BACKGROUND: The aim of this study was to evaluate the influence of an improved method of endotracheal suction on nosocomial pneumonia (NP) and tracheal colonization by Pseudomonas aeruginosa and Acinetobacter baumannii in intensive care units (ICUs). METHODS: The study was carried out in both the medical and surgical ICUs of a tertiary-care university hospital; 2,347 patients were admitted in the ICUs from January 2003 to December 2004. The method of endotracheal suction to remove secretions was improved by using a sterile, individually packed catheter and sterile fluid filled in a small container for a single use instead of sterile catheters and fluid packed or filled in large containers for a multiple use. Then, we compared the incidence of NP, the colonization rates of P. aeruginosa and A. baumanni in the respiratory tract, and their carbapenem resistance before and after the intervention. RESULTS: The incidence of NP (1,000 patient-day rate) was decreased from 4.08 to 2.46 in the SICU and from 1.4 to 0.8 in the MICU after the intervention, but the differences were not significant. The colonization rate by A. baumannii was decreased significantly from 35.7% to 4.6% in the SICU (P<0.001) and from 12.7% to 7.6% in the MICU (P<0.001). The colonization rate by P. aeruginosa was decreased significantly from 17.7% to 7.4% in the SICU (P<0.001), but not in the MICU. There was also a marked decrease in carbapenem resistance, 21% to 8% in P. aeruginosa and 70% to 16% in A. baumannii. CONCLUSION: Endotracheal suction with a sterile catheter and sterile fluid is important in preventing respiratory infections and colonization by P. aeruginosa and A. baumannii in the ICU.
Acinetobacter baumannii* ; Acinetobacter* ; Catheters ; Colon* ; Drug Resistance, Bacterial ; Humans ; Incidence ; Intensive Care Units* ; Critical Care* ; Pneumonia* ; Pseudomonas aeruginosa* ; Pseudomonas* ; Respiratory System ; Respiratory Tract Infections ; Suction*

Keratoacanthoma(KA) is a rapidly growing benign cutaneous neoplasm, usually occurring on sunexposed sites in elderly people, and it has a close clinical and pathologic resemblance to squamous cell carcinoma. Giant KA of the lower lip is extremely rare. Various treatment modalities have been reported including radiation therapy, systemic oral retinoids, and the intralesional application of 5-fluorouracil(5-FU), methotrexate(MTX) or interferon alpha-2a. Excisional surgery, however, remains the treatment of choice for the majority of KA. The disadvantages of excision are the possible requirement for extensive reconstructive surgery and the resultant cosmetic or functional deficit. Recently, we experienced a case of giant KA of the lower lip in a 60-year-old male, and he was treated successfully with intralesional methotrexate. Now we report the case with a brief review of literature.
Aged ; Carcinoma, Squamous Cell ; Humans ; Interferons ; Keratoacanthoma* ; Lip* ; Male ; Methotrexate* ; Middle Aged ; Retinoids

Patients with hyperthyroidism can develop left ventricular dysfunction and heart failure, but severe pulmonary hypertension association with hyperthyroidism is rarely seen. Herein, we describe the case of a 27-year-old female who presented with abdominal distension accompanied by pulmonary arterial hypertension and Graves' disease. Her pulmonary arterial hypertension was improved by treating the hyperthyroidism and pulmonary artery hypertension. Additionally, the patient's symptoms of right-side heart failure improved after pulmonary arterial pressure was reduced. Hyperthyroidism should be regarded as a reversible cause of associated pulmonary arterial hypertension.
Adult ; Arterial Pressure ; Ascites ; Female ; Graves Disease ; Heart Failure ; Humans ; Hypertension ; Hypertension, Pulmonary ; Hyperthyroidism ; Pulmonary Artery ; Ventricular Dysfunction, Left

Pancreatic tissue is maintained by a simple proliferation of the preexisting cells in adulthood, whereas, they are dynamically derived from precursor/ stem cells from ductal epithelia during prenatal life. It has been known that tissue regeneration rarely occurs in the normal adult pancreas, particularly in the human pancreas. However, regeneration can be experimentally induced in the adult pancreas in response to various tissue injuries such as partial resection, pancreatitis by obstruction of the duct, and chemical insults. Regenerating pancreatic tissue shares a common morphogenic feature of "neogenic regeneration" in all regenerating animal models. Neogenic regeneration occurs at the site of tissue injury by forming small tubular structures with elongated epithelial cells (ductules) which grow to form pancreatic ducts and acini. The endocrine cells, including insulin secreting beta cells, are also derived from these ductules. As a sequential process of neogenesis, the regenerating tissue becomes heterogeneous in composition. Some areas were composed by tubules and ductules in surrounding loose connective tissue while others were denser with differentiating acini derived from tubules or ductules. Such neogenic regeneration mimics tissue development during fetal pancreatic organogenesis. In the process of pancreatic neogenesis, we found unique expressions of bioactive proteins such as nestin and clusterin as morphogenic factors. It is likely that the stem/precursor cells could be recapitulated and regenerated to functional cells, including endocrine and exocrine pancreatic cells with acinar and ductal cells during neogenic regeneration of the pancreas.
Adult ; Candidiasis, Cutaneous ; Clusterin ; Connective Tissue ; Endocrine Cells* ; Epithelial Cells ; Humans ; Insulin ; Models, Animal ; Nestin ; Organogenesis ; Pancreas ; Pancreatic Ducts ; Pancreatitis ; Regeneration* ; Social Change ; Stem Cells ; Tinea

BACKGROUND AND OBJECTIVES: Adenoid enlargement occurs most commonly between the age of three and ten. Atrophy usually begins at the age of ten and is completed before the age of twenty. In recent years, an increasing number of adolescents undergoing adenoidectomy has been noticed. We investigated the age change in 1990s. MATERIALS AND METHOD: A retrospective study was performed on 1,198 patients who underwent adenoidectomy due to adenoid vegetation confirmed by physical, radiologic, and endoscopic studies. The mean age was analyzed annually and the period of 1990s was divided into the first (from January 1990 to December 1994) and second half (from January 1995 to December 1999). In addition, the same analysis was performed for each age group below ten and above eleven. RESULTS: The study showed that the mean age of study population was 7.35, with the mean age of the first half being 7.10 and the second 7.52. Specifically, the mean age of the group below ten was 6.37 in the first half and 6.16 in the second half, and the group above eleven was 12.56 in the first half and 13.32 in the second half. CONCLUSION: The mean age of the patients who underwent adenoidectomy have increased during the econd half, especially in the age groups greater more than eleven.
Adenoidectomy* ; Adenoids ; Adolescent ; Atrophy ; Humans ; Retrospective Studies

Liposarcoma is a relatively common malignant tumor that can be originated from adipose tissue in the body, especially in the lower extremity and in the retroperitoneal space. But it is extremely rare in the head and neck region. Liposarcoma can be classified histopathologically into four subtypes; well differentiated, myxoid, round cell, and pleomorphic type. The prognosis of liposarcoma is known to be generally poor due to the high local recurrence rate in spite of complete resection. We report a case of myxoid liposarcoma of the neck in a 41-year old male, who was treated with primary excision of tumor and postoperative radiation therapy. The histopathology, clinical appearance, management and prognosis of this rare condition are discussed.
Adipose Tissue ; Adult ; Head ; Humans ; Liposarcoma ; Liposarcoma, Myxoid* ; Lower Extremity ; Male ; Neck* ; Prognosis ; Recurrence ; Retroperitoneal Space

No abstract available.
Hematopoietic Stem Cell Mobilization ; Heterocyclic Compounds ; Korea ; Stem Cells

Infliximab is a chimeric antibody against tumor necrosis factor-alpha and it can be used in the treatment of ankylosing spondylitis. Tumor necorosis factor-alpha is a potent proinflammatory cytokine and plays a key role in the host response against tuberculosis. Infliximab is known to be effective on active ankylosing spondylitis but it can also cause reactivation of latent tuberculosis. Physicians should screen patients for latent tuberculous infection or disease before prescribing the drug. We experienced a case of tuberculous pleurisy after taking infliximab in a patient suffering from ankylosing spondylitis. We present the case with a review of literature.
Humans ; Latent Tuberculosis ; Spondylitis, Ankylosing ; Tuberculosis ; Tuberculosis, Pleural* ; Tumor Necrosis Factor-alpha ; Infliximab

Toxic gases and soot deposition as a consequence of smoke inhalation can cause direct injury to the upper and lower airways and even to the lung parenchyma. A delay in proper and prompt therapy can be detrimental to critically ill burn patients with an inhalation injury. Therefore, serial chest radiography is an important diagnostic tool for pulmonary complications during treatment. The radiographic findings of the chest include normal, consolidation, interstitial and alveolar infiltrates, peribronchial thickening, atelectasis, cardiogenic and non-cardiogenic pulmonary edema, and a pneumothorax as acute complications of smoke inhalation. In addition, bronchiectasis, bronchiolitis obliterans and pulmonary fibrosis can occur as late complications. We encountered a case of 44-year-old male who presented with acute lung injury after an inhalation injury. He required endotracheal intubation and mechanical ventilation due to respiratory failure. He was managed successfully with conservative treatment. Later, a cavitary lesion of the left upper lobe was observed on the chest radiography and computed tomography, which was complicated by massive hemoptysis during the follow-up. However, the cavitary lesion disappeared spontaneously without any clinical consequences.
Acute Lung Injury ; Adult ; Bronchiectasis ; Bronchiolitis Obliterans ; Burns ; Critical Illness ; Follow-Up Studies ; Gases ; Hemoptysis ; Humans ; Inhalation ; Intubation, Intratracheal ; Lung* ; Male ; Pneumothorax ; Pulmonary Atelectasis ; Pulmonary Edema ; Pulmonary Fibrosis ; Radiography ; Respiration, Artificial ; Respiratory Insufficiency ; Smoke Inhalation Injury* ; Smoke* ; Soot ; Thorax

OBJECTIVE: To compare complications of percutaneous endoscopic gastrostomy (PEG) and percutaneous radiologic gastrostomy (PRG) in brain injured patients. METHOD: The records of brain injured patients who received either PEG or PRG between January 2001 and July 2008 in Busan paik hospital were reviewed retrospectively. Documented complications (infection, leakage, blockage/delayed feeding, aspiration pneumonia, tube displacement, pain, ileus, bleeding, tube fell/pulled out, bradycardia/hypotension) were recorded and compared. RESULTS: There were 44 brain injury patients with dysphagia. All patient received PEG or PRG successfully. (32 PEG, 12 PRG) The incidences of complications were 50% in both PEG group (16 in 32) and PRG group (6 in 12). In PEG group sixteen patients developed complications, 27 minor and two major. In PRG group six patients developed complications, 11 minor and one major. The most common complication of PEG was wound infection (37.9%). But there were no wound infection in PRG group. And there were no deaths in both PEG and PRG group. CONCLUSION: Both endoscopic and radiologic gastrostomy tube placements are safe and effective methods. But in high infection risk group such as old ages, DM or CRF patients who have brain injury with dysphagia, PRG is safer method than PEG.