Acrylonitrile is most commonly used aliphatic nitrile compounds characterized by the structural formula R-C=N and used mossy to make acrylic fibers, plastics, synthetic rubber, and wall coverings. In recent, because of its extensive usage and the rapid expansion of the chemical industry, many poisonings have been reported and many studies on its health effects have been performed. Acute toxicity resembles cyanide poisoning and results mainly in effects on the nervous system. High exposure also can cause temporary damage to red blood cells and the liver and can cause lead to death. Because long-term occupational exposure to the acrylonitrile has been with cancer in humans, the U.S EPA classifies acrylonitrile as probable carcinogen. For this reason, The federal government has developed regulations and advisories to protect individuals firm the potential health effects of acylonitrile in the environment, but there are few studies, case reports and regulations of the government in our country. We experienced acute poisoning caused by acrylonitrile inhalation that occurred in an industrial accident. So, we report this case with literature reveiw.
Accidents, Occupational ; Acrylonitrile* ; Chemical Industry ; Elastomers ; Erythrocytes ; Federal Government ; Humans ; Inhalation* ; Liver ; Nervous System ; Occupational Exposure ; Plastics ; Poisoning* ; Social Control, Formal

A clinical observation was made on 19 patients of renal cell carcinoma who were treated by radical nephrectomy with extended retroperitoneal lymphadenectomy in the Department of Urology, Catholic Medical College during the period from May, 1980 to August, l985. Results were as follows; 1. Clinical stages by Robson`s staging system were 7 cases of stage I, 6 cases of stage II, 5 cases of stage III and 1 case of stage IV. Acuracy rate of clinical staging was 68.4%. 2. Pathologic stages were 8 cases of stage I, 5 cases of stage II, 4 cases of stage HI and 2 cases of stage IV. 3. Metastatic sites were perirenal fat(5 cases), regional lymphnode (2 cases), vessel(4 cases) and lung (2 cases). The rate of regional lymphnode involvement was 10.5%. 4. Postoperative complications were colocutaneous fistula (1 case), prolonged ileus (1 case) and pleural effusion (1 case). 5. Out of 19 cases 13 cases were alive without recurrence, 2 cases were alive with metastasis, 3 cases died with recurrence and 1 case died with other cause. 1 year survival rate was 77.8%.
Carcinoma, Renal Cell* ; Fistula ; Humans ; Ileus ; Lung ; Lymph Node Excision* ; Neoplasm Metastasis ; Nephrectomy* ; Pleural Effusion ; Postoperative Complications ; Recurrence ; Survival Rate ; Urology

Partial nephrectomy frequently accompanies serious complications such as secondary bleeding and urinary fistula and these complications result from necrosis of renal cut margin after partial nephrectomy. We have performed experimental partial nephrectomy to compare the extent of necrosis of renal cut margin after the wedge resection(Group l), the transverse polar resection(Group 2) and the chromic ligature resection(Group 3). In order to investigate which type of 3 partial nephrectomies cause less complications, 15 adult mongrel dogs were divided into three groups and partial nephrectomy was performed at the lower one quarter of 10 kidneys of 5 dogs in each group. The gross and microscopic findings of renal cut margin were observed at 1, 2, and 3 weeks after the operation. The results were as follows; 1. Mean depth of necrosis of the renal cortex at cut margin in Groups 1, 2 and 3 were 1.Ocm, O.2 cm and O.3cm, respectively. 2. Mean depth of necrosis of the renal medulla in Groups 1, 2 and 3 were 1.1cm, O.9cm and O.8cm, respectively. 3. On microscopic examination of the renal cortex at the 3rd week after operation, Groups 2 and 3 showed complete healing of necrosis but Group 1 showed delayed healing with remained necrotic tissue. From the present experiment it was found that both the transverse polar and chromic ligature resection cause less complications than the wedge resection.
Adult ; Animals ; Dogs* ; Hemorrhage ; Humans ; Kidney ; Ligation ; Necrosis* ; Nephrectomy* ; Urinary Fistula

BACKGROUND: The aim of this study was to investigate the relationships between left ventricular ejection fraction (LVEF) and mortality and neurologic outcomes with post-cardiac arrest syndrome (PCAS) after out-of-hospital cardiac arrest (OHCA). METHODS: Patients with PCAS after OHCA admitted to the intensive care unit between January 2014 and December 2015 were analyzed retrospectively. RESULTS: total of 104 patients were enrolled in this study. The mean age was 54.4 ± 15.3 years, and 75 of the patients were male (72.1%). Arrest with a cardiac origin was found in 55 (52.9%). LVEF < 45%, 45-55%, and > 55% was measured in 39 (37.5%), 18 (17.3%), and 47 (45.2%) of patients, respectively. In multivariate analysis, severe LV dysfunction (LVEF < 45%) was significantly related to 7-day mortality (odds ratio 3.02, 95% Confidence Interval 1.01-9.0, p-value 0.047). CONCLUSIONS: In this study, moderate to severe LVEF within 48 hours after return of spontaneous circulation was significantly related to 7-day short-term mortality in patients with PCAS after OHCA. Clinicians should actively treat myocardial dysfunction, and further studies are needed.
Echocardiography ; Humans ; Intensive Care Units ; Male ; Mortality* ; Multivariate Analysis ; Out-of-Hospital Cardiac Arrest* ; Passive Cutaneous Anaphylaxis ; Retrospective Studies ; Stroke Volume*

BACKGROUND: Head injury is one of the most common causes of emergency department visits and hospital admission in the pediatric populations, and most injuries are mild. In mild head injury, grading of severity and decision of hospital admission are difficult in the emergency department. Recent studies have suggested that patients with a normal head CT scan and neurologic exam following head injury can be safely discharged from the emergency department. However, previous studies have relied on incomplete patient follow-up and been limited for the most part to adult population. So we performed this study to assess clinical course and the incidence of significant CNS sequelae in children with a normal head CT scan and no focal neurologic sign after mild head injuries during hospital admission and follow-up for 1 month. METHODS: We reviewal the records of children(n=209) admitted to the department of emergency medicine with closed head injuries from Jan. 1, 1996 to Dec. 31, 1996, who's initial Glasgow Coma Scale was 13 to 15, and have no focal neurologic sign and a normal head CT scan. RESULT: 209 patients were studied with a mean age of 6.8(range 3 months to 15years), and 66.5% were male. The most common mechanisms of injury were pedestrian T.A(50.2%) and fall(11.5%). Patients had a mean Glasgow coma scale of 14.8 and mean Abbreviated Injury Score of 1.3. Patients had clinical symptoms of headache(49.3%), vomiting(44.5%), loss of consciousness(LOC)(29.6%), amnesia(10.0%), sleepiness(8.6%), irritability(8.6%), confusion(2.9%) and seizure(1.9%). The mean duration of admission was 4.3 days(range: 6 hours-20 days) and the mean duration of symptom was 36.4 hours. No child developed significant CNS sequelae during hospital admission. However, during hospital admission, aye children(all were preschooler) had psychologic complication ; one child developed post-traumatic stress disorder requiring psychologic treatment for 3 months. Three children developed enuresis and two children developed night terror. During 1 month fallow-up, one child developed a symptomatic hemorrhagic contusion 5 days after the head injury, not requiring neurosurgical treatment. CONCLUSION: Among children with an initial Glasgow Coma Scale of 13 to 15, a normal head CT scan and no focal neurologic sign after mild head injuries, delayed intracranial sequelae are extremely uncommon. So these patient may be discharged home with parental supervision and education for dose observation.
Adult ; Child* ; Contusions ; Craniocerebral Trauma* ; Education ; Emergencies* ; Emergency Medicine* ; Emergency Service, Hospital ; Enuresis ; Follow-Up Studies ; Glasgow Coma Scale ; Head Injuries, Closed ; Head* ; Humans ; Incidence ; Male ; Neurologic Manifestations ; Organization and Administration ; Parents ; Stress Disorders, Post-Traumatic ; Tomography, X-Ray Computed

One patient who underwent radical nephrectomy for renal cell carcinoma participated in a follow up study of the contralateral hypoplastic renal function. Compensatory renal enlargement was demonstrated on follow excretory urogram. The enlargement was 12mm in length, 16mm in width. Immediately, postoperative renal function, GFR, was decreased to minimum value, 8.6 ml/min., but GFR of the remaining kidney was increased to maximal value, 37 ml/min. on post-op 5th day, and then decreased. After post-op 2.6 month the GFR was maintained as the level of 13-14 ml/min. Plasma BUN and creatinine was increased to maximum value, BUN 46.1 mg/dl Cr. 4.1mg/dl, on post-op 9th day and then decreased continuously. But these BUN and creatinine level were maintained as 29.3 mg/dl, 3.4 mg/dl on post-up 6th month. We present a case of this renal cell carcinoma with contralateral renal hypoplasia.
Carcinoma, Renal Cell* ; Creatinine ; Follow-Up Studies ; Humans ; Kidney ; Nephrectomy ; Plasma

We evaluated the antitumor activity and toxicity of recombinant human interferon gamma (LBD -001) as a new modality for advanced renal cell carcinoma from March, 1988 to August, 1989 at the Department of Urology, St. Mary's Hospital, Catholic University Medical College. Eleven patients with advanced renal cell carcinoma were given recombinant gamma interferon at dose of 5.0-7.6 x 106U/day, subcutaneously three days per week. Among eleven patients, only one achieved partial response. Major adverse effects included fever, fatigue, myalgia and leukopenia, but no life threatening side effects were found. Although recombinant human interferon gamma have an antitumor activity against advanced renal cell carcinoma, further study is necessary to define the optimal treatment regimen.
Carcinoma, Renal Cell* ; Fatigue ; Fever ; Humans ; Interferons* ; Leukopenia ; Myalgia ; Urology

We report the first case of an angiomyomatous hamartoma (AH) of the popliteal lymph nodes (LNs) occurring in association with diffuse pigmented villonodular synovitis (PVNS) of the knee. AH is a rare benign vascular disease with a predisposition for the LNs of the inguinal region. Twenty-five cases of AH have been reported to date; however, the precise pathogenesis is still undetermined. In the present case, an open synovectomy revealed two of three popliteal LNs in close proximity to the extra-articular component of diffuse PVNS. These LNs demonstrated irregularly distributed thick-walled blood vessels in the hilum. These vessels extended into the medulla and cortex and were associated with haphazardly arranged smooth muscle cells in the sclerotic stroma. These findings are compatible with an AH. Our observations raise the possibility that AH of the popliteal LNs may represent an abnormal proliferative reaction against the inflammatory process caused by PVNS of the knee.
Angiomyoma ; Blood Vessels ; Hamartoma ; Knee ; Lymph Nodes ; Myocytes, Smooth Muscle ; Synovitis, Pigmented Villonodular ; Vascular Diseases

Many patients whose chief complaint is headache caused by accident such as traffic accident, falling, or assaults visit to emergency center. Majority of these patients has mild or moderate symptoms, and there is no need to treat surgically. However, the fact that head injury can cause SIADH(syndrome of inappropriate secretion of antidiuretic hormone) is likely to be overseen. Acute hyponatremia might have been associated with death or permanent brain damage. Hyponatremia is best handled by early recognition and correction of a downward trend in the serum sodium. Unfortunately, this is often difficult in the head-injured patient, where hyponatremia may occur fairly rapidly and is confused by symptoms of head injury. when moderate to severe hyponatremia occurs, it is important to determine its etiology and expeditiously initiate corrective action. There has not been any reported case of the occurrence of symptomatic SIADH after mild head injury in Korea yet. The authors report the experience of three cases of symptomatic SIADH after mild head injury with review of the literatures.
Accidents, Traffic ; Brain ; Craniocerebral Trauma* ; Emergencies ; Head* ; Headache ; Humans ; Hyponatremia* ; Inappropriate ADH Syndrome ; Korea ; Sodium

BACKGROUND: Pneumonia is the most common cause of death among patients with infectious disease in Korea. However, studies of pneumonia with septic shock in patients presenting to the emergency department are limited. The aim of this study was to investigate the prognostic factors associated with pneumonia with septic shock in patients presenting to the emergency department. METHODS: From January 2008 to September 2014, patients with pneumonia with septic shock admitted through the emergency department were retrospectively examined. RESULTS: Of the 561,845 patients who visited the emergency department, 398 were admitted for pneumonia with septic shock. The 28-day mortality rate in these patients was 36.4%. The independent prognostic factors were old age (>70 yrs) (odds ratio [OR], 2.42; 95%, confidence interval [CI], 1.35-4.32), Acute Physiology and Chronic Health Evaluation (APACHE) II score (OR, 1.04; 95% CI, 1.01-1.08), leukopenia (OR, 3.63; 95% CI, 1.48-8.94), prolonged PT-INR (OR, 2.53; 95% CI, 1.41-4.54), and hypoxemia (OR, 2.88; 95% CI, 1.30-6.38). CONCLUSIONS: A poor prognosis of patients with pneumonia is associated with old age (>70 yrs), increased APACHE II score, leukopenia, prolonged PT-INR, and hypoxemia.
Anoxia ; APACHE ; Cause of Death ; Communicable Diseases ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Korea ; Leukopenia ; Mortality ; Pneumonia* ; Prognosis ; Retrospective Studies ; Shock, Septic*