BACKGROUND: This study aimed to investigate bradycardia as an adverse effect after administration of dexmedetomidine during 33degrees C target temperature management. METHODS: A retrospective study was conducted on patients who underwent 33degrees C target temperature management in the emergency department during a 49-month study period. We collected data including age, sex, weight, diagnosis, bradycardia occurrence, target temperature management duration, sedative drug, and several clinical and laboratory results. We conducted logistic regression for an analysis of factors associated with bradycardia. RESULTS: A total of 68 patients were selected. Among them, 39 (57.4%) showed bradycardia, and 56 (82.4%) were treated with dexmedetomidine. The odds ratio for bradycardia in the carbon monoxide poisoning group compared to the cardiac arrest group and in patients with higher body weight were 7.448 (95% confidence interval [CI] 1.834-30.244, p = 0.005) and 1.058 (95% CI 1.002-1.123, p = 0.044), respectively. In the bradycardia with dexmedetomidine group, the infusion rate of dexmedetomidine was 0.41 +/- 0.15 microg/kg/h. Decisions of charged doctor's were 1) slowing infusion rate and 2) stopping infusion or administering atropine for bradycardia. No cases required cardiac pacing or worsened to asystole. CONCLUSIONS: Despite the frequent occurrence of bradycardia after administration of dexmedetomidine during 33degrees C target temperature management, bradycardia was completely recovered after reducing infusion rate or stopping infusion. However, reducing the infusion rate of dexmedetomidine lower than the standard maintenance dose could be necessary to prevent bradycardia from developing in patients with higher body weight or carbon monoxide poisoning during 33degrees C targeted temperature management.
Atropine ; Body Weight ; Bradycardia* ; Carbon Monoxide Poisoning ; Dexmedetomidine* ; Diagnosis ; Emergency Service, Hospital ; Heart Arrest ; Humans ; Hypothermia, Induced ; Logistic Models ; Odds Ratio ; Retrospective Studies

No abstract available.
Cutaneous Fistula ; Glomerulonephritis, Membranous* ; Humans ; Sarcoma, Kaposi*

No abstract available.
Kidney Transplantation*

Cytophagic histiocytic panniculitis gap (CHP) was described in 1980 as a chronic histiocytic disease of the subcutaneous tissue and associated with systemic manifestations such as fever, serositis, and hepatosplenomegaly. The current concept of CHP is that it represents a spectrum of lymphoproliferative disorders that induce secondary histiocytic cytophagocytosis. The pathogenesis of hemophagocytosis in CHP is unknown but may be related to histiocyte reaction to an abnormal cytokine milieu brought about by disordered T-cell function. In most cases the disease follows a fulminant course, but in some patients the disease seems limited to the skin and subcutaneous tissue and follows a more benign, chronic course. We report a case of cytophagic histiocytic panniculitis which had a long chronic course over 16 years, but recently became aggravated with the involvement of the extrapleural fat tissue and was treated with combination chemotherapy.
Cytophagocytosis ; Drug Therapy, Combination ; Fever ; Histiocytes ; Humans ; Lymphoproliferative Disorders ; Panniculitis* ; Serositis ; Skin ; Subcutaneous Tissue ; T-Lymphocytes

The most common cause of obstructive sleep apnea syndrome (OSAS) in childhood is adenotonsillar hypertrophy. Adenotonsillectomy improves the symptoms quite well in most cases. However, some patients could experience the OSAS again after adenotonsillectomy, who might have several risk factors such as incomplete operation, misdiagnosis, combined anatomical malformation, sinusitis or chronic allergic rhinitis, obesity, initial severe OSAS, and early onset OSAS. We report a case of 11-year-old obese boy who presented with snoring for several years. He was obese with body mass index (BMI) of 26.3 kg/m2 and also found to have fatty liver by ultrasonogram. Initial polysomnography (PSG) showed that he met the criteria of severe OSAS with the apnea-hypopnea index (AHI) of 70.5. He underwent adenotonsillectomy and symptoms improved immediately. Four months later symptoms were relieved with AHI of 0, but 1 year after the adenotonsillectomy he started to complain snoring again and the subsequent PSG results showed that OSAS has relapsed with AHI of 43. Paranasal sinus X-ray and physical examination showed sinusitis and re-growth of adenoid. Obesity was proved not to be a contributing factor because his BMI decreased to normal range (23.1 kg/m2) after diet control and regular exercise. Also, liver transaminase was normalized and fatty liver was disappeared on follow-up abdominal ultrasonogram. After treatment of sinusitis, symptoms were relieved with decreased AHI (8.5). This case suggests that simple adenotonsillectomy might not be the end of OSAS treatment in childhood. Patients who had adenotonsillectomy should be followed by subsequent PSG if symptoms recur. It is also important to be aware of risk factors in the recurrent OSAS for the proper intervention according to the cause.
Adenoids ; Body Mass Index ; Child ; Diagnostic Errors ; Diet ; Fatty Liver ; Follow-Up Studies ; Humans ; Hypertrophy ; Liver ; Obesity ; Physical Examination ; Polysomnography ; Reference Values ; Rhinitis ; Rhinitis, Allergic, Perennial ; Risk Factors ; Sinusitis ; Sleep Apnea, Obstructive ; Snoring

No abstract available.
Folliculitis* ; Herpesvirus 3, Human ; Scalp*

No abstract available.
Coinfection* ; Female ; Herpes Zoster Ophthalmicus* ; Herpes Zoster* ; Humans

Background: Cleft lip and cleft palate are the most frequent congenital craniofacial deformities, with an incidence of approximately 1 per 700 people. Postoperative palatal fistula is one of the most significant long-term complications. This study investigated the incidence of postoperative palatal fistula and its predictive factors based on 25 years of experience at our hospital. Methods: We retrospectively reviewed 636 consecutive palatal repairs performed between January 1996 and October 2020 by a single surgeon. Data from patients’ medical records regarding cleft palate repair were analyzed. The preoperative extent of the cleft was evaluated using the Veau classification system, and the cleft palate repair technique was chosen according to the extent of the cleft. SPSS version 25.0 was used for all statistical analyses, and exploratory univariate associations were investigated using the t-test. Results: Fistulas occurred in 20 of the 636 patients; thus, the incidence of palatal fistula was 3.1%. The most common fistula location was the hard palate (9/20, 45%), followed by the junction of the hard and soft palate (6/20, 30%) and the soft palate (5/20, 25%). The cleft palate repair technique significantly predicted the incidence of palatal fistula following cleft palate repair (P=0.042). Fistula incidence was significantly higher in patients who underwent surgery using the Furlow double-opposing Z-plasty technique (12.1%) than in cases where the Busan modification (3.0%) or two-flap technique (2.0%) was used. Conclusions The overall incidence of palatal fistulas was 3.1% in this study. Moreover, the technique of cleft palate repair predicted fistula incidence.

BACKGROUND: A habit of lying-down after eating is known as a risk factor of reflux esophagitis. However the association between gastrointestinal disorders and a postprandial lying-down habit has not yet been identified. Some people believe that lying-down after meals is helpful for their health. We intended to investigate the relationship between such a habit and the health lifestyles, gastrointestinal symptoms, disorders using a questionnaires and gastrofiberscopic results of patients who visited our general health screening center. METHODS: We examined 1,030 subjects (the frequent postprandial lying-down group was 576 persons (57.7%), the rare group was 436 persons (42.3%) who visited our general health screening center for a routine check-up including a gastrofiberoscopy during the period between January 2001 to December 2002. After frequency matching by age and sex, health lifestyles (such as smoking, alcohol consumption, exercise, eating habits, night time sleep duration and awakening frequency, nap, and coffee intake), gastrointestinal symptoms (dyspepsia, epigastric pain, heart burn, chest pain, and constipation) and gastrofiberoscopic findings were compared using results from the questionnaires and gastrofiberscopic findings. Factors such as gastritis and reflux esophagitis were set as dependent variables, while postprandial lying-down was set as an independent variable. The frequent postprandial lying-down group and the rare group were analysed through stepwised multiple logistic regression analysis. RESULTS: Subjects with a frequent postprandial lying- down habit showed a significantly greater degree in alcohol consumption (P=0.010), irregular eating habits (P<0.001), eating between meals (P<0.001), napping (P<0.001), and night time awakening frequency (P= 0.016) than the rare group did. In addition, chest pain (P=0.031) and constipation (P=0.010) were more common in the frequent postprandial lying-down group. However, prevalence of dyspepsia (P=0.147), epigastric pain (P=0.085), and heartburn (P=0.700) showed no differences between the two groups. Being controlled with age, sex, education level, body mass index, and life style factors, postprandial lying-down group showed higher prevalence ratios in erythematous gastritis (OR 1.59; P=0.090), atrophic gastritis (OR 1.71; P= 0.059), and reflux esophagitis (OR 1.78; P=0.103). CONCLUSION: A postprandial lying-down habit is associated with undesirable lifestyles and some gastrointestinal disorders. Therefore, a modification of the postprandial lying-down habit should be recommended. Further investigation is needed to clarify the causal relationships between a postprandial lying down habit and gastrointestinal symptoms and disorders.
Alcohol Drinking ; Body Mass Index ; Burns ; Chest Pain ; Coffee ; Constipation ; Deception ; Dyspepsia ; Eating ; Education ; Esophagitis, Peptic ; Gastritis ; Gastritis, Atrophic ; Heart ; Heartburn ; Humans ; Life Style* ; Logistic Models ; Mass Screening ; Meals ; Prevalence ; Risk Factors ; Smoke ; Smoking