Four Cases of Subepidermal Calcified Nodule on the Sole / 대한피부과학회지

Subepidermal calcified nodule is an unusual type of idiopathic calcinosis cutis and usually presents as an asymptomatic, solitary, firm, verrucous, white or yellowish nodule. It commonly occurs in young children, generally on the face and neck, especially eyelid, cheek. However, sole is a very rare site. Four patients presented with several months??history of solitary 2~3 mm sized firm nodule on the sole. Three of the patients were less than 1 year old, with no history of trauma. Histopathologic examination revealed hyperkeratosis, acanthosis and amorphous basophilic material in cystic space beneath the epidermis, meaning deposition of calcium salt. These histopathologic features were consistent with subepidermal calcified nodule. Serum calcium and phosphorus levels of the patients were within normal limits. Herein, we present 4 cases of subepidermal calcified nodule on the sole, an atypical location.

Development of Prototype Quality Assurance Procedure for Blood Irradiator Using Glass Dosimeter Jig / 의학물리

For the purpose of quality assurance (QA) of the blood irradiator, QA programs for daily, monthly, and yearly were developed. For daily tests, simple items for basically operating the machine are recommended. For monthly and yearly tests, the measurement of dose to assure the dose delivery system are performed by a dosimetry devices (Glass dosimeter jig) developed in this study. The QA program is practical for clinical environment.

The Value of the Total Lymphocyte Count as a Risk Index of Hospital Infection in Critically Ill Patients / 대한마취과학회지

BACKGROUND: Lymphocytopenia is a common finding in critically ill patients while lymphocyte depletion in critically ill patients is presumed to have little clinical significance. However, a total lymphocyte count has been reported to provide prognostic information in surgical patients. The aim of this study was to evaluate the association of a total lymphocyte count (TLC) with a prognostic criterion in critically ill patients. METHODS: The patients were divided into three groups according to their TLC on admission to intensive care unit (ICU) (Group 1: TLC > 1.0 x 10(9)/L, Group 2: 0.7 x 10(9)/L < TLC < 1.0 x 10(9)/L, and Group 3: TLC <0.7 x 10(9)/L). Outcomes examined were patients' in-hospital mortality, length of hospital stay and incidence of infection. RESULTS: Patients with a TLC less than 0.7 x 10(9)/L (Group 3) had an infection twice (32% VS 15%) as often as those with a TLC more than 0.7 109/L (Group 1 2). But, in the hospital stay and mortality, there was no significant difference among the groups. CONCLUSIONS: TLC is very useful indicator in critically ill patients with a high risk of hospital infection on ICU admission.

Clinical Features and Risk Factors of Patients Readmitted to ICU / 대한마취과학회지

BACKGROUND: Premature discharge from the intensive care unit (ICU) results in ICU readmission and poor outcome. Understanding the clinical features of the readmitted patients may be helpful for intensivists to improve ICU care. We performed this study to determine the causes, outcomes, and risk factors of patients readmitted to the ICU. METHODS: Data was collected from the patients admitted to medical and surgical ICUs of Severance Hospital between January, 1999 and July, 2001 retrospectively. Readmission cause, source, indication, length of ICU stay, Acute Physiology and Chronic Health Evaluation (APACHE) III score, and multiple-organ failure (MOF) score of readmitted patients were evaluated. Non-survivors and survivors after ICU readmission were compared. RESULTS: One hundred and thirty-seven readmitted and 2,412 non-readmitted patients were examined and the readmission rate was 6.3%. Respiratory disease was the major cause of readmission. Readmitted patients had longer initial ICU lengths of stay than non-readmitted patients (13.6 vs 9.4 days, p<0.05). The ICU mortality rate was not significantly higher in the readmitted patients compared with the non-readmitted patients. The MOF score on readmission (5.4 vs 3.1) and APACHE III score on initial discharge (40.7 vs 30.4) and readmission (76.3 vs 44.4), in non-survivors were higher than survivors of the readmitted patients, respectively (p<0.05). CONCLUSIONS: ICU readmission was associated with longer ICU stay and respiratory disease was the major cause of readmission. The MOF score at readmission and APACHE III score at discharge and readmission were significant risk factors of the outcome in readmitted patients.

Midodrine for the Treatment of Hypotension in a Tetraplegic Patient with Cervical Cord Injury in ICU: A case report / 대한구급학회지

Cervical spinal cord injury results in significant dysfunction of the sympathetic nervous system. Reduced sympathetic activity below the level of spinal cord injury is associated with low resting blood pressure,orthostatic hypotension,and reflex bradycardia.Hypotension can be treated with vasoactive agents,such as dopamine,epinephrine,norepinephrine, and phenylephine .Orally administered midodrine is an alpha adrenergic receptor agonist that increases blood pressure with vasoconstriction.Its action is fast and effective in treating hypotension in patients with spinal cord injury,and it has less severe side effects.A 70-year-old tetraplegic patient with fracture and dislocation of C6-7 after a motor vehicle accident was admitted to ICU and underwent anterior cervical intervertebral body fusion.Symptomatic hypotension following postural changes was treated with intravenous infusion of dopamine,but it was difficult to reduce the dose of dopamine without causing severe hypotension.Midodrine was prescribed and the patient was well tolerated without any adverse effect.With adequately maintained blood pressure,intravenous infusion of dopamine was successfully switched to the oral midodrine.This case suggests that the midodrine is effective for the treatment of hypotension in tetraplegic patients with spinal cord injury and enables patients to participate in early rehabilitation therapies.