Objective: The number of elderly patients in Korea has been on the rise recently, and hence the number of out-of-hospital cardiac arrest (OHCA) elderly patients is also rising. The causes of cardiac arrest for the elderly vary, and, it is difficult to predict the recovery of spontaneous circulation (ROSC) in OHCA patients. Therefore, the purpose of this study was to ascertain the predictive value of arterial blood gas analysis (ABGA) results in achieving ROSC in the elderly. Methods: A retrospective analysis of emergency department patients with OHCA was performed at the Kangwon National University Hospital, Korea from 1 January 2016 to 31 December 2019. The initial ABGA results were compared between two patient groups, those who had achieved a return of spontaneous circulation and those who had not. Univariate and multivariable analyses were performed to elucidate the factors associated with ROSC. Results: Overall, 229 OHCA patients were included in the final analysis. The lactate level was independently related to ROSC. A receiver operating characteristics (ROC) curve was plotted to obtain the best cutoff value. The lactate level <9.85 mmol/L showed the largest area under the ROC curve (AUC) to predict ROSC (AUC, 0.666; 95% confidence interval, 0.588-0.743). Multiple regression analysis was performed using the cutoff value, which was a lactate level of 9.85 (odds ratio, 2.907; 95% confidence interval, 1.432-5.902; P=0.003). Conclusion The ABGA results during the cardiopulmonary resuscitation of OHCA patients, showed that the lactate level was an independent factor associated with ROSC. The lactate cutoff value was 9.85 mmol/L.

Objective: The number of elderly patients in Korea has been on the rise recently, and hence the number of out-of-hospital cardiac arrest (OHCA) elderly patients is also rising. The causes of cardiac arrest for the elderly vary, and, it is difficult to predict the recovery of spontaneous circulation (ROSC) in OHCA patients. Therefore, the purpose of this study was to ascertain the predictive value of arterial blood gas analysis (ABGA) results in achieving ROSC in the elderly. Methods: A retrospective analysis of emergency department patients with OHCA was performed at the Kangwon National University Hospital, Korea from 1 January 2016 to 31 December 2019. The initial ABGA results were compared between two patient groups, those who had achieved a return of spontaneous circulation and those who had not. Univariate and multivariable analyses were performed to elucidate the factors associated with ROSC. Results: Overall, 229 OHCA patients were included in the final analysis. The lactate level was independently related to ROSC. A receiver operating characteristics (ROC) curve was plotted to obtain the best cutoff value. The lactate level <9.85 mmol/L showed the largest area under the ROC curve (AUC) to predict ROSC (AUC, 0.666; 95% confidence interval, 0.588-0.743). Multiple regression analysis was performed using the cutoff value, which was a lactate level of 9.85 (odds ratio, 2.907; 95% confidence interval, 1.432-5.902; P=0.003). Conclusion The ABGA results during the cardiopulmonary resuscitation of OHCA patients, showed that the lactate level was an independent factor associated with ROSC. The lactate cutoff value was 9.85 mmol/L.

Objective: This study examined the characteristics of the patients taking poison intentionally at the pre-hospital stage to prevent it at the community level. Methods: We retrospectively reviewed the data that had been reported to fire stations from January 2017 to December 2018. This data included sex, age, occupation, the season of the year, time, place, methods, alcohol ingestion, transferred to the hospital or not, and we examined how taking poison had an effect on the suicide success rate. Results: The subjects were a total of 1,356 patients who had been reported to fire stations due to intentionally taking poison. Forty-five point five percent of them were male, and 54.5% were female. The most common method of intentional taking poison was sedatives (58.3%), followed by pesticides (24.6%), antidepressants (19.0%), and other methods (12.6%). The home place was preferred more than any other places. The suicide success rate was 2.1% in males and 1.4% in females. For the age groups, those patients 40-64 years old tried taking poison much more than the other age groups. In the aspect of the season of the year, summer was the highest season for taking poison, at 30.3%. The daytime was more preferred than the night time. Conclusion In this study, we analyzed the characteristics of the pre-hospital intentional poisoning cases according to gender, age, occupation, season of the year, time, and between the transferred and the untransferred groups. Efforts should be made in cooperation with the community to prevent suicide attempts by intentionally taking poison.

PURPOSE: Data on the efficacy of olanzapine in patients receiving moderately emetogenic chemotherapy (MEC) are limited. This study aimed to evaluate and compare the efficacy of olanzapine versus placebo in controlling nausea and vomiting in patients receiving MEC. MATERIALS AND METHODS: We conducted a randomized, double-blind, placebo-controlled study to determine whether olanzapine can reduce the frequency of chemotherapy-induced nausea and vomiting (CINV) and improve the quality of life (QOL) in patients receiving palonosetron and dexamethasone as prophylaxis for MEC-induced nausea and vomiting. The primary end point was complete response for the acute phase (0-24 hours after chemotherapy). The secondary end points were complete response for the delayed (24-120 hours) and overall phase (0-120 hours), proportion of significant nausea (visual analogue scale ≥ 25 mm), use ofrescue medications, and effect on QOL. RESULTS: Fifty-six patients were randomized to the olanzapine (n=29) and placebo (n=27) groups. Complete response rates were not significantly different between the olanzapine and placebo groups in the acute (96.5% vs. 88.0%, p=0.326), delayed (69.0% vs. 48.0%, p=0.118), and overall phases (69.0% vs. 48.0%, p=0.118). However, the percentage of patients with significant nausea (17.2% vs. 44.0%, p=0.032) and the use of rescue medications (0.03±0.19 vs. 1.88±2.88, p=0.002) were lower in the olanzapine group than in the placebo. Furthermore, the olanzapine group demonstrated better QOL (p=0.015). CONCLUSION: Olanzapine combined with palonosetron and dexamethasone significantly improved QOL and vomiting control among previously untreated patients receiving MEC, although the efficacy was limited to the reduction of the frequency of CINV.
Antiemetics ; Dexamethasone ; Drug Therapy* ; Humans ; Nausea* ; Quality of Life ; Vomiting*

BACKGROUND: There is a need for investigating the analgesic method as part of early recovery after surgery tailored for laparoscopic colorectal cancer (LCRC) surgery. In this randomized trial, we aimed to investigate the analgesic efficacy of an inverse ‘v’ shaped bilateral, subfascial ropivacaine continuous infusion in LCRC surgery. METHODS: Forty two patients undergoing elective LCRC surgery were randomly allocated to one of two groups to receive either 0.5% ropivacaine continuous infusion at the subfascial plane (n = 20, R group) or fentanyl intravenous patient controlled analgesia (IV PCA) (n = 22, F group) for postoperative 72 hours. The primary endpoint was the visual analogue scores (VAS) when coughing at postoperative 24 hours. Secondary end points were the VAS at 1, 6, 48, and 72 hours, time to first flatus, time to first rescue meperidine requirement, rescue meperidine consumption, length of hospital stay, postoperative nausea and vomiting, sedation, hypotension, dizziness, headache, and wound complications. RESULTS: The VAS at rest and when coughing were similar between the groups throughout the study. The time to first gas passage and time to first rescue meperidine at ward were significantly shorter in the R group compared to the F group (P = 0.010). Rescue meperidine was administered less in the R group; however, without statistical significance. Other study parameters were not different between the groups. CONCLUSIONS: Ropivacaine continuous infusion with an inverse ‘v ’ shaped bilateral, subfascial catheter placement showed significantly enhanced bowel recovery and analgesic efficacy was not different from IV PCA in LCRC surgery.
Analgesia ; Analgesia, Patient-Controlled ; Anesthetics, Local ; Catheters ; Colorectal Neoplasms* ; Colorectal Surgery ; Cough ; Dizziness ; Fentanyl ; Flatulence ; Headache ; Humans ; Hypotension ; Laparoscopy ; Length of Stay ; Meperidine ; Methods ; Passive Cutaneous Anaphylaxis ; Postoperative Nausea and Vomiting ; Wounds and Injuries

A cystic parathyroid adenoma is rare. A case of primary hyperparathyroidism, with the cystic formation of a parathyroid adenoma and a severe bony lesion, is reported. A 52-year-old male was admitted due to pain in both hips and for evaluation of hypercalcemia. The plasma level of the intact parathyroid hormone(iPTH) was elevated to 1424pg/mL. Ultrasonography and the computed tomography revealed a parathyroid cyst on the left thyroid lower pole. Parathyroid scintigraphy detected a parathyroid adenoma. A radiograph showed a subperiosteal bone resorption on the phalanges, and a brown tumor(osteitis fibrosa cystica) on the femur shaft was noted. A surgical excision of the parathyroid adenoma was performed. The PTH level in the cystic fluid was increased. A histological examination confirmed a cystic parathyroid adenoma. The PTH level was normalized after the operation.
Bone Resorption ; Femur ; Hip ; Humans ; Hypercalcemia ; Hyperparathyroidism ; Hyperparathyroidism, Primary ; Male ; Middle Aged ; Osteitis Fibrosa Cystica ; Parathyroid Neoplasms* ; Plasma ; Radionuclide Imaging ; Thyroid Gland ; Ultrasonography

Purpose: This retrospective study has been undertaken to find out the clinical outcome of children with Henoch-Schonlein nephritis and its relationship with initial clinical presentations and/or renal pathologic findings. METHODS: Study population consisted of 54 children with HS nephritis who have been admitted to the Pediatric department of Kyungpook University Hospital from 1993 to 2003, and biopsy was done with indications of heavy proteinuria (1 g/m2/day) lasting over 1 month, nephrotic syndrome, and persistent hematuria and/or proteinuria over 1 years. Patients were clinically divided into 3 groups; isolated hematuria, hematuria with proteinuria and heavy proteinuria (including nephrotic syndrome). Biopsy findings were graded from I-VI according to International Study of Kidney Disease in Children. RESULTS: Mean age of presentation was 7.9+/-2.7 years and slight female predominance was noted (24 boys and 30 girls). Histopathologic grading showed grade I in 5, grade II in 17, grade III in 29, and grade VI in 3 cases. Clinical outcome at the follow- up period less than 4 years (45 cases) and more than 5 years (18 cases) showed normal urinalysis in 17 (38%) and 10 (56%), persistent isolated hematuria in 14 (31%) and 1 (5%), hematuria with mild proteinuria in 14 (31%) and 7 (39%), respectively. No patients persist heavy proteinuria more than 3 years. Clinical outcome according to histopathologic grading showed that normalization of urinalysis was significantly lower in grade III when compared to grade II (p<0.05). Disappearance of proteinuria takes significantly longer in children with crescent formation (p<0.05). CONCLUSION: The majority of children with mild HS nephritis had good prognosis. The severity of histopathologic grade was well correlated with improvement of urinalysis. Our study suggests that renal biopsy provides a valuable prediction of prognosis even in mild HS nephritis without renal functional impairment.
Biopsy ; Child* ; Female ; Gyeongsangbuk-do ; Hematuria ; Humans ; Kidney Diseases ; Nephritis* ; Nephrotic Syndrome ; Prognosis ; Proteinuria ; Retrospective Studies ; Urinalysis

PURPOSE: This retrospective study has been undertaken to find out the clinical outcome of children with HS nephritis and its relationship with initial clinical presentation and/or renal pathologic finding. PATIENTS AND METHODS: Study population consisted of 59 children with HS nephritis who have been admitted to the Pediatric department of KyungPook University Hospital from 1987 to 1999, and biopsy was done with indications of heavy proteinuria ( > 1 g/m2/day ) lasting over 1 month, nephrotic syndrome, and persistent hematuria and/or proteinuria over 1 year. Patients were divided clinically into 3 groups ; isolated hematuria, hematuria with proteinuria and heavy proteinuria (including nephrotic syndrome). Biopsy findings were graded from I-V according to International Study of Kidney Disease in Children (ISKDC). RESULTS: Mean age of presentation was 8.1+/-3.0 years and slight male proponderance was noted ( 33 boys and 26 girls ). Histopathologic grading showed Grade I ; 2, Grade II ; 44, and Grade III ; 13 cases. Clinical outcome at the follow-up period of 1-2 years (49 cases) and 3-4 years (30 cases) showed normal urinalysis in 15 ( 30.6% ) and 18 cases ( 60.0%), persistent isolated hematuria in 20 ( 40.8% ) and 2 cases ( 6.7 % ), hematuria with proteinuria in 11 ( 22.5% ) and 8 cases ( 26.6% ), and persistent heavy proteinuria in 3 ( 6.1% ) and 2 cases ( 6.7% ) respectively. Clinical outcome according to histopathologic grading showed the frequency of normalization of urinalysis being lower in Grade III compared to grade I or II. Clinical outcome according to initial clinical presentation showed no relationship to the normalization of urinalysis at follow-up periods. However, 15-20% of children with initial heavy proteinuria showed persistent heavy proteinuria ( 3 out of 20 cases at 1-2 years, and 2 out of 10 case at 3-4 years of follow-up periods). CONCLUSION: The majority of children with HS nephritis (histopathologic grade I, II, III) improved within 3-4 years, and persistent heavy proteinuria was seen only in a few of children with initial clinical presentation of heavy proteinuria.
Biopsy ; Child* ; Female ; Follow-Up Studies ; Gyeongsangbuk-do ; Hematuria ; Humans ; Kidney Diseases ; Male ; Nephritis* ; Nephrotic Syndrome ; Proteinuria ; Retrospective Studies ; Urinalysis