BACKGROUND: Community-acquired pneumonia(CAP) remains a leading cause of morbidity and mortality worldwide. Recently, the evolution of drug-resistant microorganisms has become a serious problem in CAP management. Specific antimicrobial therapy is the cornerstone of CAP management. However, obtaining an accurate etiologic diagnosis clinically is not easy and empirical antimicrobial treatment is usually administered prior to the correct microbiologic diagnosis. In this study, the clinical usefulness of empirical CAP treatment was investigated. METHODS: A total 35 cases were studied prospectively over a 16-month period in Mokpo Catholic Hospital from Dec. 1995 to Mar. 1997. The microbiologic diagnosis was made by sputum, blood culture, a specific serum antibody test and an immunologic study. RESULTS: The causative organisms were isolated in 10 (30%) out of 33 cases: 8 cases and 1 case on the sputum culture and blood culture respectively, and 1 case by an indirect hemagglutinin test. 12 cases had underlying diseases: pulmonary tuberculosis 4, alcoholism 4, diabetes mellitus 3, and liver cirrhosis 1. Antimicrobial treatment was given empirically and all cases recovered. CONCLUSION: A definite microbiologic diagnosis before commencing the appropriate treatment in CAP is not straightforward. Empirical therapy according to a clinical assessment is important and helpful. However, every effort to make the correct etiologic diagnosis should be taken.
Alcoholism ; Diabetes Mellitus ; Diagnosis ; Hemagglutinins ; Jeollanam-do* ; Liver Cirrhosis ; Mortality ; Pneumonia* ; Prospective Studies ; Sputum ; Tuberculosis, Pulmonary

PURPOSE: Tracheal intubation in a hemorrhagic airway is a difficult procedure because the visibility can be obscured by blood or vomitus. Several devices and methods have been developed to overcome such obstacles, but they are not available at all practical sites. Therefore, this study was conducted to assess the time and success rate of tracheal intubation according to the type of suction tip used in a hemorrhagic airway manikin model. METHODS: This study was a randomized crossover manikin simulation study. We recruited 18 emergency physicians to perform intubation with suction using a Yankauer suction tip and a polyvinyl chloride (PVC) catheter suction tip in a hemorrhagic airway manikin model. We then measured the time and success rate of intubation for each suction tip. RESULTS: The mean intubation time using the Yankauer suction tip was 42.3 seconds, and the mean intubation time using the PVC catheter suction tip was 91.1 seconds (p < 0.001). Two cases of esophageal intubation occurred when the PVC catheter suction tip was used (success rate, 88.9%). In contrast, there was no esophageal intubation when the Yankauer suction tip was used (success rate, 100%) (p=0.217). CONCLUSION: Intubation of a hemorrhagic airway manikin model can be performed in a shorter time when a Yankauer suction tip is used than when a PVC catheter suction tip is used.
Catheters ; Emergencies ; Hemorrhage ; Intubation ; Manikins ; Polyvinyl Chloride ; Polyvinyls ; Suction

PURPOSE: Cox-2 expression in breast carcinoma has been reported to be related to angiogenesis, lymph node metastasis and Her-2 expression. The aim of this study is to evaluate the clinicopathologic significance of Cox-2 expression in the invasive ductal carcinomas (IDC) and intraductal carcinomas (DCIS) of the breast. METHODS: The materials were 353 IDC cases and 82 DCIS cases. Immunohistochemical stain for Cox-2 was interpreted as 1+ (weak & focal) and 2+ (diffuse), and the relationships between Cox-2 and ER, PR, Her-2, p53, Ki-67 and bcl-2 expressions were analyzed. RESULTS: There was no significant difference of Cox-2 expression between IDC (148/353, 41.9%) and DCIS (38/82, 46.3%). Cox-2 (2+) expression was more frequent in low grade than intermediate and high grade IDC, but the difference was not significant statistically (P=0.0833), and there were no significant differences of Cox-2 expression according to age, tumor size, nuclear grade, lymph node metastasis in IDC and DCIS cases. In IDC cases, Cox-2 (1+ and 2+) expression showed positive relationships with p53 (+) and more than 10% of Ki-67 labeling index (P=0.0029, P=0.0015), and revealed tendencies of positive relationships with ER (+) and bcl-2 (+) (P=0.0750, P=0.0776). However, no significant relationship between Cox-2 and Her-2 expressions was recognized. In DCIS cases, Cox-2 (2+) expression rate was increased in cases showing negative for Her-2 (P=0.0092) and positive for bcl-2 (P=0.0486). CONCLUSION: Cox-2 expression seems to be involved in the development of breast carcinomas, but not related to the invasiveness. Cox-2 expression, especially 2+, in the DCIS cases suggest a possibility of less aggressive biological behavior.
Breast ; Breast Neoplasms ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Lymph Nodes ; Neoplasm Metastasis

OBJECTIVES: The objective of this study was to compare the Korean Personality Rating Scale for Children (K-PRC) profile between children with attention-deficit hyperactivity disorder (ADHD) and typically developing children. We also aimed to investigate the association of K-PRC and ADHD symptoms. METHODS: Ninety-nine youth (age 8.3+/-2.4 years, 72 boys) with ADHD and 84 controls (age 9.2+/-2.5 years, 43 boys) were recruited from the Department of Pediatric Psychiatry of the Asan Medical Center Children's Hospital. Diagnoses of ADHD and comorbid psychiatric disorders were confirmed with the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL). The parents of the subjects completed the ADHD rating scale, and K-PRC. Independent t-tests, analysis of covariance, partial correlation analyses, and Mc Nemar test were used for analysis. RESULTS: Children and adolescents with ADHD showed higher K-PRC scores in verbal development, physical development, depression, delinquency, hyperactivity, family dysfunction and psychoticism. Delinquency and hyperactivity were significantly correlated with parent-rated ADHD rating scales and ADHD scores on K-SADS-PL. The hyperactive/impulsive and combined subtypes showed higher scores on hyperactivity and delinquency than the inattentive subtype, and the inattentive subtype showed higher scores on depression and social dysfunction of the K-PRC. CONCLUSION: Our results suggest that K-PRC could be used to comprehensively evaluate symptoms, combined psychopathologies, developmental delay and family dysfunction of children with ADHD.
Adolescent ; Child* ; Chungcheongnam-do ; Comorbidity ; Depression ; Diagnosis ; Humans ; Mood Disorders ; Parents ; Weights and Measures

Hemorrhage from esophageal varices is a catastrophic complication of portal hypertension. Endoscopic variceal ligation(EVL) is a newly developed technique that may replace Endoscopic injection sclerotherapy(EIS). But there are a few reports of longterm follow-up of EVL in Korea. We analysed 42 patients to evaluate longterm effect of EVL for esophageal varices. Total 689 variceal ligations were performed during 117 separate EVL sessions. Control rate of acute bleeding was 90.5%(38 of 42 patients). Four patients who were failed on control of acute bleeding were taken EIS with successful bleeding control. The eradication rate of esophageal varix was 76.2%(32 of 42 patients), the mean session for eradication of varix was 3,0(2-6), the number of bands per person was 16.0(5-41), and the number of bands per session was 6.0(4-11). Rebleeding after initiation of EVL occured in 1l of 42 patient(26,2%). 81.8% of rebleeding occurred 6 months later after EVL was done. The mortality rate and survival rate after varix eradication during follow-up period(after 6-45 months, mean: 15.5 months) was each 14.3%(6/42) and 85.7%(36/ 42). The causes of death were hepatic failure (3/6), esophageal variceal bleeding(2/ 6) and hepatic encephalopathy(l/6). After EVL, the~re were no serious treatment-re lated complications: except mild complications: mild chest pain in 5 patient(12.0%), mild substernal pain in 7 patients(16.6%). These results suggest that EVL is a safe and effective method for treatment of variceal bleeding control and eradication of esophageal varices with least serious complication. But regular periodic examination(interval of 4-6 months) and repeat EVL after eradication of varices should be required becuse of recurrence of varix and rebleeding.
Cause of Death ; Chest Pain ; Esophageal and Gastric Varices* ; Follow-Up Studies* ; Hemorrhage* ; Humans ; Hypertension, Portal ; Korea ; Ligation* ; Liver Failure ; Mortality ; Recurrence ; Survival Rate ; Varicose Veins

BACKGROUND AND AIMS: To investigate the difference between colorectal adenocarcinomas with white spots (foamy cells) and those without white spots, clinically and histopathologically, were examined 37 cases of colorectal adenocarcinomas were classified in this study. METHODS: Two groups: those with white spots and those without. In each case, evidence of lymph node and liver metastasis was sought. Immunoreactive staining for macrophage was performed. RESULTS: Increased incidence of exophytic tumors was found (73%, p=0.028) in the group with white spots. The incidences of lymph node metastasis were 33% vs. 45% between the group with white spots and the group of without, but the difference was not statistically significant. CONCLUSIONS: These results suggested that foamy cells might have a beneficial role in colorectal cancer, although they were not statistically significant. Therefore, further prospective study be warranted.
Adenocarcinoma ; Colon* ; Colonic Neoplasms* ; Colorectal Neoplasms ; Dental Caries* ; Incidence ; Liver ; Lymph Nodes ; Macrophages ; Neoplasm Metastasis

We describe a 56-year-old man who developed an acute liver injury after taking alfuzosin for 1 month to control his newly diagnosed benign prostatic hypertrophy (BPH). There was no history of alcohol consumption or the taking herbal or traditional remedies. Viral causes, autoimmune hepatitis, and biliary tree obstruction were excluded. Other rare causes of hepatitis such as hemochromatosis, primary biliary cirrhosis and Wilson's disease were also absent in this patient. His liver test results began to improve after discontinuing the alfuzosin. Two weeks later, alfuzosin was administered again because the patient complained of dysuria. After 10 days of alfuzosin reuse, his liver test results worsened. Five months later after the complete discontinuation of the drug, his liver test results had returned to normal. This clinical sequence suggests that alfuzosin caused his acute liver injury.
Acute Disease ; Adrenergic alpha-Antagonists/*adverse effects ; Dysuria/pathology ; Humans ; Liver Diseases/*chemically induced/pathology ; Liver Function Tests ; Male ; Middle Aged ; Prostatic Hyperplasia/drug therapy ; Quinazolines/*adverse effects

Hepatocellular cell carcinoma (HCC) is one of the most common and malignant neoplasm in the world. Waldenstrom's macroglobulinemia (WM) is a rare B-lymphocyte neoplasia characterized by monoclonal production of IgM Igs and by a marrow containing a diffuse infiltrate of plasmocytoid lymphocytes. A 67-year-old man was admitted because of multiple site pain, especially right flank and posterior neck pain. Physical examination showed hepatomegaly. Laboratory findings were as follows; total protein 8.6 g/dL, albumin 3.1 g/dL with monoclomal protein(IgM-lamda). Hepatitis C virus(HCV) infection was detected by polymerase chain reaction(PCR). Computed tomography and celiac angiography disclosed HCC. Aspiration biopsy of the liver revealed HCC. Magnetic resonance imaging showed compression fracture and epidural mass in cervical spines. Bone marrow examination revealed normocellularity with an increase of lymphoplasmacytic series. He was diagnosed as having WM and HCC. HCC is frequently associated with other malignancies. As the site of the extrahepatic primary cancer, the stomach ranked first. WM is also known for its association with an increased incidence of a second neoplasm, most of which are less differentiated lymphomas. but an association with a non-lymphoreticular malignancy is quite rare. We report first case of synchronous HCC with bone metastasis and WM (IgM,lamdatype) in korean with chronic hepatitis C.
Aged ; Angiography ; B-Lymphocytes ; Biopsy, Needle ; Bone Marrow ; Bone Marrow Examination ; Carcinoma, Hepatocellular* ; Fractures, Compression ; Hepacivirus ; Hepatitis C ; Hepatitis C, Chronic* ; Hepatitis, Chronic* ; Hepatomegaly ; Humans ; Immunoglobulin M ; Incidence ; Liver ; Lymphocytes ; Lymphoma ; Magnetic Resonance Imaging ; Neck Pain ; Neoplasm Metastasis ; Neoplasms, Second Primary ; Physical Examination ; Spine ; Stomach ; Waldenstrom Macroglobulinemia*

Boerhaave's syndrome is a spontaneous esophageal perforation due to severe nausea and vomiting after hyperphagia or drinking, and it is not due to trauma, medical instrumentation or a foreign body. Untreated esophageal perforation is associated with high mortality, and the traditional treatment has been surgical drainage and primary repair of the perforation. However, non-surgical primary repair with an endoscopic procedure has recently been attempted in some selected patients with a small sized perforation, limited contamination of the mediastinum and no evidence of sepsis. We report here on 2 patients with Boerhaave's syndrome and who were successfully treated via primary repair with endoscopic hemoclips, and we review the other cases of the Boerhaave's syndrome that were treated with a endoscopic procedure.
Drainage ; Drinking ; Esophageal Perforation ; Foreign Bodies ; Humans ; Hyperphagia ; Mediastinal Diseases ; Mediastinum ; Nausea ; Sepsis ; Vomiting

An ectopic opening of the common bile duct (CBD) into the duodenal bulb is a very rare congenital anomaly of the biliary system, which may cause recurrent duodenal ulcer or biliary diseases such as choledocholithiasis and cholangitis. Endoscopic retrograde cholangiopancreatography (ERCP) plays a major role in the diagnosis of this anomaly. We report two such cases: one in a 61-year-old man and the other in a 57-year-old man. In the first case, this anomaly caused acute cholangitis with multiple CBD stones, which were successfully treated by ERCP. In the second case, abdominal computed tomography showed pneumobilia, which was further evaluated using ERCP. Besides, this patient was diagnosed with an ectopic opening of the CBD associated with gallbladder cancer. We report these unusual cases and review the relevant medical literature.
Biliary Tract ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis* ; Choledocholithiasis ; Common Bile Duct* ; Diagnosis ; Duodenal Ulcer ; Gallbladder Neoplasms* ; Humans ; Middle Aged