BACKGROUND: A large amount of blood is lost during spinal fusion surgery; therefore, a blood transfusion is required. In this study, we analyzed the amount of transfusion and hemodynamic changes in relation to the count of fusion segments in lumbosacral spinal surgeries. METHODS: We analyzed 67 patients who had undergone lumbosacral fusion. They were divided into five groups according to the levels of fusion segments (one level: Group 1, two levels: Group 2, three levels: Group 3, four levels: Group 4 and above three levels: Groups 3+4). Total amounts of transfusion and perioperative hemodynamic changes were compared among each group. RESULTS: Of the total 67 cases, 40 cases were Group 1, 19 cases were Group 2, five cases were Group 3, three cases were Group 4, and eight cases were Groups 3+4. Average volume of Red Blood Cell (RBC) transfusion per operation was 703+/-463 mL (Group 1), 934+/-372 mL (Group 2), 1,677+/-847 mL (Group 3), 1,231+/-412 mL (Group 4), and 1,509+/-669 mL (Group 3+4); and average volume of fresh frozen plasma (FFP) per operation was 55+/-141 mL (Group 1), 108+/-181 mL (Group 2), 306+/-368 mL (Group 3), 567+/-260 mL (Group 4), and 404+/-317 mL (Groups 3+4). Eight patients received transfusion of Platelet Concentrate (PC); each patient received 10 units (400 mL). The preoperative mean level of hemoglobin and platelet was 13.62+/-1.47 g/dL and 245+/-60x10(3)/microliter, postoperatively, 10.26+/-1.14 g/dL and 150+/-46x10(3)/microliter. CONCLUSION: As the fusion segments increase, the need for transfusion of RBC, FFP, and PC increases. Application of the Maximum Surgical Blood Order Schedule (MSBOS) system is required in the planning of spinal fusion, especially in multiple segments.
Appointments and Schedules ; Blood Platelets ; Blood Transfusion ; Erythrocytes ; Hemodynamics ; Hemoglobins ; Humans ; Lumbosacral Region ; Plasma ; Spinal Fusion

BACKGROUND: A large amount of blood is lost during spinal fusion surgery; therefore, a blood transfusion is required. In this study, we analyzed the amount of transfusion and hemodynamic changes in relation to the count of fusion segments in lumbosacral spinal surgeries. METHODS: We analyzed 67 patients who had undergone lumbosacral fusion. They were divided into five groups according to the levels of fusion segments (one level: Group 1, two levels: Group 2, three levels: Group 3, four levels: Group 4 and above three levels: Groups 3+4). Total amounts of transfusion and perioperative hemodynamic changes were compared among each group. RESULTS: Of the total 67 cases, 40 cases were Group 1, 19 cases were Group 2, five cases were Group 3, three cases were Group 4, and eight cases were Groups 3+4. Average volume of Red Blood Cell (RBC) transfusion per operation was 703+/-463 mL (Group 1), 934+/-372 mL (Group 2), 1,677+/-847 mL (Group 3), 1,231+/-412 mL (Group 4), and 1,509+/-669 mL (Group 3+4); and average volume of fresh frozen plasma (FFP) per operation was 55+/-141 mL (Group 1), 108+/-181 mL (Group 2), 306+/-368 mL (Group 3), 567+/-260 mL (Group 4), and 404+/-317 mL (Groups 3+4). Eight patients received transfusion of Platelet Concentrate (PC); each patient received 10 units (400 mL). The preoperative mean level of hemoglobin and platelet was 13.62+/-1.47 g/dL and 245+/-60x10(3)/microliter, postoperatively, 10.26+/-1.14 g/dL and 150+/-46x10(3)/microliter. CONCLUSION: As the fusion segments increase, the need for transfusion of RBC, FFP, and PC increases. Application of the Maximum Surgical Blood Order Schedule (MSBOS) system is required in the planning of spinal fusion, especially in multiple segments.
Appointments and Schedules ; Blood Platelets ; Blood Transfusion ; Erythrocytes ; Hemodynamics ; Hemoglobins ; Humans ; Lumbosacral Region ; Plasma ; Spinal Fusion

PURPOSE: The purpose of this study was to compare self-esteem, perceived life satisfaction, depression and aggression according to the experience of suicidal impulse in adolescents. METHODS: Data were collected from 249 middle and high school students in J city. The constructed questionnaires included items on self-esteem, perceived life satisfaction, depression and aggression. RESULTS: Self-esteem, perceive life satisfaction, depression, and aggression differed significantly between the suicidal impulse group and non-suicidal impulse group. The suicidal impulse group experienced lower self-esteem (OR=3.27), higher depression (OR=12.38) and higher aggression (OR=5.72) than the non-suicidal impulse group. CONCLUSION: The findings indicate that integrated and effective interventions are needed to prevent suicidal attempts by adolescents who had experiences of suicidal impulse. Information on the cognitive, psychological and social characteristics of adolescents must be considered when developing the interventions.
Adolescent ; Aggression ; Depression ; Humans ; Sociology ; Suicide ; Child Health ; Surveys and Questionnaires

Objective: Agitation is a common symptom in children undergoing surgery, especially when surgeries are performed under sevoflurane and when patients undergo strabismus surgery. Because agitation can increase the risk of falls and lacerations on surgical sites and can delay discharge from the recovery room, adopting measures to reduce the incidence of agitation is essential. This study aimed to compare the agitation-reducing effects of lidocaine and esmolol administered individually or as a combination. Methods: We included 80 patients scheduled to undergo strabismus surgery. Thiopental and sevoflurane were administered to induce general anesthesia. Group EL received lidocaine (2 mg/kg) right after the end of surgery and esmolol (0.5 mg/kg) immediately after recovery from anesthesia after turning the anesthetic gas off; group L received lidocaine at 2 mg/kg right after the end of surgery and did not receive esmolol, group E did not receive lidocaine at the end of the surgery but received esmolol at 0.5 mg/kg right after recovery from anesthesia, and group C received neither esmolol nor lidocaine. Agitation severity was assessed using the objective pain score, Pediatric Anesthesia Emergence Delirium Scale immediately after recovery from anesthesia and until discharge from the recovery room. Results: Groups L and EL showed significantly lower agitation than groups E and C right after recovery from anesthesia, right after arrival to the recovery room, and 10 minutes after arrival to the recovery room (P < 0.05). Groups L and EL showed no differences in the reduction of the severity of agitation (P > 0.05). Conclusion Compared to the groups without lidocaine administration, groups L and EL, which received 2 mg/kg lidocaine, showed a higher level of reduction in agitation immediately after recovery from anesthesia and right after arrival to the recovery room (P < 0.05).

PURPOSE: In clinical practice, some patients with asthma show incompletely reversible airflow obstruction, resembling chronic obstructive pulmonary disease (COPD). The aim of this study was to analyze this overlap phenotype of asthma with COPD feature. MATERIALS AND METHODS: A total of 256 patients, over the age of 40 years or more with a diagnosis of asthma, based on either 1) positive response to bronchodilator: >200 mL forced expiratory volume in 1 s (FEV1) and >12% baseline or 2) positive methacholine or mannitol provocation test, were enrolled. Among the asthma patients, we defined the overlap group with incompletely reversible airflow obstruction [postbronchodilator FEV1/forced vital capacity (FVC) <70] at the initial time of admission and continuing airflow obstruction after at least 3 months follow up. We evaluated clinical features, serum eosinophil counts, serum total immunoglobulin (Ig) E with allergy skin prick test, spirometry, methacholine or mannitol provocation challenges and bronchodilator responses, based on their retrospective medical record data. All of the tests mentioned above were performed within one week. RESULTS: The study population was divided into two groups: asthma only (62%, n=159, postbronchodilator FEV1/FVC > or =70) and overlap group (38%, n=97, postbronchodilator FEV1/FVC <70). The overlap group was older, and contained more males and a higher percentage of current or ex-smokers than the asthma only group. Significantly lower FEV1 and higher total lung capacity, functional residual capacity, and residual volume were observed in the overlap group. Finally, significantly lower serum eosinophil count and higher IgE were seen in the overlap group. CONCLUSION: Our results showed that the overlap phenotype was older, male asthmatic patients who have a higher lifetime smoking intensity, more atopy and generally worse lung function.
Adult ; Age Factors ; Aged ; Asthma/epidemiology/*physiopathology ; Female ; Forced Expiratory Volume/physiology ; Humans ; Male ; Middle Aged ; Pulmonary Disease, Chronic Obstructive/epidemiology/*physiopathology ; Retrospective Studies ; Sex Factors

BACKGROUND: This study was conducted to develop a pre-discharge group education program for liver transplant patients, and to contribute to improving the knowledge and performance of self-management after discharge. METHODS: This investigation was a methodological study consisting of analysis, design, development, operation, and evaluation stages. RESULTS: The constituent items of the pre-discharge group education program for liver transplant patients include medication management, infection management, emergency management, outpatient management, complication management, nutrition management, exercise management, wound and drainage management, disability registration, and sex life. The pre-discharge group education program for liver transplant patients was conducted once a week, 30 minutes for the coordinator, 40 minutes for the clinical nurse specialist (including 10 minutes for wound and drainage management), 30 minutes for pharmacists, 20 minutes for the nutritionist, and 20 minutes for social workers. Additionally, the contents of the lecture announced by PowerPoint were made the same as the booklet. The overall knowledge level before and 3 months after the pre-discharge group education program for liver transplantation patients increased significantly from 17.32±1.53 to 19.74±0.89. At the 3-month time point, the overall compliance was 77.39±3.04 out of 80. Overall satisfaction was 9.32±0.93 on a scale of 10. Finally, the need for medication was the highest at 3 months. CONCLUSIONS: It is expected that this program can be utilized in the clinical field as an effective nursing education intervention.
Compliance ; Drainage ; Education* ; Education, Nursing ; Emergencies ; Humans ; Liver Transplantation ; Liver* ; Methods ; Nurse Clinicians ; Nutritionists ; Outpatients ; Pamphlets ; Pharmacists ; Self Care ; Social Work ; Social Workers ; Wounds and Injuries

Antiglobulin test-negative hemolytic anemia, thrombophilia, and marrow failure, such as aplastic anemia and myelodysplastic syndrome - refractory anemia (MDS-RA), are the primary clinical manifestations of paroxysmal nocturnal hemoglobinuria (PNH). Here, we report on a case of a 56-year-old male patient diagnosed with PNH, MDS-RA, and immune hemolytic anemia (IHA). The patient was transferred to the hospital with an impression of hemolytic anemia and pulmonary embolism. Positive results were observed on direct and indirect antiglobulin tests, and alloantibody, anti-C and anti-e, autoantibodies were identified. In addition, C and e antigens were found in Rh subgrouping. Therefore, due to the presence of autoantibodies against C and e antigens, we assumed that the cause of IHA was autoimmune reaction. Spherocytosis, increased osmotic fragility test, and positivity on direct and indirect antiglobulin tests were not considered characteristics of PNH. Therefore, without the presence of pulmonary embolism and MDS-RA, it is possible that autoimmune hemolytic anemia was considered the only reason for the hemolytic anemia, and that PNH could be overlooked. In patients with PH, use of washed RBCs during transfusion is not necessary. PNH screening test is recommended for patients who have experienced a thromboembolic event and intravascular hemolysis or MDS-RA. In order to obtain accurate information regarding the percentage of GPI-AP-deficient RBCs, flow cytometric analysis should be performed prior to transfusion.
Anemia, Aplastic ; Anemia, Hemolytic ; Anemia, Hemolytic, Autoimmune ; Anemia, Refractory ; Autoantibodies ; Bone Marrow ; Coombs Test ; Hemoglobinuria, Paroxysmal ; Hemolysis ; Hepatitis B e Antigens ; Humans ; Hydrogen-Ion Concentration ; Male ; Mass Screening ; Middle Aged ; Myelodysplastic Syndromes ; Osmotic Fragility ; Pulmonary Embolism ; Thrombophilia

B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma (DLBCL) and Burkitt lymphoma (BL) (intermediate DLBCL/BL), is a heterogeneous group with some features resembling DLBCL and others resembling BL. Here, we report a case of intermediate DLBCL/BL in a Korean child. A 2-yr-old male was admitted for evaluation and management of left hip pain. Immunohistochemistry of a biopsy of the femur neck revealed tumor cells positive for CD20, CD10, BCL2, BCL6, and Ki67. A bone marrow (BM) aspirate smear revealed that 49.3% of all nucleated cells were abnormal lymphoid cells, composed of large- and medium-sized cells. Immunophenotyping of the neoplastic cells revealed positivity for CD19, CD10, CD20, and sIg lambda and negativity for CD34, Tdt, and myeloperoxidase (MPO). Cytogenetic and FISH analyses showed a complex karyotype, including t(8;14)(q24.1;q32) and IGH-MYC fusion. Intensive chemotherapy was initiated, including prednisone, vincristine, L-asparaginase, daunorubicin, and central nervous system prophylaxis with intrathecal methotrexate (MTX) and cytarabine. One month after the initial diagnosis, BM examination revealed the persistent of abnormal lymphoid cells; cerebrospinal fluid cytology, including cytospin, showed atypical lymphoid cells. The patient was treated again with cyclophosphamide, vincristine, prednisone, adriamycin, MTX, and intrathecal MTX and cytarabine. The patient died of sepsis 5 months after the second round of chemotherapy.
Antineoplastic Agents/therapeutic use ; Bone Marrow Cells/pathology ; Child, Preschool ; Chromosomes, Human, Pair 14 ; Chromosomes, Human, Pair 8 ; Cyclophosphamide/therapeutic use ; Doxorubicin/therapeutic use ; Drug Therapy, Combination ; Femur Neck/pathology ; Humans ; Immunohistochemistry ; Immunophenotyping ; In Situ Hybridization, Fluorescence ; Karyotyping ; Lymphoma, B-Cell/*diagnosis/drug therapy ; Male ; Methotrexate/therapeutic use ; Oncogene Proteins, Fusion/genetics ; Prednisolone/therapeutic use ; Republic of Korea ; Translocation, Genetic ; Treatment Outcome ; Vincristine/therapeutic use

BACKGROUND: Iron deficiency anemia (IDA) is the most common anemia followed by anemia of chronic disease (ACD). Reticulocyte indices have been shown to be helpful indicators for detecting IDA. We investigated whether RBC and reticulocyte indices can be used to differentiate ACD from IDA. METHODS: A total of 85 women showing microcytic hypochromic anemia (38 IDA and 47 ACD cases) were enrolled. IDA was defined as those with ferritin level of <6 microg/dL and total iron binding capacity (TIBC) of >450 microg/dL. ACD was defined as ferritin level of > or =6 microg/dL, TIBC of < or =450 microg/dL, and presence of underlying diseases. We measured complete blood count, TIBC, iron, ferritin, and RBC and reticulocyte indices. The mean values of each item were compared between the two groups and sensitivity and specificity of each item in the differential diagnosis of ACD from IDA were determined by ROC curve analysis. RESULTS: In ACD, most of the RBC and reticulocyte indices were significantly higher than in IDA: mean cell volume (MCV), mean cell hemoglobin (MCH), mean cell hemoglobin concentration (MCHC), cellular hemoglobin concentration mean (CHCM), cellular hemoglobin content (CH), red cell distribution width (RDW), reticulocyte hemoglobin content (CHr), and mature RBC cellular hemoglobin content (CHm). All these indices, except MCV showed significant correlations with ferritin and/or TIBC. CHr level of > or =24.6 pg could be used to differentiate ACD from IDA with 85.1% sensitivity and 81.6% specificity. CONCLUSIONS: The reticulocyte indices, especially CHr, are useful for the differential diagnosis of microcytic hypochromic anemias, ACD and IDA.
Adult ; Anemia ; Anemia, Hypochromic ; Anemia, Iron-Deficiency ; Blood Cell Count ; Chronic Disease ; Diagnosis, Differential ; Erythrocyte Indices ; Female ; Ferritins ; Hemoglobins ; Humans ; Iron ; Reticulocytes ; ROC Curve ; Sensitivity and Specificity

Crystal-storing histiocytosis (CSH) is a rare event observed in association with lymphoproliferative diseases, and mainly occurrs in plasma cell dyscrasias. It is presumed to be an intra-lysosomal accumulation of the secreted paraproteins. Crystal formation can be seen inside histiocyte-like cells with phagocytosed crystalline inclusions in the bone marrow and extramedullary sites. CSH is a rare morphological entity with poor prognostic implications and may be confused with Gaucher or pseudo-Gaucher cells. Herein we report a case of non-secretory myeloma associated with CSH showing a poor clinical course. A 79-yr-old male presenting with dizziness was evaluated in hematology department for anemia. Laboratory tests revealed Hb of 4.9 g/dL and beta2-microglobulin of 21,000 ng/mL (reference range, 0-370). Presence of monoclonal protein was not detected on protein electrophoresis and immunofixation in serum and urine. However, serum free light chain assay showed an increased kappa-light chain level of 126 mg/L (reference range, 3.3-19.4) resulting in an increased kappa/lambda ratio. The bone marrow touch print showed numerous plasma cells and crystal-laden histiocytes and immunohistochemical stainings on bone marrow biopsy revealed positivity for CD38, CD56 and kappa in the plasma cells and CD68 and kappa in crystal-laden histiocytes.
Aged ; Antigens, CD/metabolism ; Antigens, CD38/metabolism ; Antigens, Differentiation, Myelomonocytic/metabolism ; Bone Marrow Cells/pathology ; Histiocytosis/complications/*diagnosis/radiography ; Humans ; Immunoglobulin kappa-Chains/analysis ; Male ; Multiple Myeloma/complications/*diagnosis/radiography ; Tomography, X-Ray Computed