BACKGROUND: Unplanned extubation (UE) of patients requiring mechanical ventilation in an intensive care unit (ICU) is associated with poor outcomes for patients and organizations. This study was conducted to assess the clinical features of patients who experienced UE and to determine the risk factors affecting reintubation after UE in an ICU. METHODS: Among all adult patients admitted to the ICU in our institution who required mechanical ventilation between January 2011 and December 2013, those in whom UE was noted were included in the study. Data were categorized according to noninvasive or invasive management after UE. RESULTS: The rate of UE was 0.78% (the number of UEs per 100 days of mechanical ventilation). The incidence of self-extubation was 97.2%, while extubation was accidental in the remaining patients. Two cases of cardiac arrest combined with respiratory arrest after UE were noted. Of the 214 incidents, 54.7% required invasive management after UE. Long duration of mechanical ventilation (odds ratio [OR] 1.52; 95% confidence interval [CI] 1.32-1.75; p = 0.000) and high ICU mortality (OR 4.39; 95% CI 1.33-14.50; p = 0.015) showed the most significant association with invasive management after UE. In multivariate analysis, younger age (OR 0.96; 95% CI 0.93-0.99; p = 0.005), medical patients (OR 4.36; 95% CI 1.95-9.75; p = 0.000), use of sedative medication (OR 4.95; 95% CI 1.97-12.41; p = 0.001), large amount of secretion (OR 2.66; 95% CI 1.01-7.02; p = 0.049), and low PaO2/FiO2 ratio (OR 0.99; 95% CI 0.98-0.99; p = 0.000) were independent risk factors of invasive management after UE. CONCLUSIONS: To prevent unfavorable clinical outcomes, close attention and proper ventilatory support are required for patients with risk factors who require invasive management after UE.
Adult ; Heart Arrest ; Humans ; Incidence ; Intensive Care Units* ; Critical Care* ; Mortality ; Multivariate Analysis ; Respiration, Artificial ; Risk Factors

Mucormycosis is an uncommon opportunistic fungal infection mostly affecting immunocompromised patients and gastrointestinal mucormycosis is a rare and life-threatening. We describe a 31-year-old man with a history of idiopathic cyclic neutropenia who developed perforations of the stomach and intestine and intra-abdominal bleeding due to disseminated gastrointestinal mucormycosis after the initial operation.
Adult ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Immunocompromised Host ; Intestines ; Mucormycosis* ; Neutropenia ; Stomach

Conventional medical therapies have not been very successful in treating adults with refractory septic shock. The effects of direct hemoperfusion using polymyxin B and veno-arterial extracorporeal membrane oxygenation (ECMO) for refractory septic shock remain uncertain. A 66-year-old man was admitted to the emergency department and suffered from sepsis-induced hemodynamic collapse. For hemodynamic improvement, we performed direct hemoperfusion using polymyxin B. Computed tomography scan of this patient revealed emphysematous pyelonephritis (EPN), for which he underwent emergent nephrectomy with veno-arterial ECMO support. To the best of our knowledge, this is the first report of successful treatment of EPN with refractory septic shock using polymyxin B hemoperfusion and nephrectomy under the support of ECMO.
Adult ; Aged ; Emergency Service, Hospital ; Endotoxins ; Extracorporeal Membrane Oxygenation* ; Hemodynamics ; Hemoperfusion ; Humans ; Nephrectomy* ; Polymyxin B ; Pyelonephritis ; Shock, Septic*

Reactive oxygen species (ROS) and reactive nitrogen species (RNS) are natural by-products of cellular physiological processes involving metabolism of compounds containing oxygen and nitrogen, respectively. Physiological defense mechanisms against ROS/RNS readily convert them into water or urea, but dysregulation of ROS/RNS production damages cells resulting in abnormal conditions such as uncontrolled growth or cell death. ROS/RNS are closely related to the development of a variety of diseases such as cancer, diabetes, neurodegeneration, vascular disease and chronic inflammation. Thus, it has been proposed that the removal of ROS/RNS may prevent or treat oxidative stress-induced diseases. Some antioxidant molecules are synthesized in the body, while others are obtained from food in the diet including fruits, vegetables, meat and even in natural water. In addition to the natural antioxidants, synthetic antioxidants have been modified from natural chemicals so as to increase bioavailability to target organs and increase stability in the air. In developing novel antioxidants for therapeutic use, some factors to consider are: 1) improved efficacy; 2) low side effects (comparatively clear mechanism); 3) competitive price and 4) improved convenience of dosing. In this review, we will discuss the issues mentioned above and the use of antioxidants in clinical application.
Antioxidants ; Biological Availability ; Cell Death ; Defense Mechanisms ; Diet ; Fruit ; Inflammation ; Meat ; Nitrogen ; Oxygen ; Physiological Processes ; Reactive Nitrogen Species ; Reactive Oxygen Species ; Urea ; Vascular Diseases ; Vegetables ; Water

No abstract available.
Aconitum* ; Arrhythmias, Cardiac* ; Cardiopulmonary Resuscitation*

OBJECTIVE: to evaluate the incidence of complications of hysteroscopic surgery. METHODS: A total of 150 patients who was done by hysteroscopic surgery from February 1997 to February 2000 were retrospectively analyzed at Choon Hae Hospital, Pusan, Korea. We classified complications into 6 groups - infection, surgeon-related complication, distension-media related complication, energy source related complication, hemorrhage and others. RESULTS: Overall complication rates were 6% (9 to 150). Surgeon-related complication rate was 1.3% (2 of 150), media-related complication rate was 0.7% (1 of 150), hemorrhage was 4% (6 of 150). And there's no complications of infection, energy-source related, or others. CONCLUSION: Hysteroscopy is a safe procedure if you know the complications of hysteroscopy & its mechanisms.
Busan ; Hemorrhage ; Humans ; Hysteroscopy* ; Incidence* ; Korea ; Retrospective Studies ; Uterine Perforation

OBJECTIVE: to evaluate the incidence of complications of hysteroscopic surgery. METHODS: A total of 150 patients who was done by hysteroscopic surgery from February 1997 to February 2000 were retrospectively analyzed at Choon Hae Hospital, Pusan, Korea. We classified complications into 6 groups - infection, surgeon-related complication, distension-media related complication, energy source related complication, hemorrhage and others. RESULTS: Overall complication rates were 6% (9 to 150). Surgeon-related complication rate was 1.3% (2 of 150), media-related complication rate was 0.7% (1 of 150), hemorrhage was 4% (6 of 150). And there's no complications of infection, energy-source related, or others. CONCLUSION: Hysteroscopy is a safe procedure if you know the complications of hysteroscopy & its mechanisms.
Busan ; Hemorrhage ; Humans ; Hysteroscopy* ; Incidence* ; Korea ; Retrospective Studies ; Uterine Perforation

Malignant mixed Mullerian tumor of the ovary is extremely rare. This is heterologous neoplasms which apparently arise from undifferentiated mullerian stroma and is composed of mixture of malignant epithelial and stromal elements. We report a case of malignant mixed mullerian tumor of the ovary with brief literature review.
Female ; Ovary*

PURPOSE: Peripheral blood stem cell transplantation (PBSCT) has recently been used to rescue from myelosuppression following high-dose chemo-radiotherapy in patients with leukemia and solid tumor. Nevertheless, few data are still available on PBSC collection in pediatric patients, owing to technical problems. The time of stem cell harvest and the mobilization regimen may play important roles in terms of achieving adequate numbers of stem cells by leukapheresis. In this study, we analyse; 1) the technical aspects of leukapheresis as to feasibility and safety, 2) the optimal timing for PBSC collection after cytokine-based mobilizing regimens, 3) the engraftment kinetics. Method: A total of 93 leukapheresis was performed 22 children by Fenwall CS 3000 continuous cell separator, of whom 15 children weighed less than 25 kg. To mobilize hematopoietic stem cells into circulation, hematopoietic growth factor plus chemotherapy were used. Nineteen patients underwent autologous peripheral blood stem cell transplantation. RESULTS: The mean body weight was 25.3 kg (range: 10 to 56 kg). A total of 3 to 12 L of blood was processed (mean 265.4 65.9 mL/kg) for 2.5 to 5 hours (mean 3.15 hours). Extracorporeal line was primed with packed red blood cells below 25 kg. Serious morbidity was not noted. Each apheresis products contained a mean of 2.41 1.63x108 mononuclear cells/kg, 2.83 3.40x106 CD34 cells/kg, 9.30 10.3x104 colony forming unit (CFU-GM)/kg, respectively. Absolute neutrophil count (r=0.38, P<0.01) and CD34 cell count (r=0.65, P<0.001) on the day of leukapheresis seemed to predict the CFU-GM count collected in leukapheresis. A significant statistical correlation between the number of infused CFU-GM and the time to achieve an absolute neutrophil count of greater than 500/mm3 (P<0.01) was found. CONCLUSION: Leukapheresis for PBSCT seemed to be feasible and reliable in pediatric patients, conferring no major additional risks than adult patients, only if red cells are primed in extracorporeal line for small children. Absolute neutrophil count and CD34 cell number seemed to predict the timing of leukapheresis. In the PBSCT patient, engraftment was influenced by the infused CFU-GM count and bone marrow environment.
Adult ; Blood Component Removal ; Body Weight ; Bone Marrow ; Cell Count ; Child ; Drug Therapy ; Erythrocytes ; Granulocyte-Macrophage Progenitor Cells ; Hematopoietic Stem Cells ; Humans ; Kinetics* ; Leukapheresis ; Leukemia ; Neutrophils ; Peripheral Blood Stem Cell Transplantation ; Stem Cells*

No abstract available.
Copper* ; Lasers, Gas*