Ramsay Hunt Syndrome in a Patient Infected with Human Immunodeficiency Virus / 대한내과학회지

Ramsay Hunt syndrome is caused by reactivation of the varicella zoster virus in the geniculate ganglion of the sensory branch in the face and ears. It is characterized by peripheral facial palsy, ear pain, and vesicles in the auditory canal and auricle. We report on a first case of Ramsay Hunt syndrome in a patient with human immunodeficiency virus in Korea. The patient, a 40-year-old male, first presented with otalgia and ear fullness. On admission, he had right facial palsy of the peripheral type, otorrhea, headache, limited tongue movement, and right auricle vesicular eruptions. He had positive human immunodeficiency virus antibody and Western blot tests. His CD4 T cell count was 281/microL. The patient was treated with valacyclovir and steroid with highly active antiretroviral therapy. His symptoms and facial palsy improved with treatment.

The Clinical Features and Prognostic Factors in Adults with Acute Etrodotoxin Poisoning Caused by Ingesting Puffer Fish

PURPOSE: We conducted this study in order to determine clinical features and prognostic factors in adults with acute tetrodotoxin (TTX) poisoning caused by ingestion of puffer fish. METHODS: In this retrospective study, 107 patients were diagnosed with TTX poisoning. The subjects were divided into two groups according to duration of treatment; Group I, patients were discharged within 48 hours (n=76, 71.0%), Group II patients were discharged after more than 48 hours (n=31, 29.0%). Group II was subsequently divided into two subgroups [IIa (n=12, 11.2%), IIb (n=19, 17.8%)] according to the need for mechanical ventilation support. RESULTS: In multivariable logistic regression analysis, the predictors of the need for treatment over 48 hours were dizziness (odds ratio [OR], 4.72; 95% confidence intervals [CI], 1.59-12.83), time interval between onset of symptom and ingestion (OR, 0.56; 95% CI, 0.16-0.97), PaCO2<35 mmHg (OR, 8.37; 95% CI, 2.37-23.59). In addition, predictors of the need for mechanical ventilation were a time interval between onset of symptoms and ingestion (OR, 0.54; 95% CI, 0.11-0.96) and PaCO2<35 mmHg (OR, 5.65; 95% CI, 1.96-18.66). CONCLUSION: Overall, dizziness, time interval between onset of symptoms and ingestion, DeltaDBP and PaCO2<35 mmHg predict the need for treatment over 48 hours, time interval between onset of symptoms and ingestion and PaCO2<35 mmHg predict the need for mechanical ventilation support after acute TTX poisoning.

The Association between Dyscarbia and Outcome in Out-of-hospital Cardiac Arrest Survivors Treated with Therapeutic Hypothermia

PURPOSE: There is a lack of clinical evidence in terms of the association between carbon dioxide tension and outcomes in cardiac arrest survivors treated with therapeutic hypothermia (TH). We investigated the association of time-weighted mean carbon dioxide tension (TWMCO2) and outcomes in out-of-hospital cardiac arrest (OHCA) survivors treated with TH. METHODS: This was a retrospective cohort study including 177 OHCA survivors. The patients were divided into three groups according to the values of TWMCO2 (normocarbia, 35~45 mmHg; hypocarbia, 45 mmHg). The primary outcome was in-hospital mortality and the secondary outcome was neurologic outcome at discharge. We assessed neurologic outcome at hospital discharge using the Cerebral Performance Categories (CPC). Neurologic outcome was dichotomized as either good neurologic outcome (CPC1 and CPC2) or poor neurologic outcome (CPC 3 to 5). The odds ratio with 95% confidence interval (CI) was estimated. RESULTS: The median value of PaCO2 was 38.2 (33.9-43.3) mmHg. Among a total of 1,239 PaCO2 values, normocarbia, hypocarbia, and hypercarbia were 618 (49.8%), 380 (30.7%), and 241 (19.5%), respectively. Results of univariate logistic regression analysis showed that hypocarbia had a significantly high odds ratio for in-hospital mortality (2.474 (95% CI, 1.129-5.424), p=0.024) compared with normocarbia. Results of multivariate logistic regression analysis showed that hypocarbia (2.926; 95% CI, 1.212-7.066; p=0.017) and hypercarbia (4.673; 95% CI, 1.348-16.205; p=0.015) had a significantly high odds ratio for in-hospital mortality compared with normocarbia. CONCLUSION: In OHCA survivors treated with TH, dyscarbia (hypocarbia and hypercarbia) was frequent and dyscarbia showed an association with in-hospital mortality.

The Relation between Time-weighted Mean Oxygen Tension and Outcome in Out-of-hospital Cardiac Arrest Survivors Treated with Therapeutic Hypothermia

PURPOSE: Studies to determine the relation between oxygen tension and outcome in cardiac arrest survivors treated with therapeutic hypothermia (TH) are lacking. We investigated the relation of time-weighted mean oxygen tension (TWMO2) and outcome in cardiac arrest survivors treated with TH. METHODS: This was a retrospective observational study including 177 out-of-hospital cardiac arrest (OHCA) survivors. The patients were divided into four categories according to quartile values of TWMO2. The primary outcome was neurologic outcome at discharge and the secondary outcome was all cause in-hospital mortality. We assessed neurologic outcome using the Cerebral Performance Categories (CPC) at hospital discharge. Neurologic outcome was dichotomised as either good neurologic outcome (CPC1 and CPC2) or poor neurologic outcome (CPC 3 to 5). The odds ratio with 95% confidence interval (CI) was estimated. RESULTS: The median value of PaO2 was 139(104.5-170.0) mmHg. Among a total of 1,239 PaO2 values, 22(1.8%) values were hypoxia (300 mmHg). Results of univariate logistic regression analysis showed a significantly low odds ratio for poor neurologic outcome [0.353(95% CI, 0.133-0.938) and 0.321(95% CI, 0.121-0.850), respectively] and for in-hospital mortality [0.338(95% CI, 0.132-0.870) and 0.387(95% CI, 0.154-0.975), respectively] for the third quartile and the fourth quartile. However, results of multivariate logistic regression analysis showed no significant relation between TWMO2 and outcomes. CONCLUSION: In OHCA survivors treated with TH, time-weighted oxygen tension did not show an association with neurologic outcome and in-hospital mortality.

Predictors of Mortality in Hemodynamically Unstable Traumatic Patients with Pelvic Fracture

PURPOSE: Pelvic fracture is one of the more serious skeletal injuries, resulting in substantial mortality. The large amount of kinetic energy necessary to fracture the bony pelvis often leads to concomitant thoraco-abdominal injury. Pelvic fracture and combined injuries need effective initial resuscitation. However, it is hard to predict mortality due to the complexity of multiple injuries. Therefore, the purpose of this study was to identify factors predicting mortality in patients with pelvic fracture and concomitant thoraco-abdominal injury. METHODS:A retrospective study was performed on 174 cases of pelvic fracture who visited the Emergency Department between January 2003 and June 2008. Data were collected regarding demographic characteristics, mechanism of injury, injury severity score (ISS), Abbreviated Injury Score (AIS), Simplified Acute Physiologic Score II (SAPS II), transfusion requirements, fluid requirements, the findings on angiography, hemoglobin level, platelet count, prothrombin time (PT), fibrinogen, albumin, base deficit, lactate, anti-thrombin III, length of ICU stay, and total hospitalization days. Pelvic fracture categories were derived by adapting the Young-Burgess classification. RESULTS: One hundred forty patients survived (Group I); 34 died (Group II). Blood pressure, pulse rate, hemoglobin, albumin, lactate, base deficit, PT, fibrinogen and Antithrombin III were significantly different between two groups. Transfusion, fluid requirements, ISS and SAPS II were significantly higher in group II. Extravasation on the CT was more frequent found in group II. The ISS 1.194 (95% CI, 1.076~1.325) and SAPS II 1.162 (95% CI,1.042~1.296) were independent significant predictors of mortality. CONCLUSION: Predictors of mortality in pelvic fracture patients should be available during the first attempt at resuscitation. The ISS and SAPS II were the most important predictors in defining mortality.