BACKGROUND: Current guidelines of advanced trauma life support recommend open thoracotomy when pericardiocentesis reveals bloody pericardial effusion in patients with blunt chest trauma. However, open thoracotomy may not be always required for treating patients alive until arriving emergency department, because rapid accumulation of the blood into pericardial space results in immediate death at scene. We report our experiences of treating traumatic pericardial effusion, and discuss the therapeutic modality in patients with traumatic pericardial effusion. METHODS: The study consisted of 37 patients(20 males and 17 females with the mean age 42) sustaining traumatic pericardial effusion. The patients were divided according to treatment modality into 3 groups(group I : patients receiving conservative management, group II : patients treated with pericardiocentesis, group III : patients required emergency thoracotomy). We compared clinical presentations, hemodynamic profiles and echocardiographic findings among three groups. RESULTS: Cardiac tamponade was present in 14 of 37 patients. Pericardiocentesis was performed in 13 patients, and open thoracotomy in 4 patients. Pericardiocentesis was curative in 9 patients. Thoracotomy was performed in only 3(24%) of 13 patients required pericardiocentesis. 3(75%) of 4 patients having moderate or severe pericardial effusion from penetrating injury were required open thoracotomy. CONCLUSION: In selected patients who have traumatic pericardial effusion by blunt chest injury, pericardiocentesis may be curative, and thoracotomy may not be inquired as long as bleeding via indwelling pericardial catheter is not sustained after pericardiocentesis.
Advanced Trauma Life Support Care ; Cardiac Tamponade ; Catheters ; Echocardiography ; Emergencies ; Emergency Service, Hospital ; Female ; Hemodynamics ; Hemorrhage ; Humans ; Male ; Pericardial Effusion* ; Pericardiocentesis ; Thoracic Injuries ; Thoracotomy ; Thorax

PURPOSE: To compare the efficacies of photodynamic therapy (PDT) using verteporfin combined with intravitreal bevacizumab in choroidal neovascularization secondary to age-related macular degeneration and polypoidal choroidal vasculopathy (PCV). METHODS: Photodynamic therapy followed by 3 monthly intravitreal injections of bevacizumab were performed for neovascular age-related macular degeneration (AMD group) and PCV (PCV group). The injections were performed within 2 weeks after PDT and then every 4 to 6 weeks. During the 12-month follow-up period, best-corrected visual acuity (BCVA), central subfield macular thickness (CSMT), and number of reinjections were reviewed retrospectively. RESULTS: Out of 38 eyes, there were 21 eyes in the AMD group (mean age 66.8 years old) and 17 eyes in the PCV group (mean age 66.4 years old). The average follow-up duration was 17.0 months. At 12 months, the BCVA (logMAR) improved from 0.75 at baseline to 0.49 in the AMD group (p = 0.01) and from 0.81 to 0.63 in the PCV group (p = 0.03). The CSMT decreased significantly from 329 to 231 in the AMD group and from 354 to 223 in the PCV group. At 12 months, 20 eyes (95.2%) in the AMD group and 15 eyes (88.2%) in the PCV group increased or maintained BCVA. The numbers of reinjections were 4.3 in the AMD group and 3.0 in the PCV group. There were no significant differences in BCVA, BCVA changes, CSMT, or number of reinjection between the two groups. CONCLUSIONS: Combined PDT and intravitreal bevacizumab injections showed no significant difference in stabilization of vision or retreatment rates between neovascular age-related macular degeneration and PCV.
Antibodies, Monoclonal, Humanized ; Choroid ; Choroidal Neovascularization ; Eye ; Follow-Up Studies ; Intravitreal Injections ; Macular Degeneration ; Photochemotherapy ; Porphyrins ; Retreatment ; Triazenes ; Vision, Ocular ; Visual Acuity ; Bevacizumab

PURPOSE: In 2000, the American Heart Association and International Liaison Committee on Resuscitation published guidelines for CPR (Cardiopulmonary Resuscitation), and these guidelines were revised in 2005. Many physicians perform CPR differently than suggested by these guidelines. We investigated guideline conformation rates for CPR by non-emergency physicians. METHODS: From January 1st, 2005, to December 31st, 2005, and from January 1st, 2007, to September 30th, 2007, 103 in-hospital CPR cases were enrolled. We separated the 103 cases into two groups: 2005 patients and 2007 patients. Fifty-two cases in the 2005 group and 51 cases in the 2007 group were enrolled. The defibrillation method, defibrillation energy, epinephrine use, and atropine use were analyzed. RESULTS: Nineteen cases (82.6%) in the 2005 group and three cases (21.4%) in the 2007 group were performed using the appropriate defibrillation method (p=0.0002). Seventeen cases (73.9%) in the 2005 group and four cases (28.6%) in the 2007 group received the appropriate defibrillation energy (p=0.0069). Seven cases (14.0%) in the 2005 group and 16 cases (32.0%) in the 2007 group used the appropriate epinephrine dose (p=0.0325). Fourteen cases (28.0%) in the 2005 patient group and 14 cases (29.2%) in the 2007 patient group used the appropriate atropine dose (p=0.8983). CONCLUSION: Although CPR guidelines were renewed in 2005, many physicians do not follow these guidelines. We suggest that adequate information, education, feedback, and further study are needed for guideline conformation.
American Heart Association ; Atropine ; Cardiopulmonary Resuscitation ; Electric Countershock ; Epinephrine ; Humans ; Resuscitation

OBJECTIVE: Ovarian failure is often common complication by the conditioning protocol used for bone marrow transplantation (BMT). To determine the frequency of recovery of ovarian function after allo-BMT and the major factor that predict recovery, we monitored ovarian function in 24 premenopausal women METHOD: Twenty-four women met the inclusion criteria, which were (1) moderate to severe aplastic anemia before BMT, (2) disease-free at least 18 month after transplantation, (3) age younger than 40 years and more than 3 years after menarche at transplantation and (4) regular menstrual periods before transplantation. Recovery of ovarian function was determined by regular menses without menopausal symptom and sign. we divided conditioning regimen to two groups, Group I : cytoxan alone(n=17), Group II : cytoxan plus total body irradiation (TBI)(n=7). RESULTS: All women became amenorrhea after BMT and the clinical characteristics were not significant between two groups. 17 patients who received only cytoxan all recovered ovarian function between 1 to 14 months(median : 7.28) after BMT. The median age at BMT of women with regained ovarian function was 26 years (range, 21 to 33) versus 30 (range, 21 to 37) for those who did not. The age at transplantation was not significant between two groups in our study and the most predictive independent factor in ovarian recovery is the presence of total body irradiation. None of women who received TBI regained ovarian function during 19-49 month follow up. CONCLUSION: Gonadal insufficiency due to pre-BMT conditioning is more severe in radiation based regimen than cytoxan alone. therefore, we recommend early hormone replacement therapy in radiation treated women to prevent the complication of premature menopause.
Amenorrhea ; Anemia, Aplastic* ; Bone Marrow Transplantation* ; Bone Marrow* ; Cyclophosphamide ; Female ; Follow-Up Studies ; Gonads ; Hormone Replacement Therapy ; Humans ; Menarche ; Menopause, Premature ; Whole-Body Irradiation

Tricholoma matsutake has been the most valuable ectomycorrhizal fungi in Asia because of its unique flavor and taste. However, due to the difficulty of artificial cultivation, the cultiva tion of T. matsutake has relied on natural growth in forests. To cultivate the T. matsutake artificially, microorganisms in fairy rings were introduced. In this study, we isolated 30 fungal species of microfungi from the soil of fairy rings. Among them, one single fungal strain showed a promoting effect on the growth of T. matsutake. The growth effect was confirmed by measuring the growth area of T. matsutake and enzyme activities including a-amylase, cellulase, and b-glucosidase. In comparison with control, microfungal metabolite increased the growth area of T. matsutake by 213% and the enzyme activity of T. matsutake by 110– 200%. The isolated fungal strain was identified as Penicillium citreonigrum by BLAST on the NCBI database. The Discovery of this microfungal strain is expected to contribute to artificial cultivation of T. matsutake.

BACKGROUNDS/AIMS: Aggressive surgical resection for hepatic metastasis is validated, however, concomitant liver and lung metastasis in colorectal cancer patients is equivocal. METHODS: Clinicopathologic data from January 2008 through December 2012 were retrospectively reviewed in 234 patients with colorectal cancer with concomitant liver and lung metastasis. Clinicopathologic factors and survival data were analyzed. RESULTS: Of the 234 patients, 129 (55.1%) had synchronous concomitant liver and lung metastasis from colorectal cancer and 36 (15.4%) had metachronous metastasis. Surgical resection was performed in 33 patients (25.6%) with synchronous and 6 (16.7%) with metachronous metastasis. Surgical resection showed better overall survival in both groups (synchronous, p=0.001; metachronous, p=0.028). In the synchronous metastatic group, complete resection of both liver and lung metastatic lesions had better survival outcomes than incomplete resection of two metastatic lesions (p=0.037). The primary site of colorectal cancer and complete resection were significant prognostic factors (p=0.06 and p=0.003, respectively). CONCLUSIONS: Surgical resection for hepatic and pulmonary metastasis in colorectal cancer can improve complete remission and survival rate in resectable cases. Colorectal cancer with concomitant liver and lung metastasis is not a poor prognostic factor or a contraindication for surgical treatments, hence, an aggressive surgical approach may be recommended in well-selected resectable cases.
Colorectal Neoplasms* ; Humans ; Liver Neoplasms ; Liver* ; Lung Neoplasms ; Lung* ; Neoplasm Metastasis* ; Retrospective Studies ; Survival Rate

PURPOSE: Pancreatic ductal adenocarcinoma has the highest incidence between the ages of 60 and 70 years. As the elderly population has been increasing in the last several decades, the proportion of patients older than 70 years of age with resectable pancreatic cancer is expected to increase in our society. This retrospective observation was performed to evaluate surgical value of pancreaticoduodenectomy for the elderly patients with pancreatic ductal adenocarcinoma. MATERIALS AND METHODS: From January 1990 to June 2005, among the patients who underwent pancreaticoduodenectomy for pancreatic ductal adenocarcinoma, the elder patients older than 70 years of age were retrospectively reviewed. Perioperative surgical outcomes, including general clinicopathologic features, morbidity, mortality, and survival outcomes, were investigated based on available medical records. RESULTS: Seventy-seven patients underwent pancreaticoduodenenctomy (PD) for pancreatic ductal adenocarcinoma. Among them, 11 patients (14.3%) were 70 years older. More frequent incidences of morbidity (8 out of 11 vs. 25 out of 65, p=0.049), especially delayed gastric emptying (3 out of 8 vs. 3 out of 66, p=0.035), were observed and overall length of hospital stay was also longer in the elderly (49.2 +/- 13.9 days vs. 36.1 +/- 13.2, p=0.012). However, no significant differences in mortality rate and survival outcomes were noted when comparing with those of the younger patients (p > 0.05). CONCLUSION: We agree with the opinion that age factor can not be absolute contraindication for pancreaticoduodenectomy, however, appropriate preoperative evaluations, proper patient selection considering life expectancy, advanced surgical techniques and detailed perioperative management are mandatory to guarantee the safety of pancreaticoduodenectomy performed in the elderly with pancreatic ductal adenocarcinoma.
Adenocarcinoma/pathology/*surgery ; Aged ; Carcinoma, Pancreatic Ductal/pathology/*surgery ; Female ; Humans ; Male ; Pancreatic Neoplasms/pathology/*surgery ; Pancreaticoduodenectomy/*methods ; Reproducibility of Results ; Retrospective Studies ; Treatment Outcome

Tularemia is a high-risk infectious disease caused by Gram-negative bacterium Francisella tularensis. Due to its high fatality at very low colony-forming units (less than 10), F. tularensis is considered as a powerful potential bioterrorism agent. Vaccine could be the most efficient way to prevent the citizen from infection of F. tularensis when the bioterrorism happens, but officially approved vaccine with both efficacy and safety is not developed yet. Research for the development of tularemia vaccine has been focusing on the live attenuated vaccine strain (LVS) for long history, still there are no LVS confirmed for the safety which should be an essential factor for general vaccination program. Furthermore the LVS did not show protection efficacy against high-risk subspecies tularensis (type A) as high as the level against subspecies holarctica (type B) in human. Though the subunit or recombinant vaccine candidates have been considered for better safety, any results did not show better prevention efficacy than the LVS candidate against F. tularensis infection. Currently there are some more trials to develop vaccine using mutant strains or nonpathogenic F. novicida strain, but it did not reveal effective candidates overwhelming the LVS either. Difference in the protection efficacy of LVS against type A strain in human and the low level protection of many subunit or recombinant vaccine candidates lead the scientists to consider the live vaccine development using type A strain could be ultimate answer for the tularemia vaccine development.
Bioterrorism ; Communicable Diseases ; Francisella tularensis ; Humans ; Sprains and Strains ; Stem Cells ; Tularemia ; Vaccination ; Vaccines

PURPOSE: In vaccine efficacy evaluation, visualization of pathogens in whole organism at each time point would be able to reduce the consuming animals and provide the in vivo information within consistent background with identical organism. MATERIALS AND METHODS: Using IVIS spectrum whole live-animal imaging system, fluorescent intensity was optimized and visualized proportionately by concentrating Escherichia coli MC1061 strain which expresses GFP (E. coli-GFP) in BALB/C mice after injection. RESULTS: Local distribution of disseminated E. coli-GFP was traced in each organ by fluorescence. Detached organ showed more obvious fluorescent signal, and intestine showed strongest fluorescent signal. CONCLUSION: This in vivo imaging method using GFP-tagged pathogen strain suggest quantified infected pathogens by fluorescence intensity in whole animals can provide the information about the localization and distribution after infection.
Animals ; Bacterial Infections ; Escherichia coli ; Fluorescence ; Intestines ; Mice ; Molecular Imaging ; Sprains and Strains ; Track and Field

Purpose: We studied the effect of interleukin-8 (IL-8) as the factor for angiogenesis in the joint fluid of remnantpreserved anterior cruciate ligament reconstruction (RP-ACLR). Materials and methods: We measured 12 cytokines in joint fluid by multiplex assay and assessed the relationship between IL-8 and vascular endothelial growth factor (VEGF) concentrations. The signal intensity and mean sagittal diameter via postoperative magnetic resonance imaging (MRI) scans were evaluated and the stress X-ray image was analyzed at 3, 6, and 12 months after operation. Results: The IL-8 concentration was highest 3 months postoperatively in those patients who underwent RP-ACLR.Clinical data also showed that the signal intensity and stress radiography of the knee graft were significantly better at the early postoperative stage.Discussion: Our results show that IL-8 plays an important role in angiogenesis within 3 months after RP-ACLR. This effect yields better recovery after operation. RP-ACLR patients with high knee stability in clinical data were identical to those with high expression of IL-8 in experimental data. Therefore, IL-8 has been shown to help revascularization and ligamentization of the grafted tendon. These results indicate that IL-8 in RP-ACLR is an important factor for angiogenesis after operation. Unfortunately, the relationship of IL-8 and VEGF in vivo has not been studied. Conclusion Our results showed that the IL-8 concentration was very high within 3 months after RP-ACLR operation. The increase in concentration of IL-8 over time was consistent with the increase in VEGF concentration.In the IL-8 clinical setting, MRI analysis showed that ACL synovialization and tension were better in patients who underwent the remnant preservation method. In addition, it was shown that RP-ACLR may be advantageous for early anterior stability within 1 year post operation and beneficial for tendon graft in the early stage post operation.Taken together, our findings suggest that IL-8 may contribute to angiogenesis which is helpful for revascularization and ligamentization of the graft tendon in the early stages of RP-ACLR.