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Why did she lose her sight? A case of visual damage due to methanol inhalation (메탄올 흡입 후 발생한 시각장애 : 증례보고)

  • Han, Sangsoo;Shin, Hee-Jun
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.19 no.11
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    • pp.421-425
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    • 2018
  • Methanol is a clear, colorless, volatile, and poisonous liquid that is commonly used as an industrial solvent. Visual impairment is a common symptom of methanol poisoning; however, visual impairment rarely occurs after exposure through inhalation. Therefore, visual loss after methanol intoxication via respiration has rarely been reported. We report a case of visual damage associated with methanol poisoning via respiratory exposure in an industrial setting. In this case in South Korea, a 28-year-old woman who worked at a cell phone factory was admitted to the emergency department with mental changes. She had blurred vision that began two days prior, but she did not come to the hospital until she experienced mental changes. She ranked 9 on the Glasgow Coma Scale and presented with severe metabolic acidosis. So, she was admitted to intensive care, and continuous renal replacement therapy was performed. Finally, she was discharged after recovery of her mental state, but had to undergo rehabilitation for six months. Also, her visual impairment was permanent. Methanol intoxication can occur through inhalation, which is difficult to detect initially. However, treatment of methanol poisoning is time-critical. Therefore, doctors should always keep in mind that methanol intoxication may occur via respiration. If in doubt, treatment should be given as soon as possible.

Clinical Observations on 12 Children with Alport Syndrome (Alport 증후군 환아 12명의 임상적 고찰)

  • Bae Young-Min;Kim Seoung-Do;Kang Hyeon-Ho;Cho Byoung-Soo
    • Childhood Kidney Diseases
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    • v.4 no.1
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    • pp.48-56
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    • 2000
  • Purpose: Alport SD., the most common herectitary rephriris, is a renal disease with rapid progression. Deafness, ocular abnormalities and a specific EM finding may be associated in addition to a family history. We have aralyged retrospectively. Methods: We observed 12 children with Alport syndrome who were diagnosed at Dept. of pediatrics in Kyunghee Univ., College of Medicine, from Apr. 1991 until Jun. 1999. We used four criteria for diagnosis: renal disease, family history, deafness or eye abnormalities, and a specific finding in electron microscopy Results: 2 of 12 patients had all features of the four diagnostic criteria. We could not trace an exact family history in 3 patients, and 6 patients did not exhibit deafness or eye abnormality. One could not have renal biopsy because offer chronic renal failure. Other three criteria were observed in her. The ratio of male to female observed was 1:2 respectively and the mean age of initial renal symptom was 5.6 years. 9 of 12 patients had a family history of renal disease. In the audiogram and ocular examination for 11 of 12 cases, sensorineural hearing loss was observed in 6 and ocular abnormality in 2 cases. In electron microscopic finding, irregular thickness of the capillary basement membranes with lamination of lamina densa and foot process obliteration was noted in 9 of 11 and thin basement membrane with splitting and foot process obliteration was noted in the other 2. The mean period of follow-up was 3 6/12 years. And one patient developed the chronic renal failure until now and had kidney transplantation. Conclusion: For the diagnosis of Alport syndrome, the following four diagnostic criteria are very important : renal disease, family history, deafness or eye abnormalities, and a specific finding on electron microscopy. We expect that more patients can be detected through the analysis of these characteristics.

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Surgical Experience of Open Heart Surgery in Neonates (신생아개심술의 외과적 경험)

  • 이용훈;조은희
    • Journal of Chest Surgery
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    • v.29 no.8
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    • pp.828-835
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    • 1996
  • From January 1993 to April 1995, 27 neonates (under age of 30 days underwent open heart surgery in the Department of Thoracic and Cardiovascular Surgery, Dong-A Medical Center. Mean age and weight were 12.1 days(2days∼306ays) and 3.29 kg(2.6kg∼4.1 kg) respectively. Cardiac anomalies were simple complete transposition of great arteries(TGA) in 11 neonates, TGA with coarctation of aorta(COA) in 1 , total anomalous pulmonary venous connection(TAPVC) in 5, double inlet right ventricle with TAPVC in 1, interrupted aortic arch(IAA) with ventricular septal defect(VSD) in 3, pulmonary atresia(PA) with intact ventricular septum(IVS) in 3, pulmonary stenosis with IVS in 1, Taussig-Bing anomaly with IAA in 1, and hypoplastic left heart syndrome(HLHS) in 1 . Postoperative complications were myocardial and/or pulmonary edema which caused open sternum in 13 patients(54.2%), acute renal failure( RF) in 10(37.0%), Intractable low cardiac output syndrome (LCOS) including weaning failure from cardiopulmonary bypass in 7(25.9%), bronchopulmonary dysplasia in 1, wound infection in 1, and paroxysmal supraventricular tachycardia in 1. Nine of 13 patients with postoperative open sternum were recovered with delayed sternal closure, and seven of 10 patients survived postoperative ARF with peritoneal dialysis. There were 8 operative deaths(29.6%): 3 in the patients with simple complete TGA, 1 In TCA with COA, 1 in PA with IVS, 1 in Taussig-Bing anomaly with IAA, 1 in DIRV with TAPVC, and 1 in HLHS. One late death occurred after arterial switch operation in simple TGA. The mosts common cause of death was low cardiac output syndrome. Our initial experience of open heart surgery in neonates showed high operative mortality and morbidity, especially in complex anomalies.

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Arthroscopic Treatment for the Pigmented Villonodular Synovitis in the Knee (슬관절에 발생한 색소 융모 결절성 활액막염의 관절경적 치료)

  • Bae, Dae-Kyung;Cho, Nam-Su
    • Journal of the Korean Arthroscopy Society
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    • v.5 no.1
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    • pp.22-26
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    • 2001
  • Purpose : To confirm the efficacy of arthroscopic synovectomy fur the pigmented villonodular synovitis in the knee. Materials and Methods : Between October 1996 and February 2000, the arthroscopic synovectomy had been performed in six patients(six knee joints), whose diagnoses were confirmed by pathologist. All patients complained of painful swelling in involved knee and four of the six patients had trauma history. There were three male and three female patients. Average age was 35.8 years ranging from 16 to 67 years. Follow up period was average 22.7 months(range, $13\~53$ months). Results : According to arthroscopic findings, there were three localized forms and three diffuse forms. At their last follow-up examinations, all patients had improvement in pain, swelling and range of motion and there was no evidence of recurrence. Conclusion : Complete arthroscopic excision is the definitive treatment for localized pigmented villonodular synovitis and meticulous arthroscopic excision through all portals including posterior portal can be considered as a valid alternative to traditional open synovectomy for the patients with diffuse pigmented villonodular synovitis.

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Clinical Study of Rhabdomyolysis After Exercise (운동 후 발생한 횡문근 융해증의 임상적 고찰)

  • Ahn, Young-Joon;Yi, Seung-Rim;Yoo, Jae-Ho;Zoo, Min-Hong;Kim, Seong-Wan;Park, Ji-Man;Yang, Bo-Kyu
    • Journal of Korean Orthopaedic Sports Medicine
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    • v.6 no.2
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    • pp.110-114
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    • 2007
  • Purpose: This study evaluate clinical findings & management of rhabdomyolysis after strenuous activities in military police recruit. Materials and Methods: This study was carried out from June $1^{st}$, 2004 and May $23^{nd}$, 2005. The study subjects were 13 military police recruit patients who were admitted to our hospital with intractable muscle pain and swelling, and had suspicions of Rhabdomyolysis. The patients were given various blood tests (CPK, CK-MB, AST, BUN/Cr, and Electrolyte) and clinically observed. The patients were all males, and their average age was 20 $(19\sim21)$ years. Seven cases were due to push-up exercises, 5 was due to a soccer game, and 1 was due to riot control activities. The patients complained of swelling and tenderness in various parts of the extremities. Four complained of swelling and tenderness in forearm, 3 in upper arm, 1 in shoulder, and 5 in lower extremity. The diagnosis of rhabdomyolysis was made if the patient complained clinical symptom and had a blood CPK level of above 1,000 IU/L at the time of admission. Patients who took medication or had medical problem were excluded from this study. Bone scans were taken of all patients 4 hours after giving 99mTc-MDP 20mCi intravenously. Treatment was bed rest and fluid therapy. Patients who complained of excessive pain were given splint immobilization. Results: The average hospitalization day for the 13 patients was 20 days ($14\sim42$ days). Excluding one patient who exhibited ARF at time of admission, all patients showed a decrease of blood CPK below 1000 IU/L at an average hospitalization time of 8 days ($2\sim11$ days). The patient with ARF recovered after hemodialysis and fluid therapy. Conclusion: Patients complaining of swelling and severe muscle pain after excessive exercise or training should be suspicious of exercise induced rhabdomyolysis, and should be given blood tests and fluid therapy immediately.

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Changes in the Titer of Tooth Root Antibodies Accompanying Root Resorption Associated with Orthodontic Tooth Movement (치아이동시 치근 흡수에 따른 치근항체의 역가 변화)

  • Park, Soo-Byung;Son, Woo-Sung
    • The korean journal of orthodontics
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    • v.24 no.2
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    • pp.303-317
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    • 1994
  • This study was designed to measure the changes in the titer of tooth root antibodies accompanying root resorption associated with orthodontic tooth movement in dogs to explore a role of the specific immune response in root resorption during orthodontic tooth movement. Five adult mongrel dogs, 2 years of age, were used in the study. Six lower incisors were extracted as sources of homologous antigen in the dogs. Tooth root antigen preparations were made from a 6M Guanidine-HCl-10% EDTA(pH5.0) extract of these root dentins. Root resorption was elicited by intrusion of six maxillary incisors with 200-250gm intrusive force. In 9th week, resorbing six maxillary anterior teeth were extracted. Serum samples were taken from each dog prior to intrusion and weekly for 11 consecutive weeks. Serum autoantibody titers were determined with an enzyme-linked immunosorbent assay. As controls for antibody specificity, sera which were previously incubated with tooth root antigen as well as sera to an unrelated bacterial antigen (Porphyromonas gingivalis 33277) for 3 hours at 25 were measured in all runs. Root resorption was monitored monthly using occlusal radiographs. And then root resorption patterns were observed with a zoom stereo microscope (Model SZH-121, Olympus optical Co. Ltd.). Incisors did not show clear radiographic evidence of significant and progressive root resorption, but periodontal ligament space had widened. But root resorption was observed on the apical regions of the maxillary incisors with a zoom stereo microscope. Teeth showed the shallow depression generally accompanying deep resorption. These demonstrate a slight tendency for an immediate decrease followed by rebound to levels above the pre-treatment baseline. A peak titer of autoantibody to dentin antigen occurred on day 28, then steadily decreased during the 9th week period as the roots resorbed and then rapidly spiked in animals when the resorbing teeth were extracted. When sera is incubated with tooth root antigen, serum activity in the ELISA was almost absent. This is because serum activity in the ELISA could be removed by absorption of the serum with dog dentin antigen. Serum ELISA activity to the unrelated bacterial antigen remained essentially unchanged in all animals throughout the experimental period. When the time course of changes in autoantibody to homologous tooth root antigen prepatration and unrelated bacterial antigen was compared, no significant differences were found(${\alpha}=0.05$). In general, the overall pattern of changes in autoantibody was similar to the two antigens. These findings suggest the possibility that these immunologic changes precede a significant development of root resorption lesions rather than merely reflecting their presence. Therefore, this suggests that the changes of antibody levels may have some predictive value for root resorption.

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An Influence of Modified Robicsek Sternal Wiring after Median Sternotomy on the Postoperative Sternal Wound Infection (정중 흉골 절개 후 시행한 변형 Robicsek 흉골 봉합법이 수술 후 흉골감염에 미치는 영향)

  • Chang, Won-Ho;Youm, Wook;Kim, Dong-Hyun;Oh, Hong-Chul;Han, Jung-Wook;Kim, Hyun-Jo
    • Journal of Chest Surgery
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    • v.42 no.6
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    • pp.763-769
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    • 2009
  • Background: In the majority of cases, sternal instability and wound infection concomitantly present after a cardiac operation following conventional median sternotomy, and these complications have a major influence on the postoperative course. The aim of this study is to compare the results of the different sternal wiring techniques of sternal infection. Material and Method: Between April 2004 and December 2008, 157 adult patients underwent cardiac in group A, whereas 71 patients who had undergone modified Robicsek sternal wiring were included in group B. The incidences of sternal wound complications in the two groups were assessed. Result: The mean age of the group B patients was older than that of the group A patients ($61{\pm}10$ years vs $57{\pm}13$ years). The incidence of preoperative left ventricular dysfunction (ejection fraction <30%), chronic obstructive pulmonary disease, renal failure requiring dialysis and diabetes mellitus were significantly higher in Group B, whereas the other perioperative risk factors for infection were not significantly different between the two groups. Two patients in group A experienced superficial wound infection, whereas 4 patients in group B displayed superficial wound infection, but the difference was not statistically significant (p=0.255). Yet poststernotomy deep sternal wound infection appeared in 6 patients of group A, whereas none of the patients in group B displayed this malady. Conclusion: The modified Robicsek sternal wiring technique showed greater sternal stability even for the patient with a high risk for infection, and the technique caused a lower incidence of deep sternal wound infection.

Glomerular Filtration Rate Test Methods and Guidelines (Glomerular Filtration Rate 검사방법 및 가이드라인)

  • Park, Min-Ho;Lee, Ha-Young;Ryu, Hwa-Jin;Yoo, Tae-Min;Noh, Gyeong-Woon
    • The Korean Journal of Nuclear Medicine Technology
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    • v.22 no.2
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    • pp.97-100
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    • 2018
  • Purpose The glomerular filtration rate (GFR) test is an important indicator of glomerular filtration and has been used to test renal function and the extent of its function. The GFR test is performed by intravenous injection of radioactive medicines made of $^{51}Cr$-EDTA, and blood concentration is measured by taking blood according to the elapsed time. also, PET-CT, bone scan, transfusion and so on will affect the outcome. Therefore, we will improve the quality of the test by providing guidelines for the GFR test for more accurate testing. Materials and Methods 5 mL of physiological saline solution and 2 mL of $^{51}Cr$-EDTA solution are used to make 5 mL of the radiopharmaceutical solution to be injected into the patient. First, the syringe weight is measured before the injection, and then the radioactive medicine is injected into the patient's vein and the syringe weight is measured after the injection. Blood sampling is performed twice in total. In adults, blood is collected 3 hours / 5 hours after injection and in children 2 hours / 5 hours after injection. The blood sample is centrifuged at 3300 rpm for 5 minutes. Standard solution is prepared by filling diluent water up to the scale indicated in the 200-mL volumetric flask, discarding $500{\mu}L$, injecting $500{\mu}L$ of GFR reagent and mixing well. $500{\mu}L$ each of the standard solution is dispensed into two test tubes, and $500{\mu}L$ of each of the plasma samples collected in time is dispensed into two test tubes and measured with a Cobra Counter. Results At present, the reference range applied in this study is $119.5{\pm}30.3ml/min/1.73m2$ for males and $125.2{\pm}28.2ml/min/1.73m^2$ for females. Conclusion The GFR test is conducted using radioactive medical products. GFR testing is performed as a scheduled test, but PET-CT, dialysis and transfusion, which may affect GFR testing, may be scheduled during GFR testing. Therefore, we could get accurate GFR test results by notifying the ward and department beforehand when booking.

A Systematic Study on the Amphipods in Korea, II. On the Geographical Distribution and Variation of Species of Fresch-Water Gammarus(Crustacea : Amphipoda, Gammaridae) (韓國山 端脚類의 系統分類學的 硏究: II. 淡水産 Gammarus 屬의 種의 地理學分布 및 變異에 관하여)

  • Kim, Hoon Soo;Lee, Kyung Sook
    • The Korean Journal of Zoology
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    • v.20 no.1
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    • pp.29-40
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    • 1977
  • The authors examined fresh-water gammarid materials which were collected from streams in 20 localities of South Korea during the period from 1965 to 1977. As the results of the observation, the authors have concluded as follows: 1. These fresh-water gammarids belong to Gammarus pulex-group and are distributed widely in mountain-streams of mainland and surrounding islands of South Korea. 2. The present specimens are different from the subspecies, G. pulex koreanus Ueno, 1940 which was described originally from North Korea. In the latter, the pulmose setae of third uropod are limited only to the outer margin of both rami. The peduncle and flagellum of second antenna are fringed with a few short setae and the flagellum is provided with calceoli. In the former, both margins of inner ramus and outer margin of outer ramus of third uropod are fringed with long pulmose setae. The peduncle and flagellum of second antenna have abundant relatively long setase and the flagellum is not provided with calceoli. 3. The present specimens are different from the subspecies, G. pulex sobaegensis Ueno, 1966 which was described originally from South Korea. The latter dwells in cave, while the former dwells in mountain-stream. In the former, the arrangements of pulmose setae of third uropod and the setation of second antenna are similar to those of the latter. But they are quite different from each other in several characters such as shape of upper lip, shape of fifth article of second gnathopod and numbers of incisions on front distal margins of coxal plates 1-3. The former has spines on surface of coxal plates 1-3, but the latter has not. In females, the former has four pairs of marsupial plates, while the latter has three pairs. 4. The present materials show local variations. Therefore, they could be divided into 3 local groups. The first group (specimens from Mt. Odae and Mt. Sogeumgang) has pulmose setae on the both margins of both rami of third uropod and second article of outer ramus is relatively long. In general, this group has setae sparsely on the both rami and especially a few setae on the outer margin of outer ramus. The second group, which are widely distributed in South Korea, has pulmose setae on the both margins of inner ramus and on the outer margin of outer ramus of third uropod. In the third group (specimens from Mt. Soyo), the pulmose setation of third uropod is similar to that of the first group, but the second article of outer ramus is very small.

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The Clinical Manifestations of Patients with Severe Alcoholic Ketoacidosis Treated at a Medical Intensive Care Unit (한 내과계 중환자실에서 치료하였던 중증 알코올성 케톤산증 환자들의 임상적 특성)

  • Lee, Kwang Ha;Lee, Sae Hwan;Oh, Yeon-Mok;Shim, Tae Sun;Lim, Chae-Man;Lee, Sang Do;Koh, Yoonsuck;Kim, Woo Sung;Kim, Dong Soon;Kim, Won Dong;Hong, Sang Bum
    • Tuberculosis and Respiratory Diseases
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    • v.60 no.5
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    • pp.548-553
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    • 2006
  • Background : Alcoholic ketoacidosis(AKA) is a metabolic disturbance that is caused by prolonged and excessive alcohol consumption. Though the prognosis is reportedly good, its outcome is unclear in some cases that are combined with multi-organ failure. There are few reports of an analysis of cases admitted to an intensive care unit(ICU) Method: Cases of AKA admitted to the ICU over the last 5 years were retrospectively analyzed. Severe AKA was characterized by multi-organ failure that required treatment in an ICU Results : All patients were males with a history of excessive alcohol consumption. Five of them (50%) mainly complained of gastrointestinal symptoms (nausea, vomiting, diarrhea), showing metabolic acidosis with an increased asmolar and anion gap. Rhabdomyolysis with acute renal failure was the most common combined organ failure. Mechanical ventilation was performed in 80%. Six patients died and 4 patients survived. In the surviving patients, the arterial blood gas analysis(ABGA) was normalized within 12 hours after admission. Conclusion : In severe AKA patients, rhabdomyolysis with acute renal failure was the most common complication. The mortality rate was high and death from shock occurred within 3 days.