weakness. We report the case with relevant literature review.
Deglutition Disorders ; Dysarthria ; Extremities ; Female ; Humans ; Lupus Erythematosus, Systemic* ; Membranes ; Muscle, Skeletal ; Myasthenia Gravis* ; Neuromuscular Junction ; Receptors, Cholinergic ; Young Adult

The aim of this study is to evaluate the reasonableness of the medical fee on oral and maxillofacial surgery field according to surgeon's opinions and actual conditions. The medical fee has significant influence on hospital income, the supply and distribution of medical manpower, quality and facilities of medical services. Questionnaire survey was sent to 86 oral and maxillofacial surgeons who worked more than 3 years in general hospital. Among them, 25 doctors replied the 109 answers survey and the average of treatment time and physician work relative value on each category was calculated. And the health insurance cost (that has been applied since 2003) was compared with the questionnaire results. And finally we investigated items that health insurance system did not include in oral and maxillofacial field but actually performed in oral and maxillofacial surgery clinic. The result was that the medical fee did not properly reflect physician work relative value of actual treatments. In case of complicated extraction, work relative value needed 3.5 times enhancement of present value. For simple impacted tooth extraction 1.8 times, for impacted tooth extraction including odontomy 1.7 times, and for fully impacted tooth more than 2/3 of it located into the alveolar bone, 1.8 times enhancement needed. In respect of the present physician work relative value, hemimandibulectomy with neck lymph node dissection for the malignancy is appropriated as 3.3 times of open reduction and internal fixation for the mandibular fracture, but the questionnaire result showed 25 times discrepancy. In conclusion, this research shows the need for intervention that health insurance included items and legal relative medical value must act in union with treatment in clinic to reduce the imbalance between them.
Current Procedural Terminology ; Fees, Medical ; Hospitals, General ; Insurance, Health ; Lymph Node Excision ; Mandibular Fractures ; Mandibular Osteotomy ; Neck ; Surveys and Questionnaires ; Surgery, Oral* ; Tooth, Impacted

Subclavian artery(SCA) injuries are rare, accounting for only 1 to 2% of all acute vascular injuries. The majority of SCA injuries are occured by motor vehicle accident and by penetrating trauma, only 1 to 5% of all subclavian artery injuries occurred by blunt mechanisms. The incidence of brachial plexus injury is also rare and 60% of brachial plexus injuries induced by blunt injury is occurred by motor vehicle accident. Aggressive diagnostic work-up is recommended for the patients with high suspicious index and repair is essential for the successful management of these rare vascular injuries. We report the experience of one case of combined subclavian artery and brachial plexus injuries due to blunt trauma.
Brachial Plexus* ; Humans ; Incidence ; Motor Vehicles ; Subclavian Artery* ; Vascular System Injuries ; Wounds, Nonpenetrating

Purpose: We investigated the consistent efficacy and safety of eflapegrastim, a novel long-acting granulocyte-colony stimulating factor (G-CSF), in Koreans and Asians compared with the pooled population of two global phase 3 trials. Materials and Methods: Two phase 3 trials (ADVANCE and RECOVER) evaluated the efficacy and safety of fixed-dose eflapegrastim (13.2 mg/0.6 mL [3.6 mg G-CSF equivalent]) compared to pegfilgrastim (6 mg based on G-CSF) in breast cancer patients who received neoadjuvant or adjuvant docetaxel/cyclophosphamide. The primary objective was to demonstrate non-inferiority of eflapegrastim compared to pegfilgrastim in mean duration of severe neutropenia (DSN) in cycle 1, in Korean and Asian subpopulations. Results: Among a total of 643 patients randomized to eflapegrastim (n=314) or pegfilgrastim (n=329), 54 Asians (29 to eflapegrastim and 25 to pegfilgrastim) including 28 Koreans (14 to both eflapegrastim and pegfilgrastim) were enrolled. The primary endpoint, DSN in cycle 1 in the eflapegrastim arm was non-inferior to the pegfilgrastim arm in Koreans and Asians. The DSN difference between the eflapegrastim and pegfilgrastim arms was consistent across populations: –0.120 days (95% confidence interval [CI], –0.227 to –0.016), –0.288 (95% CI, –0.714 to 0.143), and –0.267 (95% CI, –0.697 to 0.110) for pooled population, Koreans and Asians, respectively. There were few treatment-related adverse events that caused discontinuation of eflapegrastim (1.9%) or pegfilgrastim (1.5%) in total and no notable trends or differences across patient populations. Conclusion This study may suggest that eflapegrastim showed non-inferior efficacy and similar safety compared to pegfilgrastim in Koreans and Asians, consistently with those of pooled population.

PURPOSE: The aim of this study was to confirm the efficacy and safety of regorafenib for advanced gastrointestinal stromal tumors (GISTs) reported in the GRID phase III trial in Korean patients. MATERIALS AND METHODS: Fifty-seven Korean patientswith advanced GISTwho experienced both imatinib and sunitinib failure were enrolled in the management access program between December 2012 and November 2013 and treated with regorafenib (160 mg orally once daily in a 3 weeks on/1 week off). RESULTS: None of the patients achieved a complete or partial response while 25 patients (44%) showed stable disease for ≥ 12 weeks. With a median follow-up of 12.7 months (range, 0.2 to 27.6 months), the median progression-free survival and overall survival were 4.5 months (95% confidence interval [CI], 3.8 to 5.3) and 12.9 months (95% CI, 8.1 to 17.7), respectively. Interestingly, 15 patients (26%) experienced an exacerbation of their cancer-related symptoms (abdominal pain in eight and abdominal distension in five) during the rest period for regorafenib, but all were ameliorated upon the resumption of regorafenib. The most common grade 3 or 4 adverse event was a hand-foot skin reaction (25%). The regorafenib dose was reduced in 44 patients (77%) due to toxicity, which manifested mainly as a hand-foot skin reaction (n=31). CONCLUSION: This study confirmed the efficacy and safety of regorafenib for advanced GIST after imatinib and sunitinib failure in Korean patients. Considering the exacerbation of the cancer-related symptoms observed during the rest periods, further exploration of the continuous dosing schedule of regorafenib is warranted in future clinical trials.
Appointments and Schedules ; Disease-Free Survival ; Follow-Up Studies ; Gastrointestinal Stromal Tumors* ; Humans ; Imatinib Mesylate* ; Skin

PURPOSE: To compare the diagnostic efficacy of fast spin-echo (FSE) T2-weighted MR imaging with and without fat suppression. MATERIALS AND METHODS: Twelve patients (7 men and 5 women; mean age, 48 years) with pathologically proven cancer of the tongue were included in this study. In all of these, FSE T2-weighted MR images with and without fat suppression were obtained in the same imaging planes before surgery or biopsy. Two radiologists visually compared the images thus obtained in terms of detection, extent, and conspicuity of the tumor, and the contrast-to-noise ratio (CNR) of each tumor was also calculated. RESULTS: In all patients, both imaging modalities were equal in terms of tumor detection. In 4 of 12(33%), the extent of the tumor was greater with fat suppression, while in eight (67%), it was almost the same both with and without. In ten patients (83%), the tumor was more conspicuous with fat suppression, and percentage CNRs were significantly higher with fat suppression than without (180 +/-70% and 113 +/-61%, respectively; p = 0.02). CONCLUSION: For the evaluation of patients with tongue cancer, fat-suppressed FSE T2-weighted MR imaging is superior to its conventional equivalent.
Biopsy ; Female ; Humans ; Magnetic Resonance Imaging* ; Male ; Tongue Neoplasms* ; Tongue*