Pulmonary artery hypertension is a common cardiovascular complication in preterm infants with bronchopulmonary dysplasia which is associated with increased morbidity and mortality. Inhaled iloprost is used as a therapeutic option in pulmonary hypertension, especially in adults. There have been but a few reports on the use of iloprost for neonates and infants. We report the case of a 5 month-old-male infant who received neonatal intensive care for 4 months due to respiratory distress syndrome and prematurity, during which he developed bronchopulmonary dysplasia. Echocardiography showed severe pulmonary hypertension. The initial treatment included respiratory support with high frequency oscillatory ventilation (HFOV); however, his clinical condition did not improve. Inhaled iloprost with sildenafil, an oral phosphodiesterase-5 inhibitor, was thus used. With the administration of iloprost and sildenafil, his condition improved and he was weaned from oxygen. Our clinical experience suggests that iloprost is a promising therapy for pulmonary hypertension, especially when inhaled nitric oxide is unavailable.
Adult ; Bronchopulmonary Dysplasia ; Cyclic Nucleotide Phosphodiesterases, Type 5 ; Echocardiography ; Humans ; Hypertension ; Hypertension, Pulmonary ; Iloprost ; Infant ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal ; Nitric Oxide ; Oxygen ; Piperazines ; Pulmonary Artery ; Purines ; Sulfones ; Ventilation ; Sildenafil Citrate

BACKGROUND AND OBJECTIVES: Benign paroxysmal positional vertigo (BPPV) is one of the critical life events that can affect physical, emotional, and functional aspects of quality of life. Canalith repositioning procedure (CRP) provides rapid and long lasting relief of symptoms in most patients with BPPV. However, some patients express nonspecific symptoms such as anxiety or discomfort after treatment, The purpose of this study was to assess the residual symptoms after CRP in patients with BPPV using Dizziness Handicap Inventory (DHI) in a questionnaire format and to evaluate the therapeutic efficacy of CRP according to accompanying the DizzyFIX device. MATERIALS AND METHODS: We performed a prospective investigation in 135 consecutive patients with confirmed posterior semicircular canal BPPV. CRP was performed until nystagmus and vertigo disappeared. Patients were divided into three group using the DizzyFIX (group A), not using the DizzyFIX (group B) and closed observation (group C) after treatment. Then patients were asked to complete the questionnaire for Korean form DHI before treatment, 1, 2, 3, 4, and 8 week after treatment. RESULTS: There was a significant improvement in DHI scores when comparing the pre CRP and post CRP three groups (p<0.05), although emotional items showed incomplete improvement at 1 week. But at 2 week after treatment, there were statistically significant differences between group A and other groups in DHI scores specially in emotional items. CONCLUSION: Even after successful CRP, DHI scores indicated incomplete recovery and residual subjective symptoms may remain. For these patients additional follow up and management are necessary and using of the DizzyFIX will be helpful to reduce the incidence of residual dizziness especially emotional aspect.
Anxiety ; Dizziness ; Follow-Up Studies ; Humans ; Incidence ; Prospective Studies ; Quality of Life ; Surveys and Questionnaires ; Semicircular Canals ; Vertigo

BACKGROUND AND OBJECTIVES: The combination of platelet glycoprotein IIb/IIIa inhibitors and a low dose thrombolytic agent may produce early Thrombolysis In Myocardial Infarction (TIMI) 3 flow and a high rate of ST elevation resolution in an ST elevation acute myocardial infarction (STEMI). The clinical effect of tirofiban combined with low dose alteplase, prior to primary percutaneous coronary intervention (PCI) in STEMI, were evaluated on the ST elevation resolution, TIMI flow and 30-day clinical outcomes. SUBJECTS AND METHODS: Following aspirin, clopidogrel and standard heparin, 45 patients with STEMI were randomized into 2 groups; tirofiban administration (Group I; n=23, 64+/-10 years; 15 male) or combined administration of tirofiban with 40 mg alteplase prior to primary PCI (Group II; n=22, 59+/-11 years; 19 male). The pre- and post-interventional TIMI flow grades, ST elevation resolution and bleeding complications were compared between the two groups. The major adverse cardiac events (MACE) were compared between the two groups during 30-days of clinical follow-up. RESULTS: Group II had a higher pre-interventional TIMI flow (TIMI flow> or =2: 34.8% vs. 90.9%, p<0.0001) and rate of ST elevation resolution (49.0+/-27.8% vs. 66.6+/-27.2%, p=0.045) than Group I. A major bleeding complication developed in 1 (5.0%) Group II patient, and minor bleeding complications developed 1 patient from each group (Group I; 9.5% vs. Group II; 10%, p=0.959). CONCLUSION: Combined administration of tirofiban with alteplase prior to primary PCI leads to a higher TIMI flow and more frequent ST elevation resolution, without bleeding complications, compared to a single administration of tirofiban.
Angioplasty ; Aspirin ; Blood Platelets ; Electrocardiography ; Follow-Up Studies ; Glycoproteins ; Hemorrhage ; Heparin ; Humans ; Myocardial Infarction* ; Percutaneous Coronary Intervention* ; Thrombolytic Therapy ; Tissue Plasminogen Activator*

PURPOSE: The study evaluated changes in the quality of chest compressions over 2 min in 30:2 cardio-pulmonary resuscitation (CPR) by lay-persons and analyzed rescuer factors affecting the quality of chest compressions over time. METHODS: CPR training courses attended by 538 adult hospital and university workers (lay-person) were conducted at a university hospital. After 4-hour CPR training, tests were performed using a manikin with Skill-ReporterTM. Data of 459 subjects were analyzed concerning the quality of chest compressions over time and rescuer factors such as age, gender, body mass index, prior CPR training and CPR experience were also analyzed to determine their effect on the change in the quality of chest compressions. RESULTS: Compression depth (p=0.002) showed significant change over 2 min, but the rate (p=0.133), chest recoil (p=0.442) and hand placement (p=0.991) were insignificant. Ineffective compression depth (mean proportions of correct depth<70%) was not observed during the 2 min CPR. Female gender (p<0.001; OR, 5.882, 95% CI, 3.098-11.167) and no CPR training (p=0.004; OR, 2.163, 95% CI, 1.277-3.663) were associated with decline of compression depth. Time-dependent analysis revealed significant ineffective compression depth (<70%) in females and underweight patients (p<0.001). CONCLUSION: Switching compressors at an interval of 2 min is reasonable for 30:2 CPR by lay-persons. But, significant decline of correct compression depth over time in female and underweight rescuers was evident.
Adult ; Body Mass Index ; Cardiopulmonary Resuscitation ; Chest Wall Oscillation ; Fatigue ; Female ; Hand ; Humans ; Manikins ; Thinness ; Thorax

Acute interstitial nephritis (AIN) is an important cause of reversible acute kidney injury and pathologically characterized by inflammatory infiltrate in the renal interstitium. Solanum nigrum (S. nigrum) is a medicinal plant member of the Solanaceae family. Although S. nigrum has been traditionally used to treat various ailments such as pain, inflammation, and fever, it has also been reported to have a toxic effect, resulting in anticholinergic symptoms. However, there have been no reports of AIN caused by S. nigrum. Here, we report the first case of biopsy-confirmed AIN after ingestion of S. nigrum. The patient was successfully treated using corticosteroid therapy.
Acute Kidney Injury ; Eating ; Fever ; Humans ; Inflammation ; Nephritis, Interstitial* ; Plants, Medicinal ; Solanaceae ; Solanum nigrum* ; Solanum*

We aimed to compare the CT findings of nontuberculous mycobacterial pulmonary diseases caused by Mycobacterium avium-intracellulare complex (MAC) and Mycobacterium abscessus. Two chest radiologists analyzed retrospectively the thin-section CT findings of 51 patients with MAC and 36 with M. abscessus infection in terms of patterns and forms of lung lesions. No significant difference was found between MAC and M. abscessus infection in the presence of small nodules, tree-in-bud pattern, and bronchiectasis. However, lobar volume decrease (p=0.001), nodule (p=0.018), airspace consolidation (p=0.047) and thin-walled cavity (p=0.009) were more frequently observed in MAC infection. The upper lobe cavitary form was more frequent in the MAC (19 of 51 patients, 37%) group than M. abscessus (5 of 36, 14%) (p=0.029), whereas the nodular bronchiectatic form was more frequent in the M. abscessus group ([29 of 36, 81%] vs. [27 of 51, 53%] in MAC) (p=0.012). In conclusion, there is considerable overlap in common CT findings of MAC and M. abscessus pulmonary infection; however, lobar volume loss, nodule, airspace consolidation, and thin-walled cavity are more frequently seen in MAC than M. abscessus infection.
Adult ; Aged ; Aged, 80 and over ; Anatomy, Cross-Sectional/methods ; Diagnosis, Differential ; Female ; Humans ; Lung Diseases/*microbiology/*radiography ; Male ; Middle Aged ; Mycobacterium Infections, Atypical/microbiology/radiography ; Mycobacterium avium-intracellulare Infection/microbiology/*radiography ; Research Support, Non-U.S. Gov't ; Retrospective Studies ; Tomography, Spiral Computed/*methods ; Tuberculosis, Pulmonary/radiography

Mycobacterium massiliense is an emerging pathogen that is increasingly reported as a causative agent occurring during medical procedures, at surgical sites, and intramuscularly [1]. Although previously classified as part of M. abscessus, M. massiliense has recently been identified as a new species of rapidly growing nontuberculous mycobacteria [1,3] via a comparative sequence analysis of rpoB and hsp65 [3,5]. However, the clinical manifestations of M. massiliense have not been well characterized. We report here in a case of recurrent pneumonia for 3 years that improved with antibiotic treatment for M. massiliense in a 37-year-old woman with Sjogren's syndrome. The patient showed a substantial response to treatment with a combination of antimicrobial therapies comprising clarithromycin and amikacin without cefoxitin for 6 months. This is the first report of pulmonary infection of M. massiliense with Sjogren's syndrome in Korea.
Adult ; Amikacin ; Cefoxitin ; Clarithromycin ; Female ; Humans ; Korea ; Mycobacterium ; Nontuberculous Mycobacteria ; Pneumonia ; Sequence Analysis ; Sjogren's Syndrome

Chryseobacterium indologenes (C. indologenes) is a nonmotile, gram-negative bacillus that is widely distributed in nature. Generally considered nonpathogenic, C. indologenes rarely infects humans and is not normally present in the human microflora. C. indologenes infections have been observed in cases of peritoneal dialysis (PD)-associated peritonitis, although the incidence of these infections is low. Although C. indologenes is generally susceptible to trimethoprim-sulfamethoxazole, levofloxacin, ciprofloxacin, piperacillin-tazobactam, and cefepime, no guidelines have been established for the treatment of PD-associated peritonitis. Here we report the first case of PD-associated peritonitis in Korea with C. indologenes identified as the sole etiologic agent. The patient recovered after intraperitoneal antibiotic treatment without the need for Tenckhoff catheter removal.
Bacillus ; Catheters ; Chryseobacterium ; Ciprofloxacin ; Humans ; Incidence ; Korea ; Levofloxacin ; Peritoneal Dialysis ; Peritonitis ; Trimethoprim, Sulfamethoxazole Drug Combination

BACKGROUND AND OBJECTIVES: Chronic suppurative otitis media (CSOM) is a common infectious disease in childhood of poor hygiene group. In addition, in industrialized countries, with rising popularity of tympanostomy tubes for management of otitis media with effusion, CSOM is a potential problem in any child who had inserted ventilating tubes previously. Hearing loss following CSOM can negatively affect learning, speech, and cognitive function, so effective and timely management of CSOM is mandatory. The surgical procedure may be necessary in some children with CSOM, but when it is performed at a too early age, there might be more chances of recurrence than adults. SUBJECTS AND METHOD: Used in the study were 51 ears from patients who received tympanomastoidectomy due to CSOM in tertiary referral center from 1995 through 2004. The mean age was 9 years and 6 months. Cholesteatoma was found in 30 cases (58.8%). Age at operation, hearing outcomes, and the surgical results were retrospectively reviewed. RESULTS: Canal wall down mastoidectomy was performed in 23 cases and canal wall up procedure in 28 cases. Revision surgery was performed in 9 cases (17.6%) and mean duration between first and revision surgery was 27 months. In the cases of cholesteatoma, the rate of revision surgery was different between under 6 years old and over 7 years old group (p=.045). The age at 1st operation and postoperative hearing outcome had no correlation. CONCLUSION: Since the1st operation is performed earlier, the rate of revision may increase, especially in cases of cholesteatoma.
Adult ; Child ; Cholesteatoma ; Communicable Diseases ; Developed Countries ; Ear ; Hearing ; Hearing Loss ; Humans ; Hygiene ; Learning ; Middle Ear Ventilation ; Otitis Media ; Otitis Media with Effusion ; Otitis Media, Suppurative* ; Otologic Surgical Procedures ; Recurrence ; Retrospective Studies ; Tertiary Care Centers

BACKGROUND AND OBJECTIVES: Surgical indications and effect of auditory rehabilitation have not been established in elderly deaf patients who received cochlear implant (CI). The aim of this study is to analyze the outcomes of CI with respect to auditory performance and surgical complication in elderly deaf patients. SUBJECTS AND METHOD: Nineteen postlingually deafened patients who were 60 years and older at the time of implantation were included in the study from April 1992 to October 2006. They were compared to a group of 53 younger patients (<60 years) at the time of implantation. Surgical complications were identified and speech performance was evaluated preoperatively and postoperatively at 1 month, 3 months, 6 months, 1 year and 2 years. RESULTS: In the etiology, progressive hearing loss was most common in both groups. Perioperative complications such as temporary dizziness, wound problem, tinnitus, and temporary facial weakness showed no significant differences between elderly and control groups despite higher incidence of underlying disease in elderly patients. Preoperative speech performance (audiologic K-CID) was significantly better in control group than in elderly group, but there were no significant differences in postoperative period. CONCLUSION: The outcomes of CI in the elderly patients have been comparable with those of younger adults. Advanced age alone could not preclude anyone from being candidates of CI.
Adult ; Aged ; Cochlear Implantation ; Cochlear Implants ; Deafness ; Dizziness ; Hearing Loss ; Humans ; Incidence ; Postoperative Period ; Tinnitus