As neonates are brought to the emergency department (ED) for various complaints, it is challenging for emergency physicians to clinically determine the urgency of the visit. We sought to explore clinical characteristics associated with urgent visits to the ED. We conducted a retrospective study by reviewing medical records of neonatal visits to a tertiary pediatric regional emergency center for 5 years. Cases of patients who were discharged after checking only chest or abdominal X-ray or discharged without workup, were classified as non-urgent visits. Cases where more examinations were performed, or when the patient was hospitalized, were classified as urgent visits. Various clinical features and process in the ED were compared between the groups. Of the 1,008 cases enrolled in this study, 856 (84.9%) were urgent and 152 (15.1%) were non-urgent visits. After adjustment by multiple logistic regression analysis, non-urgent visits were associated with self-referrals rather than physician-referrals (odds ratio [OR], 5.96), visits in the evening rather than at night or daytime (OR, 2.51), patient visits from home rather than from medical facilities (OR, 2.19; 95). Fever and jaundice were the most common complaints (25.7% and 24.5%, respectively), and their OR of non-urgent visit was relatively low (adjusted OR 0.03 and 0.03, respectively). However, other common complaints, such as vomiting and cough (7.4% and 7.1%, respectively), were more likely to be non-urgent visits (adjusted OR 2.96 and 9.83, respectively). For suspected non-urgent visits, emergency physicians need to try to reduce unnecessary workup and shorten length of stay in ED.
Cough ; Emergencies* ; Emergency Service, Hospital* ; Fever ; Humans ; Infant, Newborn ; Jaundice ; Length of Stay ; Logistic Models ; Medical Records ; Retrospective Studies ; Thorax ; Vomiting

Generalized hyperpigmentation has a wide range of causes, including endocrine diseases, uremia, drugs, and heavy metals. Cutaneous pigmentation observed in 70% of uremic patients on hemodialysis. However, it is clinically difficult to define the exact cause of hyperpigmentation in chronic renal failure patients. We experienced a case of cutaneous hyperpigmentation caused by generalized argyria in chronic hemodialysis patient. A 38-year-old male patient presented with slowly progressive blue-black discoloration of skin. He had been on maintenance hemodialysis for 5 years and took sliver pills 36 g daily during 2.5 years to relieve thirst. The other source of silver exposure could not be determined. Pathologic examination of skin biopsy specimen showed focal deposits of fine, uniform, brownish granules along the basement membrane zone of hair in the dermis, which is characteristic findings of argyria. The silver deposits were also confirmed by increase in serum silver level and silver amount in liver and skin tissue. Argyria should be suspected in chronic hemodialysis patients presenting with a diffuse bluish-gray discoloration of the skin and nails and evaluated carefully by skin biopsy with quantitation of tissue silver level.
Adult ; Argyria* ; Basement Membrane ; Biopsy ; Dermis ; Endocrine System Diseases ; Hair ; Humans ; Hyperpigmentation ; Kidney Failure, Chronic ; Liver ; Male ; Metals, Heavy ; Pigmentation ; Renal Dialysis* ; Silver* ; Skin ; Thirst ; Uremia

Generalized hyperpigmentation has a wide range of causes, including endocrine diseases, uremia, drugs, and heavy metals. Cutaneous pigmentation observed in 70% of uremic patients on hemodialysis. However, it is clinically difficult to define the exact cause of hyperpigmentation in chronic renal failure patients. We experienced a case of cutaneous hyperpigmentation caused by generalized argyria in chronic hemodialysis patient. A 38-year-old male patient presented with slowly progressive blue-black discoloration of skin. He had been on maintenance hemodialysis for 5 years and took sliver pills 36 g daily during 2.5 years to relieve thirst. The other source of silver exposure could not be determined. Pathologic examination of skin biopsy specimen showed focal deposits of fine, uniform, brownish granules along the basement membrane zone of hair in the dermis, which is characteristic findings of argyria. The silver deposits were also confirmed by increase in serum silver level and silver amount in liver and skin tissue. Argyria should be suspected in chronic hemodialysis patients presenting with a diffuse bluish-gray discoloration of the skin and nails and evaluated carefully by skin biopsy with quantitation of tissue silver level.
Adult ; Argyria* ; Basement Membrane ; Biopsy ; Dermis ; Endocrine System Diseases ; Hair ; Humans ; Hyperpigmentation ; Kidney Failure, Chronic ; Liver ; Male ; Metals, Heavy ; Pigmentation ; Renal Dialysis* ; Silver* ; Skin ; Thirst ; Uremia

University life can be stressful for even the most satisfied students. Especially medical school students have higher levels of stress. To manage their stress level and social connection, they are using SNS. The purpose of this study was to investigate the effect of SNS on medical students by analysis of SNS use pattern of medical students. In the analysis of the first grade of Medicine, 51 students (58.6%) posted on Facebook in the past year and posted a total of 1,452 articles (average: 28.5). We analyzed the content of the posts and found that most of them were celebrating a birthday (50%) or confirming their regards (18%). Next, there were other people's posts (10%) and travel posts (6%). Besides, there were profile photo upload (3%), school life (3%), romance (2%) or family (1%). Female students (16 times / 17 students) changed the profile pictures more frequently than male students (18 times / 34 students) (p = 0.003). There was no statistical significance in all items except for the change of profile picture according to sex. On the other hand, the analysis of the content of the share showed that most of the contents shared about humor (42%), food (15%) and music (14%). Most of the medical students used SNS primarily for social activities, not for educational purposes. Based on this analysis, there should be more research on how SNS can help medical students during medical education.
Education, Medical ; Female ; Hand ; Humans ; Male ; Music ; Schools, Medical ; Students, Medical*

PURPOSE: Ocular perforation during lid anesthesia is rarely reported. We describe here a case of inadvertent corneal perforation and traumatic cataract that occurred during lid anesthesia in a procedure for hordeolum removal. METHODS: A 33-year-old woman presented with a sudden visual loss of her left eye. She had undergone hordeolum removal the day before at a local clinic. On ophthalmologic examination, the cornea was perforated and the lens cortex was extruded into the anterior chamber. After cataract removal and IOL implantation, antibiotics were injected into the vitreous. RESULTS: Her final visual acuity of the left eye was 20/20. Postoperative specular microscopic examination revealed a normal-range endothelial cell count, coefficient of variation, and hexagonality despite the intracameral lidocaine injection. CONCLUSIONS: Anesthetic injection of an infected lid should be done with great caution. Although there are possibilities of corneal endothelial toxicity and endophthalmitis in case of intracameral lidocaine injection through the infected lid, yet proper management may save the patient's vision without complications.
Lidocaine/administration & dosage ; Lens Implantation, Intraocular ; Lens Capsule, Crystalline/injuries ; Injections/adverse effects ; Humans ; Hordeolum/*surgery ; Follow-Up Studies ; Female ; Eyelids ; Eyelid Diseases/*surgery ; Eye Injuries, Penetrating/diagnosis/*etiology/surgery ; Diagnosis, Differential ; Cornea/injuries ; Cataract Extraction ; Anesthetics, Local/administration & dosage ; Anesthesia, Local/*adverse effects ; Adult

PURPOSE: Recently, the use of end-tidal carbon dioxide (ETCO₂) monitoring has been suggested for early detection of hypoventilation over oxygen saturation (S(P)O₂) monitoring. We aimed to determine the usefulness of capnography in monitoring patients sedated using intramuscular (IM) ketamine in the pediatric emergency department (ED). METHODS: This study retrospectively reviewed medical records of patients younger than 16 years who were sedated using IM ketamine and whose ETCO₂ values were documented in the ED. Age, sex, American Society of Anesthesiologists physical status classification (ASA classification), and purpose of sedation were investigated. Vital signs were recorded at pre-sedation, 5 and 10 minutes after sedation, and after recovery. Hypoventilation was defined as S(P)O₂< 95%, ETCO₂≥ 50 mmHg or ≤ 30 mmHg, or increase in ETCO₂≥ 10 mmHg from the baseline without tachypnea. RESULTS: A total of 49 patients were investigated; 42 of them belonged to ASA classification I, and 7 to II. There was no patient with S(P)O₂< 95%, or ETCO₂≥ 50 mmHg, or increase in ETCO₂≥ 10 mmHg from the pre-sedation value. However, 5 patients had an ETCO₂≤ 30 mmHg, and 4 of them (8.2%) had normal respiratory rate and were suitable for hypopneic hypoventilation. Ten patients showed abnormal range of ETCO₂ (normal range, 35-45 mmHg), but did not meet the definition of hypoventilation. No one had clinically serious respiratory events. CONCLUSIONS: During sedation using IM ketamine, 8.2% of the patients had hypopneic hypoventilation without hypoxemia, and they were all younger than 36 months. Capnography for patients sedated using IM ketamine in the ED is useful in detecting hypopneic hypoventilation, and has the potential for preventing clinically serious respiratory events in patients, especially toddlers.
Anoxia ; Capnography ; Carbon Dioxide* ; Carbon* ; Classification ; Conscious Sedation ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Hypoventilation ; Ketamine* ; Medical Records ; Oxygen ; Pediatrics ; Respiratory Rate ; Retrospective Studies ; Tachypnea ; Vital Signs

Patella infera (baja) is a rare condition that can result from several etiologies including trauma around the knee. Risk factors include scar tissue formation in the retropatella fat pad, extensor mechanism dysfunction, immobilization in extension position of the knee joint, etc. Unawareness and delayed recognition are known to be associated with long-term disability. In this condition, arthroscopic treatment is generally recommended only for early cases. In this report, we present a case with reasonable outcome of delayed patella infera treated by arthroscopic treatment. Prudent arthroscopic debridement of the responsible scar tissue and accelerated rehabilitation therapy is necessary for achievement of a successful outcome.
Adipose Tissue ; Cicatrix ; Debridement ; Immobilization ; Knee ; Knee Joint ; Patella* ; Rehabilitation ; Risk Factors

Purpose: Bone age (BA) is needed to assess developmental status and growth disorders. We evaluated the clinical performance of a deep-learning-based BA software to estimate the chronological age (CA) of healthy Korean children. Methods: This retrospective study included 371 healthy children (217 boys, 154 girls), aged between 4 and 17 years, who visited the Department of Pediatrics for health check-ups between January 2017 and December 2018. A total of 553 left-hand radiographs from 371 healthy Korean children were evaluated using a commercial deep-learning-based BA software (BoneAge, Vuno, Seoul, Korea). The clinical performance of the deep learning (DL) software was determined using the concordance rate and Bland-Altman analysis via comparison with the CA. Results: A 2-sample t-test (P<0.001) and Fisher exact test (P=0.011) showed a significant difference between the normal CA and the BA estimated by the DL software. There was good correlation between the 2 variables (r=0.96, P<0.001); however, the root mean square error was 15.4 months. With a 12-month cutoff, the concordance rate was 58.8%. The Bland-Altman plot showed that the DL software tended to underestimate the BA compared with the CA, especially in children under the age of 8.3 years. Conclusion The DL-based BA software showed a low concordance rate and a tendency to underestimate the BA in healthy Korean children.

PURPOSE: The purpose of this study was to evaluate the radiologic findings of lumbosacral transitional verte-brae (LSTV), as seen on plain radiographs and MRI, and to compare the incidence of combined diseases be-tween unilateral and bilateral groups. MATERIALS AND METHODS:We retrospectively evaluated the plain radiographs and MR images of 63 patients with LSTV, classifying its type according to Castellvi 's criteria, and evaluated disc herniations, facet joint os-teoarthritic change, scoliosis, and spondylolisthesis. We then compared the incidence of each combined diseases between unilateral and bilateral groups, and as a control group, 63 patients without LSTV were also eval-uated. RESULTS: Forty of 63 cases of LSTV (63.5%) were bilateral, and 23 (36.5%) unilateral. According to Castellvi 's criteria, the incidence of type I was 41.3% (unilateral 7 cases, bilateral 19), type III30.2% (unilateral 8 cases, bilateral 11), type II23.8% (unilateral 8 cases, bilateral 7), and type IV 4.8% (unilateral 0 cases, bilateral 3).With combined diseases, the incidence of disc herniation was 66.7% (unilateral 15 cases, bilateral 27), moderate to severe facet joint osteoarthritic change 28.6% (unilateral 11 cases, bilateral 7), scoliosis 27.0% (unilateral 9 cases, bilateral 8), and spondylolisthesis 9.5% (unilateral 2 cases, bilateral 4). The incidence of facet joint os-teoarthritic change was significantly higher in the unilateral group (47.8%) than in the bilateral group (17.5%) (p=0.02), and scoliosis occurred at a higher rate in the unilateral group (39.1%) than in the bilateral group (20.0%) (p=0.18). There was, however, no significant difference in the incidence of disc herniation and spondylolisthesis between the two groups (unilateral group: 65.2% and 8.7%; bilateral group: 67.5% and 10.0%, respectively). CONCLUSION: With LSTV, the incidence of facet joint osteoarthritic change was significantly higher in the unilat-eral group than in the bilateral group, and scoliosis also showed a higher rate of occurrence in the unilateral group.
Humans ; Incidence* ; Magnetic Resonance Imaging ; Retrospective Studies ; Scoliosis ; Spine* ; Spondylolisthesis ; Zygapophyseal Joint