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

No abstract available.
Cervix Uteri* ; Drug Therapy, Combination* ; Female ; Fluorouracil*

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*

No abstract available.
Scimitar Syndrome*

Since early 1980's high resolution ultrasound has been world-widely used for detection of cranial lesions ininfants but not widely used in korea. Authors prospectively analysed ultrasonographic findings of 107 cases whichwere confirmed by CT, autopsy or follow-up studies as supplement. the distribution of 107 cases was intracranialhematoma 40 cases, hydrocephalus 36 cases, hypoxic-ischemic encephalopathy 10 cases, porencephalic cyst 5 cases,cephalhematoma 5 cases, agenesis of corpus callosum 4 cases, medulloblastoma 2 cases and each one case of A-Vmalformation, intraventricular cyst, Dandy Walker cyst, lipoma and hydranecephaly. We could conclude thatneurosonography of infants was very useful and effective method in detection of cranial lesions such asintracranial hematoma, especially germinal matrix hemorrhage or intraventricular hemorrhage in preterm infant,hydrocephalus, hypoxic-ischemic encephalopathy and congenital anomalies.
Agenesis of Corpus Callosum ; Autopsy ; Follow-Up Studies ; Hematoma ; Hemorrhage ; Humans ; Hydrocephalus ; Hypoxia-Ischemia, Brain ; Infant ; Korea ; Lipoma ; Medulloblastoma ; Methods ; Prospective Studies ; Ultrasonography ; Walkers

A pathological study was done to elucidate sequential changes of the lungs in various time intervals following experimental paragonimiasis in 15 dogs and 15 cats. The dogs and cats were fed with 30-50 metacercariae of Paragonimus westermani, and were sacrificed at 15, 20, 30, 45, 60, 90 and 120 days after infection respecively. Autopsies were performed immediately after death. Gross and microscopic examination of the lungs showed following findings: There were no qualitative difference in pathological findings between dogs and cats. Pathological findings were first noticed at 20 days of infection in thoracic cavity, which consisted of fibrinous plueritis along with superficial hemorrhage. Although no worm was found in the lung parenchyma at this period, juveniles were seen in pleural cavity together with turbid effusion. Paragonimus juveniles were first recognized inside the lung parenchyma by 30 days of infection. This was the period when the lungs showed multiple areas of hemorrhage and probably active penetration by smaller worms. Hemorrhagic bronchopneumonia was quite pronounced from this stage through 45 days of infection. Paragonimus worm cyst was essentially composed of fibrous scar and heavy inflammatory cellular infiltrate. The lining epithelial cells were first became noticed by 2 months of infection. And these epithelial cells were thought to be probably transformed alveolar lining cells rather than bronchiolar epithelial cells. As the infection progress, the cyst wall became more stabilized and often showed squamous metaplasia. Fibrinous pleuritis with pleural effusion was very prominent finding in early periods of infection. Bronchiolitis and focal vascular sclerosis were often seen in experimental paragonimiasis.
parasitology-helminth-trematoda ; Paragonimus westermani ; paragonimiasis ; pneumonia ; cyst ; hemorrhage ; pleuritis ; effusion ; bronchiolitis ; sclerosis

No abstract available.
Leukemia, Promyelocytic, Acute*

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

No abstract available.
Spinal Muscular Atrophies of Childhood*

In order to elucidate the biological effects of pulsating magnetic field in in vitro culture system we designed a pulsating magnetic apparatus using 120 Hertz, 24 Volt direct current. It can generate 63~225 Gauss in the experimental area of 90 mm petri dish, and has little thermal effect on the culture media in 37.5oC, 5% CO2. Human osteogenic sarcoma (HOS) cells were cultured in the pulsating magnetic field and the nuclear changes of cultured cells were observed routinely by hematoxylin staining, and apoptotic change was detected by ApopTag staining using both peroxidase and fluorescein labelings. Compared to the control group which formed well organized whorling pattern of HOS cell line in 3 days culture, the HOS cells cultured in the pulsating magnetic field for 12 hours or 24 hours grew irregularly and showed increased number of apoptotic cells. When the flow of pulsating magnetic field was interrupted by insertion of strong permanent magnetic bar (1000 Gauss, 5530 mm) beneath the petri dish during in vitro culture, the area of sparse pulsating magnetic field showed active proliferation and aggregation of HOS cells even in 24 hour exposure group. These data suggest that the pulsating magnetic field may play a role in inducing growth retardation and apoptosis of HOS cells. Furthermore, the hazardous effects of pulsating magnetic field can be lessened or nullified by the interruption of pulsating magnetic field with a strong permanent magnetic bar.
Apoptosis ; Cell Line* ; Cells, Cultured ; Culture Media ; Fluorescein ; Hematoxylin ; Humans* ; Magnetic Fields* ; Osteosarcoma* ; Peroxidase