BACKGROUND: Intussuseception is one of the most common diseases requiring abdominal emergency care in early childhood. The delay in diagnosis increases morbidity and, in particular, reduces the success rate of the non-surgical method of reduction. In this report, the authors determined the clinical characteristics of pediatric patients with intussusception, and the factors involved in delayed diagnosis and the efficacy of doppler ultrasonography in diagnosis. METHODS: The authors performed a retrospective study of 44 cases in 42 patients with intussusception who had visited the emergency room of SamSung medical center from January 1st to December 31, 1996. RESULTS: The sex ratio was equal and 64.3% of the patients were under 1 year of age. The prevalent complaints were vomiting(36.4%) and abdominal pain(33.8%). Ultrasonography was used in 11 cases, 3 of them were performed because of obscure symptoms and the rest were due to diagnostic delay. The average time past from visit to diagnosis was 4 hours and 20 minutes, and there were 4 diagnostic delays. Air enema reductions were unsucessful in 11 cases(25%) and that was related to hospital-visit delays and long time past from symptom onset to diagnosis. There were no motalities. CONCLUSION: To reduce delays in diagnosis and unnecessary operations, the use of doppler ultrasonography is recommanded in suspicious cases. And to reduce the hospital-visit delays, related to the failure on non-surgical reduction, the education about this disease is necessary.
Delayed Diagnosis ; Diagnosis ; Education ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital* ; Enema ; Humans ; Intussusception* ; Retrospective Studies ; Sex Ratio ; Ultrasonography ; Ultrasonography, Doppler

PURPOSE: The purpose of this study was to describe the clinical characteristics of neonatal urinary tract infection (UTI) caused by Klebsiella pneumoniae and non- Klebsiella pneumoniae UTI. METHODS: We compared clinical characteristics of 84 neonatal patients with UTI caused by Klebsiella pneumoniae who were hospitalized at the Department of Pediatricsat Han Dong University, Sunlin Hospital during the period between May, 1994 and August, 1998. The cases were divided into two groups depending upon causative organisms' Klebsiella pneumoniae UTI vs non-Klebsiella pneumoniae UTI, and the clinical characteristics of these groups were compared. RESULTS: Escherichia coli was the most common bacterial pathogen causing neonatal UTI, followed by Klebsiella pneumoniae. There was no significant difference in the sex distribution of Klebsiella pneumoniae UTI, but non-Klebsiella pneumoniae UTI showed male predominence. There were no significant differences in the incidences of hematologic, urologic, radiologic findings and perinatal complications in between these 2 groups. CONCLUSION: Klebsiella pneumoniae is the second most common pathogen causing neonatal UTI. There were no specific differences in the laboratory, symptomatologic, and radiologic findings in these two groups.
Escherichia coli ; Humans ; Incidence ; Klebsiella pneumoniae* ; Klebsiella* ; Male ; Pneumonia ; Sex Distribution ; Urinary Tract Infections* ; Urinary Tract*

We have experienced a case of 13 ring chromosome in a 40-month-old girl who demonstrated psychomotor retardation with delayed speech, growth retardation, hearing loss(left), microcephaly, trigonocephaly with flat occiput, hypertelorism, epicanthal folds, microophthalmia, broad prominamt nasal bridge, high arched palate, micrognathia, large auricles and other anomalies. Cytogenetic studies of peripheral blood lymphocytes with differential staining of chromosomes revealed 46, XX, r13. Her parents' karyotypes were normal. We reported the case with the review of the associated literatures.
Child, Preschool ; Craniosynostoses ; Cytogenetics ; Female ; Hearing ; Humans ; Hypertelorism ; Karyotype ; Lymphocytes ; Microcephaly ; Palate ; Ring Chromosomes*

BACKGROUND: The afferent and efferent pathways of fentanyl cough response (FCR) and central organization are poorly understood at present. The aim of this study was to investigate the pretreatment effects of morphine, propofol, atropine, and midazolam on FCR. METHOD: The 120 healthy patients were randomly assigned to six equal pretreatment groups. They received 2ug/kg fentanyl rapidly through a peripheral venous catheter. The patients in each group were pretreated before the time necessary for peak plasma levels with different drugs as follows: group 1, no premedication; group 2, morphine 0.05 mg/kg iv; group 3, morphine 0.05 mg/kg iv naloxone 0.01mg/kg iv; group 4, propofol 0.5 mg/kg iv; group 5, atropine 0.01 mg/kg iv; group 6, midazolam 0.05 mg/kg iv. The patients were observed for any coughing or side effects, including oxygen desaturation, bronchoconstriction, chest wall rigidity and seizure. RESULT: 40% of patients in group 1 (control) had a cough response to fentanyl. Group 2 (morphine) and group 3 (morphine naloxone) showed a reduced FCR of 10%. The incidence of coughing was 60% of the patients in group 4 (propofol), 30% in group 5 (atropine), and 40% in group 6 (midazolam). These were not statistically significant. CONCLUSION: FCR is not altered by pretreatment with propofol, atropine, or midazolam, but morphine inhibits cough response and this antitussive effect was not antagonized by naloxone.
Atropine* ; Bronchoconstriction ; Catheters ; Cough* ; Efferent Pathways ; Fentanyl* ; Humans ; Incidence ; Midazolam* ; Morphine* ; Naloxone ; Oxygen ; Plasma ; Premedication ; Propofol* ; Seizures ; Thoracic Wall

No abstract available.
Parturition*

BACKGROUND: The NMDA receptor mediates wind-up and long-term potentiation in the responses of cells to prolonged stimuli; thus we postulated that the induction and maintenance of sensitization would be affected by the timing of epidural ketamine administration under epidural anesthesia. METHODS: Sixty patients undergoing elective cesarian section were randomly and equally assigned to one of three groups. 20 ml of 2% lidocaine and 2 mg morphine with epinephrine was injected to all patients epidurally through an indwelling catheter inserted at the L2-3 interspace. Before surgical incision, the patients in group 1 were given 3 ml saline, while the patients in group 2 were given 30 mg ketamine. In group 3, patients were injected with 30 mg ketamine after peritoneal closure. An additional 2 mg morphine was injected into all patients 24 h after surgery. The analgesic effects were assessed and side effects were also evaluated. RESULTS: VAS of group 3 at 3 24 h was lower than in the group 1, and at 6 24 h it was lower than in the group 2. The number of patients using additional analgesics in group 3 was lower than in the other groups. The incidence of nausea and vomiting was higher in the group 1 than in the other groups, but dizzness was higher in the groups 2 and 3 than in the control group. CONCLUSIONS: Preoperative administration of epidural ketamine is less effective in reducing postoperative pain than when given after peritoneal closure, especially under epidural anesthesia with local anesthetics.
Analgesia* ; Analgesics ; Anesthesia, Epidural* ; Anesthetics, Local ; Catheters, Indwelling ; Epinephrine ; Humans ; Incidence ; Ketamine* ; Lidocaine ; Long-Term Potentiation ; Morphine ; N-Methylaspartate ; Nausea ; Pain, Postoperative ; Vomiting

BACKGROUND: The NMDA receptor mediates wind-up and long-term potentiation in the responses of cells to prolonged stimuli; thus we postulated that the induction and maintenance of sensitization would be affected by the timing of epidural ketamine administration under epidural anesthesia. METHODS: Sixty patients undergoing elective cesarian section were randomly and equally assigned to one of three groups. 20 ml of 2% lidocaine and 2 mg morphine with epinephrine was injected to all patients epidurally through an indwelling catheter inserted at the L2-3 interspace. Before surgical incision, the patients in group 1 were given 3 ml saline, while the patients in group 2 were given 30 mg ketamine. In group 3, patients were injected with 30 mg ketamine after peritoneal closure. An additional 2 mg morphine was injected into all patients 24 h after surgery. The analgesic effects were assessed and side effects were also evaluated. RESULTS: VAS of group 3 at 3 24 h was lower than in the group 1, and at 6 24 h it was lower than in the group 2. The number of patients using additional analgesics in group 3 was lower than in the other groups. The incidence of nausea and vomiting was higher in the group 1 than in the other groups, but dizzness was higher in the groups 2 and 3 than in the control group. CONCLUSIONS: Preoperative administration of epidural ketamine is less effective in reducing postoperative pain than when given after peritoneal closure, especially under epidural anesthesia with local anesthetics.
Analgesia* ; Analgesics ; Anesthesia, Epidural* ; Anesthetics, Local ; Catheters, Indwelling ; Epinephrine ; Humans ; Incidence ; Ketamine* ; Lidocaine ; Long-Term Potentiation ; Morphine ; N-Methylaspartate ; Nausea ; Pain, Postoperative ; Vomiting

No abstract available.
Drug Hypersensitivity ; Isoxazoles

BACKGROUND: This study aimed to assess the status of infection control during influenza A pandemic (H1N1) 2009. METHODS: A questionnaire survey was conducted in November 2009 at the 100 hospitals designated by the Korea Centers for Disease Control and Prevention (KCDC) as influenza A pandemic (H1N1) 2009-treatment institutions. RESULTS: In 32.3% of the hospitals, the ventilation system of the influenza A pandemic (H1N1) 2009 isolation ward was separated from the hospital's ventilation system. With regard to wearing personal protective equipment while caring for patients with H1N1 infection, during usual patient contact, masks were always worn by all medical staff at all the hospitals; however, medical staff at 38.7% and 51.6% of the hospitals did not wear gloves and gowns, respectively. During aerosol-generating procedures, some medical staff wore surgical masks, whereas medical staff at 10% and 23.3% of the hospitals did not wear gowns and protective goggles, respectively. In all, 64.5% of the hospitals responded that the contents of the guidelines established by the KCDC were insufficient for reference purposes in actual practice. CONCLUSION: Some of influenza A pandemic (H1N1) 2009-treatment institutions are believed to be inadequate in facilities, infection control during patient treatment, and administrative measures among their efforts to prevent transmission in hospital. In preparation against the outbreak of similar diseases in the future, the government needs to establish guidelines highly applicable by medical staff, to secure exclusive spaces and personnel for treating infectious disease patients, and to develop personal protective gear support and management systems.
Centers for Disease Control and Prevention (U.S.) ; Communicable Diseases ; Delivery of Health Care ; Eye Protective Devices ; Humans ; Infection Control ; Influenza, Human ; Korea ; Masks ; Medical Staff ; Pandemics ; Ventilation ; Surveys and Questionnaires

Various cancer types have been associated with cancer-related cerebral infarction. In this study, we describe the first case of cancer-related cerebral infarction in which the underlying disease was primary bone marrow lymphoma (PBML). A 79-year-old man presented with abruptly developed bilateral lower extremity weakness and confusion. Diffusion-weighted imaging on admission showed multiple cortical and subcortical embolic infarction lesions in multiple vascular territories. Diagnostic evaluations to determine the embolic source revealed no abnormalities. Laboratory testing demonstrated elevated D-dimer (2.59 μg/mL) but no other prothrombotic abnormalities. In suspicion of cancer-related stroke, we performed chest CT, abdomen CT, and FDG-PET to detect the hidden malignancy. Findings revealed no evidence of cancer; however, they did reveal signs of anemia (hemoglobin 9.0 g/dL). Bone marrow aspiration biopsy showed large atypical B cell involvement suggestive of high-grade B cell lymphoma. The patient was diagnosed with primary bone marrow diffuse large B-cell lymphoma initially presenting with ischemic stroke. Our case suggests that primary bone marrow cancer may be a candidate for the differential diagnosis of hidden malignancy in patients with suspected cancer-related stroke. Bone marrow biopsy may be essential for establishing an appropriate differential diagnosis in patients with abnormal hematologic findings.