• Journal of The Korean Society of Clinical Toxicology
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• v.13 no.2
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• pp.71-77
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• 2015

Purpose: Acute endosulfan poisoning is rare but causes significant morbidity and mortality. The aim of our study is to describe complications and features of seizure and determine factors associated with mortality in acute endosulfan poisoning. Methods: Twenty-eight adult patients with acute endosulfan poisoning admitted to our emergency department during a 15-year period were studied retrospectively. The clinical features of seizure, use of antiepileptic drugs during seizure, and hospital courses were evaluated. Clinical factors between survived group and non-survived group were compared for identification of factors associated with mortality. Results: Of the 28 patients with endosulfan poisoning, 4 patients (14.3%) died and 15 (53.6%) patients developed generalized tonic-clonic seizure. Thirteen patients (46.4%) and 5 patients (17.9%) progressed to status epilepticus (SE) and refractory status epilepticus (RSE), respectively. SE and RSE were associated with mortality. Almost all significant complications including shock, acute renal failure, hepatic toxicity, rhabdomyolysis, and cardiac injury developed in SE and RSE patients. Conclusion: SE and RSE were important contributors to death in endosulfan poisoning. Emergency physicians treating endosulfan poisoning should make an effort not to progress seizure following endosulfan poisoning to SE and RSE using a rapid and aggressive antiepileptic drug.

• Biomolecules & Therapeutics
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• v.24 no.2
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• pp.171-177
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• 2016

Statins, HMG-CoA reductase inhibitors, are known to cause serious muscle injuries (e.g. myopathy, myositis and rhabdomyolysis), and these adverse effects can be rescued by co-administration of coenzyme $Q_{10}$ ($CoQ_{10}$) with statins. The goal of the current research is to assess the efficacy of combined treatment of $CoQ_{10}$ with Atorvastatin for hyperlipidemia induced by high-fat diet in SD rats. 4-week-old Sprague-Dawley male rats were fed normal diet or high-fat diet for 6 weeks. Then, rats were treated with either Statin or Statin with various dosages of $CoQ_{10}$ (30, 90 or 270 mg/kg/day, p.o.) for another 6 weeks. Compared to Statin only treatment, $CoQ_{10}$ supplementation significantly reduced creatine kinase and aspartate aminotransferase levels in serum which are markers for myopathy. Moreover, $CoQ_{10}$ supplementation with Statin further reduced total fat, triglycerides, total cholesterol, and low-density lipoprotein-cholesterol. In contrast, the levels of high-density lipoprotein-cholesterol and $CoQ_{10}$ were increased in the $CoQ_{10}$ co-treated group. These results indicate that $CoQ_{10}$ treatment not only reduces the side effects of Statin, but also has an anti-obesity effect. Therefore an intake of supplementary $CoQ_{10}$ is helpful for solving problem of obese metabolism, so the multiple prescription of $CoQ_{10}$ makes us think a possibility that can be solved in being contiguous to the obesity problem, a sort of disease of the obese metabolism.

• Journal of The Korean Society of Clinical Toxicology
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• v.3 no.1
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• pp.27-32
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• 2005

Purpose: The frequency of carbon monoxide poisoning has been decreased in the interior of the Korea. But occasionally it is occurred and the risk of exposure is high in working place so far. Because of the characteristics of gas, the detection of exposure and poisoning could be delayed and fatality is high. We should apprehend of carbon monoxide poisoning. So we would report analysis of patients with carbon monoxide poisoning. Methods: A retrospective review of CO poisoned patients visited emergency department from January 2000 to December 2004 was conducted. Results: 24 patients were enrolled. Their average of age was $37.6\pm20.9$ years old and COHb was $19.4\pm13.32\%$. The blood level of initial COHb and mental status on arrival were not correlated each other. The blood level of initial COHb and loss of consciousness were not correlated, too. Initial electrocardiography (EKG) was not correlated with cardiac enzymes such as CK-MB and troponin I. But base excess was correlated with mental status on arrival and complication such as rhabdomyolysis. Hyperbaric oxygen therapy was correlated with base excess and mental status on arrival. Conclusion: The clinical features of carbon monoxide poisoning are nonspecific. For proper diagnosis, it is important that we should consider patient's environment and take patient's history carefully. The blood level of initial COHb does not reflect severity of poisoning accurately. So We should determine the treatment of choice depending on patient's status.

• Journal of The Korean Society of Clinical Toxicology
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• v.4 no.1
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• pp.69-72
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• 2006

Dicamba is a benzoic acid and classified as a chemically related chlorophenoxy herbicide which is widely used for the control of broad-leaved weeds. While the chlorophenoxy herbicide poisoning is known to be uncommon, its ingestion can result in serious or sometimes fatal outcome. A 65-year-old man ingested about 300 ml of dicamba in a suicidal attempt and three hours later he was admitted hospital, complaining abdominal pain, nausea and vomiting. On admission his vital signs were normal and laboratory findings were not remarkable except metabolic acidosis in arterial blood gas analysis. Shortly after the admission endotracheal tube was inserted due to altered mental state and activated charcoal was given after performing gastric lavage. However, his vital signs became unstable 6hrs after the ingestion and mechanical ventilation was started with administration of inotropic agents. In spite of urine alkalization for rapid elimination of the absorbed dicamba, the metabolic acidosis was aggravated with concomitant rhabdomyolysis and acute renal failure, and he died 24 hrs after the ingestion.

• Journal of Trauma and Injury
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• v.30 no.3
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• pp.80-86
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• 2017

Purpose: To analyze the data of patients who suffered trauma in a cultivator accident and visited the trauma center in rural Gyeongbuk Province. Methods: We retrospectively reviewed the medical records and Korean Trauma Data Bank data of 120 patients who suffered cultivator-related traumas and visited the rural regional trauma center in Gyeongbuk Province from January to December 2015. Results: The age of the patients ranged from 35 to 96 years (mean, 70 years). Ninety-one (75.8%) patients were men, and twenty-nine (24.2%) were women. Most of the patients were in their 70s (46 men [50.5%] and 13 women [44.8%]). In total, 113 patients (94.1%) arrived at the regional trauma center by ground transport and 7 (5.9%) arrived by air transport. Ninety-eight patients (81.7%) were transported to the regional trauma center directly from the scene of the accident, and twenty-two (18.3%) were transferred from another medical institute. The mean time from the accident to arrival at the emergency department was 139 minutes, and only 46 patients (38.3%) arrived within 1 hour. Twelve (10.0%) patients died, including two deaths on arrival and two post- cardiopulmonary resuscitation deaths in the emergency department. All deaths were of male cultivator operators. The causes of death were shock (hypovolemic, traumatic, or septic), subdural hematoma (open), hemothorax, rhabdomyolysis, and pneumonia. Conclusions: As the government - led regional trauma center project is on process, it would be clinically important to summarize the initial outcome of cultivator injuries, which are characteristically found more in regional trauma centers in the rural area, and have high mortality. Based on this study, in the future, it will be necessary to follow up and analyze more number of patients and to construct accurate database about trauma cases related to cultivator in Gyeongbuk region.

• Journal of The Korean Society of Clinical Toxicology
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• v.7 no.2
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• pp.105-112
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• 2009

Purpose: There have been local wound complications in patients who have received first aid after venomous snake bites. Yet first aid in relation to local wound complications has not been well studied. Methods: We conducted a 5-year retrospective study of 111 snake bite patients who visited the emergency departments of several medical centers between January 2004 and December 2008. We categorized the patients into those who had complications with inadequate first aid, those who had complications without first aid those who had complications with adequate first aid. We compared the genera characteristics and the laboratory and clinical findings of the three groups. Results: The ale o female ratio was 1.36. The most common bite site was fingers. The most common systemic symptom was dizziness (6.3%) and the most common complication was rhabdomyolysis (23.4%). The inadequate first aids group had more local complications (cellulitis, skin necrosis) than did the group with adequate first aid or the group with no first aids. Conclusion: Inadequate first aid after snake bite leads to local complications, so we must be careful to administer first aid after snake bite and evaluate this first aid in elation to local complications.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.22 no.3
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• pp.330-336
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• 2000

A large number of streptococci that do not fit readily into any of the established classification schemes have been relegated to a large heterogeneous group called the Streptococcus viridans, which are members of the normal flora of the mucous membranes of the body, including the oral cavity, the nasopharynx, and genitourinary tract. This group includes S. mitis, S. oralis, S. sanguis, S. salivarius, S. milleri, etc. Surveying on the literature, it has been reported that infective endocarditis, meningitis, rhabdomyolysis, cholangitis, appendicitis caused by Streptococcus viridans, which were the most important pathogen in children with malignant hematologic disease. Various antibiotics has been chosen for treatment or prophylaxis for these infections, but were generally lower antimicrobial susceptibilities because of an abuse of antibiotics and advent of resistant group. Therefore, surveillant culture must be performed to evaluate personal antimicrobial susceptibilities of intraoral microbes for proper antimicrobial choice for dental procedures. This study examined sampling from subgingival plaque of 60 chidren's microbes. The cultured bacterial isolates, Streptococcus viridans were examined 10 antimicrobial drugs with the Kirby-Bauer agar disk diffusion method. The used drugs were Penicillin, Ampicillin, Oxacillin, Cephalothin, Imipenem, Gentamicin, Erythromycin, Vancomycin, Ciprofloxacin, Clindamycin. The results were as follows : 1. Sampling Streptococcus viridans were S. mitis(65%), S. oralis(22%), S. sanguis(5%), S. intermedius(3%), S. salivarius(2%), S acidominimus(2%), Unidentified streptococcus(2%). 2. The antimicrobial susceptibility of total Streptococcus viridans : Oxacillin< Erythromycin< Pencillin=Ciprofloxacin< Cephalothin< Ampicillin< Clindamycin< Gentamicin< Imipenem=Vancomycin. 3. The antimicrobial susceptibility of S. mitis : Oxacillin=Erythromycin< Ciprofloxacin< Cephalothin< Penicillin=Ampicillin< Gentamicin< Clidamycin< Imipenem=Vancomycin. 4. The antimicrobial susceptibility of S. oralis : Oxacillin< Erythromycin< Penicillin=Ciprofloxacin=Clindamycin< Cephalothin=Gentamicin< Ampicillin< Imipenem=Vancomycin. 5. There was no significant difference in the antimicrobial susceptibility among each Streptococcus viridans group.

• Journal of The Korean Society of Clinical Toxicology
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• v.7 no.1
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• pp.10-18
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• 2009

Purpose: Carbon Monoxide Poisoning is an important medical emergency in Korea, but the factors leading to its serious manifestation are not well studied. Methods: We conducted a 5-year retrospective study of 98 carbon monoxide poisoned patients who visited the emergency departments of the Medical Center between December 2004 and March 2009. We categorized the patients into those exhibiting only local symptoms (group 1) and those showing systemic symptoms and complications (group 2). We compared the general characteristics as well as the clinical and laboratory findings between both groups. Results: The male to female ratio was 1.18. The most common systemic symptom was a mental change (43.9%), while the most common complication was rhabdomyolysis (31.6%). Poisoned area closed private room in group 2 were 23 (41.8%) cases and burning region in group 2 were 16(29.1%) cases (p=0.956). Individuals who were accidentally poisoned comprised of 43 (78.2%) cases while those that attempted suicidal poisoning comprised 12 (21.8%) cases (p=0.016). The most common symptom at arrival was mental change 33 (60.0%) cases in group 2. The mean time exposed to carbon monoxide was 43$\pm$3.97 hours in group 1 and 55$\pm$10.11 in group 2 (p=0.012). The patient's age, context of poisoning, symptom at arrival, and time exposed to the poison were found to be significant risk factors for complications by logistic regression analysis. Conclusion: Carbon monoxide poisoning is an emergency medical condition and the risk factors involved in the development of serious complications must be evaluated.

• Journal of The Korean Society of Clinical Toxicology
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• v.8 no.2
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• pp.122-124
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• 2010

$Basagran^{(R)}$ is a herbicide that is widely used in the field and it acts by interfering with photosynthesis in plants. It consists of bentazone, 2-methyl-4-chlorophenoxyacetic acid (MCPA) and surfactants. Bentazone is commonly used, but poisoning due to Bentazone has not been previously reported in Korea. The patients with toxic effects of bentazone show mild to severe symptoms and various complications. We report here on a case of a woman who intentionally ingested 500 ml of $Basagran^{(R)}$ and she was discharged without complication. As soon as the patient visited the emergency department, we started to treat her as if she had organophosphate intoxication because of the cholinergic symptoms. We could not detect the bentazone in her serum and urine, and we could confirm $Basagran^{(R)}$ ingestion only after getting information from her husband. Bentazone poisoning may induce harmful complications like muscle rigidity, rhabdomyolysis, respiratory failure and cardiac arrest. A detailed history taking, an accurate analysis method and early conservative management will be helpful for patients with acute bentazone poisoning.

• Journal of The Korean Society of Clinical Toxicology
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• v.8 no.2
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• pp.79-87
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• 2010

Purpose: The previous studies on $H_1$ antihistamine overdose have generally been limited to cases of acute doxylamine succinate (DS) poisoning, yet there have been some studies on diphenhydramine (DPH) overdosing. But many clinicians consider the two drugs to be very similar and to have similar ingredients. The purpose of this study was to clarify the toxicologic characteristics and clinical outcomes between DS and DPH poisoning/overdose. Methods: We reviewed the medical and intensive care records of the patients with acute DS or DPH poisoning and who admitted to our emergency department from January 2008 and April 2010. We collected patient information regarding the features of the poisoning and the clinical and demographic characteristics. The patients were assessed for the clinical outcomes, the GCS, the PSS (Poisoning Severity Score) and the SOFA (Sequential Organ Failure Assessment). Results: Fifty seven patients (45 cases of DS poisoning and 12 cases of DPH poisoning) were enrolled. Compared with the DS group, the DPH group had higher incidences of intubation, serious mental change, QTc prolongation and ECG conduction abnormality (p=0.041, <0.001, 0.014 and 0.044, respectively). The DPH group had a higher PSS and a longer ICU stay. The peak CPK time and the CPK normalization time were longer for the patients with rhabdomyolysis due to DS poisoning. Conclusion: Two common $H_1$ antihistamines, doxylamine and diphenhydramine, are in the same ethanolamine-structural class, but the toxico-clinical outcomes are different according to many aspects. Therefore, clinicians could take a careful approach for the differential diagnosis and management between DS and DPH poisoning.