Cardiac arrest associated with hyperkalemia during red blood cell transfusion is a rare but fatal complication. Herein, we report a case of transfusion-associated cardiac arrest following the initiation of extracorporeal membrane oxygenation support in a 9-month old infant. Her serum potassium level was increased to 9.0 mEq/L, soon after the newly primed circuit with pre-stored red blood cell (RBC) was started and followed by sudden cardiac arrest. Eventually, circulation was restored and the potassium level decreased to 5.1 mEq/L after 5 min. Extracorporeal membrane oxygenation (ECMO) priming is a relatively massive transfusion into a pediatric patient. Thus, to prevent cardiac arrest during blood-primed ECMO in neonates and infants, freshly irradiated and washed RBCs should be used when priming the ECMO circuit, to minimize the potassium concentration. Also, physicians should be aware of all possible complications associated with transfusions during ECMO.
Blood Transfusion ; Death, Sudden, Cardiac ; Erythrocyte Transfusion ; Erythrocytes ; Extracorporeal Membrane Oxygenation* ; Heart Arrest* ; Humans ; Hyperkalemia* ; Infant* ; Infant, Newborn ; Potassium

The National Forensic Hospital is the only forensic psychiatric hospital in Korea. As of January 2016, the average number of patients assigned to each psychiatrist is more than 120. In this situation, the role of psychopharmacologic treatment becomes very important. To investigate the prescription patterns of major psychotropic medications (i.e., antipsychotics, mood stabilizers, and antidepressants), we reviewed the medical records of the patients diagnosed with schizophrenia and schizoaffective disorder who were admitted in January 2016. The data from 418 patients (403 with schizophrenia and 15 with schizoaffective disorder) were retrospectively collected and analyzed. The average number of major psychotropic medications prescribed for each patient during hospitalization was as follows: antipsychotics, 3.5±1.8; mood stabilizers, 0.5±0.7; and antidepressants, 0.5±0.8. The three most frequently prescribed antipsychotics were risperidone (21.7%), olanzapine (15.5%), and quetiapine (14.4%). More than half of the patients (233, 55.9%) were prescribed an antipsychotic polypharmacy regimen. This study found that patients with schizophrenia and schizoaffective disorder in forensic psychiatric hospital tend to be prescribed many psychotropic medications.
Antidepressive Agents ; Antipsychotic Agents ; Forensic Psychiatry ; Hospitalization ; Hospitals, Psychiatric ; Humans ; Inpatients* ; Korea ; Medical Records ; Polypharmacy ; Prescriptions ; Psychiatry ; Psychopharmacology ; Psychotic Disorders* ; Quetiapine Fumarate ; Retrospective Studies ; Risperidone ; Schizophrenia*

Purpose: To introduce a method of correcting lower eyelid epiblepharon with severe epicanthal fold combined with minimal incision of medial epicanthoplasty (Hiraga method) and to report its clinical outcomes. Methods: We retrospectively reviewed the medical records of patients who underwent surgery for lower eyelid epiblepharon and minimal incision of medial epicanthus from January 2015 and January 2019. Seventy-eight eyes of 39 patients were analyzed for surgical outcomes, subjective symptoms, recurrence, and complications for more than six months of the follow-up period. Results: A total of 39 patients (14 male, 25 female) were included in the analysis. The mean patient age was 8.4 ± 4.3 years, and the mean postoperative follow-up was 14 ± 5.2 months. Eyelid shape and function were well maintained in 39 patients (100%), with no recurrence during follow-up. Conclusions For patients with lower eyelid epiblepharon with severe medial epicanthal fold, lower eyelid epiblepharon with a minimal incision of medial epicanthoplasty (Hiraga method) is a simple surgical technique to prevent recurrence of medial cilia touch, showing successful results without complications.

During administration of anesthesia, intraoperative blood pressure control is very important. Sometimes a hypertensive or anti-hypertensive agent is used in order to maintain blood pressure at an adequate level; alpha-agonist and beta-blocker are drugs frequently used. Alpha-agonists are used in various ways including their application together with local anesthetics during an operation for the purpose of vasoconstriction, to control systemic absorption of local anesthetics, to extend the duration of action, or to reduce bleeding from the surgical site. In addition, alpha-agonists are used in cardiopulmonary resuscitation. Beta-blockers are used widely as a therapeutic agent for hypertension, angina, and arrhythmia, and to lower portal pressure in liver cirrhosis. Here, we are reporting the case of acute pulmonary edema that occurred after the administration of phenylephrine, in order to maintain blood pressure in a 52-year-old female patient with liver cirrhosis. The patient was underwent emergent decompressive craniectomy for intracranial hemorrhage without acknowledging her long-term use of a beta-blocker medication.
Absorption ; Anesthesia ; Anesthetics, Local ; Arrhythmias, Cardiac ; Blood Pressure ; Cardiopulmonary Resuscitation ; Decompressive Craniectomy ; Female ; Hemorrhage ; Humans ; Hypertension ; Intracranial Hemorrhages ; Liver Cirrhosis ; Middle Aged ; Phenylephrine ; Portal Pressure ; Pulmonary Edema ; Vasoconstriction

Sporadic spastic paraplegia (SSP) and hereditary spastic paraplegia (HSP) belong to a clinical and genetically heterogeneous group of disorders characterized by progressive spasticity and weakness in the lower extremities. The symptoms are associated with pyramidal tract dysfunction and degeneration of the corticospinal tracts. Parkinsonism is uncommon in SSP/HSP patients. However, both disorders are associated with damage to the nigrostriatal dopaminergic system. In the present study, the clinical features of patients with SSP/HSP were investigated, and nigrostriatal dopaminergic binding potential was assessed using dopamine transporter (DAT) single-photon emission computer tomography (SPECT). Nine patients with spastic paraplegia participated in the present study. The subjects underwent DAT SPECT using the agent [2-[[2-[[[3-(4-chlorophenyl)-8-methyl-8-azabicyclo[3,2,1]oct-2-yl]methyl](2-mercaptoethyl)amino]ethyl]amino]ethanethiolato (3-)-N2,N20,S2,S20]oxo-[IR-(exo-exo)])-[99mTc]technetium ([99mTc]TRODAT-1). The [99mTc]TRODAT-1 SPECT images of five patients appeared normal, whereas the images of four patients revealed reduced striatal ligand uptake. Among the four patients with reduced uptake, two had parkinsonism, and one exhibited periodic limb movements and restless leg syndrome. Our DAT SPECT imaging study shows that reduced DAT density may be observed in patients with parkinsonism. The results of the present study offer an explanation for the spectrum of spastic paraplegia symptoms and the progression of the disorder.
Adult ; Aged ; Brain/*radionuclide imaging ; Dopamine Plasma Membrane Transport Proteins/metabolism ; Female ; Humans ; Male ; Middle Aged ; Organotechnetium Compounds/diagnostic use ; Paraplegia/diagnosis/genetics/*radionuclide imaging ; Parkinsonian Disorders/complications/genetics/*radionuclide imaging ; Pyramidal Tracts ; Radiopharmaceuticals/diagnostic use ; Spastic Paraplegia, Hereditary/diagnosis/genetics/*radionuclide imaging ; Tomography, Emission-Computed, Single-Photon

No abstract available.
Drug Therapy, Combination* ; Melphalan* ; Multiple Myeloma* ; Prednisone* ; Vincristine*

BACKGROUND: Measurement of the plasma adrenocorticotropic hormone (ACTH) level has been recommended as the first diagnostic test for differentiating between ACTH-independent Cushing syndrome (CS) and ACTH-dependent CS. When plasma ACTH values are inconclusive, a differential diagnosis of CS can be made based upon measurement of the serum dehydroepiandrosterone sulfate (DHEA-S) level and results of the high-dose dexamethasone suppression test (HDST). The aim of this study was to assess the utility of plasma ACTH to differentiate adrenal CS from Cushing' disease (CD) and compare it with that of the HDST results and serum DHEA-S level. METHODS: We performed a retrospective, multicenter study from January 2000 to May 2012 involving 92 patients with endogenous CS. The levels of plasma ACTH, serum cortisol, 24-hour urine free cortisol (UFC) after the HDST, and serum DHEA-S were measured. RESULTS: Fifty-seven patients had adrenal CS and 35 patients had CD. The area under the curve of plasma ACTH, serum DHEA-S, percentage suppression of serum cortisol, and UFC after HDST were 0.954, 0.841, 0.950, and 0.997, respectively (all P<0.001). The cut-off values for plasma ACTH, percentage suppression of serum cortisol, and UFC after HDST were 5.3 pmol/L, 33.3%, and 61.6%, respectively. The sensitivity and specificity of plasma ACTH measurement were 84.2% and 94.3%, those of serum cortisol were 95.8% and 90.6%, and those of UFC after the HDST were 97.9% and 96.7%, respectively. CONCLUSION: Significant overlap in plasma ACTH levels was seen between patients with adrenal CS and those with CD. The HDST may be useful in differentiating between these forms of the disease, especially when the plasma ACTH level alone is not conclusive.
Adrenocorticotropic Hormone* ; Cushing Syndrome* ; Dehydroepiandrosterone Sulfate ; Dexamethasone ; Diagnosis, Differential ; Diagnostic Tests, Routine ; Humans ; Hydrocortisone ; Pituitary ACTH Hypersecretion* ; Plasma* ; Retrospective Studies ; Sensitivity and Specificity

PURPOSE: Peripheral T-cell lymphomas(PTCL) show diverse clinical and histological characteristics and should be understood as mixtures of heterogeneous entities. Although many clinical and biological parameters have been proposed for classifying PTCL into different prognostic groups, few parameters have turned out to be appropriate for classification. To investigate the clinical significance of FUO presentation in PTCL, comparisons of clinical parameters were performed using non-FUO presentation as a control. MATERIALS AND METHODS: 66 cases of Korean PTCL were divided into FUO group and non-FUO group according to the presentation and compared with each other. RESULTS: Among 66 patients of PTCL, 19 patients presented with FUO. Compared with non-FUO group, FUO group showed no significant age and sex ratio differences. FUO group showed more advanced stage, worse performance status than non-FUO group. Predominant sites of definite diagnosis were skin, gastrointestinal tract and liver in FUO group and nasal cavity and paranasal sinus in non-FUO group. There were no significant differences between histologic classifications of both groups. Survival analysis revealed significant differences between both groups. FUO group showed significantly shorter survival. Prognostic factor analysis(multivariate) was done with stage, LDH level, performance status, and FUO status. FUO status, stage and performance status were significant determinants of survival, but LDH level proved to have no prognostic implication. CONCLUSION: PTCL with FUO presentation showed such distinct characteristics that the authors propose fever of unknown origin(FUO) as a clinical parameter for classifying PTCL. Further studies are needed to identify biological parameters which characterize PTCL with FUO presentation.
Classification ; Diagnosis ; Fever of Unknown Origin* ; Fever* ; Gastrointestinal Tract ; Humans ; Liver ; Lymphoma* ; Nasal Cavity ; Prognosis ; Sex Ratio ; Skin ; T-Lymphocytes

OBJECTIVES: Ambivalence of self-image is considered to be important in patients with schizophrenia since impairment of self-referential processing and increment in ambivalence are illness-related symptoms. This study aimed to evaluate quantitative and qualitative properties of ambivalence of self-image in patients with schizophrenia. METHODS: Twenty patients with schizophrenia and 20 normal controls performed a set of 'self-image reflection task' and then the level of ambivalence towards actual and ideal self-image were numerically scored. Ambivalence scores were compared between groups and correlation analyses with psychometric scales were done in each group. RESULTS: Patients with schizophrenia had higher level of ambivalence towards both actual and ideal self-image (p<0.001). Normal controls showed significant correlations with the scales representing level of self-concept clarity (r=-0.480, p=0.033), depression (r=0.479, p=0.033), and self-esteem (r=-0.555, p=0.011 ; R=-0.600, p=0.005) while the patients did not. CONCLUSION: Ambivalence towards one's self-image is more intense in patients with schizophrenia. This symptom may be considered to exist as an independent symptom in schizophrenia.
Depression ; Humans ; Psychometrics ; Schizophrenia* ; Weights and Measures

BACKGROUND: The purpose of this study was to compare a 1% chlorhexidine gluconate/6l% ethanol (CHG/Ethanol) emollient and 7.5% povidone-iodine (PVI) scrub for antibacterial efficacy and effect on skin condition. METHODS: Twelve healthy newly employed nurses were recruited for this clinical study to evaluate the two hand cleansing agents. The CHG/Ethanol emollient hand preparation was applied without scrubbing and 7.5% PVI was applied using a scrub brush in 5-minute surgical scrubbing. Subjects used one method for 5 days and switched to the other method for another 5 days. Samples were taken for bacterial counts using the glove juice technique before and one minute after hand cleansing and again at the end of surgical operation on Day 1, 2, and 5. The VSS (Visual Scoring of Skin condition) scores and HSA (Hand Subject Assessment) scales were used to evaluate skin condition. RESULTS: Log reduction in bacterial counts by CHG/Ethanol emollient was greater than by PVI immediately after hand cleasing (log3.73 vs log1.66) and at the end of surgical operation (log3.49 vs log1.93) on Day 1. But there were no significant difference on Day 2 and 5. CHG/Ethanol emollient caused fewer skin problems than PVI; the VSS scores of the CHG/Ethanol emollient were better than those of PVI on Day 2, 3, 4, and 5 (P<0.05), and also HSA scale for change from baseline to the end of Day 5 was significantly better for the CHG/Ethanol emollient (22.5-->24.5 vs 23.0-->19.3). CONCLUSION: Compared to PVI, the CHG/Ethanol emollient hand preparation was shown to be more antibacterial and less irritation to skin. The results showed the possibility of using the waterless, scrubless agent for surgical hand scrub in Korea.
Bacterial Load ; Chlorhexidine ; Detergents ; Ethanol ; Hand ; Hand Disinfection ; Korea ; Povidone-Iodine* ; Skin ; Weights and Measures