PURPOSE: Computed tomography (CT) with contrast media (CM) is often performed on patients with elevated serum creatinine (sCr), however, due to the risk of contrast induced nephropathy (CIN), the confirmatory use of intravenous contrast CT is not routine. This aim of this study was to differentiate between pre-renal acute kidney injury (AKI) due to severe sepsis and CIN. METHODS: Of 330 patients with sepsis who presented to an emergency center in a tertiary care hospital and who underwent CT from January 2009 until May 2010, 232 were enrolled in this study. A group of 115 septic patients with CM and a group of 117 septic patients without CM were analyzed. RESULTS: When considering the change according to difference in initial sCr, the 2~3 day increase of serum creatinine (sCr) observed in both groups did not differ significantly (p=0.236). Use of CM and the amount of iodine showed no significant association with AKI within a period of three days (p=0.64 and p=0.558, respectively). Regardless of the use of CM, elevated sCr at the time of hospital presentation was likely to lead to elevated sCr at day 2-3 (odds ratio 4, p=0.034). CONCLUSION: CIN can be confused with other causes, particularly renal failure due to sepsis. The effect of performing intravenous contrast CT on the kidney may be less than thought. The risk of checking intravenous contrast CT, which was delayed for prevention of renal impairment in patients with elevated sCr, should be reconsidered.
Acute Kidney Injury ; Contrast Media ; Creatinine ; Emergencies ; Humans ; Iodine ; Kidney ; Renal Insufficiency ; Sepsis ; Tertiary Healthcare

PURPOSE: We would like to study the effectiveness and safety during lumbar puncture by classic lumbar puncture and ultrasonography-assisted lumbar puncture in pediatric patients. METHODS: This was a prospective randomized controlled trial. We included under 14-year-old pediatric patients who needed to undergo lumbar puncture from May 2010 to August 2011. Patients were divided according to classic lumbar puncture (group A) and ultrasonography-assisted lumbar puncture (group B). Data were collected, including the patient's age, sex, height, underlying disease of vertebrate, weight, frequency of attempting procedure, procedure time, and failure of lumbar puncture. RESULTS: Group A and group B included 31 patients and 33 patients each, with average ages of 9.65+/-8.53 and 7.38+/-4.45(p=0.19), average heights of 126.65+/-29.81 cm and 122.39+/-30.01 cm (p=0.57), and average weights of 32.84 +/-20.68 kg and 29.17+/-16.96 kg (p=0.44), without statistically significant differences. Of the distribution of residencies who underwent lumbar puncture between the two groups, no statistically significant differences were observed (p=0.30). Lumbar puncture time in group A was 6.72+/-9.16 minutes and 3.88+/-1.51 minutes in group B, but without significant differences (p=0.098). The number of lumbar puncture attempts was 1.68+/-0.95 in group A and 1.45+/-0.56 in group B, without significant statistical difference (p=0.253). The number of patients who failed lumbar puncture was 11 in group A and 3 in group B, showing a statistically significant difference (p=0.015). CONCLUSION: Compared to the classic lumbar puncture, lumbar puncture using ultrasonography in pediatric patients did not reduce the number of proceduresand the time for the procedure, but reduced the failure rate. Therefore, we recommend the methods of lumbar puncture assisted by ultrasonography in pediatric patients as an effective method for use in the emergency department.
Adolescent ; Emergency Service, Hospital ; Humans ; Internship and Residency ; Pediatrics ; Prospective Studies ; Spinal Puncture* ; Ultrasonography ; Vertebrates ; Weights and Measures

One of the reasons for insertion of endotracheal tube is to provide a patent airway. Unfortunately, the tube itself may become the cause of airway obstruction. Especially, armored tube is known to be most effective in maintenance of airway patency. However, airway obstruction has been reported by a varity of causes even though armored tube was used. We experienced airway obstruction with armored tracheostomy tube by swelling of inner layer near the cuff. The tube was reused one and had been disinfected with ethylene oxide. Therefore, to prevent complication such as airway obstruction by use of armored tubes, it is desirable to avoid reusal of armored tube and to examine the lumen as well as cuff before intubation when reused.
Airway Obstruction* ; Ethylene Oxide ; Intubation ; Tracheostomy*

BACKGROUND: Breast cancer is one of the most commonly diagnosed cancers in women worldwide. Immigrant women face cultural and social impediments, discrimination, and emotional and mental stressors; and they participate less in breast cancer prevention services. Breast self examination (BSE) may be effective in early detection. The purpose of this descriptive cross-sectional study was to identify the practice of BSE and to examine predictors related to the practice of BSE among North Korean female immigrants residing in South Korea. METHODS: Data were collected from a convenience sample of 131 North Korean female immigrants aged 20 years through 65 years who had attended community centers, local churches, and women's gatherings located in Incheon, Kyeongkido, Seoul, and Jeju. RESULTS: This study found that 17.6% of the women performed BSE and 8.4% were taught the methods of detecting breast cancer including BSE. Two significant predictors to performing BSE were found-good perceived health status (P=.003)and education about breast cancer screening and the breast self examination (P<.001). CONCLUSIONS: The results showed that North Korean female immigrants who were taught the detecting methods of breast cancer including BSE were more likely to practice BSE.
Breast Neoplasms ; Breast Self-Examination* ; Cross-Sectional Studies ; Discrimination (Psychology) ; Education ; Emigrants and Immigrants* ; Female ; Humans ; Incheon ; Korea ; Mass Screening ; Seoul

Endosalpingiosis is a condition that causes the non-neoplastic proliferation of ectopic tubal epithelium. Florid cystic endosalpingiosis is an atypical subtype that is very rarely reported. It presents as a mass-like feature and therefore needs to be differentiated from tumorous conditions. Here, we report the imaging findings of a case of multicentric florid cystic endosalpingiosis in the extraperitoneal pelvic cavity and the retroperitoneal spaces.

Endosalpingiosis is a condition that causes the non-neoplastic proliferation of ectopic tubal epithelium. Florid cystic endosalpingiosis is an atypical subtype that is very rarely reported. It presents as a mass-like feature and therefore needs to be differentiated from tumorous conditions. Here, we report the imaging findings of a case of multicentric florid cystic endosalpingiosis in the extraperitoneal pelvic cavity and the retroperitoneal spaces.

BACKGROUND: Thyrotoxic periodic paralysis is an uncommon illness characterized by intermittent flaccid paralysis of skeletal muscle, usually accompanied by hypokalemia, in patient with hyperthyroidism. However. the pathophysiology of thyrotoxic periodic paralysis remains largely unexplained and controversial. This report describes the clnical and biochemical findings in 19 patients with thyrotoxic periodic paralysis who were examined at the Yeungnam University Medical Center (YUMC) during the past decade. METHODS: The medical records of 997 YUMC patients, seen between 1986 and 1996, with dignosis of hyperthyroidism were reviewed. Nineteen patients out of 997 hyperthyrodism patients were diagnosed, and examined by history, physical examination, serum electrolyte value, and thyroid function test during paralysis. On the basis of these results, compasons were made on age. sex, precipitating factors, timing, affected limbs, prognosis, serum potassium and serum phosphate and thyroid hormone levels. RESULTS: the prevalence of periodic paralysis in hyperthyroidism was 1.9 percent and the male to female prevalence ratio was 30:1 and in all patients, the development of perodic paralysis was correlated with hyperfuntional state of the throid gland. Eleven cases of periodic paralysis were associated with hypokalemia and their throid hormon levels were significantly more increased than those of the patients without hypokalemia. interestingly, our study shows the recurrence of paralysis after treatment. CONCLUSION: Although the precise pathophysiology of the disease is as yet undefined and controversial, it occurs primarily in Asians with an overwhelming male preponderance and prevalence of 2 percent in hyperthyrodism. The interactive roles of thyroid hormon. Na-K pump. and genetically inherited defect in the celluar membrance potential of the skeletal muscle can be speculated. Further investigation will be neede to firmly establish the mechanism of thyrotoxic periodic paraysis.
Academic Medical Centers ; Asian Continental Ancestry Group ; Extremities ; Female ; Humans ; Hyperthyroidism ; Hypokalemia ; Hypophosphatemia ; Male ; Medical Records ; Muscle, Skeletal ; Paralysis* ; Physical Examination ; Potassium ; Precipitating Factors ; Prevalence ; Prognosis ; Recurrence ; Thyroid Function Tests ; Thyroid Gland

Twenty two strains of Legionella species isolated from Jejudo, Korea were identified by comparing the rpoB (300 bp), dotA (360 bp), and mip (396 bp) gene sequence analysis. Furthermore, their genotypes were determined by sequence analysis of rpoB/dotA subgroup typing, pulse-field gel electrophoresis (PFGE) and random amplified polymorphic DNA (RAPD) patterns. Of the 22 isolates, 21 strains were identified as L. pneumophila and 1 strain was close to L. erythra (>95% similarity of rpoB and mip). Most of the L. pneumophila strains (90%) belonged to P-I of rpoB/dotA subgroup typing, one strain of each P-III and P-IV. L. pneumophila isolates were further grouped into 4 and 6 different PFGE (P1 to P4) and RAPD (R1 to R6) patterns, respectively. On the basis of these genotypes, which may be useful for future epidemiological studies, existence of diverse L. pneumophilla population in Jejudo, Korea were observed.
DNA ; Electrophoresis ; Epidemiologic Studies ; Genotype ; Korea ; Legionella ; Legionella pneumophila ; Molecular Biology ; Sequence Analysis ; Sprains and Strains