Snakebite in Korea: A Guideline to Primary Surgical Management

PURPOSE: Snakebite is an emergency which causes local symptoms such as pain and edema around the bite. Systemic symptoms may also develop, such as dizziness or renal failure, and may even cause death. The purpose of this research was to assess the validity and safety of snakebite protocol for surgery when treating snakebite patients. MATERIALS AND METHODS: Retrospective research was performed on patients who were admitted after being treated at the emergency center from January 2008 to December 2012. When necessary, debridement was also performed, and 46 of 111 patients (41.4%) underwent debridement. Those who had received debridement without antivenom administration due to a positive skin reaction test were classified as group A, and group B received antivenom and delayed debridement. We reviewed the emergency and admission charts of the patients in each group and recorded and compared their age, sex, bite site, severity of local and general symptoms, time to receive antivenin, and complications. RESULTS: Of the ten patients (21.7%) in group A, two (66.6%) developed cellulites, and one of them experienced skin necrosis, resulting in a skin graft. In group B, there were 36 patients (78.2%), 19 (52.7%) of whom developed cellulitis. Skin necrosis occurred in two patients, and one of these patients received a skin graft. Compartment syndrome was found in one patient, and fasciotomy and a skin graft were performed. CONCLUSION: The treatment protocol implemented to treat snakebite patients admitted to the emergency center during this research was safely and properly followed during surgical treatment.

Erratum

No abstract available.

Diffusion and Perfusion Characteristics of MELAS (Mitochondrial Myopathy, Encephalopathy, Lactic Acidosis, and Stroke-Like Episode) in Thirteen Patients

OBJECTIVE: We analyzed the diffusion and perfusion characteristics of acute MELAS (mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episode) lesions in a large series to investigate the controversial changes of the apparent diffusion coefficient (ADC) that were reported in prior studies. MATERIALS AND METHODS: We analyzed 44 newly appearing lesions during 28 stroke-like episodes in 13 patients with MELAS. We performed a visual assessment of the MR images including the ADC and perfusion maps, comparison of the ADC between the normal and abnormal areas, comparison of % ADC between the 44 MELAS lesions and the 30 acute ischemic infarcts. In addition, the patterns of evolution on follow-up MR images were analyzed. RESULTS: Decreased, increased, and normal ADCs were noted in 16 (36%), 16 (36%), and 12 (27%) lesions, respectively. The mean % ADC was 102 +/- 40.9% in the MELAS and 64 +/- 17.8% in the acute vascular infarcts (p < 0.001), while perfusion imaging demonstrated hyper-perfusion in six acute MELAS lesions. On follow-up images, resolution, progression, and tissue loss were noted in 10, 4, and 17 lesions, respectively. CONCLUSION: The cytotoxic edema gradually evolves following an acute stroke-like episode in patients with MELAS, and this may overlap with hyper-perfusion and vasogenic edema. The edematous swelling may be reversible or it may evolve to encephalomalacia, suggesting irreversible damage.

A Case of Malignant Extrarenal Rhabdoid Tumor

Malignant Rhabdoid tumor is a rare malignant neoplasm and is morphologically similar to rhabdomyosarcoma, but is different immunohistochemically. Most malignant rhabdoid tumors occur in the kidney of infants, and are rarely reported at extrarenal sites. Since Frierson and his collagues first described the malignant extrarenal rhabdoid tumor(MRT) in children in 1985, it has rarely been reported. The neoplasm is histologically and immunohistochemically identical to a renal malignant rhabdoid tumor. There have been no previous reports of this neoplasm in Korea. An MRT of the sacroiliac bone in a 11-year-old girl is described. Five months after the initial presentation, the patient is still alive with partial response to combination chemotherapy and radiotherapy. The authors review previous reports of extrarenal MRT, and discuss the pathologic characteristics, differential diagnosis, and treatment of this rare neoplasm.

Neuroprotective Effect of Focal Ischemic Preconditioning in Transient Focal Ischemia Animal Model

BACKGROUND: The term 'ischemic preconditioning', which implies the first, brief, sublethal ischemia before the next ischemia, is widely accepted to have protective effect in the myocardium, and recently with a specified circumstances, in the brain also. However, the existence of this 'ischemic tolerance' phenomenon is not yet clarified in the repeated transient focal cerebral ischemia model. This study was performed to test whether the ischemic preconditiong has protective effect also in this TIA-mimicking condition. METHODS: Using intraluminar suture technique, initial transient focal ischemia was maintained for 30 minutes in the rat brain. After this ischemic preconditioning, second ischemia of 120 minutes duration was performed using the same method at 1, 3, 5, and 7 days after the 1st ischemia (n=20). The resulting brain infarct volume was assessed and compared to that of previously sham-operated paired controls(n=20). RESULTS: Using the infarct volume as parameters, there was no significant difference between the ischemia and control group in all pairs. But when the percent of infarct volume compared to the hemispheric volume was used instead, neocortical infarct percent was significantly smaller at day 3 after preconditiong (p<0.05). But such difference was not found at 1, 5, and 7th day in the neocotex. Neither the percent of total infarct nor the subcortical infarct showed any statistical difference. CONCLUSION: It could be concluded that transient focal cerebral ischemic preconditioning have neuroprotective effect. The optimal interval between ischemia for this 'ischemic tolerance' to happen is 3 days, and this phenomenon seems to be the function of cerebral cortex, but not the subcortex.

A Case of Cobb Syndrome

No abstract available.

A Case of Cobb Syndrome

No abstract available.