Guillain-Barre syndrome (GBS) is usually characterized by acute areflexic ascending paralysis with minimal sensory involvement. Only a few cases of GBS associated with scrub typhus have been reported. Previous case reports focused on the laboratory findings, pathogenesis, and clinical manifestation. Unlike the previous case, neuropathic pain was a prominent symptom of GBS in our case. We report scrub-typhus-related GBS with a detailed description of the clinical manifestations, especially neuropathic pain, along with results of serial follow-up electrodiagnostic studies.
Follow-Up Studies ; Guillain-Barre Syndrome ; Neuralgia ; Paralysis ; Scrub Typhus

OBJECTIVE: To compare the accuracy of ultrasound (US)-guided and non-US-guided botulinum toxin (BTX) injection into the salivary glands (parotid and submandibular glands) of cadavers. METHODS: Two rehabilitation physician injected dye into three sites in the salivary glands (two sites in the parotid gland and one site in the submandibular gland) on one side of each cadaver (one was injected on the right side, while the other was injected on the left side), using either a non-US-guided injection procedure based on superficial landmarks or a US-guided procedure. Orange dye was used for the US-guided procedure, and green dye was used for the blind procedure. Two physicians uninvolved with the injection procedures and who were blinded to the method of injection dissected the cadavers to identify whether the dye was accurately injected into each target site. RESULTS: The accuracies of the blind and US-guided injections into the parotid gland were 79.17% and 95.83%, respectively. In the submandibular gland, the accuracies of the blind and US-guided injections were 50.00% and 91.67%, respectively. The difference in accuracy between the two procedures was statistically significant only in the submandibular gland (p=0.025). There were no significant differences in the accuracy of US-guided and non-US-guided injections between the two physicians for the two sites in the parotid gland (p=0.278 and p=0.146, respectively). CONCLUSION: US-guided BTX injection into the submandibular gland offers significantly greater accuracy over blind injection. For the treatment of drooling by injecting BTX into the submandibular gland, clinicians should consider using US guidance for improved accuracy.
Botulinum Toxins* ; Cadaver* ; Citrus sinensis ; Methods ; Parotid Gland ; Rehabilitation ; Salivary Glands* ; Sialorrhea ; Submandibular Gland ; Ultrasonography

This study was conducted to provide normal reference features for canine and feline anal sacs using ultrasound, low-field magnetic resonance imaging (MRI) and radiograph contrast as diagnostic imaging tools. A total of ten clinically normal beagle dogs and eight clinically normally cats were included. General radiography with contrast, ultrasonography and low-field MRI scans were performed. The visualization of anal sacs, which are located at distinct sites in dogs and cats, is possible with a contrast study on radiography. Most surfaces of the anal sacs tissue, occasionally appearing as a hyperechoic thin line, were surrounded by the hypoechoic external sphincter muscle on ultrasonography. The normal anal sac contents of dogs and cats had variable echogenicity. Signals of anal sac contents on low-field MRI varied in cats and dogs, and contrast medium using T1-weighted images enhanced the anal sac walls more obviously than that on ultrasonography. In conclusion, this study provides the normal features of anal sacs from dogs and cats on diagnostic imaging. Further studies including anal sac evaluation are expected to investigate disease conditions.
Anal Sacs* ; Animals ; Cats* ; Diagnostic Imaging* ; Dogs* ; Magnetic Resonance Imaging ; Radiography ; Ultrasonography

Twenty-six-year-old Ebstein's anomaly patient, who had failed both biventricular and one-and-a-half repair, underwent right ventricle exclusion and Fontan operation. She completed pregnancy and delivery owing to the excellent long-term clinical course. Although the caesarean section was performed due to symptoms of heart failure on the gestational age of 32+6 weeks, preterm delivery was agreeable with neonatology support. In Korea, there has not yet been a case of pregnancy and delivery of functional single ventricle patient because most patients have been discouraged from getting pregnant. However, functional single ventricle patient can endure pregnancy and delivery, if valve function and ventricular contractility, status of Fontan pathway and absence of arrhythmia predict favorable outcome as presented in this case. Although the patient maintained her pregnancy without anticoagulation owing to laminar flow in the Fontan pathway and absence of thromboembolic event, anticoagulation should be considered, weighing the benefits and risks during the pregnancy.
Arrhythmias, Cardiac ; Cesarean Section ; Delivery, Obstetric ; Ebstein Anomaly ; Female ; Fontan Procedure* ; Gestational Age ; Heart Failure ; Heart Ventricles* ; Humans ; Korea ; Neonatology ; Pregnancy* ; Risk Assessment

Twenty-six-year-old Ebstein's anomaly patient, who had failed both biventricular and one-and-a-half repair, underwent right ventricle exclusion and Fontan operation. She completed pregnancy and delivery owing to the excellent long-term clinical course. Although the caesarean section was performed due to symptoms of heart failure on the gestational age of 32+6 weeks, preterm delivery was agreeable with neonatology support. In Korea, there has not yet been a case of pregnancy and delivery of functional single ventricle patient because most patients have been discouraged from getting pregnant. However, functional single ventricle patient can endure pregnancy and delivery, if valve function and ventricular contractility, status of Fontan pathway and absence of arrhythmia predict favorable outcome as presented in this case. Although the patient maintained her pregnancy without anticoagulation owing to laminar flow in the Fontan pathway and absence of thromboembolic event, anticoagulation should be considered, weighing the benefits and risks during the pregnancy.
Arrhythmias, Cardiac ; Cesarean Section ; Delivery, Obstetric ; Ebstein Anomaly ; Female ; Fontan Procedure* ; Gestational Age ; Heart Failure ; Heart Ventricles* ; Humans ; Korea ; Neonatology ; Pregnancy* ; Risk Assessment

OBJECTIVES: Recent advances in mobile technology have opened up possibilities to provide strongly integrated mobile-based services in healthcare and telemedicine. Although the number of mobile Electronic Health Record (EHR) applications is large and growing, there is a paucity of evidence demonstrating the usage patterns of these mobile applications by healthcare providers. This study aimed to illustrate the deployment process for an integrated mobile EHR application and to analyze usage patterns after provision of the mobile EHR service. METHODS: We developed an integrated mobile application that aimed to enhance the mobility of healthcare providers by improving access to patient- and hospital-related information during their daily medical activities. The study included mobile EHR users who accessed patient healthcare records between May 2013 and May 2014. We performed a data analysis using a web server log file analyzer from the integrated EHR system. Cluster analysis was applied to longitudinal user data based on their application usage pattern. RESULTS: The mobile EHR service named M-UMIS has been in service since May 2013. Every healthcare provider in the hospital could access the mobile EHR service and view the medical charts of their patients. The frequency of using services and network packet transmission on the M-UMIS increased gradually during the study period. The most frequently accessed service in the menu was the patient list. CONCLUSIONS: A better understanding regarding the adoption of mobile EHR applications by healthcare providers in patient-centered care provides useful information to guide the design and implementation of future applications.
Delivery of Health Care ; Electronic Health Records* ; Health Personnel ; Humans ; Korea* ; Medical Informatics Applications ; Mobile Applications ; Patient-Centered Care ; Statistics as Topic ; Telemedicine ; Tertiary Care Centers* ; Wireless Technology

OBJECTIVES: The recent evolution of mobile devices has opened new possibilities of providing strongly integrated mobile services in healthcare. The objective of this paper is to describe the decision driver, development, and implementation of an integrated mobile Electronic Health Record (EHR) application at Ulsan University Hospital. This application helps healthcare providers view patients' medical records and information without a stationary computer workstation. METHODS: We developed an integrated mobile application prototype that aimed to improve the mobility and usability of healthcare providers during their daily medical activities. The Android and iOS platform was used to create the mobile EHR application. The first working version was completed in 5 months and required 1,080 development hours. RESULTS: The mobile EHR application provides patient vital signs, patient data, text communication, and integrated EHR. The application allows our healthcare providers to know the status of patients within and outside the hospital environment. The application provides a consistent user environment on several compatible Android and iOS devices. A group of 10 beta testers has consistently used and maintained our copy of the application, suggesting user acceptance. CONCLUSIONS: We are developing the integrated mobile EHR application with the goals of implementing an environment that is user-friendly, implementing a patient-centered system, and increasing the hospital's competitiveness.
Delivery of Health Care ; Electronic Health Records* ; Health Personnel ; Hospitals, General* ; Humans ; Korea* ; Medical Informatics Applications ; Medical Records ; Mobile Applications ; Telemedicine ; Vital Signs ; Wireless Technology

Medication errors such as administration of wrong drugs, wrong dosage and erroneous route of administration are not rare among medical misadventures. We present an autopsy case of accidental injection of tranexamic acid instead of bupivacaine during spinal anesthesia, accompanying the quantitative result of the tranexamic acid in the blood, cerebrospinal fluid and each internal organs. We think that warning signs on syringes and ampoules, simple and unified guideline for drug administration, separative documentation of drug administration and interpersonal communication on drug information should be done to prevent this type of medical errors.
Anesthesia, Spinal ; Autopsy ; Bupivacaine ; Medical Errors ; Medication Errors ; Syringes ; Tranexamic Acid

PURPOSE: Posterior tibialis tendon dysfunction (PTTD) is one of the most common causes of acquired flatfoot deformity in western countries. But it was known that they were very rare in eastern countries. So we want to report the clinical features and outcomes of 12 patients with PTTD. MATERIALS AND METHODS: We evaluated the results of 12 patients using clinical features and results from March 2000 to January 2007 and mean follow up periods is 32 months. RESULTS: Average age was 45 years, 8 of 12 patients were female, 2 patient with hypertension and 1 with rheumatoid arthritis. 5 patients were overweighted and 5 patients were obese. 4 patients has a history of last trauma. 4 patients experienced progression of flatfoot. On behalf of Johnson and Strom classifications 6 cases were grade I, 4 cases were grade II, grade III, and grade IV was 1 case, relatively. As a treatment we used tenosynovectomy for 3 cases of grade I, additional FDL transfer was done for 2 cases of grade I and 2 cases of grade II. For other 2 patients of grade II flexor digitorum longus transfer and Medial displacement calcaneal osteotomy was done. Pathologic findings of tendon showed degenerative tendinitis. Lastly conservative treatment group was 3 cases of grade I, III, IV each. Average preoperative and postoperative American Orthopedic Foot and Ankle Society's hindfoot/ankle scoreFAS score was 58 and 90. Initial and follow up AOFAS scores of the conservative group was 38 and 57, relatively. CONCLUSION: As a cause of acquired flatfoot in adult, PTTD is not a rare disease any more in Korea. To prevent the disability and progression of flatfoot, careful clinical evaluation and proper treatment is important.
Adult ; Animals ; Ankle ; Arthritis, Rheumatoid ; Congenital Abnormalities ; Displacement (Psychology) ; Female ; Flatfoot ; Follow-Up Studies ; Foot ; Humans ; Hypertension ; Korea ; Orthopedics ; Osteotomy ; Overweight ; Rare Diseases ; Tendinopathy ; Tendons

BACKGROUND: Circulating levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) have been used to identify and monitor myocardial dysfunction in patients with various cardiac diseases. However, its clinical significance in patients with chronic renal failure (CRF) is uncertain because NT-proBNP clearance may be affected by renal function. METHODS: We studied 331 patients with CRF (eGFR <60 mL/min/1.73m2) admitted to Samsung Medical Center between March 2003 and March 2005, in whom both NT-proBNP measurement and echocardiography were performed within a week. RESULTS: Mean value of eGFR was 29+/-15 mL/ min/1.73m2 and median value of NT-proBNP was 6,971 pg/mL. NT-proBNP levels increased with declining eGFR (p<0.05). NT-proBNP levels were also elevated in patients with left ventricular hypertrophy (LVH), systolic dysfunction and diastolic dysfunction. In multiple regression analysis, ejection fraction (beta=-0.373, p>0.01) was strong independent correlate of NT-proBNP, eGFR (beta=-0.358, p<0.01), left ventricular mass index (beta=0.126, p>0.01) and diastolic dysfunction 2 or higher (beta=0.171, p< 0.05) were also independent correlates of NT-proBNP. Receiver-operating characteristic (ROC) analyses demonstrated NT-proBNP to be 75% sensitive and 76% specific for the detection of left ventricular systolic dysfunction, as indicated by area under the ROC curve of 0.78 (p<0.05), with NT-proBNP cutoff concentration of 25,000 pg/mL. CONCLUSION: Circulating NT-proBNP levels increased with declining renal function. However, its level were significantly correlated with LVH, systolic and diastolic dysfunction in patients with CRF. The measurement of NT-proBNP levels might be useful to predict left ventricular dysfunction in patients with CRF.
Echocardiography ; Heart Diseases ; Humans ; Hypertrophy, Left Ventricular ; Kidney Failure, Chronic* ; Plasma* ; ROC Curve ; Ventricular Dysfunction, Left ; Ventricular Function, Left*