No abstract available.
Peer Review*

No abstract available.

No abstract available.
Child ; Health Promotion ; Humans ; Immunization* ; Child Health

No abstract available.

The current paper reports on a case of subdural empyema secondary to frontal sinusitis in an otherwise healthy child. Sinusitis is a common and benign condition in most pediatric cases. Because of the widespread use of antibiotics, intracranial extension of pediatric sinusitis is rarely seen today; however, complications (e.g., cavernous sinus thrombosis, orbital infection, meningitis, and subdural empyema) are potentially life threatening. A 15-year-old right-handed male presented with a 3-day history of fever, headache, and left-sided palsy. Computed tomography revealed right-sided subdural empyema with right frontal sinusitis and maxillary sinusitis. A postoperative inpatient neurological consultation was requested 2 months post-surgery due to motor function deficits. The results suggested that early and accurate diagnosis of subdural empyema leads to prompt treatment and a favorable outcome for the patient.
Adolescent ; Anti-Bacterial Agents ; Brain Abscess ; Cavernous Sinus Thrombosis ; Central Nervous System ; Child* ; Diagnosis ; Empyema, Subdural* ; Fever ; Frontal Sinus ; Frontal Sinusitis ; Headache ; Humans ; Inpatients ; Male ; Maxillary Sinus ; Maxillary Sinusitis ; Meningitis ; Orbit ; Paralysis ; Sinusitis*

INTRODUTION: The gamma-aminobutyric acid type A (GABAA) receptor is an important pharmacological target of alcohol. The phamacological characteristics of the receptor are largely determined by its subunit composition. Compared with all other alpha subtypes, the alpha6- containing receptors are more sensitive to GABA and less sensitive to benzodiazepines. The purpose of this study was to address a role for GABAAalpha6 receptor subunit gene in the development of alcohol dependence. The differential manifestation of alcohol withdrawal symptoms related to GABAAalpha6 polymorphism in patients treating with benzodiazepines was also examined. METHODS: Eighty-seven inpatients with alcohol dependence, and sixty healthy controls were evaluated using CIWA-Ar scale. Each patient was genotyped for GABAAalpha6 subunit. Association between GABAAalpha6 polymorphism and severity of withdrawal symptom were determined. RESULTS: No significant difference was found in GABAAalpha6 receptor genetic type and allelic distribution between the alcohol dependent and control subject. Tremor was more severe in CC than TT type. TT type had higher degree of anxiety, agitation and headache than CC type. The GABAAalpha6 C allele increased the average score of tremor significantly, and T allele increased that of agitation. CONCLUSION: The results suggested that GABAAalpha6 genetic polymorphism was not associated with alcohol dependence and with severity of alcohol withdrawal symptoms. But in benzodiazepine treated patients, GABAAalpha6 polymorphism and allelic type show the difference in severity of each withdrawal symptom. These differences of severity are partly responsible for the unique pharmacological properties associated with the GABAAalpha6 subunit.
Alcoholism ; Alleles ; Anxiety ; Benzodiazepines ; Dihydroergotamine ; gamma-Aminobutyric Acid ; Headache ; Humans ; Inpatients ; Polymorphism, Genetic ; Receptors, GABA ; Substance Withdrawal Syndrome* ; Tremor

OBJECTIVES: The aim of this study is to investigate the correlation between 2-dimensional (2D) cephalometric measurement and 3-dimensional (3D) cone beam computed tomography (CBCT) measurement, and to evaluate the availability of 3D analysis for asymmetry patients. MATERIALS AND METHODS: A total of Twenty-seven patients were evaluated for facial asymmetry by photograph and cephalometric radiograph, and CBCT. The 14 measurements values were evaluated and those for 2D and 3D were compared. The patients were classified into two groups. Patients in group 1 were evaluated for symmetry in the middle 1/3 of the face and asymmetry in the lower 1/3 of the face, and those in group 2 for asymmetry of both the middle and lower 1/3 of the face. RESULTS: In group 1, significant differences were observed in nine values out of 14 values. Values included three from anteroposterior cephalometric radiograph measurement values (cant and both body height) and six from lateral cephalometric radiographs (both ramus length, both lateral ramal inclination, and both gonial angles). In group 2, comparison between 2D and 3D showed significant difference in 10 factors. Values included four from anteroposterior cephalometric radiograph measurement values (both maxillary height, both body height) and six from lateral cephalometric radiographs (both ramus length, both lateral ramal inclination, and both gonial angles). CONCLUSION: Information from 2D analysis was inaccurate in several measurements. Therefore, in asymmetry patients, 3D analysis is useful in diagnosis of asymmetry.
Cephalometry ; Cone-Beam Computed Tomography ; Facial Asymmetry ; Humans ; Malocclusion

BACKGROUND & PURPOSE: The ocular torsion (OT) and tilt of the subjective visual vertical (SVV) are sensitive brainstem signs and helps us to localize lesion. We calibrated the degree of OT, SVV tilt and head tilt to investigate their characteristics and temporal profiles in patients with brainstem lesion. METHODS: We selected 15 patients with acute brainstem stroke. We took serial fundus photographs and body pictures in upright position at various times after the stroke. We also determined the deviations of patient's SVV. The data measurement for this investigation ranged from day 2 to day 47. RESULTS: Eight of ten patients with lateral medullay infarction showed ipsiversive tilt of SVV and OT. Among four patients with pontine infarction, one showed ipsiversive tilt and three contraversive. One patient with midbrain hemorrhage showed cotraversive tilt. The resolution of OT and the tilt of SVV in medullary lesions occurred over the periods ranging from 7 days to more than 47 days and was slower in patients with upper brainstem lesion than lower brainstem lesion. The directions of head tilt in our patients, especially with medullary lesions, were rather different from the previous reports. CONCLUSION: The vestibular dysfunction by the brainstem lesions disturbs the eye and head stabilization and also distorts the perception of the subjective vertical in space. The direction of OT and the tilt of SVV is ipsiversive in lower brainstem lesion and contraversive in upper brainstem lesion. But head tilt is contraversive in most lower brainstem lesion as well as upper brainstem lesion. Large-grouped study for the direction of head tilt is thought to be needed. These signs are compensated in the course of clinical recovery.
Brain Stem Infarctions* ; Brain Stem* ; Head* ; Hemorrhage ; Humans ; Infarction ; Mesencephalon ; Stroke

For hospice palliative care that provides comprehensive and general care, it is necessary to use assessment tools to objectively list issues and detail care plans. The initial assessment is a process of establishing an overall direction of care by identifying the patient's symptoms, social and spiritual issues and palliative care needs on the admission day or within one day of admission. This process is also used to identify the patients' and families' awareness of the illness, prognosis, treatment options and if the Physician Orders for Life-Sustaining Treatment (POLST) has been drafted. Consisting of 13 simple questions regarding the physical, mental, social, and spiritual domains, the Needs at the End-of-Life Screening Tool (NEST) is recommended as an initial assessment tool. Using specific assessment tools, a care plan is established for the issues identified in the initial assessment within three days of admission. A multidisciplinary assessment tool can be helpful in the physical domain. The psychosocial domain evaluates psychological distress, anxiety and depression. The social domain examines an ability to make decisions, understanding of the socioeconomic circumstance, family relationship, and death preparedness. A spiritual evaluation is also important, for which the Functional Assessment of Chronic Illness Therapy-Spiritual WellBeing Scale (FACIT-Sp) or the Spiritual Health Inventory (SHI) can be used. The use of an assessment tool could not only contribute to pain mitigation a better quality of life for patients, but also provide systematic training for a multidisciplinary team; And the process itself could be a stepping stone for the better care provision.
Anxiety ; Chronic Disease ; Depression ; Family Relations ; Hospice Care ; Hospices ; Humans ; Mass Screening ; Pain Measurement ; Palliative Care ; Prognosis ; Quality of Life

PURPOSE: The "Out-of-hospital Utstein Style" is an internationally recommended guideline for reporting outcome data for out-of-hospital resuscitation events. This study was designed to evaluate the current status of out-of-hospital cardiopulmonary resuscitation (CPR) in a tertiary emergency department and to provide basic data for a unified report on guidelines for resuscitation in Korea. METHODS: A clinical analysis of the out-of-hospital cardiac arrest (OHCA) patients, CPR performed in a tertiary emergency department, from July 1995 to December 2002 was conducted. The evaluation was made using Utstein reporting guidelines. RESULTS: Four hundred forty-nine patients were included in this study. The cardiac arrests were caused by non-cardiac medical diseases (41.9%), cardiac diseases (39.6%), unknown (10.0%), and trauma (8.5%). The initial electrocardiogram (ECG) showed asystole in 58.6% of the cases, other rhythms in 29.4%, and ventricular fibrillation/ventricular tachycardia (VF/VT) in 12.0%. Spontaneous circulation was restored (ROSC) in 41.2% of the cases. Twenty-four (5.3%) patients with witnessed and cardiogenic cardiac arrests had VF/VT on initial ECG, and of them, 5 (20.8%) patients were discharged alive. The mean circulatory arrest time was 19.7+/-13.6 minutes, and it was shorter in patients with ROSC (16.9+/-11.6) than in patients without ROSC (22.1+/-14.7, p= 0.003). CONCLUSION: The overall survival rate of OHCA patients was 6.7%, which was poorer than those of western countries. The overall duration from collapse to advanced cardiac life support (ACLS) was 19.7 minutes, which was too long. Major factors contributing to the low survival rate were most likely the lack of bystander CPR, delay in activating the emergency medical system (EMS), and inappropriate CPR by the EMT. We should make every effort to improve these areas.
Advanced Cardiac Life Support ; Cardiopulmonary Resuscitation* ; Electrocardiography ; Emergencies* ; Emergency Service, Hospital* ; Heart Arrest ; Heart Diseases ; Humans ; Korea ; Out-of-Hospital Cardiac Arrest* ; Resuscitation ; Survival Rate ; Tachycardia