PURPOSE: Actinomycosis is still a relatively rare infection, characterized by multiple abscesses, draining sinuses and the appearance of sulfur granules, which are valuable in aiding the diagnosing the discharge of involved tissues. In most instances, the onset of an abdominal disease is preceded by inflammatory or a traumatic incident resulting in the perforation of the mucosa of the gastrointestinal tract. Intensive and prolonged antimicrobial therapy, and wide surgical excision of involved tissues are the two general principles of therapy. METHODS: We experienced 8 cases of abdominal actinomycosis after a laparotomy between March 1997 and February 2002. RESULTS: The results were as follows: 1) There was a 1: 1 male to female ratio of abdominal actinomycosis, and a mean age of 47 years. 2) The clinical features were different for each involved organ, -but, most of the clinical symptoms were nonspecific to suspect actinomycosis. 3) The frequently involved organs were mainly located lower abdomen, such as the appendix and cecum, sigmoid colon and small bowel. 4) In 60% of the patients, the predisposing factors were identifiable, these being: a previous abdominal operation, IUD and abdominal injury. 5) The preoperative diagnoses included: acute appendicitis, and periappendiceal and intra-abdominal abscesses. The pre-exploratory diagnoses were made by ultrasound and abdominal CT. 6) Explorations were performed in all patients, depending on their diagnosis, to afford the proper surgical treatment and correct diagnosis. After the operation, all the patients were treated with oral antibiotics for long period. CONCLUSION: The authors conclude that pre-exploratory cytological or culture studies, with careful history taking, for low abdominal tumors or abscesses may increase the rate of correct diagnosis, as could proper explorations.
Abdomen ; Abdominal Abscess ; Abdominal Injuries ; Abscess ; Actinomycosis* ; Anti-Bacterial Agents ; Appendicitis ; Appendix ; Causality ; Cecum ; Colon, Sigmoid ; Diagnosis ; Female ; Gastrointestinal Tract ; Humans ; Laparotomy ; Male ; Mucous Membrane ; Sulfur ; Tomography, X-Ray Computed ; Ultrasonography

A clinical and statistical study was performed on 213 neonates of hyperbilirubinemia who were admitted to department of pediatrics of Korea University Hospital from Jan. 1989 to Jun. 1991. and we studied the difference between ABO compatible group and incompatible group, such as, day of apperance of hyperbilirubinemia, tendency of bilirubin concentration change, reticulocyte, hemoglobin and duration of hyperbilirubinemia. The following results were obtained. 1) There were no difference of initial body weight and gestational age between compatible (3.0 +/- 0.72kg, 38.2 +/- 3.2 weeks) and incompatible groups (3.2 +/- 0.54kg, 39.1 +/- 2.8 weeks). 2) Onset of hyperbilirubinemia within 2 days in the incompatible group (40.5%) was earlier than the compatible group (23.5%) significantly (p<0.05). 3) Mean bilirubin level in the incompatible group was higher than the compatible group significantly (p<0.05). 4) Peak bilirubin level in the incompatible group(18.7+/-4.1mg/dl) was higher than the compatible group (14.8+/-3.4mg/dl) significantly (p<0.05). 5) There were no difference of hemoglobin level, reticulocyte count, coombs positive finding and the ratio of exchange transfusion between two groups.
Bilirubin ; Body Weight ; Gestational Age ; Humans ; Hyperbilirubinemia ; Hyperbilirubinemia, Neonatal* ; Infant, Newborn ; Korea ; Pediatrics ; Reticulocyte Count ; Reticulocytes ; Statistics as Topic

It is reported that patients with primary hyperparathyroidism(PHPT) have disturbances in carbohydrate metabolism: in particular, hyperinsulinemia and insulin resistance are characteristic early metabolic aberrations of this disease. However, it is not clear whether changes of insulin secretion or insulin sensitivity are observed in all patients with PHPT, including those with normal glucose tolerance. Also, it is not clear whether these changes are reversible after surgical correction of PHPT. In the present study, glucose tolerance and insulin secretion were evaluated in 2 symptomatic patients with PHPT during 100g oral glucose tolerance test before and after parathyroid adenoma removal. Comparing these patients before and after surgery, glucose tolerance was not significantly different. However, C-peptide and insulin secretion was low after surgical correction of PHPT compared to the preoperative situation. This observation suggests that insulin hypersecretion in patients with PHPT precedes glucose intolerance and this early disturbance is reversible after surgery.
C-Peptide ; Carbohydrate Metabolism ; Glucose ; Glucose Intolerance ; Glucose Tolerance Test ; Humans ; Hyperinsulinism ; Hyperparathyroidism, Primary ; Insulin Resistance ; Insulin ; Parathyroid Neoplasms

A noncontact sensor field is an innovative device that can detect, measure, or monitor physical properties or conditions without direct physical contact with the subject or object under examination. These sensors use a variety of methods, including electromagnetic, optical, and acoustic technique, to collect information about the target without physical interaction. Noncontact sensors find wide-ranging applications in various fields such as manufacturing, robotics, automobiles, security, environmental monitoring, space industry, agriculture, and entertainment. In particular, they are used in the medical field, where they provide continuous monitoring of patient conditions and offer opportunities in rehabilitation medicine. This article introduces the potential of noncontact sensors in the field of rehabilitation medicine.

BACKGROUND: Intraoperative fluid management should be aimed at maintaining appropriate left-sided filling pressures. The pulmonary capillary wedge pressure (PCWP) will overestimate the left ventricular end-diastolic volume (LVEDV) when ventricular compliance is markedly reduced in patients with aortic stenosis. Intraoperative transesophageal echocardiography (TEE) is useful for monitoring global left ventricular function and change of preload. This study was undertaken to evaluate preload derived by conventional invasive monitoring technique compare with preload obtained simultaneously from TEE in patients with aortic stenosis. METHODS: Fifteen patients with aortic stenosis who underwent aortic valve replacement were examined. The preload was examined by the short axis view of left ventricle with TEE at the level of the papillary muscles. For each patient, simultaneous measurements of PCWP, thermodilution cardiac output and left ventricular end-diastolic area (LVEDA) measured by TEE were made after the induction of anesthesia and after surgery. RESULTS: The correlation between echo-derived LVEDA and thermodilution cardiac index (CI) (r=0.53, p<0.05) or stroke index (SI) (r=0.56, p<0.05) was good after surgery, but the correlation was not found after induction of anesthesia. No correlation was observed between PCWP and CI or SI. CONCLUSIONS: The PCWP did not provide a reliable estimate of preload and did not allow good prediction of cardiac index. These findings demonstrate that, in patients with aortic stenosis who underwent aortic valve replacement, TEE provides a better index of left ventricular preload than conventional invasive hemodynamic monitoring particularly after surgery.
Anesthesia ; Aortic Valve ; Aortic Valve Stenosis* ; Axis, Cervical Vertebra ; Cardiac Output ; Compliance ; Echocardiography, Transesophageal* ; Heart Ventricles ; Hemodynamics* ; Humans ; Papillary Muscles ; Pulmonary Wedge Pressure ; Stroke ; Stroke Volume ; Thermodilution ; Ventricular Function, Left

OBJECTIVE: End-tidal partial pressure of carbon dioxide(PETCO2) is often used as an estimate of arterial partial pressure of carbon dioxide(PaCO2), with the understanding that PaCO2 usually exceeds PETCO2. During craniotomies, because hyperventilation is used to therapeutically lower intracranial pressure, the difference between arterial and end-tidal partial pressure of carbon dioxide(P(a-ET)CO2) has therapeutic implications. To determine how much information concerning neurosurgical operation and clinical outcome is provided by the PETCO2, PaCO2 and P(a-ET)CO2 during surgery, we evaluated 81 patients who had neurosurgical operation. METHODS: There were 51 males and 30 females with a mean age of 50.3 years(range 7-85 years). After the induction of general anesthesia, body temperature was maintained in a normothermia, endtidal CO2 was maintained 28-34mmHg and the systolic blood pressure was kept 90-120mmHg. ETCO2, PaCO2 and regional cortical blood flow(rCoBF) were checked at the time of dura closure. Neurologic outcome was evaluated at 8 hours after operation to rule out other factors which may influence on the patient's long-term outcome. Data were collected and compared by student's t-test or chi-square analysis. RESULTS: The PaCO2 was 34.6+/-5.2mmHg(range, 24.9-54.8), PETCO2 was 29.9+/-4.1mmHg(range, 20.0-45.0) and P(a-ET)CO2 was 4.7+/-3.5mmHg(range, -1.1-18.6). The correlation between the PaCO2 and PETCO2 was statistically significant(PETCO2=13.3-0.57xPaCO2). But there was no correlation of rCoBF with PaCO2 and ETCO2. P(a-ET)CO2 values less than 8mmHg were correlated well with good neurologic outcome compared with higher P(a-ET)CO2 patients. PaCO2, rCoBF, mean arterial blood pressure, arterial pH and initial Glasgow coma scale showed statistically significant correlation with neurologic outcome(p<0.05). CONCLUSION: Based on our study, P(a-ET)CO2 value could be used as a good prognostic factor during the neurosurgical operation and anesthesiologist should be tried to decrease this value. And in patients who has a intact brain autoregulation, rCoBF was not influenced by PaCO2 and ETCO2, entirely.
Anesthesia, General ; Arterial Pressure ; Blood Pressure ; Body Temperature ; Brain ; Carbon Dioxide* ; Carbon* ; Craniotomy ; Female ; Glasgow Coma Scale ; Homeostasis ; Humans ; Hydrogen-Ion Concentration ; Hyperventilation ; Intracranial Pressure ; Male ; Partial Pressure*

BACKGROUND: Appropriate placement of aortic and venous cannulas is important to ensure effective systemic perfusion. The malposition of the aortic cannula may promote preferential flow down the aorta or induce flow to aortic arch vessels causing pressure gradient between mean radial arterial pressure (RAP) and femoral arterial pressure (FAP). In this study we compared mean radial to femoral artery pressure gradient before and immediately after aortic cannulation and during cardiopulmonary bypass (CPB). METHODS: Ninety two pediatric patients undergoing open heart surgery were examined. After induction of anesthesia RAP and FAP were measured. The pressure gradient was measured before and after aortic cannulation, 15, 30 and 60 minutes after aortic cross clamping (ACC). When the pressure gradient of more than 10 mmHg developed, the surgeon was recommended to manipulate position of the aortic cannula. If the pressure gradient returned to pre-CPB level after manipulation, the pressure gradient was considered to develop due to aortic cannula. The age, presence of cyanosis, adjustment of shape of aortic cannula tip before cannulation and side of radial artery cannulation as factors developing pressure gradient were examined. RESULTS: Fifteen patients (16.3%) developed pressure gradient due to position of aortic cannula. Two patients (2.2%) developed immediately after aortic cannulation and fourteen patients (15.2%) during CPB. There was no statistically significant factor developing pressure gradient except non-cyanotic disease. CONCLUSIONS: The pediatric patient could develop pressure gradient due to malposition of aortic cannula frequently during CPB. Therefore, the simultaneous monitoring of RAP and FAP may be beneficial for managing CPB in pediatric cardiac surgery.
Anesthesia ; Aorta ; Aorta, Thoracic ; Arterial Pressure ; Cardiopulmonary Bypass ; Catheterization ; Catheters* ; Constriction ; Cyanosis ; Femoral Artery* ; Humans ; Perfusion ; Radial Artery ; Thoracic Surgery*

We retrospectively reviewed the medical records of 284 patients with neutropenic fever following chemotherapy for acute leukemia at the Catholic Hematopoietic Stem Cell Transplantation Center from January 1998 to December 1999, to identify prognostic factors for infection related mortality. Twenty-eight patients died of infections. There was no difference in median age, gender ratio, or underlying disease between the dying and surviving groups. Bacteria were the main pathogens following chemotherapy, and Gram positive organisms predominated in the dying group. Pneumonia and sepsis were the main causes of death. There were 72 cases of invasive fungal infection and their mortality was 27.8%. Invasive fungal infection and previous history of fungal infection were independent prognostic factors for outcome. Recovery from neutropenia was the significant protective factor for mortality. In conclusion, the prognostic factors identified in this study could be useful for deciding on more intensive treatment for those patients at greater risk of death. To our knowledge, this is the first Korean study delineating prognostic factors in acute leukemic patients with infectious complications.
Adolescent ; Adult ; Aged ; Bacterial Infections/complications/*mortality ; Cause of Death ; Female ; Humans ; Korea ; Leukemia ; Leukemia, Lymphocytic, Acute/complications/*microbiology/*mortality ; Leukemia, Myelocytic, Acute/complications/*microbiology/*mortality ; Male ; Middle Aged ; Morbidity ; Multivariate Analysis ; Mycoses/complications/mortality ; Neutropenia ; Pneumonia/complications/mortality ; Prognosis ; Retrospective Studies ; Sepsis/complications/mortality ; Survival Rate

OBJECTIVE: The brain temperature is about 0.4-1 degrees C higher than that of the other peripheral body area. But most of these results have been obtained in normothermic condition. The objective of this study is to evaluate the temperature difference between the brain and axilla, in patients under hypothermia. METHODS: Sixty-three patients(37 women and 26 men) who underwent craniotomy with implantation of the thermal diffusion flowmetry sensor were included in this study. The temperature of the cerebral cortex and axilla was measured every 2 hours, simultaneously. The patient group was divided according to axillary temperature hyperthermia(over 38 degrees C), normothermia(36-38 degrees C) and hypothermia(under 36 degrees C). Total 1671 paired sample data were collected and analyzed. RESULTS: The temperature difference between the cerebral cortex and the axilla was 0.45+/-1.04 degrees C in hyperthermic patients, 0.97+/-1.1 degrees C in normothermic patients and 1.04+/-0.81 degrees C in hypothermic patients. The temperature difference has statistical significance in each group(unpaired t-test, p<0.05). CONCLUSION: From our study the temperature difference between the brain and the axilla in hypothermic condition increased more than that of normothermic state. And in hyperthermic condition, the temperature difference decreased.
Axilla* ; Brain* ; Cerebral Cortex ; Craniotomy ; Female ; Fever ; Humans ; Hypothermia* ; Rheology ; Thermal Diffusion

BACKGROUND: Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli) are major pathogens in community and hospital. And they sometimes cause the outbreak in hospital in the immunocompromised patients. Pulsed-field gel electrophoresis (PFGE) has been regarded as a standard method for genotyping in epidemiologic studies, but it is laborious and time-consuming. Infrequent restriction site-polymerase chain reaction (IRS-PCR), a new genotyping methods, was performed to compare the applicability with PFGE. METHODS: We performed PFGE and IRS-PCR on S. aurues (n=120) and E. coli (n=117) which were collected clinically in 4 different hospitals. We assessed each method in terms of discriminatory power, quality, and efficiency. RESULTS: In E. coli, the discriminatory power of IRS-PCR was 46.7apprx86.7%, and that of PFGE was 88.9apprx96.7% according to hospital. But in S. aurues, the discriminatory power of IRS-PCR was 20apprx56.7%, and that of PFGE was 40apprx90% according to hospital. The typicality and reproducibility of IRS-PCR were 100% of each. PFGE needed four days to complete the procedure, but IRS-PCR could be performed within one day, IRS-PCR showed better resolution than PFGE. CONCLUSION: In case of gram negative bacteria (like E. coli), IRS-PCR could be a reliable alternative for epidemiologic typing due to better efficiency and comparable discriminatory power. But in the case of gram positive bacteria (like S. aureus), IRS-PCR does not seem to be suitable for the strain-to-strain differentiation. More trials and changes of restriction enzymes or primers could reveal the efficacy of IRS-PCR in the field of molecular typing.
Electrophoresis, Gel, Pulsed-Field* ; Escherichia coli* ; Escherichia* ; Gram-Negative Bacteria ; Gram-Positive Bacteria ; Immunocompromised Host ; Molecular Typing* ; Staphylococcus aureus* ; Staphylococcus*