Torsade de pointes is a life-threatening, polymorphic ventricular tachycardia associated with prolongation of the QTc interval. Although torsade de pointes is found in many clinical settings, it is mostly drug induced. Similar problems have been described with nonsedating H1-selective antihistamines like terfenadine and astemizole. The increased risks of both H1-antihistamines were associated with exposure to supratherapeutic doses or concomitant exposure to the cytochrome P-450 inhibitors, ketoconazole, erythromycin and cimetidine. We report a 51-year-old woman with torsade de pointes and a long QTc interval caused by the combined use of terfenadine and itraconazole. After discontinuation of these drugs and treatments with electrical cardioversion and magnesium sulfate, torsade de pointes and prolonged QTc interval were no longer observed and she was discharged in good condition with a normal ECG. In conclusion, physicians should be aware that terfenadine and astemizole can cause torsade de pointes in rare cases.
Astemizole ; Cimetidine ; Cytochrome P-450 Enzyme System ; Electric Countershock ; Electrocardiography ; Erythromycin ; Female ; Histamine Antagonists ; Humans ; Itraconazole* ; Ketoconazole ; Magnesium Sulfate ; Middle Aged ; Tachycardia, Ventricular ; Terfenadine* ; Torsades de Pointes*

The purpose of this study was to provide basic data to standardize the clinical dental hygiene curriculum, based on analysis of current clinical dental hygiene curricula in Korea. We emailed questionnaires to 12 schools to investigate clinical dental hygiene curricula, from February to March, 2017. We analyzed the clinical dental hygiene curricula in 5 schools with a 3-year program and in 7 schools with a 4-year program. The questionnaire comprised nine items on topics relating to clinical dental hygiene, and four items relating to the dental hygiene process and oral prophylaxis. The questionnaire included details regarding the subject name, the grade/semester/credit system, course content and class hours, the number of senior professors, and the number of patients available for dental hygiene clinical training purposes. In total, there were 96 topics listed in the curricula relating to clinical dental hygiene training, and topics varied between the schools. There was an average of 20.4 topic credits, and more credits and hours were allocated to the 4-year program than to the 3-year program. On average, the ratio of students to professors was 21.4:1. Course content included infection control, concepts for dental hygiene processes, dental hygiene assessment, intervention and evaluation, case studies, and periodontal instrumentation. An average of 2 hours per patient was spent on dental hygiene practice, with an average of 1.9 visits. On average, student clinical training involved 19 patients and 26.6 patients in the 3-year and 4-year programs, respectively. The average participation time per student per topic was 38.0 hours and 53.1 hours, in the 3-year and 4-year programs, respectively. Standardizing the clinical dental hygiene curricula in Korea will require consensus guidelines on topics, the number of classes required to achieve core competencies as a dental hygienist, and theory and practice time.
Consensus ; Curriculum* ; Dental Hygienists ; Electronic Mail ; Humans ; Infection Control ; Korea* ; Oral Hygiene*

PURPOSE: To evaluate the CT appearance of normal variations in the minute central skull base foramina in infants and children. MATERIALS AND METHODS: One hundred and fourteen children under the age of 17 years without skull base abnormality underwent CT scanning. A high spatial frequency algorithm was used, and contiguous axial scanning parallel to the orbitomeatal line was performed from the foramen magnum to the orbital roof, with a 1-mm slice thickness. The presence or absence of eight foramina, pseudoforamina, or ossification centers including anterior presphenoidal foramen, posterior presphenoidal foramen, rostro-orbital pseudoforamen, intralateromedial postsphenoidal pseudoforamen, intrapostsphenoidal pseudoforamen, spheno-occipital pseudo-foramen, canalis basilaris medianus and intrasynchondral ossified bodies was analysed according to age. The presence of foramina or pseudoforamina was indicated if a ring-shaped structure was seen on two or more CT scans at the location anatomically predicted, and intrasynchondral ossified bodies were indicated if linear or dot-like structures with high attenuation accompanied spheno-occipital synchondrosis. RESULTS: CT indicated that within a certain age range, various kinds of foramina, pseudoforamina, and ossification centers were frequent. The anterior presphenoidal foramen was most commonly seen in infants aged 1-12 months (16/17, 94 %); the posterior presphenoidal foramen in children less than 2 years old(27/37, 73 % ) ; the rostro-orbital pseudoforamen in children aged 2 -5 years (9/17, 53%); intrapostsphenoidal pseudoforamen in children 6 -12 years old(20/37, 54%) and spheno-occipital pseudoforamen and intrasynchondral ossified bodies in children aged 13 -16 years. The canalis basilaris medianus was identified in about 20 % of all subjects regardless of age. CONCLUSION: Development of the minute central skull base foramina varied greatly according to age. Knowledge of the CT appearances of such embryologic variants of the central skull base should not only help Provide an understanding of complex skull base anatomy but also identify abnormal skull base development.
Child ; Foramen Magnum ; Humans ; Infant ; Orbit ; Skull Base* ; Skull* ; Tomography, X-Ray Computed

Follicular bronchitis/bronchiolitis is pathologically characterized by peribronchiolar lymphoid follicles, which is one of reactive pulmonary lymphoid disorders. It is associated with 1) the result of infections such as mycoplasma, chlamydia etc., 2) immunodeficiency syndromes, 3) connective tissue diseases such as rheumatoid arthritis and Sjogren's syndrome and 4) local or systemic hypersensitivity reaction. And it can be also developed without obvious causes and associated diseases(idiopathic). Radiologically it represents as bilateral interstitial patterns of pulmonary infiltrates. In this case, a 49 year-old woman was presented with intermittent cough and sputum. On chest X-ray and CT, 5 x 4 cm sized mass in right upper lobe and paratracheal lymphadenopathies were detected, by which lung malignancy was suspected. Bronchoscopy, transbronchial lung biopsy and transthoracic needle aspiration showed non-specific findings only. After right upper lobectomy, we could confirm a case of follicular bronchiolitis which presented as an unusual mass-like radiologic finding.
Arthritis, Rheumatoid ; Biopsy ; Bronchiolitis ; Bronchoscopy ; Chlamydia ; Connective Tissue Diseases ; Cough ; Female ; Fibrosis* ; Humans ; Hypersensitivity ; Lung ; Middle Aged ; Mycoplasma ; Needles ; Sjogren's Syndrome ; Sputum ; Thorax

BACKGROUND: A key to successful peripheral blood stem cell transplantation is to harvest a sufficient amount of hematopoietic stem cells. A method of quickly detecting hematopoietic stem cells in peripheral blood with simple procedures using the SE-9000TM IMI channel (TOA Medical Electronics Co., Ltd., Kobe, Japan) was developed. In this study, usefulness of determining the optimal time for peripheral blood stem cell harvest using IMI channel was investigated. METHODS: Seventy nine peripheral blood stem cell collections were performed from thirteen patients with hematologic malignancy and nineteen patients with solid organ malignancy. In 13 cases, G-CSF was administrered following chemotherapy. In 19 cases only G-CSF was used to mobilize the peripheral blood stem cells. The counts of leukocytes, mononuclear cells, CD34 positive cells, and IMI in peripheral blood and leukapheresis products were determined. RESULTS: The CD34 positive cell count in harvested PBSC showed positive correlation with leukocyte cell, mononuclear cell, CD34 positive cell, and IMI in peripheral blood, with correlation coefficients of 0.48, 0.27, 0.63, 0.66, respectively. Positive correlation was presented between IMI and CD34 positive cell in peripheral blood and harvested PBSC, with a correlation coefficient, 0.83 and 0.74, respectively. CONCLUSIONS: As the SE-9000TM enables determination of the number of PBSC easily and rapidly, within approximately 85 seconds, whereas CD34 assays is expensive and needs skilled operator, the measurement of IMI positive cells is clinically useful for monitoring the peripheral blood stem cell mobilization.
Cell Count ; Drug Therapy ; Electronics, Medical ; Granulocyte Colony-Stimulating Factor ; Hematologic Neoplasms ; Hematology* ; Hematopoietic Stem Cell Mobilization ; Hematopoietic Stem Cells ; Humans ; Leukapheresis ; Leukocytes ; Leukocytes, Mononuclear ; Peripheral Blood Stem Cell Transplantation ; Stem Cells*

The average sodium intake of Koreans was reported to be 5,279.9 mg/day, which is one of the highest intake levels worldwide. The average Koreans intake 19.6% of sodium from kimchi, showing kimchi as the main contributor of sodium in this country (Ministry of Health and Welfare, 2005). The sodium content of dishes that are frequently chosen by workers, and which were served by foodservice cafeterias were chemically analyzed. The average sodium content of one meal provided by 10 foodservice cafeterias was 2,777.7 mg. Twenty-one, one-dish-meals, frequently chosen by workers for a lunch menu, were collected at 4 different restaurants for each menu by one male, aged in the twenties and analyzed chemically also. Workers who eat lunch at a workplace cafeteria everyday could intake about 8 g of salt at a one-time meal and those who eat out for a one-dish-meal would intake 3-8 g of salt without counting sodium content from the side dishes. From these study results, one could estimate that over 10 g of salt could be possible for a single meal for workers who eat out everyday. A nationwide nutrition campaign and education for low salt diets for restaurant owners and foodservice providers should be seriously considered.
Aged ; Diet ; Eating ; Food Services ; Humans ; Lunch ; Male ; Meals ; Restaurants ; Sodium

Extended-spectrum beta-lactamase (ESBL) producing bacterial infection causes delayed response to antibiotic treatment and consequently results in serious problem, because it can hydrolyze the majority of beta-lactam antibiotics. Here we report a case of multiple renal abscess by ESBL producing Escherichia coli in a patient with diabetes mellitus who had a history of repetitive urinary tract infection. A 49-year old woman was admitted to our hospital because of intermittent fever, left flank pain, and vomiting. She had been diagnosed as acute pyelonephritis and treated with the first and third cephalosporin for 1 month at a clinic. At admission, urinary bacterial culture revealed Escherichia coli resistant to both the first and third cephalosporin such as cefotaxime, ceftriaxone, and ceftazidime. Double disk synergy test confirmed ESBL. Abdominal computed tomography demonstrated multiple renal abscess. After treatment of imipenam for 4 weeks, she discharged with improved condition.
Abscess* ; Anti-Bacterial Agents ; Bacterial Infections ; beta-Lactamases* ; Cefotaxime ; Ceftazidime ; Ceftriaxone ; Diabetes Mellitus ; Escherichia coli* ; Escherichia* ; Female ; Fever ; Flank Pain ; Humans ; Middle Aged ; Pyelonephritis ; Urinary Tract Infections ; Vomiting

KBG syndrome is a very rare genetic disorder characterized by macrodontia of upper central incisors, global developmental delay, distinctive craniofacial features, short stature, and skeletal anomalies. Ankyrin repeat domain 11 gene (ANKRD11) has recently been identified as a causal factor of this syndrome. We describe a 6-yr-old Korean boy with features of KBG syndrome. The patient had a short stature, macrodontia, dysmorphic facial features, speech and motor delay with intellectual disability, and partial seizures as indicated by the electroencephalogram, but he was neither autistic nor had autism spectrum disorders. Using high-resolution oligonucleotide array comparative genomic hybridization, we identified a heterozygous 240-kb deletion at 16q24.3 corresponding to ANKRD11. This patient provided additional evidence on the influence of ANKRD11 in KBG syndrome and suggested that deletion limited to ANKRD11 is unlikely to cause autism.
Abnormalities, Multiple/diagnosis/*genetics ; Asian Continental Ancestry Group/*genetics ; Bone Diseases, Developmental/diagnosis/*genetics ; Child ; Chromosomes, Human, Pair 16 ; Comparative Genomic Hybridization ; Electroencephalography ; Facies ; Gene Deletion ; Heterozygote ; Humans ; Intellectual Disability/diagnosis/*genetics ; Male ; Phenotype ; Repressor Proteins/*genetics ; Republic of Korea ; Tooth Abnormalities/diagnosis/*genetics

PURPOSE: To compare magnetization transfer ratios (MTR) among various cerebral edemas with different pathophysiologic processes. MATERIALS AND METHODS: Cerebral edemas seen on MR images in 45 patients were classified as one of three types: vasogenic (n=22; tumor[n=9], contusion[n=3], hemangioma[n=4], hemorrhage[n=4], others[2]); cytotoxic (n=18; all acute infarction), and interstitial edema (n=5). In all cases, both T2-weighted images with and without magnetization transfer were obtained using off-set pulses of 600Hz. MTRs in each cerebral edema were measured and compared. RESULTS: The mean MTRs of vasogenic edema, cytotoxic edema and interstitial edema were 22 +/- 5%, 26 +/- 4 % and 19 +/- 2%, respectively. There was no statistically significant difference among the three types (p>0.05). CONCLUSION: Mean MTR was highest in cytotoxic edema and lowest in interstitial edema, but the differences were not significant.
Brain Edema* ; Edema ; Humans

PURPOSE: Natural history and consequences of the novel 2009 influenza A H1N1 (2009 H1N1) infection in immunocompromised pediatric patients are not yet fully understood. In this study, we investigated the clinical features and outcomes of the 2009 H1N1 infection in pediatric patients with hematological and oncological diseases. METHODS: We retrospectively reviewed the medical records of 528 patients who had hematological and oncological diseases and who were treated at 7 referral centers located in the Yeungnam region. Among the 528 patients, 27 with definite diagnosis of 2009 H1N1 infection were the subjects of this study. All patients were divided into the following 3 groups: patients who were receiving chemotherapy (group 1), patients who were immunosuppressed due to a non-malignant hematological disease (group 2), and patients who were off chemotherapy and had undergone their last chemotherapy course within 2 years from the influenza A pandemic (group 3). RESULTS: All 28 episodes of 2009 H1N1 infection were treated with the antiviral agent oseltamivir (Tamiflu(R)), and 20 episodes were treated after hospitalization. Group 1 patients had higher frequencies of lower respiratory tract infection and longer durations of fever and hospitalization as compared to those in group 2. Ultimately, all episodes resolved completely with no complications. CONCLUSION: These results suggest that early antiviral therapy did not influence the morbidity or mortality of pediatric patients with hematological and oncological diseases in the Yeungnam region of Korea after the 2009 H1N1 infection. However, no definite conclusions can be drawn because of the small sample size.
Child ; Fever ; Hematologic Diseases ; Hospitalization ; Humans ; Immunocompromised Host ; Influenza A virus ; Influenza, Human ; Korea ; Medical Records ; Natural History ; Oseltamivir ; Pandemics ; Referral and Consultation ; Respiratory Tract Infections ; Retrospective Studies ; Sample Size