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

No abstract available.
Humans*

PURPOSE: Our study aimed to investigate prognostic factors at presentation and the survival of patients with a resected hepatocellular carcinoma (HCC). METHODS: A retrospective analysis of medical records was performed for 58 patients (59 cases) identified through the Tumor Registry as having been evaluated for a hepatocellular carcinoma at the Chonbuk National University Hospital during the 10-year period from 1989 to 1999. RESULTS: The male:female ratio was 3.2:1, and the average age was 52.7 years. Liver cirrhosis and ascites were present in 64.4% and 8.5% of the patients, respectively, and 62.7% present with the HBs antigen. The positive alpha-fetoprotein (AFP) rate was 55.9% and the elevated alkaline phosphatase (ALP) rate was 32.2%. The Child-Pugh's classifications of the patients were as follows: 49 cases (83.1%) of Grade A, 8 cases (13.6%) of Grade B, 2 cases (3.4%) of Grade C. The Indocyanine green (ICG) tests of normal range (<10%) were 69.5%. The operative mortality was 3.4% (2 cases). Preopertive transarterial chemoembolization was performed in 23 cases (39.0%). The tumor was larger than 5 cm in 50.8% of the patients and was a single tumor in 72.9%. Portal vein invasion was present in 11.9% of the cases. The surgical procedure consisted of a curative resection in 43 cases (72.9%: lobectomy in 7, trisegmentectomy in 4, segmentectomy in 22, and wedge resection in 10) and a limited resection in 16 cases (27.1%). Of the patients, 44.1% had either TNM stage III or stage IV tumor. Recurrence of the tumor was diagnosed in 19 cases and was found in the residual liver in 13 cases (68.4%). Operative morbidity developed in 16 cases (27.1%) and hepatic failure, pleural effusion, ascites were common complications. CONCLUSION: A significantly higher survival rate was seen for HCC with no ascites and a normal ALP level. A curative resection was not superior to a limited resection in terms of survival. Recent management strategy and technical advances have improved the results of surgical treament for patients with a HCC.
Alkaline Phosphatase ; alpha-Fetoproteins ; Ascites ; Carcinoma, Hepatocellular* ; Classification ; Humans ; Indocyanine Green ; Jeollabuk-do ; Liver ; Liver Cirrhosis ; Liver Failure ; Mastectomy, Segmental ; Medical Records ; Mortality ; Pleural Effusion ; Portal Vein ; Prognosis* ; Recurrence ; Reference Values ; Retrospective Studies ; Survival Rate

BACKGROUND: This study was purposed to study the therapeutic value of intraluminal oxygen insufflation on the oxygenation of gut mucosa in a feline model subjected to a hemorrhagic shock followed by reperfusion. METHODS: Eighteen cats were divided into three groups : For group 1, 6 cats were subjected to sham operation as a control group ; for group 2, 6 cats were subjected to a hemorrhagic shock for 2 hours prior to reperfusion as a hemorrhagic shock(HS) group ; for group 3, 6 cats were subjected to a simultaneous insufflation of intraluminal oxygen, continued during the shock and reperfusion periods as a oxygenated hemorrhagic shock(OHS) group. Mesenteric PvO2, mesenteric venous arterial(v-a) lactate difference, mesenteric P(v-a)CO2 and mesenteric pH(a-v) were measured for every 30 minutes during the shock and reperfusion. RESULTS: The lactate(v-a) was increased during the shock. For group OHS, the lactate(v-a) returned to the baseline value after reperfusion, but for group HS, it did not return. The values of pH(v-a) and P(v-a)CO2 were increased during the shock and returned to the baseline value for group OHS, but for group HS, the increase was greater than group OHS(p<0.05), but not returned to the baseline value after reperfusion. For both pH(v-a) and P(v-a)CO2, there were statistically significant differences(p<0.05) between group HS and group OHS during the shock and reperfusion. CONCLUSIONS: We conclude that the insufflation of intraluminal oxygen improves the oxygenation of gut mucosa in the feline model undergone a hemorrhagic shock followed by reperfusion.
Animals ; Cats* ; Insufflation* ; Lactic Acid ; Mucous Membrane* ; Oxygen* ; Reperfusion ; Shock ; Shock, Hemorrhagic

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

PURPOSE: To evaluate the result of treatment of proximal femoral shaft fracture with limited open reduction and intramedullary nailing. MATERIALS AND METHODS: Fifteen patients who had limited open reduction and intramedullary nailing due to proximal femoral shaft fracture for follow-up for more than 12 months were selected between March 2001 and December 2005. The clinical and radiologic results were analyzed. Winquist-Hansen classification and OTA/AO classification were used. RESULTS: Thirteen cases achieved bone union and 2 cases showed delayed union. The mean bone union period was 21.3 weeks (14~32). There was no postoperative infection. Nonunion was observed in 2 cases of which bone union was acquired with the exchange of intramedullary nail and bone graft in one case and with the additional plate fixation and bone graft in the other case. CONCLUSION: Treating proximal femoral shaft fracture with limited open reduction and intramedullary nailing seems to be a technique to manage proximal femoral shaft fracture that has combined fracture or ipsilateral femoral fracture or is unable to acquire acceptable reduction with closed reduction.
Femoral Fractures ; Femur ; Follow-Up Studies ; Fracture Fixation, Intramedullary ; Humans ; Nails ; Transplants

Toxic megacolon is a fatal complication of inflammatory or infectious bowel disease.Prognosis depends on the severity of the disease. In cases of poor prognosis, clinical outcomes range from intestinal resection to death, so early diagnosis and appropriate treatment are very important. However, the prevalence of toxic megacolon in children is very low, and in those without underlying diseases such as inflammatory bowel disease, early diagnosis may be delayed. A previously healthy 12-year-old boy presented to our hospital with lower abdomen pain, fever, and hematochezia. Despite antibiotic therapy, the symptoms worsened. On the third day, abdominal computed tomography revealed severe dilatation of the transverse colon, which indicated toxic megacolon. Stool culture was positive for Salmonella enteritidis group D, and rectal endoscopy showed no signs of inflammatory bowel disease. Ceftriaxone and intravenous methylprednisolone were administered, and the patient's condition improved without any complications. We report a case of toxic megacolon as a complication of infectious colitis caused by S. enteritidis group D, which was diagnosed using early imaging and successfully treated without surgical intervention.

Toxic megacolon is a fatal complication of inflammatory or infectious bowel disease.Prognosis depends on the severity of the disease. In cases of poor prognosis, clinical outcomes range from intestinal resection to death, so early diagnosis and appropriate treatment are very important. However, the prevalence of toxic megacolon in children is very low, and in those without underlying diseases such as inflammatory bowel disease, early diagnosis may be delayed. A previously healthy 12-year-old boy presented to our hospital with lower abdomen pain, fever, and hematochezia. Despite antibiotic therapy, the symptoms worsened. On the third day, abdominal computed tomography revealed severe dilatation of the transverse colon, which indicated toxic megacolon. Stool culture was positive for Salmonella enteritidis group D, and rectal endoscopy showed no signs of inflammatory bowel disease. Ceftriaxone and intravenous methylprednisolone were administered, and the patient's condition improved without any complications. We report a case of toxic megacolon as a complication of infectious colitis caused by S. enteritidis group D, which was diagnosed using early imaging and successfully treated without surgical intervention.

Background: Rapid electrocardiography diagnosis within 10 minutes of presentation is critical for acute myocardial infarction (AMI) patients in the emergency department (ED).However, the coronavirus disease 2019 (COVID-19) pandemic has significantly impacted the emergency care system. Screening for COVID-19 symptoms and implementing isolation policies in EDs may delay the door-to-electrocardiography (DTE) time. Methods: We conducted a cross-sectional study of 1,458 AMI patients who presented to a single ED in South Korea from January 2019 to December 2021. We used multivariate logistic regression analysis to assess the impact of COVID-19 pandemic and ED isolation policies on DTE time and clinical outcomes. Results: We found that the mean DTE time increased significantly from 5.5 to 11.9 minutes (P < 0.01) in ST segment elevation myocardial infarction (STEMI) patients and 22.3 to 26.7 minutes (P < 0.01) in non-ST segment elevation myocardial infarction (NSTEMI) patients.Isolated patients had a longer mean DTE time compared to non-isolated patients in both STEMI (9.2 vs. 24.4 minutes) and NSTEMI (22.4 vs. 61.7 minutes) groups (P < 0.01). The adjusted odds ratio (aOR) for the effect of COVID-19 duration on DTE ≥ 10 minutes was 1.93 (95% confidence interval [CI], 1.51–2.47), and the aOR for isolation status was 5.62 (95% CI, 3.54–8.93) in all patients. We did not find a significant association between in-hospital mortality and the duration of COVID-19 (aOR, 0.9; 95% CI, 0.52–1.56) or isolation status (aOR, 1.62; 95% CI, 0.71–3.68). Conclusion Our study showed that ED screening or isolation policies in response to the COVID-19 pandemic could lead to delays in DTE time. Timely evaluation and treatment of emergency patients during pandemics are essential to prevent potential delays that may impact their clinical outcomes.

OBJECTIVE: The time to positivity (TTP) of blood culture reflects bacterial load and has been reported to be associated with outcome in bloodstream infections. This study was performed to evaluate the relationship between the TTP of blood culture and the mortality rates associated with sepsis and septic shock according to the site of infection. METHODS: We performed a retrospective cohort study on patients with sepsis and septic shock. The rates of blood culture positivity and mortality as well as the relationship between the TTP and 28-day mortality rate were compared among patients with different sites of infection, such as the lungs, abdomen, urogenital tract, and other sites. RESULTS: A total of 2,668 patients were included, and the overall mortality rate was 21.6%. The rates of blood culture positivity and mortality were different among the different infection sites. There was no relationship between the TTP and mortality rates of total, lung, and urogenital infections. Patients with abdominal infections showed a negative correlation between the TTP and 28-day mortality rate. In patients with abdominal infections, a TTP < 20 hours was independently associated with 28-day mortality compared with patients with negative blood culture (hazard ratio, 1.73; 95% confidence interval, 1.16–2.58). However, there was no difference in mortality rates of patients with a TTP≥20 hours and a negative blood culture. CONCLUSION: The shorter TTP in patients with abdominal infections in sepsis and septic shock was associated with a higher 28-day mortality rate.
Abdomen ; Bacterial Load ; Cohort Studies ; Humans ; Lung ; Mortality* ; Retrospective Studies ; Sepsis* ; Shock, Septic