No abstract available.

PURPOSE: Colorectal perforation is a rare malady, but it usually presents abdominal emergency with high morbidity and mortality. It is very difficult to diagnose stercoral, idiopathic, or steroid induced perforation because these are very rare, but they show high mortality. The aims of this study are to: 1) evaluate and compare the characteristics of stercoral, idiopathic and steroid induced perforation with other perforations; and to 2) guide the diagnostic approach and treatment of these rare colon perforations. METHODS: We retrospectively reviewed thirty five patients underwent surgery for colorectal perforation at the Department of Surgery, Daedong Hospital, from November 1996 to January 2005. Age, gender, perforation site, grade of peritonitis, methods of operation and mortality rates were compared between the various causes. Logistic regression was used to evaluate their effect on mortality. RESULTS: There were 10 cases of iatrogenic colorectal injuries (28%), 7 of steroid induced colorectal perforation (20%), 5 of stab (14%), 4 of diverticulitis (11%), 4 of stercoral (11%), 3 of idiopathic (8%), and 2 of cancer induced perforation (5%). Total mortality rate of all the cases was 28.5% (10 out of 35) but the mortality of stercoral, steroid induced and idiopathic perforation was 57% (8 out of 14). The mortality rate was higher in older age group (60 years above) (40%), stercoral (75%), steroid induced (57%) and idiopathic (33%), preoperative systemic inflammatory response (SIRS) (42%), preoperative septic shock (83%), abnormal WBC count (10,000/mm3 above or 4,000/mm3 below) (53%), left colon perforation (36%) and diffuse peritonitis (56%). The mortality rate was lower in young age group (13%), iatrogenic (10%), stab (0%), right colon perforation (10%) and localized peritonitis (5%). The peritonitis grade (Hinchey's stage) of idiopathic group, cancer and stercoral was worse (III-IV grade: 75%, 100%, 75%) than that of diverticulitis, iatrogenic and stab (III-IV grade: 25%, 30%, 40%). CONCLUSION: The stercoral, steroid induced and idiopathic colorectal perforation was rare, difficult to diagnose but it showed high mortality. The characteristics of these are an older age, presenting with a high peritonitis grade, preoperative SIRS, preoperative septic shock, and occurrence below the splenic flexure. If surgeons encounter these perforations, they should perform prompt surgical management and intensive postoperative care to reduce the mortality.
Colon ; Colon, Transverse ; Diverticulitis ; Emergencies ; Humans ; Logistic Models ; Mortality ; Peritonitis ; Postoperative Care ; Retrospective Studies ; Shock, Septic

Severe fever with thrombocytopenia syndrome (SFTS) is firstly reported in China in 2011. Thereafter it is reported an infectious disease in Japan and Korea. It is caused by bunyavirus, called SFTS virus (SFTSV). The main vector of SFTS is Haemaphysalis longicornis tick. We investigated the distribution and detection of SFTSV in ticks collected from the environment using the dragging method and dry ice fogging method from May to November 2014 in Jeollanam-do, Korea. Sampling was taken from the province Suncheon, Gokseong, Boseong, Goheung where patients have occurred in 2013 and Gurye as control. Among the total 3,048 ticks collected, 3,030 ticks were H. longicornis (99.4%) and 18 were Amblyomma testudinarium. H. longicornis was collected 1,330 ticks in Gokseong, 1,188 ticks in Boseong, 240 ticks in Suncheon, 150 ticks in Goheung and 140 ticks in Gurye. Developmental stages by month of H. longicornis were revealed that nymph (92%) was collected from May to June, adult (30%) and nymph (70%) in July, and 93% of larvae from September to October. These results showed the different dominant stage of ticks according to seasons. However, no SFTSV-specific gene was detected in 3,030 ticks of H. longicornis.
Adult ; China ; Communicable Diseases ; Dry Ice ; Fever* ; Humans ; Japan ; Jeollanam-do* ; Korea* ; Larva ; Methods ; Nymph ; Orthobunyavirus ; Seasons ; Thrombocytopenia* ; Ticks* ; Weather

BACKGROUND: Preoperative autologous donation is one of the most widely used methods of autotransfusion. However donation of predetermined units cannot often be achieved because of falling hematocrit with donations going on. We studied on the minimal effective dosage of recombinant human erythropoietin(rhEPO) used in preoperative autologous donation. METHODS: We conducted randomized trial of rhEPO in 45 adults for posterior spinal fusion procedures who had basal hematocrit less than 40 percent. The patients received either nothing(control group) or rhEPO(25 or 50 units/kg) intravenously twice a week for 21 days, during which time up to 3 units of blood was collected. Patients were excluded from donation when their hematocrit values were less than 33 percent. All patient received iron sulfate(256mg orally three times daily). RESULTS: The mean number of units collected per patient(mean+/-SD) was 3+/-0 for the 50-unit group(P<0.05 when compared with control group), 2.84+/-0.36 for the 25-unit group and 2.67+/-0.49 for the control group. The red cell volume donated by the patients who received rhEPO(347 ml, 325 ml) was greater than that donated by the control group(255 ml, P<0.05). The differences between hematocrits of the first and the third preoperative donations were significantly less in 50-unit group(1.50+/-2.05) and 25-unit group(1.51+/-1.85) than that of control group(3.73+/-1.66). Two patients of the 25-unit group and 5 patients of the control group required additional homologous blood postoperatively. And there were no significant differences in the pattern of postoperative changes of hemoglobin and hematocrit among each group. CONCLUSIONS: Fifty units per kilogram of body weight is considered appropriate to be the minimal effective dosage for preoperative autologous donation.
Adult ; Blood Transfusion, Autologous ; Body Weight ; Cell Size ; Erythropoietin* ; Hematocrit ; Humans* ; Iron ; Spinal Fusion

Wegener's granulomatosis (WG) is a systemic necrotizing vasculitis belonging to the small- to medium-sized vessel. A 46-year-old male presented with erythematous hard plaque on chest, calf and multiple subcutaneous nodules on buttock, upper arm. Incisional biopsy was done and the histopathologic finding revealed the features of necrotizing vasculitis with focal granulomatous inflammation in subcutaneous tissue. PNS MRI showed abnormal meningeal enhancement and lung HRCT imaging showed mild infiltration. Inspite of severe systemic involvement, serum tests about ANCA showed negative result. He was treated with systemic corticosteroid and cyclophosphamide pulse therapy. Initially his condition showed improvement but later the disease worsened.
Antibodies, Antineutrophil Cytoplasmic ; Arm ; Biopsy ; Buttocks ; Cyclophosphamide ; Glycosaminoglycans ; Humans ; Inflammation ; Lung ; Male ; Middle Aged ; Subcutaneous Tissue ; Thorax ; Vasculitis ; Wegener Granulomatosis

Tinnitus-the perception of sound in the absence of an actual external sound-represents a symptom of an underlying condition rather than a single disease. Several theories have been proposed to explain the mechanisms underlying tinnitus. Tinnitus generators are theoretically located in the auditory pathway, and such generators and various mechanisms occurring in the peripheral auditory system have been explained in terms of spontaneous otoacoustic emissions, edge theory, and discordant theory. Those present in the central auditory system have been explained in terms of the dorsal cochlear nucleus, the auditory plasticity theory, the crosstalk theory, the somatosensory system, and the limbic and autonomic nervous systems. Treatments for tinnitus include pharmacotherapy, cognitive and behavioral therapy, sound therapy, music therapy, tinnitus retraining therapy, massage and stretching, and electrical suppression. This paper reviews the characteristics, causes, mechanisms, and treatments of tinnitus.
Auditory Pathways ; Autonomic Nervous System ; Cochlear Nucleus ; Massage ; Music Therapy ; Otoacoustic Emissions, Spontaneous ; Tinnitus

No abstract available.
Catheters* ; Peritoneal Dialysis, Continuous Ambulatory*

It is well documented that autotransfusion can reduce or eliminate the use of homologous blood. And recently many studies have shown that autotransfusion influences postoperative course so that patients transfused with autologous blood show less tumor recurrence rate or less wound infection rate than those transfused with homologous blood. So we conducted a study on autotransfusion compared with homologous transfusion in patients undergoing posterior spinal fusion procedures. Autotransfusion group consisted of predonation and hemodilution group. In predonation group (n=20), autotransfusion was performed by autologous preoperative donation, intraoperative salvage using Cell saver and postoperative salvage using Orth-evac drainage/ reinfusion device. In hemodilution group (n=20), autotransfusion was performed by acute normo-volemic hemodilution and intraand postoperative autotransfusion methods same as predonation group. Above autotransfusion group was compared with homologous transfusion group (n=20) on perioperative CBC (complete blood count) changes, amount and duration of postoperative drainage, transfusion side effects and complications associated with operation. Results are as follows, 1) 90% of patients in autotransfusion group could complete transfusion therapy without the use of homologous blood. 2) Total amounts of transfused blood were 1,733+/-567 ml (5.4+1.8 units) in predonation group, 1,539+/-712 ml (4.8+2.2 units) in hemodilution group and 4.7+/-1.3 units in homologous transfusion group. There is no statistically significant difference between autotransfusion and homologous transfusion group. 3) In predonation group, hemoglobin and hematocrit levels were significantly lower than those of homologous transfusion group preoperatively and at PAR (postanesthetic recovery), 2nd day and 7th day postoperatively. But at 14th day, the levels were recovered as high as those in homologous transfusion group. 4) In autotransfusion group, total amount and the duration of postoperative drainage were significantly less and shorter respectively than those of homologous transfusion group. 5) In homologous transfusion group, 60% of patients experienced one or more than one of transfusion side effects and one patient received emergency operation of hematoma evacuation immediate postoperatively. In autotransfusion group, 47.5% of patients showed fever above 38degree Centigrade, and all of which were associated with the use of postoperative autotransfusion but other complications associated with transfusion or operation could not be found. In conclusion, we think autotransfusion not only can reduce or eliminate the use of homologous blood but also seems to have beneficial influences on postoperative recovery.
Blood Transfusion, Autologous* ; Drainage ; Emergencies ; Fever ; Hematocrit ; Hematoma ; Hemodilution ; Humans ; Recurrence ; Spinal Fusion ; Wound Infection

BACKGROUND: Pressure rise time (PRT) is the time in which the ventilator aclieves the set airway pressure in pressure-targeted modes, such as pressure control ventilation (PCV). With varying PRT, in principle, the peak inspiratory flow rate of the ventilator also varies. And if PRT is set to a shorter duration, the effective duration of target pressure level would be prolonged. which in turn would increase inspiratory tidal volume(Vti) and mean airway pressure(Pmean). We also postulated that the increase in Vti with shortening of PRT may relate inversely to the patients' basal airway resistance. METHODS: In 13paralyzed patients on PCV(pressure control 18±9.5cm H2, FIO2 0.6±0.3, PEEP 5±3cm H2O, f20/min, I : E, 1 : 2) with Servo 300(Siemens-Elema, Solna, Sweden)from various causes of respiratory failure, PRT of 10%, 5% and 0% were randomly applied. At 30min of each PRT trial, peak inspiratory flow (PIF, L/sec), Vti(ml), Pmean(cm H2O) and ABGA were determined. RESULTS: At PRT 10, 5% and 0%, PIF were 01.69±0.13, 0.77±0.19, 0.83±0.22, respectively(p<0.001). Vti were 425±94, 439±101, 456±106, respectively(p<0.001), and Pmean were 11.2±3.7, 12.0±3.7, 12.5±3.8, respectively(p<0.001). pH were 7.40±0.08, 7.40 ±0.92, 7.41±0.96, respectively (p=0.004) ; PaCO2 (mm Hg) were 47.4±15.8, 47.2±15.7, 44.6±16.2, respectively (p=0.004) ; PAO2 - PaO2 (mm Hg) were 220±98, 224±95, 227±94, respectively(p=0.004) ; and Vd/Vt as determined by (PaCO2 - P CO2/PaCO2 were 0.67±0.07, 0.67±0.08, 0.66 ±0.08, respectively(p=0.007). The correlation between airway resistance and change of Vti from PRT 10% to 0% were r=-0.243(0.498). CONCLUSION: Shortening of pressure rise time during PCV was associated with associated with increased tidal volume, increased mean airway pressure and lower PaCO2.
Airway Resistance ; Humans ; Hydrogen-Ion Concentration ; Respiratory Insufficiency ; Tidal Volume* ; Ventilation* ; Ventilators, Mechanical

BACKGROUND: Vimentin is the major intermediate-size filament in the cytoplasm of cells from mesenchymal origin. The HL-60 cell is a unique human leukemic cell line capable of terminal differentiation with several chemical inducers, and then the cell line becomes a fre#quently described model system for cell differentiation in vitro. Vimentin mRNA is reduced during all-trans retinoic acid (retinoic acid) -dependent differentication but increased by 12-0-tetradecanoylphorbol-13-acetate (TPA). In this paper, we have investigated on the mechanism of transcriptional repression of vimentin gene during retinoic acid-dependent differentication of HL-60 cell. METHODS: HL-60 cells were grown in RPMI 1640 medium supplemented with 10% heat-inactivated fetal bovine serum and antibiotics in a humidified 5% CO at 37C. Total RNA was prepared by a modification of the method of Karlinsey et al. Northern blot hybridization was performed by the method of Virca et al. EcoRI fragment of pVIM-GEM was used as probe for vimentin mRNA. DNA mobility shift assay was performed by the method of Lim et al. End labeled DNA probe (Upper strand, 5-CGCITGATGAGTCAGCCG-3) for AP-1 binding activity was mixed with nuclear extracts in a 20 pL reaction volume containing 300 mM KCI, 60 mM HEPES, pH 7.9, 25mM MgC1, 1mM EDTA, 1mM DTT, 60% glycerol, and 2 pg of poly[dI-dC]. RESULTS: The level of vimentin mRNA was decreased at 12 hours after retinoic acid treatment, and not detected at 48 hours. The level of vimentin mRNA was reduced in proportion to concentration of retinoic acid, Retinoic acid-reduced vimentin mRNA was no change in cells treated with cycloheximide. Retinoic acid-dependent decrease of vimentin mRNA was partially recovered by staurosporin pretreatment. In DNA mobility shift assay, AP-1 binding activity was reduced at 48 hr during retinoic acid-induced differentiation. CONCLUSION: These results suggest that the transcriptional repression of vimentin gene during retinoic acid-induced differentiation in HL-60 cells is correlated with reduction of DNA binding activity of AP-1.
Anti-Bacterial Agents ; Blotting, Northern ; Cell Differentiation ; Cell Line ; Cycloheximide ; Cytoplasm ; DNA ; Edetic Acid ; Electrophoretic Mobility Shift Assay ; Glycerol ; HEPES ; HL-60 Cells* ; Humans ; Hydrogen-Ion Concentration ; Repression, Psychology* ; RNA ; RNA, Messenger ; Transcription Factor AP-1 ; Tretinoin ; Vimentin*