Consideration of the nutritional status of patients with acute respiratory failure and mechanical ventilation is important for effective patient assessment and management. Patients with acute respiratory failure are at a high risk for developing malnutrition. High glucose intakes given during the administration of total parenteral nutrition (TPN) have been demonstrated to increase CO2 production. The workload imposed by the high CO2 production may precipitate respiratory distress in patients experiencing compromised pulmonary function. The authors report a case of successful weaning from mechanical ventilation in patient with post-operative ARDS by proper nutritional support and by changing the proportion of calories derived from carbohydrates and fats. Substitution of fat calories for carbohydrate in TNA solutions can reduce CO2 production and help wean patients from mechanical ventilation. Conclusively, the TNA (total nutrients admixture) system is more beneficial to patients with acute respiratory failure due to less CO2 production and surfactant production than TPN. For patients with hypercapnia, providing 25% to 30% of calories as carbohydrate and 50% to 55% of calories from fat may be beneficial.
Carbohydrates ; Fats ; Glucose ; Humans ; Hypercapnia ; Malnutrition ; Nutritional Status ; Nutritional Support* ; Parenteral Nutrition, Total ; Respiration, Artificial ; Respiratory Insufficiency* ; Ventilator Weaning* ; Ventilators, Mechanical* ; Weaning

Although rare, renal arteriovenous fistulas have been discovered with increasing frequency since they were first described by Varela in 1923. Arteriovenous fistulas are classified as either congenital or acquired. The diagnosis of this condition is usually made by use of renal angiograms. In case of hematuria and/or hypertension either intra-arterial embolization or surgical excision and clipping of the arterial branch can be done. Intra-arterial superselective embolization seems to cause less functional loss of the renal parenchyme, whereas excision often leads to heminephrectomy or even total nephrectomy. Herein, we describe a case treated successfully in recurred renal A-V fistula after transcatheter embolization by Gianturco steel coil and reviewed the literature of renal A-V fistulas.
Arteriovenous Fistula ; Diagnosis ; Fistula* ; Hematuria ; Hypertension ; Kidney ; Nephrectomy ; Retreatment* ; Steel*

PURPOSE: Various factors have been cited in the morbidity of small bowel resections, but their clinical importance is uncertain. We wanted to know what were the significant risk factors elevating the morbidity and how to reduce the morbidity of small bowel resections effectively. METHODS: A retrospective study was done for 107 patients who had undergone small bowel resections from Jan. 1992 to Jul. 1999. The patients were evaluated based on sex and age, the cause and site of resection, the presence of previous abdominal operations, the morbidity, the mortality, and the cause of death in order to determine their clinical significance for small bowel resections. Also the differences of morbidity were analyzed according to the risk factors of old age, pre-op hypotension and hypoalbuminemia, the cause of resection, emergency operation, the presence of a previous abdominal operation, the length of the resection, the presence of associated chronic illness, and spillage of the intestinal content. RESULTS: Complications after small bowel resections occurred in 41 cases (38.3%). The morbidity was significantly increased in the cases with associated chronic illness and spillage of intestinal content by perforation combined with strangulation (p<0.05). Factors such as old age, hypotension, hypoalbuminemia, cause of resection, emergency operation, the length of the resection and spillage of intestinal contents by simple perforation elevated the morbidity, but this result is not statistically significant (0.050.5). CONCLUSIONS: We concluded that intensive peri-operative care, a rapid and precise operative technique, and the surgeon's efforts can decrease the morbidity and the mortality after small bowel resections. The selection of the high risk patients should be done based on the surgeon's knowledge of the risk factors including associated chronic illness, and cumulative data obtained by using instituted surveillance for morbidity.
Cause of Death ; Chronic Disease ; Emergencies ; Gastrointestinal Contents ; Humans ; Hypoalbuminemia ; Hypotension ; Mortality ; Retrospective Studies ; Risk Factors*

OBJECTIVE: The purpose of this study was to evaluate the ultrasonographic (US) findings in the shoulder impingement syndrome and to correlate them with the Hawkins and Kennedy's clinical stages. METHOD: 41 patients with suspected shoulder impingement syndrome were evaluated. All patients were divided into 3 clinical groups according to Hawkins and Kennedy and US examination was done in each group. RESULTS: US findings were as follows. In stage I, there were 3 normal findings, 5 tendinitis of the rotator cuff (RC), 2 partial thickness tear of RC, and 0 full thickness tear of RC. In stage II, 6 normal findings, 13 tendinitis of RC, 3 partial thickness tear of RC and 2 full thickness tear of RC. In stage III, 0 normal findings, 1 tendinitids of RC, 1 partial thickness tear of RC, and 5 full thickness tear of RC. The most common findings in the tendinits of RC were tendon thickness, focal hypoechogenicity and calcification. In partial thickness tear of RC, focal hypoechogenicity and impingement in abduction were most common findings. In full thickness tear of RC, the irregular humeral head surface and the biceps tendon effusion were most common findings CONCLUSION: The ultrasonography is a valuable means of evaluating the shoulder impingement syndrome and its findings have good correlation with clinical stages
Humans ; Humeral Head ; Rotator Cuff ; Shoulder Impingement Syndrome* ; Shoulder* ; Tendinopathy ; Tendons ; Ultrasonography*

Gymnopilus spectabilis, a hallucinogenic mushroom belonging to the family Cortinariaceae, is found growing in dense clusters on stumps and logs of hardwoods and conifers. It contains the hallucinogenic alkaloid psilocybin and its strongly bitter taste makes it undesirable as an edible. In an effort to identify chemical constituents of Korean native wild mushrooms, 4,6-decadiyne-1,3,8-triol (1), ergosta-4,6,8(14), 22-tetraen-3-one (2), bisnoryangonin (3), and hispidin (4) were isolated from the methanolic extract of the fruiting bodies of G. spectabilis. Their structures were assigned on the basis of various spectroscopic studies. Compounds 3 and 4 displayed significant scavenging activity against the ABTS radical cation, DPPH radical, and superoxide radical anion, while 1 and 2 exhibited no antioxidant activity.
Agaricales ; Benzothiazoles ; Coniferophyta ; Fruit ; Humans ; Methanol ; Pyrones ; Sulfonic Acids ; Superoxides

Scrub typhus is caused by Orientia tsutsugamushi characterized by fever, headache, lymphadenopathy and eschar formation. Infiltration of inflammatory cells around blood vessels and within the affected organs is known to be pathologic hallmark of the scrub typhus. Recently, expression of adhesion molecules on vascular endothelial cells was implicated as an important pathogenic mechanism in rickettsial disease. This study was performed to examine the expression of adhesion molecules and to investigate its role in the pathogenesis of O. tsutsugamushi infection. The expression of adhesion molecules on human umbilical vein endothelial cells (HUVEC) was measured by flow cytometry and indirect immunofluorescence. Expression of E-selectin, ICAM-1 and VCAM-1 was significantly increased 4 hours after the infection and persisted at least for 24 hours. Expression of those molecules was not induced by killed O. tsutsugamushi. Adhesion of polymorphonuclear cells and mononuclear cells to HUVEC was increased after the infection with O. tsutsugamushi. In conclusion, adhesion molecules are expressed on HUVEC during the infection of live O. tsutsugamushi and those molecules can contribute to the infiltration of inflammatory cells during the infection.
Blood Vessels ; E-Selectin ; Endothelial Cells ; Fever ; Flow Cytometry ; Fluorescent Antibody Technique, Indirect ; Headache ; Human Umbilical Vein Endothelial Cells* ; Humans* ; Intercellular Adhesion Molecule-1 ; Lymphatic Diseases ; Orientia tsutsugamushi* ; Scrub Typhus ; Vascular Cell Adhesion Molecule-1

In patients having malignant or aggressive bone tumors around the knee joint and requiring amputation, segmental resection and rotationplasty was performed and the clinical results were analyzed. Twenty-six patients underwent segmental resection and rotationplasty between February 1988 and June 1994. The mean follow-up period was 57 (6 - 120) months and the average age of patients was 21.4 (5 - 37) years. Out of 26 patients, there were 18 osteosarcomas (> or = stage IIB), 2 synovial sarcomas, and 6 giant cell tumors. Clinical results were evaluated by the Shriner's rating system. Four patients were excluded due to death or amputation and the remaining twenty-two patients were included for assessment. Eighteen patients had excellent results, 3 good, and 1 fair. Range of motion of the ankle joint was -11 (dorsiflexion) - 80 (plantarflexion) degrees and daily walking activity was possible. Local recurrence developed in 2 patients and distant metastasis in 10. Early complications include 3 thromboses and 1 sepsis, and late complications were 6 nonunion, 2 malrotation and 1 stiffness of the ankle joint. Rotationplasty, which is functionally excellent, may serve as an effective partial limb salvage procedure, especially in patients younger than 10 years old who are expected to have leg length discrepancy or loosening of the tumor prosthesis due to the growth of the medullary cavity or when amputation is inevitable for a wide resection margin.
Adolescent ; Adult ; Bone Neoplasms/*surgery ; Child ; Child, Preschool ; Female ; Giant Cell Tumors/*surgery ; Human ; Knee Joint/*surgery ; Male ; Neoplasm Recurrence, Local ; *Orthopedic Procedures/adverse effects ; Osteosarcoma/*surgery ; Retrospective Studies ; Rotation ; Sarcoma, Synovial/*surgery ; Treatment Outcome

PURPOSE: Among persons sustaining severe burns, burn wound infection may develop into devastating sepsis. The purpose of this study is to validate the risk factors for burn wound infection in order to increase the effectiveness of the early treament of those patients at high risk for burn wound infection. METHODS: We retrospectively evaluated 155 hospitalized burn patients with an affected burn area greater than 20% extent and who underwent wound culture because of clinically suspected wound infection from March 1997 to December 2000. RESULTS: When patient age, cause of burn, total burn surface area (TBSA), full thickness burn area (FTBA), anatomical distribution of burn, dehydration at admission treated as independent variables, TBSA and FTBA were seen to significantly influence the burn wound infection rate (p<0.05). When the length of hospital stay, interval from burn to skin graft, outcome of burn were taken as independent variables, the length of hospital stay and outcome of burn were significantly influenced by burn wound infection (p<0.05). CONCLUSION: The high risk group for wound infection comprises patients with extensive TBSA or FTBA and should be selected early to undergo intensive treatment as follows ; meticulous wound monitoring and aseptic maneuver, early eschar excision and early skin graft, adequate nutritional support, isolation against hospital-acquired infection, judicious antibiotic management based on antimicrobial susceptibility testing and control of emergent antibiotic-resistant bacteria.
Bacteria ; Burns* ; Dehydration ; Humans ; Length of Stay ; Nutritional Support ; Prognosis ; Retrospective Studies ; Risk Factors* ; Sepsis ; Skin ; Transplants ; Wound Infection* ; Wounds and Injuries*

PURPOSE: With the increasing use of neoadjuvant chemotherapy and minimally invasive therapy, the accuracy of preoperative determination of breast tumor size and axillary lymph node status become more important. The purpose of this study was to correlate physical examination, mammographic, and ultrasonographic measurements of tumor size and regional lymph node status with pathologic findings and to evaluate the accuracy of various preoperative examination methods. METHODS: Ninety patients presenting with palpable primary breast cancer treated with mastectomy or breast conserving surgery with axillary dissection were measured breast tumor size and axillary lymph node status by physical examination, mammography, and high resolution duplex ultrasonography, and correlated with the values obtained at pathologic examinations. RESULTS: The sensitivity of mammography and sonography for breast tumor were 82.5% and 90.8%, respectively. The average diameter of tumors was 3.39+/-1.77 cm on pathologic examination. Physical examination demonstrated the highest correlation coefficient (r=0.759) in measurement of the tumor size. The sensitivity of physical examination mammography, and sonography for axillary node involvement were 37.5%, 57.7%, and 73.9%, respectively, and with specificity of 98.1%, 86.5%, and 92.9%, respectively, and with positive predictive value of 93.8%, 75.0%, and 85.0%, respectively. CONCLUSION: Physical examination is the best non-invasive predictor of the real size of palpable primary breast cancer, whereas high resolution duplex ultrasonography is most sensitive assessment method of axillary lymph node status. The specificity of axillary nodal status can be increased by fine-needle biopsy under sonographic guidance and it can be serve as useful adjuncts to sentinel node biopsy.
Biopsy ; Biopsy, Fine-Needle ; Breast Neoplasms* ; Breast* ; Drug Therapy ; Humans ; Lymph Nodes* ; Mammography* ; Mastectomy ; Mastectomy, Segmental ; Neoplasm Metastasis* ; Physical Examination* ; Sensitivity and Specificity ; Ultrasonography*

The histological distinction between benign and malignant phyllodes tumors (PT) is often difficult and arbitrary. We analyzed clinical, histological features and expressions of Ki-67 and p53 using immunohistochemistry and estimate its significance in assessing the grade of malignancy and in predicting the clinical behavior of these tumors on 20 cases of PT of the breast (11 benign, 3 low-grade malignancy and 6 high-grade malignancy). Statistically significant differences between benign, low-grade malignant, and high-grade malignant PT by size of tumor, cellular atypism, stromal cellularity, margin of tumor, and number of mitotic figures. The mean labeling index (LI) of Ki-67 in high-grade malignant PT (9.6+/-9.6) was three-fold higher than that in benign PT (2.7+/-2.2), but this difference was not statistically significant (P=0.074). None of the benign PT were positive for p53, whereas 2 of 3 low-grade malignant and 3 of 6 high-grade malignant PT were positive for p53. Statistically significant differences in the pattern of p53 expression existed among the benign, low-grade malignant, and high-grade malignant lesions (P=0.018). Ki-67 LI and p53 expression were associated with numbers of mitotic figure, but were not associated with metastasis (P=0.546 and 0.216). Increased p53 immunoreactivity is present in high-grade and low-grade malignant PTs in contrast to benign PTs, and malignant PT had a higher Ki-67 LI than benign PT. Thus, p53 and Ki-67 expression may assist in distinguishing benign from malignant PT in diagnostically difficult cases.
Breast* ; Immunohistochemistry ; Neoplasm Metastasis ; Phyllodes Tumor* ; Prognosis