PURPOSE: Although the nasopharyngeal aspirate (NPA) is more commonly used because of relatively higher accuracy, the nasal swab (NS) is a less painful and easier method than NPA. A few recent reports have shown that NS is more effective than NPA for the detection of respiratory virus using immunofluorescence or viral culture. The objective of the present study was to compare the results of NPA and NS sampling specimens in children for respiratory viruses detection using multiplex RT-PCR. METHODS: From December 2008 to June 2009 Paired NPA and NS specimens were collected from 250 children admitted with symptoms of acute respiratory infections at the Department of Pediatrics, Soonchunhyang University Cheonan Hospital, Cheonan, Korea. The sensitivity and agreement of virus detection between NPA and NS using multiplex RT-PCR were compared and analyzed. RESULTS: The median age of the subjects was 1.3 years (range, 20 days to 16.5 years), and 228 patients (91.2%) were under the age of 5 years. The agreement of virus detection between NPA and NS was excellent (Cohen's kappa >0.8) for parainfluenza virus type 3 or substantial (0.6 to 0.8) for rhinovirus A, RSV A and RSV B, moderate (0.4 to 0.6) for adenovirus and metapneumovirus and poor (<0.4) for influenza A. The overall sensitivity of detection of respiratory viruses was significantly higher in NPA (0.96) than in NS (0.59, P<0.05). CONCLUSION: We recommend NPA may be more accurate specimen for detection of respiratory viruses in hospitalized children. NS might be used in limited cases at a office setting or for larger epidemiological studies. However, results obtained from NS for influenza virus type A, metapneumovirus and adenovirus, should be interpreted carefully.
Adenoviridae ; Child ; Child, Hospitalized ; Epidemiologic Studies ; Fluorescent Antibody Technique ; Humans ; Influenza, Human ; Korea ; Metapneumovirus ; Orthomyxoviridae ; Parainfluenza Virus 3, Human ; Pediatrics ; Respiratory Tract Infections ; Rhinovirus ; Viruses

PURPOSE: Although the nasopharyngeal aspirate (NPA) is more commonly used because of relatively higher accuracy, the nasal swab (NS) is a less painful and easier method than NPA. A few recent reports have shown that NS is more effective than NPA for the detection of respiratory virus using immunofluorescence or viral culture. The objective of the present study was to compare the results of NPA and NS sampling specimens in children for respiratory viruses detection using multiplex RT-PCR. METHODS: From December 2008 to June 2009 Paired NPA and NS specimens were collected from 250 children admitted with symptoms of acute respiratory infections at the Department of Pediatrics, Soonchunhyang University Cheonan Hospital, Cheonan, Korea. The sensitivity and agreement of virus detection between NPA and NS using multiplex RT-PCR were compared and analyzed. RESULTS: The median age of the subjects was 1.3 years (range, 20 days to 16.5 years), and 228 patients (91.2%) were under the age of 5 years. The agreement of virus detection between NPA and NS was excellent (Cohen's kappa >0.8) for parainfluenza virus type 3 or substantial (0.6 to 0.8) for rhinovirus A, RSV A and RSV B, moderate (0.4 to 0.6) for adenovirus and metapneumovirus and poor (<0.4) for influenza A. The overall sensitivity of detection of respiratory viruses was significantly higher in NPA (0.96) than in NS (0.59, P<0.05). CONCLUSION: We recommend NPA may be more accurate specimen for detection of respiratory viruses in hospitalized children. NS might be used in limited cases at a office setting or for larger epidemiological studies. However, results obtained from NS for influenza virus type A, metapneumovirus and adenovirus, should be interpreted carefully.
Adenoviridae ; Child ; Child, Hospitalized ; Epidemiologic Studies ; Fluorescent Antibody Technique ; Humans ; Influenza, Human ; Korea ; Metapneumovirus ; Orthomyxoviridae ; Parainfluenza Virus 3, Human ; Pediatrics ; Respiratory Tract Infections ; Rhinovirus ; Viruses

Conjoined twinning is a rare congenital malformation, accounting for 1% monozygotic twins. Conjoined twins result if twining is initiated after the embryonic disc and rudimentary amniotic sac have been formed and if division of the embryonic disc is incomplete. Recently we experienced a case of conjoined twins, dicephalus dipus dibrachius, who had died at 3 hours of life, and performed autopsy. Autopsy revealed a total duplication of the heads, spines up to sacrum, small bowels, thymus and lungs. Two hearts existed within a common pericardium.
Autopsy ; Head ; Heart ; Humans ; Lung ; Pericardium ; Sacrum ; Spine ; Thymus Gland ; Twins, Conjoined* ; Twins, Monozygotic

Progressive ischemia can result in gangrenous changes of the tissues. Most commonly the digits are affected initially, but progression to the hand is not unusual. Small amounts of infection superimposed on a severe chronic ischemic state can progress very rapidly to gangrene. Clinically, dry and wet gangrene should be differentiated. Dry gangrene represents mummification of tissue, and active purulent tissue and cellulitis are absent. Wet gangrene is characterized by active infection with cellulitis and purulent tissue planes and is an indication for urgent amputation to prevent ascending infection. We experienced a case of dry gangrenous extremity due to septic shock after anethesia.
Amputation ; Cellulitis ; Extremities* ; Gangrene ; Hand ; Humans ; Ischemia ; Shock, Septic*

No abstract available.
Animals ; Embryonic Structures* ; Mice* ; Quality Control*

Change in heart rate, mean arterial pressure, PaO2 and PaCO2 Caused by enflurane and halothane anesthesia were investigated in patients premedicated with diazepam and glycop-yrrolate. Enflurane caused a slightly(10.1%) increase in heart rate and not change in mean arter-ial pressure(0.1%), Halothane depressed heart slightly(10.16%) and arterial pressure was also (12.2%). The authors conclude that enflurane possesses a positive chronotropic effect.
Anesthesia* ; Arterial Pressure* ; Diazepam ; Enflurane* ; Halothane* ; Heart Rate* ; Heart* ; Humans

BACKGROUND: It is difficult to choose the appropriate drug when hypotension develops in patients with pulmonary hypertension (PH). There is no known drug to increase the systemic blood pressure (BP) without an increase of pulmonary arterial pressure (PAP). We observed the effects of phenylephrine (PE) and norepinehrine (NE) on systemic and pulmonary hemodynamics when hypotension was treated in patients with PH. METHODS: Patients with PH (mean PAP > or = 25 mmHg, n = 28) were studied. When hypotension occurred (systolic BP < or = 100 mmHg, T1) after the induction of anesthesia, PE or NE was randomly infused to raise the systolic BP above 130 mmHg (T2) and 150 mmHg (T3). Hemodynamic variables were measured at T1, T2 and T3, and the ratio (RBP) of mean PAP to mean BP was calculated. The measurements were performed before skin incision to avoid the effects of surgical stimulation. RESULTS: NE increased BP concomitantly with relatively small increase of PAP, meaning a decrease of RBP (P < 0.05) without any other changes of hemodynamic variables in all patients. However, PE could not raise BP above 130 mmHg in one third of patients, and decreased the cardiac index without a significant decrease of RBP. CONCLUSIONS: NE increased BP and decreased RBP without tachycardia or any other hemodynamic disturbances. NE is considered to be a proper and safe drug to raise BP when hypotension occurs in patients with PH.
Anesthesia ; Arterial Pressure ; Blood Pressure ; Hemodynamics* ; Humans ; Hydrogen-Ion Concentration ; Hypertension, Pulmonary* ; Hypotension ; Norepinephrine* ; Phenylephrine* ; Skin ; Tachycardia

PURPOSE: The purpose of this study was to investigate the effects of three-dimensional virtual reality horse riding simulator training using a head-mounted display on gait and balance in children with cerebral palsy.METHODS: Ten children with cerebral palsy were randomly assigned to the horse riding simulator (HRS) group (n=5) or the horse riding simulator with virtual reality (HRSVR) group (n=5). To evaluate balance, center of gravity (COG) sway velocity and total sway distance of each group were assessed using the Wii balance board, and gait speed and stride length of each group were assessed using a gait analysis system.RESULTS: Intra-group comparisons between pre- and post-intervention measures revealed that there were significant changes in all gait and balance variables such as stride length, gait velocity, COG sway velocity and COG sway distance in the HRSVR group (p<0.05). In the HRS group, there were significant changes in all variables except stride length (p<0.05). In addition, inter-group comparisons showed significant differences between the two groups in stride length, gait velocity and COG sway distance except COG sway velocity (p<0.05).CONCLUSION: The findings of this study suggest that horse riding simulator training combined with 3D virtual reality can be a new positive therapeutic approach for improving functional performance in children with cerebral palsy.
Cerebral Palsy ; Child ; Gait ; Gravitation ; Horses ; Humans ; Pilot Projects

BACKGROUND: It has been reported that the association between blood pressure and cognitive impairment could be modified by factors such as gender, education, and Apo E genotypes. This study was aimed to investigate whether `age' could also be a modifier of the association. METHODS: The study group consisted of 489 participants aged 65 years or over who lived in Namwon, Korea. The presence of hypertension was ascertained by the measurement of their resting blood pressure. A cognitive impairment was considered to be present when a Korean Mini-Mental State Examination score was less than 19 (30th percentile). RESULTS: A higher systolic blood pressure was significantly associated with cognitive impairment, after an adjustment for age, gender, education, and occupation. However, the significance was lost in subjects aged 71 or over. CONCLUSIONS: High systolic blood pressure is a factor strongly associated with cognitive impairment in an aged population. However, in the subjects with far advanced age, the association is not significant. Further studies are required to elucidate whether blood pressure lowering strategies should be differentiated according to age in order to reduce cognitive impairment.
Adult* ; Aged* ; Apolipoproteins E ; Blood Pressure* ; Education ; Genotype ; Humans ; Hypertension ; Jeollabuk-do ; Korea ; Occupations

Activation of caspase-1 by NALP3 inflammasomes has been shown to be important in initiating acute gouty arthritis. The objectives of this study were to measure the levels of caspase-1 in synovial fluid in gout and various arthritides, and to elucidate the clinical significance of caspase-1 levels in synovial fluid. Caspase-1, IL-1beta, IL-18, and uric acid were measured in synovial fluid from 112 patients with gout and other arthritides, such as rheumatoid arthritis, osteoarthritis, and spondyloarthropathy. Caspase-1 in synovial fluid from patients with crystal-induced arthritis, inflammatory arthritis, osteoarthritis, and spondyloarthropathy was 35.9 +/- 86.7, 49.7 +/- 107.7, 2.1 +/- 7.0, and 152.6 +/- 155.7 pg/mL, respectively. The mean level and the frequency of high levels (> or =125 pg/mL) of caspase-1 in spondyloarthropathy were significantly higher than those in the other arthritides including gout. Caspase-1 was detectible in the synovial fluid of patients with the various arthritides. Contrary to our hypothesis, the caspase-1 level in the synovial fluid of patients with gout was not higher than in that of other arthritides. High levels of caspase-1 may be helpful in differentiating spondyloarthropathy from other arthritides.
Adult ; Aged ; Arthritis, Rheumatoid/enzymology/metabolism/pathology ; Caspase 1/*analysis ; Female ; Gout/*enzymology/metabolism/pathology ; Humans ; Interleukin-18/analysis ; Interleukin-1beta/analysis ; Leukocyte Count ; Male ; Middle Aged ; Osteoarthritis/enzymology/metabolism/pathology ; Spondylarthropathies/*enzymology/metabolism/pathology ; Synovial Fluid/*enzymology/metabolism ; Uric Acid/analysis