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Difficult Intubation due to Diffuse Type of Tracheo-bronchial Stenosis (complete tracheal rings) from Pulmonary Arterial Sling: A case report.

Seok Ran YEOM ; Jung Ho SHIN ; Jong Whan SHIN ; Gun LEE ; Eell RYOO ; Sung Youl HYUN ; Wook JIN ; Jae Kwang KIM

Journal of the Korean Society of Emergency Medicine.2001;12(4):570-574.

Pulmonary arterial sling, a rare developmental vascular anomaly forms a sling around the distal trachea and the proximal right main bronchus, where it sometimes makes tracheo-bronchial stenosis. Tracheobronchial stenosis from pulmonary arterial sling may produce non-specific symptoms of stridor, noisy breathing, dyspnea, recurrent upper respiratory tract infection, chronic cough, and dysphagia. The diagnosis of this anomaly begins with a high index of suspicion because of the lack of pathognomonic finding on usual evaluation. In this case, initial difficult intubation makes us evaluate further. Other cases reported the diagnosis is established by imaging studies, usually MRI and angiography. But, when our case was evaluated, we used cervico-thoracic enhanced computered tomography and tracheal fluoroscopy. Up to now, tracheobronchial stenosis from vascular anomaly is a rare and challenging disorder with a poor prognosis. However, early exact diagnosis would make us perform the accurate surgical treatment and reduce the mortality and morbidity.
Angiography ; Bronchi ; Constriction, Pathologic* ; Cough ; Deglutition Disorders ; Diagnosis ; Dyspnea ; Fluoroscopy ; Intubation* ; Magnetic Resonance Imaging ; Mortality ; Prognosis ; Respiration ; Respiratory Sounds ; Respiratory Tract Infections ; Trachea

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Rhabdomyolysis Associated with Cerivastatin-Gemfibrozil Combination Therapy: 1 case.

Sin Chul KIM ; Myoung Chun KIM ; Young Gwan KO

Journal of the Korean Society of Emergency Medicine.2001;12(4):565-569.

Most currently available statins are associated with an increase with risk of myositis, including rhabdomyolysis. Myopathy is believed to be caused by interference in the cytochrome P450 3A4 enzyme system, which results in a marked increase in reductase activity. Cerivastatin, a new synthetic HMG-CoA reductase inhibitor, is a safe, well-tolerated effective drug for the treatment of patients with dyslipidemia. The drug is metabolized by the cytochrome P450 3A4 and cytochrome P450 2C8 hepatic isoenzymes. Because of this dual metabolic pathway, it has been suggested that cerivastatin is less subject to drug-todrug interactions. We describe a 60-year-old woman with rhabdomyolysis and localized myositis, after she had taken cerivastatin(lipobay, 0.3 mg/day) and gemfibrozil(lopid, 500 mg/day) for 1month.
Cytochrome P-450 Enzyme System ; Dyslipidemias ; Female ; Gemfibrozil ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Isoenzymes ; Metabolic Networks and Pathways ; Middle Aged ; Muscular Diseases ; Myositis ; Oxidoreductases ; Rhabdomyolysis*

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Acute Mediastinal Tamponade Secondary to Blunt Chest Trauma: Case report.

Sang Kyu YOON ; Jong Seok PARK ; Joon Pil CHO

Journal of the Korean Society of Emergency Medicine.2001;12(4):560-564.

Sternal fractures are most common in drivers of motor vehicles whose anterior chest hits the steering wheel during sudden deceleration. Sternal fractures may result in mediastinal hematoma secondary to bone marrow oozing. The hematoma usually resolves itself without complications, so an anterior mediastinal hematoma causing tamponade is rarely reported. We describe a case of blunt chest trauma resulting in a sternal fracture with a resultant anterior mediastinal hematoma and mediastinal tamponade.
Bone Marrow ; Deceleration ; Hematoma ; Motor Vehicles ; Thorax*

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Two Cases of Hydrocarbon(Gasoline) Intoxication Following Ingestion and Inhalation.

Kyung Won LEE ; Jeong Heon LEE

Journal of the Korean Society of Emergency Medicine.2001;12(4):551-559.

Hydrocarbon poisoning is one of the most common poisonings accounting for about 3% of all poisonings in the USA. Hydrocarbons are a broad group of organic compounds consisting of hydrogen and carbon atoms. Many household products contain hydrocarbons. The primary complication of hydrocarbon poisoning results from involvement of the respiratory and the central nervous systems. Other reported complications include cardiac arrthymia, hepatocellular damage, renal failure, peripheral neuropathy, intravascular hemolysis, cutaneous injury, sudden death, and so on. We experienced two cases of acute poisoning caused by hydrocarbons: one was a 64-year-old man with cardiac arrhythmia after ingestion of gasoline and the other was a 61-year-old man with aspiration pneumonia after inhalation of combustion gas of gasoline. We report these cases and present a literature review.
Arrhythmias, Cardiac ; Carbon ; Central Nervous System ; Death, Sudden ; Eating* ; Gasoline ; Hemolysis ; Household Products ; Humans ; Hydrocarbons ; Hydrogen ; Inhalation* ; Middle Aged ; Peripheral Nervous System Diseases ; Pneumonia, Aspiration ; Poisoning ; Renal Insufficiency

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Idiopathic Acute Gastric Dilatation with Ischemic Necrosis.

Tae Hoon LEE ; Jae Baek LEE ; Du Hyun YANG

Journal of the Korean Society of Emergency Medicine.2001;12(4):546-550.

Acute gastric dilatation without obstructive or organic disease is rare, but is possible after a gastric or an abdominal operation in cases of trauma, retroperitoneal hematoma, diabetic gastroparesis, hypoxemia, electrolyte imbalance, etc. However ischemic necrosis due to acute gastric dilatation is very rare and has been reported only in patients who has anorexia nervosa or overeat suddenly. If the distended stomach is not decompressed successfully by using a conservative method or if the process proceeds to ischemic necrosis, operative treatment is necessary. We experienced a case in which the stomach was acutely distended, and mutiple ischemic necroses had developed. The patient was a 27-year-old woman and had no specific underlying disease in her medical history. After overeating, the stomach was distended acutely. During the operation, mutiple ischemic necroses were found in the stomach. A total gastrectomy and Roux-en-Y esophagojejunostomy were performed.
Adult ; Anorexia Nervosa ; Anoxia ; Female ; Gastrectomy ; Gastric Dilatation* ; Gastroparesis ; Hematoma ; Humans ; Hyperphagia ; Necrosis* ; Stomach

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A Case of Stevens-Johnson Syndrome Which Was Misdiagnosed as Sepsis and Infectious Skin Disease.

Sung Koo JUNG ; Myung Chun KIM ; Young Gwan KO

Journal of the Korean Society of Emergency Medicine.2001;12(4):541-545.

Stevens-Johnson syndrome(SJS) is a rare, life-threatening, drug-induced cutaneous reaction which presents dramatic, unforgettable manifestations. While the characteristic features of the disease are well known universally, many physicians have not seen a case of SJS which may result in delay in recognition and treatment. We report a rare case of SJS, which was initially misiagnosed as sepsis with skin infection and atypical pneumonia on emergency department presentation, and we give a brief review of the literature.
Emergency Service, Hospital ; Pneumonia ; Sepsis* ; Skin ; Skin Diseases, Infectious* ; Stevens-Johnson Syndrome*

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A Case of Primary Central Nervous System Lymphoma with Panhypopituitarism.

Won Young KIM ; Won KIM ; Gyu Chong CHO ; Jung Suck HONG ; Mi Woo LEE ; Sung Eun JANG ; Se Hyun OH ; Kyoung Soo LIM

Journal of the Korean Society of Emergency Medicine.2001;12(4):536-540.

A primary central nervous system lymphoma(PCNSL) is defined as a lymphoma limited to the cranialspinal axis without systemic involvement. PCNSLs were formerly very rare, only 0.5~1.2% of all intracranial neoplasms, and were usually associated with acquired immuno-deficiency syndrome(AIDS) and other immuno-compromised states. Recently, there has been a clear rise in the incidence of this disease among normal individuals. We describe a 77-year-old female with hyponatremia who presented with a confused mental state. Computed tomography(CT) of the brain demonstrated a suprasellar mass with enhancement. We evaluated the basic hormonal studies and the magnetic resonance imaging(MRI). A ventricular biopsy was done, and the result was a diffuse, large, B-cell-type malignant lymphoma. She presented panhypopituitarism and partial central diabetes insipidus. She received chemotheraphy and was discharged in an improved condition. We report a case of panhypopituitarism due to PCNSL and give a review of the literature.
Aged ; Axis, Cervical Vertebra ; Biopsy ; Brain ; Brain Neoplasms ; Central Nervous System* ; Diabetes Insipidus, Neurogenic ; Female ; Humans ; Hyponatremia ; Incidence ; Lymphoma*

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A case of The Primary Aldosteronism with Hypokalemic Periodic Paralysis.

Ryeok AHN ; Won KIM ; Gyu Chong CHO ; Jung Suck HONG ; Mi Woo LEE ; Sung Eun JANG ; Se Hyun OH ; Kyoung Soo LIM

Journal of the Korean Society of Emergency Medicine.2001;12(4):528-535.

Primary aldosteronism is a syndrome characterized by hypertension, hypokalemia, suppressed plasma renin activity, and elevated serum aldosterone levels. Conn first described it 1955 in association with adrenal cortical adenoma(Conn's syndrome). Today, it can be divided into at least six distinctive subgroups. The diagnosis of primary aldosteronism is usually suspected when the patient presents with poorly controlled hypertension with hypokalemia. The main issues in the evaluation of primary aldosteronism are to differentiate an adenoma from hyperplasia and to localize the adenoma. Basic hormonal studies and computed tomographic(CT) scanning can be used effectively for that differentiation. An adenoma is one of a few potentially curable forms of hypertension, and it is best treated by removing the adrenal tumor. We experienced a case of a typical adrenal adenoma. The patient was a 37-year-old male who had experienced in both his legs over a period of several days a weakness due to hypokalemia. He was diagnosed using basic hormonal studies and adrenal CT scanning. After, he received laparoscopic adrenalectomy and was discharged with improved condition.
Adenoma ; Adrenalectomy ; Adult ; Aldosterone ; Diagnosis ; Humans ; Hyperaldosteronism* ; Hyperplasia ; Hypertension ; Hypokalemia ; Hypokalemic Periodic Paralysis* ; Leg ; Male ; Plasma ; Renin ; Tomography, X-Ray Computed

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Idiopathic Spontaneous Renal Rupture.

Jae Chol YOON ; Won KIM ; Gyu Chong CHO ; Jung Suck HONG ; Mi Woo LEE ; Sung Eun JANG ; Se Hyun OH ; Kyoung Soo LIM

Journal of the Korean Society of Emergency Medicine.2001;12(4):523-527.

Spontaneous renal rupture is a rare, but important, clinical problem that heralds a variety of kidney abnormalities. Tumors are the most common cause, followed by vascular disease, infection, nephritis and blood dyscrasia. In some cases, no underlying abnormality of the kidney can be found. The patients usually present with an acute onset of flank pain, a tender mass, and common symptoms and signs of shock. In most cases rapid surgical intervention is necessary and nephrectomy remains the treatment of choice in cases of a ruptured tumor. A 47 year-old female, who had been in good health previously, was hospitalized because of a sudden onset of left flank pain for one day. There was no history of trauma. Physical examination revealed marked tenderness and guarding over the left flank abdomen. A perirenal hematoma on the left side was seen with abdominal sonography. Computerized tomography demonstrated a large perirenal hematoma and a kidney rupture caudally. Selective renal angiography demonstrated an active bleeding over the lower pole, so a coil embolization and nephrectomy were performed. The histological examination of the kidney revealed no underlying abnormality. We report a case of idiopathic spontaneous renal rupture, along with a literature review.
Abdomen ; Angiography ; Embolization, Therapeutic ; Female ; Flank Pain ; Hematoma ; Hemorrhage ; Humans ; Kidney ; Middle Aged ; Nephrectomy ; Nephritis ; Physical Examination ; Rupture* ; Shock ; Vascular Diseases

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Paralytic Shellfish Poisoning by Saxitoxin: Two case reports.

Sang Cheon CHOI ; Jong Seok PARK ; Yoon Seok JUNG

Journal of the Korean Society of Emergency Medicine.2001;12(4):518-522.

Paralytic shellfish poisoning results from consumption of mollusks that have fed on dinoflagellates capable of producing neurotoxins such as saxitoxin. The saxitoxin is concentrated in the shellfish and acts by decreasing sodium-channel permeability, thereby blocking neuronal transmission in skeletal muscles. Symptoms including paresthesia, perioral numbness, perioral tingling, nausea, vomiting, extremity numbness, extremity tingling, dizziness, ataxia, dysphagia, and weakness have been reported. In serious cases, respiratory hold may occur up to 6~24 hours after ingestion. Generally, the treatment for paralytic shellfish poisoning is supportive care, but mechanical ventilation is needed in serious cases acompanied by respiratory hold. We experienced two cases of paralytic shellfish poisoning. Respiratory hold was presented in one case and only mild paresthesia in the other case. After supportive management, including mechanical ventilation in former case, both patients were discharged without sequalae.
Ataxia ; Deglutition Disorders ; Dinoflagellida ; Dizziness ; Eating ; Extremities ; Humans ; Hypesthesia ; Mollusca ; Muscle, Skeletal ; Nausea ; Neurons ; Neurotoxins ; Paresthesia ; Permeability ; Respiration, Artificial ; Saxitoxin* ; Shellfish ; Shellfish Poisoning* ; Vomiting

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