BACKGROUND: Homelessness is associated with an increased risk of exposure to Mycobacterium tuberculosis. Several factors, including alcoholism, malnutrition, lack of stable housing, combine to make tuberculosis more prevalent in the homeless. The aims of this study were to determine the factors associated with increasing success rate of tuberculosis treatment in the homeless. METHODS: A cross-sectional analysis of the clinical features in 142 pulmonary tuberculosis-positive homeless patients admitted to the Busan Medical Center from January 2001 to December 2010 was carried out. These results were compared with a successful treatment group and incomplete treatment group. We also evaluated the risk factors of treatment non-completion. Statistical analysis for the comparisons was performed using a chi2 test, independent samples t-test, and multiple logistic regression. RESULTS: Comparison of clinical characteristics showed significant differences between the two groups in the type of residence (P < 0.001), diseases with risk factors (P = 0.003), and history of tuberculosis treatment (P = 0.009). Multiple regression analysis revealed the residence (odds ratio [OR], 4.77; 95% confidence interval [CI], 2.05 to 11.10; P < 0.001) and comorbidity with risk factor (OR, 2.72; 95% CI, 1.13 to 6.53; P = 0.025) to be independently associated with treatment success. CONCLUSION: To improve the success rate of tuberculosis treatment in the homeless person, anti tuberculosis medication should be taken until the end of treatment and a management system for the homeless person is required. Further social and medical concerns for stable housing and management of comorbidity may lead to an improvement in the successful tuberculosis treatment of homeless person.
Alcoholism ; Comorbidity ; Cross-Sectional Studies ; Homeless Persons ; Hospitals, Public ; Housing ; Humans ; Malnutrition ; Mycobacterium tuberculosis ; Risk Factors ; Tuberculosis ; Tuberculosis, Pulmonary

Rheumatic manifestations in non-Hodgkin's lymphoma (NHL) are common but actual arthritis as a presenting feature appears to be very rare. We experienced a case of NHL presenting as polyarthritis in a 24-year-old woman. Eight months ago she was admitted to the hospital due to polyarthritis and skin rash. She had pleural and pericardial effusion. Antinuclear antibody was positive and rheumatoid factor was negative. Joint X-ray showed periarticular osteopenia at both knees, wrists, hands and feet. Prednisolone, salsalate and anti-tuberculosis drugs were administered under the impression of either probable lupus or rheumatoid arthritis and pleural tuberculosis. After then pleuropericardial effusion and skin rash improved. But polyarthralgia persisted and she developed right cervical lymphadenopathy. On her second admission she was found to have a round mass in left lower lung field and multiple mediastinal lymph node enlargement. Cervical lymph node biopsy revealed non-Hodgkin's lymphoma. She received 8 cycles of systemic chemotherapy until 1996 July. NHL was remitted completely and polyarthralgia disappeared. We report a case of non-Hodgkin's lymphoma presenting as polyarthritis and literatures are reviewed.
Antibodies, Antinuclear ; Arthralgia ; Arthritis* ; Arthritis, Rheumatoid ; Biopsy ; Bone Diseases, Metabolic ; Drug Therapy ; Exanthema ; Female ; Foot ; Hand ; Humans ; Joints ; Knee ; Lung ; Lymph Nodes ; Lymphatic Diseases ; Lymphoma, Non-Hodgkin* ; Pericardial Effusion ; Prednisolone ; Rheumatoid Factor ; Tuberculosis, Pleural ; Wrist ; Young Adult

Mucopolysaccharidosis is characterized by the progressive accumulation of glycosaminoglycans in multiple organs. Valve and coronary involvement, upper airway obstructive disease, joint stiffness, and mental retardation are associated perioperative anesthetic risks. Nineteen patients and 23 anesthetic cases were presented for elective surgery. The mean patient age was 10.8 years. General anesthesia was administered in 21 cases and intubation was failed in two. Mask ventilation without intubation was performed in two cases in day surgery unit. In one case, spinal anesthesia was performed. Otolaryngologic procedures, i.e., tonsillectomy and adenoidectomy, and ventilation tube insertion were most common. Percutaneous endoscopic gastrostomy and herniorrhaphy were also frequent. Dexamethasone was given to all intubated cases and all patients were extubated in the postanesthesia care unit or in the intensive care unit. There was no perioperative mortality. Cautious airway management until intubation is recommended and mask ventilation with short-acting inhalation or intravenous anesthetics is enough to manage relatively short procedures. For herniorrhaphy, a spinal block could be used.
Adenoidectomy ; Airway Management ; Ambulatory Surgical Procedures ; Anesthesia, General ; Anesthesia, Spinal ; Anesthetics, Intravenous ; Dexamethasone ; Gastrostomy ; Glycosaminoglycans ; Herniorrhaphy ; Humans ; Inhalation ; Intellectual Disability ; Intensive Care Units ; Intubation ; Joint Diseases ; Masks ; Mortality ; Mucopolysaccharidoses* ; Mucopolysaccharidosis I ; Tonsillectomy ; Ventilation

BACKGROUND: Although opioids are widely used and effectively control postoperative pain, they contribute to the delayed recovery of gastrointestinal function. The aim of this study was to investigate the effects of intravenous patient controlled analgesia (iv PCA) with morphine, meperidine or fentanyl on postoperative bowel function. METHODS: Sixty ASA physical status I or II adult patients who were scheduled for elective gastrectomy were randomly allocated to morphine, meperidine, or fentanyl groups. After administering an initial bolus dose of morphine 5 mg, meperidine 25 mg, or fentanyl 50microgram at OR, each iv PCA pump was started at PACU. The following program was used: morphine group-concentration 3 mg/ml, basal infusion rate 1.5 mg/hr, bolus 1.5 mg, meperidine group-concentration 15 mg/ml, basal infusion rate 7.5 mg/hr, bolus 7.5 mg, fentanyl group-concentration 30microgram/ml, basal infusion rate 15microgram/hr, bolus 15microgram. The lockout time was 15 min in all groups. Postoperative pain at rest was evaluated with NRS (0-100) 6, 24, 48 and 72 hr after the end of surgery. Times from end of surgery to the passage of the first flatus were recorded. RESULTS: Pain scores were comparable at rest in the three groups over the three postoperative days. Time from the end of surgery to the first postoperative flatus was 116.6 +/- 13.2 hr in morphine group, 97.5 +/- 17.6 hr in meperidine group, and 91.8 +/- 19.1 hr in fentanyl group. Time from the end of surgery to first postoperative flatus was significantly longer in the morphine group than in the other two groups (P = 0.002, P = 0.000). Side effects were not significantly different among the groups. CONCLUSIONS: Meperidine or fentanyl were found to have an advantage in terms of bowel function over morphine when used for iv PCA after gastrectomy.
Adult ; Analgesia, Patient-Controlled* ; Analgesics, Opioid ; Fentanyl* ; Flatulence ; Gastrectomy* ; Humans ; Meperidine* ; Morphine* ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis