PURPOSE: The aim of this study was to determine the reliability and validity of the Visual Analogue Scale (VAS), as a pain measurement tool in children and adolescents who visit the Pediatric Emergency Department (PED). METHODS: This was a prospective, descriptive study, using convenience sampling, of all children between the ages of 5 and 16 years who presented to a PED. The children were excluded who did not cooperate, who altered mentality or sensorium, who were clinically unstable or required admission to the intensive care unit, or who were developmentally delayed. Children were asked to mark their pain severity on the standardized 100-mm VAS, being instructed to slide the marker to the point on the scale that best described their pain. They were also asked to describe their pain as "none", "mild", "moderate", "severe", or "worst". RESULTS: A total of 716 children and adolescents were enrolled with a mean age of 9.7+/-3.6 years. Males accounted for 439(61.3%). In the children and adolescent who rated their pain as none, (n=10), the mean score was 3.9 mm (95% CI = 0.7 to 7.1); for mild (n=292), the mean score was 30.1 mm (95% CI=28.8 to 31.5); and for moderate pain (n=209) the mean score was 52.4 mm (95% CI=51.2 to 53.6). For those with severe pain (n=187), the mean score was 75.0 mm (95% CI=73.5 to 76.5), and for those who considered their pain the worst (n=18), the mean score was 94.7 mm (95% CI=90.0 to 99.5) (p=0.000). There was no significant relationship between VAS and sex, injury mechanism, or location of pain (p=0.387, p=0.233, p=0.144). The VAS was higher in patients who visited at night on ordinary days (p=0.022) and who were diagnosed with a fracture (71.1+/-20.0 mm) or headache (60.5+/-21.0 mm) (p=0.000). The value was also higher in patients who needed admission (64.9+/-21.5 mm) and an operation (70.7+/-23.0 mm) (p=0.000, p=0.000). CONCLUSION: This study demonstrates the quantification via the VAS of pain severity in children and adolescents who visit to the PED. This scale can be used as a tool for triage, pain management, and deriving a prognosis in the PED.
Adolescent ; Child ; Emergencies ; Headache ; Humans ; Intensive Care Units ; Male ; Pain Management ; Pain Measurement ; Prognosis ; Prospective Studies ; Reproducibility of Results ; Triage

No abstract available.
Herpesvirus 1, Suid* ; Pseudorabies*

BACKGROUND: This study was performed to evaluate the dose-related effects of naloxone on morphine analgesia in the rat formalin test, and observe the correlation of pain behavior and spinal c-fos expression induced by a formalin injection. METHODS: Fifty rats were divided into five groups; control, morphine (morphine pre-treated, intra-peritoneal injection of 0.1 mg of morphine 5 min prior to formalin injection), and three naloxone groups, which were divided according to the administered dose-ratio of naloxone to morphine; 20: 1 (5microgram), 10: 1 (10microgram), and 1: 1 (100microgram) representing the low-, medium-, and high-dose naloxone groups, respectively, were injected intra-peritoneally 16 min after a formalin. A fifty ul of 5% formalin was injected into the right hind paw. All rats were observed for their pain behavior according to the number of flinches during phases 1 (2-3, 5-6 min) and 2 (1 min per every 5 min from 10 to 61 min). The spinal c-fos expression was quantitatively analyzed at 1 and 2 hours after the formalin injection using a real-time PCR. RESULTS: The morphine pre-treated (morphine and three naloxone) groups during phase 1, and the morphine, low- and medium-dose naloxone groups during phase 2, showed significantly less flinches compared to those of the control (P < 0.05). In the three naloxone groups, the numbers of flinches were transiently reduced following the naloxone injection in the low- and medium-dose groups compared to those of the morphine group (P < 0.05). The duration of the reduced flinches was longer in the medium-dose group (P < 0.05). The high-dose group revealed immediate increases in flinches immediately after the naloxone injection compared to those of the morphine, low- and medium-dose groups (P < 0.05 for each). The spinal c-fos expression showed no significant patterns between the experimental groups. CONCLUSIONS: Our data suggest that relatively low-dose naloxone (1/20 to 1/10 dose-ratio of morphine) transiently potentiates morphine analgesia; whereas, high-dose (equal dose-ratio of morphine) reverses the analgesia, and the spinal c-fos expression does not always correlate with pain behavior in the rat formalin test.
Analgesia* ; Animals ; Formaldehyde* ; Morphine* ; Naloxone* ; Pain Measurement* ; Rats* ; Real-Time Polymerase Chain Reaction

Hashimoto encephalopathy shares common clinical features with Creutzfeldt-Jakob disease and must be regarded as a differential diagnosis because of its good prognosis. We report a case of Hashimoto encephalopathy, which had not been recognized before the diagnosis of Creutzfeldt-Jakob disease. The electroclinical findings were compatible with probable Creutzfeldt-Jakob disease and coexistence of Hashimoto thyroiditis was supported by high titers of anti-thyroid microsomal antibody and cytopathologic findings. Hashimoto encephalopathy was not improved, which was most likely due to the coexistence of Creutzfeldt-Jakob disease.
Creutzfeldt-Jakob Syndrome* ; Diagnosis ; Diagnosis, Differential ; Hashimoto Disease ; Prognosis

BACKGROUND: The purpose of this study was to evaluate the effect of head rotation on the anatomical relationship of the right internal jugular vein (RIJV) and the carotid artery (CA) with using ultrasound images in Korean patients. METHODS: We investigated 117 patients (age range: 16-87 years old) who were placed in the supine position, but not in the Trendelenburg position. An ultrasound probe was placed on the right neck at the apex of the triangle formed by the head of the sternocleidomastoid muscle and the clavicle, and it was directed toward the ipsilateral nipple at a 30 degree angle to the coronal plane. For each head rotation (0, 30, 60 degrees), we measured the horizontal diameter of the RIJV and CA, and the percentage of overlap of the CA and the RIJV with using an ultrasound system. RESULTS: The mean RIJV diameter was 18.4 +/- 4.3 mm and the mean CA diameter was 7.5 +/- 1.2 mm at the neutral head position. Following head rotation, the percentage overlap of the CA and RIJV increased significantly (0degrees: 32.7%, 30degrees: 45.4%, 60degrees: 57.0%) (P < 0.05). The percentage overlap of the CA and RIJV in the neutral head position increased more in the patients with a BMI over 25. However, age did not have any effect on the percentage of overlap. CONCLUSIONS: Head rotation toward the contralateral side increases the percentage of overlap of the CA and RIJV. To decrease the risk of CA puncture, rotate the head from the neutral position as little as possible when performing RIJV catheterization.
Carotid Arteries ; Catheterization ; Catheters ; Clavicle ; Head ; Head-Down Tilt ; Humans ; Jugular Veins ; Muscles ; Neck ; Nipples ; Punctures ; Supine Position

BACKGROUND: The purpose of this study was to evaluate the effect of head rotation on the anatomical relationship of the right internal jugular vein (RIJV) and the carotid artery (CA) with using ultrasound images in Korean patients. METHODS: We investigated 117 patients (age range: 16-87 years old) who were placed in the supine position, but not in the Trendelenburg position. An ultrasound probe was placed on the right neck at the apex of the triangle formed by the head of the sternocleidomastoid muscle and the clavicle, and it was directed toward the ipsilateral nipple at a 30 degree angle to the coronal plane. For each head rotation (0, 30, 60 degrees), we measured the horizontal diameter of the RIJV and CA, and the percentage of overlap of the CA and the RIJV with using an ultrasound system. RESULTS: The mean RIJV diameter was 18.4 +/- 4.3 mm and the mean CA diameter was 7.5 +/- 1.2 mm at the neutral head position. Following head rotation, the percentage overlap of the CA and RIJV increased significantly (0degrees: 32.7%, 30degrees: 45.4%, 60degrees: 57.0%) (P < 0.05). The percentage overlap of the CA and RIJV in the neutral head position increased more in the patients with a BMI over 25. However, age did not have any effect on the percentage of overlap. CONCLUSIONS: Head rotation toward the contralateral side increases the percentage of overlap of the CA and RIJV. To decrease the risk of CA puncture, rotate the head from the neutral position as little as possible when performing RIJV catheterization.
Carotid Arteries ; Catheterization ; Catheters ; Clavicle ; Head ; Head-Down Tilt ; Humans ; Jugular Veins ; Muscles ; Neck ; Nipples ; Punctures ; Supine Position

Infiltrating lipoma is a rare mesenchymal neoplasm that, in spite of benign nature, characteristically infiltrates adjacent tissues and tends to recur after surgery. It has a predilection for the extremities and the trunk and is extremely rare in the head and neck region. We present a case of congenital infiltrating lipoma of the face, describing the intrabony invasion and osseous dystrophy as well as the soft tissue changes seen on plain radiographs and magnetic resonance imaging.
Extremities ; Head ; Lipoma* ; Magnetic Resonance Imaging ; Maxilla* ; Neck

Infiltrating lipoma is a rare mesenchymal neoplasm that, in spite of benign nature, characteristically infiltrates adjacent tissues and tends to recur after surgery. It has a predilection for the extremities and the trunk and is extremely rare in the head and neck region. We present a case of congenital infiltrating lipoma of the face, describing the intrabony invasion and osseous dystrophy as well as the soft tissue changes seen on plain radiographs and magnetic resonance imaging.
Extremities ; Head ; Lipoma* ; Magnetic Resonance Imaging ; Maxilla* ; Neck

PURPOSE: Recommended dietary allowance of vitamin C was determined on the basis of preventing the scurvy without considerations of the important function of the vitamin C as a first line antioxidant. So we measured the whole blood and plasma vitamin C concentrations of the contemporay healthy elementary school children in Chinju for the establishment of the optimal daily vitamin C requirment in the elementary school children. METHODS: Whole blood and plasma vitamin C concentrations were measured by the 2,4-dinitrophenylhydrazine method in 338 children from the 1st to the 6th grade of one elementary school in Chinju. RESULTS: Whole blood and plasma vitamin C concentrations were 1.36+/-0.34mg/dL and 1.07+/-0.33mg/dL respectively. There existed an close relationship between whole blood and plasma vitamin C concentrations (r=0.77, p=0.0001). Whole blood vitamin C concentration decreased as the age became older (r=-0.22 p=0.0001), but plasma vitamin C concentration did not change. There were no sex differences in the whole blood and plasma vitamin C concentrations except in the 3rd grade (p<0.05). Twenty-three of 338 elementary school children (6.8%) had the plasma vitamin C concentration less than 0.6mg/dL. CONCLUSIONS: We produced the blood and plasma vitamin C concentrations of the contemporay elementary school children in Chinju. These values were not satisfactory in consideration of the importance of the childhood health.
Ascorbic Acid* ; Child* ; Gyeongsangnam-do* ; Humans ; Plasma* ; Recommended Dietary Allowances ; Scurvy ; Sex Characteristics ; Vitamins*

PURPOSE: The incidence of breast cancer is continuously increasing in Korea, and the age of the initially detected breast cancer is younger than western people. The purpose of this study was to compare radiological, pathological, and clinical findings of breast cancers according to age and then contribute to the basis of screening program of breast cancer. METHODS: Retrospectively, the 325 patients who had pathologically confirmed breast cancer were included in this study. The patients were classified into 6 groups according to age, 20~29, 30~39, 40~49, 50~59, 60~69, and more than 70 years. We evaluated the radiological findings of 325 cases of mammography and 144 cases of breast ultrasonography, classified as four types; mass, microcalcification, others, and non-detected lesion, and then analyzed radiological findings according to age. We evaluated pathological and clinical findings according to age and compared with radiological findings. We used Mantel-Haenszel's chi 2 test and trend test for comparison according to age. RESULTS: The incidence of breast cancer was 61 cases (19%) in 30~39 years, 122 (38%) in 40~49 years, 92 (28%) in 50~59 years. Most of breast cancer was invasive ductal carcinoma, 258 (79%) and in situ carcinoma was 32 (10%). Most of in situ carcinoma was detected in 20~59 years, 31/32 (97%). Mammography showed mass in 237 (73%), microcalcification in 45 (14%), other finding in 13 (4%), and non-detected lesion in 30 (9%). Twenty-one (47%) of 45 cases with microcalcification were in situ carcinoma and most of in situ carcinoma was presented as microcalcification on mammography, 21/32 (66%). In twenty-eight of 30 cases (93%) with non-detected lesion on mammography, breast cancer was detected on ultrasonography. In terms of clinical findings, there was no symptom in 12/32 (38%) with in situ carcinoma and 57/258 (22%) with invasive ductal carcinoma. CONCLUSION: The incidence of breast cancer is abruptly increasing from 4th decades and there is no significant difference in radiological and clinical findings according to age. But, most of in situ carcinoma was detected in 20~59 years and presented as microcalcification on mammography. Thus, Screening mammography should be considered from 4th decades.
Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Diagnosis ; Female ; Humans ; Incidence ; Korea ; Mammography ; Mass Screening ; Retrospective Studies ; Ultrasonography ; Ultrasonography, Mammary