Kawasaki disease (KD) is an acute systemic vasculitis of unknown etiology. We report a case of KD with acute respiratory distress syndrome (ARDS) after intravenous immunoglobulin (IVIG) infusion. Lung manifestations associated with KD have previously been reported in the literature. Although IVIG infusion is an effective therapy for acute KD, there are some reported complications related to IVIG infusion: hypotension, aseptic meningitis, acute renal failure, hemolytic anemia, etc. The case of KD reported here was treated with IVIG and aspirin. A few days after recovery from KD, the patient developed fever and maculopapular rash. A diagnosis of relapse KD was made and retreated with IVIG infusion. However, the patient developed ARDS four days after the second IVIG infusion. The patient recovered from ARDS after nine days of ICU care, which included high frequency oscillation ventilation with inhaled nitric oxide, steroid treatment and other supportive care.
Acute Kidney Injury ; Anemia, Hemolytic ; Aspirin ; Diagnosis ; Exanthema ; Fever ; High-Frequency Ventilation ; Humans ; Hypotension ; Immunoglobulins* ; Immunoglobulins, Intravenous ; Lung ; Meningitis, Aseptic ; Mucocutaneous Lymph Node Syndrome* ; Nitric Oxide ; Recurrence ; Respiratory Distress Syndrome, Adult* ; Systemic Vasculitis

PURPOSE: Few reports have described the prognostic factors affecting the occurrence of subsequent unprovoked seizure in patients who present with febrile seizure (FS) after 6 years of age. We investigated the prognostic factors affecting the development of unprovoked seizures after FS among patients from Jeju Island. METHODS: We included patients who developed FS after 6 years of age, who presented to our outpatient clinic between January, 2011 and June, 2017. Clinical data were obtained through chart reviews and phone call interviews. We used logistic regression analysis to analyze the risk factors associated with the occurrence of subsequent unprovoked seizure. RESULTS: Of the 895 patients who presented to our hospital due to their febrile seizure, 83 developed FS after 6 years of age. Among them, 3 patients were prescribed antiepileptic drugs before the onset of the unprovoked seizure, and 4 patients developed an unprovoked seizure before 6 years of age. Thus, overall, 76 patients were included in the study. 51 patients developed first FS before 6 years of age. In the remaining patients, the first FS developed after 6 years of age. The mean observational period since the last outpatient follow-up visit was 3.2 years (median 3.04 years, range: 1.42-4.71 years). Among them, 21% developed an unprovoked seizure. Logistic regression analysis showed that electroencephalographic (EEG) abnormalities served as an independent risk factor for a subsequent unprovoked seizure. CONCLUSION: EEG is the proper diagnostic tool to predict the risk of a subsequent unprovoked seizure in patients with FS after 6 years of age.
Ambulatory Care Facilities ; Anticonvulsants ; Electroencephalography ; Follow-Up Studies ; Humans ; Logistic Models ; Outpatients ; Risk Factors ; Seizures* ; Seizures, Febrile*

Since the government is fully aware of the specificity and importance of the healthcare field, it operates bureaucracy and affiliated organizations composed of many government ministries and experts and is also handling the related bureaus. However, recent incidents of humidifier disinfectant not only make these government activities unreliable but also cause disappointment to many people. Why did not the government take active measures to ensure product safety? But why was the Korea Centers for Disease Control and Prevention (KCDC) able to speed up the identification of the cause and the recovery of the product? The purpose of this study is to clarify the behavioral mechanisms of government intervention by comparing the behaviors of the Ministry of Trade, Industry and Energy and the KCDC. Then, we will discuss the desirable government structure.

Background: Conflict in the medical world in 2020 led to the rejection of the national examination for doctors. This study explained the process until the end of the national test refusal situation triggered in 2020 through the signaling game theory. The government has succeeded in requiring medical students to take the national exam. Methods: To explain the rejection of the national examination, we first compose and show an example of two small non-signaling games where medical students know which type the government is of, then combine them to play a signaling game. Results: The behavior of the government and medical students was examined through the signaling game model. In the context of the coronavirus disease 2019 (COVID-19) pandemic, the government makes an ultimatum, whatever the type. And the medical students accept it. They judged that the government could not be expected to abolish the policy. If COVID-19 had not occurred, medical students would have been able to continue the confrontation. Conclusion The government instilled in the other party the perception that the government would not bend its policies because it was the surly type and would not be afraid of a strong confrontation. Through the image created in this way, the government was forced to accept the ultimatum by medical students. Academically, this study is to deal with the policy-making process through the signaling game theory. In the area of health care policy, this study suggests that various situations such as the type of government or the spread of COVID-19 can become important in addition to the rationality of the policy itself.

Background: In this study, we compared the incidents of humidifier disinfectants and incidents of mild hepatitis in Japan to highlight the differences in government response in the health care field in terms of “chain of responsibility”. Methods: We examined whether the three mechanisms of action and the chain of responsibility hypothesis were applied to compare the cases of Korea and Japan. The incident of Japan occurred in 1987 in Misawa city, Aomori prefecture. In the 1990s, the safety of blood products increased dramatically. However, relief for infected victims was neglected. Green Cross did not notify the parties. In Korea, in the spring of 2011, a number of lung disease patients were accidentally admitted to a hospital in Seoul, and a female patient with respiratory failure symptoms expired. The Korea Centers for Disease Control and Prevention conducted animal tests and the Ministry of Health and Welfare issued an order for forced collection of humidifier disinfectants. Results: In the case of Japan, the Ministry of Health and Welfare had to take responsibility for follow-up measures such as the investigation of the cause, so it was tied to a “chain of responsibility”. However, in the case of Korea, the Ministry of Health and Welfare was free from the chain. Conclusion Through the comparison between the cases of Japan and Korea, we confirmed that whether or not a government organization chooses to conceal responsibility depends on its past behavior, which is whether it is free from the chain of responsibility or not. Therefore, it was reaffirmed that an organization (ministry or department) free from the chain of responsibility must exist within the government.

Purpose: The purpose of this study was to describe the profile of graduates from accelerated second-degree Bachelor of Science in Nursing programs and to analyze the relative efficiency of nursing colleges using data envelopment analysis. Methods: An online survey link was emailed to the deans of nursing colleges, who were then asked to send the link to graduates of the respective colleges. The survey questionnaire included demographics, reasons for applying to the accelerated second-degree Bachelor of Science in Nursing program, employment after graduation, and nursing career satisfaction. Results: Sixty-two graduates of the accelerated second-degree Bachelor of Science in Nursing program responded to the survey. The mean age at admission was 24.28 (± 3.01) years. Reasons for applying to the accelerated second-degree Bachelor of Science in Nursing program were primarily increasing job security and using it as a stepping stone to another career. Nursing career job satisfaction was 4.81 (± 1.07) and more than 82% recommended this program. The data envelopment analysis found the average efficiency score to be 0.84 (± 0.20) and 4 nursing colleges to be relatively efficient. Conclusion The accelerated second-degree Bachelor of Science in Nursing program can be considered to be an effective means to produce quality nurses with non-nursing bachelor degrees in a short time; however, outcomes of this program need to be systematically monitored to maintain quality level. Through this, competent nurses with knowledge of adjacent studies will be added to the nursing workforce.

PURPOSE: To report the outcome of laparoscopic pyelo- and ureterolithotomies with the aid of flexible nephroscopy. MATERIALS AND METHODS: A retrospective analysis was performed in 71 patients with complex renal stones or large and impacted proximal ureteral stones. Patients underwent laparoscopic pyelo- or ureterolithotomies with or without the removal of small residual stones by use of flexible nephroscopy between July 2005 and July 2010. Operative success was defined as no residual stones in the intravenous pyelogram at 12 weeks postoperatively. Perioperative results and surgical outcomes were analyzed. RESULTS: The patients' mean age was 54.7+/-13.7 years, and 53 males (74.6%) and 18 females (25.4%) were included. The mean maximal stone size was 19.4+/-9.4 mm. A total of 47 cases were complex renal stones and 24 cases were impacted ureteral stones. Mean operative time was 139.0+/-63.7 minutes. Stones were completely removed in 61 cases (85.9%), and no further ancillary treatment was needed for clinically insignificant residual fragments in 7 cases (9.9%). For complex renal stones, the complete stone-free rate and clinically significant stone-free rate were 80.9% and 93.6%, respectively. Multivariate analysis showed that the use of flexible nephroscopy for complex renal stones can reduce the risk of residual stones. A major complication occurred in one case, in which open conversion was performed. CONCLUSIONS: Laparoscopic stone surgery is a safe and minimally invasive procedure with a high success rate, especially with the aid of flexible nephroscopy, and is not associated with procedure-specific complications.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Kidney Calculi/pathology/radiography/*surgery ; Laparoscopy/methods ; Male ; Middle Aged ; Nephrostomy, Percutaneous/*methods ; Retrospective Studies ; Treatment Outcome ; Ureteral Calculi/pathology/radiography/*surgery ; Young Adult

Drainage of pancreatic abscesses is required for effective control of sepsis. Endoscopic ultrasound (EUS)-guided endoscopic drainage is less invasive than surgery and prevents local complications related to percutaneous drainage. Endoscopic drainage with stent placement in the uncinate process of the pancreas is a technically difficult procedure. We report a case of pancreatic abscess treated by repeated EUS-guided aspiration and intravenous antibiotics without an indwelling drainage catheter or surgical intervention.
Abscess* ; Anti-Bacterial Agents ; Catheters ; Drainage ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Pancreas ; Sepsis ; Stents ; Ultrasonography

Kawasaki disease (KD) is an acute systemic vasculitis of unknown etiology. We report a case of KD with acute respiratory distress syndrome (ARDS) after intravenous immunoglobulin (IVIG) infusion. Lung manifestations associated with KD have previously been reported in the literature. Although IVIG infusion is an effective therapy for acute KD, there are some reported complications related to IVIG infusion: hypotension, aseptic meningitis, acute renal failure, hemolytic anemia, etc. The case of KD reported here was treated with IVIG and aspirin. A few days after recovery from KD, the patient developed fever and maculopapular rash. A diagnosis of relapse KD was made and retreated with IVIG infusion. However, the patient developed ARDS four days after the second IVIG infusion. The patient recovered from ARDS after nine days of ICU care, which included high frequency oscillation ventilation with inhaled nitric oxide, steroid treatment and other supportive care.
Acute Kidney Injury ; Anemia, Hemolytic ; Aspirin ; Diagnosis ; Exanthema ; Fever ; High-Frequency Ventilation ; Humans ; Hypotension ; Immunoglobulins ; Immunoglobulins, Intravenous ; Lung ; Meningitis, Aseptic ; Mucocutaneous Lymph Node Syndrome ; Nitric Oxide ; Recurrence ; Respiratory Distress Syndrome, Adult ; Systemic Vasculitis

Pulmonary alveolar proteinosis is a rare disorder that is characterized by the abundant accumulation of surfactant-derived material within the alveolar spaces and distal bronchioles. Although the findings of homogenous ground-glass opacities overlaid by thickened septa, which form a "crazy paving" pattern on high-resolution computed tomography, can assist in making a diagnosis, a lung biopsy is usually required. This disorder has a variable clinical course, from spontaneous resolution to respiratory failure and death. While a whole lung lavage has been the standard treatment since the early 1960s, GM-CSF therapy has been attempted based on the recently suggested pathogenetic mechanism. We report a case of pulmonary alveolar proteinosis that resolved spontaneously after an open lung biopsy.
Biopsy ; Bronchioles ; Bronchoalveolar Lavage ; Diagnosis ; Granulocyte-Macrophage Colony-Stimulating Factor ; Lung ; Pulmonary Alveolar Proteinosis* ; Respiratory Insufficiency