BACKGROUND: Overnight transfusions have been associated with higher transfusion risk than transfusions during the day. The aim of the study was to evaluate the transfusion status at our hospital and to help provide plans for overnight transfusions. METHODS: All blood products, including red blood cell products (RBC), fresh frozen plasmas (FFP), and all platelet products (PLT) issued between January 2013 and December 2014 were included. Night1 (5 pm∼8 am) and Night2 (8 pm∼8 am) were defined as overnight, and all issued bloods (IB) were analyzed in accordance with the issued time, ordered medical departments, and the reason of transfusion. RESULTS: The total unit number of IB at Night1 (Night2) was 53,483 (38,224), and it consisted of 44.4% (31.7%) total IB; 53.2% (39.6%) FFP; 46.8% (33.4%) RBC; and 39.3% (27.6%) PLT. The IB ordered from the departments of trauma & acute care surgery and emergency medicine consisted of 40% IB. The 80.9% RBC, 53.1% FFP and 70.2% PLT could be considered as appropriate for overnight transfusion. CONCLUSION: Due to the characteristics of our hospital with many trauma patients, the percentage of IB during an overnight period in our hospital was higher than those in other countries, and the rate of appropriate reason for RBC transfusion was also higher. However, as inappropriate overnight transfusions may have been still performed, education for medical staffs and appropriate policies for overnight transfusion could be helpful in reducing inappropriate transfusion.
Blood Platelets ; Blood Transfusion ; Education ; Emergency Medicine ; Erythrocytes ; Humans ; Medical Staff ; Plasma ; Tertiary Care Centers*

PURPOSE: Non-alcoholic fatty liver disease (NAFLD) has been recognized as an important childhood liver disease, especially where the prevalence of childhood obesity is increasing. The purpose of this study is to clarify the usefulness of elevated serum aminotransferase activities and their ratio for predicting the presence of fatty liver and its severity in obese children. METHODS: Forty-four children (M/F 29/15, age 4 to 16 years) with obesity (weight excess>20%) were analyzed retrospectively with medical records based on degree of obesity, bioelectrical impedence, serum aminotransferase activities, lipid profiles and ultrasonography. RESULTS: 1) Ultrasonography was carried out in 34 cases. Elevated serum ALT was found in 89.7% (26/29) of the patients diagnosed as fatty liver by ultrasonography and decreased AST/ALT ratio (<1) was found in 96.6% (28/29). There was a strong correlation between elevated serum ALT (>45 IU/L) or decreased AST/ALT ratio (<1) and the fatty liver in obese children (p<0.05). 2) There was no significant correlation between the serum ALT or AST/ALT ratio and the degree of fatty liver (p>0.05). 3) There was a significant correlation between total cholesterol, triglyceride and fatty liver (p<0.05). CONCLUSION: Serum ALT activity and AST/ALT ratio were useful to predict the presence of fatty liver diagnosed by ultrasonography in obese children, whereas they were not useful to predict the degree of fatty liver. Therefore, to prevent fatty liver progressing to advanced liver disease, it is necessary to manage and monitor the obese children continuously, especially those who have predicting factors of fatty liver.
Child* ; Cholesterol ; Fatty Liver* ; Humans ; Liver Diseases ; Medical Records ; Obesity ; Pediatric Obesity ; Prevalence ; Retrospective Studies ; Triglycerides ; Ultrasonography

BACKGROUND: Even though careful techniques is utilized and proper concentration of local anesthetics are used, tissue toxicity is common. METHOD: The fibroblast cell lines (NUGM) was exposed with each concentration of 10(-6), 10(-5), 10(-4) M lidocaine and bupivacaine in culture media for 24 hours. Glucose consumption rate and LDH activity in cultured media were measured for using as indicator of cellular damage on 0. 24, 48, 72 hours. By using that, we calculated the trend lines of the change of glucose consumption rate and LDH (lactic dehydrogenase) activity. On the trend lines, we searched out for decreasing time to 1/2 of glucose concentration and increasing time to 2 times of LDH activity compared to control. RESULTS: 1) In control group, Decreasing time to 1/2 of glucose concentration was 236.0 hours (p<0.05) and increasing time to 2 times of LDH activity was 1168.6 hours (p<0.05). 2) At each concentration of 10 6, 10 5, 10 4 M lidocaine, decreasing time to 1/2 of glucose concentration was 873.7 (370%), 938.7 (398%), 1101.6 (467%) hours compared with 236.0 (100%) hours of control (p<0.05) and then increasing time to 2 times of LDH activity was 135.1 (12%), 85.6 (7%), 93.9 (8%) hours when compared with 1168.6 (100%) hours of control (p<0.05). 3) At each concentration of 10(-6), 10(-5), 10(-4) M bupivacaine, decreasing time to 1/2 of glucose concentration was 706.7 (299%), 948.1 (402%), 1018.2 (431%) hours when compared with 236.0 (100%) hours of control (p<0.05) and then increasing time to 2 times of LDH activity was 111.6 (10%), 69.5 (6%), 59.1 (5%) hours when compared with 1168.6 (100%) hours of control (p<0.05). 4) On light microscopy, cells are showed destruction in each concentration of 10(-6), 10(-5), 10(-4) M lidocaine and bupivacaine with dose dependent fashion. CONCLUSIONS: 1) Glucose consumption rate and LDH activity in cultured media could be used as a useful index of cellular destruction by toxic effect on cultured cell. 2) Even at any concentration of lidocaine and bupivacaine could be toxic on cell. With all of above results, cell-line on 3 demensional cultured method could be use as another method for determining of cellular toxicity of local anesthetics.
Anesthetics, Local* ; Bupivacaine* ; Cell Line ; Cells, Cultured* ; Culture Media ; Fibroblasts ; Glucose* ; Lidocaine* ; Microscopy ; Oxidoreductases*

PURPOSE: Rotavirus is one of the most important causes of nosocomial infections among children. The aim of this study is to determine the risk of nosocomial rotavirus infections and to evaluate the effectiveness of breast-feeding and probiotics in the prevention of nosocomial rotavirus infections. METHODS: This study was carried out on admitted children without diarrhea between March 1, 2003 and February 29, 2004. Three hundred ninety patients aged 4 days to 13 years during this study were available. We examined the feces of all children for rotavirus by latex agglutination on admission, during hospital, and after discharge, to see whether they developed diarrhea or not. RESULTS: Nosocomial rotavirus infections was significantly increased with children under 12 months of age(P=0.008). The monthly attack rate was great between December and March(P=0.046). Prolonged hospital stay was associated with an increased attack rate of nosocomial rotavirus infections (P=0.003). The risk of nosocomial rotavirus infections was not associated with the number of roommates and whether or not they were breast-fed or fed on probiotics. CONCLUSION: Nosocomial rotavirus infections are significantly more likely to occur in children under 12 months of age, admitted between December and March, and with prolonged hospital stays. Prompt identification and isolation of children with nosocomial rotavirus infections, even without diarrhea, may decrease rates of nosocomial rotavirus infections.
Agglutination ; Child* ; Cross Infection ; Diarrhea ; Feces ; Humans ; Latex ; Length of Stay ; Probiotics ; Risk Factors* ; Rotavirus Infections* ; Rotavirus*

Hypertension (HT) is a well-known risk factor for stroke, either hemorrhagic or ischernic like small artery disease (SAD) and large artkry territory infarction (LAI). And it sometunes causes both types of stroke in a single patient. We investigated the vascular nsk factors (controlling HT) that nught be related to their stroke types in 307 acute stroke patients with HT: 152 patients with intracerebral hemorrhage (ICH), 77 with SAD, and 78 with LAL These factors were compared between the groups using the univanate statistical methods. The most significant ICH-related factor was the lower serum level of triglyceride, compared to ischemic stroke. And ischemic stroke-rqlated profile included longer duration of HT, smoking, diabetes mellitus(DM), higher level of uric acid. And lower level of HDL-cholesteroL Increased hematocrit, DM and smoking were particularly related to LAI. These findings suggest that a well-balanced control of the above-mentioned risk factors is warranted to prevent future stroke, in addition to strict control of HT. And management of hypertensive stroke patients should be differentiated and individualized a6cording to the coexisting stroke type-related profiles.
Arteries ; Cerebral Hemorrhage ; Hematocrit ; Humans ; Hypertension ; Infarction ; Risk Factors* ; Smoke ; Smoking ; Stroke* ; Triglycerides ; Uric Acid

PURPOSE: Laparoscopic totally extraperitoneal herniorrhaphy (TEP) was developed as an alternative treatment of inguinal hernias to open hernia repair. This study evaluated 92 cases of laparoscopic surgery to determine the effectiveness and safety of laparoscopic TEP. METHODS: Laparoscopic TEP was performed on 92 patients with inguinal hernias from January 2008 to December 2010. Through a retrospective study of these patients, information om TEP repair was collected including the patients' characteristics, operation time, hospital stay, analgesic use and related complications. RESULTS: Laparoscopic herniorrhaphy were performed on a total of 92 patients (85 men and 7 women, age ranging from 16 to 83 years, with a mean of 56 years). The mean operation time for a unilateral inguinal hernia and bilateral inguinal hernia was 58.7 and 84.2 min, respectively. The mean postoperative hospital stay was 4.0 days (range, 2~9 days). Thirty nine patients were discharged without an analgesic injection, whereas 36 patients were injected with analgesic on the day of surgery. Of these 92 procedures, 10 complications were recorded; one granuloma complication, two patients with operation site discomfort, five with urinary retention issues, one patient with a scrotal seroma, and one patient with scrotal edema. CONCLUSION: TEP repairs have minimal morbidity and are more effective with less pain than the open procedure. TEP repair can be considered a favorable procedure for patients who request minimally invasive procedures for inguinal hernia repairs.
Female ; Granuloma ; Hernia ; Hernia, Inguinal ; Herniorrhaphy ; Humans ; Laparoscopy ; Length of Stay ; Male ; Pyrazines ; Retrospective Studies ; Seroma ; Urinary Retention

OBJECTIVES: Benzodiazepines are most often used for the treatment of alcohol withdrawal, but they also may result in several adverse consequencies such as sedation, respiratory depression, cognitive impairment, disinhibition, and abuse. New anticonvulsants, topiramate may have a potential to treat alcohol withdrawal effectively. This study compared the therapeutic responses of a benzodiazepine, lorazepam, and an anticonvulsant, topiramate, for the treatment of alcohol withdrawal. METHODS: Fifty-two hospitalized patients with the diagnosis of DSM-IV Alcohol dependence, after obtaining written informed consent, were randomely divided into the either lorazepam (N=27) or the topiramate (N=25) groups. Subjects were assessed with CIWA-Ar scores at the time of baseline, 1, 3, 5 day after the last alcohol drinking. Lorazepam was given 4 mg divided by 4 on day 1, tapering to 2 mg divided by 2, and topiramate was given fixed single dose of 50 mg a day. RESULTS: There were no significant differences between two groups in demographic or clinical characteristics except marital status and s-ALT level. Two groups had similar ADS scores and baseline withdrawal severity. There were no significant differences by treatment group in CIWA-Ar scores over time (F=0.883, p>0.05). CONCLUSION: Efficacy and safety were not different between the two groups. Therefore our results suggest that topiramate is a promising alternative agent to benzodiazepine for treating alcohol withdrawal.
Alcohol Drinking ; Alcoholism ; Anticonvulsants ; Benzodiazepines ; Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Informed Consent ; Lorazepam ; Marital Status ; Respiratory Insufficiency

There are diverse neurologic manifestations in patients with idiopathic or pseudohypoparathyroidism. Although one knows that hypocalcemia provokes symptoms of tetany, there is little knowldege about the paroxysmal dystonic choreoathetosis(PKC). We report two patients with paroxysmal symptoms resulting from hypocalcemia associated with idiopathic hypoparathyroidism and pseudohypoparathryoidism respectively, which were misdiagnosed and treated as epilepsy. They showed repetitive paroxysmal dystonic choreoathetotic movements that lasted for several seconds and typically induced by sudden voluntary movement. The ne-uroimaging showed bilateral symmetrical calcifications., mainly in the basal ganglia. In the clinical setting, these types of paroxysmal movements may be readily misdiagnosed as partial seizure or tetany. Therefore, not only the laboratory work up for hypocalcemia, but careful history taking and clinical observation is important in differential diagnosis of epilepsy and paroxysmal movements in the patient with hypocalcemia.
Basal Ganglia ; Diagnosis, Differential ; Epilepsy ; Humans ; Hypocalcemia ; Hypoparathyroidism* ; Neurologic Manifestations ; Pseudohypoparathyroidism ; Seizures ; Tetany

PURPOSE: To investigate the clinical characteristics and management of lacrimal gland ductal disease, a rare disease often mistaken for other diseases. METHODS: A retrospective chart review of 11 patients (11 eyes, 5 males, 6 females) diagnosed with lacrimal ductal disease between March 2007 and April 2013 was performed. RESULTS: Among 11 eyes in 11 patients, 4 were diagnosed with dacryops and 7 with lacrimal gland ductulitis initiated by dacryolith. The mean age of the subjects was 47.9 years (range, 30-80 years). Lacrimal gland ductulitis patients received treatment for conjunctivitis or hordeolum for several months. Four cases involved the right eye and 7 cases involved the left eye. Symptoms included foreign body sensation, pus-like discharge and palpable mass. Biopsy was performed in 3 cases and showed no specific findings. Patients with dacryops underwent marsupialization, whereas patients diagnosed with lacrimal gland ductulitis underwent excision and dacryolith curettage. During the 2-month follow-up period, all cases showed no signs of recurrence or complications. CONCLUSIONS: Lacrimal gland ductal disease can be mistaken for other diseases such as conjunctivitis, hordeolum, or orbital cyst, thus requiring accurate diagnosis and appropriate management.
Biopsy ; Conjunctivitis ; Curettage ; Diagnosis ; Follow-Up Studies ; Foreign Bodies ; Hordeolum ; Humans ; Lacrimal Apparatus* ; Male ; Orbit ; Rare Diseases ; Recurrence ; Retrospective Studies ; Sensation

OBJECTIVES: Mental fitness issues have recently become a point of dispute in the field of health. Drivers are occupationally in danger of a possible accident, and are also exposed to other factors aside from accidents that threaten their mental health. The purpose of this research is to examine the level and state of post traumatic stress disorder (PTSD) and overall mental fitness in bus drivers. In addition, we wish to understand the various causes that can influence PTSD. METHODS: From April 1 to June 30, 2009, taking the region and number of workers into consideration, survey sheets were distributed to selected bus drivers who belonged to the public transportation union. The questionnaire included questions on experiences, details of accidents, the characteristics of the working environment, and the status of mental health. We used the Davidson Trauma Scale to investigate PTSD symptoms and the Center for Epidemiological Studies Depression Scale to evaluate depression. RESULTS: Regardless of the type of accident, the group of bus drivers with accident experience showed stronger signs of suffering from PTSD. It seemed that the experience of an accident that caused the death of passengers or conflict with passengers were important factors for PTSD. Within the PTSD group, we found more symptoms of depression, and also this group is more likely to take time off work. CONCLUSIONS: The experience of an accident threatens the mental health of bus drivers. Since bus drivers are responsible for the safety of many citizens, we must work towards finding ways to protect their mental health.
Depression ; Dissent and Disputes ; Epidemiologic Studies ; Mental Health ; Occupations ; Questionnaires ; Stress Disorders, Post-Traumatic ; Stress Disorders, Traumatic ; Stress, Psychological ; Transportation