BACKGROUND: Unplanned extubation (UE) of patients requiring mechanical ventilation in an intensive care unit (ICU) is associated with poor outcomes for patients and organizations. This study was conducted to assess the clinical features of patients who experienced UE and to determine the risk factors affecting reintubation after UE in an ICU. METHODS: Among all adult patients admitted to the ICU in our institution who required mechanical ventilation between January 2011 and December 2013, those in whom UE was noted were included in the study. Data were categorized according to noninvasive or invasive management after UE. RESULTS: The rate of UE was 0.78% (the number of UEs per 100 days of mechanical ventilation). The incidence of self-extubation was 97.2%, while extubation was accidental in the remaining patients. Two cases of cardiac arrest combined with respiratory arrest after UE were noted. Of the 214 incidents, 54.7% required invasive management after UE. Long duration of mechanical ventilation (odds ratio [OR] 1.52; 95% confidence interval [CI] 1.32-1.75; p = 0.000) and high ICU mortality (OR 4.39; 95% CI 1.33-14.50; p = 0.015) showed the most significant association with invasive management after UE. In multivariate analysis, younger age (OR 0.96; 95% CI 0.93-0.99; p = 0.005), medical patients (OR 4.36; 95% CI 1.95-9.75; p = 0.000), use of sedative medication (OR 4.95; 95% CI 1.97-12.41; p = 0.001), large amount of secretion (OR 2.66; 95% CI 1.01-7.02; p = 0.049), and low PaO2/FiO2 ratio (OR 0.99; 95% CI 0.98-0.99; p = 0.000) were independent risk factors of invasive management after UE. CONCLUSIONS: To prevent unfavorable clinical outcomes, close attention and proper ventilatory support are required for patients with risk factors who require invasive management after UE.
Adult ; Heart Arrest ; Humans ; Incidence ; Intensive Care Units* ; Critical Care* ; Mortality ; Multivariate Analysis ; Respiration, Artificial ; Risk Factors

We found an error in this article. The Fig. 1A.

Invasive aspergillosis (IA) is most commonly seen in patients with risk factors, such as cytotoxic chemotherapy, prolonged neutropenia, corticosteroids, transplantation and acquired immune deficiency syndrome. IA commonly occurs in the respiratory tract. Extrapulmonary aspergillosis is usually a part of a disseminated infection, and primary invasive intestinal aspergillosis is very rare. Herein, we report a case of an immunocompetent 53-year-old male who suffered recurrent septic shock in the intensive care unit (ICU) and was finally diagnosed as invasive intestinal aspergillosis without dissemination. IA is rarely considered for patients who do not have an immune disorder. Thus, when such cases do occur, the diagnosis is delayed and the clinical outcome is often poor. However, there is a growing literature reporting IA cases in patients without an immune disorder, mostly among ICU patients. Primary intestinal aspergillosis should be considered for critically ill patients, especially with severe disrupted gastrointestinal mucosal barrier.
Acquired Immunodeficiency Syndrome ; Adrenal Cortex Hormones ; Aspergillosis* ; Critical Illness ; Diagnosis ; Drug Therapy ; Gastrointestinal Diseases ; Humans ; Immune System Diseases ; Immunocompromised Host* ; Intensive Care Units ; Male ; Middle Aged ; Neutropenia ; Respiratory System ; Risk Factors ; Shock, Septic

A xanthoma is a localized collection of tissue histiocytes containing lipid and is usually associated with hyperlipidemia. Tendinous and tuberous xanthomatosis have been found in association with familial hypercholesterolemia, Type III hyperlipidemia, beta-sitosterolemia and cerebrotendinous xanthomatosis. Tendinous and tuberous xanthomatosis without hyperlipidemia have been reported very rarely. Especially tendinous xanthomatosis without hyperlipidemia have not been reported at all in korea. We are reporting a patient with tendinous and tuberous xanthomatosis accompanied by normal plasma lipids
Histiocytes ; Humans ; Hyperlipidemias ; Hyperlipoproteinemia Type II ; Korea ; Plasma ; Xanthomatosis ; Xanthomatosis, Cerebrotendinous

Conventional medical therapies have not been very successful in treating adults with refractory septic shock. The effects of direct hemoperfusion using polymyxin B and veno-arterial extracorporeal membrane oxygenation (ECMO) for refractory septic shock remain uncertain. A 66-year-old man was admitted to the emergency department and suffered from sepsis-induced hemodynamic collapse. For hemodynamic improvement, we performed direct hemoperfusion using polymyxin B. Computed tomography scan of this patient revealed emphysematous pyelonephritis (EPN), for which he underwent emergent nephrectomy with veno-arterial ECMO support. To the best of our knowledge, this is the first report of successful treatment of EPN with refractory septic shock using polymyxin B hemoperfusion and nephrectomy under the support of ECMO.
Adult ; Aged ; Emergency Service, Hospital ; Endotoxins ; Extracorporeal Membrane Oxygenation* ; Hemodynamics ; Hemoperfusion ; Humans ; Nephrectomy* ; Polymyxin B ; Pyelonephritis ; Shock, Septic*

Mucormycosis is an uncommon opportunistic fungal infection mostly affecting immunocompromised patients and gastrointestinal mucormycosis is a rare and life-threatening. We describe a 31-year-old man with a history of idiopathic cyclic neutropenia who developed perforations of the stomach and intestine and intra-abdominal bleeding due to disseminated gastrointestinal mucormycosis after the initial operation.
Adult ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Immunocompromised Host ; Intestines ; Mucormycosis* ; Neutropenia ; Stomach

No abstract available.
Hypopituitarism* ; Hypothyroidism*

Routine neonatal circumcision has widely performed without anesthesia under the assumption that the penis of neonates does not yet have functioning pain sensory nerve endings at this early stage of development. However, there was no experimental evidence supporting this hypothesis or critical age of limit for routine neonatal circumcision. We evaluated the physiologic responses of 26 infants during operation of circumcision without anesthesia through checking the crying time by sound recording and heart rate by EKG monitoring. Mean chronological and gestational age of neonates at circumcision were 17.9+/-7.6 hours and 277.5+/-10.4 days respectively. Mean operation time was 7.8+/-2.7 min. The patients were crying for average 72% (5.3+/-l.6min.) of total operation time and heart rates were increased by average 19.0% of their basal heart rates. The pattern of change of physiologic stress showed increasing tendency according to the gestational age rather than chronological age. We conclude that employing local anesthesia is needed to alleviate such pain or physiologic stress and we might consider the gestational age of neonates in case of circumcision without anesthesia.
Anesthesia ; Anesthesia, Local ; Circumcision, Male* ; Crying ; Electrocardiography ; Female ; Gestational Age ; Heart Rate ; Humans ; Infant ; Infant, Newborn ; Male ; Penis ; Sensory Receptor Cells

No abstract available.
Thumb*

We report the case of a 24-year-old man suffering from a pituitary diabetes insipidus associated with massive urinary tract dilatation with infravesical obstruction. The patient had been admitted and diagnosed to bulbous urethral stricture in our department. Endoscopic internal urethrotomy had been performed for his urethral stricture, but his abdominal distention had not been improved. About 1 year later, he was revisited to emergency room due to painful gross total hematuria and abdominal distention after trivial abdominal blunt trauma. On the abdominal CT finding, the right renal pelvis was collapsed, from which the contrast media was extravasated. The right pyeloplasty, nephrostomy, ureteral stent indwelling and suprapubic cystostomy were performed. During immediate postoperative management, extreme fluid and electrolyte imbalances were occurred. However, we overcame these troubles using hypotonic saline and hormonal replacement. So we reported this case with literatures.
Contrast Media ; Cystostomy ; Diabetes Insipidus, Neurogenic* ; Dilatation ; Emergency Service, Hospital ; Hematuria ; Humans ; Hydronephrosis* ; Kidney Pelvis ; Stents ; Tomography, X-Ray Computed ; Ureter ; Urethral Stricture ; Urinary Tract ; Young Adult