No abstract available.
Humans ; Infant, Low Birth Weight* ; Infant, Newborn

Cerebral malaria means that the patient with demonstrable asexual forms of Plasmodium falciparum in peripheral blood smear who have disturbed mental state and in whom other causes of encephalopathy, such as bacterial, fungal, or viral meningoenoephalitides, drug intoxications other metabolic disease have been excluded. In cerebral malaria, the mortality rate is up to 30% and most of death is within 96 hours, so is known as neurological emergency that urgent treatment should be required. A 42 years old male patients admitted our emergency room with spiking fever 2 days before admission and drowsy mental state at the moming of admission day. The patient traveled in Africal 2 weeks ago. On physical and neurologic examination, the hepatomegaly, drowsy mental state and divergent eyeball was observed. Brain CT scan was normal but pulmonary edema was seen in chest PA and mild increased protein(76mg/dl) was observed in spinal tapping. In peripheral blood smear, severe thrombocytopenia and trophozoa of ring form and band form wer found so diagnosed as mixed infected cerebral malaria. The patient was started the treatment of chloroguine and tetracycline and recovered 2 weeks after treatment. Cerebral malaria should be once considered as differential diagnosis in patients with unknown origin fever and mental confusion in intemalized society like modem.
Adult ; Brain ; Diagnosis, Differential ; Emergencies ; Emergency Service, Hospital ; Fever ; Fever of Unknown Origin ; Hepatomegaly ; Humans ; Malaria, Cerebral* ; Male ; Metabolic Diseases ; Modems ; Mortality ; Neurologic Examination ; Plasmodium falciparum ; Pulmonary Edema ; Spinal Puncture ; Tetracycline ; Thorax ; Thrombocytopenia ; Tomography, X-Ray Computed

Laser Surgery is widely employed because it has many advantages over the conventional surgery. Laser surgery involving airway tract shows excellent results for its minimnal postoperative tissue edema, good hemostasis and operation fields. But some of complications, although it is not frequent with precaution, can develop fatal outcome to patient. We experienced a case of fire ignited by the CO2 laser during laryngeal microscopic surgery.
Edema ; Fatal Outcome ; Fires* ; Hemostasis ; Humans ; Laser Therapy ; Lasers, Gas*

BACKGROUND: Even though several oral anti-diabetic drugs (OAD) with various modes of action are replacing sulfonylurea (SU), some patients seem to be dependent on SU for adequate glycemic control. Therefore, we evaluated the clinical characteristics of such patients. METHODS: We selected the patients with type 2 diabetes who met following criteria from 2009 to 2014 at Seoul National University Hospital: glycated hemoglobin (HbA1c) was maintained below 7.5% for at least 6 months under small dose of SU (glimepiride < or =2 mg/day or equivalent dose); after discontinuation of SU, HbA1c increased > or =1.2% within 3 months or > or =1.5% within 6 months; and after resuming SU, HbA1c reduction was > or =0.8% or reduction of fasting plasma glucose was > or =40 mg/dL within 3 months. Patients with impaired hepatic or renal function, and steroid users were excluded. RESULTS: Nineteen subjects were enrolled: after averaged 4.8+/-1.5 months of SU-free period, HbA1c increased from 6.7%+/-0.4% to 8.8%+/-0.8% even though adding other OAD such as gliptins. However, HbA1c decreased to 7.4%+/-0.7% after resuming SU within 2.4+/-0.8 months. There was no sexual predominance. Despite their old age (67+/-11 years) and long duration of diabetes (18+/-10 years), fasting C-peptide was relatively well-reserved (3.9+/-2.6 ng/mL), and nephropathy was not observed (albumin-creatinine ratio 21.2+/-16.6 mg/g and estimated glomerular filtration rate 75.8+/-18.0 mL/min/1.73 m2). Strong family history was also noted (73.7%). CONCLUSION: Despite hypoglycemia risk of SU, it seemed indispensable for a subset of patients with regard to insulin secretion. Genetic influences would be evaluated.
Blood Glucose ; C-Peptide ; Diabetes Mellitus ; Dipeptidyl-Peptidase IV Inhibitors ; Fasting ; Glomerular Filtration Rate ; Hemoglobin A, Glycosylated ; Humans ; Hypoglycemia ; Insulin ; Seoul

BACKGROUND: To examine the influencing factors on patients' satisfaction in the emergency department(ED) far quality assurance. METHODS: Patients who visited to the ED were prospectively investigated from November 1 to December 31,1997. Authors developed questionnaire to investigate influencing factors on patients' satisfaction.4 Chi-square test and 115-REL 7.0 were applied far statistical analysis. RESULTS: Patients' satisfaction was significantly related to physical environment variables, accessibility variables, kindness of hospital personnel variables, and patient's trust for doctors variables. In path analysis, willingness for revisit was influenced by patients' satisfaction, accessibility, physical environment, patients' trust for doctors in order, and willingness for recommendation was influenced by accessibility, patients' satisfaction, and kindness of hospital personnel in order. CONCLUSIONS : The influencing factors on patients' satisfaction are physical environment, accessibility, kindness of hospital personnel, and patient's trust far doctors. Willingness far revisit and willingness far recommendation are influenced by patients' satisfaction. In spite of some limitations, the results of this study can be used as a baseline information for exploring the influencing factors on patients' satisfaction. Further comprehensive research efforts should be made on the study of patients' satisfaction in the ED.
Emergencies* ; Emergency Service, Hospital* ; Humans ; Personnel, Hospital ; Prospective Studies ; Surveys and Questionnaires

BACKGROUND: A randomized, multicenter, open-label, parallel group study was performed to compare the effects of remifentanil and morphine as analgesic drugs on the duration of weaning time from mechanical ventilation (MV). METHODS: A total of 96 patients with MV in 6 medical and surgical intensive care units were randomly assigned to either, remifentanil (0.1-0.2 mcg/kg/min, n = 49) or morphine (0.8-35 mg/hr, n = 47) from the weaning start. The weaning time was defined as the total ventilation time minus the sum of controlled mode duration. RESULTS: Compared with the morphine group, the remifentanil-based analgesic group showed a tendency of shorter weaning time (mean 143.9 hr, 89.7 hr, respectively: p = 0.069). Secondary outcomes such as total ventilation time, successful weaning rate at the 7th of MV day was similar in both groups. There was also no difference in the mortality rate at the 7th and 28th hospital day. Kaplan-Meyer curve for weaning was not different between the two groups. CONCLUSIONS: Remifentanil usage during the weaning phase tended to decrease weaning time compared with morphine usage.
Analgesics ; Humans ; Critical Care ; Morphine* ; Mortality ; Respiration, Artificial* ; Ventilation ; Ventilator Weaning ; Weaning*

No abstract available.
Morphine* ; Respiration, Artificial* ; Weaning*

BACKGROUND: We compared clinical outcomes after total knee arthroplasty with the Low Contact Stress (LCS) rotating platform mobile bearing knee system and the Press Fit Condylar Sigma rotating platform high flexion (PFC Sigma RP-F) mobile bearing knee system. METHODS: Fifty cases of total knee arthroplasty were performed with the PFC Sigma RP-F mobile bearing knee system and sixty-one cases were performed with the LCS mobile bearing total knee arthroplasty. The average duration of follow-up was 2.9 years. RESULTS: The mean Hospital for Special Surgery (HSS) knee score was 62.1 (range, 52 to 75) in the LCS group and 61.9 (range, 50 to 74) in the Sigma RP-F group preoperatively, and 90.1 (range, 84 to 100) in the LCS group and 89.8 (range, 83 to 100) in the Sigma RP-F group at the final follow-up. The mean preoperative flexion contracture was 6.7degrees (range, 0degrees to 10degrees) in the LCS group and 9.3degrees (range, 0degrees to 15degrees) in the Sigma RP-F group preoperatively. The mean range of motion was 124.6degrees (range, 105degrees to 150degrees) in the LCS group and 126.1degrees (range, 104degrees to 145degrees) in the Sigma RP-F group at the final follow-up. CONCLUSIONS: After a minimum duration of follow-up of two years, we found no significant differences between the two groups with regard to the range of knee motion or the clinical or radiographic results.
Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Knee/*methods ; Chi-Square Distribution ; Female ; Follow-Up Studies ; Humans ; Knee Joint/*physiology/radiography/surgery ; *Knee Prosthesis ; Male ; Middle Aged ; Pain Measurement ; Range of Motion, Articular/physiology ; Treatment Outcome

A 42-year-old male was hospitalized with abdominal pain, dyspnea, and turbid peritoneal fluid. He was diagnosed with hypertension, diabetes and started continuous ambulatory peritoneal dialysis (CAPD) 11 months ago. He was treated with intraperitoneal cefazolin and ceftazidime, and then white blood cell counts of dialysate decreased. Incidentally, liver abscess was found in chest CT performed for the evaluation of dyspnea, and patient was febrile persistently. So percutaneous abscess drainage was done by pigtail catheter. We changed the antibiotics to ceftriaxone and metronidazole, and hemodialysis was started. Klebsiella pneumoniae was cultured from peritoneal fluid and blood simultaneously. We concluded that liver abscess is a primary cause of CAPD peritonitis.
Abdominal Pain ; Abscess ; Adult ; Anti-Bacterial Agents ; Ascitic Fluid ; Catheters ; Cefazolin ; Ceftazidime ; Ceftriaxone ; Drainage ; Dyspnea ; Humans ; Hypertension ; Klebsiella ; Klebsiella pneumoniae ; Leukocyte Count ; Liver ; Liver Abscess ; Male ; Metronidazole ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis ; Renal Dialysis ; Thorax

Hemorrhagic cystitis (HC), a serious form of cystitis, is characterized by diffuse bladder mucosal inflammation with hemorrhage. The known causes of HC are radiation, chemotherapy, drug, and infection. But, most cases happen without definite etiology. Radiation induced HC can be developed at any time from 6 months to 10 years after pelvic irradiation therapy, and can appear as late as 2 decades. The complications of HC are anemia, chronic cystitis, and acute renal failure (ARF). However, HC- induced severe postrenal ARF is rare. We experienced a case of a postrenal ARF caused by hematoma in HC. A 55-year-old woman had past history of pelvic irradiation therapy for carcinoma of the cervix 13 years ago. She was initially treated by bladder catheterization and bladder irrigation with normal saline. HC and renal function were improved. However, HC was recurred shortly after stopping irrigation and serum creatinine was elevated again. Thus, we treated this patient successfully with both percutaneous nephrostomy and antegrade double J stent catheterization.
Acute Kidney Injury ; Anemia ; Catheterization ; Catheters ; Cervix Uteri ; Cinnarizine ; Creatinine ; Cystitis ; Female ; Hematoma ; Hemorrhage ; Humans ; Inflammation ; Middle Aged ; Nephrostomy, Percutaneous ; Stents ; Urinary Bladder