PURPOSE: Mycoplasma pneumoniae (MP) is a major cause of community-acquired pneumonia in children. Since 2000, emerging macrolide-resistant MP has been reported. Three epidemics of MP pneumonia have occurred in Korea during the past 10 years: 2006–2007, 2011, and 2015. We investigated the differences in MP pneumonia of each epidemic in terms of clinical, laboratory, and radiologic perspectives. METHODS: We retrospectively analyzed 529 medical records of children (1–18 years of age) who were admitted and diagnosed with MP pneumonia at Kangbuk Samsung Hospital during the past 3 epidemic periods. We compared the clinical, laboratory, and radiologic characteristics of MP pneumonia among individual epidemics and between children younger and older than 6 years of age. RESULTS: The mean age of the patients was 5.7 years old, which had increased by each epidemic and showed the highest (6.3 years old) in 2015 compared to previous epidemics. Among 3 epidemics, there were no sex differences. The duration of fever after admission and hospitalization, and the percentage of lobar pneumonia and use of systemic steroids increased significantly in 2015 epidemic. Since 2006, the mean levels of erythrocyte sedimentation rate and lactate dehydrogenase had increased and in 2015 it marked the highest. Children older than 6 years showed a higher proportion of lobar pneumonia and pleural effusion as well as longer duration of fever (before and after admission) and hospitalization days than those younger than 6 years. CONCLUSION: This study suggests an increasing incidence of refractory MP pneumonia which required a more frequent use of systemic steroids over the past 10 years, and children older than 6 years were found to have more severe pneumonia than those younger than 6 years.
Blood Sedimentation ; Child* ; Fever ; Hospitalization ; Humans ; Incidence ; Korea ; L-Lactate Dehydrogenase ; Medical Records ; Mycoplasma pneumoniae* ; Mycoplasma* ; Pleural Effusion ; Pneumonia* ; Pneumonia, Mycoplasma* ; Retrospective Studies ; Sex Characteristics ; Steroids

Obstructive sleep apnea (OSA) is characterized by a disorder of breathing with prolonged partial and/or complete airway obstruction which causes frequent arousal during sleep. The prevalence of OSAS is approximately 2%–3.5% in children. It is mainly caused by enlarged tonsils and adenoids. Obesity, craniofacial abnormality, and neuromuscular disease are also relevant predisposing factors. Snoring is the most common presenting complaint in children with OSA, but the clinical presentation varies according to age. The pathogenesis of OSA is complex and involved in multifactorial, relative roles of anatomic and neurohumoral factors. The role of the nose is considered a component of the pathophysiology of OSA. It is unlikely that the first manifestation of OSA is intermittent snoring with nasal obstruction, often considered a coincidental finding. Childhood OSA should be diagnosed and treated, if clinically suspected, because various symptoms, signs, and consequences can be improved with proper management. Adenotonsillectomy is the first-line treatment modality in pediatric OSA with adenotonsillar hypertrophy. In addition, treatment of allergic rhinitis, nonallergic rhinitis, and other structural problems of the nasal cavity, if it is needed, may be included in the treatment of OSA.
Adenoids ; Airway Obstruction ; Arousal ; Causality ; Child* ; Craniofacial Abnormalities ; Humans ; Hypertrophy ; Nasal Cavity ; Nasal Obstruction ; Neuromuscular Diseases ; Nose ; Obesity ; Palatine Tonsil ; Prevalence ; Respiration ; Rhinitis ; Rhinitis, Allergic ; Sleep Apnea, Obstructive* ; Snoring

No abstract available.
Child* ; Humans ; Mycoplasma pneumoniae* ; Mycoplasma* ; Pneumonia, Mycoplasma*

No abstract available.
Dislocations*

The fibromyalgia syndrome (FMS) could be approached by various treatments modalities including education, aerobic exercise, cognitive behavioral therapy, tricyclic antidepressants, serotonin norepinephrine reuptake inhibitors, pregabalin, and so on. If other treatments fail, opioids including morphine should be considered. In this case report, we describe the case of a 44-year-old woman who was diagnosed with FMS three years ago, and suffered from severe intractable pain, side effects from other drugs, and opioid tolerance. Administration of morphine via an implantable drug delivery system resulted in significant improvement in the patient's pain intensity, fibromyalgia impact questionnaire score, and sleep disturbance. Our case demonstrates that an implantable drug delivery system with morphine can be a potential treatment option for refractory fibromyalgia patients.
Adult ; Analgesics, Opioid ; Antidepressive Agents, Tricyclic ; Cognitive Therapy ; Drug Delivery Systems* ; Education ; Exercise ; Female ; Fibromyalgia* ; Humans ; Injections, Spinal ; Morphine* ; Norepinephrine ; Pain, Intractable ; Pregabalin ; Serotonin

Osteonecrosis of the femoral head (ONFH) can cause femoral head depression and cortical discontinuity. Treatment for ONFH remains challenging. We performed botulinum toxin type A injection to psoas major muscle in five patients with radiological femoral head collapse (Association Research Circulation Osseus classification stage III) who were non-responsive after two years of conservative treatment (tramadol 200 mg/day, mefenamic acid 1,000 mg/day). At two weeks after the procedure, their mean hip pain was decreased from 88 ± 0.4/100 mm to 22 ± 0.4/100 mm based on visual analogue scale (VAS). The pain was maintained at a minimum of 20/100 mm and a maximum of 30/100 mm in VAS for at least six weeks after the procedure. These values were mean ± SD. These patients were followed-up for 6 months. There was no exacerbation of pain from repeated (three times) botulinum toxin type A injection to the psoas major muscle.
Botulinum Toxins* ; Botulinum Toxins, Type A* ; Classification ; Depression ; Femur Head Necrosis ; Head* ; Hip ; Humans ; Mefenamic Acid ; Osteonecrosis* ; Psoas Muscles*

Meralgia paresthetica (MP) is a painful mononeuropathy of the lateral femoral cutaneouse nerve (LFCN) characterized by localized symptoms of numbness, tingling, pain and paresthesia along the anterolateral thigh area. L4 and L5 radiculopathy is set of symptoms that include sharp, burning or shooting pain, which is usually localized to anterolateral leg area and along the dermatomal distribution. When symptoms of MP and lumbar disc disease occur together it is not easy to diagnose MP. We report a case of synchronous post-traumatic MP and radiculopathy due to intervertebral disc herniation at L3–4 and 4–5. A 59-year-old male patient was admitted to the emergency room with symptoms of low back pain with left severe L4, L5 radiculopathy. This patient also complained of numbness and paresthesia in the left anterolateral thigh. After detailed history taking and lateral femoral cutaneouse nerve block, he was diagnosed with MP.
Burns ; Emergency Service, Hospital ; Humans ; Hypesthesia ; Intervertebral Disc ; Leg* ; Low Back Pain ; Male ; Middle Aged ; Mononeuropathies ; Nerve Block ; Paresthesia ; Radiculopathy* ; Thigh

Herpes zoster is caused by the reactivation of the varicella-zoster virus, and it typically presents as single dermatomal rash and vesicles. It can cause postherpetic neuralgia as a common complication. In immunocompromised patients, the lesions can be cutaneous, disseminated into two non-contiguous dermatomes, and this entity is referred to as herpes zoster duplex unilateralis or bilateralis. We present a case of postherpetic neuralgia after herpes zoster duplex bilateralis in a 60-year-old immunocompromised man. He had a past history of acute lymphocytic leukemia and was treated with allogeneic peripheral blood stem cell transplantation 1 year before herpes zoster reactivation. His postherpetic neuralgia pain was difficult to treat and it was refractory to conservative medication and neuraxial block.
Exanthema ; Herpes Zoster* ; Herpesvirus 3, Human ; Humans ; Immunocompromised Host* ; Middle Aged ; Neuralgia, Postherpetic* ; Peripheral Blood Stem Cell Transplantation ; Precursor Cell Lymphoblastic Leukemia-Lymphoma

BACKGROUND: Previous studies have shown that measuring the distance from the skin to the ligamentum flavum by ultrasound preceding cervical epidural block can be beneficial in excluding false loss of resistance. However, the measurement value using ultrasound may vary depending on the degree of operator experience. Therefore, we aimed to determine the depth from skin to cervical epidural space by using lateral cervical spine X-ray, which is a more intuitive method. METHODS: We enrolled 102 adult patients who were scheduled to undergo cervical epidural anesthesia for vascular bypass surgery of upper arm. After attaching a steel rod on the needle insertion site, lateral cervical spine X-ray was taken before the epidural procedure. We measured the distance from the steel rod to the midpoint of interlaminar space on the spinolaminar line. The X-ray depth was compared with needle depth. RESULTS: Of the 102 enrolled patients, 18 patients including 13 in whom we were unable to measure X-ray depth were excluded from the analysis. In total, 84 patients were included in the analysis. Concordance correlation coefficient between the X-ray-measured depth and needle depth was 0.925. Bland-Altman analysis indicated a mean difference of ± 1.96 SD with 0.06 ± 0.56 cm. CONCLUSIONS: Lateral cervical spine X-ray can be useful for prediction of the midline depth from skin to epidural space, particularly for operators who are not skilled at spine ultrasound or the use the C-arm fluoroscopy.
Adult ; Anesthesia ; Anesthesia, Epidural ; Arm ; Cervical Vertebrae ; Epidural Space* ; Female ; Fluoroscopy ; Humans ; Ligamentum Flavum ; Methods ; Neck ; Needles ; Skin* ; Spine* ; Steel ; Ultrasonography

The most frequent perioperative cardiovascular event is cardiac dysrhythmia, defined as an abnormality of cardiac rate, rhythm or conduction. Although the occurrence of arrhythmia during the perioperative period is not uncommon, a case of newly developed perioperative atrial flutter which spontaneously converts to atrial fibrillation is rare. We report a case of atrial flutter that developed immediately after induction of general anesthesia, in a 70-year-old male patient who previously had a normal sinus rhythm. Atrial flutter changed spontaneously to atrial fibrillation after discharge to the recovery room. Dysrhythmia was unresponsive to drug therapy, and the atrial fibrillation disappeared after electric cardioversion.
Aged ; Anesthesia, General* ; Arrhythmias, Cardiac ; Atrial Fibrillation* ; Atrial Flutter* ; Drug Therapy ; Electric Countershock ; Humans ; Male ; Perioperative Period ; Recovery Room