A case of chemical pneumonitis induced by hydrocarbon ingestion / 대한내과학회지

Chemical pneumonitis induced by hydrocarbon ingestion is rare in Korea. Cresol and xylenol, commonly used hydrocarbon disinfectants, can cause chemical burn on skin, gastrointestinal corrosive injury, central nervous system disturbance, and multiorgan failure including acute respiratory failure and chemical pneumonitis following intoxication1, 2, 8). We will report a case of chemical pneumonitis induced by ingestion of a hydrocarbon disinfectant as suicidal attempt.A 39-years-old female was found unconscious after ingestion of 100-200mL of solution containing cresol (5.5 g/100 mL), xylenol (7.5 g/100 mL), and benzene (37.5 g/100 mL).Upon arriving at emergency room the patient was in coma, had undectable blood pressure (0/0) and had no self respiration. Cardiopulmonary resuscitation were given immediately, resulting in reversed her consciousness and elevated blood pressure.The patient had dermal burn on face, erosion of oral and gastric mucosa, impairment of liver function, leukocytosis, metabolic acidosis with hypoxemia, chemical pneumonitis, and spontaneous pneumothorax. The patient survived after artificial ventilation, intensive general supportive treatment and wound care. She was discharged in relatively good clinical condition with minimal sequele.

A Case of High Degree AV Block Treated by Implantation of Permanent Pacemaker in Emery-Dreifuss Muscular Dystrophy

Emery-Dreifuss muscular dystrophy is characterized by 1) early contractures of the elbows, Achilles tendons, and postcervical muscles, 2) slowly progressive muscle wasting and weakness with a humeroperoneal distribution in the early stages, and 3) cardiomyopathy with conduction defects and risk of sudden death. The inheritance is usually X-linked recessive but can be autosomal dominant and recessive. We report a case of 28-year old woman who presented with dizziness, palpitation, and progressive muscular weakness. Her ECG revealed high degree AV block and muscle biopsy demonstrated diffuse degenerative change consistent with Emery-Dreifuss muscular dystrophy. She was diagnosed as autosomal dominant Emery-Dreifuss muscular dystrophy by characteristic clinical features, and findings of ECG, nerve conduction test, electromyography and muscle biopsy findings. A VVI-type permanent pacemaker was implanted.

Clinical Utility of APACHE III Scoring System as a Method for Predicting the Patient with Cardiovascular Disease admitted in Coronary Care Unit (CCU)

BACKGROUND AND OBJECTIVES: Risk assessment methods specially designed for coronary care unit (CCU) are lacking. The aims of this study were first to assess the utility of the Acute Physiology and Chronic Health Evaluation III (APACHE III) scoring system for the prediction of mortality in CCU patients and second to derive an equation for estimation of death risk. MATERIALS AND METHOD: 310 patients were retrospectively investigated. The day 1-scores of APACHE III were determinated. An equation for estimation of death risk was derived, using multivariate logistic regression analysis. A receiver operating characteristic (ROC) curve for APACHE III score was plotted. RESULTS: The average APACHE III scores of non-survivors were significantly higher than those of survivors (P<0.01). Multivariate logistic regression analysis showed that the APACHE III scores and the diagnoses on admission were two significant predictors of mortality. we formulated an equation which could predict outcomes : Probability of death =eX / 1+X, where X = -8.64 +diagnostic category weight +(0.10xAPACHE III scores). The ROC curve for APACHE III confirmed it as a predictor of mortality, with an area under the curve of 0.933 (standard error(SE)=.016). The sensitivity (95% confidence limit(CL)), specificity (95%CL) for APACHE III scores were, respectively, 0.84 (0.72-0.92), 0.88 (0.83-0.92). CONCLUSION: We conclude that the APACHE III scoring system is a useful tool for the overall assessment and management of cardiovascular disease patients in CCUs.

Clinical Utility of APACHE III Scoring System as a Method for Predicting the Patient with Cardiovascular Disease admitted in Coronary Care Unit (CCU)

BACKGROUND AND OBJECTIVES: Risk assessment methods specially designed for coronary care unit (CCU) are lacking. The aims of this study were first to assess the utility of the Acute Physiology and Chronic Health Evaluation III (APACHE III) scoring system for the prediction of mortality in CCU patients and second to derive an equation for estimation of death risk. MATERIALS AND METHOD: 310 patients were retrospectively investigated. The day 1-scores of APACHE III were determinated. An equation for estimation of death risk was derived, using multivariate logistic regression analysis. A receiver operating characteristic (ROC) curve for APACHE III score was plotted. RESULTS: The average APACHE III scores of non-survivors were significantly higher than those of survivors (P<0.01). Multivariate logistic regression analysis showed that the APACHE III scores and the diagnoses on admission were two significant predictors of mortality. we formulated an equation which could predict outcomes : Probability of death =eX / 1+X, where X = -8.64 +diagnostic category weight +(0.10xAPACHE III scores). The ROC curve for APACHE III confirmed it as a predictor of mortality, with an area under the curve of 0.933 (standard error(SE)=.016). The sensitivity (95% confidence limit(CL)), specificity (95%CL) for APACHE III scores were, respectively, 0.84 (0.72-0.92), 0.88 (0.83-0.92). CONCLUSION: We conclude that the APACHE III scoring system is a useful tool for the overall assessment and management of cardiovascular disease patients in CCUs.

A Case of Renal Oncocytomatosis with Chronic Renal Failure / 대한신장학회잡지

Renal oncocytomas account for approximately 5% of renal parenchymal tumors. Usually it has unilateral solitary oncocytic nodule, but bilateral multifocal renal oncocytomasis is rare. The term renal oncocytoma should be used to characterize a well-differentiated renal epithelial tumor with eosinophilic granular cytoplasm that has benign behavior and favourable progress. Also, multiple oncocytoma distributed diffusely in both kidneys is termed renal oncocytomatosis Because of the benign nature, multicentricity, possible bilaterality and absence of pathognomonic radiographic features, renal oncocytomas should be considered in differential diagnosis of solid masses, especially renal cell carcinoma. We report a patient with bilaleral multifocal renal oncocytomatosis, who had progressive renal failure. Renal oncocytomatosis was diagnosed pathologically after bilateral nephrectomy.