OBJECTIVE: This study was conducted to compare the outcome of cardiopulmonary resuscitation (CPR) with AutoPulse and LUCAS in out-of-hospital cardiac arrest patients. METHODS: Between July 2017 and March 2018, a total of 152 out-of-hospital cardiac arrest patients were included for analysis. Included patients were divided into an AutoPulse group and LUCAS group. Patient's age, sex, bystander CPR, witness arrest, initial shockable rhythm, time from arrest to CPR, pre-hospital CPR duration, in-hospital CPR duration, automatic external defibrillator operation by paramedic, intubation by paramedic, intravenous line access by paramedic and target temperature management were reviewed retrospectively. In addition, blood pH, lactate level, white blood cell (WBC) count, and delta neutrophil index (DNI) were analyzed. Additionally, return of spontaneous circulation (ROSC), hospital and intensive care unit (ICU) length of stay, complications from chest compressions, and cerebral performance category (CPC) scale at discharge were analyzed. RESULTS: No differences in initial shockable rhythm, patient characteristics, management for patients and CPR duration were observed between the two groups. ROSC were significantly higher in the LUCAS group than the AutoPulse group (17.9 vs. 34.7%, P=0.025). However, hospital and ICU length of stay, CPC scale at discharge as clinical outcome and pH, lactate level, WBC count, and DNI as laboratory outcomes were not significantly different between the AutoPulse group and LUCAS group. Although the case numbers were scarce, complications from chest compressions were not significantly different between the two groups. CONCLUSION: CPR using LUCAS showed better ROSC than CPR using AutoPulse. However, hospital and ICU length of stay and CPC scale at discharge did not differ between the two groups.
Allied Health Personnel ; Cardiopulmonary Resuscitation ; Defibrillators ; Emergency Service, Hospital ; Humans ; Hydrogen-Ion Concentration ; Intensive Care Units ; Intubation ; Lactic Acid ; Length of Stay ; Leukocytes ; Neutrophils ; Out-of-Hospital Cardiac Arrest ; Retrospective Studies ; Thorax

Systemic sclerosis is an autoimmune disease characterized by progressive fibrosis of the skin and visceral organs. Myasthenia gravis is also an autoimmune disease characterized by weakness and fatigue of skeletal muscles. The symptoms of systemic sclerosis and myasthenia gravis overlap clinically, so the recognition of disease co-occurrence may be delayed. Co-occurrence of myasthenia gravis and systemic sclerosis is very uncommon and usually diagnosed after use of D-penicillamine for treating the systemic sclerosis. We report a case of a 49-year-old female patient who complained of general weakness and was diagnosed with myasthenia gravis. Four months earlier she was diagnosed with systemic sclerosis with Sjogren's syndrome and her medications did not include D-penicillamine.
Autoimmune Diseases ; Fatigue ; Female ; Fibrosis ; Humans ; Middle Aged ; Muscle, Skeletal ; Myasthenia Gravis ; Penicillamine ; Scleroderma, Systemic ; Sjogren's Syndrome ; Skin

OBJECTIVES: Laryngomicrosurgery (LMS) is used to manage most vocal fold lesions. However, the functional voice outcome of the LMS might be diverse due to the influence of various factors. We intend to evaluate the incidence and etiologic factors of persistent dysphonia after LMS for benign vocal fold disease (BVFD). METHODS: We performed a retrospective review of 755 patients who underwent LMS for BVFD. We analyzed the clinical characteristics, preoperative and postoperative two onths voice studies. Postsurgical dysphonia was defined as grade 1 or above in GRBAS (grade, roughness, breathiness, asthenia, and strain) scale. Thirty nine patients (5.2%; 25 males and 14 females; average, 42.9 years; range, 21 to 70 years) were diagnosed with postsurgical dysphonia. RESULTS: There was no correlation between the diagnosis, coexistence with laryngopharyngeal reflux disease, habit of smoking, or occupational voice abuse and voice outcome. The patients with a worse preoperative acoustic parameter had aworse voice outcome. Stroboscopic findings showed excessive scarring or bowing in 21 cases, presence of lesion remnant in eight cases, prolonged laryngeal edema in five and no abnormal findings in three. CONCLUSION: Great care should be taken in patients with worse preoperative jitter. With a few exceptions, postoperative dysphonia can be avoided by the use of an ppropriate surgical technique.
Acoustics ; Asthenia ; Cicatrix ; Dysphonia ; Humans ; Incidence ; Laryngeal Edema ; Laryngopharyngeal Reflux ; Male ; Retrospective Studies ; Smoke ; Smoking ; Vocal Cords ; Voice

The authors introduced a new approach for clipping of the incidental aneurysm of the middle cerebral artery (MCA) and reported the clinical results. We retrospectively reviewed 26 patients with 27 incidental MCA aneurysms who were treated from January 2010 to December 2012. All clippings were performed through a small temporal craniotomy and linear skin incision. Follow-up imaging showed complete occlusion of 26 aneurysms (96.3%), residual neck in one (3.7%). In one case, residual neck of the aneurysm did not grow on serial follow up. In one of 26 cases (3.8%), approach-related complication was retraction injury of the temporal cortex. Two patients developed postoperative infarction on the MCA territories due to vasospasm and on the cerebellum due to unknown causes. These were not approach-related complications. Operation time was 95 min-250 min (mean 143 min). There were no complications of temporal muscle atrophy, scar deformity, paresthesia, or pain around the scalp incision and frontalis palsy. This approach offers good surgical possibilities and little approach related morbidity in the clipping of incidental MCA aneurysms.
Aneurysm* ; Atrophy ; Cerebellum ; Cicatrix ; Congenital Abnormalities ; Craniotomy* ; Follow-Up Studies ; Humans ; Infarction ; Middle Cerebral Artery* ; Neck ; Paralysis ; Paresthesia ; Retrospective Studies ; Scalp ; Skin* ; Temporal Muscle

OBJECTIVE: Atypical teratoid/rhabdoid tumor(AT/RT) is a new entity among malignant pediatric brain tumors, and shows variable histopathologic features. The authors investigate the clinicopathologic and cytogenetic features of the tumor. METHODS: Five cases were included in this study ; three of them were primarily diagnosed, and two cases were reclassified from primitive neuroectodermal tumor/medulloblastoma to AT/RT. Mean age of patients at diagnosis was 5.6 years. The tumors were located in infratentorial or supratentorial areas. Maximum survival period was 13 months. RESULTS: Histopathologically, the tumors were mainly composed of modified rhabdoid cells and undifferentiated small cells, and mixed with epithelial, mesenchymal components, and other features mimicking glioma and chordoma. The histopathologic features were supported by polyphenotypic immunoreactivity, including epithelial membrane antigen, cytokeratin, vimentin, smooth muscle actin, and glial fibrillary acidic protein. Cytogenetic studies for karyotype analysis and fluorescent in situ hybridization revealed monosomy of chromosome 22 in two cases out of three cases of the tumor. CONCLUSION: Atypical teratoid/rhabdoid tumor may be an unique clinicopathologic entity, and histopathologic diagnosis should be made carefully by differentiating other polymorphous tumors of the brain.
Actins ; Brain ; Brain Neoplasms ; Central Nervous System* ; Chordoma ; Chromosomes, Human, Pair 22 ; Cytogenetics ; Diagnosis ; Glial Fibrillary Acidic Protein ; Glioma ; Humans ; In Situ Hybridization, Fluorescence ; Karyotype ; Keratins ; Monosomy ; Mucin-1 ; Muscle, Smooth ; Neural Plate ; Vimentin

OBJECTIVE: To report an observational investigation of small high attenuated foci in computed tomography (CT) scan followed by brain parenchymal catheterization. METHODS: From January 2011 to March 2015, we retrospectively reviewed the 381 patients who had undergone brain catheterization in our clinic and enrolled the patients who had newly developed high attenuation foci in the postoperative CT scans. The brain CT scans were reviewed about the lesion location, Hounsfield Unit (HU) and the time of appearance. RESULTS: Twenty seven of 381 patients had high attenuation foci in CT scans after the procedure. The location of high density lesions was as follows: parenchyma in 9 (33.3%) cases, ventricle in 5 (18.5%), combined in parenchyma and ventricle in 13 (48.1%). The lesions were identified in the catheter tract in parenchymal type, and catheter-lodged frontal horn or choroid plexus in ventricular type. We could not find the calcific foci before the catheter removal, and those were found after removal in all cases. The time of appearance after the removal was variable from 0 to 14 days (mean 4.2, median 3). The regular rules of HU change in CT scans were not found as times go on. CONCLUSION: The high attenuation foci in CT scans were bone dust originated from skull during operation. Although these lesions did not make troubles, we should clean the operation field before the insertion of brain catheter and we may use another material, like Surgicel to seal up the burr hole instead of bone dust in the end of operation.
Animals ; Bone Transplantation ; Brain* ; Calcinosis ; Catheterization* ; Catheters* ; Choroid Plexus ; Dust ; Horns ; Humans ; Retrospective Studies ; Skull ; Tomography, X-Ray Computed

Intramural pregnancy is one of the rarest forms of ectopic pregnancy. The pathologic diagnosis of the intramural ectopic pregnancy requires that the myometrium surrounds the products of conception separated from the endometrial cavity or fallopian tubes. Because the early diagnosis is very difficult, most cases are found after the onset of complications such as a uterine rupture or hemoperitoneum. The previous histories of curettage, cesarean section, myomectomy, salpingectomy and manual removal of the placenta are known as possible etiology of the intramural pregnancy. We have recently experienced a case of intramural pregnancy after 10 times of curettages and are reporting with a brief review of the literatures.
Animals ; Cesarean Section ; Curettage ; Diagnosis ; Early Diagnosis ; Fallopian Tubes ; Female ; Fertilization ; Hemoperitoneum ; Mice ; Myometrium ; Placenta ; Pregnancy* ; Pregnancy, Ectopic ; Salpingectomy ; Uterine Rupture

PURPOSE: The separation of prescription and dispensation of drugs starting from July 2000 has led to a reduced exposure to drugs for the general population. Therefore, we hypothesize that the policy of separation the prescribing and the dispensing of drugs has decreased the actual incidence of drug intoxication from drug abuse. METHODS: Patients with acute intentional drug intoxication who were admitted to emergency centers in Seoul were retrospectively studied. The study period was subdivided into three: before, during, and after the launch of the policy of separation of prescription and dispensation, corresponding to the periods January to June, 2000; January to June 2001; and January to June 2002, respectively. RESULTS: Acute drug intoxication was associated with 0.2% of all prescriptions during the studied period. There was no significant difference in the types of intoxicating drugs whereas the most commonly abused drug was Doxylamine succinate. Prescribed medications accounted for 37.0%, 29.2%, and 32.3% of the acute drug intoxication cases in 2000, 2001, and 2002, respectively. There was no significant difference in the treatment outcomes between the three study groups although three patients died of paraquat intoxications in 2001. CONCLUSION: The launch of the policy of separation of prescription and dispension of drugs did not significantly reduce the rate of acute drug intoxication from drug abuse which questions the effectiveness of the policy in decreasing drug abuse. We suggest reassessment of sedatives, in particular, those prescribed medications, in order to decrease the incidence of acute intoxications.
Doxylamine ; Emergencies* ; Humans ; Hypnotics and Sedatives ; Incidence ; Paraquat ; Poisoning* ; Prescriptions* ; Retrospective Studies ; Seoul ; Substance-Related Disorders ; Succinic Acid

Hemangiomas are rare benign tumors of the adrenal gland. We report here on the CT findings of a cavernous hemangioma of the right adrenal gland. The CT revealed a well-delineated adrenal mass having an internal necrotic portion and tiny peripheral calcifications. After administration of the contrast media, the tumor showed peripheral enhancement on the arterial phase, and this was followed by progressive centripetal fill-in.
Adrenal Glands* ; Contrast Media ; Hemangioma ; Hemangioma, Cavernous*

PURPOSE: Ceftriaxone, a parenteral third-generation cephalosporine, is widely used in the treatment of various bacterial infections. It possesses high calcium-binding affinity, forming complexes with calcium in bile salts to develop precipitate that mimics gallstone on ultrasonography. Biliary pseudolithiasis resolves completely with cessation of therapy, but several symptomatic patients have undergone cholesystectomy. We prospectively evaluated the incidence, risk factors and dose- related comparison with ultrasonography. METHODS: Between November 1998 and August 1999, 81 cases of inpatients on ceftriaxone treatment in Dongguk University Pohang Hospital were enrolled for this study. They were divided according to dose of ceftriaxone, high-dose and low-dose groups. Repeated sonography was performed on 1, 3, 5 and 7 days after initiation of ceftriaxone treatrnent and then weekly until pseudolithiasis were resolved. RESULTS: Thirty-eight percent of the subjects acquired pseudolithiasis. Sonographic abnormalities appeared from 1 to 10 days after ceftriaxone therapy and completely resolved from 1 to 24 days after cessation of ceftriaxone therapy. The incidence of pseudolithiasis was significantly higher in the high-dose group(P<0.001). In the high-dose group, fasting over a day was a significant risk factor of pseudolithiasis(P<0.01). Sex, age, duration of ceftriaxone therapy, laboratory findings, type of infection or chief complaint were not significant risk factors for pseudolithiasis. CONCLUSION: We suggest that abdominal ultrasonography should be considered in all children who receive high dose ceftriaxone with fasting over a day. If pseudolithiasis was developed, we can detect the most of resolution after 30 days of cessation of therapy.
Bacterial Infections ; Bile Acids and Salts ; Calcium ; Ceftriaxone ; Child ; Fasting ; Gallstones ; Gyeongsangbuk-do ; Humans ; Incidence ; Inpatients ; Prospective Studies* ; Risk Factors ; Ultrasonography