No abstract available.
Autoantibodies* ; DNA*

PURPOSE: The prevalence of intoxication and toxidromes, such as altered mental status, from Sedatives/hypnotics is high. Many patients have been transferred to a higher-level emergency center. This study was designed to analyze the clinical features of these patients and to compare patients transferred from a regional hospital with patients who directly visited a higher-level emergency center. METHODS: A retrospective study was conducted on 298 sedative/hypnotic intoxication patients examined from January 2008 to December 2012. After excluding patients intoxicated from other category medications and missing data on medical records, 158 acute intoxication patients were enrolled in the study and divided into transferred and direct-visit groups. Gastric lavage patients (n=108) were also subdivided into two groups by irrigation site. Clinical features, treatments, and complications were investigated. RESULTS: There were no significant differences between the two groups in initial clinical manifestations, laboratory data, and toxicological information, except for charcoal treatment and complications from pneumonia. The use of charcoal was significantly lower in the group transferred from a regional medical center. The transferred group showed a higher incidence of pneumonia than the direct-visit group (10/54(18.5%) vs. 5/104(4.8%), respectively, p=0.007). In the subgroup analysis of gastric lavage patients, there was also a higher incidence of pneumonia in the regional hospital lavage group compared to the higher-level emergency center lavage group (8/32(25.0%) vs. 5/76(6.6%), respectively, p=0.011). From a comparative analysis of pneumonic complications and mental status, pneumonia patients showed a higher incidence of painful responses and unresponsive mentality (6(40.0%) and 4(26.7%), respectively, p<0.001). CONCLUSION: In acute sedative/hypnotic intoxication patients, transferred patients, including regional hospital gastric lavage patients, showed a higher incidence of pneumonia. Pneumonic complication patients showed a higher incidence of a decreased mentality. Therefore, for patients transferred or treated for an altered mental status, precautions for complications from pneumonia must be considered.
Charcoal ; Emergencies* ; Gastric Lavage ; Humans ; Hypnotics and Sedatives ; Incidence ; Medical Records ; Pneumonia ; Poisoning ; Prevalence ; Retrospective Studies ; Therapeutic Irrigation

OBJECTIVE: To establish the standard values for proper antenatal weight gain, biweekly mean weight gains, standard deviations were calculated from the 5th to the 42nd gestational week and their percentiles were determined. And the influence of prepregnancy body mass index and/or parity on biweekly weight gain was investigated. METHODS: We analyzed the biweekly weight gain data from 910 women who had noncomplicated singleton term pregnancy. Data was categorized in three groups according to body mass index (BMI). RESULTS: The biweekly weight gain table has been determined and 'Sigmoid(S) shaped' weight gain curves were presented. Primipara and multipara have significantly less weight gain than nullipara beyond the 25th weeks. Biweekly weight gain was significantly different among prepregnancy BMI groups from the 13th week. CONCLUSION: More careful prenatal care according to the biweekly weight gain-gestational week tables is needed to prevent a lot of complications which may be associated with abnormal weight gain during pregnancy. To establish Korean standard value for antenatal weight gain, a nationwide multicenter study is needed.
Body Mass Index ; Female ; Humans ; Parity ; Pregnancy* ; Prenatal Care ; Weight Gain*

Aconite, derived from the roots of certain aconitum species (Racunculaceae), is widely distributed in Korea. Aconitine, an extremely toxic substance present in aconite, has pharmacological effects, including anti-inflammatory, analgesic, and positive inotropic actions. Due to its relatively low safe dose, we sometimes encounter cases of serious aconite intoxication. The toxic compound mainly affects the CNS, heart, and muscle tissues, resulting primarily in cardiovascular complications. Aconite poisoning presents with a combination of neurological, cardiovascular, and gastrointestinal features. The main cause of death is severe cardiotoxicity causing refractory ventricular tachyarrhythmias and asystole. As there is no specific antidote, management of aconite poisoning is supportive. All patients require close monitoring of blood pressure and cardiac rhythm since ventricular arrhythmias may occur during the first 24 hours of poisoning, resulting in sudden deterioration in the patient's clinical condition. Extracorporeal membrane oxygenation (ECMO) has traditionally been utilized for perioperative cardiac failure and cardiomyopathies. More recently, the indications for ECMO have expanded to patients with acute cardiovascular decompression including intractable arrhythmias. We report on a patient who developed life threatening ventricular tachyarrhythmia after ingestion of herbal tablets containing aconite alkaloids. Our patient was resuscitated with intravenous infusion of amiodarone, repeated cardioversion/defibrillation, and mechanical circulatory support with ECMO.
Aconitine ; Aconitum* ; Alkaloids ; Amiodarone ; Arrhythmias, Cardiac* ; Blood Pressure ; Cardiomyopathies ; Cause of Death ; Decompression ; Eating ; Extracorporeal Membrane Oxygenation* ; Heart ; Heart Arrest ; Heart Failure ; Humans ; Infusions, Intravenous ; Korea ; Poisoning ; Tablets ; Tachycardia ; Tachycardia, Ventricular

BACKGROUND/AIMS: There have been much debates on the effects of HBV mutants on the clinical course of HBV-associated chronic liver diseases. The purpose of this study was to define the relationship among HBV mutants, severity of hepatitis and expression patterns of HBcAg METHODS: HBV DNA was extracted from the liver tissue of 31 patients who had been HBsAg positive for more than 6 months. The amplification of X was performed as well as core promoter/precore region of HBV DNA by polymerase chain reaction and then direct sequencing of them. Pathologic severity was classified utilizing Scheuer's scoring system and immunohistochemical staing for HBcAg in hepatocytes was performed. The expression patterns of HBcAg were divided into four types according to expression location of HBcAg: Type I as a nuclear predominant expression of HBcAg; Type II as mixed patterns, combined expression of cytoplasmic and nuclear localization of HBcAg; Type III as a diffuse cytoplasmic expression of HBcAg; and Type II as an inclusive body-like expression in cytoplasm. RESULTS: In investigating the relationship between HBV mutants and clinical findings, ALT, HBV DNA and hepatitis activity index (HAI) in hepatitis with wild HBV were normal to high but those in hepatitis with core promoter or precore mutants were high . There were no statistically significant differences (p=0.062). In terms of the relationship between HBV mutants and the expression pattern of HBcAg, type I, II, IV were noticed in hepatitis with wild HBV but in almost all mutants cases type III, II were noticed (p<0.01). The score of HAI increased as the number of the expression pattern of HBcAg increased from type I to type III or IV(p<0.05). No relationships among the mutation in X region, the mutations in other regions and clinicopathological severity could be found. CONCLUSION: The mutation in X, core promoter and precore region had little association with the severity of hepatitis. And the relationship did not exist between precore mutants and X mutants. The expression pattern of HBcAg could be a useful indicator in determining what stage of chronic hepatitis B is in and whether mutant strains exist.
Cytoplasm ; DNA ; Hepatitis ; Hepatitis B Core Antigens ; Hepatitis B Surface Antigens ; Hepatitis B, Chronic ; Hepatocytes ; Humans ; Liver ; Liver Diseases ; Polymerase Chain Reaction

OBJECTIVE: To calculate monthly weight gains during pregnancy among 20s, early and late 30s, and to investigate the influence of age groups on monthly weight gains. METHODS: We analyzed the monthly weight gain data from 892 women who had visited before 20 weeks of gestation and had healthy singleton term pregnancy. Data was categorized in three groups according to age (20s, early and late 30s). RESULTS: The monthly weight gain tables among 20s, early and late 30s have been determined. Monthly weight gain was not significantly different among three age groups. CONCLUSION: Although statistically insignificant among three age groups, more cautious prenatal care according to the monthly weight gain-gestational month tables for each age group is needed to prevent complications which may be associated with abnormal weight gain during pregnancy.
Female ; Humans ; Pregnancy* ; Prenatal Care ; Weight Gain*

Sezary syndrome is a variant of cutaneous T-cell lymphoma (CTCL) featuring erythroderma, pruritus, adenopathy and circulating atypical T-lymphocytes. Recent studies suggest that patients with prolonged idiopathic erythroderma, possibility of Sezary syndrome should be considered because in a certain proportion of these patients, they may develop CTCL. We report a case of a 35-year-old man with a prolonged erythroderma for three years. On physical examination, multiple swellings of lymph nodes were noted. Presence of Sezary cells in the peripheral blood, skin and lymph nodes supported the diagnosis of Sezary syndrome.
Adult ; Dermatitis, Exfoliative ; Diagnosis ; Humans ; Lymph Nodes ; Lymphoma, T-Cell, Cutaneous ; Physical Examination ; Pruritus ; Sezary Syndrome* ; Skin ; T-Lymphocytes

PURPOSE: To evaluate the diagnostic value of source images of 3D TOF MR angiography in patients with hemifacial spasm. MATERIALS AND METHODS: Thirteen patients with surgically-confirmed hemifacial spasm and 30 who were not suffering from this condition were included in this study. T1 and T2-weighted images and 3D TOF MR angiography were performed. In 43 randomly-selected individuals, we retrospectively determined whether source images obtained during 3D TOF MR angiography could be used to evaluate symptoms. The results were correlated with surgical findings. RESULTS: Sensitivity was 92% and specificity was 86%. In all 13 patients with hemifacial spasm, neurovascular compression was detected during their operation. Offending vessels were the anterior inferior cerebellar artery (AICA) in four cases, the posterior inferior cerebellar artery (PICA) in seven, both the vertebral artery and PICA in one, and the vertebral vein, also in one. There were ten false-positive cases in the asymptomatic control group, nine of which showed neurovascular contact in the root entry zone of the facial nerve; one case showed indentation of the pons. CONCLUSION: Source images obtained during 3D TOF MR angiography are useful in the preoperative evaluation of hemifacial spasm.
Angiography ; Arteries ; Facial Nerve ; Hemifacial Spasm* ; Humans ; Pica ; Pons ; Retrospective Studies ; Sensitivity and Specificity ; Veins ; Vertebral Artery

OBJECTIVE: The treatment with low-dose aspirin in the patients with unexplained infertility has been reported to improve the pregnancy rate and implantation rate via increasing the blood flow in the endometrium. But there are little known about the relationships between low-dose aspirin and cell adhesion molecules, NCAM. The aim of this study was to evaluate the effect of low-dose aspirin and clomiphene citrate treatment on the expression of NCAM in the endometrium. METHODS: The patients with unexplained infertility (N=37) were grouped into 3 groups: clomiphene citrate and low-dose aspirin treated group (N=8), clomiphene citrate treated group (N=10), and natural cycle group (N=10, no treatment). As control group, the proliferative and menopausal endometrium was used. Each endometium was obtained by endometrial biopsy performed in late luteal phase and immunohistochemical staining with NCAM was performed. RESULTS: In the stromal cells, the staining intensity of NCAM expression and the number of vessels were significantly increased in the endomterium treated with clomiphene citrate and low-dose aspirin compared with other groups (p<0.05). And the expression of NCAM in the prolifertive and menopausal endometrium showed very weak staining. CONCLUSION: The expression of NCAM in the stromal cells and the number of vessels were increased in the endometrium of unexplained infertility patients treated with clomiphene citrate and low-dose aspirin. These findings may suggest low-dose aspirin has an important role during the secretory phase of endometrium to improve the implantation via increasing the expression of cell adhesion molecules, especially NCAM and increasing the number of vessels.
Aspirin* ; Biopsy ; Cell Adhesion Molecules ; Clomiphene* ; Endometrium* ; Female ; Humans* ; Infertility ; Luteal Phase ; Neural Cell Adhesion Molecules* ; Pregnancy Rate ; Stromal Cells

Churg-Strauss syndrome is one of idiopathic, systemic necrotizing vasculitis characterized by a history of asthma or allergic rhinitis, eosinophilia of peripheral blood and variable symptoms of systemic vasculitis. There have been several recent case reports of Churg-Strauss syndrome in association with leukotriene modifier therapy when oral corticosteroids were withdrawn in asthmatic patients. We report a case of a 31-year-old man with steroid-dependent asthma who developed Churg-Strauss syndrome after 9 months of steroid withdrawal period, while he was receiving leukotriene modifier (Pranlukast).
Adrenal Cortex Hormones* ; Adult ; Asthma ; Churg-Strauss Syndrome* ; Eosinophilia ; Humans ; Rhinitis ; Systemic Vasculitis ; Vasculitis