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: Settlements between doctors and patients provide a solution to complicated disputes. However, some disputes may be renewed as a result of negligence by both parties. The purpose of this study was to review the legal issues that may potentially arise during the preparation of settlement agreements and to propose a list of requirements for ensuring the effectiveness of these settlement agreements. METHODS: Data from 287 civil cases concerning aesthetic surgery that took place between 2000 and 2015 were collected from a court database in South Korea. Factors that influenced the effectiveness of settlement agreements were analyzed. RESULTS: Among the 287 court precedents, there were 68 cases of covenant not to sue. Eighteen cases were dismissed because the settlement agreements were recognized as effective, and 50 cases were sent forward for judgment on their merits because the agreements were not recognized as effective. The types of surgery and types of complications were classified by frequency. We evaluated the geographical distribution of the precedents, the settlement timing, and the effectiveness and economic impact of the settlements. We found that there was no statistically significant relationship among these factors. Four major factors that made a settlement agreement legally effective were identified, and the data showed that fee-free reoperations were not considered by the court in determining the compensation amount. CONCLUSIONS: When preparing a settlement agreement, it is advisable to review the contents of the agreement rather than to take the preparation of a settlement agreement per se to be legally meaningful.
Compensation and Redress ; Dissent and Disputes ; Humans ; Judgment ; Jurisprudence* ; Korea* ; Malpractice ; Plastics* ; Surgery, Plastic*

Postoperative infections are rare after plastic surgery; however, when present, they can affect the aesthetic outcome. Currently, many malpractice lawsuits are associated with surgical site infection. The present study aimed to analyze malpractice claims associated with surgical site infection in the field of plastic surgery through a review of Korean precedents. We analyzed the type of procedure, associated complications, and legal judgment in these cases. Most claimants were women, and claims were most often related to breast surgery. The common complications related to surgical site infection were deformity, scar, and asymmetry. Among the 40 cases, 34 were won by the plaintiff, and the mean claim settlement was 2,832,654 KRW (USD 2,636.6). The reasons for these judgements were as follows: 1) immediate bacterial culture tests were not performed and appropriate antibiotics were not used; 2) patients were not transferred to a high-level hospital or the infection control department was not consulted; 3) surgical site infection control measures were not appropriate; and 4) surgical procedures were performed without preoperative explanation about surgical site infection. The number of claims owing to surgical site infection after surgery is increasing. Infection handling was one of the key factors that influenced the judgement, and preoperative explanation about the possibility of infection is important. The findings will help surgeons achieve high patient satisfaction and reduce liability concerns.
Anti-Bacterial Agents ; Breast ; Cicatrix ; Congenital Abnormalities ; Cross Infection ; Female ; Humans ; Infection Control ; Judgment ; Malpractice* ; Patient Satisfaction ; Plastics* ; Surgeons ; Surgery, Plastic* ; Surgical Wound Infection*

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by autoantibodies and immune complex depositions, has been known that it could be aggravated during pregnancy. We report a case who developed massive pericardial effusion, pleural effusion, and proteinuria during the second trimester of pregnancy. This patient had a history of leukopenia for several years and showed several features of SLE before pregnancy, however, no specific diagnosis was made before pregnancy. High dose oral glucocorticoid with intravenous immunoglobulin administration was done, but serositis and nephritis did not improve. The induced abortion and the use of immunosuppresive agent resulted in remission. We emphasize the importance of the early diagnosis and management of SLE before pregnancy in the patients with the features of autoimmune disease such as leukopenia, skin lesion and Raynaud phenomenon for successful outcome.
Abortion, Induced ; Antigen-Antibody Complex ; Autoantibodies ; Autoimmune Diseases ; Diagnosis ; Early Diagnosis ; Female ; Humans ; Immunoglobulins ; Leukopenia ; Lupus Erythematosus, Systemic* ; Lupus Nephritis ; Nephritis* ; Pericardial Effusion ; Pleural Effusion ; Pregnancy Trimester, Second ; Pregnancy* ; Proteinuria ; Raynaud Disease ; Serositis* ; Skin