Purpose: Erythropoietin (EPO) is a promising neuroprotective drug. We investigated whether EPO has beneficial effects on neurodevelopmental outcomes in infants with hypoxic-ischemic encephalopathy (HIE). Methods: We retrospectively reviewed the data of 56 infants with HIE born at or after 35 weeks of gestation who were admitted to Inha University Hospital between 2012 and 2021. Patients were divided into two groups based on EPO use and compared. In the EPO group, patients were administered 1,000 U/kg of EPO on days 1, 2, 3, 5, and 7, starting within 24 hours after birth. The primary outcome was death or neurodevelopmental impairment (NDI) at the age of 12 months. Results: EPO was administered to 38 infants, and 18 did not receive EPO. Only 37.5% of patients with HIE (21/56) and 60% of patients with moderate-to-severe HIE (21/35) received therapeutic hypothermia. Among all patients with HIE, death or NDI (21.1 % vs. 50.0%; odds ratio [OR], 0.09; 95% confidence interval [CI], 0.01 to 0.78; P=0.029) and brain injury on imaging (42.1% vs. 83.3%; OR, 0.16; 95% CI, 0.03 to 0.92; P=0.040) were significantly lower in the EPO group than in the control group. Among patients with moderate-to-severe HIE, brain injury on imaging (54.2% vs. 90.9%; OR, 0.04; 95% CI, 0.002 to 0.700; P=0.027) was significantly lower in the EPO group than in the control group. Conclusion EPO administration significantly reduced mortality and NDI in infants with HIE. EPO can be considered an adjunctive therapeutic agent for neonatal HIE.

During a 9-year period 43 children and adolescents 2 to 18 years old underwent 140 extracorporeal shock wave lithotripsy (ESWL) treatments for 48 calculi. The second generation piezoelectric lithotriptor (LT01) was used in 28 cases (65%) while the remaining cases were treated with the third generation piezoelectric lithotriptor (LT02). LT02 lithotriptor differs from an earlier model LT01 in 2 important respects; a stone localization system consisting of ultrasound and fluoroscopy, and more energy per shock wave. The LT01 necessitated caudal anesthesia in 14 cases (50%) while the LT02 necessitated caudal anesthesia in 2 cases (13%) and intravenous anesthesia in 2 cases (13%). Two upper ureteral stones without ureteral dilatation and 1 mid ureteral stone, which were difficult to detect with ultrasound, could be localized by combined ultrasound and fluoroscopy on LT02. The success rate by LT01 and LT02 ESWL was 92.9% and 100%, respectively. The mean session of LT01 and LT02 ESWL was 3.6+/-.4.09 and 2.6+/-2.47, respectively, and the total storage of LT02 ESWL (93+/-97.8) was much less(p<0.05) than that of LT01 ESWL (363+/-380.3). There were no statistical differences in regard to success and the use of stents, stone size or location between the 2 lithotriptors. Six patients required adjuvant procedures, and ESWL complications were not required admission or surgical management. Therefore, LT02 piezoelectric lithotripsy, in comparison with LT01, is more efficient to localize stones and can lessen total storage by reducing treatment sessions in children and adolescents.
Adolescent* ; Anesthesia, Caudal ; Anesthesia, Intravenous ; Calculi ; Child* ; Dilatation ; Fluoroscopy ; Humans ; Lithotripsy* ; Shock ; Stents ; Ultrasonography ; Ureter ; Urinary Calculi

PURPOSE: To evaluate the values of C-reactive proteins(CRP) for predicting the severity and results of treatment for acute pyelonephritis in women, we compared the severity of symptoms and signs, the laboratory findings and the initial serum CRP according to the early response to treatment. MATERIALS AND METHODS: We retrospectively analyzed 298 female patients who were diagnosed with acute uncomplicated pyelonephritis between January 2002 and Match 2007. All the medical records were reviewed for a variety of factors, and the baseline characteristics and CRP level were compared between the patients with an early response to treatment and those without according to the 3rd hospital day urine analysis. RESULTS: The initial white blood cell(WBC) counts, the CRP level, the neutrophil ratio and severity of symptoms were significantly higher in the delayed response groups than those in the early response groups. The age, history of previous pyelonephritis, symptom duration, body mass index(BMI), and the number of positive blood and urine cultures were not different between the two groups. According to the results of the multivariate logistic regression analysis, the CRP level, neutrophil ratio and mild symptoms were independent predictive variables that affected the delayed response. The odds ratios(95% CI) were 1.078(1.028-1.131) for the CRP, 1.030(1.001-1.060) for the neutrophil ratio and 9.268(1.072-80.166) for the severe symptoms. The differences between the areas under the ROC curves for CRP and the WBC counts and for the CRP level and neutrophil ratio were statistically significant(p<0.001 and p<0.05, respectively). CONCLUSIONS: We found that the discriminatory power of the initial CRP level was high with regard to predicting an early response. So, we were able to determine a CRP level that would be useful in guiding hospitalization.
Acute-Phase Proteins ; C-Reactive Protein* ; Female ; Hospitalization ; Humans ; Logistic Models ; Medical Records ; Neutrophils ; Pyelonephritis* ; Retrospective Studies ; ROC Curve

Heparin is commonly used to prevent and treat of thromboembolic events during the endovascular intervention. Rarely, heparin-induced thrombocytopenia (HIT), which is characterized by moderate thrombocytopenia and paradoxical vascular thromboses, complicates systemic heparinization given during endovacular procedures. We present a case of an endovascular treatement of the anterior communicating artery aneurysm complicated by HIT. This case of HIT manifested thromboembolic event and intracerebral hemorrhage simultaneously.
Aneurysm ; Cerebral Hemorrhage ; Embolization, Therapeutic* ; Heparin ; Intracranial Aneurysm* ; Thrombocytopenia* ; Thrombosis

Tension pneumocephalus may follow a cerebrospinal fluid (CSF) leak communicating with extensive extradural air. However, it rarely occurs after diagnostic lumbar puncture, and its treatment and pathophysiology are uncertain. Tension pneumocephalus can develop even after diagnostic lumbar puncture in a special condition. This extremely rare condition and underlying pathophysiology will be presented and discussed. The authors report the case of a 44-year-old man with a basal skull fracture accompanied by pneumothorax necessitating chest tube suction drainage, who underwent an uneventful lumbar tapping that was complicated by postprocedural tension pneumocephalus resulting in an altered mental status. The patient was managed by burr hole trephination and saline infusion following chest tube disengagement. He recovered well with no neurologic deficits after the operation, and a follow-up computed tomography (CT) scan demonstrated that the pneumocephalus had completely resolved. Tension pneumocephalus is a rare but serious complication of lumbar puncture in patients with basal skull fractures accompanied by pneumothorax, which requires continuous chest tube drainage. Thus, when there is a need for lumbar tapping in these patients, it should be performed after the negative pressure is disengaged.
Adult ; Chest Tubes ; Drainage ; Follow-Up Studies ; Humans ; Neurologic Manifestations ; Pneumocephalus ; Pneumothorax ; Skull ; Skull Fractures ; Spinal Puncture ; Suction

BACKGROUND: Rosacea is a common skin condition, but the currently available treatments are not satisfactory. OBJECTIVE: We wanted to assess the efficacy and safety of photopneumatic therapy (PPx), which delivers pneumatic energy and broadband light (400~1,200 nm), for the treatment of erythematotelangiectatic rosacea. METHODS: Twenty two patients with erythematotelangiectatic rosacea were treated 3~5 times with PPx. Three independent dermatologists evaluated the efficacy of PPx by comparing the photographs taken before and after treatment. Patient self-assessment was also done by interviews. RESULTS: The photographic assessment by the dermatologists of the improvement showed that >50% improvement occurred in 64% (14/22) of the patients. The specific categories of improvement were as follows: poor (<25% improvement), 1 patient; fair (25~50% improvement), 7 patients; good (50~75% improvement), 11 patients; and excellent (>75% improvement), 3 patients. Based on the patients' self-assessment, 20 patients (91%) acknowledged an improvement. CONCLUSION: PPx is an effective and safe treatment option for erythematotelangiectatic rosacea.
Humans ; Light ; Rosacea ; Self-Assessment ; Skin

A man visited the emergency room with a headache. Brain computed tomography showed aneurysmal subarachnoid hemorrhage (SAH) and multiple aneurysms. After aneurysm clipping surgery, the patient was discharged. After 5 days, he was admitted to the hospital with skin ulceration and was diagnosed with Behcet syndrome. An angiogram taken 7 weeks after aneurysmal SAH showed intracranial vasospasm. Because inflammation in Behcet syndrome may aggravate intracranial vasospasm, intracranial vasospasm after aneurysmal SAH in Behcet syndrome should be monitored for longer compared to general aneurysmal SAH.
Aneurysm* ; Behcet Syndrome* ; Brain ; Emergency Service, Hospital ; Headache ; Humans ; Inflammation ; Skin Ulcer ; Subarachnoid Hemorrhage* ; Vasospasm, Intracranial

The incidence and the nature of visual involvement in Friedreich's ataxia who showed progressive visual impairment a few years before developing characteristic clinical manifestations of Friedreich's ataxia. The progress of disease in this case suggests that visual involvement may be from the same pathogenetic mechanism of peripheral nervous system in Friedreich's ataxia.
Friedreich Ataxia* ; Incidence ; Optic Atrophy* ; Peripheral Nervous System ; Vision Disorders

PURPOSE: We aimed to identify microbiological characteristics in patients with acute prostatitis after transrectal prostate biopsy to provide guidance in the review of prevention and treatment protocols. MATERIALS AND METHODS: A retrospective analysis of medical records was performed in 1,814 cases who underwent prostate biopsy at Seoul St. Mary's Hospital and St. Vincent's Hospital over a 5 year period from 2006 to 2011. Cases in which acute prostatitis occurred within 7 days after the biopsy were investigated. Before starting treatment with antibiotics, sample collections were done for culture of urine and blood. Culture and drug susceptibility was identified by use of a method established by the Clinical and Laboratory Standards Institute. RESULTS: A total of 1,814 biopsy procedures were performed in 1,541 patients. For 1,246 patients, the procedure was the first biopsy, whereas for 295 patients it was a repeat biopsy. Twenty-one patients (1.36%) were identified as having acute bacterial prostatitis after the biopsy. Fifteen patients (1.2%) had acute prostatitis after the first biopsy, and 6 patients (2.03%) experienced acute prostatitis after a repeat biopsy. Even though the incidence of acute bacterial prostatitis was higher after repeat biopsy than that after the first biopsy, there was no statistically significant intergroup difference in terms of incidence (chi2=1.223, p=0.269). When the collected urine and blood samples were cultured, Escherichia coli was found in samples from 15 patients (71.4%), Klebsiella pneumoniae in 3 patients (14.3%), Enterobacter intermedius in 1 patient (4.8%), E. aerogenes in 1 patient (4.8%), and Pseudomonas aeruginosa in 1 patient (4.8%). A fluoroquinolone-resistant strain was confirmed in 5 cases (23.8%) in total. Three cases of E. coli and 1 case of Klebsiella had extended-spectrum beta-lactamase activity. CONCLUSIONS: Empirical treatment of acute prostatitis should be done with consideration of geographical prevalence and drug resistance. This study will provide meaningful information for the management of acute prostatitis after transrectal prostate biopsy.
Acute Disease ; Anti-Bacterial Agents ; beta-Lactamases ; Biopsy ; Drug Resistance ; Enterobacter ; Escherichia coli ; Humans ; Incidence ; Klebsiella ; Klebsiella pneumoniae ; Medical Records ; Prevalence ; Prostate ; Prostatitis ; Pseudomonas aeruginosa ; Retrospective Studies ; Sprains and Strains

We report a case of spinal, cerebral and cerebellar embolism that occurred following injection sclerotherapy with n-butyl-2-cyanoacrylate for variceal bleeding. The patient had been diagnosed with alcoholic liver cirrhosis and esophageal variceal bleeding. We performed injection sclerotherapy with n-butyl-2-cyanoacrylate. The patient complained of both leg motor weakness and left arm motor weakness after injection and was diagnosed with spinal, cerebral and cerebellar embolism following the n-butyl-2-cyanoacrylate injection. At the follow-up examination, the patient's neurologic symptoms had improved, but left leg motor weakness remained. To our knowledge, this is the first report of a case of multiple embolizations including the spine, cerebrum and cerebellum after n-butyl-2-cyanoacrylate injection for treatment of esophageal variceal bleeding.
Arm ; Cerebellum ; Cerebrum ; Embolism* ; Enbucrilate* ; Esophageal and Gastric Varices* ; Follow-Up Studies ; Humans ; Leg ; Liver Cirrhosis, Alcoholic ; Neurologic Manifestations ; Sclerotherapy ; Spine