The congenital long-QT syndrome (LQTS) is characterized by recurrent syncope, prolonged QT intervals, QT interval lability, polymorphic ventricular tachycardia, and sudden death. We report a case of congenital long QT syndrome in a 28-day-old male infant who presented with syncope, bradycardia with 2: 1 pseudo-atrioventricular block and a markedly prolonged QT inteval. One episode occured after crying and degenerated into ventricular fibrillation and terminated after cardioversion. A VVI type cardiac pacemaker was implanted. Subsequently, the infant's heart rate was over 110/min and 2: 1 AV block and any other arrhythmia were absent. The infant recovered from the accompanied pneumonia and sepsis and was discharged 47 days after adrnission. However, 13 days after discharge, the infant returned to our hospital ER with syncope. Ventricular fibrillation ceased after cardioversion. Despite medication with propranolol, ventricular tachycardia persisted. The infant expired the day after he was discharged against medical advice.
Arrhythmias, Cardiac ; Atrioventricular Block* ; Bradycardia ; Crying ; Death, Sudden ; Electric Countershock ; Heart Rate ; Hospitals ; Humans ; Infant ; Long QT Syndrome ; Male ; Pneumonia ; Propranolol ; Sepsis ; Syncope ; Tachycardia, Ventricular ; Ventricular Fibrillation

This research identifies the ingress to egress primary factors that causes a patient to receive delayed emergency medical care. This material was collected between February 1st to 28th, 1998. Research envolved 4,118 people who visited the college emergency medical center in Kyeongido Province, South Korea. Medical records were examined, using the retrospective method, to determine the length of stay and the main cause for waiting. Results are as follows: 1. The age group with the highest admission rate was 10 and under, approximately 1,394 (33.9%). Followed by an even distribution for ages between 11-50 at 10-15% for their respective ranges. The lowest admission rate was 50 years and above. 2. From the 4,118 records examined, 3,489 received outpatient treatment (84.7%); 601 were admitted for inpatient care (14.6%); 25 arrived dead on arrival (0.6%); and 4 people died at the hospital. 3. Between 7PM to 12AM, 42.9% were admitted to the EMC. The hours from 9PM to 11PM recorded the highest admission rate and 5AM to 8AM was the lowest. From 8PM to 12AM, the most beds were occupied. 4. For most patients, the average length of stay was approximately 2.2 hours. By medical department, external medicine was the longest for 2.8 hours. Pediatrics was the shortest for 1.6 hours. The average waiting period for inpatient admission was 2.6 hours. Inpatient admission for pediatrics and external medicine was 3.4 hours and 2.2 hours respectively. 5. Theses are primary factors for delay at EMC: 1) pronged medical consultations to decide between inpatient versus outpatient treatment, and delaying to be inpatient, 2) when you call physicians they are delayed to come, 3) Understaffing during peak or critical hours, 4) Excessive consulting with different medical departments, 5) some patients require longer monitoring periods, 6) medical records are delayed in transit between departments, 7) repeated laboratory tests make delay the result, 8) overcrowded emergency x-ray place causes delay taking x-ray and portable x-ray, 9) the distance between EMC and registration and cashier offices is too far, 10) hard to control patient's family members. The best way to reduce EMC waiting and staying time is by cooperation between departments, both medical and administrative. Each department must work beyond their job description or duty and help each other to provide the best medical service and satisfy the patient needs. The most important answer to shortened the EMC point from ingress to egress is to see things from a patient point of view and begin from there to find the solution.
Emergencies* ; Humans ; Inpatients* ; Job Description ; Korea ; Length of Stay* ; Medical Records ; Outpatients ; Pediatrics ; Referral and Consultation ; Retrospective Studies

Melanosis coli is the brownish black discoloration of the colon due to accumulation of pigment containing macrophages in lamina propria. The nature and source of this pigment is controversial but many studies have suggested that the pigment is related to lipofuscin. Melanosis coli has been reported to be closely associated with prolonged administration of anthraquinone purgatives. But this condition is sometimes associated with colonic polyp colon cancer, rediation therapy or non-anthraquinone purgatives administration. Moreover the fact that melanosis coli could be found in subjects who never used purgatives suggested that, even though chronic consumption of anthraquinone purgatives seems to play a major role, other factors may be involved in the pathogenesis of melanosis coli. We presented a case of melanosis Coli in a 47-year-old female with history of rectal instillation of petroleum for control of hemorrhoids.
Administration, Rectal* ; Cathartics ; Colon ; Colonic Neoplasms ; Colonic Polyps ; Female ; Hemorrhoids ; Humans ; Lipofuscin ; Macrophages ; Melanosis* ; Middle Aged ; Mucous Membrane ; Petroleum*

Background: The purpose of this study is to search for reports on the clinical effectiveness of FLS being implemented worldwide through the systematic review, analyze the roles of coordinators in each study, and provide basic data for the development of future coordinator education programs. Methods: A systematic search of the literature using the Medline, PubMed, and EMBASE databases and the Cochrane Library was conducted for using the following keywords: ‘osteoporosis’ AND ‘fractures’ AND ’secondary prevention’. Finally, 65 studies are included in this study. Results: At the coordinator-based fracture liaison service (FLS) center, the coordinator (often a nurse) acts as a central player in the establishing of patient connections, orthopedic surgeons, radiologists, and attending physicians. Coordinators help bridge the nursing gap by supporting identification, investigation, initiation of treatment, and patient follow-up. Medics has opened the way to effectively manage patients at high risk of developing another fracture. In addition, nurses are in a unique and important role as nurses responsible for enhancing their daily lives by building relationships with patients and families. Conclusions The coordinator in the FLS program plays an important role in the multidisciplinary management of vulnerable fractures, as well as in the diagnosis and treatment of osteoporosis and in maintaining continuity of treatment. In the future, the broader role of coordinators should be systematically organized and developed into accredited educational programs.

Various treatment methods for huge cystic lesion of the jaw exist, such as, resection of the involved bone, enucleation and decompression. Among these methods, enucleation after decompression is a conservative technique that decreases the size of the cystic cavity and reduces the risk of intrabony defects, which could be induced by primary enucleation. In addition, it can save the adjacent anatomic structures. In these cases, the decompression combined with partial enucleation, which was performed before complete cyst enucleation was performed on huge cystic lesions of the mandible. During the process, a decrease in the size of the lesion and the growth of normal oral tissues was observed. The size of the lesion decreased until the time of complete enucleation, and surgery could be performed under local anesthesia. No damage to inferior alveolar nerve was observed. We report these cases with a review of the relevant literature.
Anesthesia, Local ; Decompression ; Jaw ; Mandible ; Mandibular Nerve

Intravascular stents are being used with increasing frequency in interventional neuroradiology. We present two cases of arterial rupture and subarachnoid hemorrhage during middle cerebral artery stenting. Extravasation of contrast material and massive subarachnoid hemorrhage during stenting in one case resulted in mortality. In the other case, overlapping stenting and balloon tamponade on the dissected vessel, however, were performed emergently. Thereafter, thrombotic occlusion of the middle cerebral artery was managed by intraarterial abciximab administration. Serial angiography showed that normal vessel patency was reestablished within 20 min. We discuss complications of stenting for symptomatic middle cerebral artery stenosis and their rescue work.
Angiography ; Balloon Occlusion ; Constriction, Pathologic* ; Middle Cerebral Artery* ; Mortality ; Rescue Work ; Rupture ; Stents* ; Subarachnoid Hemorrhage

MELAS syndrome is characterized by mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes. A 14-year-old male presented with symptoms that resemble stroke including headache, seizure, visual disturbance and slight left hemiparesis. Laboratory investigation showed elevated lactate level in the blood. Brain computed tomography and magnetic resonance image revealed acute infarction in the right occipitoparietal lobe, which was not restricted to a specific vascular territory. Magnetic resonance spectroscopy showed decreased N-acetyl aspartate and increased lactate level in the affected lobe. A molecular genetic analysis identified A3243G point mutation in the peripheral blood leukocytes and confirmed MELAS syndrome. We describe clinical, radiological and molecular genetic findings in the patient with MELAS syndrome presenting occipital brain infarct.
Acidosis, Lactic ; Adolescent ; Aspartic Acid ; Brain* ; Headache ; Humans ; Infarction ; Lactic Acid ; Leukocytes ; Magnetic Resonance Spectroscopy ; Male ; MELAS Syndrome* ; Mitochondrial Myopathies ; Molecular Biology ; Paresis ; Point Mutation ; Seizures ; Stroke

PURPOSE: Although congenital bronchogenic cysts in the cervical region, especially in the thyroid or perithyroidal area, are rare, distinguishing them from other cervical cystic lesions (e.g., thyroglossal duct and branchial cleft cysts) and metastatic cervical lymph nodes is difficult preoperatively. Additionally, cystic degeneration of metastatic lymph nodes is common in patients with thyroid cancer. We investigated the clinical characteristics and proper treatment for individuals with cervical bronchogenic cysts. METHODS: Of the 18,900 patients treated for thyroid cancer, 18 patients with pathologically confirmed bronchogenic cysts were retrospectively reviewed. Bilateral total thyroidectomy or less than total thyroidectomy with central compartment node dissection, including cystic mass excision was done and cystic mass was confirmed by postoperative pathologic examination. RESULTS: All cervical bronchogenic cysts were asymptomatic. Their mean size was 1.2 cm (range, 0.3 to 3 cm). Of these 18 patients, 15 did not have any abnormal radiological findings, except for lymphadenopathy during preoperative evaluations. Most bronchogenic cysts were detected around the thyroid and paratracheal areas. On preoperative imaging and intraoperatively, most were indistinguishable from metastatic cervical lymph nodes or other cystic lesions. CONCLUSION: Although cervical bronchogenic cysts are rare and benign, they should be distinguished from other cystic cervical masses, especially metastatic cervical lymph nodes associated with thyroid cancer. Possible cervical bronchogenic cysts found during thyroid cancer evaluation or surgery should be surgically excised.
Branchial Region ; Bronchogenic Cyst* ; Humans ; Lymph Nodes* ; Lymphatic Diseases ; Retrospective Studies ; Thyroid Gland ; Thyroid Neoplasms* ; Thyroidectomy

PURPOSE: Ultrasound (US) and US-guided fine needle aspiration biopsies (FNAB) are considered the modalities of choice for assessing lymph nodes suspected of containing metastases, but the sensitivity of FNAB varies and is specific to the operator. We analyzed the risk of FNAB providing false negative results of lateral neck node metastasis, and evaluated diagnostic accuracy of FNAB, in patients with papillary thyroid cancer. MATERIALS AND METHODS: FNAB was performed in 242 patients suspected of having lateral neck node metastasis on preoperative imaging. Thyroglobulin in the fine-needle aspirate washout (FNA wash-out Tg) and computed tomography enhancement (Hounsfield units) were measured. Patients with negative results on FNAB were examined by intraoperative frozen section. The false negative and true negative groups were compared. RESULTS: Of the 242 patients, 130 were confirmed as having lateral neck node metastases. In 74 patients, the metastasis was identified by FNAB. False positive results were observed in 2 patients (0.8%) and false negatives in 58 (44.6%). Risk analysis showed that patient age <45 years (p=0.006), tumor size >1 cm (p=0.008) and elevated FNA wash-out Tg (p=0.004) were significantly associated with false negative results on FNAB. The accuracy of FNAB increased significantly when combined with FNA wash-out Tg (p=0.003). CONCLUSION: To reduce the false negative rate of FNAB, patient age (<45 years), tumor size (>1 cm) and FNA wash-out Tg (>34.8 ng/mL) should be considered in preoperative planning. Accuracy may be improved by combining the results of FNAB and FNA wash-out Tg.
Adolescent ; Adult ; Aged ; Biopsy, Fine-Needle ; Carcinoma/*diagnosis/*pathology/radiography/surgery ; False Negative Reactions ; Female ; Humans ; Lymph Nodes/*pathology/radiography ; Lymphatic Metastasis/*pathology/radiography ; Male ; Middle Aged ; Multivariate Analysis ; Preoperative Care ; Risk Factors ; Sensitivity and Specificity ; Thyroglobulin/metabolism ; Thyroid Gland/*pathology ; Thyroid Neoplasms/*diagnosis/*pathology/radiography/surgery ; Tomography, X-Ray Computed ; Young Adult

OBJECTIVE: In this study, we evaluate the efficacy of captopril comparing with nifedipine for management of hypertensive urgencies in autonomic dysreflexia in patients with spinal cord injury (SCI). METHOD: Twenty-four patients with SCI above T6 were documented and treated with drug therapy in this study whose systolic blood pressure (SBP) was at or above 150 mmHg despite the use of nondrug management during an autonomic dysreflexia episode. They were divided into two groups; captopril group (n=12) and nifedipine group (n= 12). Captopril group was administered captopril 25 mg sublingually and nifedipine group was administered nifedipine 10 mg sublingually. Diastolic blood pressure(DBP), systolic blood pressure (SBP), heart rate and side effects were monitored after administration. RESULTS: Mean DBP and SBP at baseline and 15, 30, 60 minutes after captopril were significantly decreased (p<0.05). There were no significant side effects such as reactive hypotension. The administration of nifedipine also successfully reduced mean SBP and DBP after 15, 30, 60 minutes (p<0.05), but some side effects were reported such as reactive hypotension, tarchycardia and headache. CONCLUSION: For the management of hypertension in autonomic dysreflexia, captopril appears to be one of the safe and effective methods in patients with SCI.
Autonomic Dysreflexia* ; Blood Pressure ; Captopril* ; Drug Therapy ; Headache ; Heart Rate ; Humans ; Hypertension ; Hypotension ; Nifedipine ; Spinal Cord Injuries* ; Spinal Cord*