Purpose: Association between hyponatremia and the severity of respiratory symptoms in infants with respiratory syncytial virus (RSV) infection has not yet been studied. This study aimed to compare respiratory symptoms, assessed using the Pediatric Respiratory Score (PRS), in infants with RSV infection, with or without hyponatremia. Methods: RSV­positive patients aged <12 months who were admitted with respiratory symptoms within 7 days of onset at Jeonbuk National University Children’s Hospital from January 2016 to December 2019 were retrospectively analyzed. Each patient was categorized into those with or without hyponatremia (serum sodium concentration of <136 mmol/L). Clinical findings included PRS on the day of admission. Results: The mean±standard deviation age of the 125 patients included in the study was 2.7±3.3 months, and, 20 patients (16.0%) showed hyponatremia. Infants with RSV infection and hyponatremia had lower birth weights, longer hospital stays, and higher blood urea nitrogen level. The C­reactive protein level was significantly higher in the hyponatremic infants, who had higher PRSs. The non­hyponatremia group had more normal PRSs than the hyponatremia group, which had more severe PRSs. After adjustment for age at admission, blood urea nitrogen level (OR, 1.218; 95% CI, 1.023 to 1.451; P<0.05), and PRS grade (OR, 2.885; 95% CI, 1.158 to 7.187; P< 0.05) were identified as independent risk factors. Conclusion Hyponatremia was strongly associated with respiratory severity in infants with RSV. Therefore, infants admitted with RSV infection who show higher PRS grade need to be evaluated and treated for hyponatremia.

To evaluate the clinical usefulness of fiberoptic intubation, we recorded the changes of arterial pressure, heart rate and cardiac output during fiberoptic nasotracheal and orotracheal intubation, while measuring the time taken for the intubation procedure. Anesthesia of pharynx was achieved by oral gargling of 10 ml of 4% lidocaine, and for nasotracheal intubation, nasal mucosa was anesthetized by application of 4% cocaine usirig cotton-tipped swabs. Anesthesia of the larynx and trachea was done by superior laryngeal nerve block with 6 ml of 2% lidocaine, and translaryngeal injection with 4% lidocaine by cricothyroid membrane puncture. After sedation with intravenous diazepam and fentanyl, awake fiberoptic (n=32) or orotracheal intubation (n=18) was performed on the patients (ASA class 1 or 2) in whom difficult intubation was expected. Mean arterial pressure, heart rate and cardiac output did not change significantly during intubation procedure, nor were these values significantly different between nasotracheal and orotracheal intubation group. The time taken by intubation procedure were compared, and there was no significant difference between two groups. In postoperative interviews, a few (3/28) patients complained discom-forts. It could be concluded that under approapriate anesthesia and sedation, awake fiberoptic nasotracheal or orotracheal intubation is a safe and useful approach producing minimal cardiovascular changes and discomforts.
Anesthesia ; Arterial Pressure ; Blood Pressure* ; Cardiac Output* ; Cocaine ; Diazepam ; Fentanyl ; Heart Rate* ; Heart* ; Humans ; Intubation* ; Laryngeal Nerves ; Larynx ; Lidocaine ; Membranes ; Nasal Mucosa ; Pharynx ; Punctures ; Trachea

No abstract available.
Dexamethasone* ; Prognosis*

The aim of this study was to develop guidelines for the prevention and management of particulate matter (PM)/Asian dust particle (ADP)-induced adverse effects in patients with pulmonary diseases. The guideline development committee reviewed the literature on particulate matter, ADP, and pulmonary diseases. In adults, exposure to particulate matter with a diameter of 10 microm or less (PM10) induces a decline in lung function. PM exposure confers an increased risk of lung cancer, and PM10 is associated with increased hospital admission and mortality due to chronic obstructive pulmonary disease. ADP exposure is associated with increased hospital admission and emergency room visits due to chronic obstractive pulmonary disease exacerbation. Idiopathic pulmonary fibrosis exacerbation may also be induced by pollution, although the evidence for this is very weak. There is no published study on the proper prevention or management of the exacerbation of pulmonary diseases due to PM or ADP exposure. The preventive use of a facial mask with a filter in patients with pulmonary disease should be considered carefully because there have been no clinical study of the efficacy and adverse effects of masks in pulmonary diseases. The committee created guidelines based on a discussion of the peer-reviewed literature. The proper management of PM- and ADP-induced exacerbation of pulmonary disease and the efficacy of facial mask use should be evaluated in future studies.
Adenosine Diphosphate ; Adult ; Air Pollution ; Dust* ; Emergency Service, Hospital ; Humans ; Idiopathic Pulmonary Fibrosis ; Lung ; Lung Diseases* ; Lung Neoplasms ; Masks ; Mortality ; Particulate Matter ; Pulmonary Disease, Chronic Obstructive

Background: and Purpose: The importance of the specialized management of neurocritical patients is being increasingly recognized. We evaluated the impact of neurointensivist comanagement on the clinical outcomes (particularly the mortality rate) of neurocritical patients admitted to a semiclosed neurocritical-care unit (NCU). Methods: We retrospectively included neurocritical patients admitted to the NCU between March 2015 and February 2018. We analyzed the clinical data and compared the outcomes between patients admitted before and after the initiation of neurointensivist co-management in March 2016. Results: There were 1,785 patients admitted to the NCU during the study period. Patients younger than 18 years (n=28) or discharged within 48 hours (n=200) were excluded. The 1,557 remaining patients comprised 590 and 967 who were admitted to the NCU before and after the initiation of co-management, respectively. Patients admitted under neurointensivist co-management were older and had higher Acute Physiologic Assessment and Chronic Health Evaluation II scores. The 30-day mortality rate was significantly lower after neurointensivist co-management (p=0.042). A multivariate logistic regression analysis demonstrated that neurointensivist co-management significantly reduced mortality rates in the NCU and in the hospital overall [odds ratio=0.590 (p=0.002) and 0.585 (p=0.001), respectively]. Conclusions Despite the higher severity of the condition during neurointensivist co-management, co-management significantly improved clinical outcomes (including the mortality rate) in neurocritical patients.

Hughes-Stovin Syndrome is an exceedingly rare combination of distal pulmonary arterial aneurysm and deep vein thrombosis, mostly found in young patients. There are striking similarities between the vascular manifestation of Behcet's disease and Hughes-Stovin Syndrome. It has been suggested that they may have a similar pathogenesis. Most patients died of massive hemoptysis due to rupture of aneurysm. Recently we have experienced the first case of Hughes-Stovin Syndrome in Korea. A 37 year old male patient was admitted because of recurrent hemoptysis and intermittent fever. He had a history of recurrent aphthous ulcers and erythema nodosum-like skin rash, But no other findings of Behcet's disease was found. Angiography showed multiple pulmonary arterial aneurysm and deep vein thrombosis in Right lower extremity. Histologic examination of specimens of open lung biopsy revealed leukocyto- clastic angiitis. Pulmonary arterial aneurysms were successfully treated by coil embolization and he is in good condition with corticosteroid and cyclophosphamide therapy.
Aneurysm ; Angiography ; Biopsy ; Cyclophosphamide ; Embolization, Therapeutic ; Erythema ; Exanthema ; Fever ; Hemoptysis ; Humans ; Korea ; Lower Extremity ; Lung ; Male ; Rupture ; Stomatitis, Aphthous ; Strikes, Employee ; Vasculitis ; Venous Thrombosis

BACKGROUND AND PURPOSE: The use of decompressive hemicraniectomy (DHC) for the treatment of malignant cerebral edema can decrease mortality rates. However, this benefit is not sufficient to justify its use in elderly patients. We investigated the effects of therapeutic hypothermia (TH) on safety, feasibility, and functional outcomes in elderly patients with malignant middle cerebral artery (MCA) infarcts. METHODS: Elderly patients 60 years of age and older with infarcts affecting more than two-thirds of the MCA territory were included. Patients who could not receive DHC were treated with TH. Hypothermia was started within 72 hours of symptom onset and was maintained for a minimum of 72 hours with a target temperature of 33°C. Modified Rankin Scale (mRS) scores at 3 months following treatment and complications of TH were used as functional outcomes. RESULTS: Eleven patients with a median age of 76 years and a median National Institutes of Health Stroke Scale score of 18 were treated with TH. The median time from symptom onset to initiation of TH was 30.3±23.0 hours and TH was maintained for a median of 76.7±57.1 hours. Shivering (100%) and electrolyte imbalance (82%) were frequent complications. Two patients died (18%). The mean mRS score 3 months following treatment was 4.9±0.8. CONCLUSIONS: Our results suggest that extended use of hypothermia is safe and feasible for elderly patients with large hemispheric infarctions. Hypothermia may be considered as a therapeutic alternative to DHC in elderly individuals. Further studies are required to validate our findings.
Aged* ; Brain Edema* ; Cerebral Infarction ; Humans ; Hypothermia* ; Hypothermia, Induced ; Infarction ; Middle Cerebral Artery ; Mortality ; National Institutes of Health (U.S.) ; Shivering ; Stroke

PURPOSE: To compare prospectively and randomly tension-free vaginal tape(TVT) with transobturator vaginal tape inside-out(TVT-O) for the surgical treatment of female stress urinary incontinence(SUI). MATERIALS AND METHODS: One hundred twenty women with SUI were alternately assigned to either the TVT group(n=60) or TVT-O group(n=60). The preoperative evaluation included urodynamic study and a Korean version of the incontinence quality of life questionnaire(I-QoL). At 1-year after operation, surgical outcome, patient I-QoL parameters, long-term complications and uroflowmetry were evaluated in 2 groups. RESULTS: Preoperative patient characteristics including I-QoL and urodynamic study were comparable in the two groups. The rates of cure(86.8% for TVT vs. 86.8% for TVT-O), improvement(6.6% for TVT vs. 8.2% for TVT-O), and failure (6.6% for TVT vs. 5.0% for TVT-O) were similar for the two groups. The I-QoL parameters one year after surgery were improved significantly in both groups(p<0.001) and there was no difference between the two groups(p>0.05). The rates of the patient satisfaction with the procedure were 93.4% in the TVT group versus 95.0% in the TVT-O group(p>0.05). Mean operation time(11.5+/-1.4 min versus 15.2+/-1.8 min, p<0.05) was significantly shorter in the TVT-O than TVT. There were no long-term complications, such as vaginal erosion and prolonged voiding difficulty, in either group. CONCLUSION: TVT-O appears to be equally effective as TVT for the surgical treatment of stress urinary incontinence in women at a 1-year follow-up.
Female* ; Follow-Up Studies* ; Humans ; Patient Satisfaction ; Prospective Studies* ; Quality of Life ; Suburethral Slings* ; Urinary Incontinence* ; Urinary Incontinence, Stress ; Urodynamics

PURPOSE: This study was conducted to predict poor outcomes in coma patients resuscitated from cardiac arrest due to submersion. METHODS: We retrospectively investigated 27 submersion victims who were comatose for more than 6 hours after cardiac arrest. Vegetative state and death (GOS 1-2) were classified as poor outcomes whereas all other outcomes (GOS 3-5) were classified as good outcomes. Demographic, clinical, laboratory, radiologic, eletrophysiologic, and treatment variables were evaluated for their usefulness in predicting outcome. RESULTS: Of the 27 patients, 9 (33%) presented with good outcomes. Among the many variables, a GCS score of 3-5 in the first 24 hours, absence of pupillary reactions in the first 24 hours or on day 3, motor response to pain flexion or less (M1 - 3) or no motor response to pain (M1) in the first 24 hours or on day 3, bilateral absence of N20 on SEP showed significant differences between the two outcome groups (p<0.05). Prognostic factors with 100% specificity for prediction of poor outcome included absence of pupillary reactions in the first 24 hours or on day 3, no motor response to pain (M1) on day 3, and bilateral absence of N20 on SEP. CONCLUSION: The factors including chest radiography, body temperature, and laboratory findings which were associated with submersion showed no significant differences between the good and the poor outcome groups. Absence of pupillary reactions in the first 24 hours or on day 3, no motor response to pain (M1) on day 3, and bilateral absence of N20 on SEP helped predict poor outcome in submersion patients resuscitated from cardiac arrest.
Body Temperature ; Coma* ; Heart Arrest* ; Humans ; Immersion* ; Outcome Assessment (Health Care) ; Persistent Vegetative State ; Radiography ; Retrospective Studies ; Sensitivity and Specificity ; Thorax

Alopecia ; Classification ; Diarrhea ; Female ; Functional Food ; Hair ; Hair Follicle ; Humans ; Leuconostoc ; Male ; Pilot Projects ; Probiotics ; Scalp ; Soybeans