A Case of Small Bowel Obstruction and Perforation by Anisakiasis

Anisakiasis is a disease that often occurs after the ingestion of raw marine fish infected with nematodes of the Anisakis genus. Ingested Anisakis causes a variety of symptoms, including abdominal pain, nausea, and vomiting, when they invade the gastric wall. Although invasion of the gastric wall is common, rare cases of Anisakis invading the small bowel have been reported. These rare cases have resulted in small bowel obstruction and perforation and usually require surgical treatment. A 57-year-old man visited the emergency room suffering from abdominal pain and distension. He ate raw marine fish three days prior and suffered from epigastrium pain a day after this meal. X-ray and computed tomography showed small bowel obstruction without adhesion and required an operation for treatment. A laparotomy revealed dilated and congested jejunum and ileum with perforated distal ileum. We found a small thin long worm, confirmed by histopathology as a member of Anisakis. The patient was discharged after surgery without any complication.

Influence on a Doctorless Island Residents' Health Care Utilization by Video Telemedicine

PURPOSE: Video telemedicine system is efficient method of health care delivery that uses communication technologies via the internet and video-conferring to provide real-time video remote health provider, patient, or both. Video telemedicine system has the potential to improve access to the specialty of emergency medicine, particularly in rural and remote settings. Inadequate maintenance of ongoing health issues can result in high-cost care for both acute illness and long-term complications, whereas prevention of even a small percentage of these costs can pay for the cost of a video telemedicine system. METHODS: We visited a doctorless island on September 8th, 2006 and studied the public health status of the citizens, making charts while giving a free medical examination and treatment. We maintained and analyzed the charts for one year and then surveyed citizens to evaluate the effectiveness of video telemedicine system and to query them regarding future remedies. RESULTS: Out of 178 cases using video telemedicine system, 99 cases were the first medical examination and 12 cases were emergent, with 7 cases resulting in transfer to a mainland hospital. Of the patients transferred to the 3rd grade hospital, 41.4% had a heart problem. Thirty-eight cases were newly diagnosed via video telemedicine system, including 12 cases of vertebral disease (31.5%). 74.0% of citizens were satisfied with the video telemedicine system and among them 45.0% indicated satisfaction with the ease of seeing a doctor. After experiencing video telemedicine system, 100% of the citizens were agreed to continue video telemedicine system on the 'doctorless island', so more support and development is needed. CONCLUSION: Evidence suggests that a variety of video telemedicine system techniques can be applied effectively and safely to deliver emergency medicine across a variety of clinical settings. The utility and efficacy of telemedicine is discussed. Patient satisfaction is generally reported as high.

A Patient with Methemoglobinemia after Herbicide Intoxication has Hemolytic Anemia Induced by Methylene Blue

Methylene blue is the first choice for treating methemoglobinemia, any increase in normal methemoglobin levels. Methemoglobin is an abnormal hemoglobin in which the iron has been oxidized to the ferric(+3) state, making it incapable of oxygen transport. Methemoglobinemia most commonly results from exposure to oxidizing chemicals, but may also arise form genetic, dietary, or even idiopathic etiologies. Patients with low methemoglobin levels are asymptomatic, but high methemoglobin levels can lead to headaches or even death. Methylene blue, the first-line treatment for methemoglobinemia, can also produce hemolytic anemia. Jaundice or dark urine during methylene blue treatment may indicate hemolytic anemia. A 47-year-old female patient with a history of depressive mood disorder developed significant methemoglobinemia after ingesting a Propanil overdose. Twenty-two hours after ingestion, methemoglobin levels in the blood were 73.2%. She was treated with intravenous methylene blue in the therapeutic range (1 mg/kg every 4 h for 3days). The 2nd day after methylene blue use, methemoglobin levels in the blood were 33%, and the 5th day decreased to 10% with better general condition. The patient had hyperbilirubinemia after hemolytic anemia, but she recovered completely.

A Case of Acute Toxic Encephalopathy due to an Oxycodone Overdose

Acute encephalopathies can be defined as an acute central nervous system (CNS) insult, due to an underlying pathology. The clinical symptoms almost always include an acute state of confusion and cognitive impairment. Toxic encephalopathies can occur acutely or chronically depending on the toxic drugs and other substances as well as the individual metabolism of the drug. The organs acutely affected include the heart, lung and kidneys. However, the brain, spinal cord and sympathetic nerves can be affected chronically. If the toxic substance passes through the bloodbrain barrier into the hypothalamus and the posterior pituitary gland, the result can be diabetes insipidus. If the substance affects the anterior pituitary gland, the result can include hormone dysfunction, impaired immune function and altered cognition or personality. We report a patient that developed acute toxic encephalopathy after the prescribed dose of oxycodone was exceeded.

A case Report of Hyponatremia Resulting from Treatment of Anaphylaxis and Rhabdomyolysis in a Snake Bite Patient

Hyponatremia is a condition of body fluid and electrolyte imbalance frequently encountered in clinical practice. However, treatment with small amounts of furosemide has in rare instances been reported to be associated with hyponatremia. We report a case of a 50-years-old woman who developed symptomatic hyponatremia after treatment for anaphylaxis and rhabdomyolysis resulting from snake bite. The woman was presented with hypotension and hypersensitivity induced by administration of antivenom after a snake bite. She was treated by fluid therapy and administration of epinephrine. One day after hospitalization, she complained of abdominal pain, and her myoglobin level and creatine phosphokinase concentration had increased. She was treated with hydration and urine alkalization. Renal failure and compartment syndrome were not complications of the clinical course. However, pleural effusion and ascites developed following fluid therapy. A small amount of furosemide was administered for treatment, and one day after administration, hyponatremia was found to have developed. The possibility of prescribing a small amout furosemide should be considered for patients who are treated with fluid therapy and require administration of antivenom for anaphylaxis and rhabdomyolysis resulting from snake bite.