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Extended endotracheal intubation in infancy causes various complications. Upper airway disruption is very rare but reversible cause of respiratory insufficiency. Tracheostomy may not be avoidable in severe upper respiratory tract lesions especially in large subglottic cysts and severe subglottic stenosis; however, avoiding it is a priority when possible. A 7-month-old child who had a history of newborn respiratory distress syndrome and extended endotracheal intubation developed respiratory symptoms including stridor. A subglottic cyst was found by bronchoscopy and surginally removed with the tubeless anesthesia technique without tracheostomy. This method was successful even on infants. We report this case with a review of literature.
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Background@#Coronavirus disease 2019 (COVID-19) is a global public health crisis that has had a significant impact on emergency medical services (EMS). Several studies have reported an increase in the incidence of out-of-hospital cardiac arrest (OHCA) and a decreased survival due to COVID-19, which has been limited to a short period or has been reported in some regions. This study aimed to investigate the effect of COVID-19 on OHCA patients using a nationwide database. @*Methods@#We included adult OHCA patients treated by EMS providers from January 19, 2019 to January 20, 2021. The years before and after the first confirmed case in Korea were set as the non-COVID-19 and COVID-19 periods, respectively. The main exposure of interest was the COVID-19 period, and the primary outcome was prehospital return of spontaneous circulation (ROSC). Other OHCA variables were compared before and after the COVID-19 pandemic and analyzed. We performed a multivariable logistic regression analysis to understand the independent effect of the COVID-19 period on prehospital ROSC. @*Results@#The final analysis included 51,921 eligible patients, including 25,355 (48.8%) during the non-COVID-19 period and 26,566 (51.2%) during the COVID-19 period. Prehospital ROSC deteriorated during the COVID-19 period (10.2% vs. 11.1%, P = 0.001). In the main analysis, the adjusted odds ratios (AORs) for prehospital ROSC showed no significant differences between the COVID-19 and non-COVID-19 periods (AOR [95% confidence interval], 1.02 [0.96–1.09]). @*Conclusion@#This study found that the proportion of prehospital ROSC was lower during the COVID-19 period than during the non-COVID-19 period; however, there was no statistical significance when adjusting for potential confounders. Continuous efforts are needed to restore the broken chain of survival in the prehospital phase and increase the survival rate of OHCA patients.
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Background@#This study aimed to investigate the impact of the coronavirus disease 2019 (COVID-19) outbreak on the Emergency Medical Service (EMS) system in South Korea. The study focused on the differences in EMS time intervals following the COVID-19 outbreak, particularly for patients with fever. @*Methods@#A retrospective analysis of EMS patient transportation data from 2017 to 2022 was conducted using the national EMS database. @*Results@#Starting from the year 2020, coinciding with the COVID-19 outbreak, all EMS time intervals experienced an increase. For the years 2017 to 2022, the mean response time interval values were 8.6, 8.6, 8.6, 10.2, 12.8, and 11.4 minutes, and the mean scene time interval values were 7.1, 7.2, 7.4, 9.0, 9.8, and 10.9 minutes. The mean transport time interval (TTI) values were 12.1, 12.3, 12.4, 14.2, 16.9, and 16.2 minutes, and the mean turnaround time interval values were 27.6, 27.9, 28.7, 35.2, 42.0, and 43.1 minutes. Fever (≥ 37.5°C) patients experienced more pronounced prolongations in EMS time intervals compared to non-fever patients and had a higher probability of being non-transported. The mean differences in TTI between fever and non-fever patients were 0.8, 0.8, 0.8, 4.3, 4.8, and 3.2 minutes, respectively, from 2017 to 2022. Furthermore, the odds ratios for fever patients being transported to the emergency department were 2.7, 2.9, 2.8, 1.1, 0.8, and 0.7, respectively, from 2017 to 2022. @*Conclusion@#The study findings highlight the significant impact of the COVID-19 outbreak on the EMS system and emphasize the importance of ongoing monitoring to evaluate the burden on the EMS system.
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Background@#A precise anatomical understanding of the adductor canal (AC) and its neural components is essential for discerning the action mechanism of the AC block. We therefore aimed to clarify the detailed anatomy of the AC using micro-computed tomography (micro-CT), histological evaluation, and immunofluorescence (IF) assays. @*Methods@#Gross dissections of 39 thighs provided morphometric data relevant to injection landmarks. Serial sectional images of the AC were defined using micro-CT and ultrasonography. The fascial and neural structures of the AC proper were histologically evaluated using Masson’s trichrome and Verhoeff-Van Gieson staining, and double IF staining using choline acetyltransferase (ChAT) and neurofilament 200 antibodies. @*Results@#The posteromedial branch insertion of the nerve to vastus medialis (NVM) into the lateral border of the AC proper was lower (14.5 ± 2.4 cm [mean ± SD] above the base of the patella) than the origin of the proximal AC. The AC consists of a thin subsartorial fascia in the proximal region and a thick aponeurosis-like vastoadductor membrane in the distal region. In the proximal AC, the posteromedial branch of the NVM (pmNVM) consistently contained both sensory and motor fibers, and more ChAT-positive fibers were observed than in the saphenous nerve (27.5 ± 11.2 / 104 vs. 4.2 ± 2.6 / 104 [counts/µm2], P < 0.001). @*Conclusions@#Anatomical differences in fascial structures between the proximal and distal AC and a mixed neural component of the neighboring pmNVM have been visualized using micro-CT images, histological evaluation, and IF assays.
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Background@#We aimed to analyze outcomes of clipping and coiling in treating unruptured intracranial aneurysms (UIAs) in elderly patients and to identify the age at which perioperative risk increases based on national cohort data in South Korea. @*Methods@#The incidence of perioperative intracranial hemorrhage (ICRH), perioperative cerebral infarction (CI), mortality, and moderate to severe disability data of the patients who underwent coiling or clipping for UIAs were retrieved. Estimated breakpoint (EBP) was calculated to identify the age at which the risk of treatment increases. @*Results@#A total of 38,207 patients were treated for UIAs. Among these, 22,093 (57.8%) patients underwent coiling and 16,114 (42.2%) patients underwent clipping. The incidence of ICRH, requiring a secondary operation, within 3 months in patients ≥ 65 years that underwent coiling and clipping was 1.13% and 4.81%, respectively, and that of both groups assessed were significantly higher in patients ≥ 75 years (coiling, P = 0.013, relative risk (RR) 1.81; clipping, P = 0.015) than younger patients. The incidence of CI within 3 months in patients aged ≥ 65 was 13.90% and 9.19% in the coiling and clipping groups, respectively. The incidence of CI after coiling in patients aged ≥ 75 years (P < 0.001, RR 1.96) and after clipping in patients aged ≥ 70 years (P < 0.001, RR 1.76) was significantly higher than that in younger patients. The mortality rates within 1 year in patients with perioperative ICRH or CI were 2.41% and 3.39% for coiling and clipping groups, respectively, in patients ≥ 65. These rates increased significantly at age 70 in the coiling group and at age 75 for the clipping group (P = 0.012 and P < 0.001, respectively). @*Conclusion@#The risk of treatment increases with age, and this risk increases dramatically in patients aged ≥ 70 years. Therefore, the treatment decisions in patients aged ≥ 70 years should be made with utmost care.
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Purpose@#The objective of this study was to investigate the change in near visual function after the administration of oral silodosin to patients with lower urinary tract symptoms (LUTS). @*Methods@#This prospective study included treatment-naive patients who were scheduled to start treatment with silodosin for LUTS. A comprehensive ophthalmological evaluation including the near vision and the automated pupillometry was performed at baseline and after 3 months of silodosin treatment. For subjective assessment of near visual ability and satisfaction, a Near Activity Visual Questionnaire-10 (NAVQ-10) was also used at the same time (higher scores indicating worse quality). @*Results@#Of 23 patients enrolled in this study, 15 continued with silodosin (8 mg once daily) treatment for 3 months and completed a follow-up evaluation. The mean age of participants was 60.4±8.4 years. Distant visual acuity and spherical error were unchanged after silodosin treatment. However, near vision acuity (logMAR) was improved after treatment (right, 0.47±0.36 vs. 0.38±0.39, P=0.018; left, 0.41±0.37 vs. 0.31±0.34, P=0.068; both, 0.27±0.26 vs. 0.21±0.27, P=0.043). Pupil size under room light decreased significantly in both eyes (right, 3.77±0.60 vs. 3.16±0.58, P=0.001; left, 3.72±0.80 vs. 3.21±0.75, P=0.002). The Rasch scale at NAVQ-10 improved from 54.7±9.9 to 48.5±11.2 (P=0.004). @*Conclusions@#This preliminary study demonstrated that highly selective alpha-1A adrenergic receptor antagonists such as silodosin improve near visual acuity and quality in patients with LUTS/benign prostatic hyperplasia. Decrease in pupil size caused by inhibition of adrenergic alpha 1 mediated contraction of iris dilator muscle is a possible mechanism underlying improved near vision.
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Purpose@#The objective of this study was to investigate the change in near visual function after the administration of oral silodosin to patients with lower urinary tract symptoms (LUTS). @*Methods@#This prospective study included treatment-naive patients who were scheduled to start treatment with silodosin for LUTS. A comprehensive ophthalmological evaluation including the near vision and the automated pupillometry was performed at baseline and after 3 months of silodosin treatment. For subjective assessment of near visual ability and satisfaction, a Near Activity Visual Questionnaire-10 (NAVQ-10) was also used at the same time (higher scores indicating worse quality). @*Results@#Of 23 patients enrolled in this study, 15 continued with silodosin (8 mg once daily) treatment for 3 months and completed a follow-up evaluation. The mean age of participants was 60.4±8.4 years. Distant visual acuity and spherical error were unchanged after silodosin treatment. However, near vision acuity (logMAR) was improved after treatment (right, 0.47±0.36 vs. 0.38±0.39, P=0.018; left, 0.41±0.37 vs. 0.31±0.34, P=0.068; both, 0.27±0.26 vs. 0.21±0.27, P=0.043). Pupil size under room light decreased significantly in both eyes (right, 3.77±0.60 vs. 3.16±0.58, P=0.001; left, 3.72±0.80 vs. 3.21±0.75, P=0.002). The Rasch scale at NAVQ-10 improved from 54.7±9.9 to 48.5±11.2 (P=0.004). @*Conclusions@#This preliminary study demonstrated that highly selective alpha-1A adrenergic receptor antagonists such as silodosin improve near visual acuity and quality in patients with LUTS/benign prostatic hyperplasia. Decrease in pupil size caused by inhibition of adrenergic alpha 1 mediated contraction of iris dilator muscle is a possible mechanism underlying improved near vision.
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Background@#We aimed to analyze outcomes of clipping and coiling in treating unruptured intracranial aneurysms (UIAs) in elderly patients and to identify the age at which perioperative risk increases based on national cohort data in South Korea. @*Methods@#The incidence of perioperative intracranial hemorrhage (ICRH), perioperative cerebral infarction (CI), mortality, and moderate to severe disability data of the patients who underwent coiling or clipping for UIAs were retrieved. Estimated breakpoint (EBP) was calculated to identify the age at which the risk of treatment increases. @*Results@#A total of 38,207 patients were treated for UIAs. Among these, 22,093 (57.8%) patients underwent coiling and 16,114 (42.2%) patients underwent clipping. The incidence of ICRH, requiring a secondary operation, within 3 months in patients ≥ 65 years that underwent coiling and clipping was 1.13% and 4.81%, respectively, and that of both groups assessed were significantly higher in patients ≥ 75 years (coiling, P = 0.013, relative risk (RR) 1.81; clipping, P = 0.015) than younger patients. The incidence of CI within 3 months in patients aged ≥ 65 was 13.90% and 9.19% in the coiling and clipping groups, respectively. The incidence of CI after coiling in patients aged ≥ 75 years (P < 0.001, RR 1.96) and after clipping in patients aged ≥ 70 years (P < 0.001, RR 1.76) was significantly higher than that in younger patients. The mortality rates within 1 year in patients with perioperative ICRH or CI were 2.41% and 3.39% for coiling and clipping groups, respectively, in patients ≥ 65. These rates increased significantly at age 70 in the coiling group and at age 75 for the clipping group (P = 0.012 and P < 0.001, respectively). @*Conclusion@#The risk of treatment increases with age, and this risk increases dramatically in patients aged ≥ 70 years. Therefore, the treatment decisions in patients aged ≥ 70 years should be made with utmost care.
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Objective@#The frequency of penetrating neck injuries has gradually increased with the development of industry and the rising crime rates. There have been few studies with penetrating neck injuries reported in Korea. Thus, we analyzed clinical factors that could differentiate between superficial and deep injuries in patients with penetrating neck injuries. @*Methods@#We investigated the medical records of 90 patients with penetrating neck injuries who visited the emergency department between January 2010 and March 2020. To identify the degree of injuries, we compared age, sex, onset and arrival time, onset-to-arrival time, initial vital signs, Glasgow Coma Scale, Revised Trauma Score, cause, mechanism, location and number of injuries, anatomical zone, alcohol intake and psychiatric history were classified as early clinical factors. @*Results@#Among 90 patients, 51 had superficial injuries, and 39 had deep injuries. The early clinical factors showing statistically significant differences were the Glasgow Coma Scale, Revised Trauma Score, cause of injury and anatomical zones. As the Glasgow Coma Scale increased by 1 point, deep injuries decreased by 0.807 times compared to superficial injuries. Homicidal injuries were 3.233 times deeper than suicidal injuries. @*Conclusion@#If the Glasgow Coma Scale is low or the cause of injury is homicide, the possibility of a deep penetrating injury is high. Therefore, it is important to treat the patient carefully, considering these factors.
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Osteoporosis is a major disease in aged women, increasing the risk for fractures accompanied by changes in the microarchitecture. The aim of this study was to investigate the three-dimensional (3D) histomorphology of femur diaphysis in the animal model for postmenopausal osteoporosis. The cortical bone of femur diaphysis of the rat was serially sectioned at a thickness of 5 μm and evaluated age-associated changes of the intracortical (osteonal) canal networks three-dimensionally. Cortical microstructures of 10-month old rats were not affected by ovariectomy. Intracortical canal networks were radial toward endosteal aspect and frequently interconnected across the neighboring canals with short arciform and irregular canals reminiscent for resorption spaces in ovarectomized 16-month old rats, contrary to intact canals in 16-month old control rat. Increased proportion of the periosteal circumference lamella and deformed endosteal regions with rare cortical canals hampered reconstructive histomorphology in ovarectomized rats of 26 month age. We have shown that 3D reconstruction of rat femur of the aged model over 16-month old is suitable methods that evaluate and microstructural change of the intracortical canals and cortical bone porosity by estrogen depletion.
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Osteoporosis is a major disease in aged women, increasing the risk for fractures accompanied by changes in the microarchitecture. The aim of this study was to investigate the three-dimensional (3D) histomorphology of femur diaphysis in the animal model for postmenopausal osteoporosis. The cortical bone of femur diaphysis of the rat was serially sectioned at a thickness of 5 μm and evaluated age-associated changes of the intracortical (osteonal) canal networks three-dimensionally. Cortical microstructures of 10-month old rats were not affected by ovariectomy. Intracortical canal networks were radial toward endosteal aspect and frequently interconnected across the neighboring canals with short arciform and irregular canals reminiscent for resorption spaces in ovarectomized 16-month old rats, contrary to intact canals in 16-month old control rat. Increased proportion of the periosteal circumference lamella and deformed endosteal regions with rare cortical canals hampered reconstructive histomorphology in ovarectomized rats of 26 month age. We have shown that 3D reconstruction of rat femur of the aged model over 16-month old is suitable methods that evaluate and microstructural change of the intracortical canals and cortical bone porosity by estrogen depletion.
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The biocompatibility of dialysis membranes has significantly reduced adverse responses to dialysis, such that nowadays they are rarely reported. We report the case of a patient diagnosed and subsequently treated for thrombocytopenia caused by a dialysis reaction, as an example of a hemostatic disorder mistaken for an immature arteriovenous fistula. The peridialysis pattern of the platelet count helped to confirm the diagnosis. Further studies of the negative effects of dialysis are needed, including risk factors, predictors, treatment, and prevention.
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The aim of this study was to identify the three-dimensional topography of the sphenoid door jamb (SDJ) in the lateral orbital wall and to propose navigational guidelines for safe deep lateral decompression using surgical landmarks. The 120 orbits and SDJs of 60 subjects were three-dimensionally reconstructed using Mimics software. The mean volumes of the orbit and SDJ were 24.3 mm³ and 2.0 mm³, respectively. The mean distances from the lateral orbital margin (LOM) to the anterior and posterior margins of the SDJ were 13.2 and 36.3 mm, respectively. The mean distances from the superior orbital fissure to the LOM and to the posterior margin of the SDJ were 40.2 mm and 4.6 mm, respectively. The mean distances from the inferior orbital fissure (IOF) to the anterior and posterior margins of the SDJ were 3.8 mm and 20.5 mm, respectively. In the superior approach of the orbit, it can be predicted that the area up to 3 cm posterior from the LOM is safe, while 1 cm posterior from the safe zone could be a dangerous zone. In the inferior approach of the orbit, the safe area will be about 1 cm posterior from the anterior tip of the IOF, and the area up to 1 cm posterior from the safe zone should be approached with extreme care.
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Descompressão , Doença de Graves , ÓrbitaRESUMO
The biocompatibility of dialysis membranes has significantly reduced adverse responses to dialysis, such that nowadays they are rarely reported. We report the case of a patient diagnosed and subsequently treated for thrombocytopenia caused by a dialysis reaction, as an example of a hemostatic disorder mistaken for an immature arteriovenous fistula. The peridialysis pattern of the platelet count helped to confirm the diagnosis. Further studies of the negative effects of dialysis are needed, including risk factors, predictors, treatment, and prevention.
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Humanos , Fístula Arteriovenosa , Diagnóstico , Diálise , Transtornos Hemostáticos , Membranas , Contagem de Plaquetas , Diálise Renal , Fatores de Risco , TrombocitopeniaRESUMO
OBJECTIVES: The purpose of this study was to investigate the role of self-esteem as a moderator of the factors influencing suicidality among middle-schoolers. METHODS: Moderated multiple regression analysis was applied to assess the influence of happiness, depression, and hostility on suicidality and to determine the degree to which self-esteem served as a moderator of those relationships. Data were collected from 268 students at a middle school in Busan, Korea, using a self-administered structured questionnaire. RESULTS: Happiness, depression, and hostility had significant direct effects on suicidality. Self-esteem showed no direct effect, but had a significant moderating effect on the relationship between hostility and suicidal behavior. CONCLUSIONS: These results suggest that various interventions, such as counseling programs, should be designed to alleviate hostility and depression and to enhance happiness and self-esteem among early adolescents.
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Adolescente , Humanos , Aconselhamento , Depressão , Felicidade , Hostilidade , Coreia (Geográfico)RESUMO
OBJECTIVES@#The purpose of this study was to investigate the role of self-esteem as a moderator of the factors influencing suicidality among middle-schoolers.@*METHODS@#Moderated multiple regression analysis was applied to assess the influence of happiness, depression, and hostility on suicidality and to determine the degree to which self-esteem served as a moderator of those relationships. Data were collected from 268 students at a middle school in Busan, Korea, using a self-administered structured questionnaire.@*RESULTS@#Happiness, depression, and hostility had significant direct effects on suicidality. Self-esteem showed no direct effect, but had a significant moderating effect on the relationship between hostility and suicidal behavior.@*CONCLUSIONS@#These results suggest that various interventions, such as counseling programs, should be designed to alleviate hostility and depression and to enhance happiness and self-esteem among early adolescents.
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This study investigated the topographic relationships among the eyeball and four orbital margins with the aim of identifying the correlation between orbital geometry and eyeball protrusion in Koreans. Three-dimensional (3D) volume rendering of the face was performed using serial computed-tomography images of 141 Koreans, and several landmarks on the bony orbit and the cornea were directly marked on the 3D volumes. The anterior-posterior distances from the apex of the cornea to each orbital margin and between the orbital margins were measured in both eyes. The distances from the apex of the cornea to the superior, medial, inferior, and lateral orbital margins were 5.8, 5.8, 12.0, and 17.9 mm, respectively. Differences between sides were observed in all of the orbital margins, and the distances from the apex of the cornea to the superior and inferior orbital margins were significantly greater in females than in males. The anterior-posterior distance between the superior and inferior orbital margins did not differ significantly between males (6.3 mm) and females (6.2 mm). The data obtained in this study will be useful when developing practical guidelines applicable to forensic facial reconstruction and orbitofacial surgeries.
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Feminino , Humanos , Masculino , Córnea , ÓrbitaRESUMO
Background: The purpose of the study was to investigate the frequencies and types of Y chromosome microdeletions in infertile men and to analyze the relationship between the levels of reproductive hormones and Y microdeletions
Methods: A total of 1,226 infertile men were screened for Y chromosome microdeletions using multiplex PCR assay. Karyotype analysis was performed on peripheral blood lymphocytes with standard G-banding. Serum reproductive hormone levels were measured
Results: Out of 1,226 infertile patients, 134 [10.93%] had Y microdeletions. One hundred seven of 765 [13.99%] non-obstructive azoospermic patients and 27 of 133 [20.30%] severe oligozoospermic patients had Y microdeletions. Among the 134 infertile men with Y microdeletions, the most frequent microdeletions were detected in the AZFc region, followed by AZFbc, AZFb, AZFa, AZFabc[Yq], Yp[SRY]+Yq, and partial AZFc regions. Karyotype analysis was available for 130 of the 134 patients with Y microdeletions. Of them, 36 [27.69%] patients had sex chromosomal abnormalities. Levels of FSH and LH in patients with AZFc microdeletion were significantly lower, while those in patients with Yp[SRY]+Yq were significantly higher than in patients without Y microdeletions. Level of testosterone in patients with AZFabc[Yq] or Yp[SRY]+Yq was significantly lower than that in patients without Y microdeletions. However, there was no significant difference in the levels of reproductive hormones between all patients with and without Y microdeletions
Conclusion: These results highlight the need for Y chromosome microdeletion screening for correct diagnosis of male infertility. Obtaining reliable genetic information for assisted reproductive techniques can prevent unnecessary treatment and vertical transmission of genetic defects to offspring
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Ependymomas are the most common intramedullary spinal cord tumors in adults. Although a hemorrhage within spinal ependymoma on imaging studies is not uncommon, it has rarely been reported to bea cause of acute neurological deficit. In the present report, we describe a case of a 24-year-old female patient who developed acute paraplegia as a result of hemorrhagic spinal ependymoma immediately after a cesarean delivery under spinal regional anesthesia. We review the literature of hemorrhagic spinal ependymomas presenting with acute neurological deficit and discuss the most appropriate treatment for a good neurological recovery.
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Adulto , Feminino , Humanos , Adulto Jovem , Anestesia por Condução , Raquianestesia , Ependimoma , Hemorragia , Máscaras , Paraplegia , Neoplasias da Medula EspinalRESUMO
Ependymomas are the most common intramedullary spinal cord tumors in adults. Although a hemorrhage within spinal ependymoma on imaging studies is not uncommon, it has rarely been reported to bea cause of acute neurological deficit. In the present report, we describe a case of a 24-year-old female patient who developed acute paraplegia as a result of hemorrhagic spinal ependymoma immediately after a cesarean delivery under spinal regional anesthesia. We review the literature of hemorrhagic spinal ependymomas presenting with acute neurological deficit and discuss the most appropriate treatment for a good neurological recovery.