Background: The clinical features of pediatric rhabdomyolysis differ from those of the adults with rhabdomyolysis; however, multicenter studies are lacking. This study aimed to investigate the characteristics of pediatric rhabdomyolysis and reveal the risk factors for acute kidney injury (AKI) in such cases. Methods: This retrospective study analyzed the medical records of children and adolescents diagnosed with rhabdomyolysis at 23 hospitals in South Korea between January 2007 and December 2016. Results: Among 880 patients, those aged 3 to 5 years old composed the largest subgroup (19.4%), and all age subgroups were predominantly male. The incidence of AKI was 11.3%. Neurological disorders (53%) and infection (44%) were the most common underlying disorder and cause of rhabdomyolysis, respectively. The median age at diagnosis in the AKI subgroup was older than that in the non-AKI subgroup (12.2 years vs. 8.0 years). There were no significant differences in body mass index, myalgia, dark-colored urine, or the number of causal factors between the two AKI-status subgroups. The multivariate logistic regression model indicated that the following factors were independently associated with AKI: multiorgan failure, presence of an underlying disorder, strong positive urine occult blood, increased aspartate aminotransferase and uric acid levels, and reduced calcium levels. Conclusions Our study revealed characteristic clinical and laboratory features of rhabdomyolysis in a Korean pediatric population and highlighted the risk factors for AKI in these cases. Our findings will contribute to a greater understanding of pediatric rhabdomyolysis and may enable early intervention against rhabdomyolysis-induced AKI.

PURPOSE: The purpose of this study is to examine the prevalence of malnutrition in hospitalized patients aged 18 years old or older at the time of admission in Korea. METHODS: This multi-center, preliminary survey included patients over 18 years old who were admitted on a given day from six hospitals in Korea. Nutritional status was assessed using Subjective Global Assessment tool. Data collected included hospital characteristics, patient characteristics, nutrition screening, and nutrition assessment. RESULTS: Among the 99 patients recruited (47 males, 47.5%), 18 (18.2%) and 2 (2.0%) patients were moderately malnourished and severely malnourished, respectively. The mean age of the malnourished group was older than that of the well-nourished group (49.7+/-17.1 vs. 60.5+/-13.6 years old, P-value=0.010). Patients admitted for medical treatment were more malnourished than those admitted for surgical treatment. CONCLUSION: Results of the multi-center preliminary survey showed 20.2% prevalence of malnutrition on admission. A national survey was piloted and will be followed by full implementation.
Humans ; Inpatients ; Korea ; Male ; Malnutrition ; Mass Screening ; Nutrition Assessment ; Nutritional Status* ; Prevalence

PURPOSE: Current studies have demonstrated the neuroprotective effects of 6-cyano-7-nitroquinoxalin-2,3-dione (CNQX) in many animal models of brain injury, including hypoxic-ischemic (HI) encephlopathy, trauma and excitotoxicity, but limited data are available for those during the neonatal periods. Here we investigated whether CNQX can protect the developing rat brain from HI injury via mediation of nitric oxide synthase. METHODS: In an in vivo model, left carotid artery ligation was done in 7-day-old Sprague-Dawley (SD) rat pups. The animals were divided into six groups; normoxia (N), hypoxia (H), hypoxia with sham-operation (HS), hypoxia with operation (HO), HO treated with vehicle (HV), and HO treated with CNQX at a dose of 10 mg/kg (HC). Hypoxia was made by exposure to a 2 hr period in the hypoxic chamber (92% N2, 8% O2). In an in vitro model, embryonic cortical neuronal cell culture of SD rats at 18-day gestation was done. The cultured cells were divided into three groups: normoxia (N), hypoxia (H), and hypoxia treated with CNQX (HC). The N group was prepared in 5% CO2 incubators and the other groups were placed in 1% O2 incubators (94% N2, 5% CO2) for 16 hr. RESULTS: In the in vitvo and in vivo models, the expressions of iNOS and eNOS were reduced in the hypoxia group when compared to the normoxia group, whereas they were increased in the CNQX-treated group compared to the hypoxia group. In contrast, the expression of nNOS was showed reversely. CONCLUSION: CNQX has neuroprotective property over perinatal HI brain injury via mediation of nitric oxide synthase.
6-Cyano-7-nitroquinoxaline-2,3-dione ; Animals ; Anoxia ; Brain ; Brain Injuries ; Brain Ischemia ; Carotid Arteries ; Cell Culture Techniques ; Cells, Cultured ; Incubators ; Ligation ; Models, Animal ; Negotiating ; Neurons ; Neuroprotective Agents ; Nitric Oxide ; Nitric Oxide Synthase ; Pregnancy ; Rats

Although single-shot caudal blockade is known as a relatively safe procedure, it is not always without complications. We present a case of accidental bladder puncture that was identified with fluoroscopy by chance after single-shot caudal blockade in a 17-months-old, 12 kg boy who underwent inguinal hernioplasty.
Child ; Fluoroscopy ; Herniorrhaphy ; Humans ; Punctures ; Urinary Bladder

Achalasia is a primary esophageal motor disorder, which is a rare disease with an estimated prevalence of 0.5-1 per 100,000 general population. The typical symptoms are vomiting, dysphagia and weight loss, but the respiratory symptoms are often presented in the 20-30% of the patients. The respiratory symptoms are known to be caused by the regurgitation or aspiration of the undigested food. Choking, recurrent pneumonia nocturnal cough are common and bronchiectasis, lung abscess and atelectasis also have been reported. The treatment of achalasia aimed at improving esophageal peristalsis by reducing pressure at the lower esophageal sphincter. We experienced a case of esophageal achalasia coincidentally found in a 10-year-old girl who was admitted with the exacerbation of asthma. She had pneumatic dilatation and her asthma symptoms including nocturnal cough much improved.
Airway Obstruction ; Asthma ; Bronchiectasis ; Child ; Cough ; Deglutition Disorders ; Dilatation ; Esophageal Achalasia ; Esophageal Sphincter, Lower ; Humans ; Lung Abscess ; Peristalsis ; Pneumonia ; Prevalence ; Pulmonary Atelectasis ; Rare Diseases ; Vomiting ; Weight Loss

BACKGROUND: Some studies reported that lowering central venous pressure (LCVP) during liver resection could significantly reduce the intra-operative blood loss, however it is still controversial concerning LCVP induced renal dysfunction, hypovolemia, hemodynamic instability. This study evaluated the association of low central venous pressure with blood loss during liver resection comparing the control group. METHODS: A total 62 patients aged 20 to 70 underwent hepatectomy by the same group of surgeon were randomized into group L (CVP < 10 mmHg, n = 30) and control group C (CVP > 10 mmHg, n = 32) during dissection and lobectomy period. Data such as age, sex, concurrent disease, liver resection site (right or left), pre-, intra- and postoperative day 3 hemoglobin, blood urea nitrogen, creatinine, bleeding time, prothrombin time, activated partitial thromboplastin time, intraoperative blood loss, urine output, transfusion volume, length of hospital stay were collected and compared between the two groups and t-test was used for comparison of results. RESULTS: The difference of total blood loss between two groups was 193.6 +/- 432.2 ml (group L; 589.1 +/- 380.8 ml, group C; 782.7 +/- 316.7 ml), however statistically insignificant (P value = 0.1243). Additionally, there were no significant differences in other data including the length of hospital stay. CONCLUSIONS: Our results suggest maintaining CVP under 10 mmHg is not effective in reducing blood loss during liver resection.
Bleeding Time ; Blood Urea Nitrogen ; Central Venous Pressure* ; Creatinine ; Hemodynamics ; Hepatectomy ; Humans ; Hypovolemia ; Length of Stay ; Liver ; Liver Diseases ; Prothrombin Time ; Thromboplastin

BACKGROUND: Although controlled ventilation can shorten the induction time during vital capacity inhalation induction (VCII) with sevoflurane, it may associated with decrease in blood pressure and hyperventilation-related hyperdynamic responses such as hypertension and tachycardia. This study was designed to compare the clinical effects between controlled ventilation (CV) within acceptable ranges of PETCO2 and spontaneous breathing (SB) during VCII. METHODS: 100 patients were randomly allocated to the one of two groups. After the loss of consciousness during VCII with sevoflurane, controlled ventilation was applied in CV group within acceptable ranges of PETCO2 and spontaneous breathing was maintained in SB group. Alfentanil 4 mcg/kg was given i.v. 2 minutes prior to intubation. PETCO2, mean arterial pressure (MAP), heart rate (HR), SPO2, and BIS were measured at 1, 2 and 3 minute after the loss of consciousness (LOC). Clinical side effects were evaluated. RESULTS: MAP and HR were significantly decreased and increased in CV group compare to the baseline values at 1 minute after LOC. There were statistical differences of MAP and HR between two groups at 1 and 2 minutes after LOC. 46 of 50 (92%) showed delayed expiration with holding their breath > 20 s in SB group. No differences of other clinical side effects except hypotension between two groups. CONCLUSIONS: We conclude that spontaneous breathing provides a stable hemodynamic status and relatively acceptable ventilation profile compare to controlled ventilation during VCII.
Alfentanil ; Arterial Pressure ; Blood Pressure ; Heart Rate ; Hemodynamics ; Humans ; Hypertension ; Hypotension ; Inhalation* ; Intubation ; Respiration* ; Tachycardia ; Unconsciousness ; Ventilation* ; Vital Capacity*

A healthy, 25-year old female patient with no medical history complained of excessive palmar, plantar, axillary, back, and thigh sweating due to stress or a high temperature. Her whole body hyperhidrosis was often disabling and embarrassing in daily life. Plantar hyperhidrosis interfered with her social activities, and accordingly, she was suggested to have a lumbar sympathetic ganglion block with alcohol. Right side ganglion block was performed without any problem at the 3rd and 4th lumbar vertebrae. After sympathetic block, right foot sweating stopped, but phantom sweating continued for a week, and an ache in the pelvic area and flushing of the right foot continued for more than 10 days. Thus a left side procedure was postponed, but all symptoms disappeared after 21 days and the chemical neurolytic block of left side was subsequently performed, and plantar hyperhidrosis was resolved. However, 2 days after completing the lumbar sympathetic block, excessive sweating occurred in the facial, axillary, and back regions with upper body flushing. Two months later, her whole body, excepting the lower extremity showed running sweat after a 10 minute walk on exertion. To reduce the sweating, aluminum chloride, and oral and topical glycopyrrolate were prescribed to no affects. She is currently waiting for the return of normal lumbar sympathetic ganglion function.
Adult ; Aluminum ; Female ; Flushing ; Foot ; Ganglia, Sympathetic* ; Ganglion Cysts ; Glycopyrrolate ; Humans ; Hyperhidrosis* ; Lower Extremity ; Lumbar Vertebrae ; Running ; Sweat ; Sweating ; Thigh

PURPOSE: Irritable bowel syndrome (IBS) is frequently yet little understood disease. Review was performed to promote understanding on the characteristics, pathophysiology, and risk factors of IBS. CONTENT: IBS is characterized by abdom in women and people with higher educational and social background, but there are some controversies. IBS is diagnosed by the Rome II or Manning criteria after excluding organic gastrointestinal diseases. The pathophysioloy is explained by abnormal control mechanism of central and enteric nervous system. Mucosal immunity, secretions, and neurotransmitter are also associated with the hypersensitivity and motility change of bowel function. Stress is known as a major triggering factor and contributed to symptoms. Other risk factors are genetic elements, childhood experiences, inflammation, anxiety, depression, diet, and sleep disorders.
Anxiety ; Depression ; Diet ; Enteric Nervous System ; Female ; Gastrointestinal Diseases ; Humans ; Hypersensitivity ; Immunity, Mucosal ; Inflammation ; Irritable Bowel Syndrome* ; Neurotransmitter Agents ; Risk Factors* ; Sleep Wake Disorders

Persistent hiccups are described as a recurring troublesome series of involuntary inspirations accompanied by glottic closure, lasting longer than a month. Recently, baclofen, the most effective treatment for intractable hiccups was found to be a useful drug for the management of chronic hiccups, and that substituting gabapentin for baclofen can be effective. Moreover, gabapentin was used successfully in combination with baclofen. We report here on three patients with persistent hiccups, where gabapentin was used successfully as an "add-on" with baclofen.
Baclofen* ; Hiccup* ; Humans