No abstract available.
Ischemia* ; Skin*

No abstract available.
Goldenhar Syndrome*

The large size and vascularity of the neonatal adrenal glands are vulnerable to traumatic and asphyxial injuries. This condition varies in presentation, which the most common is an abdominal mass alone or mass with jaundice and anemia. Some infants show signs of adrenal insufficiency. Abdomial ultrasonogram is the most valuable diagnostic tool. To result in adrenal insuffiency, hemorrhage must involve both adrenals and at least 90% of the adrenocortical tissue must be destroyed. To affect infant may show signs of hypovolemic shock, electrolyte imbalance and metabolic acidosis. Treatment for adrenal insufficiency must be immediate and vigorous, and consists of intravenous glucose, fluid, and electolyte replacement. And conservative treatment failure is candidate for steroid replacement. We experienced a case of bilateral hemorrhage with adrenal insufficiency, who improved with hydrocortisone.
Acidosis ; Adrenal Glands ; Adrenal Insufficiency* ; Anemia ; Glucose ; Hemorrhage* ; Humans ; Hydrocortisone ; Infant ; Jaundice ; Shock ; Treatment Failure ; Ultrasonography

No abstract available.
Budesonide* ; Humans

OBJECTIVE: Postoperative delirium (POD) is characterized by an acute change in cognitive function and can result in longer hospital stays, higher morbidity rates, and more frequent discharges to long-term care facilities. In this study, we investigated the incidence and risk factors of POD in 224 patients older than 70 years of age, who had undergone a neurosurgical operation in the last two years. METHODS: Data related to preoperative factors (male gender, >70 years, previous dementia or delirium, alcohol abuse, serum levels of sodium, potassium and glucose, and co morbidities), perioperative factors (type of surgery and anesthesia, and duration of surgery) and postoperative data (length of stay in recovery room, severity of pain and use of opioid analgesics) were retrospectively collected and statistically analyzed. RESULTS: POD appeared in 48 patients (21.4%) by postoperative day 3. When we excluded 26 patients with previous dementia or delirium, 17 spontaneously recovered by postoperative day 14, while 5 patients recovered by postoperative 2 months with medication, among 22 patients with newly developed POD. The univariate risk factors for POD included previously dementic or delirious patients, abnormal preoperative serum glucose level, pre-existent diabetes, the use of local anesthesia for the operation, longer operation time (>3.2 hr) or recovery room stay (>90 min), and severe pain (VAS>6.8) requiring opioid treatment (p<0.05). Backward regression analysis revealed that previously dementic patients with diabetes, the operation being performed under local anesthesia, and severe postoperative pain treated with opioids were independent risk factors for POD. CONCLUSION: Our study shows that control of blood glucose levels and management of pain during local anesthesia and in the immediate postoperative period can reduce unexpected POD and help preventing unexpected medicolegal problems and economic burdens.
Alcoholism ; Analgesics, Opioid ; Anesthesia ; Anesthesia, Local ; Blood Glucose ; Delirium ; Dementia ; Glucose ; Humans ; Incidence ; Length of Stay ; Long-Term Care ; Pain, Postoperative ; Postoperative Period ; Potassium ; Recovery Room ; Retrospective Studies ; Risk Factors ; Sodium

BACKGROUND: Myoclonus-dystonia is a rare familial disease characterized by autosomal dominant inheritance, nonor slowly progressive axial myoclonus combined with dystonic posture, normal electroencephalography (EEG) finding, and dramatic response to alcohol intake. METHODS: Clinical manifestations were studied in a family with myoclonus-dystonia. Response to alcohol intake was investigated in affected adult patients. Brain magnetic resonance imaging (MRI) and other laboratory examination were performed in 3 patients. RESULTS: Eight (male: 5, female: 3) of the 14 biological family members through 4 generations were found to be affected by myoclonus-dystonia on neurological examinations. Another 5 members (male: 3, female: 2) were suspected to be affected in family history. All eight affected members showed axial myoclonus affecting the neck, trunk, and proximal muscles of the limbs. Six of them also had dystonia affecting the neck or the distal part of the arm. Myoclonus and dystonia were ameliorated dramatically after small dose of alcohol intake. Brain MRI, EEG study, and ophthalmologic examination showed no abnormalities. CONCLUSIONS: Our patients showed clinical features compatible with myoclonus-dystonia. This is the first Korean family with myoclonus-dystonia.
Adult ; Arm ; Brain ; Dystonia ; Electroencephalography ; Extremities ; Family Characteristics ; Female ; Humans ; Magnetic Resonance Imaging ; Muscles ; Myoclonus ; Neck ; Neurologic Examination ; Posture ; Wills

The cause of congenital nasal pyriform aperture stenosis is unclear. The development of the facial skeleton occurs between the fifth and the eighth week of gestation. It is at this stage that the stenosis occurs due to overgrowth of the ossification of the maxilla. Infants are obligate nasal breathers. Incomplete and milder forms of nasal airway obstruction may be present with mild respiratory distress, cyanosis, respiratory failure, asphyxia and eventual death. The diagnosis is done by CT, which demonstrates marked narrowing of the nasal inlet. Mild stenosis can be managed conservatively with humidification and topical decongestants but if conservative treatment fails, surgical intervention is candidate. We report a case of congenital nasal pyriform aperture stenosis. The patient, a 2-day old male neonate, had cyanosis during feeding and noisy breathing relieved by crying. His symptoms and signs were improved with surgical intervention without development disturbances.
Asphyxia ; Bays ; Constriction, Pathologic* ; Crying ; Cyanosis ; Diagnosis ; Humans ; Infant ; Infant, Newborn ; Male ; Maxilla ; Nasal Decongestants ; Nasal Obstruction ; Pregnancy ; Respiration ; Respiratory Insufficiency ; Skeleton

BACKGROUND: We evaluated a rapid screening kit for the detection of hepatitis surface antigen (HBsAg) and antibody (anti-HBs) using an immunochromatographic method. MATERIALS AND METHODS: We selected 499 serum specimens for the evaluation. Each specimen was tested by enzyme immunoassay (EIA; Cobas Core, Roche, Switzerland), reverse passive hemagglutination (RPHA; Serodia HBs, Asan, Korea) for HBsAg, passive hemagglutination (PHA; Serodia Anti-HBs, Asan, Korea) for anti-HBs, and with the Genedia HBsAg and Anti-HBs Rapid (Green Cross Corp., Korea) kits. Results of each assay were compared with those of the EIA. RESULTS: The sensitivities and specificities of the Genedia HBsAg Rapid kit were 98.0% and 100%, and those for the Genedia Anti-HBs Rapid kit were 95.3% and 98.0%, respectively. These were higher than those for RPHA (96.0% and 100%), and PHA (83.2% and 96.0%). Concordance rates between EIA and Genedia HBsAg Rapid, Genedia Anti-HBs Rapid, RPHA, and PHA were 98.8%, 96.4%, 97.6%, and 88.4%, respectively. Extending the incubation time from the recommended 30 minutes to 2 hours increased the sensitivities of the Genedia kits. CONCLUSION: The Genedia HBsAg and Anti-HBs Rapid kits are simple, sensitive, and inexpensive assays suitable for screening or use in emergency situations.
Antigens, Surface ; Chungcheongnam-do ; Emergencies ; Hemagglutination ; Hepatitis ; Hepatitis B Surface Antigens* ; Immunoenzyme Techniques ; Mass Screening*

BACKGROUND/AIMS: To compare the diagnostic accuracy of endoscopic ultrasound-guided core needle aspiration with that of standard fine-needle aspiration by systematic review and meta-analysis. METHODS: Studies using 22/25-gauge core needles, irrespective of comparison with standard fine needles, were comprehensively reviewed. Pooled sensitivity, specificity, diagnostic odds ratio (DOR), and summary receiver operating characteristic curves for the diagnosis of malignancy were used to estimate the overall diagnostic efficiency. RESULTS: The pooled sensitivity, specificity, and DOR of the core needle for the diagnosis of malignancy were 0.88 (95% confidence interval [CI], 0.84 to 0.90), 0.99 (95% CI, 0.96 to 1), and 167.37 (95% CI, 65.77 to 425.91), respectively. The pooled sensitivity, specificity, and DOR of the standard needle were 0.84 (95% CI, 0.79 to 0.88), 1 (95% CI, 0.97 to 1), and 130.14 (95% CI, 34.00 to 495.35), respectively. The area under the curve of core and standard needle in the diagnosis of malignancy was 0.974 and 0.955, respectively. The core and standard needle were comparable in terms of pancreatic malignancy diagnosis. There was no significant difference in procurement of optimal histologic cores between core and standard needles (risk ratio [RR], 0.545; 95% CI, 0.187 to 1.589). The number of needle passes for diagnosis was significantly lower with the core needle (standardized mean difference, -0.72; 95% CI, -1.02 to -0.41). There were no significant differences in overall complications (RR, 1.26; 95% CI, 0.34 to 4.62) and technical failure (RR, 5.07; 95% CI, 0.68 to 37.64). CONCLUSIONS: Core and standard needles were comparable in terms of diagnostic accuracy, technical performance, and safety profile.
Biopsy, Fine-Needle ; Diagnosis ; Needles* ; Odds Ratio ; ROC Curve ; Sensitivity and Specificity

Classical cyclic neutropenia is the most frequent of the cyclic hematopoietic disorders and a rare condition characterized by regular and predictable oscillations in the peripheral neutophil counts with the cycle length varying from 14 to 28 days and in many cases simultaneous fluctuation in the other blood cell line. The etiology of cyclic neutropenia is unknown, but has usually been considered as stem-cell disorder. We have observed a 17-year-old boy with a cyclic pancytopenia with a constant and predictable oscillation period of about 120 days. Serial bone marrow biopsies showed a similar fluctuating pattern and myelodysplatic change. We report this case and review the literature regarding this unusal long period cyclic neutropenia.
Adolescent ; Biopsy ; Blood Cells ; Bone Marrow ; Hematopoiesis* ; Humans ; Male ; Neutropenia ; Pancytopenia