BACKGROUND: Postoperative admission to the surgical intensive care unit (S-ICU) is commonly planned to prevent and treat complications, unnecessary admission to the S-ICU increases medical costs and length of hospital stay. This study aimed evaluated outcome and the predictive factors for mortality in patients admitted to the S-ICU after abdominal surgery. METHODS: The 168 patients admitted to the S-ICU immediately after abdominal surgery were reviewed retrospectively from January to December 2011. RESULTS: The mortality rate of patients admitted to the S-ICU after abdominal surgery was 8.9% (15 of 168). Two preoperative factors (body mass index [BMI] < 18.5 kg/m2 [p < 0.001] and serum albumin < 3.0 g/dL [p = 0.018]), two operative factors (the need for transfusion [p = 0.008] or vasopressors [p = 0.013] during surgery), and three postoperative variables (mechanical ventilation immediately following surgery [p < 0.001], sequential organ failure assessment [p = 0.001] and SAPS II [p = 0.001] score) were associated with mortality in univariate analysis. After adjusting for age, gender, and SAPS II by a Cox regression, which revealed that BMI < 18.5 kg/m2 (p < 0.001, hazard ratio [HR] 9.690, 95% confidence interval [CI] 2.990-25.258) and the use of mechanical ventilation on admission to S-ICU (p < 0.001, HR 34.671, 95% CI 6.440-186.649) were independent prognostic factors. CONCLUSIONS: In patients in S-ICU after abdominal surgery, low BMI and postsurgical mechanical ventilation should be considered important predictors of mortality.
Abdomen* ; Body Mass Index ; Humans ; Critical Care ; Intensive Care Units ; Length of Stay ; Mortality ; Postoperative Complications ; Prognosis* ; Respiration, Artificial ; Retrospective Studies ; Serum Albumin ; Ventilation

Reports of bowing and pseudarthrosis of the humerus and clavicle are rare. Most patients with congenital pseudoarthrosis of the clavicle involving the right side and midportion of clavicle tended to heal better than congenital pseudoarthrosis of the tibia. We experienced a patient who had special features in terms of location, pseudoarthrosis pattern, and neurofibromatosis, and report on this case here.
Clavicle* ; Humans ; Humerus ; Neurofibromatoses* ; Pseudarthrosis* ; Tibia

A trienzyme extraction method (use of alpha-amylase, protease and folate conjugase) for food folate assay has been used to release folate from the food matrix. In order to reduce the incubation time with three enzymes, folate values were compared between two incubation protocols; separate incubation (SI, incubated with alpha-amylase and conjugase separately for 2 hours after protease treatment) and combined incubation (CI, incubated with alpha-amylase and conjugase together for 2 hours after protease treatment) using 88 food items from 12 kinds of fast foods and processed foods. We found that folate values by CI were comparable to or higher than those by SI, indicating that CI might be a better extraction procedure to shorten the entire incubation time. We measured folate contents in 49 fast foods and 26 processed foods by microbiological assay after CI. Mean folate contents of one serving of various burgers ranged from 43.1 to 62.0 microgram. One serving of French fries, pizza, sandwich and triangled kimbab contained a mean of 53.3, 28.4, 47.4, and 25.7 microgram of folate, respectively. Folate contents of non-alcoholic beverages were very low, ranging from 1.0 to 5.2 microgram/100 g. Some of our values were comparable to the values in the folate database published in Korean Nutrition Society, however, some of the published values were 140 times higher than the measured values in this study. Folate values measured by the more recent modifications here can be used to update Korean folate database to accurately estimate dietary folate intake
alpha-Amylases ; Beverages ; Fast Foods ; Folic Acid ; gamma-Glutamyl Hydrolase

OBJECTIVE: To develop and evaluate the psychometric properties of a modified Naturalistic Action Test (m-NAT) for Korean patients with impaired cognition. The NAT was originally designed to assess everyday action impairment associated with higher cortical dysfunction. METHODS: We developed the m-NAT by adapting the NAT for the Korean cultural background. The m-NAT was modeled as closely as possible on the original version in terms of rules and scoring. Thirty patients receiving neurorehabilitation (twenty-three stroke patients, five traumatic brain injury patients, and two dementia patients) and twenty healthy matched controls were included. Inter-rater reliability was assessed between two raters. Validity was evaluated by comparing the m-NAT score with various measures of attention, executive functions, and daily life. RESULTS: Performance on the m-NAT in terms of the total score was significantly different between patients and controls (p<0.01). Patients made significantly more total errors than controls (p<0.01). Omissions error was the most frequent type of error in patient group. Intraclass correlation coefficients for total m-NAT score was 0.95 (95% confidence interval [CI], 0.92 to 0.97; p<0.001); total error was 0.91 (95% CI, 0.89 to 0.92; p<0.001). Total m-NAT score showed moderate to strong correlations with Stroop test interference score & index, Trail Making Test parts A and B, Sustained Attention to Response Task commission error, Functional Independence Measure, Korean instrumental activities of daily living, Korean version of the Cognitive Failures Questionnaire, and Executive Behavior Scale (p<0.05). CONCLUSION: The m-NAT showed very good inter-rater reliability and adequate validity. The m-NAT adjusted to Korean cultural background can be useful in performance-based assessment of naturalistic action for clinical and research purposes.
Activities of Daily Living ; Brain Injuries ; Cognition ; Dementia ; Executive Function ; Humans ; Psychometrics ; Stroke ; Stroop Test ; Trail Making Test ; Uronic Acids ; Surveys and Questionnaires

Purpose: We aimed to analyze changes in suprascapular nerve (SSN) position within the suprascapular notch during in vivo shoulder abduction. Materials and Methods: Three-dimensional models of the shoulder complex were constructed based on magnetic resonance imaging of the brachial plexus (BP-MR) in a patient diagnosed with SSN dysfunction but normal scapular movement. Using BP-MR in neutral position and computed tomography data on shoulder abduction, shoulder abduction was simulated as the transition between two positions of the shoulder complex with overlapping of a neutral and abducted scapula. SSN movement during abduction was evaluated using the finite element method. Contact stress on the SSN was measured in the presence and absence of the transverse scapular ligament (TSL). Results: In the neutral position, the SSN ran almost parallel to the front of the TSL until entering the suprascapular notch and slightly contacted the anterior-inferior border of the TSL. As shoulder abduction progressed, contact stress decreased due to gradual loss of contact with the TSL. In the TSL-free scapula, there was no contact stress on the SSN in the neutral position. Towards the end of shoulder abduction, contact stress increased again as the SSN began to contact the base of the suprascapular notch in both TSL conditions. Conclusion We identified changes in the position of the SSN path within the suprascapular notch during shoulder abduction. The SSN starts in contact with the TSL and moves toward the base of the suprascapular notch with secondary contact. These findings may provide rationale for TSL release in SSN entrapment.

BACKGROUND: To determine the natural progression of conservatively treated rotator cuff tears, we evaluated changes in radiologic and clinical parameters in patients whose recalcitrant tears were neglected after conservative treatment. METHODS: A total of 73 patients with recalcitrant rotator cuff tears in spite of conservative treatment were included in this study. We measured changes in tear size and in the extent of fatty infiltration of the rotator cuff by comparing the initial and final follow-up magnetic resonance imagings (MRIs). To determine factors influencing the change in tear size, we collected the medical history of patients taken at the time of initial admission. RESULTS: The average follow-up period was 20.1 months, and the average increase in tear size across this period was 6.2 mm. In terms of steroid injection, we found that the increases in tear size of the steroid injection group (p=0.049) and of the sub-group that had received more than three steroid injections (p=0.010) were significantly greater than that of the non-steroid injection group. CONCLUSIONS: We found that the increase in cuff tear size was on average 6.2 mm across the follow-up period, indicating that neglecting cuff tears may cause them to progress into more severe tears. We also observed that a history of steroid injection might be a possible risk factor for a worse prognosis of cuff tears. Therefore, we suggest that patients with rotator cuff tears and a history of steroid injection are recommended aggressive modes of treatment such as surgery.
Follow-Up Studies ; Humans ; Magnetic Resonance Imaging* ; Prognosis ; Retrospective Studies* ; Risk Factors ; Rotator Cuff* ; Tears*

Although failure of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR TKI) is generally believed to be associated with cross-resistance to other EGFR TKI, the benefit of administering erlotinib as a second EGFR TKI after resistance of gefitinib as the first TKI has been well known. However, good response to gefitinib after an initial response to erlotinib has been rare. We report that a 45-year-old woman (never smoked), with lung adenocarcinoma and EGFR mutation, showed an initial response to erlotinib, and then responded to gefitinib again.
Adenocarcinoma ; Female ; Humans ; Lung ; Lung Neoplasms ; Middle Aged ; Protein-Tyrosine Kinases ; Quinazolines ; Receptor, Epidermal Growth Factor ; Erlotinib Hydrochloride

BACKGROUND: Osteoporosis is a significant comorbidity in patients with chronic obstructive pulmonary disease (COPD). This study examined the prevalence and risk factors associated with osteoporosis in patients with COPD. METHODS: The bone mineral densities (BMDs) of the lumbar spine and femoral bone were measured in 53 patients with clinically stable COPD and 41 age- and gender-matched control subjects showing a normal lung function. Osteoporosis was defined as a T-score < or =-2.5. The subjects' clinical characteristics and laboratory data were reviewed, and multiple logistic regression analysis was used to identify the risk factors associated with osteoporosis in COPD patients. RESULTS: The prevalence of osteoporosis was 47% and 32% in the COPD patients and controls, respectively. In particular, using the femoral neck T-score, the prevalence of osteoporosis in COPD patients was higher than that in the controls (26% vs. 5%; p=0.006). The average T-score of the lumbar spine (p=0.025) and femoral neck of COPD patients were significantly lower than those of the controls (p=0.001). The forced expiratory volume in the 1 second (FEV1) % predicted (p=0.019; odds ratio [OR], 0.955; 95% confidence interval [CI], 0.919-0.993) and age (p=0.024; OR, 1.144; 95% CI, 1.018-1.287) were independently associated with osteoporosis in patients with COPD. CONCLUSION: Using the femoral neck T-score, the prevalence of osteoporosis in patients with COPD was higher than the age-and gender-matched controls. A lower FEV1 and older age further increase the risk of osteoporosis in patients with COPD.
Bone Density ; Comorbidity ; Femur Neck ; Forced Expiratory Volume ; Humans ; Logistic Models ; Lung ; Odds Ratio ; Osteoporosis ; Prevalence ; Pulmonary Disease, Chronic Obstructive ; Risk Factors ; Spine

Abdominal wall hematoma is a rare but well-known disease, usually caused by trauma or, on rare occasions, occurring spontaneously. Hematomas of the rectus sheath and the anterolateral abdominal wall are commonly associated with injury to the inferior epigastric artery and the deep circumflex iliac artery, respectively. The diagnosis of spontaneously developed abdominal wall hematoma is sometimes delayed, due its clinical manifestations being similar to those of other causes of the acute abdomen. CT and angiography can be helpful in the diagnosis of the hematoma and the injured vessel. Herein, we report on a rare case of a spontaneously developed anterolateral abdominal wall hematoma treated with microcoil embolization of the left deep circumflex iliac artery.
Abdomen, Acute ; Abdominal Wall* ; Angiography ; Diagnosis ; Embolization, Therapeutic* ; Epigastric Arteries ; Hematoma* ; Iliac Artery ; Rupture, Spontaneous*

PURPOSE: We wished to compare CT colonography with conventional colonoscopy for the detection of colorectal polypoid lesions, and we wanted to evaluate the role of IV contrast-enhanced CT colonography for the differentiation between benign polypoid lesions and malignant polypoid lesions. MATERIALS AND METHODS: Thirty-four consecutive patients underwent CT colonography prior to conventional colonoscopy. Precontrast prone-position CT images and postcontrast supine position CT images were obtained and the virtual colonoscopic images were reconstructed. Axial, sagittal and coronal images with virtual colonoscopic images were prospectively interpreted for the presence, size and morphologic features of colorectal polypoid lesions, and then these findings were compared with the colonoscopic findings. The degree of enhancement of colorectal polypoid lesions was measured by subtracting the attenuation values obtained with precontrast and postcontrast CT images for the differentiation of benignity and malignancy of the colorectal polypoid lesions. RESULTS: Among 75 colorectal polypoid lesions identified on conventional colonoscopy, 49 neoplasms were found on CT colonography, and the overall detection rate was 65.3%. Detection rate of lesions smaller than 10 mm was 52.1% (24/46), and the detection rate for lesions equal to or larger than 10 mm was 86.2% (25/29). Morphologic features of the sessile type lesions on CT colonography were well correlated with those noted on colonoscopy, but the stalks were not identified in 6 of 13 polyps on CT colonography. There was no statistical correlation between benignity and malignancy and the degree of contrast enhancement on CT colonography. CONCLUSION: CT colonography is a useful modality for the detection of colorectal polypoid lesions equal to or larger than 10mm, and it well demonstrates the morphologic features, except for the stalk of pedunculated polyps. However, CT colonography cannot differentiate benignity from malignancy.
Colonography, Computed Tomographic* ; Colonoscopy ; Humans ; Polyps ; Prospective Studies ; Supine Position ; Tomography, X-Ray Computed