The purpose of this study was to verify the validity of the Patient Severity Classification Tool by examining the correlations between the APACHE III and the Patient Severity Classification Tool and to propose admission criteria to the ICU. The instruments used for this study were the APACHE III developed by Knaus and thePatient Severity Classification Tool developed by Korean Clinical Nurses Association. Data was collected from the 156 Medical ICU patients during their first 24 hours of admission at the Seoul National University Hospital by three trained Medical ICU nurses from April 20 to August 31 1999. Data were analyzed using the frequency, X2, Wilcoxon rank sum test, and Spearman rho. There was statistically significant correlations between the scores of the APACHE III and the Patient Severity Classification Tool. Mortality rate was increased as patients classification of severity in both the APACHE III and the Patient Severity Classification Tool scored higher. The Patient Severity Classification Tool was proved to be a valid and reliable tool, and a useful tool as one of the severity predicting factors, ICU admission criteria, information sharing between ICUs, quality evaluations of ICUs, and ICU nurse staffing. 1) This paper was awarded the first prize at the Seoul National Hospital Nursing Department Research Contest.
APACHE* ; Awards and Prizes ; Classification* ; Humans ; Information Dissemination ; Mortality ; Nursing ; Seoul

Wiskott-Aldrich syndrome is a rare inheritable disease. Though there are many reported cases in the world, there are only 3 reported cases in Korea. We experienced a 7 years old boy with Wiskott-Aldrich syndrome. The initial presentation was generalized petechiae due to thrombocytopenia. We diagnosed him to have idiopathic thrombocytopenic purpura and followed up him for several years. During follow-up the patient have been suffered from croup, perianal abscess, bronchitis, and otitis media. One year ago, inguinal mass developed and 3 months ago, cervical and axillary masses developed. The fine needle aspiration cytology and biopsy revealed angioimmunoblastic lymphadenopathy like atypical lymphoproliferative disorders associated with congenital immune deficiency. So we diagonsed the patient to have Wiskott-Aldrich syndrome through his clinical course and laboratory findings including eczema, persistent low platelet counts, low mean platelet volume, monoclonal gammopathy on serum electrophoresis and biopsy finding.
Abscess ; Biopsy ; Biopsy, Fine-Needle ; Bronchitis ; Child ; Croup ; Eczema ; Electrophoresis ; Follow-Up Studies ; Humans ; Immunoblastic Lymphadenopathy ; Korea ; Lymphoproliferative Disorders ; Male ; Mean Platelet Volume ; Otitis Media ; Paraproteinemias ; Platelet Count ; Purpura ; Purpura, Thrombocytopenic, Idiopathic ; Thrombocytopenia* ; Wiskott-Aldrich Syndrome*

BACKGROUND: Pulmonary complications including pneumonia and pulmonary edema frequently develop in critically ill surgical patients. Lung ultrasound (LUS) is increasingly used as a powerful diagnostic tool for pulmonary complications. The purpose of this study was to report how LUS is used in a surgical intensive care unit (ICU). METHODS: This study retrospectively reviewed the medical records of 67 patients who underwent LUS in surgical ICU between May 2016 and December 2016. RESULTS: The indication for LUS included hypoxemia (n = 44, 65.7%), abnormal chest radiographs without hypoxemia (n = 17, 25.4%), fever without both hypoxemia and abnormal chest radiographs (n = 4, 6.0%), and difficult weaning (n = 2, 3.0%). Among 67 patients, 55 patients were diagnosed with pulmonary edema (n = 27, 41.8%), pneumonia (n = 20, 29.9%), diffuse interstitial pattern with anterior consolidation (n = 6, 10.9%), pneumothorax with effusion (n = 1, 1.5%), and diaphragm dysfunction (n = 1, 1.5%), respectively, via LUS. LUS results did not indicate lung complications for 12 patients. Based on the location of space opacification on the chest radiographs, among 45 patients with bilateral abnormality and normal findings, three (6.7%) and two (4.4%) patients were finally diagnosed with pneumonia and atelectasis, respectively. Furthermore, among 34 patients with unilateral abnormality and normal findings, two patients (5.9%) were finally diagnosed with pulmonary edema. There were 27 patients who were initially diagnosed with pulmonary edema via LUS. This diagnosis was later confirmed by other tests. There were 20 patients who were initially diagnosed with pneumonia via LUS. Among them, 16 and 4 patients were finally diagnosed with pneumonia and atelectasis, respectively. CONCLUSIONS: LUS is useful to detect pulmonary complications including pulmonary edema and pneumonia in surgically ill patients.
Anoxia ; Critical Care* ; Critical Illness ; Diagnosis ; Diaphragm ; Fever ; Humans ; Lung* ; Medical Records ; Pneumonia ; Pneumothorax ; Pulmonary Atelectasis ; Pulmonary Edema ; Radiography, Thoracic ; Retrospective Studies ; Ultrasonography* ; Weaning

BACKGROUND: Idiopathic Central Diabetes Insipidus in children or adolescents requires a frequent follow-up regimen using serial brain MRI and CSF examinations especially if an isolated pituitary stalk thickening or loss of a hyperintense signal in the posterior pituitary lobe is observed. Although a detailed description has not been made in adults who had Idiopathic Central Diabetes Insipidus, the clinical course of a Central Diabetes Insipidus in children or in adolescents can not be applied to adults because a follow-up study is so invasive and expensive. In this report, we evaluated the clinical course of Idiopathic Central Diabetes Insipidus in adults. METHODS: The diagnosis of Idiopathic Central Diabetes Insipidus was based on the presenting clinical symptoms, the water deprivation test, biochemical studies and a brain MRI. We measured the urine specific gravity, urine and plasma osmolarity, electrolytes, and daily urine amount and we also performed an anterior pituitary evaluation. Patients had contrast-enhanced MRI and biochemical studies every 4 to 12 months. RESULTS: The patients included 8 females and 4 males. Their ages ranged from 20 to 76 years and their mean age was 45+/-17 years. Tumor markers in the CSF were not detected any of the patients. An anterior pituitary evaluation showed that four patients had hyperprolactinemia, and five patients had impaired secretory responses of Growth Hormone to an insulin induced hypoglycemia. Nine of the 12 patients had thickening of the pituitary stalk, seven had lacked the hyperintense signal of a normal neurohypophysis. The abnormalities of MRI disappeared in 3 patients by the 4th, 27th and 36th month follow up periods, respectively. The follow up duration was between 8 months and 11 years 3 months and the mean follow up duration period was 50.6+/-45.5 months. Clinical symptoms were corrected by DDAVP administration. Other symptoms were absent. CONCLUSION: In our study, of Idiopathic Central Diabetes Insipidus in adults there were no observed germinomas or other disease that were observed. Therefore this disorder may have a benign course.
Adolescent ; Adult* ; Brain ; Child ; Deamino Arginine Vasopressin ; Diabetes Insipidus, Neurogenic* ; Diagnosis ; Electrolytes ; Female ; Follow-Up Studies ; Germinoma ; Growth Hormone ; Humans ; Hyperprolactinemia ; Hypoglycemia ; Insulin ; Magnetic Resonance Imaging ; Male ; Osmolar Concentration ; Pituitary Gland ; Pituitary Gland, Posterior ; Plasma ; Specific Gravity ; Biomarkers, Tumor ; Water Deprivation

BACKGROUND AND OBJECTIVES: Since the liberated otoconia from the degenerated utricle has been postulated as the cause of the benign paroxysmal positional vertigo (BPPV), the relationship of the utricular function and the generation of BPPV have been studied. In addition, abnormal bone metabolism and vascular risk factors resulting insufficient circulation to utricle has been reported to be related to the utricular degeneration in BPPV. We investigated the relationship between the vascular risk factors, bone mineral density (BMD) and recurrence for the BPPV and otholith function tests of BPPV. MATERIALS AND METHODS: Consecutive patients 84 with BPPV were recruited in a dizziness clinic. Caloric test, ocular vestibular evoked myogenic potentials (oVEMPs) were tested in all the patients in acute phase of BPPV. At the same time, vascular risk factors and BMD were performed. Vascular risk factors were history of hypertension, diabetes mellitus, hyperlipidemia and ischemic heart disease. All the data were analyzed for the relationship between abnormal results of vestibular function tests and the risk factors. RESULTS: Patients 58 (69%) showed abnormal cervical VEMPs that were related to decreased bone density, having more than one vascular risk factor, and older age (>55 years). Abnormal oVEMPs were showed in 53 patients (63%) that were related to older age and vascular risk factors, but not statistically related to bone mineral density. Caloric tests failed to show any statistically significant results. CONCLUSION: We found abnormal results of cVEMPs and oVEMPs is related to the BMD, vascular risk factors and age. VEMPs could be used for the demonstration of presumptive otolith degeneration in BPPV.
Bone Density ; Caloric Tests ; Diabetes Mellitus ; Dizziness ; Humans ; Hyperlipidemias ; Hypertension ; Myocardial Ischemia ; Otolithic Membrane ; Recurrence ; Risk Factors ; Saccule and Utricle ; Vertigo ; Vestibular Evoked Myogenic Potentials ; Vestibular Function Tests

STUDY DESIGN: Case Report. OBJECTIVES: The aim of this study was to report 2 cases of calcified spinal meningioma that displayed differences in appearance during resection, and to review the current literature on calcified and ossified spinal meningiomas. SUMMARY OF LITERATURE REVIEW: Calcified and ossified spinal meningiomas are rare, and tumor calcification is a risk factor for poor neurological outcomes resulting from the additional manipulations required to dissect the tumor. MATERIALS AND METHODS: We describe the clinical course and intraoperative findings of 2 female patients who presented with symptoms of myelopathy. Magnetic resonance imaging showed calcified spinal meningiomas of the thoracic spine. The type of tumor resection performed was dependent on the solidity and texture of the individual tumors. RESULTS: Pathologic evaluation revealed psammoma bodies, which suggested calcified meningioma. The patients' neurologic symptoms resolved with no neurologic sequelae. CONCLUSIONS: Although there are a few pathologic differences regarding the main type and pathogenesis of ossified and calcified meningioma, both are thought to have a poor prognosis. For these tumors, adequately accounting for the expected poor prognosis and performing a wide laminectomy in order to ensure an adequate surgical margin are important factors for achieving a favorable outcome.
Female ; Humans ; Laminectomy ; Magnetic Resonance Imaging ; Meningioma* ; Neurologic Manifestations ; Prognosis ; Risk Factors ; Spinal Cord Diseases ; Spine

No abstract available.

Adult onset Stills Disease (AOSD) is a systemic inflammatory disease characterized by spiking high fevers, arthritis, and an evanescent rash. Although many patients respond to nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroid, some patients fail to do so or are found to be resistant and require high doses of corticosteroid which induce severe side effects. Recently, treatment with intravenous immunoglobulin (IVIG) has been reported to be effective in patients with AOSD who were refractory to NSAIDs. Here, we report a case of AOSD treated with IVIG with a review of the literature.
Adult* ; Anti-Inflammatory Agents, Non-Steroidal ; Arthritis ; Exanthema ; Fever ; Humans ; Immunoglobulins* ; Immunoglobulins, Intravenous ; Still's Disease, Adult-Onset*

There have been a few cases of occupational allergy caused by herb materials. In this study, we report a case of occupational asthma and rhinitis sensitized by six kinds of herb materials-Ostericum (Kangwhal), Angelica (Danggui), Cnidium (Chunkung), Pinellia (Banha), Zingerber (Kunkang) and Discoreae (Sanyak) in a pharmacist working at a pharmacy. The patient had shown negative responses to 80 common inhalant and food allergens, but strong positive responses to six herb material extracts, Kangwhal, Danggui, Chunkung, Banha, Kunkang and Sanyak, were noted on skin-prick test. Bronchoprovocation test showed a dual asthmatic response to Danggui extract. Serum specific IgE antibodies to Chunkung, Banha and Sanyak were detected by enzyme-linked immunosorbent assay (ELISA) with no specific IgE binding to Kangwhal, Danggui and Kunkang extracts. In order to further characterize the allergic components of these three extracts, sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) and electroblotting studies were performed. One IgE binding components (60 kDa) were detected within Chunkung extract, two (10, 25 kDa) in Banha and four (33, 34, 65, 98 kDa) in Sanyak. It is suggested that Chunkung, Banha and Sanyak may induce IgE-mediated bronchoconstriction in an exposed worker. Further studies are needed to investigate the pathogenic mechanisms induced by Kangwhal, Danggui and Kunkang.
Allergens ; Angelica ; Antibodies ; Asthma ; Asthma, Occupational* ; Bronchoconstriction ; Cnidium ; Electrophoresis ; Enzyme-Linked Immunosorbent Assay ; Humans ; Hypersensitivity ; Immunoglobulin E ; Occupational Diseases ; Pharmacists ; Pharmacy ; Pinellia ; Rhinitis ; Sodium

Thrombosis is one of the important complications of nephrotic syndrome. The mechanism of vascular thrombosis in nephrotic syndrome is under debate, but the hypercoagulable state is regarded as a predisposing factor to that. Most of vascular thrombosis in nephrotic syndrome have occurred in veins. Arterial thrombosis is relatively uncommon and often related with steroid or diuretic use. We experienced a case of bilateral popliteal arterial occlusion due to femoral arterial thrombosis as the first presentation of nephrotic syndrome. A 59-year old male patient was admitted with complaints of pain on left lower extremity for five days. The diagnosis of thrombosis in left popliteal artery was made by arterial angiography. The emergent thrombolytic therapy and anticoagulation was performed. During anticoagulation, another episode of bilateral popliteal arterial occlusion was occurred once again. He had heavy proteinuria, and renal pathology revealed minimal change disease. There was no recurrence of thrombosis for 1 year after treatment with steroid and warfarin.
Angiography ; Causality ; Diagnosis ; Humans ; Lower Extremity ; Male ; Middle Aged ; Nephrosis, Lipoid* ; Nephrotic Syndrome ; Pathology ; Popliteal Artery ; Proteinuria ; Recurrence ; Thrombolytic Therapy ; Thrombosis* ; Veins ; Warfarin