Comparison of Prescription Patterns and Clinical Features according to Clinical Departments in Sedative-hypnotic Intoxication

PURPOSE: The purpose of this study was to compare prescription patterns and clinical features according to clinical departments in sedative-hypnotic intoxication. METHODS: This was a retrospective study of histories, substances of poisoning, acquisition routes, clinical courses, and outcomes of patients treated for acute intoxication in a single emergency medical center from January, 2011 to December, 2013. RESULTS: A total of 769 patients were treated for acute intoxication, 281 patients ingested sedative hypnotics during the study period. Among 281 patients, 155 patients were prescribed by psychiatric department and 80 patients were prescribed by non-psychiatric department. Benzodiazepines were more likely to be prescribed by psychiatrists, and zolpidem was preferred by non-psychiatrists (p<0.001). Non-psychiatrists were more likely to prescribe short acting benzodiazepines than psychiatrists (p<0.001). However, there was no statistically significant difference in the clinical outcomes, including prevalence of admission to ICU, ventilator care, and length of stay in ICU. In patients prescribed by non-psychiatrists, there were more patients prescribed without psychiatric diagnosis and diagnosed as major depression disorder after hospitalization. CONCLUSION: To promote rational prescribing of sedative hypnotics, proper psychiatric evaluation should be performed before prescribing, and educational programs including the contents of interactions and side effects of sedative hypnotics are needed.

Comparison of Urine Iodine/Creatinine ratio between Patients following Stringent and Less Stringent Low Iodine Diet for Radioiodine Remnant Ablation of Thyroid Cancer / 핵의학분자영상

A low iodine diet (LID) for 1~2 weeks is recommended for patients who undergoing radioiodine remnant ablation. However, the LID educations for patients are different among centers because there is no concrete recommendation for protocol of LID. In this investigation, we compared two representative types of LID protocols performed in several centers in Korea using urine iodine to creatinine ratio (urine I/Cr). METHODS: From 2006, April to June, patients referred to our center for radioiodine remnant ablation of thyroid cancer from several local hospitals which had different LID protocols were included. We divided into two groups, stringent LID for 1week and less stringent LID for 2 weeks, then measured their urine I/Cr ratio with spot urine when patients were admitted to the hospital. RESULTS: Total 27 patients were included in this investigation (M:F=1:26; 13 in one-week stringent LID; 14 in two-week less stringent LID). Average of urine I/Cr ratio was 127.87+/-78.52 microgram/g in stringent LID for 1 week, and 289.75+/-188.24 microgram/g in less stringent LID for 2 weeks. It was significantly lower in stringent LID for 1 week group (p=0.008). The number of patients whose urine I/Cr ratios were below 100 microgram/g was 6 of 13 in stringent LID for 1 week group, and 3 of 14 in less stringent LID for 2 weeks group. CONCLUSION: Stringent LID for 1 week resulted in better urinary I/Cr ratio in our investigation compared with the other protocol. However it still resulted in plenty of inadequate range of I/Cr ratio, so more stringent protocol such as stringent LID for 2 weeks is expected more desirable.

A case of epiphrenic diverticulum with solitary mediastinal tumor / 대한내과학회지

Epiphrenic diverticulum(traction type) is such a rare disease. The case of this disease which is due to mediastinal tumor, not because of inflammatory adhesion or of motor disorder is especially hard to find. The patient was a 50-year-old male and admitted with the intermittent postprandial chest discomfort. The chest CT and esophagography showed epiphrenic diverticulum(traction type). The tumor was located at the left anterolateral of thoracic spine, adhered to the right wall of esophagus. We performed the diverticulectomy and extirpation of mediastinal tumor under left posterolateral thoracotomy. The tumor and the esophagus were well seperated without invasion to the esophagus. In the pathology of resected tissues, solitary neurofibroma was diagnosed. There was no complication or recurrence after surgical resection.

A Case of Sponataneous Regressing Retroperitoneal Fibrosis after Ureteral Stent Insertion / 대한신장학회잡지

A 76 year old man was admitted because of periumbilical aMominal pain and nausea for 20days before admission. Initial serum creatinine level was 6.1mg/dL. Radioisotope renography showed obstruc- tive uropathy in both ureters. Retrograde pyelography of the left kidney revealed about 1cm of filling defect on the level of L5. Percutaneous nephrostomography of the right kidney revealed ureteral stricture in the lower ureter. In order to preserve renal function, a double J stent was inserted into each ureter. Serum creatinine level decreased to 1.5mg/dL after the insertion of ureteral stents. 12 weeks later, both stents were removed. 3 months after removal of the ureteral stents, retroperitoneal fibrosis and hydronephrosis disappeared in follow up abdominal CT. Recent his serum creatinine has shown about 1.5mg/dL. The patient is under continuing observation with serum creatinine level and sonography for detection of recurrence. This is a rare case of retroperitoneal fibrosis which showed spontaneous regression after ureteral stent insertion for 12 weeks without ureterolysis or corticosteroid therapy. In this case, the ureteral stent played a important role in preserving renal function by relieving ureteral obstruction. But the key point was that in the early stage in the early stage of retroperitoneal fibrosis, it was thaught having reversible process. There are some reports that ureteral obstruction was relieved only by correction of fluid and electrolytes balance or ureter diversion such as percutaneous nephro-stomy. Corticosteroid therapy promotes this rever-sible change in early stage of this disease by immunosuppression and antiinflammatory reaction. But once fibrosis has established in late stage of retroperitoneal fibrosis, corticosteroid is not effective for reducing the fibrosis and ureteral obstruction. In that case, operation is the choice for preservation of renal function. We reported an idiopathic retroperitoneal fibrosis case which showed spontaneous regression after preserving renal function by double J stent insertion without ureterolysis or corticosteroid therapy. We thought that idiopathic retroperitoneal fibrosis is a reversible process in the early stage.

A Case of Bronchial Lipoma with Extrabronchial Growth causing Middle Lobe Syndrome and Pneumonia / 결핵

Benign pulmonary tumors are rare entities, and among them bronchial lipomas are the most uncommon. Up to date, about 80 cases have been reported in the English literature. But, the bronchial lipoma with extrabronchial growth causing middle lobe syndrome and pneumonia is extremely rare. Bronchial lipomas, mainly arising from normal fatty tissue of the proximal portion of the lobar or segmental bronchi, are histologically benign. But if diagnosis and treatments are delayed, they can produce extensive pulmonary parenchymal damage and irreversible brochiectasis distally. So whenever possible, the treatment of choice is resection by means of bronchoscopy via early diagnosis. But if endoscopic removal is not possible because the distal end of the tumor could not be visualized by fiberoptic bronchoscopy or if the nature of the tumor is unclear, surgery is necessary, with lobectomy or pneumonectomy being required in most cases due to the extensively damaged pulmonary parenchyma. We present a case of bronchial lipoma with extrabronchial growth, with a review of the literature and report of an unusual case.

Usefulness of Tc-99m MIBI Scan in the Postoperative Follow Up Of Well-Differentiated Thyroid Cancer / 대한핵의학회잡지

To evaluate the clinical utility of Tc-99m MIBI scan in the detection of residual thyroid tissue or metastatic lesion in postoperative thyroid cancer patients, we compared Tc-99m MIBI scan with I-131 diagnostic and therapeutic scan in 30 postoperative well-differentiated thyroid cancer patients. Thyroglobulin levels of both on and off thyroid hormone medication and antithyroglobulin antibody were tested [Tg(on), Tg(off)l Positive rates for I-131 diagnostic and Tc-99m MIBI scan were 81% and 68% respectively. Concordance between I-131 diagnostic and Tc-99m MIBI scan was observed in 15 cases; 12 positive and 3 negative respectively Among the 6 cases with negative I-131 diagnostic scan and positive Tc-99m MIBI scan, 4 were positive in the therapeutic I-131 scan. We concluded that Tc-99m MIBI scan maybe a useful complementary modality to the currently established method of I131 scan and serum thyroglobulin level in the detection of recurrent or metastatic thyroid cancer, especially in the case of negative I-131 diagnostic scan.