Clinical Observation of Anticholinesterase-inhibitor Insecticides Poisoning / 대한내과학회지

BACKGROUND: Organophosphate and carbamate insecticides have been used extensively in agriculture resulting in serious increases in poisoning. Levels of poisoning by carbamates and organic phosphorus compounds and the severity of associated symptoms are dependent not only on the degree of reduction of acetylcholinesterase activity in the nervous system but also on the rate of inhibition and the type of inhibitive action. The most striking differences between the clinical effects of the two groups of compounds are the much more rapid and spontaneous recovery from poisoning by carbamates and the relatively large difference between the smallest dosage of any carbamate that will cause mild illness and the lethal dosage of the same compound. The purpose of this study is to compare the clinical characteristics of acute intoxication by organophosphate and carbamate insecticides. METHOD: We retrospectively analyzed the clinical characteristics of 41 patients poisoned with organophsphates and 12 patients poisoned with carbamates, who were admitted to the department of internal medicine, Soonchunhyang Chunan hospital from January 1995 to December 1996. RESULTS: 1) The most common organophosphate was EPN (9 cases) followed by Dichlorvos (7 cases). In the carbamates group, Carbofuran (5 cases) was the most common followed by Methomyl (3 cases).2) The main cause of poisoning was ingestion for the purpose of suicide in both groups.3) The severity of poisoning was more acute in the organophosphate group than in the carbamate group.4) Altered consciousness and respiratory depression occurred more frequently in the organophosphate group than in the carbamate group. Six cases out of the organophosphate group suffered from respiratory depression 24 hours to 96 hours after poisoning.5) The activity of serum cholinesterase showed no significant difference between poisoning with organophosphates and with carbamates.6) The mortality rate was 22% in organophosphate intoxication and 16.7% in carbamate intoxication. The most common complication of organophosphate and carbamate intoxication was aspiration pneumonia. CONCLUSION: Carbamate insecticides exhibited less toxicity than organophosphates.

Cholecysto - Duodeno - Colic Fistula : Report of One Case / 대한소화기내시경학회지

Biliary-enteric fistula is in 0.5% to 5% of patients undergoing biliary tract surgery. The most common cause of biliary-enteric fistula is gallstones and their complications, Much less common causes are complieation of peptic ulcer, malignancy, trauma, and rarely, Crohns, disease. The most common type of biliary-enteric fistula is cholecysto-duadenal. Cholecysto-colic, cholecysto-gastric, and choledocho-duodenal fistula are reported much less frequently. The combination of cholecysto-duodenal fistula with cholecysto-colic fistula is a very rare. Symptoms are generally nonspecific, so diagnosis has depended on plain film of abdomen and barium studies. Recently, endoscopic examination and cannulation of the fistula for precise radiographic delineation will help to make a diagnosis. A 78-year-old man was admitted our hospital because of epigastric discomfort, indigestion, nausea and vomiting for 10 days. He was confirmed as cholecysto-duodeno-colic fistula by gastroduodenoscopy, colonoscopy, and endoscopic cholangio-graphic techniques. So, we report a case of cholecysto-duodeno-colic fistula of the patient with a review of relevant literatures.

Comparision of Chest Radiographs and Pulmonary Function in Coal Workers' Pneumoconiosis and Welders' Lung / 결핵

BACKGROUND: Chest X-ray of coal werkers' pneumoconiosis and shipyard welders' lung show similar and regular opacities mostly, it is very difficult that we distinguish the former from the latter by only chest X-ray. so we performed this study to understand the progression of the disease and to provide the disease by considering pulmonary function and other factors in proportion to the porfusion of small regular opacities of chest X-ray in both groups. METHOD: 430 coal workers' pneumoconiosis were compared with 311 shipyard welders' lung by the number, the age, the duration of dust exposure, %vital capacity(%VC), %FEV1.0, the type of ventilatory impairment, the combined pulmonary disease according to the profusion of small regular opacities on the chest radiographs, which were classiffied into category 0/1, category 1, and category 2. RESULT: 1) the percent of category 2 in coal workers' pneumoconiosis was 54.4%. the percent of category 1, and category 2 in welders' lung were 60.0%, 7.4%. the progression to the category 2 was higher in coal workers' pneumoconiosis than in welders' lung 2) The mean age was higher in coal workers' pneumoconiosis than in welders' lung, significantly increased in proportion to the progresion of profusion of small regular opacities in both groups 3) There was no difference in the duration of dust exposure by category 1/0, but the duration of dust exposure by category 1, 2 in coal workers' pneumoconiosis more significantly increased than in welders' lung, the duration in the proportion of category 2 to category 0/1, 1 significantly increased in the proportion to small regular opacities in coal workers' pneumoconiosis, but there was no significant difference in the proportion to small regular opacities in duration of dust exposure in welders' lung. 4) There was no sinificant difference of mean values of %VC(%vital capacity)in both groups except for category 1, the mean values of %VC had no relationship between the progression of small regular opacities in both groups. 5) The mean values of %FEV1.0 decreased more significantly in coal workers' pneumoconiosis than in welders" lung except for category 0/1. and decreased sinificantly in proportion to the profusion of small regular opacities in coal workers' pneumoconiosis, there was significant difference of %FEV1.0 in the proportion of category 2 to category 0/1 in welders' lung. 6) there were no significant difference of %FEV1.0, %VC in smoker and nonsmoker in both groups. 7) With regard to the type of ventilation in both groups in coal workers' pneumoconiosis 21.4 percent of patients belonged to the restrictive type, 11.6 percent to the obstructive type, 5.6 percent to the combined type, but in welders' lung 21.8 percent to the restrictive type, 2.9 percent to the obstructive type, 1.9 percent to the combined type. 8. in the pulmonary disease, the incidence of the pulmonary tuberculosis was the most in both groups, was more in coal workers' pneumoconiosis than welders' lung CONCLUSION: If we compare coal workers' pneumoconiosis with electric arc welders' lung by considering pulmonary function and other factors in proportion to the profusion of chest X-ray, I think that we will have the better result in understanding the progression of the disease and provision of the disease in both groups.