In air leak syndrome, a significant portion of the volume delivered during a positive pressure breath can be lost through the leak. HFOV can achieve adequate ventilation at lower peak and/or mean intrapulmonary pressure than conventional mechanical ventilation (CMV) and has been an effective treatment of already established air leak syndrome. We report a 1-day-old male infant with severe respiratory failure from pneumothorax and pneumomediastinum, who was refractory to CMV with chest tube drainage. HFOV was applied to this patient for 114 hours, and improvement of oxygenation and ventilation as well as significant reduction of pneumothorax followed.
Chest Tubes ; Drainage ; Humans ; Infant ; Male ; Mediastinal Emphysema ; Oxygen ; Pneumothorax ; Respiration, Artificial ; Respiratory Insufficiency ; Ventilation*

Olivary hypertrophic degeneration (OHD) is caused by lesions in dentato-rubro-olivary pathway(myoclonic triangle) and responsible for palatal myoclonus and other involuntary movements. We report the clinical features and magnetic resonance imaging(MRI) findings of 5 patients with OHD. All patients had previous brainstem hemorrhage mainly involving pontine tegmentum in four patients and right superior cerebellar peduncle in one patient T2-weighted MR] revealed round or oval shaped high signal area in the ventral or ventrolateral portion of the medulla. Their clinical presentations were as followings: palatal myoclonus (4 case), ocular myoclonus (3 case), pharyngeal and laryngeal myoclonus (2 case), limb myoclonus (2 case), head shaking (I case) and perioral tremulous movement (1 case). The frequency of myoclonus was 70-170/minute and the median time interval between the insult of the primary lesion and the onset of myoclonic symptoms was 2 months. OHD shown as hyperintense lesions on T2 weighted MRI should be differentiated from ischemic, neoplastic or other pathologic lesions. The characteristic clinical presentations and the location of primary lesions involving myoclonic triangle may be helpful in differential diagnosis from primary medullary lesions.
Brain Stem ; Brain* ; Diagnosis, Differential ; Dyskinesias ; Extremities ; Head ; Hemorrhage ; Humans ; Magnetic Resonance Imaging ; Myoclonus

Purpose: The purpose of this study was to estimate the medical expenditures for poisoning patients in Korea using data from National Health Insurance and the Korea Health Panel Survey. Methods: The operational definition of poisoning was the presence of Korean Standard Classification of Diseases codes from T36 to T65. The number of poisoning patients, the amount of legal copayments, and benefit and non-benefit costs were extracted from both databases. The frequency of emergency, inpatient, and outpatient treatment utilization by poisoning patients was determined, and medical expenses were calculated. Linear regression analyses were performed to investigate factors affecting the medical expenses of poisoning patients. Results: The number of poisoning patients increased from 97,965 in 2011 to 147,984 persons in 2020. Medical expenses also increased by 74% from Korean won (KRW) 30.1 billion to KRW 52.3 billion, and benefit costs also increased by 79%. The average outpatient cost per person was KRW 67,660, and the inpatient cost was KRW 1,485,103. The average non-benefit medical expenses were KRW 80,298, accounting for about 16.2% of the total expenses. Multivariable analysis showed that the total expenditure was associated with economic status and disabilities. Conclusion The average medical expenditure per poisoning patient was KRW 534,302 in 2020, and poisoning-related costs gradually increased during the study period. Further research on the economic burden of poisoning should include indirect costs and reflect disease-adjusted life years.

No abstract available.
Cerebral Hemorrhage ; Parkinson Disease

PURPOSE: To determine whether photodynamic therapy (PDT) is effective and safe for the treatment of chronic central serous chorioretinopathy (CSC) in Korean patients. METHODS: Eleven eyes of 11 patients with chronic CSC underwent PDT. The laser spot size was chosen to cover the hyperfluorescent area on indocyanine green (ICG) angiography principally and to cover wide area including leaking point or detachment of retinal pigment epithelium on fluorescein angiography. We analyzed the medical records retrospectively to know the changes in visual acuity and serous detachment. RESULTS: The mean follow-up was 14.2+/-6 months and exudative macular detachments resolved completely in 11 eyes within 1 month. In addition, eight weeks after treatment, the visual acuity improved in 3 eyes, and remained unchanged in 7 eyes and decreased in one eye. However, in 2 eyes, visual acuity decreased immediately after PDT due to choroidal hypoperfusion, and in one of them, the final visual acuity did not recover to the pre-treatment level. CONCLUSIONS: In Korean patients, PDT seems to be effective for treatment of chronic CSC in the short term, but the long-term efficacy still must be determined. In addition, in PDT used for treatment of choroidal neovascularization (CNV), there was a possibility of irreversible occlusion in normal choroidal capillaries. Further studies are needed to determine the treatment parameters of PDT.
Angiography ; Capillaries ; Central Serous Chorioretinopathy* ; Choroid ; Choroidal Neovascularization ; Fluorescein Angiography ; Follow-Up Studies ; Humans ; Indocyanine Green ; Medical Records ; Photochemotherapy* ; Retinal Pigment Epithelium ; Retrospective Studies ; Visual Acuity

Purpose: Given the morphological characteristics of schistocytes, thrombotic microangiopathy (TMA) score can be beneficial as it can be automatically and accurately measured. This study aimed to investigate whether serial TMA scores until 48 h post admission are associated with clinical outcomes in patients undergoing targeted temperature management (TTM) after out-of-hospital cardiac arrest (OHCA). Materials and Methods: We retrospectively evaluated a cohort of 185 patients using a prospective registry. We analyzed TMA scores at admission and after 12, 24, and 48 hours. The primary outcome measures were poor neurological outcome at discharge and 30-day mortality. Results: Increased TMA scores at all measured time points were independent predictors of poor neurological outcomes and 30-day mortality, with TMA score at time-12 showing the strongest correlation [odds ratio (OR), 3.008; 95% confidence interval (CI), 1.707–5.300; p<0.001 and hazard ratio (HR), 1.517; 95% CI, 1.196–1.925; p<0.001]. Specifically, a TMA score ≥2 at time-12 was closely associated with an increased predictability of poor neurological outcomes (OR, 6.302; 95% CI, 2.841–13.976; p<0.001) and 30-day mortality (HR, 2.656; 95% CI, 1.675–4.211; p<0.001). Conclusion Increased TMA scores predicted neurological outcomes and 30-day mortality in patients undergoing TTM after OHCA. In addition to the benefit of being serially measured using an automated hematology analyzer, TMA score may be a helpful tool for rapid risk stratification and identification of the need for intensive care in patients with return of spontaneous circulation after OHCA.

PURPOSE: The aim of this study was to validate the Glasgow-Blatchford score and the pre-endoscopic Rockall score to assess their ability to predict the presence of active bleeding in emergency department patients with suspected upper gastrointestinal bleeding. METHODS: We reviewed and extracted data from electronic medical records on patients presenting with a suspicion of acute upper gastrointestinal bleeding at our emergency department from January 1, 2012 to December 31, 2012. For each patient we calculated the Glasgow-Blatchford score and the pre-endoscopic Rockall score. Discriminative ability of the scoring systems for predicting active bleeding was evaluated by receiver operator characteristic (ROC) curve analysis. RESULTS: We identified 636 patients with upper gastrointestinal bleeding. There were 118 (18.6%) patients with active bleeding and 520 (81.8%) patients with need for intervention. The ROC curve analysis showed poor discriminative ability of the Glasgow-Blatchford score and the pre-endoscopic Rockall score for determining the presence of active bleeding (area under the curve (AUC)=0.546, 95% confidence interval (CI) 0.490-0.602 vs. 0.576, 95% CI 0.523-0.630; p=0.34). The sensitivity and the specificity of the two scoring systems were suboptimal. However, the Glasgow-Blatchford score outperformed the pre-endoscopic Rockall score in predicting the need for clinical intervention (AUC=0.867, 95% CI 0.831-0.903 vs. 0.698, 95% CI 0.643-0.754; p<0.001). CONCLUSION: The Glasgow-Blatchford score was superior in predicting the need for intervention in emergency department patients with suspected gastrointestinal hemorrhage. However, these clinical decision rules may be insufficient to predict the presence of active bleeding.
Electronic Health Records ; Emergency Service, Hospital* ; Gastrointestinal Hemorrhage ; Hemorrhage* ; Hemostasis ; Humans ; ROC Curve ; Sensitivity and Specificity ; Upper Gastrointestinal Tract

Xanthogranulomatous epididymitis is an atypical form of severe destructive epididymal infection, characterized by massive inflammatory cell and foamy histiocyte microscopically. We report two cases of xanthogranulomatous epididymitis that presented as epididymal inflammation with fluid collection in old aged patients, and resulted in orchiectomy. We suggest that xanthogranulomatous epididymitis should be considered as one of the differential diagnosis in epididymitis with abscess formation.
Abscess ; Diagnosis, Differential ; Epididymitis* ; Histiocytes ; Humans ; Inflammation ; Male ; Orchiectomy

OBJECTIVES: Serum uric acid levels have been reported to be associated with a variety of cardiovascular conditions. However, the direct association between uric acid levels and metabolic syndrome remains controversial. Thus, we evaluated the association of serum uric acid levels and metabolic syndrome in a community-based cohort study in Korea. METHODS: We performed cross-sectional analysis of baseline data of 889 males and 1491 females (aged 38 to 87) who participated in baseline examinations of the Korean Genome and Epidemiology Study: Kanghwa study. Blood samples were collected after at least an 8 hour fast. Uric acid quartiles were defined as follows: <4.8, 4.8-<5.6, 5.6-<6.5, > or =6.5 mg/dL in males; and <3.8, 3.8-<4.3, 4.3-<5.1, > or =5.1 mg/dL in females. Metabolic syndrome was defined by the National Cholesterol Education Program Adult Treatment Panel III Criteria with adjusted waist circumference cutoffs (90 cm for males; 80 cm for females). The association between serum uric acid quartiles and metabolic syndrome was assessed using multivariate logistic regression. RESULTS: The odds ratio for having metabolic syndrome in the highest versus lowest quartiles of serum uric acid levels was 2.67 (95% confidence interval [CI], 1.60 to 4.46) in males and 2.14 (95% CI, 1.50 to 3.05) in females after adjusting for age, smoking, alcohol intake, body mass index, total cholesterol, HbA1c, albumin, gamma-glutamyltransferase, blood urea nitrogen, and log C-reactive protein. The number of metabolic abnormalities also increased gradually with increasing serum uric acid levels (adjusted p for trend < 0.001 in both sexes). CONCLUSIONS: Higher serum uric acid levels are positively associated with the presence of metabolic syndrome in Korean males and females.
Adult ; Aged ; Aged, 80 and over ; Biological Markers/blood ; Cohort Studies ; Cross-Sectional Studies ; Female ; Humans ; Hyperuricemia/*blood ; Inflammation ; Logistic Models ; Male ; Metabolic Syndrome X/*blood ; Middle Aged ; Odds Ratio ; Prospective Studies ; Republic of Korea ; Risk Assessment ; Rural Health

OBJECTIVES: A positive association between serum albumin levels and metabolic syndrome has been reported in observation studies, but it has not been established in the Korean population. The purpose of this study was to evaluate the association between serum albumin levels and the presence of metabolic syndrome among a sample of apparently healthy Korean adults. METHODS: This cross-sectional study analyzed data of 3189 community-dwelling people (1189 men and 2000 women) who were aged 40 to 87 years and were living in a rural area in Korea. Serum albumin levels were classified into quartile groups for each sex. Metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III guidelines with an adjusted waist circumference cut-off value (> or =90 cm for men and > or =85 cm for women). An independent association between serum albumin levels and metabolic syndrome was assessed by multiple logistic regression analysis. RESULTS: Higher serum albumin levels were associated with increased prevalence of metabolic syndrome. The odds ratio (95% confidence interval) of the prevalence of metabolic syndrome for the highest versus the lowest serum albumin quartiles was 2.81 (1.91 to 4.14) in men and 1.96 (1.52 to 2.52) in women, after adjusting for age, smoking status, alcohol consumption, and physical activity. When each metabolic abnormality was analyzed separately, higher serum albumin levels were significantly associated with hypertriglyceridemia and hyperglycemia in both sexes, and with abdominal obesity in men. CONCLUSIONS: These results suggest that higher serum albumin levels are positively associated with an increased risk of metabolic syndrome in Korean adults.
Adult ; Aged ; Aged, 80 and over ; Biological Markers/blood ; Cross-Sectional Studies ; Female ; Humans ; Male ; Metabolic Syndrome X/*blood/epidemiology ; Middle Aged ; Prevalence ; Republic of Korea/epidemiology ; Risk Assessment/methods ; *Rural Health ; Serum Albumin/*analysis