Chemical Pneumonitis after Inhalation of Waterproofing Spray: A Case Report / 계명의대학술지

Waterproofing spray is commonly used to waterproof textile, tents, boots, etc. Chemical pneumonitis caused by inhalation of waterproofing spray has often been reported. Most waterproofing sprays contain a fluoropolymer in combination with hydrocarbons. However, chemical pneumonitis caused by waterproofing spray not containing fluoropolymer is uncommon. The authors are reporting a case of chemical pneumonitis caused by waterproofing spray, which contained hydrocarbon only. A 35-year-old man presented with dyspnea. The patient used a waterproofing spray on a tent for 30 minutes in a closed room. One hour and a half after spraying, the patient developed dyspnea, and his dyspnea had gotten worse. The patient's respiratory rate was fast, and the patient's arterial blood gas analysis showed hypoxemia. The chest X-ray and high resolution computed tomography showed bilateral ground-glass opacities and areas of consolidation in both lower lung fields. The patient was diagnosed with chemical pneumonitis caused by inhalation of waterproofing spray. Oxygen was given to the patient, and the patient was started on methylprednisolone intravenously. The patient's symptom improved after one day. After one week, most of symptoms of the patient improved and his chest X-ray showed improvement, so the patient was discharged. After discharge, oral prednisolone was prescribed instead of methylprednisolone, and was gradually tapered off. One month later, the patient's chest X-ray showed complete resolution.

Association of IL-10 genotypes with cardiovascular risk factors in patients with hemodialysis / 대한내과학회지

BACKGROUND: Chronic systemic inflammation in ESRD patients due to uremia and hemodialysis procedure itself comes into notice as a main factor for premature mortality secondary to rapid progressing atherosclerosis. Various pro-inflammatory cytokine, known to mediate these reaction of malnutrition, inflammation and atherosclerosis, are regulated by anti-inflammatory cytokine, such as IL-10. Quantitative production of IL-10 shows interindividual variability determined genetically by polymorphisms of promotor gene. The aim of this study was to measure the degree of IL-10 synthesis in ESRD patients treated with hemodialysis and evaluate the association with genotypes and cardiovascular risk factors. METHODS: The IL-10 genotypes for polymorphic bases at position at -1082 was determined in 66 chronic hemodialysis patients and 98 healthy subjects using highly specific PCR and the lipopolysaccharide (LPS)-stimulated IL-10 (sIL-10) release from whole blood were measured by ELISA. RESULTS: The distribution of the IL-10 genotypes in hemodialysis patients were similar to the general population, but the proportion of A allele in hemodialysis group was significantly higher (72.3% vs 59.8%, p=0.05). sIL-10 concentration were lower in hemodialysis patients compared with normal control (21.1 pg/mg vs 36.1 pg/mg, p=0.001) and both groups showed same relationship of sIL-10 with genotypes, that AA type was low producer. In multiple regression analysis, sIL-10 of normal group correlated negatively with age, creatinine, uric acid and existence LVH, and positively with albumin, hemoglobin. On the other hand, lower albumin, lower ejection fraction on echocardiography and existence of left ventricular hypertrophy were associated with higher sIL-10 in hemodialysis group. CONCLUSION: Polymorphisms by IL-10 genotypes were associated with production of IL-10 by endotoxin stimulation, and sIL-10 was lower in hemodialysis patients than in normal control. According to relation of sIL-10 with cardiovascular risk factors such as existence LVH, ejection fraction and malnutrition, it could be suggested that sIL-10 is useful marker in evaluating the risk of cardiovascular events.

Chemical Pleurodesis as a Treatment for Hydrothorax Complicating Peritoneal Dialysis / 대한신장학회잡지

Hydrothorax complicating continuous ambulatory peritoneal dialysis (CAPD) occurs approximately 2% of continuous ambulatory peritoneal dialysis. Management might begin with interruption of peritoneal dialysis for 2-6 weeks. But, approximately half of the patients failed to respond to the conservative approach, as thus some authors advocated the combined use of intrapleural sclerosing agents and discontinuation of CAPD. As a rule of thumb, a 10-day wait is recommended after pleurodesis before resuming CAPD. As opposed to closed pleurodesis, the diaphragmatic defects can be identified and repaired under direct vision with surgical approach. But, limited eligibility of dialysis patients for open thoracostomy or video-assisted thoracostomy has been a major impediment for this definitive treatment of choice. From 1999 to 2003, among patients undergoing CAPD in Korea University Hospital, hydrothorax developed in four patients. Discontinuation of CAPD and conventional pleurodesis were performed. Three patients were treated successfully. A patient who interrupted peritoneal dialysis only for four days recurred after resuming CAPD. In conclusion, when pleural effusion complicates in a CAPD patient, chemical pleurodesis and cessation of CAPD during at least 10 days might be an initial tratement of choice.

Psychometric Properties of Korean Version of Drug Attitude Inventory(KDAI-10) / 대한정신약물학회지

OBJECTIVE: The aim of this study was to test the psychometric properties of Korean version of 10 items of Drug Attitude Inventory (KDAI-10). METHODS: A total of 157 stabilized schizophrenic patients were entered into the study after completion of screening tests. They completed the KDAI-10. And then they were interviewed with various scales such as Subjective Response Scale (SRS), Positive and Negative Syndrome Scale (PANSS), Extrapyramidal Side Effects Rating Scale (ESRS), and Global Assessment of Functioning (GAF). Correlations of KDAI-10 with these scales were tested. RESULTS: The Cronbach's alpha used to measure the internal consistency of the scale, was high (0.83). Principal component analysis with varimax rotation produced 2 factors, which explained 50.37% of the total variances. The First factor including 6 items was the positive subjective feelings and the second factor including 4 items was the negative subjective feelings, which were identical to the original authors'. Individual item correlations with total scores were all statistically significant (r=0.48-0.72, p<.001). And correlations of KDAI-10 with SRS, PANSS, ESRS and GAF showed that they were significantly correlated. CONCLUSION: Although the results were not quite satisfactory, KDAI-10 was demonstrated to have good reliability and construct validity.

A Case of lambda-type Light Chain Deposition Disease Manifested as Acute Renal Failure and Multiple Organ Dysfunction by Embolic Events / 대한신장학회잡지

Light chain deposition disease is caused by systemic paraprotein deposition resulting from monoclonal plasma cell dyscrasia. It is usually characterized rapidly progressive renal failure and multiple organ dysfunctions. Besides deposition of light chain, it can lead to multiple organ dysfunctions due to hyperviscosity syndrome. We experienced a case of 54-year-old man who presented as an acute renal failure, and elevation of liver enzyme. Radiologically, there was no abnormal finding except enlargement of both kidney in abdominal sonogram. Globulinuria was noticed on 24 hrs-urine study. The histologic findings of kidney showed lambda chain deposits in basement membrane of tubules and glomeruli, interstitium, and vessel walls. On 10th day of hospitalization, he developed sudden hypoxia that was not corrected by oxygen supplementation, and focal neurologic signs accompanied with a change of consciousness. We report a case of light chain deposition disease manifested as an acute renal failure and liver enzyme elevation with suspicious multiple organ embolic events later.

c-JUN Expression and Apoptotic Cell Death in Kainate-Induced Temporal Lobe Epilepsy

Following kainate (KA)-induced epilepsy, rat hippocampal neurons strongly ex-press immediate early gene (IEG) products, i.e., c-FOS and c-JUN, and neural stress protein, HSP72. Prolonged expression of c-JUN and c-FOS 48 hr after cerebral ischemia has been underwent delayed neuronal death. However, it is not yet clear whether IEGs actually assume the essential roles in the cell death process or simply as a by-product due to external stimuli because of the prolonged expression of c-FOS, more than one week, on intact CA2 neurons of the hippocampus in a KA-induced epilepsy model. This study investigated the relationships between prolonged expression of c-JUN and hippocampal neuronal apoptosis in a KA-induced epilepsy model. Epileptic seizure was induced in rats by a single microinjection of KA (1g/l) into the left amygdala. Characteristic seizures and hippocampal neuronal injury were developed. The expression of c-JUN was evaluated by immunohistochemistry, and neuronal apoptosis by in situ end labeling. The seizures were associated with c-JUN expression in the hippocampal neurons, of which the level showed a positive correlation with that of apoptosis. Losses of hippocampal neurons, especially in the CA3 region, were partly caused by apoptotic cell death via a c-JUN-mediated signaling pathway. This is thought to be an important component in the pathogenesis of hippocampal neuronal injury via KA-induced epilepsy.

The Acute Pharmacodynamic Effects of Venlafaxine and Mirtazapine on Psychomotor Performance, Motor Activity, and Daytime Sleepiness / 대한정신약물학회지

OBJECTIVE: For the optimal use of antidepressants, it is important to consider the behavioral effects of drugs affecting the real lives of depressed patients, as there is little difference in therapeutic effects between drugs. The aim of this study was to determine the acute pharmacodynamic effects of two recently introduced antidepressants, venlafaxine and mirtazapine, on psychomotor performance, motor activity and daytime sleepiness. METHODS: Twelve healthy male volunteers received a single dose of venlafaxine 37.5 mg, mirtazapine 15 mg or amitriptyline 25 mg (positive control) at one-week intervals in a double-blind, placebo-controlled, crossover design. Volunteers wore an actigraph on their non-dominant wrist for the duration of each test day. A battery of psychomotor tests was performed prior to dosing and at 2 and 6 h post-dose. Subjective daytime sleepiness was also assessed at the end of each test day. RESULTS: Venlafaxine did not affect psychomotor performance, motor activity and daytime sleepiness. Mirtazapine decreased thresholds in critical flicker fusion frequency, increased reaction times in choice reaction tests, and increased peripheral reaction times in compensatory tracking tests. It also caused significant daytime sleepiness and decreased motor activity. CONCLUSION: The differences in the behavioral effect profiles presented in this study should assist in the selection or scheduling of antidepressants.

Doctor's Perspectives for Epilepsy in Kwangju, Chollanam-do Area

The attitude and awareness of medical practitioner for epilepsy have influence on that of the public and the patient. We intended to evaluate medical practitioner's perspectives for epilepsy. The questionnaire which used in this study was designed specifically to evaluate the medical practitioner's perspectives for epilepsy. It is studied in 160 medical practitioners at Kwangju city and Chollanam-do province, who had answered over 50% of the.questionnaire and certified themselves. The results are as follows; 1) The 'prejudice' toward epilepsy is common finding even in medical practitioners regardless of their experience and training. It is more common in older doctors over 40 years old. 2) The number of lately treated patients with epilepsy is about 3.7 per one medical practitioner in this area. It falls short of expected number which is calculated with already reported prevalence of epilepsy by others. 3) The treatment of epilepsy is being performed by medical practitioners individually without any interdepartmental relationship in our society. 4) Most of the medical practitioners lack basic knowledge about epilpsy such as International Classification, first line antiepileptic drugs for different seizure type regardless Of their age, training and experience for treatment of patient with epilepsy. These results suggested that effective education is necessary for medical practitioner about epilepsy.

Prevention of Obturator Nerve Reflex during Transurethral Surgery of Bladder Tumor / 대한비뇨기과학회지

Adductor contraction from obturator nerve stimulation occurs frequently in certain situations during transurethral operations. Bladder perforation is a common result. A simple and safe technique involving use of a nerve stimulator for accurate obturator blockade and psoas compartment block are described. Only one of seven cases has obturator nerve stimulation after psoas compartment block. But there were no adductor contractions in more than seventeen transurethral resections during one year interval. There were no complications from the block itself or use of the nerve stimulator. Herein we introduce these safe methods for prevention of obturator nerve stimulation during transurethral resection.

A Case of Adrenal Hemorrhage in an Adult / 대한비뇨기과학회지

Acute bilateral adrenal hemorrhage in patients who have been stressed by surgery, sepsis, and /or hypotension, as well as in patients who have been a preexisting coagulopathy, has previously been reported, but acute unilateral adrenal hemorrhage is extremely uncommon. We describe herein a 37-year-old man who had diabetes for 2 years and developed unilateral adrenal hemorrhage in coexisting adrenocortical adenoma.

An Aldosterone Secreting Adrenal Cortical Carcinoma / 대한비뇨기과학회지

Adrenal carcinoma is a rare disease and has a poor prognosis. The incidence is estimated as one case per 1.7 million, accounting for 0.02% of cancers and 0.2% of all cancer deaths. About 79% of adrenal carcinoma is functional and most common functional tumor is Cushing's syndrome. Primary aldosteronism due to adrenal carcinoma is very rare. In most cases with evidence of mineralocorticoid excess and hypokalemia due to adrenal carcinoma, there are also signs of abnormalities in glucocorticoid or androgen secretion. We report a case of aldosterone secreting adrenal cortical carcinoma in a 52 years old female patient.

False Positive Findings in CTAP (CT during arterial portography) using Spiral CT

PURPOSE: CTAP(CT during arterial portography) has been shown to be the most sensitive technique available for the detection of hepatic mass. But because of many false positive lesions, it is important to interpretate the findings correctly. So we tried to analyse the false positive findings in CTAP. MATERIALS AND METHODS: Materials were 47 patients that had (;TAP for the detection of hepatic lesions. After performing superior roesenteric artery (SMA) arterial portography for the detection of vascular variation, CT

First experience in treatment of urolithiasis using therasonic LT-1000 / 대한비뇨기과학회지

Two hundred sixteen patients with symptomatic urinary calculi underwent extracorporeal shock wave lithotripsy utilizing Therasonic Lithotripsy System (Theratonic LT -1000) at Kyunepook National Universily Hospital from April 1991 to march 1992. About 95.O per cent of stones were completely treated with one to nine session. The stone-free rate for patients with renal, upper and lower ureteral calculi was 93.9, 94.4 and 97.8 per cent respectively. Stone-free rate for individual patient depended on stone size. location. composition. and quality of disintegration. Postextracorporeal shock wave lithotripsy complications were minimal, these were gross hematuria. fever. flank pain, gastrointestinal trouble and stein strasse. Combined therapy utilizing percutaneous surgery or multiple sequential ESWL treatments is necessary for complex stones. In our opinion. ESWL utilizing Therasonic Lithotripsy System is more safe and effective treatment modality for urinary calculi except midureter and bladder than others.

A clinical analysis of the upper urinary tract transitional cell carcinoma and associated bladder tumor / 대한비뇨기과학회지

Urothelial tumor is characterized by a tendency of multicentricity. We analyzed retrospectively 43 cases of the upper urinary tract transitional cell carcinoma from June 1980 to May 1990. Of these cases. 16 (37.2%) cases involved the transitional cell carcinoma of the bladder (synchronous 6. metachronous 10). Of the metachronous group, the interval between treatment of the upper urinary tract lesion and the diagnosis of initial bladder tumor was within 1 year in 7 cases (70%) To compare the synchronous group to the metachronous group, the primary site of the upper urinary tract tumor was pelvis (1:4), ureter (2:2), pelvis + ureter (3:4). By histologic diagnosis, high grade (III, IV) and high stage (PT2-PT4) lesions of the upper urinary tract were 3:5 and 5:8. The 3 year cumulative survival rate of the upper urinary tract tumor without a history of bladder tumor, with the synchronous group and with the metachronous group was 59%, 50% and 62% respectively. There was no significant value (P>0.05) among them. Therefore it was considered that longer follow-ups and a larger series of patients were required.