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

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*

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

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

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

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

BACKGROUND: The triggering receptor expressed on myeloid cells-1 (TREM-1) is an activating receptor that is expressed on the surface of neutrophils and mature monocytes when stimulated with several microbial components, which can amplify the inflammatory response. This study analyzed the prognostic value of the sTREM-1 levels in patients with acute respiratory distress syndrome (ARDS). METHODS: The bronchoalveolar lavage (BAL) fluid and blood was collected prospectively from 32 patients with ARDS, 15 survivors and 17 nonsurvivors. An enzyme-linked immunosorbent assay was performed to measure the sTREM-1. The following data was obtained: APACHE II score, Clinical Pulmonary Infection Score (CPIS), BAL fluid analysis, C-reative protein. Mortality in the ICU was defined as the end point. RESULTS: The serum sTREM-1 level was significantly higher in the nonsurvivors than survivors (54.3+/-10.3 pg/ml vs. 22.7+/-2.3 pg/ml, p<0.05). The sTREM-1 level in the serum, but not in the BAL fluid, was an independent predictor of the ICU mortality (OR: 22.051, 95% CI: 1.780~273.148, p<0.016), and a cut-off value of > or =33 pg/ml yielded a diagnostic sensitivity of 71% and specificity of 93%. CONCLUSION: The serum sTREM-1 level may be a useful predictor of the outcome of ARDS patients.
APACHE ; Bronchoalveolar Lavage ; Enzyme-Linked Immunosorbent Assay ; Humans ; Monocytes ; Neutrophils ; Prognosis ; Prospective Studies ; Respiratory Distress Syndrome, Adult ; Survivors

PURPOSE: This study was performed to analyse urine gamma-hydroxybutyric acid(GHB) in children with seizures, and to investigate the pattern of seizures and neurologic abnormalities in children related with gamma-hydroxybutyric aciduria. METHODS: We reviewed retrospectively medical records of children who admitted to our hospital with seizures between August 1. 2001 and February 28. 2003. We compared urine GHB levels with controls, and also analyzed the clinical features of patients who showed increased urine GHB. RESULTS: The mean urine GHB was 1.7+/-1.6 mmol/mol cr in febrile seizures, 1.8+/-2.5 mmol/mol cr in non-febrile seizures, and 1.8+/-2.0 mmol/mol cr in controls. Compared with control group, there was no significant difference in urine GHB levels(P>0.05). In 8 of 64 children with seizures, GHB levels increased above 2 standard deviation of normal controls. The types of seizure in children who showed increased urine GHB were generalized tonic clonic seizure in 3 patients, complex partial seizure in 2 patients, febrile seizure in 2 patients, and benign Rolandic epilepsy in 1 patient. 3 patients showed neurologic abnormalities, 4 patients showed electroencephalographic abnormalities, and 2 patients of 6 patients who performed brain imaging study showed brain imaging abnormalities. CONCLUSION: Children with gamma-hydroxybutyric aciduria should be suspected succinic semialdehyde dehydrogenase deficiency as a cause of underlying disease.
Child* ; Epilepsy* ; Epilepsy, Rolandic ; Humans ; Medical Records ; Neuroimaging ; Retrospective Studies ; Seizures* ; Seizures, Febrile ; Succinate-Semialdehyde Dehydrogenase

BACKGROUND: Reduced lung compliance and increased lung resistance are the primary lung mechanical abnomalities in acute respiratory distress syndrome (ARDS). Although there is little information regarding the mecha nisms responsible for the increases in the respiratory resistance of ARDS, bronchodilators have been frequently administered in mechanically ventilated ARDS patient. To determine the effect of a bronchodilator on the respiratory mechanics depending on the level of applied positive end-expiratory pressure (PEEP), the change in the respiratory mechanics by salbutamol ingalation was measured under the variable PEEP level in patients with ARDS. METHODS: Fifteen mechanically ventilated paralyzed ARDS patientss (14 of male, mean age 57 years) were enrolled in this study. The respiratory system compiance, and the maximum and minimun inspiratory occlusion method during constant flow inflaction using the CP-100 pulmonary monitor (Bicore, Irvine, CA, USA). The measurements were performed at randomly applied 8, 10 and 12 cm H2O PEEP before and 30 mins after administrating salbutamol using a meter-dose-inhaler (100 micro gram X 6). RESULTS: 1) The maximum inspiratory resistance of the lung was higher than the reported normol values due to an increase in the minimal inspiratory resistance and additional resistance. 2) The maximum inspiratory resistance and peak airway pressure were significantly higher at 12 cm H2O of PEEP compared with those at 10cm H2O of PEEP. 3) Salbutamol induced a significant decrease in the maximum and the minimum inspiratory resistance but no significant change in the additional resistance only was observed at 12 cm H2O of PEEP (from 15.66+/-1.99 to 13.54+/-2.41, from 10.24+/-2.98 to 8.04+/-2.34, and from 5.42+/-3.41 to 5.50+/-3.58 cm H2O/l/sec, respectively). 4) The lung compliance did not change at the applied PEEP and salbutamol inhalation levels. CONCLUSIONS: The bronchodiator response would be different depending on the level of applied PEEP despite the increased respiratory resistance in patients with ARDS.
Albuterol ; Bronchodilator Agents ; Humans ; Inhalation* ; Lung ; Lung Compliance ; Male ; Positive-Pressure Respiration ; Respiratory Distress Syndrome, Adult* ; Respiratory Mechanics* ; Respiratory System