BACKGROUND: Several antibiotics can be used to treat ventilator-associated pneumonia caused by carbapenem-resistant A. baumannii (CRAB-VAP) including high-dose sulbactam. However, the effectiveness of high-dose sulbactam therapy is not well known. We report our experience with high-dose sulbactam for treatment of CRAB-VAP. METHODS: Medical records of patients with CRAB-VAP who were given high-dose sulbactam between May 2013 and June 2015 were reviewed. RESULTS: Fifty-eight patients with CRAB-VAP were treated with high-dose sulbactam. The mean age was 72.0 ± 15.2 years, and the acute physiology and chronic health evaluation II (APACHE II) score was 15.1 ± 5.10 at the time of CRAB-VAP diagnosis. Early clinical improvement was observed in 65.5% of patients, and 30-day mortality was 29.3%. Early clinical failure (odds ratio [OR]: 8.720, confidence interval [CI]: 1.346-56.484; p = 0.023) and APACHE II score ≥ 14 at CRAB-VAP diagnosis (OR: 10.934, CI: 1.047-114.148; p = 0.046) were associated with 30-day mortality. CONCLUSIONS: High-dose sulbactam therapy may be effective for the treatment of CRAB-VAP. However, early clinical failure was observed in 35% of patients and was associated with poor outcome.
Acinetobacter baumannii* ; Acinetobacter* ; Anti-Bacterial Agents ; APACHE ; Diagnosis ; Humans ; Medical Records ; Mortality ; Pneumonia, Ventilator-Associated* ; Sulbactam*

BACKGROUND: Tuberculous pleurisy treatment improve symptoms such as fever, chest pain, cough, and prevents the progression to active pulmonary tuberculosis and the development of residual pleural thickening that decrease diaphragm and rib cage movement. This study investigated how the degree of residual pleural thidkening affects the pulmonary function. METHODS: Fifty seven patients who were initially diagnosed as having tuberculous pleurisy, were treated with anti-tuberculous medication for 6 months and had residual pleural thickening between May 1998 and January 2000 at the Eulji university hospital were reviewed. A chest X-ray and pulmonary function test(PFT, Sensormedics 2200) were perfored. The predicted value (%) of the forced vital capacity(FVC), forced inspiratory vital capacity(FIVC) and total lung capacity(TLC) were measured. The residual pleural thickening was defined the average of the summation in the lateral chest at the level of the imaginary line intersecting from the cardiophrenic angle to the diaphragmatic dome and the lowest part of the costophrenic angle between them. The results were sorted into three grades according to pleural thickness; <2mm(grade I), 2~10mm(grade II), 10mm(grade III). RESULTS: 1. FVC(% pred) and FIVC(% pred) were statistically different between grade I and III, and II and III. However, there was no difference between the TLC(% pred) between each of the groups. 2. The pleural thickness that cause restrictive dysfunction(FVC<80%) and a statisticall difference, is 3 mm. CONCLUSION: The larger the extent of the residual pleural thickness after antituberculous medication, the greater the reduction in the FVC, FIVC, TLC. A pleural thickness of 3 mm is recommended as a guideline for diagnosing a restrictive pulmonary dysfunction.
Chest Pain ; Cough ; Diaphragm ; Fever ; Humans ; Lung ; Respiratory Function Tests ; Ribs ; Thorax ; Tuberculosis, Pleural* ; Tuberculosis, Pulmonary

Pleural effusion is not a rare disease in Korea. The diagnosis of pleural effusion is very difficult, even though the patients often complain of typical symptoms indicating of pleural diseases. Pleural effusion is characterized by the pleural cavity filled with transudative or exudative pleural fluids, and it is developed by various etiologies. The presence of pleural effusion can be confirmed by radiological studies including simple chest radiography, ultrasonography, or computed tomography. Identifying the causes of pleural effusions by pleural fluid analysis is essential for proper treatments. This review article provides information on the diagnostic approaches of pleural effusions and further suggested ways to confirm their various etiologies, by using the most recent journals for references.
Diagnosis ; Humans ; Korea ; Pleural Cavity ; Pleural Diseases ; Pleural Effusion* ; Pleurisy ; Radiography ; Rare Diseases ; Thorax ; Ultrasonography

OBJECTIVE: Expectorated sputum examination applied first in all patients with suspected pulmonary tuberculosis is low sensitivity. Bronchoscopy is applied next in patients with smear negative sputum. In some instances, bronchoscopy can not be available in patients because of poor conditions or cooperations. The aim of this study was to determine whether sputum induction is more simple and more convenient method than bronchoscopy or not to diagnose pulmonary tuberculosis in AFB smear-negative patients. METHODS: The objects of this study were 47 patients whose smear results of expectorated sputum were negative or could not produce expectorated sputum. Consecutive patients underwent sputum induction with 3% hypertonic saline delivered by ultrasonic nebulizer at least 24 hour before bronchial washing by fiber-optic bronchoscopy. All specimens were examined for acid-fast bacilli with Ziehl-Neelsen stain and cultured for mycobacteria. RESULTS: 1) Sensitivity of AFB smear were 36% (17/47) in induced sputum, 53%(25/47) in bronchoscopy, but statistically not significant(p>0.05). 2) Sensitivity of mycobacterial culture were 53%(25/47) in induced sputum, 68%(32/47) in bronchoscopy, statistically not significant(p>0.05). 3) Positive AFB smear in endobronchial tuberculosis(n=9) were 5 in induced sputum, and 9 in bronchoscopy. 4) In 10 patients who were not obtainable sputum initially, AFB smear were positive in 7 in induced sputum and 9 in bronchoscopy 5) In 11 patients who cultured in expectorated sputum later, positive culture were 10 patients both in induced sputum and bronchoscpy. 6) All 5 patients who didn't undergo bronchoscopy were positive AFB smear in induced sputum CONCLUSION: In suspected active pulmonary tuberculosis patients with negative AFB smear of expectorated sputum, induced sputum does not replace bronchoscopy to diagnose active pulmonary tuberculosis. But, sputum induction is useful diagnostic method to detect mycobacteria before or in not available bronchoscopy.
Bronchoscopy* ; Diagnosis* ; Humans ; Nebulizers and Vaporizers ; Sputum* ; Tuberculosis, Pulmonary* ; Ultrasonics

Verruciform xanthoma is an uncommon benign lesion. The most common presentation occurs in the oral cavity; however, it has also been described in other sites, especially the penis. Herein is reported the first case of verruciform xanthoma of the penis in China, the fourteenth case in the literature. Clinically, genital verruciform xanthoma is often confuses with papillomas, verrucous carcinomas and squamous cell carcinomas, and therefore a histopathological diagnosis is necessary.
Carcinoma, Squamous Cell ; Carcinoma, Verrucous ; China ; Diagnosis ; Male ; Mouth ; Papilloma ; Penis* ; Xanthomatosis*

No abstract available.
Spleen*

PURPOSE: To report a case of a patient with cytomegalovirus (CMV) retinitis who was treated with oral valganciclovir. CASE SUMMARY: A 34-year-old man who had undergone anti-cancer chemotherapy for Non-Hodgkin lymphoma was referred to the ophthalmologic oncology clinic because of decreased vision in both eyes. Fundus examination showed white, opaque, and granular retinal lesions in both eyes, and a serologic test showed a positive response to CMV antibody IgG and a negative response to CMV antibody IgM. The patient received induction therapy with intravenous ganciclovir and maintenance therapy with oral valganciclovir 900 mg once daily. CMV retinitis reactivated 4 weeks after maintenance therapy was discontinued. At that point, the patient received induction therapy with oral valganciclovir 900 mg twice daily for 3 weeks and maintenance therapy with 900 mg once daily for 5 weeks. The retinal lesion disappeared and did not recur after oral administration of valganciclovir. The patient discontinued valganciclovir after 5 weeks of maintenance therapy, and CMV retinitis did not reactivate during 6 months of follow-up. CONCLUSIONS: Oral valganciclovir was clinically effective in the treatment of CMV retinitis in a patient who was treated with anti-cancer chemotherapy for non-Hodgkin lymphoma.
Administration, Oral ; Adult ; Cytomegalovirus ; Cytomegalovirus Retinitis ; Eye ; Follow-Up Studies ; Ganciclovir ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Lymphoma, Non-Hodgkin ; Retinaldehyde ; Retinitis ; Serologic Tests ; Vision, Ocular

Addisons disease is relatively rare than secondary adrenal insufficiency and result from progressive adrenocortical destruction. The common causes are idiopathic autoimmune atrophy and tuberculosis of adrenal glands. It is generally regarded as incurable in the sense that substitution therapy is required for the rest of the patients life. We report a case of tuberculous primary adrenal insufficiency which was confirmed by biopsy. This case was treated with antituberculous medication and showen to have improved adrenocortical function after six months.
Addison Disease* ; Adrenal Glands ; Adrenal Insufficiency ; Atrophy ; Biopsy ; Humans ; Tuberculosis

Pneumatosis intestinalis is an uncommon condition that is characterized by the presence of gas within the bowel wall. We experienced a case of pneumatosis intestinalis after cession of chemotherapy and we herein report on this case. A 58-year old man was admitted to our hospital for the evaluation of incidentally recognized pneumatosis intestinalis. He was diagnosed as having non small cell lung cancer in August 2006 and he received radiation therapy for concomitant brain metastasis and SVC syndrome in September 2006. He achieved a partial response after completing 6 cycles of chemotherapy with gemcitabine and cisplatin. Newly enlarged lymph nodes were observed on the follow-up CT, and chemotherapy with paclitaxel and carboplatin was started in July 2007. Due to the lack of a response, the therapeutic regimen was switched to oral erlotinib. After 1 month of treatment, the follow-up CT for response evaluation revealed pneumatosis intestinalis in the ascending colon without any subjective symptoms such as fever or abdominal pain. The laboratory results were within the normal range except for a slight increase of leukocytes. He underwent right hemicolectomy, but he didn't survive his postoperative acute renal failure and pneumonia
Abdominal Pain ; Acute Kidney Injury ; Brain ; Carboplatin ; Cisplatin ; Colon, Ascending ; Deoxycytidine ; Fever ; Follow-Up Studies ; Humans ; Leukocytes ; Lung ; Lung Neoplasms ; Lymph Nodes ; Neoplasm Metastasis ; Paclitaxel ; Pneumonia ; Quinazolines ; Reference Values ; Small Cell Lung Carcinoma ; Erlotinib Hydrochloride

BACKGROUND: Serum eosinophil cationic protein(ECP) level has been proposed as a indirect marker of eosinophilic inflammation of the airway in bronchial asthma. OBJECTIVE: To evaluate serum ECP against indirect clinical markers of disease, we compared bronchial obstruction, bronchial hyperresponsiveness and peripheral blood eosinophil counts, total IgE with serum ECP levels in patients with bronchial asthma and normal controls. METHOD: Fourty-two patients with bronchial asthma and twenty-six normal controls were enrolled. Measurement were made by spirometry, inhalation challenge with methacholine, peripheral blood eosinophil counts, total IgE and FEIA(fluoroenzymatic immunoassay) of serum ECP RESULT: Serum ECP levels were significantly higher in asthmatic patients than normal controls(p<0.0,5). Serum ECP levels were correlated with peripheral blood eosinophil counts(p<0.01, r=0.544) and bronchial hyperresponsiveness(PC,)(p<0.01, r=-0.456) in patients with bronchial asthma. Serum ECP levels were correlated with degree of bronchial obstruction(FEV, % to predicted value, FEV1/FVC%) in total subjects, but not in asthmatic patients. CONCLUSION: Serum ECP level may be used as indicator of disease activity in bronchial asthma and be helpful in differentiation between normal person and asthmatic patients on simple serological method. Further studies on the changes of serum ECP levels according to disease course and therapeutic responses are needed.
Asthma* ; Biomarkers ; Eosinophil Cationic Protein* ; Eosinophils ; Humans ; Immunoglobulin E ; Inflammation ; Inhalation ; Methacholine Chloride ; Spirometry