• Title, Summary, Keyword: treatment delays

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A Case of Ethylene Glycol intoxication with Acute Renal Injury: Successful Recovery by Fomepizole and Renal Replacement Therapy

  • Song, Chang Hun;Bae, Hong Jin;Ham, Young Rok;Na, Ki Ryang;Lee, Kang Wook;Choi, Dae Eun
    • Electrolytes & blood pressure
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    • v.15 no.2
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    • pp.47-51
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    • 2017
  • Ethylene glycol is a widely used and readily available substance. Ethylene glycol ingestion does not cause direct toxicity; however, its metabolites are highly toxic and can be fatal even in trace amounts. Poisoning is best diagnosed through inquiry, but as an impaired state of consciousness is observed in most cases, poisoning must be suspected when a significantly elevated osmolar gap or high anion gap metabolic acidosis is found in blood tests. Hemodialysis and alcohol dehydrogenase inhibitors such as ethanol and fomepizole are a part of the basic treatment, and timely diagnosis and treatment are crucial because any delays can lead to death. However, there are few reported cases in Korea, and no report on the use of fomepizole. Herein, we report a case of acute renal failure caused by ethylene glycol poisoning that was treated with fomepizole and hemodialysis and present a literature review.

Successful Treatment of Blunt Traumatic Rupture of the Left Atrial Appendage and Pericardium: A Case Report (둔상에 의한 외상성 좌심실 파열환자를 성공적으로 치료한 예)

  • Kyoung, Kyu-Hyouck;Jung, Sung-Ho;Hong, Suk-Kyung
    • Journal of Trauma and Injury
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    • v.24 no.2
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    • pp.168-170
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    • 2011
  • Blunt cardiac rupture is uncommon and is associated with significant mortality. Patients with blunt cardiac rupture usually have combined injury and do not always show signs of cardiac tamponade, which delays the diagnosis of cardiac rupture and increases mortality. We report a case of cardiac rupture diagnosed and treated by using only thoracic exploration based on clinical impression, with radiologic studies, including even echocardiography, showing negative results.

A Study on Diesel Spray Combustion Modeling by Eulerian and Lagrangian Conditional Moment Closure Models (Eulerian 및 Lagrangian CMC 모델을 사용한 디젤분무연소 모델링에 관한 연구)

  • Kim, Woo Tae;Cho, Hyun Su;Huh, Kang Y.
    • 한국연소학회:학술대회논문집
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    • pp.195-198
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    • 2012
  • Numerical simulation is performed to evaluate the conditional moment closure (CMC) models for spray development, ignition, and turbulent combustion for the Engine Combustion Network (ECN) test cases. The CMC model is implemented in the open source code, OpenFOAM, to provide conditional flame structures through the solution of Eulerian as well as Lagrangian conditional transport equations. In spite of more accurate treatment of the convective term, Eulerian CMC provides similar ignition delays and lift-off lengths with Lagrangian CMC.

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Clinical Experience of Tracheal Resection after Laser Ablation in a Patient having Tracheal Neurilemoma with Tracheal Stenosis. (기관폐쇄를 동반한 기관 신경초종 환자에 있어 레이져를 이용한 부분절제술후 기관절제술의 경험)

  • 박성민;김광택
    • The Korean Journal of Thoracic and Cardiovascular Surgery
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    • v.32 no.10
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    • pp.947-950
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    • 1999
  • Tracheal neurilemoma, an extremely rare benign tracheal tumor that there has been only one case reported in 1996 throughout the nation, is a slowly progressing disease that obliterates the upper airway, delays diagnosis for its symptom similarity to asthma, and makes intubation for operation difficult. Bronchoscopic is therefore needed for diagnosis. There are two options for the treatment methods, a bronchoscopic resection or open surgical resection; however if intubation is difficult, then the bronchoscopic resection is used first to keep the airway open for the surgical resection. In this case, the severe tracheal stenosis impeding intubation made the surgical resection of the primary tracheal neurilemoma with extratracheal mass impossible; therefore, bronchoscopic laser resection was applied first to optain the airway passage for endotracheal intubation, followed by a successful open surgical resection.

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High-pressure Injection Injuries in the Hand (수부의 고압 분사 손상)

  • Kim, Seong-Ki;Roh, Si-Gyun;Lee, Nae-Ho;Yang, Kyung-Moo
    • Archives of Plastic Surgery
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    • v.37 no.3
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    • pp.245-249
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    • 2010
  • Purpose: High-pressure injection injury is caused by accidental injection of the high-pressure injection devices in industry. The initial benign appearance of the wound fools patients into delays in an adequate treatment. And it can result in disastrous outcomes such as necrosis and amputation. To avoid the poor prognosis, the injuries require a prompt surgical intervention. The purpose of this article is to recognize the poor outcome of the highpressure injection injury and to introduce an adequate treatment in need. Methods: We have 4 cases of the high-pressure injection injuries in the hand from April, 2005 to March, 2009. Average age is 39 years (30 - 49 years old), 2 cases are the palm of dominant hand, 1 case is the thumb of dominant hand, and 1 case is the palm of non-dominant hand, respectively. We followed up these patients for 20 months on average. In 3 cases, the immediate, aggressive surgical intervention was carried out, but the other one was delayed in early adequate treatment. The wounds were covered by local advancement flap, anterolateral thigh free flap, conservative treatment with antibiotics and dressing. Results: No pathogens after culture were found nor any findings of fracture in imaging study. Conservative treatment, local advancement flap and anterolateral thigh free flap for the open wound resulted in a desirable aesthetic outcome. In a long-term follow up, functional capability of the patient was also satisfactory. Conclusion: Upon initial evaluation, most high-pressure injection injuries present as innocuous wounds with very few symptoms and result in delaying the proper management. And the majority of high-pressure injection injuries will produce significant morbidity to the hand, amputation. And the initial aggressive surgical debridement was needed to prevent the poor outcome. The key to success in treating high-pressure injection injuries of the hand is the prompt aggressive surgical intervention.

ERUPTION AND AUTOTRANSPLANTATION OF A PERMANENT TOOTH RELATED TO DENTIGEROUS CYST IN MIXED DENTITION (혼합치열기의 함치성 낭종 치료 시 영구치의 맹출과 자가치아이식)

  • Choi, Ji-Wook;Choi, Jong-Myung;Cha, In-Ho;Kim, Hyung-Jun
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.35 no.6
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    • pp.462-466
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    • 2009
  • Purpose: Dentigerous cyst is the most common intra-osseous lesion of the jaw. Dentigerous cysts can cause delays in eruption of the affected permanent tooth in mixed dentition. It has been suggested that the affected permanent tooth could be erupted spontaneously after the dentigerous cyst was enucleated. But in some cases, orthodontic treatment or autotransplantation technique is known to be required. This study reviews previously performed prognoses of affected permanent teeth, which will lead to a more efficient treatment plan. Patients and Methods: With 28 patients who have undergone cyst enucleation and 10 patients who have undergone autotransplantation, the prognosis of permanent teeth was observed. Results: After cyst enucleation, spontaneous eruption of a permanent tooth was observed in 56.3% patients, orthodontic treatment was performed in 25% patients. The success rate of autotransplantation was 60.0%. Discussion: The first choice for treatment of dentigerous cyst in mixed dentition is to guide spontaneous eruption of permanent teeth. For cases without enough eruption space, the orthodontic treatment should be considered. Autotransplantation should be considered when the spontaneous eruption is not expected. It should be considered that the rate of successful autotransplantation is decreased on maxilla anterior area.

Effects of Green Chopping on Grain Yield of Naked and Malting Barleys in Cheju (제주지방에서 쌀보리와 맥주보리의 청예 및 종실 겸용재배 연구)

  • 강영길
    • KOREAN JOURNAL OF CROP SCIENCE
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    • v.34 no.4
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    • pp.408-421
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    • 1989
  • The effects of seeding and clipping termination dates, and seeding and fertilizer rates on forage and grain yields were evaluated in 1989 harvest year for dual production of forage and grain of naked and malting barleys in Cheju province. In the experiment I, 'Saessalbori' (naked barleY)1 and 'Doosan 22' (malting barley) were seeded on Sept. 21, Oct. 12 and Nov. 2, respectively. An unclipped(grain-only) treatment that was planted on Nov. 2 was included for check. In the experiment II, the two above cultivars were planted at seed rate of 14, 20 and 26 and kg/l0a. Fertilizer rates were 9-6-12, 17-13-8 and 22-16-11 (N-P$_2$O$\sub$5/-K$_2$O) kg/l0a. Seeding dates were Oct. 13 and Nov. 7 for clipped treatments and grain -only treatment(seeding rate: 14kg/l0a, N-P$_2$O$\sub$5/-K$_2$O=9-6-12 kg/l0a), respectively. All treatments in both experiments were harvested for grain yield. In Saessalbori, survival following forage removal was 100% regardless of seeding and clipping termination dates, and seeding and fertilizer rates. In Doosan 22, survival percenage decreased with increasing seeding and fertilizer rates when plants was clipped in January to Febuary. Forage yield of two cultivars increased with early planting and delays in clipping termination and tended to increase as seeding and fertilizer rates were increased. Crude ash and fat were not affected by seeding and fertilizer rates, and clipping date. Crude protein increased with an increase in fertilizer rate and decreased with delays in clipping date. N free extract tended to increase with delaying clipping date and decreased with increasing fertilizer rate. Earlier planting resulted in earlier heading and maturity. Clipping slightly delayed heading of Saessalbori and greatly delayed that of Doosan 22. Maturity of Doosan 22 was delayed 3 to 5 days by increased fertilization. Clipping shortened culm length more severely in Doosan 22 than in Saessalbori. The later the clipping termination, the shorter the culm length. The number of spikes per m$^2$ and the number of kernels per spike were not affected by clipping in Saessalbori while those of Doosan 22 were decreased with delays in clipping termination. Delaying forage harvest resulted In a reduction in grain yield. However, final clipping on Feb. 27 reduced grain yield of Saessalbori by only 6-11 % compared to the grain-only treatment. In Doosan 22, forage harvest after Dec. 28 resulted in 6 to 66% reduction of grain yield. The data indicate that grazing of naked and malting barleys until late Feb. and late Dec., respectively, might not reduce grain yields when planted on mid-Sept. to mid-Oct.

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Successful switching from insulin to sulfonylurea in a 3-month-old infant with diabetes due to p.G53D mutation in KCNJ11

  • Yoon, Jong Seo;Park, Kyu Jung;Sohn, Young Bae;Lee, Hae Sang;Hwang, Jin Soon
    • Annals of Pediatric Endocrinology and Metabolism
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    • v.23 no.3
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    • pp.154-157
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    • 2018
  • Permanent neonatal diabetes mellitus is most commonly caused by mutations in the ATP-sensitive potassium channel ($K_{ATP}$) subunits. Prompt initiation of sulfonylurea treatment can improve glycemic control in children with KCNJ11 mutation. In this report, we present a case of permanent neonatal diabetes caused by a mutation in the KCNJ11 gene that was successfully treated via early switching of insulin to sulfonylurea treatment. A 53-day-old female infant presented with diabetic ketoacidosis. Insulin was administered for the ketoacidosis and blood glucose regulation. At 3 months of age, using genomic DNA extracted from peripheral lymphocytes, direct sequencing of KCNJ11 identified a heterozygous mutation of c.158G>A (p.G53D) and confirmed the diagnosis of permanent neonatal diabetes mellitus. Subsequently, treatment with sulfonylurea was initiated, and the insulin dose was gradually tapered. At 4 months of age, insulin therapy was discontinued, and sulfonylurea (glimepiride, 0.75 mg/kg) was administered alone. At 6 months after initiation of administration of sulfonylurea monotherapy, blood glucose control was stable, and no hypoglycemic events or developmental delays were reported. C-peptide levels increased during treatment with sulfonylurea. Early switching to sulfonylurea in infants with permanent diabetes mellitus owing to a KCNJ11 mutation could successfully help regulate glycemic control, which suggests the need for early genetic testing in patients presenting with diabetes before 6 months of age.

Estimating willingness-to-pay for Kremezin in delaying the initiation of dialysis treatments among patients with chronic renal failure (크레메진의 만성신부전증 환자 투석도입 지연효과에 대한 최대지불의사액(willingness-to-pay) 추청)

  • Lee Sun-Mi;Mun Youn-Ok;Cho Woo-Hyun;Lee Hoo-Yeon;Kang Hye-Young
    • Health Policy and Management
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    • v.16 no.2
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    • pp.96-116
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    • 2006
  • To assess the economic value of pharmaceutical therapy with Kremezin, we investigated the maximum amount of willingness-to-pay (WTP) of patients with chronic renal failure (CRF) for a hypothetical effect of Kremezin in delaying the initiation of dialysis treatments. A face-to-face survey was carried out in a sample of 141 CRF patients from 2 dialysis centers, composed of 82 hemodialysis patients, 38 peritoneal dialysis patients, and 21 non-dialysis CRF patients. Using a bidding game method with a starting point of 320,000 Won, which is the average monthly out-of-pocket payment for dialysis treatment, we asked the study subjects how much they would pay per month to receive Kremezin therapy. The mean out-of-pocket monthly WTP for Kremezin was 310,000, 430,000, and 520,000 Won (p<0.05, repeated one-way ANOVA)) when Kremezin delays the initiation of dialysis treatments by 1, 2, and 4 years. Significant correlation between the respondent's WTP and income $(r=0.266{\sim}0.368,\;p<0.05)$ confirmed the construct validity of the WTP instrument. Regression results showed that patients with a higher education, with diabetes as a major causes of CRF, and undergoing hemodialysis treatments tended to express higher WTP for Kremezin. The economic value of WTP from the perspective of patients varied from 310,000 to 520,000 Won depending on the effect size of Kremezin. The mean WTP was higher than 32,000 Won, only when the hypothetical effect of Kremezin in delaying the initiation of dialysis is for 2 years. This implies that Kremezin might be the preferred choice of therapy by CRF patients if it delays the initiation of dialysis treatment for at least 2 years.

Common features of atopic dermatitis with hypoproteinemia

  • Jo, So Yoon;Lee, Chan-Ho;Jung, Woo-Jin;Kim, Sung-Won;Hwang, Yoon-Ha
    • Clinical and Experimental Pediatrics
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    • v.61 no.11
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    • pp.348-354
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    • 2018
  • Purpose: The purpose of this study was to identify the causes, symptoms, and complications of hypoproteinemia to prevent hypoproteinemia and provide appropriate treatment to children with atopic dermatitis. Methods: Children diagnosed with atopic dermatitis with hypoproteinemia and/or hypoalbuminemia were retrospectively reviewed. The patients' medical records, including family history, weight, symptoms, treatment, complications, and laboratory test results for allergies and skin cultures, were examined. Results: Twenty-six patients (24 boys) were enrolled. Seven cases had growth retardation; 7, keratoconjunctivitis; 6, aural discharges; 5, eczema herpeticum; 4, gastrointestinal tract symptoms; and 2, developmental delays. In 21 cases, topical steroids were not used. According to the blood test results, the median values of each parameter were elevated: total IgE, 1,864 U/mL; egg white-specific IgE, $76.5kU_A/L$; milk IgE, $20.5kU_A/L$; peanut IgE, $30kU_A/L$; eosinophil count, $5,810/{\mu}L$; eosinophil cationic protein, $93.45{\mu}g/L$; and platelet count, $666.5{\times}10^3/{\mu}L$. Serum albumin and total protein levels decreased to 2.7 g/dL and 4.25 g/dL, respectively. Regarding electrolyte abnormality, 10 patients had hyponatremia, and 12, hyperkalemia. Systemic antibiotics were used to treat all cases, and an antiviral agent was used in 12 patients. Electrolyte correction was performed in 8 patients. Conclusion: Hypoproteinemia accompanying atopic dermatitis is common in infants younger than 1 year and may occur because of topical steroid treatment continuously being declined or because of eczema herpeticum. It may be accompanied by growth retardation, keratoconjunctivitis, aural discharge, and eczema herpeticum and can be managed through skin care and topical steroid application without intravenous albumin infusion.