No abstract available.
Eosinophilia*

The authors describe three patients of syringomyelia associated with posterior fossa tumor. The lesions were diagnosed by magnetic resonance imaging. Total removal of tumor without decompression of foramen magnum was done and regression of syringomyelia and improvement of symptoms were demonstrated. It is suggested that the blockage of cerebrospinal fluid flow at the foramen magnum by tonsilar herniation may play an important role in syrinx formation.
Cerebrospinal Fluid ; Decompression ; Foramen Magnum ; Humans ; Infratentorial Neoplasms* ; Magnetic Resonance Imaging ; Syringomyelia*

Background: Transfusions in pediatrics need to be performed carefully because of various variables, such as the blood volume and immature immune system. As a result, adverse transfusion reactions may appear differently from adults. This study examined the frequency and types of adverse transfusion reactions in pediatric patients. Methods: From January 2018 to December 2021, this study was conducted on 58 children who requested red blood cells, platelets, and plasma blood components from Chungbuk National University Hospital. The frequency and types of adverse transfusion reactions were analyzed retrospectively by reviewing blood transfusion-related medical records and compared with previous studies. Results: Approximately 0.9% of total blood components were transfused into pediatric patients; 1,179 units of blood components were transfused. The number of transfusions for red blood cells, platelets, and plasma was 383, 712, and 84 units, respectively. Among 58 patients, 23 adverse transfusion reactions were observed in 15 (25.9%) patients. Of these, 18 were febrile nonhemolytic transfusion reactions, and five were allergic transfusion reactions. Febrile nonhemolytic transfusion reactions occurred in 66.7% of cases with red blood cells, and allergic transfusion reactions occurred with platelets in 60% of cases. Conclusion This paper reported the incidence and types of adverse transfusion reactions in pediatric patients. This is expected to be more frequent in pediatric patients than adults, but most of them were relieved by supportive treatment because the symptoms were mild. As the awareness of hemovigilance is still low, it is essential to recognize and deal with adverse transfusion reactions through continuous education.

A 55-year-old male was admitted to emergency department with a hypoglycemic shock of unknown origin. He was presented with tonic seizure activity after admission. Initial diagnostic procedure could exclude diabetes mellitus, drug side effects, and exogenous insulin application. Detailed evaluation of the patient's history revealed that the patient had experienced repeated hypoglycemic episodes for 2 years. He was diagnosed with hypothyroidism six years ago. Initial laboratory investigations revealed hypoglycemia, hyponatremia, and low plasma cortisol level (0.18 microg/dL). Sellar magnetic resonance imaging showed empty sella. Replacement therapy with hydrocortisone resulted in the improvement of clinical symptoms. Combined pituitary stimulation test with exception of hypoglycemia induced growth hormone and cortisol stimulation test was performed. The response of thyroid stimulating hormone, prolactin, follicle-stimulating hormone, and luteinizing hormone was normal. We report the case of empty sella syndrome associated with hypoglycemic shock due to with multiple anterior pituitary hormone deficiencies.
Coma* ; Diabetes Mellitus ; Emergency Service, Hospital ; Empty Sella Syndrome* ; Follicle Stimulating Hormone ; Growth Hormone ; Humans ; Hydrocortisone ; Hypoglycemia ; Hyponatremia ; Hypothyroidism ; Insulin ; Luteinizing Hormone ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Plasma ; Prolactin ; Seizures ; Shock ; Thyrotropin

OBJECTIVE: Despite several limitations, the Trauma Injury Severity Score (TRISS) is normally used to evaluate trauma systems. The aim of this study was to evaluate the preventable trauma death rate using the TRISS method in severe trauma patients with traumatic brain injury using our emergency department data. METHODS: The use of the TRISS formula has been suggested to consider definitively preventable death (DP); the deaths occurred with a probability of survival (Ps) higher than 0.50 and possible preventable death (PP); the deaths occurred with a Ps between 0.50 and 0.25. Deaths in patients with a calculated Ps of less than 0.25 is considered as no-preventable death (NP). A retrospective case review of deaths attributed to mechanical trauma occurring between January 1, 2011 and December 31, 2011 was conducted. RESULTS: A total of 565 consecutive severe trauma patients with ISS>15 or Revised Trauma Score<7 were admitted in our institute. We excluded a total of 24 patients from our analysis : 22 patients younger than 15 years, and 2 patients with burned injury. Of these, 221 patients with head injury were analyzed in the final study. One hundred eighty-two patients were in DP, 13 in PP and 24 in NP. The calculated predicted mortality rates were 11.13%, 59.04%, and 90.09%. The actual mortality rates were 12.64%, 61.547%, and 91.67%, respectively. CONCLUSION: Although it needs to make some improvements, the present study showed that TRISS performed well in predicting survival of traumatic brain injured patients. Also, TRISS is relatively exact and acceptable compared with actual data, as a simple and time-saving method.
Brain ; Brain Injuries ; Craniocerebral Trauma ; Emergencies ; Humans ; Injury Severity Score ; Retrospective Studies

Purpose: We aimed to evaluate the usefulness and safety of high-flow nasal cannula (HFNC) oxygen therapy in children with complex chronic diseases (CCD) with impending respiratory failure in the general ward. Methods: Medical records of subjects with HFNC oxygen use in the general ward at a Korean tertiary children’s hospital were reviewed. Children with CCD and impending respiratory failure were included. treatment success was defined as successful weaning from HFNC oxygen support and treatment failure as weaning failure that led to higher level of respiratory support such as invasive ventilation or noninvasive positive pressure ventilation. Results: Fifty cases were included. Thirty-five cases (70%) were weaned off HFNC oxygen successfully, 15 cases (30%) failed. At the time of HFNC oxygen administration, the treatment failure group showed higher heart rate (P = 0.043), carbon dioxide partial pressure (P = 0.002), and initial inspired oxygen fraction (P = 0.007). Within 72 hours of initial treatment, 20% of patients in the treatmentsuccess group were weaned off the HFNC oxygen and half in the treatment-failure group required invasive ventilation. One case experienced complication. Conclusion HFNC oxygen is safe and effective for respiratory support in the general ward to avoid invasive mechanical ventilation in children with CCD and impending respiratory failure.

OBJECTIVE: Investigation of initial 51 cases of single port access (SPA) laparoscopic surgery for large adnexal tumors and evaluation of safety and feasibility of the surgical technique. METHODS: We retrospectively reviewed the medical records of the first 51 patients who received SPA laparoscopic surgery for large adnexal tumors greater than 10 cm, from July 2010 to February 2015. RESULTS: SPA adnexal surgeries were successfully completed in 51 patients (100%). The mean age, body mass index of the patients were 43.1 years and 22.83 kg/m², respectively. The median operative time, median blood loss were 73.5 (range, 20 to 185) minutes, 54 (range, 5 to 500) mL, and the median tumor diameter was 13.6 (range, 10 to 30) cm. The procedures included bilateral salpingo-oophorectomy (n=18, 36.0%), unilateral salpingo-oophorectomy (n=14, 27.45%), and paratubal cystectomy (n=1, 1.96%). There were no cases of malignancy and none were insertion of additional ports or conversion to laparotomy. The cases with intraoperative spillage were 3 (5.88%) and benign cystic tumors. No other intraoperative and postoperative complications were observed during hospital days and 6-weeks follow-up period after discharge. CONCLUSION: Our results suggest that SPA laparoscopic surgery for large adnexal tumors may be a safe and feasible alternative to conventional laparoscopic surgery.
Body Mass Index ; Cystectomy ; Female ; Follow-Up Studies ; Humans ; Laparoscopy* ; Laparotomy ; Medical Records ; Minimally Invasive Surgical Procedures ; Operative Time ; Ovary ; Postoperative Complications ; Retrospective Studies

BACKGROUND: Malassezia yeasts are lipophilic fungi that are found in 75~80% of healthy adults. Recently, various molecular biological techniques are being preferred to identify and classify the Malassezia yeasts. Pyrosequencing is a real-time DNA sequencing technique. This technology has the potential advantage of accuracy, ease-of-use, high flexibility and is now emerging as a popular platform for microbial typing. OBJECTIVE: We sought to implement novel molecular biology technique, namely pyrosequencing method in identifying and classifying Malassezia yeasts, and assess its clinical applicability. METHODS: We obtained ribosomal RNA sequences of 11 Malassezia standard strains from NCBI database. Primers for the initial PCR amplification of the target region (ITS2) and sequencing primers within the regions amplified by the PCR primers were designed using Pyrosequencing Assay Design Software (Biotage AB, Uppsala, Sweden). We obtained PCR amplifying fragments of genomic DNA isolated from the Malassezia yeasts. And pyrosequence reactions were performed using reagents provided with the PSQ 96 Sample Preparation kit. RESULTS: In the PCR analysis, all of 11 standard strains are shown at the 130 bp levels. In the pyrosequencing analysis, M. obtusa and M. furfur sequences were corresponded among 11 Malassezia standard strains. But, in 4 cases, Malassezia strains mismatched with expected Malassezia strain and in rest of 5 Malassezia strains, pyrosequencing was failed. CONCLUSION: As evidenced above, pyrosequencing analysis could provide a sensitive and rapid identification system for Malassezia species. But it still has many limitation to be applied to epidemiological surveys and clinical practice.
Adult ; Classification* ; DNA ; Fungi ; Humans ; Indicators and Reagents ; Malassezia* ; Molecular Biology ; Pliability ; Polymerase Chain Reaction ; RNA, Ribosomal ; Sequence Analysis, DNA ; Yeasts*

BACKGROUND: Malassezia yeasts are lipophilic fungi that are found in 75~80% of healthy adults. The yeasts are known to be associated with pityriasis versicolor, seborrheic dermatitis, Malassezia folliculitis, and recently its pathogenicity is being expanded to other various skin disorders, such as atopic dermatitis and acne vulgaris. Recently, various molecular biological techniques are being preferred over morphological analysis. In order to perform a DNA-based diagnostic test, availability of a simple, rapid, and reliable DNA extraction protocol is essential. OBJECTIVE: We sought to implement novel molecular biology technique, namely colony PCR method using microwave as the easiest way to amplification of Malassezia target DNA, and assess its clinical applicability. METHODS: Instead of using templates of purified genomic DNA, we performed the PCR directly from Malassezia colonies. A fresh yeast colony transferred to the bottom of a microcentrifuge tube and microwaved for 1 min three times in the presence of a pyrex beaker containing 50 ml of sterile water to dissipate excess heat. Following this microwave lysis, PCR-reaction mixture was added directly to the microcentrifuge tube. Two DNA extraction methods (boiling method, glass beads method) were used for comparing the sensitivity and effectiveness with the colony PCR method. All reactions were performed using the primers 26S and ITS1 complementary to the rDNA region. Results 1. As a result of gel electrophoresis, we recognized expected PCR products (approximately 580 bp for 26S rDNA and 250~320 bp for ITS1) from both colony PCR method and two DNA extraction methods (boiling method, glass beads method). 2. As a result of measuring nucleic acid level with the spectrophotometer, colony PCR disregarding DNA extraction process shows relatively similar PCR efficacy compared with the boiling and glass beads method. And there is no significant difference among those methods statistically (p>0.001). 3. In conducting the PCR method, boiling method required approximately 400 minutes, and glass beads method required approximately 360 minutes, respectively. As contrasted with two methods, colony PCR method required approximately 150 minutes, and could be capable of saving time. In addithion, colony PCR had an economic efficiency comparing with boiling method and glass beads methods. CONCLUSIONS: All these findings suggest that directly application of the Malassezia yeasts obtained from culture colony for PCR reaction is a fast, reliable, cost-effective and simple method for performing any PCR-based protocol including diagnostic tests.
Acne Vulgaris ; Adult ; Dermatitis, Atopic ; Dermatitis, Seborrheic ; Diagnostic Tests, Routine ; DNA ; DNA, Ribosomal ; Electrophoresis ; Folliculitis ; Fungi ; Glass ; Hot Temperature ; Humans ; Malassezia* ; Microwaves ; Molecular Biology ; Polymerase Chain Reaction* ; Skin ; Tinea Versicolor ; Virulence ; Water ; Yeasts*

BACKGROUND: Malassezia (M.) yeasts are lipophilic fungi which are regarded as normal flora of the skin, and are recovered in 75~98% of healthy adults. Gueho et al reclassified the Malassezia yeasts into 7 species (M. furfur, M. obtusa, M. globosa, M. slooffiae, M. sympodialis, M. pachydermatis, M. restricta) on the basis of molecular biology and by employing an interdisciplinary approach of morphology, microstructurology and physiology. Recently novel species of the genus Malassezia have been discovered as a result of molecular analysis. But there are no additional reports in Korea regarding newly reported Malassezia species because most identification and classification of Malassezia in Korea depend on classical methods and research on molecular biologic application is insufficient. OBJECTIVE: Five clinical isolates of M. dermatis were isolated from the skin of healthy subjects without skin disease or seborrheic dermatitis patients using molecular biology techniques for the first time in Korea. Hence the present study describes mycological and molecular biological characteristics of these five isolates as a novel species of M. dermatis. METHODS: Morphological and biochemical analyses, such as colony morphologies, microscopic morphologies and physiological characteristic were done targeting 5 clinical isolates of M. dermatis. Molecular techniques, namely, 26S rDNA PCR-RFLP, 26S rDNA and internal transcribed spacer region 1 (ITS1) sequencing, were done for identification and phylogenetic systematic analysis. RESULTS: Five clinical isolates of M. dermatis showed positive in the catalase test. No growth is obtained on Sabouraud's dextrose agar (SDA) without lipid supplementation but all grew in 0.5% Tween 60 and 0.1% Tween 80 added 2% glucose/1% peptone culture medium. Round and ellipsoidal yeast cells and budding of the yeast cells were observed under microscope, resembling M. sympodialis, M. furfur, and M. nana. The 26S rDNA PCR-RFLP pattern showed the same pattern as M. dermatis (JCM 11348), the standard strain. 26S rDNA and ITS1 sequencing were performed for exact identification, showing 99% accordance with M. dermatis (AB070361), and M. dermatis (AB070356), confirming the species to be new, the first to be reported in Korea. Phylogenetic trees based on the D1/D2 domains of the 26S rDNA sequences and nucleotide sequences of the ITS 1 region showed that the isolates were conspecific and belonged to the genus Malassezia and crusted with M. sympodialis. CONCLUSION: Taking a molecular biological classification approach, we have successfully isolated 5 cases of M. dermatis-the first in Korea. Although it is not known whether M. dermatis plays a role in Malassezia-related skin disease, this species was part of the microflora in both patients with seborrheic dermatitis and healthy subjects.
Adult ; Agar ; Base Sequence ; Catalase ; Classification ; Dermatitis, Seborrheic ; DNA, Ribosomal ; Fungi ; Glucose ; Humans ; Korea ; Malassezia* ; Molecular Biology ; Peptones ; Physiology ; Polysorbates ; Population Characteristics ; Skin ; Skin Diseases ; Yeasts