PURPOSE: Methotrexate (MTX) is one of the most widely used anticancer agents, with indications and established protocols in a range of childhood and adult cancers. High dose MTX (HD-MTX) requires aggressive care to prevent toxicity. Limited inpatient conditions are forcing major changes in health care delivery patterns and decisions. We conducted a retrospective study to describe the safety, feasibility and cost-effectiveness of HD-MTX administration in the outpatient setting. METHODS: Patients with acute lymphoblastic leukemia who underwent HD-MTX (3 g/m2) administration in either the inpatient (N=70) or outpatient setting (N=70) from January to July 2012 were included. In the outpatient setting, HD-MTX was administered intravenously (IV) over 6 hours and included hydration with sodium bicarbonate (2000 ml/m2/for 12 hours). Daily visits to the outpatient setting followed. Leucovorin was given 24 hours after MTX at a standard dose (15 mg/m2 IV bolus) every 6 hours. We compared the serum drug levels of MTX, hematologic and renal toxicity, hepatotoxicity, frequency of subsequent unscheduled outpatient visits and readmission episodes, medical expenses and duration of hospital stay between the two groups. RESULTS: HD-MTX administrations were successfully completed in both groups. No significant differences were found between the two groups for the parameters studied. Patients who received HD-MTX in the inpatient setting had 2.37 times and 2.24 times greater medical expenses and duration of hospital stay respectively than outpatient recipients. CONCLUSION: This study suggests that HD-MTX administration done with aggressive monitoring in the outpatient setting is safe and efficient, without a greater incidence of major toxicities.
Adult ; Antineoplastic Agents ; Child* ; Delivery of Health Care ; Humans ; Incidence ; Inpatients* ; Length of Stay ; Leucovorin ; Methotrexate* ; Outpatients* ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Retrospective Studies ; Sodium Bicarbonate

Factor XI deficiency (Hemophilia C) is a very rare autosomal recessive bleeding disorder. Patients with factor XI deficiency do not typically show any spontaneous bleeding or specific symptoms. Sometimes those who have this disorder are identified during special situations such as trauma or surgery. Orthognathic surgery is particularly associated with a high bleeding risk. Therefore, great care must be taken when treating patients with bleeding disorders such as factor XI deficiency. There are a few reports that address the management of patients with bleeding disorders during orthognathic surgery. The current report describes a patient with factor XI deficiency who underwent Le Fort I osteotomy together with bilateral sagittal split osteotomy. The patient's condition was assessed using both rotation thromboelastometry (ROTEM™) and noninvasive measurements of total hemoglobin (SpHb) using Masimo Radical 7 (Masimo Co. CA, USA).
Anesthesia* ; Factor XI Deficiency* ; Factor XI* ; Hemorrhage ; Humans ; Orthognathic Surgery* ; Osteotomy ; Thrombelastography

PURPOSE: To evaluate anatomical locations and distributions of supraorbital notch and foramen using facial 3D computed tomography in the Korean adult population. METHODS: The study sample was composed of 87 adult patients with no history of trauma or ocular disease. The horizontal position of the supraorbital foramen or notch was recorded in relation to a vertical line defined by a reproducible hypothetical point, such as the nasion and mid-maxilla and the midpoint of the horizontal supraorbital plane. The distance and angle for each supraorbital foramen and notch were calculated from the defined vertical line. Furthermore, vertical distance from supraorbital plane, which was established using the highest points of both supraorbital rims, was obtained from the supraorbital foramen. RESULTS: The mean age of the 87 patients was 45.44 +/- 8.34 years (range, 30-59 years). There were 66 eyes in the supraorbital notch and 108 eyes in the supraorbital foramen. There were no distributional differences between the 2 sides. The mean horizontal distance of both types was 23.95 +/- 3.93 mm (range, 16.41-38.94 mm). The horizontal distance of male patients was longer than the female patients (25.18 +/- 4.16 mm vs. 22.63 +/- 3.19 mm, p < 0.001, based on independent t-test) and the horizontal distance of supraorbital notch was shorter than the supraorbital foramen (22.59 +/- 3.18 mm vs. 26.18 +/- 4.04 mm, respectively, p < 0.001, based on independent t-test). The mean vertical distance and mean angles of the supraorbital foramen were 3.02 +/- 1.119 mm and 6.81 +/- 2.31 degrees (degrees), respectively. CONCLUSIONS: The present study described the anatomical location of each supraorbital opening type in Korean adults. According to horizontal distance, a surgeon can avoid iatrogenic injury of the supraorbital neurovascular complex, especially during brow surgery. In addition, the anatomy can aid in targeting supraorbital neurovascular complex in cases of nerve block.
Adult ; Female ; Humans ; Male ; Nerve Block

Background: To evaluate binocular function and clinical features in patients with esotropia (ET) accompanied by congenital ptosis. Methods: Clinical records of 44 ET patients with congenital ptosis (ET-ptosis group) and 71 age-matched ET patients without ptosis (ET only group) who presented for eye examination between January 2016 and December 2021 were retrospectively reviewed. Best-corrected visual acuity (BCVA), magnitude of esodeviation and stereopsis at the first visit were reviewed. Stereopsis and other clinical features of the two groups were compared. Results: The mean (±standard deviation) age of overall patients was 5.7 (±1.9) years. The margin reflex distance 1 (MRD1) of patients with ptosis was greater than 0 but less than or equal to 2, indicating that mild ptosis was included. There was no significant difference in the distribution of age, sex, spherical equivalent refractive errors, BCVA, or magnitude of ET (at distance or near) between the two groups (all p>0.05). Furthermore, stereopsis and the number of patients with amblyopia did not differ significantly between the two groups. The magnitudes of esodeviation, near stereopsis and BCVA did not differ significantly between the 0Conclusions In patients with ET and congenital mild ptosis, stereopsis and visual acuity were not different from those in ET only patients. The presence of coexisting mild ptosis might not have a further deleterious impact on binocular function in ET patients.

Background: To evaluate binocular function and clinical features in patients with esotropia (ET) accompanied by congenital ptosis. Methods: Clinical records of 44 ET patients with congenital ptosis (ET-ptosis group) and 71 age-matched ET patients without ptosis (ET only group) who presented for eye examination between January 2016 and December 2021 were retrospectively reviewed. Best-corrected visual acuity (BCVA), magnitude of esodeviation and stereopsis at the first visit were reviewed. Stereopsis and other clinical features of the two groups were compared. Results: The mean (±standard deviation) age of overall patients was 5.7 (±1.9) years. The margin reflex distance 1 (MRD1) of patients with ptosis was greater than 0 but less than or equal to 2, indicating that mild ptosis was included. There was no significant difference in the distribution of age, sex, spherical equivalent refractive errors, BCVA, or magnitude of ET (at distance or near) between the two groups (all p>0.05). Furthermore, stereopsis and the number of patients with amblyopia did not differ significantly between the two groups. The magnitudes of esodeviation, near stereopsis and BCVA did not differ significantly between the 0Conclusions In patients with ET and congenital mild ptosis, stereopsis and visual acuity were not different from those in ET only patients. The presence of coexisting mild ptosis might not have a further deleterious impact on binocular function in ET patients.

Background: To evaluate binocular function and clinical features in patients with esotropia (ET) accompanied by congenital ptosis. Methods: Clinical records of 44 ET patients with congenital ptosis (ET-ptosis group) and 71 age-matched ET patients without ptosis (ET only group) who presented for eye examination between January 2016 and December 2021 were retrospectively reviewed. Best-corrected visual acuity (BCVA), magnitude of esodeviation and stereopsis at the first visit were reviewed. Stereopsis and other clinical features of the two groups were compared. Results: The mean (±standard deviation) age of overall patients was 5.7 (±1.9) years. The margin reflex distance 1 (MRD1) of patients with ptosis was greater than 0 but less than or equal to 2, indicating that mild ptosis was included. There was no significant difference in the distribution of age, sex, spherical equivalent refractive errors, BCVA, or magnitude of ET (at distance or near) between the two groups (all p>0.05). Furthermore, stereopsis and the number of patients with amblyopia did not differ significantly between the two groups. The magnitudes of esodeviation, near stereopsis and BCVA did not differ significantly between the 0Conclusions In patients with ET and congenital mild ptosis, stereopsis and visual acuity were not different from those in ET only patients. The presence of coexisting mild ptosis might not have a further deleterious impact on binocular function in ET patients.

Background: To evaluate binocular function and clinical features in patients with esotropia (ET) accompanied by congenital ptosis. Methods: Clinical records of 44 ET patients with congenital ptosis (ET-ptosis group) and 71 age-matched ET patients without ptosis (ET only group) who presented for eye examination between January 2016 and December 2021 were retrospectively reviewed. Best-corrected visual acuity (BCVA), magnitude of esodeviation and stereopsis at the first visit were reviewed. Stereopsis and other clinical features of the two groups were compared. Results: The mean (±standard deviation) age of overall patients was 5.7 (±1.9) years. The margin reflex distance 1 (MRD1) of patients with ptosis was greater than 0 but less than or equal to 2, indicating that mild ptosis was included. There was no significant difference in the distribution of age, sex, spherical equivalent refractive errors, BCVA, or magnitude of ET (at distance or near) between the two groups (all p>0.05). Furthermore, stereopsis and the number of patients with amblyopia did not differ significantly between the two groups. The magnitudes of esodeviation, near stereopsis and BCVA did not differ significantly between the 0Conclusions In patients with ET and congenital mild ptosis, stereopsis and visual acuity were not different from those in ET only patients. The presence of coexisting mild ptosis might not have a further deleterious impact on binocular function in ET patients.

Background: To evaluate binocular function and clinical features in patients with esotropia (ET) accompanied by congenital ptosis. Methods: Clinical records of 44 ET patients with congenital ptosis (ET-ptosis group) and 71 age-matched ET patients without ptosis (ET only group) who presented for eye examination between January 2016 and December 2021 were retrospectively reviewed. Best-corrected visual acuity (BCVA), magnitude of esodeviation and stereopsis at the first visit were reviewed. Stereopsis and other clinical features of the two groups were compared. Results: The mean (±standard deviation) age of overall patients was 5.7 (±1.9) years. The margin reflex distance 1 (MRD1) of patients with ptosis was greater than 0 but less than or equal to 2, indicating that mild ptosis was included. There was no significant difference in the distribution of age, sex, spherical equivalent refractive errors, BCVA, or magnitude of ET (at distance or near) between the two groups (all p>0.05). Furthermore, stereopsis and the number of patients with amblyopia did not differ significantly between the two groups. The magnitudes of esodeviation, near stereopsis and BCVA did not differ significantly between the 0Conclusions In patients with ET and congenital mild ptosis, stereopsis and visual acuity were not different from those in ET only patients. The presence of coexisting mild ptosis might not have a further deleterious impact on binocular function in ET patients.

PURPOSE: This study was to identify the physical, psychological and social symptoms of ALL (acute lymphoblastic leukemia) children and adolescents receiving maintenance chemotherapy to build a basic data set to produce effective nursing intervention and ultimately help their early return to school and social adaptation. METHODS: Fifty ALL children and adolescents between 4 and 18, who were receiving maintenance chemotherapy were surveyed on days 2, 7, and 28. For younger children, between the age of 4 and the 3rd year in elementary school, their primary caregivers answered the survey and those between the 4th year in elementary school and the age of 18 answered the survey themselves. RESULTS: During maintenance chemotherapy, ALL children and adolescents experience diverse physical, psychological and social symptoms. On days 7 and 28, physical and social symptoms were greater than physical symptoms. Physical symptoms were greatest on day 2 and the most psychological and social symptoms were observed on day 7. During the maintenance chemotherapy period, 40% of the children and adolescents could not attend regular educational institutions. CONCLUSION: Since each point in the maintenance chemotherapy period shows different symptomatic characteristics, nursing intervention can be provided appropriately for each specific point to help the patients' social adaptation and early return to school.
Adolescent* ; Caregivers ; Child* ; Dataset ; Drug Therapy ; Education* ; Humans ; Maintenance Chemotherapy* ; Nursing ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Symptom Assessment

BACKGROUND: To prepare for possible emergency situations during dental treatment, it is helpful to know how often and what kinds of emergencies may arise. This study set out to evaluate the incidences, causes, treatments, and outcomes of emergency situations in the outpatient clinic of a dental teaching hospital in Korea. METHODS: We retrospectively reviewed the records of patients who had experienced an emergency situation and emergency response team activated in a selected outpatient clinic between November 2004 and November 2013. Specific information about the emergency cases was collected, including the patient characteristics and the frequency, types, treatments, and outcomes of the emergency situations. RESULTS: We identified 35 instances of emergency situations in 2,890,424 patients (incidence = 0.012 per 10,000 outpatients). The number of cases was as follows: 10 (28.6%) in the Department of Periodontics, 10 (28.6%) in the Department of Oral and Maxillofacial Surgery, 6 (17.1%) in the Department of Oral and Maxillofacial Radiology, 4 (11.4%) in the Department of Prosthodontics, 2 (5.7%) in the Department of Conservative Dentistry, 2 (5.7%) in the Department of Pediatric Dentistry, and 1 (2.9%) in the Department of Orthodontics. Three (8.6%) of the emergency situations arose before treatment, 22 (62.9%) during treatment, 7 (20.0%) after treatment, and 2 (5.7%) in a patient's guardian. CONCLUSIONS: In accordance with the growing elderly population and more aggressive dental procedures, the number of emergency situations may increase in the future. We recommend that clinicians keep in mind airway management and the active control of emergency situations.
Aged ; Airway Management ; Ambulatory Care Facilities* ; Dentistry ; Emergencies* ; Emergency Medical Services ; Hospital Rapid Response Team ; Hospitals, Teaching* ; Humans ; Incidence ; Korea* ; Orthodontics ; Outpatients* ; Pediatric Dentistry ; Periodontics ; Prevalence ; Prosthodontics ; Retrospective Studies* ; Surgery, Oral