• Journal of Korean Neurosurgical Society
• /
• 제66권5호
• /
• pp.582-590
• /
• 2023

Objective : Trauma is a leading causes of death and disability in all ages. The aim of this study was to describe the demography and characteristics of paediatric head trauma in our institution and examine the predictors of outcome and incidence of injury related mortality. Methods : We examined our institutional Trauma Registry over a 2 year period. Results : A total of 1100 trauma patients were seen over the study period. Of the 579 patients who had head injury 99 were in the paediatric age group. Of the paediatric head trauma patients 79 had documented Glasgow coma score (GCS), 38 (48.1%), 17 (21.5%) and 24 (30.4%) had mild, moderate and severe head injury respectively. The percentage mortality of head injury in the paediatric age group was 6.06% (6/99). There is an association between mortality and GCS (p=0.008), necessity for intensive care unit (ICU) admission (p=0.0001), associated burns (p=0.0001) and complications such as aspiration pneumonia (p=0.0001). The significant predictors of outcome are aspiration (p=0.004), the need for ICU admission (p=0.0001) and associated burns (p=0.005) using logistic binary regression. During the study period 46 children underwent surgical intervention with extradural haematoma 16 (34.8%), depressed skull fracture 14 (30.4%) and chronic subdural haematoma five (10.9%) being the commonest indication for surgeries. Conclusion : Paediatric head injury accounted for 9.0% (99/1100) of all trauma admissions. Majority of patients had mild or moderate injuries. Burns, aspiration pneumonitis and the need for ICU admission were important predictors of outcome in children with traumatic brain injury.

• Pediatric Infection and Vaccine
• /
• 제3권2호
• /
• pp.154-162
• /
• 1996

Purpose : Adenoviruses(Ad) have been shown to play an important role in the etiology of severely acute respiratory diseases, particulary in infants and young children, and the occurrence of fatal outcome and chronic pulmonary sequelae in association with adenoviral infection has been a cause of great interest and concern. This report presents the resul of a retrospective analysis on 30 cases of lower respiratory infection from which adenovirus was isolated. Patients & Methods : The 30 patients in this study represent all detected cases of adenovial infection out of 240 children who were admitted to Sang Sung Medical Center between February to June 1996 showing signs and symptoms of lower respiratory tract infection. The diagnosis of adenovirus infection was based on microscopic visualization of typical cytopathic effect in HEp-2 tissue culture and used monoclonal Ab with nasopharyngeal aspiration. Results : The male/female ratio was 2:1 and the majority of age range was below 36months. Clinical diagnoses in all 30 patients were pneumonia(n=21), bronchitis and Bronchiolitis(n=5) and ARDS(n=4). We recieved the most of patients in the month of May. The chief complaints were fever(93.3%) and cough(80%) and extrapulmonary symptoms were diarrhea(n=5), seizure(n=4), abdominal pain(n=1). The mean duration of fever was $11.95{\pm}6.54$days. Physical examination on admission were crackles(73.3%), coarse breathing sounds(60%), hepatosplenomegaly(33.3%), decreased brething sounds(30%). In WBC counts, 8cases were below $4000/mm^3$ and 14 cases were above $10,000/mm^3$. In platelets counts, 4cases were below $150,000/mm^3$ and 10 cases were above $450,000/mm^3$. 21 cases were above 1 in CRP. GOT and GPT were abnormal in some cases. Chest X-ray revealed diffuse pulmonary infiltration(n=15), pleural effusion(n=6), consolidation(n=4) and hyperaeration(n=3). Seven patients were treated at the peditric intensive care unit with respiratory support and high dose of gammaglobulin. However, one patients died even through he was treated with NO ventilation and high frequency ventilation. Conclusion : Those with adenoviral pneumonia and respiratory infection having long fever duration and symptoms like bacterial pneumonia must be carefully differentiated in order to provide proper treatement and preventive measures due to possible fatal outcome.

• Journal of Korean Biological Nursing Science
• /
• 제16권4호
• /
• pp.267-275
• /
• 2014

Purpose: The practice of enteral nutrition with gastric residual volumes (GRVs) as a clinical indicator is poorly standardized in intensive care units. This study aims to summarize the results from studies that evaluated the clinical outcomes related to the GRVs. Methods: This systematic review study analyzed 11 studies consisting of four randomized controlled trials, one non-randomized controlled trial, and six observational studies. Results: No consistent relationship between GRV thresholds and clinical outcomes was observed. Higher GRVs were not consistently correlated with clinical outcomes such as higher gastrointestinal complications, aspiration pneumonia, or mortality. Higher GRVs significantly generate complications more often. Findings show that a single GRV more than 200 mL or two consecutive GRVs more than 150 mL should raise concern about negative consequences. Conclusion: Critical care nurses need to monitor GRVs closely during their practice of enteral nutrition. For critically ill patients receiving enteral nutrition, a GRV threshold of 200 ml would be a desirable limit to provide safe and adequate nutrition with a conservative approach.

• Journal of Chest Surgery
• /
• 제24권2호
• /
• pp.190-196
• /
• 1991

Clinical experience of 48 acute pericarditis with effusion was reviewed and presented. There were 28 male and 20 female patients ranging from 3 years to 77 years old. Malignant effusion; Twenty patients had underlying malignancy. These etiologies were lung ca[8 patients, 40%], breast ca[7 patients 35%], lymphoma[2 patients, 10%], esophageal ca[1 patients, 5%], stomach ca[1 patient, 5%], ovarian ca[1 patient, 5%]. Uremic effusion; 15 patients with renal failure required surgical intervention. Traumatic effusion; 7 patients had traumatic pericarditis. These etiologies were stab wound [5 patients, 71.4%] and aspiration[2 patients, 28.6%]. Pyogenic effusion: 6 patients had pyogenic pericarditis. These etiologies were empyema thoracis[3 patients, 50%], liver abscess[2 patients, 33.3%], pneumonia[1 patient, 16.7%]. The patients were treated by pericardiocentesis, subxiphoid tube drainage, pericardiectomy: 4 of them underwent pericardiocentesis; 37, subxiphoid tube drainage; 5, pericardiectomy. We conclude that subxiphoid tube pericardial drainage was effective for treatment of pericardial effusion.

• Journal of Chest Surgery
• /
• 제39권12호
• /
• pp.943-945
• /
• 2006

수유 곤란과 반복적인 흡인성 폐렴을 주소로 내원한 11개월 된 여아가 우대동맥궁, Kommerell 게실, 식도 후방의 좌쇄골하 및 동맥관 인대로 형성된 완전 혈관륜을 진단 받고 수술적 교정을 받았다. 수술은 좌측 후측 개흉 후 동맥관 인대를 분리하여 식도 압박 요인을 제거하고, Kommerell 게실을 하행대동맥으로부터 분리, 절제한 후 좌쇄골하 동맥을 좌측 총경동맥으로 단측 문합하였다. 환아의 수술 경과는 양호하였으며, 현재 외래 관찰 중이다.

• Journal of Yeungnam Medical Science
• /
• 제33권1호
• /
• pp.48-51
• /
• 2016

Milk-alkali syndrome (MAS), a triad of hypercalcemia, metabolic alkalosis, and renal failure, is associated with ingestion of large amounts of calcium and absorbable alkali. MAS is the third most common cause of hypercalcemia in hospital, after primary hyperparathyroidism and malignant neoplasm. MAS is not often reported in the Korean literature. We describe MAS secondary to intake of calcium citrate for the treatment of osteoporosis with thoracic spine compression fracture. A 70-year-old man presented to our hospital with a 1-week history of general weakness and lethargy. He was found with acute kidney injury (serum creatinine, 4.6 mg/dL), hypercalcemia (total calcium, 14.8 mg/dL), and alkalosis. Laboratory evaluation excluded both hyperparathyroidism and malignancy. Mental status and serum calcium level was normalized within a week after proper hydration and intravenous administration of furosemide. However, he developed aspiration pneumonia, pseudomembranous colitis, and sepsis with multi-organ failure. Despite intensive treatment including inotropics, mechanical ventilation, and renal replacement therapy, he expired with no signs of renal recovery on the 28th hospital day.

• The Korean Journal of Pain
• /
• 제11권2호
• /
• pp.346-349
• /
• 1998

The technique of the stellate ganglion block is widely used as it is relatively simple and safe. But it can cause severe complications because there are major blood vessels and nerves around the stellate ganglion. We practiced CPR because of the respiratory failure caused by severe hematoma in the neck following the stellate ganglion block. A 46-year-old male patient admitted to ENT department because of the both sudden sensorineural hearing loss that happened after URI. He was referred to Pain Clinic for further evaluation and treatment. We decided to block the stellate ganglion. We injected 6ml of 0.5% mepivacaine on both sides of the stellate ganglion. There were no blood aspiration and abnormal vital signs during the 30 minute observation, either. Three hours after he went to the private room, he had pain and edema in his neck, but no respiratory defficulty. But later, respiratory failure was suddenly followed. So we practiced CPR. We confirmed severe hematomas in the neck through CT scanning. Hematomas is removed and the ruptured blood vessels which is supposed to be muscular branch of vertebral artery is ligated under general anesthesia. The patient was discharged from hospital after the treatment of pneumonia and duodenal ulcer as complications. We recommand you to compress the block site more than five minutes and not to prick with the needle several times at one point to prevent the formation of hematomas.

• 대한한방소아과학회지
• /
• 제20권3호
• /
• pp.87-95
• /
• 2006

Objectives : Cerebrovascular disease in children is more common than once recognized and the etiology. In stroke patient, dysphagia is a common. Dysphagia often affects the rehabilitation of stroke patients by increasing the risk of aspiration pneumonia and malnutrition. This is the clinical report about 1 case of patient with dysphagia who had a stroke developed after operation. Methods : The herb medicine, moxibustion and acupuncture therapies were applied for treating this patient's chief symptom. Results : This patient's dysphagia was improved by oriental medical therapy. Conclusions : The result suggests that the herb medicine and acupuncture therapies is efficacious against dysphagia associated with stroke. We though that more studies about the Oriental medical treatment on dysphagia associated with stroke are needed.

• 한국임상수의학회지
• /
• 제29권1호
• /
• pp.107-111
• /
• 2012

Three dogs (An 8 years-old intact female Poodle, a 7 years-old intact male Schunauzer, and an 8 yearsold Golden Retriever) were presented due to acute vomiting, dyspnea, and generalized weakness. Megaesophagus was confirmed through radiographic examination in all 3 dogs. Relative oesophageal diameter (ROD) was measured and results of ROD measurements showed the possibility of megaesophagus secondary to myasthenia gravis in three dogs. Thus we performed anticholinesterase test as screening test for myasthenia gravis. In all three dogs, esophageal diameter was reduced after neostigmine methylsulfate administration. For definite diagnosis of acquired myasthenia gravis, serum acetylcholine receptor antibody titer was measured, but definite diagnosis was confirmed only in one case. However, based on history, radiographic findings, anticholinesterase test, ROD measurement, other two cases were still suspected as megaesophagus secondary to myasthenia gravis. Treatment with pyridostigmine bromide was initiated in all dogs, and improvement of esophageal diameter was shown in all dogs. One dog was successfully managed for 15 months after initial treatment and, is still alive, but other two dogs were died shortly after initial treatment, because of severe aspiration pneumonia.

• Journal of Chest Surgery
• /
• 제28권1호
• /
• pp.53-58
• /
• 1995

Open lung biopsy still has important roles for the marking of diagnosis of diffuse infiltrative lung disease even though transbronchial bronchoscopic lung biopsy and percutaneous needle aspiration biopsy gain popularity nowadays. This is clinical retrospective review of the 56 patients with diffuse infiltrative lung disease undergoing open lung biopsy by minithoracotomy from 1984 to Dec. 1992 in the Department of Thoracic & Cardiovascular Surgery of Catholic University Medical College. 27 men and 29 women, aged 17 to 73 year [mean 49 year , were enrolled & divided into 2 groups;Group A consisted of patients with immunocompromised state [n=19 , Group B patients with non-immunocompromised state[n=38 . Pathologic diagnosis was made in 54 cases[96.4% of these two groups and as follows: infectious; 12 patients[21.4% , Neoplastic; 10 patients[17.9% , granulomatous; 4 patients[7.1% , interstitial pneumonia; 12 patients[21.4% , Pulmonary fibrosis; 8 patients[14.3% , others; 3 patients[5.4% , nonspecific; 5 patients[8.9% , and undetermined; 2 patients[3.6% . Therapeutic plans were changed in 39 patients[69.6% after taking of tissue diagnosis by open lung biopsy. Group B has higher incidence of infectious diseases and change of therapeutic plan than the Group A. The postoperative complications developed in 8 cases[14.3% ,and there is no difference of incidence between the 2 groups. 4 patients belongs to group A, died of respiratory distress syndrome [2 and sepsis [2 which were not related with open lung biopsy procedure. In conclusion, open lung biopsy is a reliable method to obtain a diagnosis in diffuse pulmonary infiltrates and can be performed safely, even in acutely ill, immunosuppressed patients.