No abstract available.
Chest Pain* ; Child* ; Humans ; Thorax*

No abstract available.
Masticatory Muscles* ; Spasm* ; Tetanus*

Objective: This study aimed to analyze the clinical characteristics of patients with acute glufosinate ammonium (GLA) poisoning and investigate the indicators associated with the severity of neurotoxicity in GLA-poisoned patients. Methods: We retrospectively collected the data of patients who were admitted due to GLA poisoning from 2018 to 2022, to gather the factors that could influence neurologic outcomes. These outcomes were estimated based on the Glasgow Coma Scale (GCS) scores at admission, the worst GCS score during impaired consciousness, the GCS score at discharge, and the presence and duration of seizures. Results: Among the 67 GLA-poisoned patients, the average GCS score at admission was 13.8±2.6 points, the worst GCS score recorded was 11.2±3.5 points, and the GCS score at discharge was 13.7±2.9 points. The factors significantly influencing the GCS score at the initial admission included respiration rate, saturation, white blood cell count, and pH (P=0.037, P=0.005, P=0.021, and P=0.001, respectively). Factors affecting the worst GCS score included age, diastolic blood pressure, platelet count, blood urea nitrogen (BUN), and pH (P=0.001, P=0.016, P=0.015, P=0.002, and P<0.001, respectively). The GCS score at discharge exhibited significant correlations with age, BUN, and pH (P<0.001, P<0.001, and P=0.011, respectively). The average age of the patients who experienced seizures after GLA poisoning was significantly higher at 75.1±12.9 years compared to that of patients without seizures (mean age, 65.0±15.2 years; P=0.006). Additionally, the average bicarbonate level was lower in patients with seizures, measuring 19.0±4.7 mmol/L, when compared with that of patients without seizures (average, 21.4±4.3 mmol/L; P=0.045). Conclusion The elderly, metabolic acidosis, and elevated BUN could serve as good indicators for adverse neurological outcomes in GLA-poisoned patients.

We report two cases of recurrent extramarnmary Pagets disease after wide local excision. Both cases involved the scrotum and the penoserotal junction, respectively. On histopathological examination, we could observed many Paget cells confined to the epidermis and the hair follicle, but not invading the underlying dermis in both cases. There was no evidence of internal malignancy. Both cases were treated with wide local reexcision.
Dermis ; Epidermis ; Hair Follicle ; Paget Disease, Extramammary* ; Scrotum

Objectives: This study was aimed to assess the usefulness of the quantitative assessment of clock drawing test (CDT) combined with the Mini-Mental State Examination (MMSE) compared to that of the Montreal Cognitive Assessment (MoCA) or the MMSE alone for screening of dementia in Parkinson disease (PD) in patients with a low educational level. Methods: A representative sample of 91 PD patients was administered MMSE, MoCA and CDT. The discriminative validity of the MMSE, MoCA, and a MMSE+CDT combination for dementia screening was determined by estimating the sensitivity and specificity of each test and by testing integrated discrimination improvement (IDI). Results: The mean age and educational years were 69.0 (years) and 7.3 in the study population. The best screening cut-off points for the MMSE, MoCA, and MMSE+CDT were 25/26, 21/22 and 41/42. In a group of patients with educational years ≤6,
Dementia

Objective: This study aimed to clarify the relationship between several viral infections and clinical features of febrile seizures. The clinical expression pattern was determined according to the virus. Methods: Data were collected on patients who visited the emergency room with febrile seizures from March 2016 to February 2019. The clinical characteristics of seizures and the clinical differences between each respiratory viral infection were analyzed. The severity of febrile seizures was measured by checking complex febrile seizures and electroencephalogram abnormalities. Results: Of the 227 febrile convulsions, 138 (60.8%) were men, and 89 (39.2%) were women. Sixty-five patients (28.6%) had a family history of febrile seizure, 68 (30.0%) had complex seizures, and 13 (7.1%) had electroencephalogram (EEG) abnormalities. Of the 13 respiratory viruses examined, rhinoviruses were detected more significantly in 63 patients (32.4%), but there was no significant difference when comparing the rate of febrile seizure among patients with fever. There were no significant differences in the clinical features, such as body temperature, duration, and complex seizure. In addition, each virus showed a similar incidence of EEG abnormalities. Conclusion No significant difference in the clinical features and objective examination according to the virus were observed, and the tendency of developing febrile seizures is similar.

Objective: This study aimed to clarify the relationship between several viral infections and clinical features of febrile seizures. The clinical expression pattern was determined according to the virus. Methods: Data were collected on patients who visited the emergency room with febrile seizures from March 2016 to February 2019. The clinical characteristics of seizures and the clinical differences between each respiratory viral infection were analyzed. The severity of febrile seizures was measured by checking complex febrile seizures and electroencephalogram abnormalities. Results: Of the 227 febrile convulsions, 138 (60.8%) were men, and 89 (39.2%) were women. Sixty-five patients (28.6%) had a family history of febrile seizure, 68 (30.0%) had complex seizures, and 13 (7.1%) had electroencephalogram (EEG) abnormalities. Of the 13 respiratory viruses examined, rhinoviruses were detected more significantly in 63 patients (32.4%), but there was no significant difference when comparing the rate of febrile seizure among patients with fever. There were no significant differences in the clinical features, such as body temperature, duration, and complex seizure. In addition, each virus showed a similar incidence of EEG abnormalities. Conclusion No significant difference in the clinical features and objective examination according to the virus were observed, and the tendency of developing febrile seizures is similar.

BACKGROUND: Most studies on the incidence rate (IR) and post-exposure reporting rate (RR) of needle-stick injuries (NSIs) were performed using retrospective surveillance, which is vulnerable to recall bias. This study aimed to identify the agreement between IRs and RRs obtained from prospective and retrospective surveillance. METHODS: The prospective surveillance was performed with 716 nurses working at 3 hospitals from August to September in 2012. They prospectively reported when they experienced the NSIs, and the investigator retrospectively calculated the RR from records in the infection control unit or health care unit during the same periods when they reported the number of NSIs. The retrospective surveillance was carried out with 312 nurses who participated in the prospective surveillance. They retrospectively answered the question on the number of NSIs and post-exposure reporting after recalling the experienced NSI from August to September in 2012. RESULTS: The IR of NSIs was 9.8 per 100 nurses by the prospective surveillance and 36.4 per 100 nurses by the retrospective surveillance, which was statistically significantly different (P<0.001). The RR of NSIs was 14.3% by the prospective surveillance and 8.5% by the retrospective surveillance, which was not statistically significantly different. CONCLUSION: We recommend using a prospective approach for calculating the IR of NSIs to reduce the risk of recall bias. However, the RR of NSIs can be calculated using both prospective and retrospective approaches.
Bias (Epidemiology) ; Delivery of Health Care ; Humans ; Incidence* ; Infection Control ; Memory ; Needlestick Injuries* ; Prospective Studies* ; Research Personnel ; Retrospective Studies*

BACKGROUND AND PURPOSE: The use of decompressive hemicraniectomy (DHC) for the treatment of malignant cerebral edema can decrease mortality rates. However, this benefit is not sufficient to justify its use in elderly patients. We investigated the effects of therapeutic hypothermia (TH) on safety, feasibility, and functional outcomes in elderly patients with malignant middle cerebral artery (MCA) infarcts. METHODS: Elderly patients 60 years of age and older with infarcts affecting more than two-thirds of the MCA territory were included. Patients who could not receive DHC were treated with TH. Hypothermia was started within 72 hours of symptom onset and was maintained for a minimum of 72 hours with a target temperature of 33°C. Modified Rankin Scale (mRS) scores at 3 months following treatment and complications of TH were used as functional outcomes. RESULTS: Eleven patients with a median age of 76 years and a median National Institutes of Health Stroke Scale score of 18 were treated with TH. The median time from symptom onset to initiation of TH was 30.3±23.0 hours and TH was maintained for a median of 76.7±57.1 hours. Shivering (100%) and electrolyte imbalance (82%) were frequent complications. Two patients died (18%). The mean mRS score 3 months following treatment was 4.9±0.8. CONCLUSIONS: Our results suggest that extended use of hypothermia is safe and feasible for elderly patients with large hemispheric infarctions. Hypothermia may be considered as a therapeutic alternative to DHC in elderly individuals. Further studies are required to validate our findings.
Aged* ; Brain Edema* ; Cerebral Infarction ; Humans ; Hypothermia* ; Hypothermia, Induced ; Infarction ; Middle Cerebral Artery ; Mortality ; National Institutes of Health (U.S.) ; Shivering ; Stroke

Malignant cerebral infarction has a high risk of fatal brain edema and increased intracranial pressure with cerebral herniation causing death. One of the major causes of death is a rebound cerebral edema during rewarming phase. A 66-year-old male patient presented with the right hemiplegia and global aphasia due to malignant cerebral infarction in the whole territory of middle cerebral artery with the occlusion of the proximal internal carotid artery. Being refused decompressive hemicraniectomy, he received the therapeutic hypothermia for 6 days. After rewarming for 6 hours, mentality was suddenly decreased and dilated left pupil. Follow-up CT revealed that midline shifting was more aggravated. We decided on repeated hypothermia for rebound cerebral edema and successfully controlled. We report our experience with repeated hypothermia for rebound cerebral edema following therapeutic hypothermia in malignant cerebral infarction.
Aphasia ; Brain Edema ; Carotid Artery, Internal ; Cause of Death ; Cerebral Infarction ; Follow-Up Studies ; Hemiplegia ; Humans ; Hypothermia ; Hypothermia, Induced ; Intracranial Hypertension ; Intracranial Pressure ; Male ; Middle Cerebral Artery ; Pupil ; Rewarming