The usefulness of universal ultrasound before hospital discharge for early diagnosing hip dysplasia in Korean neonates with breech presentation in a single center: A retrospective study.

Developmental dysplasia of the hip (DDH) is a broad-spectrum disorder. Early diagnosis and treatment are important for improved prognosis and a lower risk of long-term complications. Selecting high-risk infants is important for the early diagnosis of DDH using ultrasonography; however, there are no standard international guidelines. This study aimed to identify the usefulness of universal ultrasound before hospital discharge in breech-born neonates and proposes selective ultrasound for high-risk patients. A retrospective chart review was conducted to identify breech-born neonates who underwent hip ultrasonography before discharge for the detection of DDH between 2019 and 2023. Patients were categorized into DDH and non-DDH groups according to the ultrasound results. We compared sex, gestational age, birth weight, first-born status, twin pregnancy, associated anomalies, presence of symptoms, physical examination results, and timing of the first hip ultrasound. The medical records of the mothers were reviewed to identify the amount of amniotic fluid and duration of breech presentation. This study included 102 patients, of whom 62 and 40 were assigned to the non-DDH and DDH groups, respectively. Congenital anomalies, positive symptoms, and positive physical examination results were significant risk factors. However, female sex, first-born status, and oligohydramnios were not statistically significant. The duration of breech presentation during pregnancy was not significant. Additionally, the risk of Pavlik harnesses was higher in patients who underwent a positive physical examination. Universal ultrasonography before discharge is not recommended for the early diagnosis of DDH in all breech-born neonates because of the high rate of overdiagnosis. We recommend that ultrasonography be performed in patients with congenital anomalies, except for foot problems, or in those with a positive physical examination conducted by trained specialists.

Mortality Cases of Mushroom Poisoning with Russula subnigricans.

Mushroom poisoning is increasing worldwide, as well as the incidence of fatal mushroom poisoning. Several new syndromes associated with mushroom poisoning have been described in the literature. Notably, 1 of the newly identified mushroom poisonings is Russula subnigricans poisoning. R subnigricans can be classified as causing a delayed-onset rhabdomyolytic syndrome as patients with this severe poisoning present with severe rhabdomyolysis, acute kidney injury, and cardiomyopathy. However, there are only a few reports on the toxicity of R subnigricans. We recently treated 6 patients with R subnigricans mushroom poisoning, of whom 2 died. The 2 patients showed severe rhabdomyolysis, metabolic acidosis, acute renal failure, electrolyte imbalance, and irreversible shock, which caused their deaths. Mushroom poisoning should be considered in the evaluation of rhabdomyolysis of unknown origin. In addition, in cases of mushroom poisoning with severe rhabdomyolysis, R subnigricans poisoning should be promptly identified.

Comparison of blood flow between two mechanical compression devices using ultrasound: Animal trial.

BACKGROUND: During manual chest compression, maintaining accurate compression depth and consistency is a challenge. Therefore, mechanical chest compression devices(mCCDs) have been increasingly incorporated in clinical practice. Evaluation and comparison of the efficacy of these devices is critical for extensive clinical application. Hence, this study compared the cardiopulmonary resuscitation(CPR) efficiency of two chest compression devices, LUCAS™ 3(Physio-Control, Redmond, USA) and Easy Pulse (Schiller Medizintechnik GMBH, Feldkirchen, Germany), in terms of blood flow using ultrasonography(USG) in a swine model. METHODS: A swine model was used to compare two mCCDs, LUCAS™ 3 and Easy Pulse. Cardiac arrest was induced by injecting potassium chloride(KCl) solution in eight male mongrel pigs and the animals were randomly divided into two groups. Mechanical CPR was provided to two groups using LUCAS™ 3(LUCAS™ 3 group) and Easy Pulse(Easy Pulse group). USG was used to measure hemodynamic parameters including femoral peak systolic velocity(PSV) and femoral artery diameters(diameter during systole and diastole). Blood flow rate was calculated by multiplying the PSV and cross-sectional area of the femoral artery during systole. The end-tidal carbon dioxide(EtCo2), chest compression depth was measured. Systolic blood pressure, mean blood pressure, and diastolic blood pressure were also measured using an arterial catheter. RESULTS: The chest compression depth was much deeper in LUCAS™ 3 group than Easy Pulse group(LUCAS™ 3: 6.80 cm; Easy Pulse: 3.279 cm, p < 0.001). However, EtCo2 was lower in the LUCAS™ 3 group(LUCAS™ 3: 19.8 mmHg; Easy Pulse: 33.4 mmHg, p < 0.001). The PSV was higher in the LUCAS™ 3 group(LUCAS™ 3: 67.6 cm s-1; Easy Pulse: 55.0 cm s-1, p < 0.001), while the systolic(LUCAS™ 3: 1.5 cm; Easy Pulse: 2.0 cm, p < 0.001) and diastolic diameters were larger in the Easy Pulse group(LUCAS™ 3: 0.4; Easy Pulse: 0.8 cm, p < 0.001). The femoral flood flow rate was also lower in the LUCAS™ 3 group(LUCAS™ 3: 32.55 cm3/s; Easy Pulse: 61.35 cm3/s, p < 0.001). CONCLUSION: The Easy Pulse had a shallower compression depth and slower PSV but had a wider systolic diameter in the femoral artery as compared to that in LUCAS™ 3. Blood flow and EtCo2 were higher in the easy pulse group probably because of the wider diameter. Therefore, an easy pulse may create and maintain more effective intrathoracic pressure.

Russula subnigricans Poisoning Causes Severe Rhabdomyolysis That Could be Misdiagnosed as Non-ST Segment Elevation Myocardial Infarction.

Mushroom poisoning and subsequently the number of patients visiting emergency rooms are increasing, as well as the proportion of fatal mushroom poisonings. Myocytic mushroom poisoning is one of the new clinical classifications. This report documents the course of a family with Russula subnigricans poisoning complicated by severe rhabdomyolysis, including a case that was misdiagnosed as myocardial infarction. A 64-y-old man visited our hospital with symptoms including substernal chest discomfort, nausea, vomiting, and myalgia, lasting for 12 h. His laboratory tests showed elevated serum high-sensitive troponin I. He was diagnosed with non-ST segment elevation myocardial infarction. After that, 2 family members who ate mushrooms together were transferred from a local emergency room with the diagnosis of rhabdomyolysis. Consequently, rhabdomyolysis due to mushroom poisoning was diagnosed. They were hospitalized in the intensive care unit. After admission, conservative management, including primary fluid resuscitation, was performed, and the patients were discharged without complications. R subnigricans poisoning was revealed after investigation and should be considered in mushroom poisoning with rhabdomyolysis. Early recognition and intensive supportive care are important for mushroom poisoning patients.