Risk factors for abnormal CT findings in preschool children head injuries without neurological deficit

Objective@#This study aimed to apply abnormal computed tomography (CT) findings to help identify clinical and physical characteristics which suggest a traumatic brain injury, in preschool children with mild head injuries but without neurological deficit. @*Methods@#Among the 1,735 preschool children (aged ≤6 years) with head trauma who visited our hospital and underwent CT scans, 1,711 students without severe neurologic deficits were retrospectively assessed via images and electronic records. The relationship between the occurrence of abnormal CT findings and clinical symptoms, physical examination findings, and the conditions of children were assessed using Pearson’s chi-squared test and multivariable logistic regression analysis. @*Results@#Traumatic brain injury with abnormal CT findings were observed in 75 of the 1,711 patients, and the association with brain injury was more prominent among patients who had fallen from a height of ≥1 m, had posttraumatic irritability, or had posttraumatic scalp swelling. @*Conclusion@#Free fall from a height of ≥1 m, posttraumatic irritability, and posttraumatic scalp swelling should be carefully assessed in patients who have suffered a traumatic brain injury and show abnormal CT findings but no neurologic deficits. Regardless of their initial signs, an active test is recommended for children who complain of multiple symptoms. Patients with these risk factors require greater in-depth brain CT examination. Abnormal CT findings are more meaningful in the case of patients with multiple symptoms.

Comparison of antimicrobial resistances and clinical features in community-onset Escherichia coli and Klebsiella pneumoniae bacteremia

Background/Aims@#The aim of this study was to compare antimicrobial resistance, clinical features, and outcomes of community-onset Escherichia coli (COEC) and Klebsiella pneumoniae (COKP) bacteremia. @*Methods@#The medical records of patients diagnosed with E. coli or K. pneumoniae bacteremia in the emergency department of a 750-bed secondary care hospital in Daegu, Korea from January 2010 to December 2016 were retrospectively reviewed. @*Results@#A total of 866 patients with COEC bacteremia and 299 with COKP bacteremia were enrolled. COEC bacteremia, compared to COKP bacteremia, had higher rates of 3rd generation cephalosporin (3GC) (18.8% vs. 8.4%, p < 0.001) and f luoroquinolone (FQ) (30.4% vs. 8.0%, p < 0.001) resistance. The patients with COKP bacteremia had higher Charlson comorbidity indices (CCI) (1.8 ± 2.0 vs. 1.5 ± 1.8, p = 0.035), Pittsburgh bacteremia scores (PBS) (2.0 ± 2.6 vs. 1.3 ± 1.8, p < 0.001), and 30-day mortality (14.44% vs. 8.8%, p = 0.008) than the patients with COEC bacteremia. Age younger than 70 years, male sex, polymicrobial infections, pneumonia, intra-abdominal infection, PBS ≥ 2, and Foley catheter insertion were independent predictive factors for COKP bacteremia compared to COEC bacteremia in the multivariate analysis. CCI, PBS, and intensive care unit admission were independent risk factors for 30-day mortality in the multivariate analysis. @*Conclusions@#3GCs and FQs are still useful for the empirical treatment of patients with probable COKP bacteremia. The patients with COKP bacteremia had worse outcomes because of its greater severity and more frequent underlying comorbidities.

Risk factors for abnormal CT findings in preschool children head injuries without neurological deficit

Objective@#This study aimed to apply abnormal computed tomography (CT) findings to help identify clinical and physical characteristics which suggest a traumatic brain injury, in preschool children with mild head injuries but without neurological deficit. @*Methods@#Among the 1,735 preschool children (aged ≤6 years) with head trauma who visited our hospital and underwent CT scans, 1,711 students without severe neurologic deficits were retrospectively assessed via images and electronic records. The relationship between the occurrence of abnormal CT findings and clinical symptoms, physical examination findings, and the conditions of children were assessed using Pearson’s chi-squared test and multivariable logistic regression analysis. @*Results@#Traumatic brain injury with abnormal CT findings were observed in 75 of the 1,711 patients, and the association with brain injury was more prominent among patients who had fallen from a height of ≥1 m, had posttraumatic irritability, or had posttraumatic scalp swelling. @*Conclusion@#Free fall from a height of ≥1 m, posttraumatic irritability, and posttraumatic scalp swelling should be carefully assessed in patients who have suffered a traumatic brain injury and show abnormal CT findings but no neurologic deficits. Regardless of their initial signs, an active test is recommended for children who complain of multiple symptoms. Patients with these risk factors require greater in-depth brain CT examination. Abnormal CT findings are more meaningful in the case of patients with multiple symptoms.

Classify the Acute Drug Intoxication Patients with Poisoning Severity Score(PSS) and Calculate the Optimal Cutoff Value of PSS, PSSsum to Predict Poor Prognosis

PURPOSE: This study examined the Poisoning Severity Score (PSS) from acute poisoning patients, to determine the relationships among the PSS, PSSsum, the primary outcome (prolonged stay at the ER over 24 hours, general ward and ICU admission and the application of intubation and mechanical ventilator, and the administration of inotropes). METHODS: A retrospective study was conducted through the EMR for 15 months. The PSS grade was classified according to the evidence of symptoms and signs. The differences in the primary outcomes between the PSS of when a single organ was damaged, and the PSS, PSSsum combined with the grade of when multiple organs were damaged, were studied. The cutoff value was calculated using the receiving operating characteristics (ROC) curve. RESULTS: Of the 284 patients; 85 (29.9%) were men with a mean age of 48.8 years, and their average arrival time to the ER was 4.4±6.7 hours. The most frequently used drug was hypnotics. The number of patients with PSS grade 0, 1, 2, 3, and 4 was 17, 129, 122, 24, and one, respectively. No ICU admissions, application of intubation and mechanical ventilators, administration of inotropes were observed among the patients with PSS grades 0 and 1 but only on patients with PSS grades 2 to 4. At PSS, when separating the patients according to the number of damaged organs, 17 had no symptoms, 133 had one organ damaged, 75 had two organs damaged, 36 had three organs damaged, and 23 had four organs damaged. Significant differences were observed between increasing number of damaged organs and the primary outcome. CONCLUSION: Among the acute poisoning patients, the PSS was higher in severity when the grade was higher. The number of damaged organs and the primary outcome showed meaningful statistical differences. This study confirmed that when the patients' PSS>2 and PSSsum>5, the frequency of ICU admission was higher, and they were considered to be severe with an increased prescription risk of application of intubation and mechanical ventilator, and the administration of inotropes.

Epileptic Seizure Revealing a Fahr's Syndrome with Pseudohypoparathyroidism: A Case Report

Fahr's disease is a rare disease characterized by idiopathic abnormal deposits of calcium in intracranial areas. Fahr's syndrome occurs secondarily to other diseases. Endocrine disorders, particularly parathyroid hormone disorders, are most commonly associated with Fahr's syndrome. Common clinical features of Fahr's disease or syndrome include movement disorder, phychiatric disorder, epileptic seizure, dementia, headache, dystonia, myoclonus, tremor, and parkinsonism. We report on a case of a 35-year-old woman with Fahr's syndrome who presented with epileptic seizure and pseudohypoparathyroidism.

The Prognostic Factors For Alcoholic Ketoacidosis

PURPOSE: This study was undertaken to evaluate the prognostic factors for patients suffering with alcoholic ketoacidosis. METHODS: We retrospectively evaluated and categorized 55 alcoholic ketoacidosis patients into two groups: the survivors (group 1) and non-survivors (group 2). We compared the general characteristics and the laboratory results, including the arterial blood gas analysis (ABGA) and the complications of the two groups, and we assessed the severity of the between the two groups by using the Acute Physiology and Chronic Health Evaluation (APACHE) II score and the Simplified Acute Physiology Score (SAPS). RESULTS: There were 50 male patients (90%) and 5 female patients (10%). On laboratory testing, the levels of arterial HCO3-, total protein, albumin and serum glucose were significantly lower in group 2 than that in group 1. The levels of total bilirubin and BUN (blood urea nitrogen), the PT (prothrombin time) and the aPTT (activated partial thromboplastin time) were significantly higher in group 2 than that in group 1. Serial ABGA follow-up showed that unimproved ABGA results meant a poor prognosis. The SAPS was significantly higher for group 2 than that for group 1 (p<0.001) but the APACHE II was not significantly different. The incidence of hepatic encephalopathy, hepatic failure and acute respiratory distress syndrome (ARDS) were higher in group 2 than that in group 1. The total bilirubin, arterial HCO3- and albumin were found to be significant prognostic factors by logistic regression analysis. CONCLUSION: The poor prognostic factors for alcoholic ketoacidosis were low levels of arterial HCO3-, impaired hepatic function, the incidence of ARDS and unimproved ABGA results.

Consideration of Factors associated with Complications and Systemic Symptoms of Snake Bites

PURPOSE: Venomous snakebite is an important medical emergency in Korea, but the factors affecting outcomes are unclear. METHODS: We conducted an 8-year retrospective study of 169 snake bite patients who visited the emergency departments of Keimyung University at Dongsan Medical Center between January, 2000, and December, 2007. Patients were divided by systemic symptoms and complications (group 1) or local symptoms only (group 2). We compared the general characteristics and clinical and laboratory findings of the two groups. RESULTS: The male to female ratio was 1.19. The most common systemic symptom was dizziness (7.6%), and the most common complication was rhabdomyolysis (23.6%). Distal bite sites (finger, toe) in group 1 occurred in 20 (35.7%) cases, and proximal (hand, foot, ankle, arm, calf, perianal area) in 36 (64.3%) cases (p<0.05). The median interval from envenomation to hospital visit was 6.0 (0.3-96.0) h in group 1, which was longer than group 2 (p<0.05). Among 33 (19.5%) patients with local effect scores of 9~16, 25 (75.8%) patients had systemic symptoms and complications. The local effect scores and the interval from bite to antivenin treatment in the hospital were significant risk factors for systemic symptoms and complications in logistic regression analysis. CONCLUSION: Snakebite poisoning is an emergency and we must evaluate risk factors to prevent the development of serious complications.

Early Experience of Laparoscope Assisted Radical Retropubic Prostatectomy / 대한비뇨기과학회지

PURPOSE: A laparoscopic radical prostatectomy (LRP) is a less invasive alternative to a conventional radical prostatectomy. However, the learning curve for a LRP is steep; therefore, becoming skilled at the procedure is difficult. Herein, our experience of laparoscope assisted radical retropubic prostatectomy (LARRP) is reported. MATERIALS AND MATHODS: LARRP was performed on 16 patients with clinically organ confined prostate cancer. The mean age and serum prostate- specific antigen (PSA) of the patients were 63+/-5.7 years (51-70) and 20.01+/-24.8ng/ml (3.45-97.50), respectively. A longitudinal skin incision was made from the symphysis pubis to midway of the umbilicus. The incision was retracted with a self-retractor, without port placement and gas insufflation. The laparoscope was directly inserted into the wound, with modified bilateral pelvic lymph node dissection, prostatectomy and vesicourethral anastomosis performed under laparoscopic monitoring, using both open and laparoscopic instruments in the same order as for open surgery. RESULTS: The mean operative time was 282+/-45.7 minutes (200-375), including the time required for the modified bilateral pelvic lymphadenectomy. The mean estimated blood loss and specimen weight were 2,500+/-1,247ml (500-5,000) and 53+/-19.0gm (20-98), respectively. The surgical margins and lymph nodes were positive in 3 (19%) and 2 patients (13%), respectively. The mean number of dissected lymph node and incision length were 12+/-7.5 (4-31) and 11+/-3.2cm (6-15), respectively. Gradual recovery of continence occurred in 13 (93%) for 1 years after the operation. CONCLUSIONS: LARRP is a feasible and less invasive alternative to conventional RRP, which is also devoid of the steep learning curve associated with a LRP. LARRP may be a bridge between an open RRP and a pure LRP. With the increase in the number of cases, LARRP may prove to be an effective treatment option for localized prostate cancer.