• Annals of Clinical Neurophysiology
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• 제20권1호
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• pp.41-43
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• 2018

ntermediate syndrome (IMS) typically occurs at 24-96 hours following organophosphate (OP) poisoning, after an acute cholinergic crisis, but before OP-induced delayed polyneuropathy. It is characterized by proximal muscle weakness and respiratory insufficiency, which is a major contributing factor of OP-related morbidity and mortality. We report an atypical IMS case showing rapid-onset ascending paralysis and respiratory disturbance with an acute cholinergic crisis occurring 4-5 days after skin exposure to OP.

• 대한수의학회지
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• 제61권2호
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• pp.15.1-15.5
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• 2021

A three-month-old, intact male Maltese dog was presented to the hospital with lethargy after taking a human medication, Motilitone. Physical examination, including a neurological examination, revealed no remarkable findings, but cholinergic crisis symptoms appeared gradually. Blood and radiological examinations showed no remarkable findings. The dog was tentatively diagnosed with a cholinergic crisis associated with Motilitone intake. Treatment included intravenous administration of atropine (0.02 mg/kg) every 30 minutes and supportive fluid therapy. After 12 hours of treatment, the patient's clinical signs were resolved. This is the first case report describing Motilitone toxicity in a dog.

• Tuberculosis and Respiratory Diseases
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• 제47권2호
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• pp.247-254
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• 1999

급성 유기인제 중독에서의 주사망 원인인 호흡부전은 급성 콜린성 위기시에 발생하지만 콜린성 위기에서 회복된 후 콜린양 증상의 동반없이 24-96시간에 근위부 사지근육, 경부굴근 및 운동뇌신경 분포근육의 무력증과 함께 호흡부전이 발생하기도 한다. 이를 IMS이라 하며 조기에 인지하고 적절히 치료하지 못했을 때 호흡근 마비로 사망 할 수 있어 모든 유기인제 중독환자를 최소 5일 이상 병원내에서 무호흡보조 치료에 대한 준비상태를 갖추고 근접관찰 하여야 한다. 저자들은 유기인제 중독에서 콜린성 위기 회복후 호흡부전을 유발한 IMS 2 례를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• 대한임상독성학회지
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• 제11권1호
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• pp.31-35
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• 2013

Acute organophosphate intoxication is important because of its high morbidity and mortality. The mortality is still high despite the use of atropine as specific antidotal therapy and oximes for reactivation of acetylcholinesterase. Inhibition of acetylcholinesterase by organophosphate can cause acute parasympathetic system dysfunction, muscle weakness, seizure, coma, and respiratory failure. Acute alteration in conscious state or a coma, which may occur following organophosphate intoxication, is an indication of severe intoxication and poorer prognosis. This acute decline in conscious state often reverses when the cholinergic crisis settles; however, it may be prolonged in some patients. We report on a case of a 60-year-old male who showed prolonged decline in conscious state due to of Central Nervous System (CNS) toxicity after a suicide attempt with organophosphate.

• Journal of Chest Surgery
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• 제20권1호
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• pp.112-127
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• 1987

Myasthenia gravis is a neuromuscular transmission function disorder characterized by fatigue and weakness of voluntary muscles. This muscular weakness is intensified by activity and stress, and improved by the use of anticholinesterase compounds. It was initially described by Erb in 1879 and later named myasthenia gravis by Jolly in 1895. Although the pathogenesis is Known to be an autoimmune related reduction in the number of available acetylcholine receptors at neuromuscular junctions, the role of thymus in myasthenia gravis is still unclear and under investigation. Thymectomy in the management of myasthenia gravis has become increasingly important since Dr. Blalock observed in 1939 that some patients with thymic tumors and myasthenia gravis improved following thymectomy. A clinical study of 102 cases of myasthenia gravis was performed at Yonsei University College of Medicine. Seoul, Korea from Jan. 1976 to Jun. 1986. In order to determine which factors are of prognostic significance, attention is focused upon pre-operative patient evaluation, problems in operative and post-operative care, and long-term follow-up observations. The results were as follows: 1. The sex distribution was 67 females and 35 males, the mean age of onset was 28.95*1.69 years, and the maximal incidence occurred between 21 and 40 years of age [56 cases: 54.9%]. 2. Clinical manifestations of ocular symptoms were seen to 70 patients [68.6%] extremities weakness in 33 [32.3%], bulbar weakness in 29 [28.4%], and dyspnea in 13 [12.7%]. 3. Study cases more than two thirds were classified as mild types [MG 1 and MG 11A] and 6 cases as grave [MG 1V] based on the modified Osserman`s classification system, 4. Thymectomy was performed in 19 cases which presented in severe myasthenia symptoms and showed no improvement with cholinergic drugs. Histologic examination of the excised thymus glands revealed no abnormalities in 4 cases, thymic hyperplasia in 5, benign thymoma in 5, and malignant thymoma in 5. 5. Immediate post-operative complications included 2 cases of pneumothorax which were treated by tube thoracostomies, there was no operative mortality. 6. The response to cholinergic drugs in 36 cases younger than 20 years old and in 27 cases older than 40 years was relatively poor, while that in 35 cases between the ages of 21 and 40 years old was good. 7. Thirty of 39 cases in groups IIB, III & IV improved markedly with medical or surgical management while only 16 of 59 cases in the mild groups [I and IIA] improved, almost all surgical cases improved in all categories. 8. There were 5 deaths. occurring between 7 months and 3 years 3 months of treatment of myasthenia gravis. The causes of death were myasthenic crisis in 2 cases, respiratory failure due to candidiasis & radiation pneumonitis in one case, cerebral hemorrhage due to high blood pressure in two case.