BACKGROUND: Pulmonary complications including pneumonia and pulmonary edema frequently develop in critically ill surgical patients. Lung ultrasound (LUS) is increasingly used as a powerful diagnostic tool for pulmonary complications. The purpose of this study was to report how LUS is used in a surgical intensive care unit (ICU). METHODS: This study retrospectively reviewed the medical records of 67 patients who underwent LUS in surgical ICU between May 2016 and December 2016. RESULTS: The indication for LUS included hypoxemia (n = 44, 65.7%), abnormal chest radiographs without hypoxemia (n = 17, 25.4%), fever without both hypoxemia and abnormal chest radiographs (n = 4, 6.0%), and difficult weaning (n = 2, 3.0%). Among 67 patients, 55 patients were diagnosed with pulmonary edema (n = 27, 41.8%), pneumonia (n = 20, 29.9%), diffuse interstitial pattern with anterior consolidation (n = 6, 10.9%), pneumothorax with effusion (n = 1, 1.5%), and diaphragm dysfunction (n = 1, 1.5%), respectively, via LUS. LUS results did not indicate lung complications for 12 patients. Based on the location of space opacification on the chest radiographs, among 45 patients with bilateral abnormality and normal findings, three (6.7%) and two (4.4%) patients were finally diagnosed with pneumonia and atelectasis, respectively. Furthermore, among 34 patients with unilateral abnormality and normal findings, two patients (5.9%) were finally diagnosed with pulmonary edema. There were 27 patients who were initially diagnosed with pulmonary edema via LUS. This diagnosis was later confirmed by other tests. There were 20 patients who were initially diagnosed with pneumonia via LUS. Among them, 16 and 4 patients were finally diagnosed with pneumonia and atelectasis, respectively. CONCLUSIONS: LUS is useful to detect pulmonary complications including pulmonary edema and pneumonia in surgically ill patients.
Anoxia ; Critical Care* ; Critical Illness ; Diagnosis ; Diaphragm ; Fever ; Humans ; Lung* ; Medical Records ; Pneumonia ; Pneumothorax ; Pulmonary Atelectasis ; Pulmonary Edema ; Radiography, Thoracic ; Retrospective Studies ; Ultrasonography* ; Weaning

No abstract available.
Brain Abscess* ; Brain* ; Catheters*

OBJECTIVE: To investigate the changes of gait patterns in subjects who use the ankle foot orthoses (AFOs) with a variable ankle joint stop. METHOD: Six young subjects without a known physical disability were involved in this study. Double upright AFOs with three kinds of ankle joint stops (eg. AFOs with 85o posterior stop, 90o posterior stop, and 95o posterior stop) were used for the right foot and a rigid shoe was used for the left foot. Gait patterns of the subjects using the AFOs with a variable ankle joint stop were evaluated with the three dimensional gait analysis system. RESULTS: The gait patterns of the subjects with a 85o posterior stop AFO showed a shorter duration of single support phase than the subjects with a 90o posterior stop or 95o posterior stop. They showed the increased maximal knee flexion angles, decreased knee extension angles and decreased ankle range of motions by the kinematics. These linear changes in parameters and kinematics were statistically significant. In kinetics, the gait patterns of the subjects using a AFO with 85o posterior stop had the largest maximal knee flexion moment and the gait patterns of the subjects using a AFO with 95o posterior stop had the largest maximal knee extension moment. However these results were not statistically significant. CONCLUSION: For the patients with uncontrolled ankle motion, the AFOs with 90o or 95o posterior stop would be more desirable than the AFOs with 85o posterior stop, for the clearance of foot and stability of knees but not for the correction of the knee hyperextension.
Ankle Joint* ; Ankle* ; Biomechanical Phenomena ; Foot Orthoses* ; Foot* ; Gait* ; Humans ; Kinetics ; Knee ; Shoes

No abstract available.
Child ; Femoral Fractures ; Humans

BACKGROUND AND OBJECTIVE: There has been little clinical data on the treatment outcome of patients with acute asthma attack in Korea. We designed a management protocol of acute asthma, and analyzed clinical p arameters obtained from this protocol. METHOD: A total of 32 cases with acute asthma were treated with oxygen, beta2 agonist, and methylprednisolone. Ipratropium was added in cases of severe attack. After 90 minutes, intravenous aminophylline was given to the patients with poor response. RESULT: Beta2 agonist and methylprednisolone were sufficient for symptom control in 17 cases. Ipratropium and aminophylline were added in 6 and 9 cases, respectively. There was no difference in improvement of PEF, heart rate, respiratory rate, PaO2, PaCO2, and SaO2 at 90 minutes and 8 hours between beta2 agonist inhalation and subcutaneous group. Serum potassium concentration levels significantly decreased in patients treated with ipratropium of aminophylline(n=15, 4.17+/-0.45 vs. 3.99+/-0.35mM/L, p<0.05), compared with patients using only beta2 agonist and methylprednisolone(n=17, 3.89+/-0.30 vs. 4.14+/-0.45mM/L, p>0.05). CONCLUSION: Subcutaneous beta2 agonist may be an alternative to inhalant beta2 agonist for the emergency treatment of acute asthma, and we think a consensus regarding use of aminophylline in the emergency room should be made.
Aminophylline ; Asthma* ; Consensus ; Emergency Service, Hospital ; Emergency Treatment ; Heart Rate ; Humans ; Inhalation ; Ipratropium ; Korea ; Methylprednisolone ; Oxygen ; Potassium ; Respiratory Rate ; Treatment Outcome*

Tyrosine kinase A (TrkA)is an essential component of the high affinity nerve growth factor (NGF) receptor necessary to the mediate the biological effects of the neurotrophins, NGF. This study examined the distribution of TrkA-immunoreactivity (IR)cells in the postnatal rat cerebral cortex and the changes that occur in postnatal development as a result of the expression of this protein. TrkA-IR was detected at postnatal day (PD)3, PD6, PD9 and PD15. Base upon their somatodendritic morphology, the most commonly labeled cell type was the pyramidal neurons. At PD3 and PD6, layer I, II, III and V was immunopositive for TrkA, at PD9, not only at layer I, II, III, and V but also at layer VI. At PD15, the TrkA-positive cells were distributed in all layers. These TrkA-positive cells were not detected at PD0. In contrast, there was significant increase in the percentage of cells exhibiting TrkA-IR with development and the highest level was detected at PD15. These results suggest that the cerebral cortex expresses TrkA strongly during the postnatal period. Moreover, the postnatal development-related increase in the expression of TrkA-cells shows that NGF may have a trophic effect on these cerebral cortex neurons from the postnatal period.
Animals ; Animals, Newborn ; Cerebral Cortex/*growth&development/*metabolism ; Gene Expression Regulation, Developmental/*physiology ; Neurons/*metabolism ; Rats ; Rats, Sprague-Dawley ; Receptor, trkA/*metabolism

No abstract available.
Alagille Syndrome* ; Cholestasis ; Xanthomatosis*

OBJECTIVE: To define the ultrasonographic findings of the median nerve within the carpal tunnel and to verify the differences of the median nerve according to age, sex and the wrist in the normal Korean adults. METHOD: We studied 152 hands of 76 normal Korean adults who had no symptoms of carpal tunnel syndrome such as hand numbness, pain, dysesthesia or hand weakness. All subjects were examined with a real-time ultrasonography. We evaluated the flattening ratio (FR) and cross-sectional area (CSA) of the median nerve within the carpal tunnel. RESULTS: The CSA of the median nerve was 6.44+/-0.02 mm2 (at distal radioulnar joint), 6.34+/-0.02 mm2 (at pisiform) and 6.31+/-0.02 mm2 (at hamate). The FR at distal radioulnar joint is 2.36+/-0.02, at pisiform is 2.33+/-0.01 and at hamate is 2.33+/-0.01. Men have a larger cross-sectional area and flattening ratio of the median nerve than women. The older group over age 50 years has a smaller cross-sectional area and flattening ratio than the younger group. There were differences between men and women in body mass index (BMI) as well as between the older and the younger. There was also a linear relationship with CSA and FR in weight and height. CONCLUSION: The ultrasonographic finding of the normal Korean adult's median nerve in the carpal tunnel were different according to age and sex. Weight, height and BMI might be important factors to bring different results according to race, sex and age.
Adult ; Body Mass Index ; Carpal Tunnel Syndrome ; Continental Population Groups ; Female ; Hand ; Humans ; Hypesthesia ; Joints ; Male ; Median Nerve ; Paresthesia ; Wrist

Purpose: The aim of this study was to assess the efficacy of intravenous hydrocortisone, ascorbic acid, and thiamine (HAT) combination therapy in complicated intraabdominal infection (cIAI) patients with septic shock. Methods: This was a single-center, retrospective before-after clinical study comparing clinical outcomes of cIAI patients with septic shock treated with HAT in a surgical intensive care unit (ICU). Delta modified sequential organ failure assessment (mSOFA) scores were evaluated to assess recovery of organ dysfunction. Additional outcomes included procalcitonin level change, daily vasopressor dosage, mean number of days free of mechanical ventilation in 28 days, and renal replacement therapy days. Results: The delta mSOFA score (ICU admission mSOFA score minus 7th-day mSOFA score) was significantly higher in the HAT group than in the control group on the 7th day (2.30 vs. –0.90, P = 0.003). The median 7-day change in procalcitonin score was higher in the control group than in the HAT group (5.94 vs. 10.72, P = 0.041). The difference in vasopressor score between the 1st day and the 4th day was significantly higher in the HAT group (17.63 vs. 9.91, P = 0.005). Conclusion In our study of cIAI in patients with septic shock, administration of HAT therapy may improve the recovery from organ dysfunction.

Purpose: The aim of this study was to assess the efficacy of intravenous hydrocortisone, ascorbic acid, and thiamine (HAT) combination therapy in complicated intraabdominal infection (cIAI) patients with septic shock. Methods: This was a single-center, retrospective before-after clinical study comparing clinical outcomes of cIAI patients with septic shock treated with HAT in a surgical intensive care unit (ICU). Delta modified sequential organ failure assessment (mSOFA) scores were evaluated to assess recovery of organ dysfunction. Additional outcomes included procalcitonin level change, daily vasopressor dosage, mean number of days free of mechanical ventilation in 28 days, and renal replacement therapy days. Results: The delta mSOFA score (ICU admission mSOFA score minus 7th-day mSOFA score) was significantly higher in the HAT group than in the control group on the 7th day (2.30 vs. –0.90, P = 0.003). The median 7-day change in procalcitonin score was higher in the control group than in the HAT group (5.94 vs. 10.72, P = 0.041). The difference in vasopressor score between the 1st day and the 4th day was significantly higher in the HAT group (17.63 vs. 9.91, P = 0.005). Conclusion In our study of cIAI in patients with septic shock, administration of HAT therapy may improve the recovery from organ dysfunction.