BACKGROUND: Many physicians hesitate to discuss do-not-resuscitate (DNR) orders with patients or family members in critical situations. In the intensive care unit (ICU), delayed DNR decisions could cause unintentional cardiopulmonary resuscitation, patient distress, and substantial cost. We investigated whether the timing of DNR designation affects patient outcome in the medical ICU. METHODS: We enrolled retrospective patients with written DNR orders in a medical ICU (13 bed) from June 1, 2014 to May 31, 2015. The patients were divided into two groups: early DNR patients for whom DNR orders were implemented within 48 h of ICU admission, and late DNR patients for whom DNR orders were implemented more than 48 h after ICU admission. RESULTS: Herein, 354 patients were admitted to the medical ICU and among them, 80 (22.6%) patients had requested DNR orders. Of these patients, 37 (46.3%) had designated DNR orders within 48 hours of ICU admission and 43 (53.7%) patients had designated DNR orders more than 48 hours after ICU admission. Compared with early DNR patients, late DNR patients tended to withhold or withdraw life-sustaining management (18.9% vs. 37.2%, p = 0.072). DNR consent forms were signed by family members instead of the patients. Septic shock was the most common cause of medical ICU admission in both the early and late DNR patients (54.1% vs. 37.2%, p = 0.131). There was no difference in in-hospital mortality (83.8% vs. 81.4%, p = 0.779). Late DNR patients had longer ICU stays than early DNR patients (7.4 ± 8.1 vs. 19.7 ± 19.2, p < 0.001). CONCLUSIONS: Clinical outcomes are not influenced by the time of DNR designation in the medical ICU. The late DNR group is associated with a longer length of ICU stay and a tendency of withholding or withdrawing life-sustaining treatment. However, further studies are needed to clarify the guideline for end-of-life care in critically ill patients.
Advance Directives ; Cardiopulmonary Resuscitation ; Consent Forms ; Critical Illness* ; Hospital Mortality ; Humans ; Intensive Care Units ; Resuscitation Orders* ; Retrospective Studies ; Shock, Septic

The histogenesis and differentiation of sweat gland tumors are controversial. Twenty-two cases of sweat gland tumors were stained by immunoperoxidase technique (ABC method) for the presence of S-100 protein, CEA, and two kinds of keratin. Four syringomas, 4 eccrine poromas, 2 eccrine porocarcinomas, 2 eccrine spiradenomas, 1 papillary eccrine adenoma, 3 clear cell hidradenomas, 3 mixed tumors of skin, 2 papillary syringocystadenomas, and 1 cylindroma were included. All samples were formalin-fixed and paraffin-erribedded. Two monoclonal cytokeratin ant.ibodies, MA-902 (specific for cytokeratin No. 8) and MA-903 (specific for cytokeratins No.1,5,10,11) were used. In normal eccrine and apocrine glands, MA-902 stains cells of the intradermal duct and secretory portion. While MA-903 stains cells of the intraepidermal and intradermal duct and myoepithelial cells of eccine and apocrine glands, S-100 protein is found in the secretory cells of the intradermalduct and secretory portion, while CEA stains the secretory and ductal cells of eccrine and apocrine glands. All sweat gland tumors we studied stained by 4 antibodies in variable positive rates, Based on these findings, we discuss the histogenesis of various sweat gland tumors.
Acrospiroma ; Adenoma ; Antibodies ; Apocrine Glands ; Carcinoma, Adenoid Cystic ; Coloring Agents ; Eccrine Porocarcinoma ; Immunoenzyme Techniques ; Keratins ; Poroma ; S100 Proteins ; Skin ; Sweat Glands* ; Sweat* ; Syringoma

Severe sepsis and septic shock are the main causes of death in critically ill patients. Early detection and appropriate treatment according to guidelines are crucial for achieving favorable outcomes. Endotoxin is considered to be a main element in the pathogenic induction of gram-negative bacterial sepsis. Polymyxin B hemoperfusion can remove endotoxin and is reported to improve clinical outcomes in patients with intra-abdominal septic shock, but its clinical efficacy for pneumonic septic shock remains unclear. Here, we report a case of a 51-year-old man with pneumonic septic shock caused by Pseudomonas aeruginosa, who recovered through polymyxin B hemoperfusion.
Cause of Death ; Critical Illness ; Gram-Negative Bacteria* ; Hemoperfusion* ; Humans ; Middle Aged ; Polymyxin B* ; Polymyxins* ; Pseudomonas aeruginosa ; Sepsis ; Shock, Septic*

In an attempt to clarify the epidemiological feature of C. sinensis in Mangyeong riverside area, the prevalence of clonorchiasis, infestation rate of the cercariae in Parafossarulus manchouricus, and detection rate of the metacercariae in fresh-water fishes were investigated from March 1 to September 30, 1983 at the upper, middle and lower reaches of the river. The results obtained were summarized as follows:Detection rate of C. sinensis egg among inhabitants was 8.2 percent out of a total of 1,266 persons. but the differences in detection rates were not statistically signifcant among upper, middle and 1ower reaches. According to sex, the detection rates were 10.3 percent in male and 6.1 percent in female (p<0.05), but by age groups, increases of the rates were observed as increase in age (p<0.05). Out of a total of 380 fresh-water fishes of 32 different species, 93 fishes (25 percent) of 12 species were found positive with Clonorchis metacercariae, and there were differences in infection rates of the metacercariae among the fishes in 3 parts of the river; 11 percent in upper, 35 percent in middle, and 34 percent in lower reaches respectively. The metacercarial detection rates from various fishes were 97 percent in Pseudorasbora parva, Cultriculus eigenmanni (85 percent), Gnathopogon strigatus (67 percent), Microphysogobio yaluensis (50 percent), Gnathopogon coreanus (47 percent), Pungtungia herzi(44 percent), Abbottina rivularis (40 percent), Moroco oxycephalus (33 percent), Coreoleuciscus splendidus (32 percent), Gnathopogon majimae (26 percent), Rhodeus ocellatus (7 percent), and Aphyocypris chinensis (3 percent) respectively. Although very few P. manchouricus were collected at upper reach, 12 snails (0.7 percent) among a total of 1,713 were found infected with Clonorchis cercariae. Also the cercariae of Echinochasmus japonicus (7.99 percent), Lexogenes liberum (0.99 percent), Cyathocotyle orientalis (0.75 percent), Exorchis oviformis (0.23 percent) and Asymphylodora japonica (0.05 percent) were detected from the snails.
parasitology-helminth-trematoda ; Clonorchis sinensis ; clonorchiasis ; epidemiology ; Pseudorasbora parva ; Cultriculus eigenmanni ; Gnathopogon strigatus ; Microphysogobio yaluensis ; Gnathopogon coreanus ; Pungtungia herzi ; Abbottina rivularis ; Moroco oxycephalus ; Coreoleuciscus splendidus ; Gnathopogon majimae ; Rhodeus ocellatus ; Aphyocypris chinensis ; Parafossarulus manchouricus ; Echinochasmus japonicus ; Lexogenes liberum ; Cyathocotyle orientalis ; Exorchis oviformis ; Asymphylodora japonica

We evaluated the effects of guanosine 5′-monophosphate (GMP)-chelated calcium and iron (CaFe-GMP) on health and egg quality in layers experimentally infected with Salmonella Gallinarum. In this study, a CaFe-GMP feed additive was added to a commercial layer feed and fed to layers over a four-week period. All were inoculated with Salmonella Gallinarum. Body weight, mortality, clinical symptoms, and poultry production including feed intake, egg production, egg loss, and feed conversion rate were observed, and Salmonella Gallinarum was re-isolated from the liver, spleen, and cecum of the layers. All tested internal organs for the CaFe-GMP additive group exhibited significantly lower re-isolation numbers of Salmonella Gallinarum and less severe pathological changes than those in the control group, indicating that the CaFe-GMP feed supplement induced bacterial clearance and increased resistance to Salmonella Gallinarum. Additionally, due to the inhibitory action of CaFe-GMP on the growth of Salmonella Gallinarum, the CaFe-GMP additive group exhibited better egg production, including a higher laying rate and fewer broken eggs. The results suggest that a 0.16% CaFe-GMP additive may help prevent salmonellosis in the poultry industry.
Body Weight ; Calcium* ; Cecum ; Eggs ; Guanosine* ; Iron* ; Liver ; Mortality ; Ovum* ; Poultry ; Poultry Products ; Salmonella Infections ; Salmonella* ; Spleen

Thrombotic thrombocytopenic purpura (TTP) is a life-threatening condition characterized by microangiopathic hemolytic anemia, thrombocytopenia, renal insufficiency, neurological abnormalities, and fever. Cardiac involvement is not uncommon and can be fatal; however, right ventricular heart involvement after surgery is rare. Here, we report a case of TTP presenting with right ventricular heart failure after total knee replacement surgery. TTP was successfully treated with four rounds of plasma exchange. The patient made a full recovery and was discharged after 11 weeks.
Anemia, Hemolytic ; Arthroplasty, Replacement, Knee* ; Fever ; Heart Failure* ; Heart* ; Humans ; Orthopedics ; Plasma Exchange ; Purpura, Thrombotic Thrombocytopenic* ; Renal Insufficiency ; Thrombocytopenia

BACKGROUND: Severe sepsis is a major cause of morbidity and mortality in intensive care units. This study aimed to evaluate the prevalence, characteristics, outcomes and prognostic factors of severe sepsis in a medical intensive care unit (MICU) of a tertiary care hospital in Korea. METHODS: We retrospectively reviewed the medical chart of 249 patients who were admitted to a medical intensive care unit with severe sepsis. RESULTS: From January 2000 to December 2001, 3410 patients were admitted to the ICU. The prevalence of severe sepsis was 7.3%. The mortality of severe sepsis was 64.6%. The prognostic factors for severe sepsis were the number of organ systems that acutely failed (p = 0.036) and an admission route from general wards (p = 0.018). There was no difference in the outcome of severe sepsis according to infectious organisms (p = 0.24) and the site of infections (p = 0.38). CONCLUSIONS: Severe sepsis in the MICU is a common, expensive and often fatal condition. We expect that early rescucitation and recovery from acute organ system failure will improve the outcome of severe sepsis.
Humans ; Critical Care ; Intensive Care Units ; Patients' Rooms ; Prevalence ; Retrospective Studies ; Sepsis ; Tertiary Care Centers ; Tertiary Healthcare

PURPOSE: In this retrospective study, we analyzed the outcomes of prostate cancer patients treated with the CyberKnife radiotherapy system (Accuray). MATERIALS AND METHODS: Between 2007 and 2010, 31 patients were treated for prostate cancer by use of the CyberKnife radiotherapy system. After excluding six patients who were lost to follow-up, data for the remaining 25 patients were analyzed. Patients were divided into the CyberKnife monotherapy group and a postexternal beam radiotherapy boost group. Clinicopathologic features and treatment outcomes were compared between the groups. The primary endpoint was biochemical recurrence-free survival period based on the Phoenix definition. Toxicities were evaluated by using the Radiation Therapy Oncology Group scoring criteria. RESULTS: Of 25 patients, 17 (68%) and 8 (32%) were classified in the monotherapy and boost groups, respectively. With a median follow-up of 29.3 months, most of the toxicities were grade 1 or 2 except for one patient in the boost group who experienced late grade 3 gastrointestinal toxicity. The overall biochemical recurrence rate was 20% (5/25) and the median time to biochemical recurrence was 51.9 months. None of the patients with low or intermediate risk had experienced biochemical recurrence during follow-up. Among D'Amico high-risk populations, 16.7% (1/6) in the monotherapy group and 50.0% (4/8) in the boost group experienced biochemical recurrence. CONCLUSIONS: Our data support that prostate cancer treatment by use of the CyberKnife radiotherapy system is feasible. The procedure can be a viable option for managing prostate cancer either in a monotherapy setting or as a boost after conventional radiotherapy regardless of the patient's risk stratification.
Follow-Up Studies ; Humans ; Lost to Follow-Up ; Prostate* ; Prostatic Neoplasms* ; Radiosurgery ; Radiotherapy* ; Recurrence ; Retrospective Studies

BACKGROUND: Administering extracorporeal membrane oxygenation (ECMO) to critically ill patients with acute respiratory distress syndrome has substantially increased over the last decade, however administering ECMO to patients with hematologic malignancies may carry a particularly high risk. Here, we report the clinical outcomes of patients with hematologic malignancies and severe acute respiratory failure who were treated with ECMO. METHODS: We performed a retrospective review of the medical records of patients with hematologic malignancies and severe acute respiratory failure who were treated with ECMO at the medical intensive care unit of a tertiary referral hospital between March 2010 and April 2015. RESULTS: A total of 15 patients (9 men; median age 45 years) with hematologic malignancies and severe acute respiratory failure received ECMO therapy during the study period. The median values of the Acute Physiology and Chronic Health Evaluation II score, Murray Lung Injury Score, and Respiratory Extracorporeal Membrane Oxygenation Survival Prediction Score were 29, 3.3, and -2, respectively. Seven patients received venovenous ECMO, whereas 8 patients received venoarterial ECMO. The median ECMO duration was 2 days. Successful weaning of ECMO was achieved in 3 patients. Hemorrhage complications developed in 4 patients (1 pulmonary hemorrhage, 1 intracranial hemorrhage, and 2 cases of gastrointestinal bleeding). The longest period of patient survival was 59 days after ECMO initiation. No significant differences in survival were noted between venovenous and venoarterial ECMO groups (10.0 vs. 10.5 days; p = 0.56). CONCLUSIONS: Patients with hematologic malignancies and severe acute respiratory failure demonstrate poor outcomes after ECMO treatment. Careful and appropriate selection of candidates for ECMO in these patients is necessary.
Adult* ; APACHE ; Critical Illness ; Extracorporeal Membrane Oxygenation* ; Hematologic Neoplasms* ; Hemorrhage ; Humans ; Intensive Care Units ; Intracranial Hemorrhages ; Lung Injury ; Male ; Medical Records ; Respiratory Distress Syndrome, Adult ; Respiratory Insufficiency* ; Retrospective Studies ; Tertiary Care Centers ; Weaning

BACKGROUND: Because ventilator-induced lung injury is partly dependent on the intensity of vascular flow, we hypothesized that hypothermia may attenuate the degree of such an injury through a reduced cardiac output. METHODS: Twenty-seven male Sprague-Dawley rats were randomly assigned to normothermia (37±1℃)-injurious ventilation (NT-V) group (n=10), hypothermia (27±1℃)-injurious ventilation (HT-V) group (n=10), or nonventilated control group (n=7). The two termal groups were subjected to injurious mechanical ventilation for 20 min with peak airway pressure 30cm H2O at zero positive end-expiratory pressure, which was translated to tidal volume 54±6ml in the NT-v group and 53±4ml in the HT-V group(p>0.05). RESULTS: Pressure-volume(P-V) curve after the injurious ventilation was almost identical to the baseline P-V curve in the HT-V group, whereas it was shifted rightward in the NT-V group. On gross inspection, the lungs of the HT-V group appeared smaller in size, and showed less hemorrhage especially at the dependent regions, than the lungs of the NT-V group. [Wet lung weight(g)/body weigh (kg)] (1.6±0.1 vs 2.4±1.2 ; p=0.014) and [wet lung weight/dry lung weight] (5.0±0.1 vs 6.1±0.8 ; p=0.046) of the HT-V group were both lower than those of the NT-V group, while not different from those of the control group(1.4±0.4, 4.8±0.4, respectivyly). Protein concentration of the BAL fluid of the HT-V group was lower than that of the NT-V group(1,374±726 ug/ml vs 3,471±1,985 ug/ml;p=0.003). Lactic dehydrogenase level of the BAL fluid of the HT-V group was lower than that of the NT-V group(0.18±0.10 unit/ml vs 0.43±0.22 unit/ml;p=0.046). CONCLUSIONS: Hypothermia attenuated pulmonary hemorrhage, permeability pulmonary edema, and alveolar cellular injuries associated with injurious mechanical ventilation, and preserved normal P-V characteristics of the lung in rats.
Animals ; Cardiac Output ; Hemorrhage ; Humans ; Hypothermia* ; Lung ; Male ; Oxidoreductases ; Permeability ; Positive-Pressure Respiration ; Pulmonary Edema ; Rats* ; Rats, Sprague-Dawley ; Respiration, Artificial ; Tidal Volume ; Ventilation ; Ventilator-Induced Lung Injury*