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

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

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: 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

PURPOSE: We studied to compare computed tomographic(CT) findings of liver injury with management methods in adults and, moreover, to present the CT basis for the management. MATERIALS AND METHODS: We retrospectively reviewed CT scans of 43 adults diagnosed as liver injury during a 66-month period. Thirty-eight patients were hemodynamically stable. Thirty-two of them were managed conservatively, whereas six managed operatively. Five unstable patients underwent emergency operation. We classified CT findings according to the severity of liver injuries(ie, hematoma, laceration, and periportal tracking) and hemperitoneum, ranging from grade 1 to 5 and from 0 to 3+, respectively. Thus, we compared the CT classificafions with their management(ie, operation rate), especially hemodynamically stable patients. RESULTS: Operation rates of all patients and hemodynamically stable patients were 26% and 16%, respectively. Operation rate at each grade of liver injury was low, especially in hemodynamically stable, despite relatively high operation rate in grade 4. Operation rate of 3+ hemoperitoneum was 100%, including hemodynamically stable patients, in contrast to otherwise low operation rate of others. CONCLUSION: Most liver injury in adults, including grade 4, were managed conservatively, especially hemodynamically stable. Though large amount of hemoperitoneum(ie, 3+) required operation, most hemoperitoeum were managed conservatively. Thus, CT findings of liver injury is helpful in the decision for the management method.
Adult* ; Classification* ; Emergencies ; Hematoma ; Hemoperitoneum ; Humans ; Lacerations ; Liver* ; Retrospective Studies ; Tomography, X-Ray Computed

OBJECTIVE: Previous studies have reported that both preference for spicy food and drinking behavior are associated with the activity of the opioid system in the central nervous system. The relationship between the preference for spicy food and the risk of alcohol dependence by comparing spicy food preference in alcohol-dependent patients vs. healthy controls was investigated. Also the association between the preference for spicy food and OPRM1 A118G was studied. METHODS: A total of 150 Korean male patients with alcohol dependence and 100 normal male control subjects were included in this study. Preference for spicy food was measured using the Food Preference Scale (FPS). DNA analysis was conducted to detect the A118G polymorphism. RESULTS: The mean FPS score was significantly higher in the alcohol-dependent patients (61.2±24.2) than in the normal control subjects (53.0±22.0). FPS scores differed significantly between alcohol-dependent patients and normal control subjects who had the G allele in OPRM1 A118G, but not between the two groups with the AA genotype. CONCLUSION: A strong preference for spicy food can be assumed to be a risk factor for alcohol dependence, particularly in those carrying the G allele in OPRM1 A118G.
Alcoholism* ; Alleles ; Central Nervous System ; DNA ; Drinking Behavior ; Food Preferences* ; Genotype ; Humans ; Male ; Risk Factors

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

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.