PURPOSE: The objectives of this study were to find factors related to medical intensive care unit (ICU) readmission and to develop a prediction index for determining patients who are likely to be readmitted to medical ICUs. MATERIALS AND METHODS: We performed a retrospective cohort study of 343 consecutive patients who were admitted to the medical ICU of a single medical center from January 1, 2008 to December 31, 2012. We analyzed a broad range of patients' characteristics on the day of admission, extubation, and discharge from the ICU. RESULTS: Of the 343 patients discharged from the ICU alive, 33 (9.6%) were readmitted to the ICU unexpectedly. Using logistic regression analysis, the verified factors associated with increased risk of ICU readmission were male sex [odds ratio (OR) 3.17, 95% confidence interval (CI) 1.29-8.48], history of diabetes mellitus (OR 3.03, 95% CI 1.29-7.09), application of continuous renal replacement therapy during ICU stay (OR 2.78, 95% CI 0.85-9.09), white blood cell count on the day of extubation (OR 1.13, 95% CI 1.07-1.21), and heart rate just before ICU discharge (OR 1.03, 95% CI 1.01-1.06). We established a prediction index for ICU readmission using the five verified risk factors (area under the curve, 0.76, 95% CI 0.66-0.86). CONCLUSION: By using specific risk factors associated with increased readmission to the ICU, a numerical index could be established as an estimation tool to predict the risk of ICU readmission.
Aged ; Aged, 80 and over ; Cohort Studies ; Female ; Humans ; Intensive Care Units/*statistics & numerical data ; Male ; Medical Records ; Middle Aged ; Odds Ratio ; Patient Readmission/*statistics & numerical data ; Predictive Value of Tests ; Regression Analysis ; Republic of Korea ; Retrospective Studies ; Risk Factors

BACKGROUND/AIMS: Gastric atrophy can be diagnosed by serum pesinogen I/II ratio. The aim of this study was to investigate whether the changes of serum pepsinogen I/II ratio can be predicted by gastroscopy. MATERIALS AND METHODS: Sixty healthy subjects who underwent screening for serum pepsinogen I/II levels, serum Helicobacter pylori (H. pylori) antibody, and gastroscopy for two sequential years were included. Endoscopic findings were classified into four different categories according to the degree of chronic atrophic gastritis; none, mild, moderate, and severe. Changes of the serum pepsinogen I/II ratio, body mass index, H. pylori antibody, and endoscopic findings were analyzed after a year. RESULTS: The serum pepsinogen I/II ratio showed a tendency to decrease after a year in subjects with H. pylori infection (P=0.013) and those with moderate to severe atrophic gastritis (P=0.004), whereas it increased in subjects without H. pylori infection and those with none to mild atrophic gastritis. On multivariate analysis, the degree of atrophic gastritis was the only factor that was related to the changing trends of the serum pepsinogen I/II ratio (odds ratio=5.385, P=0.023). CONCLUSIONS: The degree of atrophic gastritis on endoscopic findings can predict the changes of the serum pepsinogen I/II ratio after a year. Regardless of the current status of H. pylori infection, the serum pepsinogen I/II ratio decreases after a year in subjects with moderate to severe atrophic gastritis.
Atrophy ; Body Mass Index ; Gastritis, Atrophic ; Gastroscopy ; Helicobacter pylori ; Mass Screening ; Multivariate Analysis ; Pepsinogen A

BACKGROUND/AIMS: Human hepatocellular carcinoma (HCC) is a hypervascular tumor, and vascular endothelial growth factor (VEGF) plays a key role in the regulation of tumor-associated angiogenesis. In this study, we analyzed the significance of the expression of VEGF family members on the prognosis and clinicopathologic progress of HCC. METHODS: Surgically resected specimens of HCC and noncancerous liver tissue were obtained from 323 patients with HCC, and VEGF mRNA was examined by quantitative reverse transcriptase-polymerase chain reactions (RT-PCRs). Patients who were seropositive for hepatitis B surface antigen were selected for the analysis (n=208). The VEGF(tumor)/GAPDH (glyceraldehyde-3-phosphate dehydrogenase)(tumor)/VEGF(nontumor)/GAPDH(nontumor) ratio was calculated using a quantitative RT-PCR assay, and the relationships between the expressions of VEGF family members and clinicopathologic parameters were analyzed to evaluate their significance in the prognosis of HCC. RESULTS: The disease-free survival was significantly worse in the high-VEGF-A group than in the low-VEGF-A group (P=0.035), whereas VEGF-A expression was not significantly related to overall survival (P=0.172). The factors significantly related to poor prognosis in univariate analysis were tumor size, portal vein invasion, microvascular thrombi, intrahepatic metastasis, tumor capsule invasion, liver capsule invasion, preoperative serum albumin level, and VEGF-A ratio. Multivariate analysis showed that a poor prognosis in HCC patients was significantly related to portal vein invasion (hazard ratio=3.381, P<0.001), intrahepatic metastasis (hazard ratio=2.379, P<0.001), tumor size (hazard ratio=1.834, P=0.003), and preoperative serum albumin level (hazard ratio=2.050, P=0.006). CONCLUSIONS: Our study showed that the expression of VEGF-A is positively correlated with the recurrence rate of HCC after curative resection. Therefore, a high expression of VEGF-A might be predictive of HCC recurrence after curative resection.
Adult ; Aged ; Base Sequence ; Carcinoma, Hepatocellular/*diagnosis/*surgery/virology ; Female ; Hepatitis B/complications ; Hepatitis B Surface Antigens/blood ; Humans ; Liver Neoplasms/*diagnosis/*surgery/virology ; Male ; Middle Aged ; Molecular Sequence Data ; Multivariate Analysis ; Neoplasm Invasiveness ; Neoplasm Staging ; Predictive Value of Tests ; Prognosis ; RNA, Messenger/analysis ; Reverse Transcriptase Polymerase Chain Reaction ; Survival Analysis ; Vascular Endothelial Growth Factors/genetics/*metabolism

PURPOSE: To evaluate the differences of radiological outcomes of uniportal and biportal vertebroplasty in the point of bone cement distribution and leakage. MATERIALS AND METHODS: A retrospective study reviewing the period between May 2002 and January 2006 investigated 100 vertebrae which underwent vertebroplasty and followed for more than three months by uniportal approach (55 vertebrae, group 1) and biportal approach (45 vertebrae, group 2). The operative time, the amount of bone cement injected, anterior vertebral height restoration, kyphotic angle, bone cement distribution, and bone cement leakage were evaluated. RESULTS: The amount of injected bone cement of group 1 (3.9 cc) was statistically smaller than that of group 2 (5.1 cc) (p=0.016). There were no significant differences in the operative time, anterior vertebral height restoration, kyphotic angle in both groups. The rate of bone cement distribution over 8 zones was significantly higher in group 2 than in group 1 (p=0.014). However, the rate of bone cement distribution over 7 zones and the rate of bone cement distributed on whole anterior vertebral body were not significantly different in both groups. The cement leakage was not also significantly different in both groups. CONCLUSION: Although the amount of injected bone cement was smaller in uniportal vertebroplasty, the radiological results and cement leakage were similar to biportal vertebroplasty. These findings suggest that uniportal vertebroplasty can be the operative options in osteoporotic vertebral fracture.
Ion Transport* ; Operative Time ; Retrospective Studies ; Spine ; Vertebroplasty*

BACKGROUND/AIMS: The aim of this study was to compare the patient's satisfaction and tolerance of transnasal (TN) and transoral (TO) endoscopy prospectively. METHODS: 120 patients were assigned to undergo TN (age: 49.5, M : F=65 : 55) or TO (age: 47.4, M : F=63 : 57) endoscopy according to their wishes. RESULTS: The patients' satisfaction was higher in the TN group than in the TO group (8.45 vs. 4.95, p <0.05). The degree of choking sensation, nausea, and throat soreness was lower in the TN group than the TO group. There was no difference in endoscopists' satisfaction between the two groups. The duration for TN was longer than for TO. Epistaxis and nasal pain were the common complications in the TN group. All complications were mild and were relieved spontaneously. An endoscopic examination could be completed in all patients in the TO group. In the TN group, examination failure was quite common in the early phase but the incidence decreased with increasing experience. It took the experience of at least 20 cases for the endoscopist to adapt to the TN route. CONCLUSIONS: TN endoscopy is believed to be a comfortable and safe procedure for improving the patients' satisfaction and for reducing the level of inconvenience.
Airway Obstruction ; Endoscopy* ; Epistaxis ; Humans ; Incidence ; Nausea ; Pharynx ; Prospective Studies ; Sensation

Diabetic ketoacidosis is an acute complication of diabetic mellitus. The most common triggering factors are infection, insulin therapy omission and the onset of the disease, but if these are excluded, other less frequent etiologic factors must be ruled out. We report a case of 22-year-old woman with Graves' disease presented as diabetic ketoacidosis. She was diagnosed type 1 diabetes mellitus at 13 years old and continually has been treated with insulin therapy until now. She typically showed tachycardia at rest in spite of correction of metabolic acidosis. Hyperthyroidism worsens glycemic control in diabetic patients and may precipitate diabetic ketoacidosis. Hyperthyroidism always should be investigated in diabetic patients presenting diabetic ketoacidosis without obvious triggering factors.
Acidosis ; Adolescent ; Diabetes Mellitus, Type 1 ; Diabetic Ketoacidosis* ; Female ; Graves Disease ; Humans ; Hyperthyroidism* ; Insulin ; Ketosis ; Tachycardia ; Young Adult

Malignancy may cause variable musculoskeletal symptoms which resemble connective tissue disorder. This symptoms as a fine sign of hidden neoplasm can precede the diagnosis of underlying malignancy. But only one case of stomach cancer associated with cancer arthritis was reported in the world. This fact is very interesting in Asia which has high prevalence of stomach cancer. We experienced one case of gastric adenocarcinoma with oligoarthritis involving both knee and right elbow. A 48-year-old man was diagnosed stomach cancer by gastric endoscope and biopsy. After then, he complained pain, tenderness, heating sensation, swelling of both knee and right elbow with high fever. Both knee MRI showed abundant synovial effusion and soft tissue edema. Full dose of nonsteroidal anti-inflammatory drug was not effective to control fever and arthritis. But fever and arthritis were gone after resection of tumor.
Adenocarcinoma* ; Arthritis ; Asia ; Biopsy ; Connective Tissue ; Diagnosis ; Edema ; Elbow ; Endoscopes ; Fever ; Heating ; Hot Temperature ; Humans ; Knee ; Magnetic Resonance Imaging ; Middle Aged ; Prevalence ; Sensation ; Stomach Neoplasms

Agranulocytosis is a rare adverse effect associated with prolonged vancomycin therapy, and is potentially serious, especially in end stage renal disease (ESRD) patients. We describe a continuous ambulatory peritoneal dialysis (CAPD) patient that developed vancomycin-induced agranulocytosis during treatment for methicillin-resistant Staphylococcus aureus (MRSA) -associated external cuff infection and pneumonia. The agranulocytosis was rapidly resolved by granulocyte colony-stimulating factor (G-CSF) therapy and by the discontinuation of vancomycin.
Aged ; Agranulocytosis/*chemically induced/drug therapy ; Anti-Bacterial Agents/*adverse effects/therapeutic use ; Catheters, Indwelling/microbiology ; Granulocyte Colony-Stimulating Factor/therapeutic use ; Human ; Kidney Failure, Chronic/complications/therapy ; Male ; Peritoneal Dialysis, Continuous Ambulatory ; Staphylococcal Infections/drug therapy ; Vancomycin/*adverse effects/therapeutic use

Primary iliopsoas abscess is a rare but potentially serious condition. The diagnosis is frequently delayed due to its variable and nonspecific features and occult clinical course. The delayed diagnosis and treatment of iliopsoas abscess is the major poor prognostic factor. We report a rare case of primary iliopsoas abscess that presented as a femoral neuropathy in a patient on hemodialysis. A 49-year-old man with end stage renal disease was admitted due to pain in the left inguinal area, and weakness and hypoesthesia of left lower leg. Left iliopsoas abscess was confirmed by CT and MRI. Left femoral neuropathy was diagnosed with electrodiagnostic study. Iliopsoas abscess with femoral neuropathy was completely treated with CT-guided aspiration, antibiotics and prolonged physical therapy of hip and knee joints. To our knowledge, this is the first case report of primary iliopsoas abscess presented as a femoral neuropathy in a patient on hemodialysis in Korea.
Anti-Bacterial Agents ; Delayed Diagnosis ; Diagnosis ; Femoral Neuropathy* ; Hip ; Humans ; Hypesthesia ; Kidney Failure, Chronic ; Knee Joint ; Korea ; Leg ; Magnetic Resonance Imaging ; Middle Aged ; Psoas Abscess* ; Renal Dialysis*

PURPOSE: cDNA microarray provided a powerful alternative, with an unprecedented view scope, in monitoring gene expression levels, and led to the discovery of regulatory pathways involved in complicated biological processes. This study was performed to gain better understanding of the molecular mechanisms underlying the carcinogenesis and progression of lung cancer. MATERIALS AND METHODS: Using a cDNA microarray, representing 4, 600 cDNA clusters, we studied the expression profiles in 10 non-small cell lung cancer (NSCLC) samples and the adjacent noncancerous lung tissues form the same patients. The alterations in the levels of gene expression were confirmed by reverse-transcription PCR in 10 randomly selected genes. RESULTS: Genes that were differently expressed in the cancerous and noncancerous tissues were identified. One hundred and nine genes (of which 68 were known) and 69 cDNAs (of which 32 were known) were up- and down-regulated in>70% of the NSCLC samples, respectively. In the cancerous tissues, the genes related to the cell cycle, metabolism, cell structure and signal transduction, were mostly up-regulated. Furthermore, we identified a few putative tumor suppressor genes that had previously been proposed by other workers. CONCLUSIONS: These results provide, not only a new molecular basis for understanding the biological properties of NSCLC, but also useful resources for the future development of diagnostic markers and therapeutic targets for NSCLC.
Biological Processes ; Carcinogenesis ; Carcinoma, Non-Small-Cell Lung* ; Cell Cycle ; DNA, Complementary ; Gene Expression Profiling* ; Gene Expression* ; Genes, Tumor Suppressor ; Humans ; Lung ; Lung Neoplasms ; Metabolism ; Oligonucleotide Array Sequence Analysis ; Polymerase Chain Reaction ; Signal Transduction