PURPOSE: Incorrect umbilical venous catheter(UVC) position results in an increased incidence of complications and rnisleading pressure measurements. Most modern catheters are radiopaque and are easily seen on plain film radiographs but the exact relation of the catheter tip to vascular anatomic landmarks is not available. We assessed the ability of ultrasonography to locate the tip of UVC. And we described the relationship between the locations of the tip of UVC on the ultrasonography and the anatomical landmark seen on the radiography. METHODS: From February 1997 to June 1997, 40 newborns admitted to NICU at Guro Hospital, Korea University, and required UVC insertion for clinical care. UVC position was checked by anteroposterior and cross table lateral radiography. And then ultrasonographic assessment was performed using Hewlett Packard Sonos-1000(Hewlett Packard, UK) with a 5 MHz transducer. The ultrasonographic examinations were documented on hard copy and compared with current plain film radiographs. The sensitivity, specificity, positive predictive value, negative predictive value for the radiography as a test to detect properly positioned UVC were calculated. RESULTS: 1) In 23 of 40 newborns the UVCs were properly positioned by anteroposterior radiography (T8-T10), but ultrasonographic examination showed that 3 UVCs were malpositioned(false positive value 13%). Detection of properly located UVC by anteroposterior radiography had a sensitivity of 76.9%, specificity of 78.6%, positive predictive value of 87% and negative predictive value of 64.7%. 2) In 13 of 40 newborns the UVCs were properly positioned by anteroposterior radiography (T8- T9), ultrasonographic examination showed that all UVCs were positioned in RA and IVC(false positive value 0%). Detection of properly located UVC by anteroposterior radiography had a sensitivity of 50%, specificity of 100%, positive predictive value of 100% and negative predictive value of 51.9%. 3) In 18 of 40 newborns the UVCs were properly positioned by cross table lateral radio- graphy(less than 7mm between diaphragm and tip of UVC), but ultrasonographic examination showed that all UVCs were positioned in RA and IVC(false positive value 10.5%). Detection of properly located UVC by cross table lateral radiography had a sensitivity of 69.2%, specificity of 100%, positive predictive value of 100%, negative predictive value of 63.6%. CONCLUSION: Ultrasonographic catheter localization is a noninvasive technique that uses no ionizing radiation and has no known deterimental side effects, and allows direct visualization of the pertinent vascular anatomy and provides more information than traditional radiography. Use of ultrasonographic guidance at the time of UVC insertion allows the catheter position to be immediately adjusted, with confirmation of the amended position, obviating the need for repeated radiological evaluations. When ultrasonography is unavailable, proper placement of UVC can be estimated by use of radiography to position the tip of UVC between the eighth and ninth thoracic vertebral body by anteroposterior radiography and less than 7mm above or below the diaphragm by cross table lateral radiography.
Anatomic Landmarks ; Catheters* ; Diaphragm ; Humans ; Incidence ; Infant, Newborn* ; Korea ; Radiation, Ionizing ; Radiography* ; Sensitivity and Specificity ; Transducers ; Ultrasonography

OBJECTIVES: This study was conducted to investigate factors influencing physical activities of daily living in the elderly with cognitive impairment. METHODS: The Barthel activities of daily living, modified Blessed Dementia Rating Scale, Korean version of mini-mental state examination, and Motoricity Index were administered to 45 elderly people whose corrected MMSEK scores were 24 or less. They were inhabitants in an institution in Taegu. RESULTS: Of the aforementioned S variables, the Motoricity Index could account far 42% of the variance of the Barthel activities of daily living. If the modified Blessed Dementia Rating Scale score was included in the multiple regression, the accountable portion of the Barthel activities of daily living variance increased by 6% only. CONCLUSION: Motor function of the limbs and severity of dementia may be the most important variables in the physical activities of daily living of the elderly with cognitive impairment.
Activities of Daily Living ; Aged* ; Cognition ; Daegu ; Dementia ; Extremities ; Humans ; Motor Activity*

Pnuemocystis jirovecii pneumonia (PJP) is one of leading causes of acute respiratory failure in patients infected with human immunodeficiency virus (HIV), and the mortality rate remains high in mechanically ventilated HIV patients with PJP. There are several reported cases who received extracorporeal membrane oxygenation (ECMO) treatment for respiratory failure associated with severe PJP in HIV-infected patients. We report a patient who was newly diagnosed with HIV and PJP whose condition worsened after highly active antiretroviral therapy (HAART) initiation and progressed to acute respiratory distress syndrome requiring veno-venous ECMO. The patient recovered from PJP and is undergoing treatment with HAART. ECMO support can be an effective life-saving salvage therapy for acute respiratory failure refractory to mechanical ventilation following HAART in HIV-infected patients with severe PJP.
Antiretroviral Therapy, Highly Active* ; Extracorporeal Membrane Oxygenation* ; HIV ; Humans ; Mortality ; Pneumocystis jirovecii* ; Pneumocystis* ; Pneumonia* ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult* ; Respiratory Insufficiency ; Salvage Therapy

Human toxocariasis is a zoonotic parasitic disease caused by the larva of toxocara canis or cati. It is one of the most commonly reported zoonotic helminth infection in the world. Human are infected mainly by the accidental ingestion of embryonated eggs due to the pica, geophagia, the consumption of contaminated raw vegetables and poor personal hygiene particularly in childhood. In adults, the consumption of raw meat from potential paratenic hosts e.g. chickens, lambs, rabbits and dogs is a major cause of human toxocariasis. The larva can reach various organs such as the liver, lung, brain, and eye by the hematogenous spread and cause visceral larva migrans We experience a case of pulmonary infiltration with eosinophilia by visceral larva migrans after eating the raw liver and kidney of a dog.
Child ; Adult ; Male ; Female ; Humans ; Dogs ; Rabbits ; Animals

Pnuemocystis jirovecii pneumonia (PJP) is one of leading causes of acute respiratory failure in patients infected with human immunodeficiency virus (HIV), and the mortality rate remains high in mechanically ventilated HIV patients with PJP. There are several reported cases who received extracorporeal membrane oxygenation (ECMO) treatment for respiratory failure associated with severe PJP in HIV-infected patients. We report a patient who was newly diagnosed with HIV and PJP whose condition worsened after highly active antiretroviral therapy (HAART) initiation and progressed to acute respiratory distress syndrome requiring veno-venous ECMO. The patient recovered from PJP and is undergoing treatment with HAART. ECMO support can be an effective life-saving salvage therapy for acute respiratory failure refractory to mechanical ventilation following HAART in HIV-infected patients with severe PJP.
Antiretroviral Therapy, Highly Active ; Extracorporeal Membrane Oxygenation ; HIV ; Humans ; Mortality ; Pneumocystis jirovecii ; Pneumocystis ; Pneumonia ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult ; Respiratory Insufficiency ; Salvage Therapy

BACKGROUND/AIMS: We aimed to evaluate the efficacy and safety of peginterferon plus ribavirin for chronic hepatitis C (CHC) patients under real life setting in Korea. METHODS: We retrospectively analyzed the medical records of 758 CHC patients treated with peginterferon plus ribavirin between 2000 and 2008 from 14 university hospitals in the Gyeonggi-Incheon area in Korea. RESULTS: Hepatitis C virus (HCV) genotype 1 was detected in 61.2% of patients, while genotype 2 was detected in 35.5%. Baseline HCV RNA level was > or =6x10(5) IU/mL in 51.6% of patients. The sustained virological response (SVR) rate was 59.6% regardless of genotype; 53.6% in genotype 1 and 71.4% in genotype 2/3. On multivariate analysis, male gender (p=0.011), early virological response (p<0.001), genotype 2/3 (p<0.001), HCV RNA <6x10(5) IU/mL (p=0.005) and adherence to the drug >80% of the planned dose (p<0.001) were associated with SVR. The rate of premature discontinuation was 35.7%. The main reason for withdrawal was intolerance to the drug due to common adverse events or cytopenia (48.2%). CONCLUSIONS: Our data suggest that the efficacy of peginterferon and ribavirin therapy in Koreans is better in Koreans than in Caucasians for the treatment of CHC, corroborating previous studies that have shown the superior therapeutic efficacy of this regimen in Asians.
Asian Continental Ancestry Group ; Genotype ; Hepacivirus ; Hepatitis C, Chronic ; Hepatitis, Chronic ; Hospitals, University ; Humans ; Male ; Medical Records ; Multivariate Analysis ; Retrospective Studies ; Ribavirin ; RNA

Background: Only few studies have shown the efficacy and safety of glucose-control strategies using the quadruple drug combination. Therefore, the aim of the present study was to investigate the usefulness of the quadruple combination therapy with oral hypoglycemic agents (OHAs) in patients with uncontrolled type 2 diabetes mellitus (T2DM). Methods: From March 2014 to December 2018, data of patients with T2DM, who were treated with quadruple hypoglycemic medications for over 12 months in 11 hospitals in South Korea, were reviewed retrospectively. We compared glycosylated hemoglobin (HbA1c) levels before and 12 months after quadruple treatment with OHAs. The safety, maintenance rate, and therapeutic patterns after failure of the quadruple therapy were also evaluated. Results: In total, 357 patients were enrolled for quadruple OHA therapy, and the baseline HbA1c level was 9.0%±1.3% (74.9± 14.1 mmol/mol). After 12 months, 270 patients (75.6%) adhered to the quadruple therapy and HbA1c was significantly reduced from 8.9%±1.2% to 7.8%±1.3% (mean change, –1.1%±1.2%; P<0.001). The number of patients with HbA1c <7% increased significantly from 5 to 68 (P<0.005). In addition, lipid profiles and liver enzyme levels were also improved whereas no changes in body weight. There was no significant safety issue in patients treated with quadruple OHA therapy. Conclusion This study shows the therapeutic efficacy of the quadruple OHA regimen T2DM and demonstrates that it can be an option for the management of T2DM patients who cannot use insulin or reject injectable therapy.

Only few studies have shown the efficacy and safety of glucose-control strategies using the quadruple drug combination. Therefore, the aim of the present study was to investigate the usefulness of the quadruple combination therapy with oral hypoglycemic agents (OHAs) in patients with uncontrolled type 2 diabetes mellitus (T2DM).

Only few studies have shown the efficacy and safety of glucose-control strategies using the quadruple drug combination. Therefore, the aim of the present study was to investigate the usefulness of the quadruple combination therapy with oral hypoglycemic agents (OHAs) in patients with uncontrolled type 2 diabetes mellitus (T2DM).