Aprotinin is a serine protease inhibitor that improves the hemostatic function and modulates the anti-inflammatory responses. Recently, aprotinin has been widely used in various surgical procedures including open heart surgery. One of the complications of aprotinin is anaphylactic reaction and the incidence increases with re-exposure. We experienced a case of anaphylactic reaction in a 5-year-old female during open heart surgery. After cardiopulmonary bypass weaning, during aprotinin i.v. infusion for reducing blood loss, sudden hypotension and bradycardia occurred. After re-institution of CPB, the patient recovered. In the post-operative review of the chart and patient, we found that this patient had been exposed to aprotinin 20 days ago. In conclusion, we recommend some preventable methods for anaphylaxis of aprotinin; aprotinin should be used after a skin test or i.v. infusion test and used by mixing with CPB priming solution.
Anaphylaxis ; Aprotinin* ; Bradycardia ; Cardiopulmonary Bypass ; Child, Preschool ; Female ; Heart* ; Humans ; Hypotension ; Incidence ; Serine Proteases ; Skin Tests ; Thoracic Surgery* ; Weaning

Head ; Lipoma ; Neck Muscles ; Neck ; Recurrence ; Shoulder ; Subcutaneous Tissue

Background: Despite the demand for greater competence of dental hygienists in recent times, and the consequent standardization of systems in the organizations, there is a lack of a proper system for hierarchal positions of dental hygienists.The aim of this study was to identify the tasks performed by Korean dental hygienists in various work settings and hierarchal positions to suggest a standardized system for task-related hierarchal positions. Methods: A survey was conducted by sending questionnaires to 966 dental hygienists, and responses from 757 participants were included in the final analysis. The survey comprised questions regarding participants’ general characteristics, tasks, current positions, and the internal policies or standards of the respective organizations to define these positions. The participants’ positions were analyzed as frequency and cross-sectional analysis with respect to their general characteristics, their place in the organizational charts, the size of their workplaces, and differences in the tasks performed. Results: Data showed that 82.6% of the hospitals and clinics in Korea have organizational systems to determine the positions, and there was a significant difference in the systems according to the size of the health facility (p＜0.05). The standards or policies used to define positions within general or university hospitals were determined by internal regulations or bylaws, whereas work experience was the major determinant of positions in smaller dental hospitals or clinics. The main tasks performed by dental hygienists in Korea were dental assistance (81.2%), routine dental hygiene tasks (53.4%), and administrative tasks, such as reception and billing (46.1%). Conclusion Most dental hygienists in Korea are actively involved in dental assistance. Therefore, their specific tasks and responsibilities should be standardized more effectively. The data obtained from this study can be used to establish a standardized position system.

We have used mivacurium in two myasthenic patients, a generalized myasthenia gravis (MG) patient presenting for thymectomy and a Lambert-Eaton myasthenic (LEM) patient for mediastinoscopic lymph node biopsy. Both of them received nitrous oxide/oxygen (1:1)-narcotic-enflurane anesthesia with mivacurium as a muscle relaxant and the neuromuscular blocking effect of mivacurium was monitored continuously through the operation as well as before the induction of anesthesia. The dose of mivacurium for MG patient was 5.5 mg and LEM patient was 12 mg, because MG patient showed more severe clinical symptoms. The response to train-of-four (TOF) ulnar nerve stimulation was recorded using accelography. The onset times to maximal block in MG and LEM patients were 30 and 120 sec, respectively after injection and the recovery times to 25% from maximal block were 117 and 76 min, respectively. Mivacrium would be safe and appropriate for use in myasthenic patients, with relatively small dose under the neuromuscular monitoring.
Anesthesia ; Biopsy ; Humans ; Kinetocardiography ; Lymph Nodes ; Myasthenia Gravis ; Neuromuscular Blockade ; Neuromuscular Monitoring ; Thymectomy ; Ulnar Nerve

PURPOSE: Group B streptococcal (GBS) meningitis is the leading cause of mortality and morbidity in neonates. There are limited current data regarding outcomes from GBS meningitis and factors that predict an adverse outcome. METHODS: Twenty-three cases of GBS meningitis that were proven by cerebrospinal fluid culture from 2000 to 2010 were retrospectively reviewed. RESULTS: All GBS meningitis cases occurred in young infants less than 3 months and were late-onset (> or =7 days). Four infants (17.4%) died, and three (13.0%) were neurologically impaired at hospital discharge. Compared to the 16 infants with normal neurologic examinations, the 7 infants who died or had adverse outcomes at hospital discharge were more likely to present with seizures within hours of admission, have coma, require pressor support or ventilator support, have an initial peripheral blood leukocyte count less than 4,000/mm3 or neutrophil count less than 1,000/mm3, and have ampicillin resistance on culture. CONCLUSION: Despite advances in intensive care, 30.4% of infants with GBS meningitis die or have neurologic impairment at hospital discharge. Poor outcome can be predicted in cases that have seizures, coma, peripheral leukopenia, or require ventilator or pressor support on initial presentation. These cases show a tendency toward resistance to ampicillin, so vancomycin can be tried initially.
Ampicillin ; Ampicillin Resistance ; Coma ; Humans ; Infant ; Infant, Newborn ; Critical Care ; Leukocyte Count ; Leukopenia ; Meningitis ; Neurologic Examination ; Neutrophils ; Prognosis ; Retrospective Studies ; Seizures ; Streptococcus agalactiae ; Vancomycin ; Ventilators, Mechanical

A 73-year-old male presented a six-month history of buttock pain radiating into his thigh. The MRI revealed a large enhancing mass lesion involving the sacrum, with extension into the sacral canal. The tumor markers were measured to distinguish skeletal metastasis of carcinoma from primary bone tumor. The CA 19-9 was elevated. Despite the investigation, the primary site of cancer could not be found. Sacral bone biopsy was done. The pathologic examination revealed necrosis, chronic granulomatous inflammation, and multinucleated giant cells, consistent with tuberculosis. Sacral tuberculosis is rare in patients with no history of tuberculosis. Such solitary osteolytic lesions involving the subarticular region of large joints may mimic bone neoplasms and may be called "tuberculous pseudotumors." This case report intends to emphasize that bone tuberculosis should be a differential diagnosis in the presence of atypical clinical and radiological features. As tuberculous lesions may be mistaken for neoplasms, a small amount of fresh tissue should be sent for culture even if clinical diagnosis of a tumor seems likely. Described herein is a case of sacral tuberculosis mimicking metastatic bone tumor with elevated CA 19-9.
Aged ; Biopsy ; Bone Neoplasms ; Buttocks ; Diagnosis, Differential ; Giant Cells ; Humans ; Hydrazines ; Inflammation ; Joints ; Male ; Necrosis ; Neoplasm Metastasis ; Sacrum ; Thigh ; Tuberculosis ; Tuberculosis, Osteoarticular ; Biomarkers, Tumor

Purpose: We investigated disparities in retinal nerve fiber layer (RNFL) thickness surrounding the optic disc among pediatric migraine patients based on the presence of a concomitant visual aura. Methods: We used optical coherence tomography to measure RNFL thickness around the optic disc in children with migraines and no organic diseases, along with a control group of healthy children. Differences in RNFL thickness were analyzed based on the pattern of prognostic symptoms. Additionally, we investigated the effects of migraine duration and frequency on RNFL thickness. Results: In total, 45 children with migraine and 30 healthy controls were enrolled in this study. Among the children with migraine, 15 experienced visual aura, whereas 30 did not exhibit visual aura. Visual prognostic symptoms included blurred vision, scotoma, and scintillating scotoma. Seven children presented with blurred vision and scotoma, whereas eight reported scintillating scotomas. The mean RNFL thickness around the optic disc was significantly lower in patients with blurred vision and scotomas (89.19 ± 7.99 μm) compared with the control group (98.79 ± 8.49 μm), patients without visual aura (100.55 ± 6.43 μm), and patients with scintillating scotoma (102.21 ± 10.13 μm, p < 0.05). Conclusions RNFL thickness around the optic disc was significantly reduced in children with migraine who reported symptoms of blurred vision and scotoma.

PURPOSE: The purpose of this study was to compare clinical manifestations of human bocavirus (hBoV), respiratory syncytial virus (RSV), and human rhinovirus (hRV) in children with acute wheezing. METHODS: We retrospectively investigated 549 virus-positive throat swabs obtained between January 2006 and December 2008 from pediatric inpatients with acute respiratory tract disease at Kwangju Christian Hospital. Among them, 109 patients, who had lower respiratory tract infections with wheezing, were enrolled in this study. The medical records of patients with positive results were reviewed for clinical data. RESULTS: The mean age of the patients with RSV was 7.15 months, 15.66 months in those with hRV, and 15.04 months in those with hBoV. The mean fever duration and frequency of patients with fever was 2.43 days and 47.9% for RSV, 2.86 days and 51.7% for hRV, and 3.75 days and 69.6% for hBoV. The frequency of patients with acute otitis media was 20.8% in the RSV, 20.7% in the hRV, and 13.0% in the hBoV groups. The frequency of lung infiltration on chest X-ray was 12.5% in the RSV, 20.7% in the hRV, and 47.8% in the hBoV groups. CONCLUSION: We compared the clinical manifestations of respiratory viral infections in infants and children with wheezing. However, further surveillance will be necessary to clarify the clinical manifestations of the viruses.
Bocavirus ; Child ; Fever ; Human bocavirus ; Humans ; Infant ; Inpatients ; Korea ; Lung ; Medical Records ; Otitis Media ; Pharynx ; Respiratory Sounds ; Respiratory Syncytial Viruses ; Respiratory Tract Diseases ; Respiratory Tract Infections ; Retrospective Studies ; Rhinovirus ; Thorax

Neonatal hydrometrocolpos is the cystic dilatation of the vagina and uterus, which is caused by the combination of vaginal obstruction such as imperforate hymen, transverse vaginal septum, or vaginal atresia, and glandular secretion by maternal estrogenic stimulation. Although hydrometrocolpos is a rare congenital abnormality unlike pubertal hematocolpos, it is one of the relatively common abdominal masses in neonates. In typical cases the diagnosis may be determined easily by the combination of a pelvic mass, upper urinary tract dilatation and a bulging membrane in the vaginal introitus. The presense of a lower abdominal mass in a female infant should always arouse suspicion of hydrometrocolpos and lead to careful examination of the vagina. We report a case of neonatal hydrometrocolpos due to imperforate hymen which was initially presented as a large abdominal mass and a bulging membrane in the vaginal introitus. For 72 hrs, the abdominal mass increased rapidly, accompanied by urinary tract obstruction. It was relieved by a simple incision of the imperforate hymen and drainage of 300 cc of whitish mucoid vaginal fluid, and by Foley catheter drainage of 750 cc urine. No other anomaly was observed.
Catheters ; Congenital Abnormalities ; Diagnosis ; Dilatation ; Drainage ; Estrogens ; Female ; Hematocolpos ; Humans ; Hymen ; Infant ; Infant, Newborn ; Membranes ; Urinary Tract* ; Uterus ; Vagina