The efficacy of acetaminophen, sponging plus acetaminophen, and sponging alone as method of lowering body temperature was compared in 108 children aged 8 weeks to 5 years who presented with an axillary temperature of 38.5degrees C or greater during the period from January 1993 to April 1993. The following results were obtained. 1) The male to female ratio was 2.5:1 and clinical diagnosis in the order of frequency were upper respiratory infection, gastroenteritis, pneumonia, urinary tract infection, cellulitis, chickenpox and hand-foot-mouth disease. 2) At thirty minutes after treatment, there was no significant difference on the decrement of temperature among the three groups. 3) At sixty minutes, the temperature decrement was the greatest in the group of sponging plus acetaminophen and that was statistically significant (P<0.01). But there was no significant difference between the group of acetaminophen and that of sponging.
Acetaminophen ; Body Temperature ; Cellulitis ; Chickenpox ; Child* ; Diagnosis ; Female ; Fever* ; Gastroenteritis ; Humans ; Male ; Pneumonia ; Urinary Tract Infections

The authors determined the value of performing urine microscopy on biochemically negative urine sepcimens in a pediatric population. The 746 urine specimens of patients who were either visited or admitted to the Department of Pediatrics, National Police Hospital, from March 1991 to July 1992 were reviewed on the basis of comparative evaluation of biochemical and microscopic urine analysis. Eight reactions of Clinitek(r) 200 were used as biochemical indicators, namely, pH, nitrite, albumin, glucose, ketone, urobilinogen, bilirubin, and blood. Out of 746 urine specimens studied, 186 were true positive. Thirty-six specimens reacted biochemically in the absence of positive microscopic findings (false postive), 492 specimens were true negatives. Thirty-two specimens had negative biochemical indicators, in spite of positive microscopy. The sensitivity of the biochemical parameters for predicting significant microscopy of urinary sediment is 85% and the specificity is 99%. The positive predictive value is 69.7% and the negative predictive value is 99.3%. The sensitivity of blood for RBC is 94%. and the specificity is 99%. The predictive value of a positive result is 84.6% and that of a negative result is 99.7%. We therefore conclude that urine microscopy is less necessary in biochemically negative urine specimens from asymptomatic pediatric patients, with hopefully resultant time and cost effectiveness.
Bilirubin ; Cost-Benefit Analysis ; Glucose ; Humans ; Hydrogen-Ion Concentration ; Microscopy ; Pediatrics ; Police ; Sensitivity and Specificity ; Urinalysis* ; Urobilinogen

BACKGROUND: There have been no studies of airway management strategies for difficult intubation and cannot intubate, cannot ventilate (CICV) situations in Korea. This study was intended to survey devices or methods that Korean anesthesiologists and intensivists prefer in difficult intubation and CICV situations. METHODS: A face-to-face questionnaire that consisted of a doctor's preference, experience and comfort level for alternative airway management devices was presented to anesthesiologists and intensivists at study meetings and conferences from October 2014 to December 2014. RESULTS: We received 218 completed questionnaires. In regards to difficult intubation, the order of preferred alternative airway devices was a videolaryngoscope (51.8%), an optical stylet (22.9%), an intubating laryngeal mask airway (11.5%), and a fiber-optic bronchoscope (10.6%). One hundred forty-two (65.1%) respondents had encountered CICV situations, and most of the cases were identified during elective surgery. In CICV situations, the order of preferred methods of infraglottic airway management was cricothyroidotomy (CT) by intravenous (IV) catheter (57.3%), tracheostomy by a surgeon (18.8%), wire-guided CT (18.8%), CT using a bougie (2.8%), and open surgery CT using a scalpel (2.3%). Ninety-eight (45%) of the 218 respondents were familiar with the American Society of Anesthesiologists' difficult airway algorithm or Difficult Airway Society algorithm, and only 43 (19.7%) had participated in airway workshops within the past five years. CONCLUSION: The videolaryngoscope was the most preferred device for difficult airways. In CICV situations, the method of CT via an IV catheter was the most frequently used, followed by wire-guided CT method and tracheostomy by the attending surgeon.
Airway Management ; Bronchoscopes ; Catheters ; Congresses as Topic ; Education ; Intubation* ; Intubation, Intratracheal ; Korea* ; Laryngeal Masks ; Methods ; Surveys and Questionnaires ; Tracheostomy

Individuals with Asia type DEL blood group, the RhD-variant that classified as serologically RhD-negative, do not produce anti-D even when exposed to the D-antigen. Therefore, it is considered safe to transfuse RhD-positive blood products to them. However, such transfusions are still rare in medical institutions, with only two cases reported in Korea. Here, we present cases of two additional patients based on our experience. A 60-year-old female patient undergoing extra corporeal membrane oxygenation (ECMO) for myocarditis presented with severe anemia.The patient was serologic RhD-negative. Due to the lack of RhD-negative RBC inventory for emergency transfusion, RhD-positive blood was transfused. After confirming the patient’s RHD genotype as Asia type DEL, the planned RhD-positive blood transfusion was continued. A total of 13 units of RhD-positive RBCs and 26 units of single donor platelets (SDPs) were transfused over 25 days. Throughout this period, all unexpected antibody tests were negative. The second patient, a 50-year-old male diagnosed with myelodysplastic syndrome (MDS), was serologic RhD-negative, and the RHD genotyping confirmed Asia type DEL. During the hospitalization period, a total of 113 units of RhD-positive SDPs and 10 units of fresh frozen plasma (FFP) were transfused over 64 days, and all unexpected antibody tests were negative. These two cases suggest the transfusion of RhD-positive blood products to patients with Asia type DEL is safe.

The antihypertensive efficacy and safety of Dilevalol, compared with Nicardipine, were evaluated in mild to moderate hypertensive patients in a randomized crossover study. Following a 3 week placebo washout (phase I), the first crossover (phase II) was initiated with 63 patients randomized to dilevalol and 62 to nicardipine. The 6 weeks of treatment was initiated with 100mg of dilevalol once daily or 40mg of nicardipine (20mg B.I.D.). After 2 weeks, patients not achieving a sitting DBP to < or =90mmHg or a decrease of > or =10mmhg were uptitrated to 200mg Dilevalol once daily or 60mg Nicardipine twice daily. A second three week placebo washout (phase III) followed by a second 6 week active treatment phase (phase IV) during which patients were crossed over to the alternative therapy as during phase II if the sitting DBP again met the entrance criteria. 18 patients were only evaluable for the first washout and treatment period because of early discontinuation or protocol violations. They were included in the safety evaluation. phass II patients treated with Dilevalol (n=63) were mean age of 52.9 years, 49% male and 51% mild hypertensives (< or =105mmHg). Phase ??patients treated with Nicardipine (n=62) were mean age of 51.2 years 55% male and 66% mild hypertensives. Both Dilevalol and Nicardipine significantly and equivalently lowered blood pressure relative to baseline (71% versus 67% normalization). Dilevalol slightly but significantly lowered heart rate (-5 beat/min versus -1 beat/min). Dilevalol significantly increased HDL cholesterol (2.1mg/dl, 4.2%) and decreased total cholesterol (9.6mg/dl, 4.2%) while Nicardipine produced only a small but not significant reduction in total cholesterol (3.2mg/dl, 1.2%). The incidence of adverse effects were lower with Dilevalol than with Nicardipine and especially flushing and ankle edema occurred significantly more often with Nicardipine. in conclusion, dilevalol is equally effective but has a superior safety profile to nicardipine in the treatment of mild to moderate hypertension.
Ankle ; Blood Pressure ; Cholesterol ; Cholesterol, HDL ; Cross-Over Studies ; Edema ; Flushing ; Heart Rate ; Humans ; Hypertension* ; Incidence ; Labetalol* ; Male ; Nicardipine*

To evaluate the sensitivity and specificity of transthoracic fine needle aspiration cytology(TFNAC) in the preoperative diagnosis of pulmonary nodules, a retrospective analysis was carried out on a consecutive series of 200 TFNACs. They included 186 primary malignant tumors, 66 squamous cell carcinomas, 65 adenocarcinomas, 36 small cell carcinomas, 7 large cell carcinomas, 4 carcinoids, 8 others, 9 metastatic tumors, and 5 benign tumors. On cytohistologic correlation of malignant pulmonary tumors, the pro- cedure had a sensitivity of 97.3% and a specificity of 100%. A 86.6% correct correlation between the cytologic and histologic diagnoses was achieved. Five out of the 7 undifferentiated large cell carcinomas, 10 out of the 65 adenocarcinomas, 2 out of the 36 small cell carcinomas, and 2 out of the 66 squamous cell carcinomas were turned out to be mistyped in cytologic diagnosis. We concluded that TFNAC is a highly sensitive and specific preoperative diagnostic procedure in the investigation of patients with discrete pulmonary nodules in whom the specific cell type of the malignant neoplasm has important implications in treatment modality and prognosis.
Adenocarcinoma ; Bezafibrate ; Biopsy, Fine-Needle ; Carcinoid Tumor ; Carcinoma, Large Cell ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Diagnosis ; Endometrial Neoplasms ; Female ; Humans ; Hydronephrosis* ; Kidney* ; Natural History* ; Papanicolaou Test ; Prognosis ; Retrospective Studies ; Sensitivity and Specificity

Purpose: The ratio of soluble fms-like tyrosine kinase 1 (sFlt-1) to placental growth factor (PlGF) is considered a predictive marker of preeclampsia. However, the relationship between the sFlt-1/PlGF ratio and perinatal and neonatal outcomes remains unknown. This study aimed to determine the associations of the sFlt-1/PlGF ratio with perinatal and neonatal outcomes in newborns born to mothers with preeclampsia. Methods: This retrospective cohort study reviewed singleton neonates born to mothers with preeclampsia who underwent testing for the sFlt-1/PlGF ratio. We investigated the relationship between maternal sFlt-1/PlGF ratios and gestational age (GA), birth weight (Bwt), Bwt z-score, morbidities, and mortality of neonates born to mothers tested for the sFlt-1/PlGF ratio. Maternal sFlt-1/PlGF ratios examined within 30 days before delivery were used for analysis. Neonatal morbidities and mortality were investigated only in preterm infants born earlier than 32 weeks GA. Results: A total of 225 neonates were included, of which 163 (72.4%) were preterm infants. GA (R=– 0.577, p<0.001), Bwt (R=–0.713, p<0.001), and Bwt z-score (R=–0.608, p<0.001) exhibited significant negative correlations with the sFlt-1/PlGF ratios. Among the 50 preterm infants born earlier than 32 weeks GA, neonatal morbidities were not significantly associated with the sFlt-1/PlGF ratio after adjusting for GA and Bwt. Conclusion In mothers with preeclampsia, a higher sFlt-1/PlGF ratio was associated with the delivery of newborns with lower GA and lower Bwt. However, this ratio was not associated with increased morbidity or mortality in premature infants born earlier than 32 weeks GA.

PURPOSE: To determine whether there is any difference in variceal distribution between patients with and without a history of esophageal variceal bleeding. MATERIALS AND METHODS: To compare the distribution of varices, abdominal CT scans of 24 patients with a history of esophageal variceal bleeding (hemorrhagic group) and 90 patients without a history of bleeding (non-hemorrhagic group) were retrospectively assessed. RESULTS: The most common varices in both the hemorrhagic (n = 21, 87.5 %) and nonhemorrhagic group (n = 53, 58.9 %) were coronary varices, with a statistically significant frequency (p < .01). Esophageal varices were also more common in the hemorrhagic than the nonhemorrhagic group (n=19, 79.2 % vs n = 36, 40.0 % : P < .005). Splenorenal shunts were more common in the nonhemorrhagic (n = 8, 8.9 %) than in the hemorrhagic group(n = 0, 0 %) (P < .05). Other types of varice such as paraumbilical (n = 10, 41.7 % vs n = 21, 23.3 %), perisplenic (n = 6, 25 % vs n = 15, 16.7 %) and retroperitoneal-paravertebral (n = 11, 45.8 % vs n = 24, 26. 7 %) were more common in the hemorrhagic group, but without a statistically significant frequency. CONCLUSION: The frequency of coronary and esophageal varices was significant in patients with a history of esophageal variceal bleeding. In patients without such a history, splenorenal shunts were seen.
Esophageal and Gastric Varices ; Hemorrhage ; Humans ; Hypertension, Portal* ; Retrospective Studies ; Splenorenal Shunt, Surgical ; Tomography, X-Ray Computed ; Varicose Veins

OBJECTIVE: To describe the radiologic findings of migrating lobar atelectasis of the right lung. MATERIALS AND METHODS: Chest radiographs (n = 6) and CT scans (n = 5) of six patients with migrating lobar atelectasis of the right lung were analyzed retrospectively. The underlying diseases associated with lobar atelectasis were bron-chogenic carcinoma (n = 4), bronchial tuberculosis (n = 1), and tracheobronchial amyloidosis (n = 1). RESULTS: Atelectasis involved the right upper lobe (RUL) (n = 3) and both the RUL and right middle lobe (RML) (n = 3). On supine anteroposterior radiographs (n = 5) and on an erect posteroanterior radiograph (n = 1), the atelectatic lobe(s) occupied the right upper lung zone, with a wedge shape abutting onto the right mediastinal border. On erect posteroanterior radiographs (n = 6), the heavy atelectatic lobe(s) migrated downward, forming a perior infrahilar area of increased opacity and obscuring the right cardiac margin. Erect lateral radi-ographs (n = 4) showed inferior shift of the anterosuperiorly located atelectatic lobe(s) to the anteroinferior portion of the hemithorax. CONCLUSION: Atelectatic lobe(s) can move within the hemithorax according to changes in a patient's position. This process involves the RUL or both the RUL and RML.
Amyloidosis/radiography ; Atelectasis/*radiography ; Carcinoma, Bronchogenic/radiography ; Female ; Human ; Lung Diseases/radiography ; Male ; Middle Age ; Posture ; Tuberculosis, Pulmonary/radiography

An intratesticular simple cyst is a rare lesion. The pathogenesis of such lesions is uncertain. Clinically, an intratesticular simple cyst may be difficult to differentiate from a cystic neoplasm. However, preoperative diagnosis is possible using ultrasonography (US). Testis-sparing surgery with simple enucleation of the cyst has a favorable outcome. We report an intratesticular simple cyst in a 48-year-old male who had a non-tender cystic mass in the right testis for 2 years. The diagnosis was made by preoperative US. The patient underwent a testis-sparing surgery. After simple excision of the cyst, histological examination revealed a simple cyst lined by ciliated cuboidal and columnar epithelium.
Cilia ; Diagnosis ; Epithelium* ; Humans ; Male ; Middle Aged ; Testis ; Ultrasonography