Neuroleptic malignant syndrome is a rare, but potentially life-threatening adverse event associated with the use of neuroleptic agents. We describe the case of a 47-year-old schizophrenic woman who was treated with clozapine for years. The patient developed acute renal failure with pulmonary edema, and underwent mechanical ventilation and hemodialysis.
Acute Kidney Injury ; Antipsychotic Agents ; Clozapine* ; Female ; Humans ; Middle Aged ; Neuroleptic Malignant Syndrome* ; Pulmonary Edema ; Renal Dialysis ; Respiration, Artificial ; Rhabdomyolysis

Medico-legal investigations in Korea depend mostly on postmortem inspection without autopsy. Both untrained physicians and experienced forensic pathologists may not be able to determine the cause and manner of death only by postmortem inspection. The aim of our study was to show the limitations of postmortem inspection by evaluating the discrepancy between the results of postmortem inspection and autopsy after natural death. The manner of death by postmortem inspection changed to unnatural death in 9.4% of the cases (12 cases/127 cases) after autopsy. The cause of death in most cases was consumption of alcohol, agricultural chemicals, and antipsychotic intoxication. The cause of death by postmortem inspection changed in 24.3% of the cases (26 cases/107 cases) among cases of confirmed natural death after autopsy. The positive predictive value of cause of death by postmortem inspection was higher for cardiovascular disease (79.0%) and lower for chronic alcoholism and/or chronic liver disease (28.6%). This study shows that forensic pathologists could make considerable errors in determining the cause and manner of death without autopsy and emphasizes the necessity to refine medico-legal investigations in Korea by introducing the limited autopsy with toxicologic study and supportive postmortem imaging.
Agrochemicals ; Alcoholism ; Autopsy ; Cardiovascular Diseases ; Cause of Death ; Korea ; Liver Diseases

Eradication of Helicobacter pylori has contributed to the treatment of peptic ulcers and mucosa-associated lymphoid tissue lymphoma. Moreover, it has possibly decreased the prevalence of gastric cancer. However, eradication therapy is associated with various adverse effects, of which diarrhea is the most common. The incidence of diarrhea after eradication treatment varies from 8% to 48%. In particular, the incidence is higher in patients who receive first-line standard triple therapy compared with those who receive second-line therapy. Both antibiotics and proton pump inhibitors, components of eradication therapy, have short-term and long-term impacts on gut microbiota. The alterations of gut microbiota may not recover until 1 year after eradication therapy. Most cases of diarrhea that occur after eradication therapy are antibiotic-associated diarrhea caused by the destruction of the normal gut microbiota. In some cases, Clostridioides difficile-associated diarrhea occurs after eradication therapy. If bloody diarrhea occurs after eradication therapy and the Clostridioides difficile toxin is not detected, antibiotic-associated hemorrhagic colitis associated with Klebsiella oxytoca infection should be suspected. It is crucial to explain the possibility of diarrhea before initiating eradication therapy to increase compliance. Furthermore, probiotics may be administered to reduce diarrhea. If severe diarrhea or symptoms other than the usual antibiotic-associated diarrhea occur during or after eradication therapy, antibiotics should be discontinued. In addition, appropriate tests to determine the cause of diarrhea should be performed. This review summarizes the alteration of the gut microbiota, the causes of diarrhea after Helicobacter pylori eradication therapy, and its management.

Eradication of Helicobacter pylori has contributed to the treatment of peptic ulcers and mucosa-associated lymphoid tissue lymphoma. Moreover, it has possibly decreased the prevalence of gastric cancer. However, eradication therapy is associated with various adverse effects, of which diarrhea is the most common. The incidence of diarrhea after eradication treatment varies from 8% to 48%. In particular, the incidence is higher in patients who receive first-line standard triple therapy compared with those who receive second-line therapy. Both antibiotics and proton pump inhibitors, components of eradication therapy, have short-term and long-term impacts on gut microbiota. The alterations of gut microbiota may not recover until 1 year after eradication therapy. Most cases of diarrhea that occur after eradication therapy are antibiotic-associated diarrhea caused by the destruction of the normal gut microbiota. In some cases, Clostridioides difficile-associated diarrhea occurs after eradication therapy. If bloody diarrhea occurs after eradication therapy and the Clostridioides difficile toxin is not detected, antibiotic-associated hemorrhagic colitis associated with Klebsiella oxytoca infection should be suspected. It is crucial to explain the possibility of diarrhea before initiating eradication therapy to increase compliance. Furthermore, probiotics may be administered to reduce diarrhea. If severe diarrhea or symptoms other than the usual antibiotic-associated diarrhea occur during or after eradication therapy, antibiotics should be discontinued. In addition, appropriate tests to determine the cause of diarrhea should be performed. This review summarizes the alteration of the gut microbiota, the causes of diarrhea after Helicobacter pylori eradication therapy, and its management.

No abstract available.
Hysterectomy* ; Sexual Behavior*

Accidents, Traffic ; Diagnosis ; Facial Injuries ; Female ; Head ; Humans ; Incidence ; Inpatients ; Jeollanam-do ; Lacerations ; Male ; Mandibular Fractures ; Neck ; Postoperative Complications ; Social Environment ; Surgery, Oral ; Violence

PURPOSE: In the management of Hirschsprung's disease (HD), conventional Duhamel's, Swenson's or Soave's procedures have generally been performed. The author tried a new procedure, a transanal one-stage pull-through procedure (TOP). The aim of this study is to compare functional outcome of TOP with the conventional procedures that are generally used in treating HD. METHODS: Thirty-one cases received TOP procedure from November 2000 to December 2003. The postoperative results were evaluated by performing a retrospective medical record review, and by using as questionnaire. These results were then compared with reports' on patients after using one of the conventional procedures. RESULTS: In this study, the mean age of patients was 73.4 days, the mean hospital stay was 5.7 days and the mean follow-up period was 20.1 months. Postoperative results were as follows: (1) 23 cases (74.2%) had 1~2 times of defecation per day. (2) 26 cases (83.9%) had no problematic soiling. (3) 22 cases (70.9%) had soft consistency of stool. (4) 24 cases (77.4%) had no straining during defecation. (5) 25 cases (80.7%) didn't need stool softner. (6) In 14 cases (45.2%), an anal dilator was necessary for transient postoperative anal stricture. (7) After 24 months of age, a diaper was not necessary in 12 cases (70.6%). (8) The parents felt satisfactory in 28 cases (90.3%) for their children, as compared with the children from other families, and the parents felt satisfactory in 18 cases (94.7%) for the HD children compared with the other children of their family.(9) 23 cases (74.2%) had not shown constipation findings on simple abdomen film. (10) At the first digital rectal examination, perianal rash was found in 13 cases (41.9%), anastomotic stricture had occurred in 12 cases (38.7%), and normal squeezing pressure was felt in 27 cases (87.1%). However, at the last examination during the follow-up period, perianal rash was found in 2 cases (6.5%), the anastomotic stricture had not persisted, and normal squeezing pressure was felt in all cases (100%). (11) On the barium study, 13 months after operation, no retention of contrast within 24 hours was shown in 21 cases (95.5%). (12) According to the SanFilippo system, there were 24 excellent cases (77.4%) and 7 good cases (22.6%), so all the cases showed a favorable functional outcome. (13) In comparison with other reports' results, there was no significant difference between the author's outcomes and other reports' outcomes (p=0.752). CONCLUSION: This transanal one-stage pull-through procedure (TOP) seems to be as effective as the traditional method for the management of HD.
Abdomen ; Barium ; Child ; Constipation ; Constriction, Pathologic ; Defecation ; Digital Rectal Examination ; Exanthema ; Follow-Up Studies ; Hirschsprung Disease* ; Humans ; Length of Stay ; Medical Records ; Parents ; Surveys and Questionnaires ; Retrospective Studies ; Soil

PURPOSE: Necrotizing enterocolitis (NEC) is one of the most common surgical emergencies during the neonatal period. The aim of this study was to identify and assess the factors affecting the postoperative mortality in infants with NEC that require surgical treatment. METHODS: The authors retrospectively reviewed 37 infants surgically treated, at the Department of Surgery, Pusan National University Hospital, between Jan. 2000 and Dec. 2004. The patients were divided two groups according to the clinical outcomes; the survival and non-survival groups. Eight variables, i.e., sex, gestational age, weight at birth and at the time of the first operation, weight change between birth and the time of the first operation, degree of clinical manifestations (as a modified Bell's stage), interval between the onset of symptoms and the time of the first operation, the extent of necrotic intestine and associated anomalies, were analyzed. RESULTS: Among 37 infants, 6 expired (a mortality rate of 16.2%). The postoperative mortality was not affected by sex, gestational age, and the weight at birth and at the time of the first operation, weight change between birth and at the time of the first operation, degree of clinical manifestations and the interval between the onset of symptoms and the time of the first operation. However, the extent of necrotic intestine was associated with a significantly increased mortality (P=0.046). CONCLUSION: These data suggest that the extent of necrotic intestine is the only statistically significant factor affecting the postoperative mortality in infants with NEC that require surgical treatment.
Busan ; Emergencies ; Enterocolitis, Necrotizing* ; Gestational Age ; Humans ; Infant ; Intestines ; Mortality* ; Parturition ; Retrospective Studies

No abstract available.
Gestational Trophoblastic Disease*

OBJECTIVE: To evaluate the usefulness of alendronate for prevention and treatment of postmenopausal osteoporosis this study was taken. METHODS: This prospective randomized clinical trial examined the effects of oral alendronate and HRT(conjugated estrogen plus medroxyprogesterone acetate), in combination and seperately, on BMD, biochemical markers of bone turnover in 79 women with low bone mass. Treatment included alendronate(10mg daily) plus HRT(group I, n=38), or HRT(group II, n=41) for 6 months. Bone density measurements were performed at months 0 and 6 at the lumbar spine. Biochemical markers of bone turnover were also measured every three months. RESULTS: Serum Osteocalcin decreased by 19.2% in group I and by 10.0% in group II at 3 months(p<0.05), and by 30.9% in group I and by 19.8% in group II at 6 months(p<0.05). Urinary deoxypyridinoline showed decrease of 19.75%(I) vs. 10.4%(II) at 3 months, 30.1%(I) vs. 20.7%(II) at 6 months, the difference was significant. Percent change of BMD measurements from baseline at 6 months in group I was 6.2% and in group II 0.6% on the lumbar spine(p<0.05). CONCLUSION: The treatment with alendronate is useful to postmenopausal women with osteoporosis by decreasing bone turnover markers, and by increasing the BMD.
Alendronate* ; Biomarkers ; Bone Density ; Estrogens ; Female ; Humans ; Medroxyprogesterone ; Osteocalcin ; Osteoporosis* ; Osteoporosis, Postmenopausal ; Prospective Studies ; Spine