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Juvenile xanthogranuloma (JXG) is a histiocytic proliferative tumor that predominantly affects infants and young children. It is classified as a benign disease that comprises the majority of non-Langerhans cell histiocytes and is characterized by reddish-brown or yellow papules and nodules commonly found on the face and trunk. Although JXG presents with distinct clinical features, an exceedingly uncommon subset of JXG includes lesions that surpass 20 mm in diameter, referred to as giant JXG, which can occasionally be misdiagnosed as other tumors. Herein, we report a rare case of a giant JXG in a 1-month-old Korean boy, highlighting the significance of accurate diagnoses. Additionally, we provide a comprehensive literature review to enhance our understanding of this rare variant.
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Erythema nodosum (EN) is the most common form of panniculitis and may be triggered by a variety of stimuli, including infections, drugs, pregnancy, sarcoidosis, inflammatory bowel disease, and malignancies. Rare cases of vaccination-related EN have been reported, but none due to the coronavirus disease 2019 (COVID-19) vaccine of Pfizer have been documented. We report a case of EN associated with the Pfizer vaccine. A 43-year-old woman presented with acute-onset painful nodular lesions that appeared bilaterally on the extensor surface of the lower legs. These lesions appeared 5 days after the first dose of Pfizer vaccination. The patient reported no recent infectious history other than fever for 3 days after vaccination. Skin biopsy revealed inflammation extending into the subcutaneous fat with a septal distribution. It is important for physicians to be aware of the side effects of the COVID-19 vaccine because more people are bound to be vaccinated.
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Background@#Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are potentially fatal acute hypersensitivity reactions that involve the skin and mucous membranes. Because they are relatively rare diseases, it is difficult to obtain well-organized epidemiological data. The clinicodemographic characteristics, culprit drugs, and factors related to disease prognosis may vary. @*Objective@#To identify the characteristics of SJS/TEN by investigating patient clinicopathological characteristics, laboratory findings, suspected drugs, and mortality through a retrospective study using medical record data. @*Methods@#The clinical records of patients diagnosed with SJS/TEN between February 2009 and February 2019 at three medical institutions of Soonchunhyang University were retrospectively reviewed. Data pertaining to sex, age, history, suspected drugs, latent period, laboratory findings, and mortality were collected, and their correlations were analyzed. @*Results@#We identified SJS/TEN in 88 patients. Among the probable causative agents, antibiotics were the most common (29 cases, 33.0%), followed by nonsteroidal anti-inflammatory drugs (NSAIDs) in 20 cases (22.7%). The period between drug administration and symptom onset varied with the causative agent. Patients who died had high SCORTEN scores. In addition, hypertension, diabetes, renal failure, and cardiac disease had a statistically significant association with high SCORTEN. @*Conclusion@#Antibiotics, NSAIDs, antiepileptics and allopurinol were the most commonly implicated drugs in our retrospective study. There was a significant correlation between comorbidities. Because SJS/TEN is a life-threatening condition, early recognition of the suspected drug are important. The results of this study may provide insights that aid in the early diagnosis and prediction of disease outcomes of SJS/TEN in the Korean population.
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Background@#Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are potentially fatal acute hypersensitivity reactions that involve the skin and mucous membranes. Because they are relatively rare diseases, it is difficult to obtain well-organized epidemiological data. The clinicodemographic characteristics, culprit drugs, and factors related to disease prognosis may vary. @*Objective@#To identify the characteristics of SJS/TEN by investigating patient clinicopathological characteristics, laboratory findings, suspected drugs, and mortality through a retrospective study using medical record data. @*Methods@#The clinical records of patients diagnosed with SJS/TEN between February 2009 and February 2019 at three medical institutions of Soonchunhyang University were retrospectively reviewed. Data pertaining to sex, age, history, suspected drugs, latent period, laboratory findings, and mortality were collected, and their correlations were analyzed. @*Results@#We identified SJS/TEN in 88 patients. Among the probable causative agents, antibiotics were the most common (29 cases, 33.0%), followed by nonsteroidal anti-inflammatory drugs (NSAIDs) in 20 cases (22.7%). The period between drug administration and symptom onset varied with the causative agent. Patients who died had high SCORTEN scores. In addition, hypertension, diabetes, renal failure, and cardiac disease had a statistically significant association with high SCORTEN. @*Conclusion@#Antibiotics, NSAIDs, antiepileptics and allopurinol were the most commonly implicated drugs in our retrospective study. There was a significant correlation between comorbidities. Because SJS/TEN is a life-threatening condition, early recognition of the suspected drug are important. The results of this study may provide insights that aid in the early diagnosis and prediction of disease outcomes of SJS/TEN in the Korean population.
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BACKGROUND: Lumbosacral transforaminal epidural injection (TFEI) is an effective treatment for spinal disease. However, TFEI may have several types of complications, some of which can be attributed to intravascular injection. We reviewed studies to compare the intravascular injection rate among different needle types. METHODS: We searched the literature for articles on the intravascular injection rate among different needle types used in TFEI. The search was performed using PubMed, MEDLINE, the Cochrane Library, EMBASE, and Web of Science. RESULTS: A total of six studies comprising 2359 patients were identified. Compared with the Quincke needle, the Whitacre needle reduced the intravascular injection rate (OR = 0.57, 95% CI = [0.44–0.73], P < 0.001). However, compared with the Quincke needle, the Chiba needle did not reduce the intravascular injection rate (OR = 0.80, 95% CI = [0.44–1.45], P = 0.46). In one study, the intravascular injection rate using a blunt-tip needle was lower than that using a sharp needle. In another study, the Whitacre and the blunt-tip needle have similar intravascular injection rates, while, the catheter-extension needle showed a reduced intravascular injection rate. CONCLUSIONS: This meta-analysis showed that the Whitacre needle reduced the intravascular injection rate as compared with the Quincke needle, but failed to establish that the Chiba needle can decrease the intravascular injection rate in TFEI. Moreover, the blunt-tip needle can reduce the intravascular injection rate compared with the Quincke needle, and the catheter-extension needle can reduce the intravascular injection rate compared with the Whitacre and the blunt-tip needle.
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Humanos , Anestesia Epidural , Inyecciones Epidurales , Agujas , Enfermedades de la Columna VertebralRESUMEN
Emerging evidence has emphasized the importance of cancer therapies targeting an abnormal metabolic state of tumor-initiating cells (TICs) in which they retain stem cell-like phenotypes and nicotinamide adenine dinucleotide (NAD⁺) metabolism. However, the functional role of NAD⁺ metabolism in regulating the characteristics of TICs is not known. In this study, we provide evidence that the mitochondrial NAD⁺ levels affect the characteristics of glioma-driven SSEA1⁺ TICs, including clonogenic growth potential. An increase in the mitochondrial NAD⁺ levels by the overexpression of the mitochondrial enzyme nicotinamide nucleotide transhydrogenase (NNT) significantly suppressed the sphere-forming ability and induced differentiation of TICs, suggesting a loss of the characteristics of TICs. In addition, increased SIRT3 activity and reduced lactate production, which are mainly observed in healthy and young cells, appeared following NNT-overexpressed TICs. Moreover, in vivo tumorigenic potential was substantially abolished by NNT overexpression. Conversely, the short interfering RNA-mediated knockdown of NNT facilitated the maintenance of TIC characteristics, as evidenced by the increased numbers of large tumor spheres and in vivo tumorigenic potential. Our results demonstrated that targeting the maintenance of healthy mitochondria with increased mitochondrial NAD⁺ levels and SIRT3 activity could be a promising strategy for abolishing the development of TICs as a new therapeutic approach to treating aging-associated tumors.
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Glioblastoma , Ácido Láctico , Metabolismo , Mitocondrias , NAD , NADP Transhidrogenasas , Fenotipo , Tics , Regulación hacia ArribaRESUMEN
BACKGROUND: Spinal pain is most common symptom in pain clinic. In most cases, before the treatment of spinal pain, physician explains the patient's disease and treatment. We investigated patient's satisfaction and physician's explanation related to treatments in spinal pain patients by questionnaires. METHODS: Anonymous questionnaires about physician's explanation and patient's satisfaction in each treatment and post-treatment management were asked to individuals suffering from spinal pain. Patients who have spinal pain were participated in our survey of nationwide university hospitals in Korea. The relationships between patient's satisfaction and other factors were analyzed. RESULTS: Between June 2016 and August 2016, 1007 patients in 37 university hospitals completed the questionnaire. In the statistical analysis, patient's satisfaction of treatment increased when pain severity was low or received sufficient preceding explanation about nerve block and medication (P < 0.01). Sufficient explanation increased patient's necessity of a post-treatment management and patients' performance rate of post-treatment management (P < 0.01). CONCLUSIONS: These results show that sufficient explanation increased patients' satisfaction after nerve block and medication. Sufficient explanation also increased the practice of patients' post-treatment management.
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Humanos , Anónimos y Seudónimos , Hospitales Universitarios , Corea (Geográfico) , Bloqueo Nervioso , Clínicas de Dolor , Satisfacción del PacienteRESUMEN
BACKGROUND/AIMS: Controversy still exists regarding the benefits of covered self-expandable metal stents (SEMSs) compared to uncovered SEMSs. We aimed to compare the patency and stent-related adverse events of partially covered SEMSs (PC-SEMSs) and uncovered SEMSs in unresectable malignant distal biliary obstruction. METHODS: A total of 134 patients who received a PC-SEMS or uncovered SEMS for palliation of unresectable malignant distal biliary obstruction were reviewed retrospectively. The main outcome measures were stent patency, stent-related adverse events, and overall survival. RESULTS: The median stent patency was 118 days (range, 3 to 802 days) with PC-SEMSs and 105 days (range, 2 to 485 days) with uncovered SEMSs (p=0.718). The overall endoscopic revision rate due to stent dysfunction was 36.6% (26/71) with PC-SEMSs and 36.5% (23/63) with uncovered SEMSs (p=0.589). Tumor ingrowth was more frequent with uncovered SEMSs (4.2% vs 19.1%, p=0.013), but migration was more frequent with PC-SEMSs (11.2% vs 1.5%, p=0.04). The incidence of stent-related adverse events was 2.8% (2/71) with PC-SEMSs and 9.5% (6/63) with uncovered SEMSs (p=0.224). The median overall survival was 166 days with PC-SEMSs and 168 days with uncovered SEMSs (p=0.189). CONCLUSIONS: Compared to uncovered SEMSs, PC-SEMSs did not prolong stent patency in unresectable malignant distal biliary obstruction. Stent migration was more frequent with PC-SEMSs. However, tumor ingrowth was less frequent with PC-SEMSs compared to uncovered SEMSs.
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Humanos , Incidencia , Evaluación de Resultado en la Atención de Salud , Estudios Retrospectivos , StentsRESUMEN
BACKGROUND: The usefulness of dynamic parameters derived by heart-lung interaction for fluid responsiveness in pediatric patients has been revealed. However, the effects of peak inspiratory pressure (PIP) that could affect the absolute values and the accuracy in pediatric patients have not been well established. METHODS: Participants were 30 pediatric patients who underwent ventricular septal defect repair. After completion of surgical procedure and sternum closure, mean arterial blood pressure, heart rate, central venous pressure, cardiac output, cardiac index and stroke volume variation (SVV) were measured at PIP 10 cmH2O (PIP10), at PIP 15 cmH2O (PIP15), at PIP 20 cmH2O (PIP20) and at PIP 25 cmH2O (PIP25). RESULTS: SVV at PIP15 was larger than that at PIP10 (13.7 +/- 2.9% at PIP10 vs 14.7 +/- 2.5% at PIP15, P < 0.001) and SVV at PIP20 was larger than that at PIP10 and PIP15 (13.7 +/- 2.9% at PIP10 vs 15.4 +/- 2.5% at PIP20, P < 0.001; 14.7 +/- 2.5% at PIP15 vs 15.4 +/- 2.5% at PIP20, P < 0.001) and SVV at PIP25 was larger than that at PIP10 and PIP15 and PIP20 (13.7 +/- 2.9% at PIP10 vs 17.4 +/- 2.4% at PIP25, P < 0.001; 14.7 +/- 2.5% at PIP15 vs 17.4 +/- 2.4% at PIP25, P < 0.001; 15.4 +/- 2.5% at PIP20 vs 17.4 +/- 2.4% at PIP25, P < 0.001). CONCLUSIONS: SVV is affected by different levels of PIP in same patient and under same volume status. This finding must be taken into consideration when SVV is used to predict fluid responsiveness in mechanically ventilated pediatric patients.
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Humanos , Presión Arterial , Gasto Cardíaco , Procedimientos Quirúrgicos Cardíacos , Presión Venosa Central , Fluidoterapia , Frecuencia Cardíaca , Defectos del Tabique Interventricular , Esternón , Volumen Sistólico , Cirugía Torácica , Ventilación , Ventiladores MecánicosRESUMEN
An 86-year-old female with a history of right rotator cuff injury was admitted for arthroscopic shoulder surgery under general anesthesia. There were no remarkable immediate postoperative complications. However, while recovering in the general ward, she developed dyspnea with hypoxia. She was immediately treated with oxygen, and antibiotics after pneumomediastinum was confirmed on both chest x-ray and chest computed tomography. Subcutaneous emphysema on either face or neck followed by arthroscopic shoulder surgery was common, but pneumomediastinum with hypoxia is a rare but extremely dangerous complication. Thus we would like to report our case and its pathology, the diagnosis, the treatment and prevention, with literature review.
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Femenino , Humanos , Anestesia General , Hipoxia , Antibacterianos , Artroscopía , Disnea , Enfisema Mediastínico , Cuello , Oxígeno , Habitaciones de Pacientes , Complicaciones Posoperatorias , Manguito de los Rotadores , Hombro , Enfisema Subcutáneo , TóraxRESUMEN
Q fever is a zoonosis caused by a Coxiella burnetii. Q fever is clinically variable, presenting as asymptomatic infection, pneumonia, hepatitis and endocarditis. Treatment of acute Q fever with doxycycline is usually successful. Autoantibodies, such as anti-mitochondrial antibodies, smooth muscle antibodies (SMA), anti-cardiolipin and lupus anticoagulant, often rise in acute Q fever infection. Some cases may occasionally meet the criteria for autoimmune disease like systemic lupus erythematosus. We report a first case of Q fever that may mimic systemic lupus erythematosus in Korea.
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Anticuerpos , Infecciones Asintomáticas , Autoanticuerpos , Enfermedades Autoinmunes , Coxiella burnetii , Doxiciclina , Endocarditis , Hepatitis , Hidrazinas , Corea (Geográfico) , Inhibidor de Coagulación del Lupus , Lupus Eritematoso Sistémico , Músculo Liso , Neumonía , Fiebre QRESUMEN
Q fever is a zoonosis caused by a Coxiella burnetii. Q fever is clinically variable, presenting as asymptomatic infection, pneumonia, hepatitis and endocarditis. Treatment of acute Q fever with doxycycline is usually successful. Autoantibodies, such as anti-mitochondrial antibodies, smooth muscle antibodies (SMA), anti-cardiolipin and lupus anticoagulant, often rise in acute Q fever infection. Some cases may occasionally meet the criteria for autoimmune disease like systemic lupus erythematosus. We report a first case of Q fever that may mimic systemic lupus erythematosus in Korea.
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Anticuerpos , Infecciones Asintomáticas , Autoanticuerpos , Enfermedades Autoinmunes , Coxiella burnetii , Doxiciclina , Endocarditis , Hepatitis , Hidrazinas , Corea (Geográfico) , Inhibidor de Coagulación del Lupus , Lupus Eritematoso Sistémico , Músculo Liso , Neumonía , Fiebre QRESUMEN
Activated charcoal is an inert substance and it is used in standard therapy in patients with acute intoxication. Charcoal has some side effects such as pulmonary aspiration, gastrointestinal complications, and electrolyte abnormalities. Although aspiration of charcoal is a rare complication, it can cause fatal sequelae. We report a 69-year old man who developed acute respiratory failure associated with charcoal aspiration after management of glyphosate poisoning. The patient was drowsy and suffered severe vomiting during transport to our hospital. On arrival, acute respiratory failure was observed due to charcoal aspiration, but the clinical state was improved with repeated bronchoscopy with a bronchoalveolar lavage (BAL). We presumed that the aspirated charcoal was an important factor in evoking a lung injury. Early bronchoscopy with a BAL might be an effective method for eliminating charcoal from the lung, especially in the case of a large amount of aspiration, and be helpful in decreasing respiratory failure due to charcoal aspiration.
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Humanos , Lavado Broncoalveolar , Broncoscopía , Carbón Orgánico , Glicina , Pulmón , Lesión Pulmonar , Aspiración Respiratoria , Insuficiencia Respiratoria , VómitosRESUMEN
PURPOSE: To investigate the effect of yellow tinted intraocular lenses (IOLs), implanted in the bag after phacoemulsification, on the result of frequency doubling technique (FDT) perimetry. METHODS: For 68 eyes of 52 patients, an IOL was implanted in the bag after phacoemulsification. The patients were categorized into three groups according to the type of implanted IOLs used. IOLs were selected randomly among two types of yellow IOLs (Acrysof SN60WF IOL, Hoya YA60BBR IOL) and a clear IOL was used as a control. A FDT Humphrey matrix was performed 2 months after the surgery. The mean deviation (MD) and pattern standard deviation (PSD) among these three groups was analyzed using Mann-Whitney U-test. RESULTS: Two months after the procedure, there was no significant difference between each of the three groups: the clear IOL and Hoya YA60BBR IOL (MD, p = 0.21; PSD, p = 0.27), the clear IOL and Alcon SN60WF IOL (MD, p = 0.11; PSD, p = 0.22), and the Hoya YA60BBR IOL and Alcon SN60WF IOL (MD, p = 0.33; PSD, p = 0.56). CONCLUSIONS: When interpreting the result of the FDT after cataract surgery, the color and type of IOLs used should not be considered.
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Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Extracción de Catarata/métodos , Color , Diseño de Equipo , Implantación de Lentes Intraoculares , Lentes Intraoculares , Facoemulsificación , Periodo Posoperatorio , Estudios Prospectivos , Pruebas del Campo Visual/métodosRESUMEN
BACKGROUND: Fiberoptic bronchoscope guided intubation is an important method of difficult airway management. The use of specific airways has been devised to assist the fiberoptic intubation. The authours compared effectiveness of separated airway with fiberoptic bronchoscope guided intubation and the hemodynamic responses. METHODS: 104 adult patients of American Society of Anesthesiologists grading (ASA) I-II who scheduled for surgery under general anesthesia were randomly divided into the Laryngoscope group (L group, n = 30) or the Fiberoptic bronchoscope group (F group, n = 36) or the Fiberoptic bronchoscope with separated airway (MF group, n = 38). A Fiberoptic bronchoscope guided intubation and a fiberoptic bronchoscope with separated airway and a direct laryngoscope was performed after inducing anesthesia. Intubation time, Jaw thrust incidence, mean blood pressure and heart rate after anaesthesia induction, at intubation and every two minute for a further 7 min were recorded. RESULTS: The intubation time was significantly shorter in the MF group (58.3 +/- 13.7 sec) than F group (71.9 +/- 22.1 sec). Jaw thrust incidence was lower in the MF group (60.5%) than F group (100%). The changes of MAPs and HRs during the observation were not significantly different in three group. CONCLUSIONS: Fiberoptic intubation using separated airway reduced intubation time and the incidence of jaw thrust.
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Adulto , Humanos , Manejo de la Vía Aérea , Anestesia , Anestesia General , Presión Sanguínea , Broncoscopios , Frecuencia Cardíaca , Hemodinámica , Incidencia , Intubación , Maxilares , LaringoscopiosRESUMEN
Intravascular ultrasonography (IVUS) imaging is a user-friendly technique widely used during coronary interventions. An 80-year-old man was admitted with chest pain, and successful percutaneous coronary intervention was performed with stent implantation. One week later, the patient complained of further chest pain. Urgent coronary angiography showed total occlusion of the middle left anterior descending artery and the aspiration of thrombi was high. IVUS imaging showed inadequate stent strut apposition and distal dissection. We attempted another stent implantation but the IVUS catheter was stuck on the 0.014 inch wire. Therefore, we tried to pass the wire across the lateral side. After the wire was successfully passaged, the sprinter balloon was passed through the crushed stent to expand it. After 4 days later, the patient was discharged with no symptoms or electrocardiographic change.
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Anciano de 80 o más Años , Humanos , Angioplastia Coronaria con Balón , Arterias , Catéteres , Dolor en el Pecho , Angiografía Coronaria , Electrocardiografía , Intervención Coronaria Percutánea , Stents , Ultrasonografía IntervencionalRESUMEN
BACKGROUND: Simulation-based training is becoming more wide-spread in clinical education because of the increased technology of patient simulators in conjunction with their increased use by many medical centers. Simulation-based training enhances the learning, clinical skills and judgment of the trainees. However, the effect of repetition of simulation-based training has not yet been evaluated. The purpose of this presentation will be to examine whether the number of experiences could have an influence on the interest of the trainee. METHODS: Simulation-based training was designed as an introductory course for new interns and residents. The training course was divided into three sessions: Airway management training, cardiac massage training and advance cardiac life support mega code training. All the trainees were divided into the new interns and residents group. The two group's performances during conducting the three sessions were monitored by video equipment. All the trainees were debriefed and given a post intervention survey to assess their satisfaction with the simulation-based training. RESULTS: A total of 110 trainees completed the survey. On a four point scale, the students rated their stimulation of interest, the usefulness of the knowledge that they learned and if they enjoyed the simulation. There were no significant differences in the effectiveness of the three sessions of simulation-based training among the groups. CONCLUSIONS: Simulation is a powerful tool to get trainees excited about applying the skills they learned in the classroom. Most trainees in both groups agreed that the exercises were a great experience helpful and exciting. We postulate that the repetition of simulation-based training will not decrease the effectiveness of the training.
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Humanos , Manejo de la Vía Aérea , Reanimación Cardiopulmonar , Competencia Clínica , Ejercicio Físico , Masaje Cardíaco , Juicio , AprendizajeRESUMEN
BACKGROUND: Although many clinicians know about the reducing effects of the pulsed and low-dose modes for fluoroscopic radiation when performing interventional procedures, few studies have quantified the reduction of radiation-absorbed doses (RADs). The aim of this study is to compare how much the RADs from a fluoroscopy are reduced according to the C-arm fluoroscopic modes used. METHODS: We measured the RADs in the C-arm fluoroscopic modes including 'conventional mode', 'pulsed mode', 'low-dose mode', and 'pulsed + low-dose mode'. Clinical imaging conditions were simulated using a lead apron instead of a patient. According to each mode, one experimenter radiographed the lead apron, which was on the table, consecutively 5 times on the AP views. We regarded this as one set and a total of 10 sets were done according to each mode. Cumulative exposure time, RADs, peak X-ray energy, and current, which were viewed on the monitor, were recorded. RESULTS: Pulsed, low-dose, and pulsed + low-dose modes showed significantly decreased RADs by 32%, 57%, and 83% compared to the conventional mode. The mean cumulative exposure time was significantly lower in the pulsed and pulsed + low-dose modes than in the conventional mode. All modes had pretty much the same peak X-ray energy. The mean current was significantly lower in the low-dose and pulsed + low-dose modes than in the conventional mode. CONCLUSIONS: The use of the pulsed and low-dose modes together significantly reduced the RADs compared to the conventional mode. Therefore, the proper use of the fluoroscopy and its C-arm modes will reduce the radiation exposure of patients and clinicians.
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Humanos , Fluoroscopía , Compuestos Organotiofosforados , Dosis de Radiación , Intensificación de Imagen RadiográficaRESUMEN
Duodenal perforation associated with endoscopic retrograde cholangiopancreatography is very uncommon. However, it usually requires early diagnosis and surgical management. Perforations are commonly caused by endoscopic sphincterotomy, biliary or duodenal stent placement, guidewire-related causes, and endoscopy itself. Perforatioins can follow various clinical courses, and management depends on the cause of the perforation. Among the above causes, guidewire-induced perforation is very rare and related reports and analyses are limited. Herein we describe four cases of guidewire-induced periampullary perforation during endoscopic retrograde cholangiopancreatography, and analyze clinical characteristics and management.
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Colangiopancreatografia Retrógrada Endoscópica , Diagnóstico Precoz , Endoscopía , Esfinterotomía Endoscópica , StentsRESUMEN
BACKGROUND/AIMS: Calcium channel blockers (CCBs) are anti-hypertensive medications that are used worldwide. CCB overdose has increased in proportion to the use of these drugs. Although amlodipine is the most widely used CCB, many physicians are not familiar with amlodipine overdose. We report the clinical outcome in patients with an intentional amlodipine overdose. METHODS: We retrospectively reviewed the medical records of the patients who visited Soonchunhyang University Cheonan Hospital with an amlodipine overdose from January 2002 through December 2010. We recorded the initial vital signs, blood chemistry, electrocardiography, and estimated amount of amlodipine ingested. RESULTS: Nine patients were enrolled, of whom two patients died. Both patients who died had ingested more than 200 mg/m2 of amlodipine, while all of the patients who ingested less than 200 mg/m2 of amlodipine survived. Three patients had blood sugar levels exceeding 200 mg/dL and two of these died despite high-dose insulin therapy in combination with glucose infusion (hyperinsulinemia/euglycemia therapy). Although three patients also took a glimepiride overdose, none had hypoglycemia. The amount of amlodipine ingested relative to the body surfaced area (BSA) was 197.1 +/- 92.3 mg/m2 in patients with an abnormal ECG and 58.5 +/- 27.1 mg/m2 in patients with a normal ECG. CONCLUSIONS: Amlodipine overdose can induce hyperglycemia, resulting in lethal cardiogenic shock owing to the decreased calcium influx, inappropriate energy production, and weakened inotropic effect. Therefore, amlodipine-induced hyperglycemia indicates a poor prognosis.