Performance of the combined models of Pediatric Risk of Admission scores I and II, and C-reactive protein for prediction of hospitalization in febrile children who visited the emergency department

PURPOSE: To study the performance of the combined models of Pediatric Risk of Admission (PRISA) scores I and II and Creactive protein (CRP) for prediction of hospitalization in febrile children who visited the emergency department.METHODS: We reviewed febrile children aged 4 months-17 years who visited a tertiary hospital emergency department between January and December 2017. White blood cell count, CRP concentration, the PRISA scores, and systemic inflammatory response syndrome score were calculated. We compared areas under the curves (AUCs) of the admission decision support tools for hospitalization using receiver operating characteristic curve analysis.RESULTS: Of 1,032 enrolled children, 423 (41.0%) were hospitalized. CRP and the PRISA scores were significantly higher in the hospitalization group than in the discharge group (all P < 0.001). Among the individual tools, CRP showed the highest AUC (0.69; 95% confidence interval [CI], 0.66–0.72). AUC was 0.71 (95% CI, 0.69–0.74) for the combined model of the PRISA I score and CRP, and 0.71 (95% CI, 0.68–0.74) for that of the PRISA II score and CRP. The AUC of PRISA score I and CRP combined was significantly higher than that of isolated CRP (P = 0.048).CONCLUSION: The combined model of the PRISA I score and CRP may be useful in predicting hospitalization of febrile children in emergency departments.

Alterations of papilla dimensions after orthodontic closure of the maxillary midline diastema: a retrospective longitudinal study

PURPOSE: The aim of this study was to evaluate alterations of papilla dimensions after orthodontic closure of the diastema between maxillary central incisors. METHODS: Sixty patients who had a visible diastema between maxillary central incisors that had been closed by orthodontic approximation were selected for this study. Various papilla dimensions were assessed on clinical photographs and study models before the orthodontic treatment and at the follow-up examination after closure of the diastema. Influences of the variables assessed before orthodontic treatment on the alterations of papilla height (PH) and papilla base thickness (PBT) were evaluated by univariate regression analysis. To analyze potential influences of the 3-dimensional papilla dimensions before orthodontic treatment on the alterations of PH and PBT, a multiple regression model was formulated including the 3-dimensional papilla dimensions as predictor variables. RESULTS: On average, PH decreased by 0.80 mm and PBT increased after orthodontic closure of the diastema (P<0.01). Univariate regression analysis revealed that the PH (P=0.002) and PBT (P=0.047) before orthodontic treatment influenced the alteration of PH. With respect to the alteration of PBT, the diastema width (P=0.045) and PBT (P=0.000) were found to be influential factors. PBT before the orthodontic treatment significantly influenced the alteration of PBT in the multiple regression model. CONCLUSIONS: PH decreased but PBT increased after orthodontic closure of the diastema. The papilla dimensions before orthodontic treatment influenced the alterations of PH and PBT after closure of the diastema. The PBT increased more when the diastema width before the orthodontic treatment was larger.

Usefulness of Ultrasonography to Predict Response to Injection Therapy in Carpal Tunnel Syndrome

OBJECTIVE: To verify the feasibility of initial parameters of ultrasonography or electromyography for the prediction of effect after steroid injection therapy in a carpal tunnel syndrome (CTS) patient. METHOD: We recruited individuals with clinical and electrodiagnostic evidence of CTS. Results from the Boston self-assessment questionnaire, median motor and sensory nerve conduction studies, and median nerve ultrasonography were evaluated at baseline, 1 month, and 6 months after injection. Evaluation of median nerve ultrasonography parameters included measurements taken at the maximal swelling point (MS), 2 cm proximal from MS (2MS), and 12 cm proximal from MS (12MS), and its ratio (MS/12MS, 2MS/12MS) was calculated. The correlation between improvement of the symptom score after treatment and baseline parameters was estimated. RESULTS: Fourteen individuals (14 women, mean age 53.8 years) with 22 affected wrists were enrolled. After steroid injection therapy, clinical and electromyographic parameters showed significant improvements at 1 month or 6 months after injection, and ultrasonographic parameters showed significant changes in maximal area and area ratio (MS/12MS) of the median nerve. Symptom score improvement showed a positive correlation in the initial 2MS and ratio of 2MS/12MS after 6 months (p<0.05). CONCLUSION: Most of the improvements occurred during the first month after injection and lasted up to 6 months. The initial median nerve swelling and its ratio may be a useful predictor of response after steroid injection.

Feasibility of Ultrasonographic Area Ratio of Median Nerve in the Diagnosis of Carpal Tunnel Syndrome in Korea

OBJECTIVE: To examine the usefulness of ratio of maximal swelling to normal cross sectional area (CSA) of median nerve with ultrasound in patients with carpal tunnel syndrome (CTS) and healthy controls. METHOD: Patients with electrodiagnostically proven CTS underwent ultrasonography of the median nerve. The median nerve area was measured at three points (maximal swelling site, 2 cm proximal to maximal swelling site, 12 cm proximal to maximal swelling site) and compared to values from asymptomatic volunteers. RESULTS: The ratio of maximal swelling site to 12 cm proximal was 1.34+/-0.14 in asymptomatic volunteers and 2.31+/-0.43 in patients presenting with CTS. The ratio of maximal swelling site to 12 cm proximal gave 73.7% sensitivity and 90.0% specificity. While using only median nerve area at the wrist resulted in 81.6% sensitivity and 70.0% specificity, depending on the cutoff value used. CONCLUSION: The ratio of maximal swelling site to proximal in patients with CTS is elevated as compared to asymptomatic controls. The ratio of maximal swelling site to 12 cm proximal has higher specificity to diagnose CTS, and may be superior to measuring median nerve area at the wrist alone.

The Clinical Comparison between Open Surgery and Percutaneous Endoscopic Lumbar Discectomy in Extraforaminal Lumbar Disc Herniation

OBJECTIVE: The objective of this study is to evaluate and compare the clinical results between classical open surgery and percutaneous endoscopic lumbar discectomy(PELD) in cases of extraforaminal lumbar disc herniation. METHODS: We obtained the clinical data from 47 patients with extraforaminal lumbar disc herniations who underwent the open paramedian muscle-splitting approach or percutaneous endoscopic lumbar discectomy(PELD) between January 2001 and February 2004. This study consisted of patients with soft disc extraforaminal herniations. The patients were assessed with the visual analogue scale(VAS) and MacNab's criteria before surgery, just before discharge, and postoperative 1 year. RESULTS: There were 25 cases in the open surgery group and 22 cases in the PELD group. The average operating time was 78+/-36.71 min in the PELD group and 110+/-29.68 min in the open surgery group. The mean hospital stay was 2.73+/-2.62 days in the PELD group and 7.68+/-2.59 days in the open surgery group. VAS decreased from 8.34+/-0.66 to 1.29+/-2.27 in the PELD group and from 8.40+/-1.40 to 1.70+/-1.72 in the open surgery group at the one-year follow-up. The success rate of PELD was 86.4%, compared with 80.0% for open surgery. However, there were no statistically significant difference between two groups for success rate and VAS. CONCLUSION: Although the success rates were similar in both groups, PELD is less invasive, faster, and safe procedure than open surgery for extraforaminal disc herniation in selected patients.

The Treatment of Acute External Laryngotracheal Injuries / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Acute laryngotracheal injury is uncommon but can be a life-threatening event and often poses as a difficult airway management problem. Therefore, the immediate recognition and appropriate initial assessment and treatment are vital for a successful outcome. We performed this study to evaluate an appropriate management of acute laryngotracheal injury patients. MATERIALS AND METHOD: Twenty-two patients with acute external laryngotracheal injury who underwent conservative treatment or surgery from 1998 to 2003 were evaluated. The record of patients were reviewed retrospectively. These patients have been studied with attention to clinical symptoms, sign, injury mechanism, injury site, degree of injury, treatment and outcome after the treatment. RESULTS: Sixteen cases were categorized as blunt trauma and the other six cases as penetrating trauma. The main symptoms and signs were dyspnea and hoarseness. Common sites of injury were laryngeal mucosa, thyroid cartilage and trachea. The patients in group I, II were treated conservatively mainly and those in group III, IV, V were mainly treated surgically. All patients were decannulated. Sixteen patients made a full return to normal voice, and six were assessed fair. CONCLUSION: The immediate recognition of acute external laryngotracheal injury and early proper treatment are vital for life and successful outcome.

Three Cases of Intracranial Hematoma Associated with Meningioma

Spontaneous intracranial hematoma in patients with brain tumors is well recognized, However, intracranial hematoma associated with meningioma has been rarely reported. Not infrequently, clinical manifestations of such tumors have been masked by the associated hematoma, which preclude correct diagnosis of these tumors. Meningioma-associated hemorrhages have been reported regardless of sex, age, or location and histology of the tumor. The mechanisms of such hemorrhage are yet to be clarified. During the last two years, we have experienced three cases of intracranial hemorrhage associated with meningioma. Two of them occurred acutely without antecedent symptoms of the meningioma and other one after gamma knife surgery of meningioma. We reviewed partinent literature and discussed possible mechanisms of these rare intratumoral or peritumoral hemorrhages associated with meningiomas.

A Case of Successful Pregnancy in Patient with Recurrent Spontaneous Abortion by Preimplantation Genetic Diagnosis Following IVF-ET / 대한불임학회지

It was reported that the etiologies of recurrent spontaneous abortion are immunologic factors, endocrinologic problems, anatomical abnormalities, genetic abnormalities, infection, and unexplained factors. Among those etiologic factors, genetic abnormalities occur in about 5% of the couples who experience recurrent spontaneous abortions, and most common parental chromosomal abnormality contributing to recurrent abortion is balanced translocation. The advent of in vitro fertilization (IVF), the development of skills associated with the handling of human embryo, and an explosion of knowledge in molecular biology have opened the possibility of early diagnosis of genetic disease in preimplantation embryos. Therefore preimplantation genetic diagnosis (PGD) is indicated for couples, infertile or not, at risk of transmitting a genetic disease. A case of successful pregnancy and term delivery by PGD using fluorescence in situ hybridization (FISH) technique in patient with recurrent spontaneous abortion due to balanced translocation is presented with brief review of literatures.