A 34-year-old man presented with an out-of-hospital cardiac arrest shortly after dermal exposure to tetramethylammonium hydroxide (TMAH). The patient was accidentally exposed to 2.38% TMAH despite the use of personal protective equipment and was referred to our emergency department one hour after the exposure. He was resuscitated using advanced cardiac life support and intensive care. However, he remained unconscious despite target temperature management. Second-degree chemical burns were found on 10% of his total body surface area. Brain magnetic resonance imaging showed severe anoxic-ischemic encephalopathy involving bilateral supratentorial grey matter. TMAH was detected in the patient’ s blood and urine. To the best of our knowledge, this is the first report of the identification of TMAH in the serum and urine after exposure to the agent. Previous cases of cardiac arrest reported were due to exposure to high concentrations of 25% TMAH. We postulate that even low concentrations of TMAH could be absorbed rapidly after dermal exposure and can have fatal consequences.

Health centers provided intensive health care services for local residents according to changes in the times and environment. Public health centers were given various roles such as medical treatment, administration, and service, and the demand for functional reorganization has emerged. We analyzed the literature on the functional restructuring of public health care institutions. In addition, the current status of medical services, which is the main function of institutions, will be analyzed through health insurance statistical data, and detailed contents will be analyzed according to regional types and income levels. As a result of the analysis of medical services at institutions, the total number of patients was 2,238,000, and the number of visits was 11,806 times. Total medical expenses were 169.6 billion won, of which 132 billion won was found to be benefit. When analyzing the number of patients per institution, public health centers had the largest number of 4,326, and the share of benefit was also the highest at public health centers. It should focus on the function of providing local health and medical services related to health promotion and disease prevention in the community. This functional reorganization of public health centers can contribute to forming cooperative relationships with private medical institutions in the local community. For this, first, to establish the role, essential functions for public health centers for preventive health management are established. Secondly, regular manpower expansion and flexible manpower management are required in the human resources sector. Finally, in the organizational sector, it is necessary to establish a step-by-step organizational system according to environmental changes.

Clopidogrel is an antiplatelet agent prescribed widely to prevent stent thrombosis after coronary or peripheral vascular interventions and for stroke prophylaxis. The side effects of this drug include gastrointestinal symptoms, such as nausea, abdominal pain, vomiting, and bleeding. Thrombotic thrombocytopenia purpura (TTP) is a rare complication of this drug. Here, we report a case of clopidogrel-associated TTP in a patient with cerebral infarction. To our knowledge, it is first reported case of clopidogrel-associated TTP in Korea.
Abdominal Pain ; Cerebral Infarction* ; Hemorrhage ; Humans ; Korea ; Nausea ; Purpura ; Purpura, Thrombotic Thrombocytopenic* ; Stents ; Stroke ; Thrombocytopenia ; Thrombosis ; Vomiting

Clopidogrel is an antiplatelet agent prescribed widely to prevent stent thrombosis after coronary or peripheral vascular interventions and for stroke prophylaxis. The side effects of this drug include gastrointestinal symptoms, such as nausea, abdominal pain, vomiting, and bleeding. Thrombotic thrombocytopenia purpura (TTP) is a rare complication of this drug. Here, we report a case of clopidogrel-associated TTP in a patient with cerebral infarction. To our knowledge, it is first reported case of clopidogrel-associated TTP in Korea.
Abdominal Pain ; Cerebral Infarction* ; Hemorrhage ; Humans ; Korea ; Nausea ; Purpura ; Purpura, Thrombotic Thrombocytopenic* ; Stents ; Stroke ; Thrombocytopenia ; Thrombosis ; Vomiting

OBJECTIVE: compare quality of life (QoL) and sexual functioning between sexually active ovarian cancer survivors and healthy women. METHODS: A cross-sectional study was performed in 103 successfully treated ovarian cancer survivors and 220 healthy women. All women had engaged in sexual activity within the previous 3 months, and ovarian cancer survivors were under surveillance after primary treatment without evidence of disease. QoL and sexual functioning were assessed using three questionnaires; the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30), Ovarian Cancer Module (EORTC QLQ-OV28), and the Female Sexual Function Index (FSFI). Propensity score matching was used to adjust covariates between the ovarian cancer survivor and healthy women groups. In total, 73 ovarian cancer survivors and 73 healthy women were compared. RESULTS: Poorer social functioning (mean, 82.4 vs. 90.9; p=0.010) and more financial difficulties (mean, 16.4 vs. 7.8; p=0.019) were observed among ovarian cancer survivors than among healthy women. Sexuality, both in terms of desire, arousal, lubrication, orgasm, satisfaction, and pain and in terms of interest in sex, sexual activity, and enjoyment of sex (EORTC QLQ-OV28) were similar between the groups. However, vaginal dryness was more problematic in ovarian cancer survivors, with borderline statistical significance (p=0.081). CONCLUSION: Sexuality was not impaired in ovarian cancer survivors who were without evidence of disease after primary treatment and having sexual activities, compared with healthy women, whereas social functioning and financial status did deteriorate. Prospective cohort studies are needed.
Adult ; Case-Control Studies ; Cross-Sectional Studies ; Female ; Health ; Humans ; Middle Aged ; *Ovarian Neoplasms/epidemiology/psychology/rehabilitation ; *Quality of Life/psychology ; Sexual Behavior/*physiology/psychology ; *Sexuality/physiology/psychology ; Socioeconomic Factors ; Surveys and Questionnaires ; *Survivors/psychology/statistics & numerical data

BACKGROUND: Fecal occult blood tests have been widely used as a means of gastrointestinal bleeding and colorectal cancer screening. HM-JACKarc (Kyowa Medex Co. Ltd, Japan) is a recently introduced automated fecal occult blood test analyser, which uses latex agglutination method. We evaluated the analytical performance of HM-JACKarc. METHODS: The linearity and precision for HM-JACKarc were evaluated according to the corresponding Clinical and Laboratory Standard Institute guidelines. The comparison study between HM-JACKarc and OC-SENSOR DIANA (Eiken Chemical Co. Ltd., Japan) was done with stool specimens. RESULTS: The linearity was good (R²=0.999) and the coefficients of variation of within-day precision and between-day precision were 5.2% and 4.9%, respectively, in low concentration and 2.7% each in high concentration. The concordance rate between HM-JACKarc and OCSENSOR DIANA was 99.0% (198 out of 200). CONCLUSIONS: HM-JACKarc showed excellent performance in linearity, precision, and comparison studies. Therefore, it appears to be a useful automated fecal occult blood test analyser.
Agglutination ; Colorectal Neoplasms ; Hemorrhage ; Latex ; Mass Screening ; Methods ; Occult Blood*

PURPOSE: To report on 2 cases of Eales' disease that were successfully regressed with laser photocoagulation and intravitreal bevacizumab (Avastin; Genetech, Inc, San Francisco, California, USA) injection. CASE SUMMARY: Two male patients (30 years and, 40 years of age,) with a history of recurrent vitreous hemorrhage were diagnosed with Eales' disease. The 2 patients had peripheral retina neovascularization and active phlebitis in fundus fluorescein angiography. No other findings were observed in their eyes in the general examination. Scatter laser photocoagulation and intravitreal bevacizumab injection were performed. After 1 month follow-up, neovascularization completely regressed. There was no complication or recurrent vitreous hemorrhage at the 1 year follow up. CONCLUSIONS: Intravitreal bevacizumab injection, as combination treatment of laser photocoagulation, may be helpful in the regression of neovascularization due to Eales' disease.
Antibodies, Monoclonal, Humanized ; California ; Eye ; Fluorescein Angiography ; Follow-Up Studies ; Humans ; Light Coagulation ; Male ; Phlebitis ; Retina ; San Francisco ; Vitreous Hemorrhage ; Bevacizumab

PURPOSE: To report central retinal vein and artery occlusion after retrobulbar anesthesia for a cataract operation. CASE SUMMARY: A 65-year-old woman was transferred to our facility 4 days after she had undergone cataract extraction with IOL implantation. She could count fingers and had a relative afferent papillary defect in her left eye. As seen upon fundus examination, dot-shaped, circular-shaped irregular, and partially linear-shaped retinal hemorrhages were evident. Fluorescein angiography revealed that branch arteries around the nasal and temporal areas were not filled, and that the filling of veins was delayed. After two weeks, the patient was only able to recognize hand motion, and her intraocular pressure was 10 mmHg. According to a fundus examination, the size and quantity of retinal hemorrhages increased, and a pale, macular edema was observed. Following fluorescein angiography, the filling defect of branch vessels on the nasal and temporal areas was still evident, and the blocked fluorescence of capillaries on the fundus was prominent. After two months, she could still only recognize hand motion, and her intraocular pressure had increased to 35 mmHg; we therefore diagnosed a neovascular glaucoma. CONCLUSIONS: A patient experienced a serious central retinal vessel occlusion after retrobulbar anesthesia for cataract extraction. Retrobulbar injections should therefore be administered with great caution to prevent this outcome.
Aged ; Anesthesia ; Arteries ; Capillaries ; Cataract ; Cataract Extraction ; Eye ; Female ; Fingers ; Fluorescein Angiography ; Fluorescence ; Glaucoma, Neovascular ; Glycosaminoglycans ; Hand ; Humans ; Intraocular Pressure ; Macular Edema ; Retinal Hemorrhage ; Retinal Vein ; Retinal Vessels ; Veins

Myeloid sarcoma is a solid, extramedullary tumor comprising of immature myeloid cells. It may occur in any organ; however, the invasion of peripheral nervous system is rare. Herein, we report the case of myeloid sarcoma on the brachial plexus. A 37-year-old woman with acute myelogenous leukemia achieved complete remission after chemotherapy. One year later, she presented right shoulder pain, progressive weakness in the right upper extremity and hypesthesia. Based on magnetic resonance images (MRI) and electrophysiologic study, a provisional diagnosis of brachial plexus neuritis was done and hence steroid pulse therapy was carried out. Three months later the patient presented epigastric pain. After upper gastrointestinal endoscopy, myeloid sarcoma of gastrointestinal tract was confirmed pathologically. Moreover, 18-fluoride fluorodeoxyglucose positron emission tomography showed a fusiform shaped mass lesion at the brachial plexus overlapping with previous high signal lesion on the MRI. Therefore, we concluded the final diagnosis as brachial plexopathy due to myeloid sarcoma.
Brachial Plexus ; Brachial Plexus Neuritis ; Brachial Plexus Neuropathies ; Endoscopy, Gastrointestinal ; Female ; Gastrointestinal Tract ; Humans ; Hypesthesia ; Leukemia, Myeloid, Acute ; Magnetic Resonance Spectroscopy ; Myeloid Cells ; Peripheral Blood Stem Cell Transplantation ; Peripheral Nervous System ; Positron-Emission Tomography ; Sarcoma, Myeloid ; Shoulder Pain ; Upper Extremity

PURPOSE: To investigate the characteristics of the clear oil-drop residue observed in the vitreous cavity after intravitreal injection of different brands of triamcinolone acetonide (TA), and to compare this ingredient's effects in those products. METHODS: Intravitreal injections of four different brands of triamcinolone acetonide (4 mg/0.1 mL), which are commercially available in Korea, were given to 40 eyes for the treatment of macular edema due to a variety of causes from October 2005 through February 2006. Regular slit-lamp biomicroscopy of fundus had been performed periodically with digital image acquisition equipment after injection of TA for at least two months. We analyzed the characteristics of this residue and compared the number and size of this residue in each product. RESULTS: Four TA products commercially available in Korea were used, with vehicles composed of preservatives and suspending agents. There were differences between products in respect to ingredients and content, as well as the characteristics of the intravitreal clear oil droplet-like residue. CONCLUSIONS: Each TA product has a variable frequency and variable amounts of clear oil droplet-like residue, which seems to be a component of the vehicle. This variation could generate differences in efficacy, side effects, and retaining duration. It should be verified whether commercial TA products are consistently safe and effective.
Excipients ; Eye ; Intravitreal Injections ; Korea ; Macular Edema ; Triamcinolone ; Triamcinolone Acetonide