Although the nasogastric tube (NGT) is widely used in critically ill patients, most intensivists do not give much thought to it or its possible complications. NGT syndrome is a rare but fatal complication characterized by throat pain and vocal cord paralysis in the presence of NGT. Recently, we experienced a case of NGT syndrome developed in an 86-year-old female twelve days after NGT insertion. We immediately removed the NGT and secured the airway by tracheostomy. She was treated successfully with an intravenous antibiotic, steroid and proton pump inhibitor and the syndrome did not recur after reinsertion of the NGT.
Aged, 80 and over ; Critical Illness ; Female ; Humans ; Intensive Care Units* ; Critical Care* ; Pharynx ; Proton Pumps ; Tracheostomy ; Vocal Cord Paralysis

We experienced 3 cases of Candida esophagitis in infancy which were diagnosed by esophageal endoscopy. First case, 10 month-old boy with combined immune deficiency had suffered from oral thrush and poor feeding for more than 4 months. Esophageal endoscopy revealed multiple whitish creamy patches on the friable erythematous and necrotic mucosa of the esophagus. He was firstly treated with amphotericin-B but in vain. Then he was treated with fluconazole (5 mg/kg/day) and in a few days oral thrush nearly disappeared and endoscopy after 2 weeks revealed complete healing of the esophagitis. Second case, 6 month-old boy with some cellular immue defect also suffered from oral thrush, poor feeding and intermittent fever. He was treated with fluconazole and oral thrush was imporved. He was discharged without follow up endoscopy. Third case, 4 month-old girl with liver cirrhosis due to infantile cholestasis had Candida sepsis. Esophagitis was found incidentally during the endoscopic examination of esophageal varix. First 2 cases showed multiple small filling defects and decreased motility on esophagography. Candida antigen was not detected in the sera of all 3 cases of candidiasis. We conclude that Candidia esophagitis should be suspected when an infant has been suffering from long-term treatmet-resistant oral thrush and poor feeding and that esophageal endoscopy can be easily performed in infants also and useful in diagnosing esophagitis and assessing the outcome of treatment.
Candida* ; Candidiasis ; Candidiasis, Oral ; Cholestasis ; Endoscopy ; Esophageal and Gastric Varices ; Esophagitis* ; Esophagus ; Female ; Fever ; Fluconazole ; Humans ; Infant ; Liver Cirrhosis ; Male ; Mucous Membrane ; Sepsis

In modern society, characterized by variability of daily life, complicated industrial structure and surprisingly increased traffics, the danger of unexpected accident if always threatening the people. In America, for instance, almost 0.5% of the whole population annually suffers from head injury. About two thirds of traffic accident patients have head injury of various forms. Among the head injury patients due to traffic accidents, the commonest cause of death is head injury itself in about 70%. In this study, 585 cases of adult head injury patients over 15 years of age, observed at the Department of Neurosurgery, Seoul National University Hospital during the period from January, 1966 till September, 1971 were reviewed. 1) There were 447 men and 138 women; male female ratio was 3:1.2) The commonest cause of head injury was traffic accident (57.3% of the total patients). A second common cause was "falls"(25.5%). 3) In skull fracture patients, vault fractures were twice as frequent as basal skull fracture. The incidence of simple fractures was remarkably higher than that of compound fractures, the ratio being 7:4. The incidence of linear fractures was slightly higher than that of depressed fractures, the ratio being 6:5. Most of linear fractures were simple fractures, but about 79% of depressed fractures were compound fractures. 4) Among the intracranial hemorrhagic lesion, subdural hematoma occupied about half of the total cases, most of whom were acute cases. The predilection site of subdural hematoma was the cerebral convexity (frontal, parietal and temporal areas). The epidural hematoma , of which the predilection site was temporal area, occupied about 30 % of the total intracranial hemorrhage lesions. Temporal lobe was the predilection site of intracerebral hematoma. 5) About half of the patients with intracranial hemorrhagic lesions were accompanied by skull fractures. About 28% of the cases with skull fractures were accompanied by intracranial hemorrhagic lesions. 6) Altered consciousness was observed in about 90% of the total patients. Lucid interval was observed in 26% of the cases with intracranial hemorrhagic lesion. Vomiting occurred in a quarter of the total patients and early convulsive attacks were noticed in 5%. 7) Overall mortality rate of all the head injury patients was 12.3% and their operative mortality rate was 20.1%. The mortality rate in the patients with skull fractures was five times as high as in the patients without skull fractures. The mortality rate in the patients with intracranial hemorrhagic lesions was nearly three times as high as in those without. The mortality rate in the patients with linear skull fractures was about three times as high as in those with depressed skull fractures. 8) Sequelae were noticed in about half of the total patients. The most frequent one was postconcussion syndrome, the incidence being 36% of the total patients. 9) Associated injuries were found in about 10% of the total patients. The frequent ones were clavicle fracture, tibia/fibula fracture and mandible fracture, in order.
Accidents, Traffic ; Adult* ; Americas ; Cause of Death ; Clavicle ; Consciousness ; Craniocerebral Trauma* ; Female ; Fractures, Open ; Hematoma ; Hematoma, Subdural ; Humans ; Incidence ; Intracranial Hemorrhages ; Male ; Mandible ; Mortality ; Neurosurgery ; Rabeprazole ; Seoul ; Skull Fracture, Depressed ; Skull Fractures ; Temporal Lobe ; Vomiting

Non-acetylated salicylates have been recommended for use as alternatives to nonsteroidal anti-inflammatory drugs (NSAIDs) in aspirin and/or tartrazine-sensitive patients. We experienced a case of an aspirin-sensitive asthmatic patient who developed a broncho-obstructive reaction after taking 100 mg of sodium salicylate. The result of this study suggests that sodium salicylate may cross-react with aspirin in aspirin-and tartrazine-sensitive patients.
Aspirin/*adverse effects/immunology ; Asthma/*complications/diagnosis/etiology ; Bronchial Provocation Tests ; Cross Reactions ; Drug Hypersensitivity/*complications/diagnosis/etiology ; Female ; Humans ; Middle Aged ; Sodium Salicylate/*adverse effects/immunology ; Tartrazine/adverse effects

BACKGROUND: Over the decade, Klebsiella pneumoniae resistant to broad-spectrum oephalosporins have been involved in hospital outbreaks, particulaly in intensive care units. Betwem March 20 and June 12. 1900. an outbreak of sepsis caused by multiresistant K. pneumoniae in the neonatal intensive care unit (NICU) of Asan Medical Center. This paper describes bacteriologic, molecular and epidemiologic features of the outbreak. METHODS: For surveillance purpose, stool specimens were obtained from all patients, nurses and house staff in NICU and cultured onto MacConkey agar medium containg cefotaxim, (10 microgram/ml). All K. pneumoniae isolated blood culture isolates form patients with sepsis were tested for antobiogram by microbroth dilution method and for detection of extended-spectrum beta-Iactamase (ESBL) by double disk synergy test and ESBL Etest. Restriction profiles of total genomic DNAs were compared by pulsed filed gel electrophoresis(PFGE) after cleavage by Xbal. beta-Lactamase was tested using nitroefin disks and characterized by transconjugation to Escherichia coli and isoelectric focusing. For infection control, all infected or colonized patients and nurses were cohorted into a separate room and strict barrier precautions were enforced. RESULTS: The outbreak involved 7 patients with sepsis form whom multiresistant. K. pneumoniae were isolated. Surveillance culture revealed that 9 of 37 patients and 2 of 48 nurses and house staff were colonized. The 18 isolates showed 8 different antimicrobial resistance patterns with cefotaxime resistance in all. Test for ESBL was positive in all 18 isolates but only 15 isolates by ESBL Etest. PFGE analysis showed that 6 of the 7 blood isolate from infected patient and 9 of the 11 fecal isolates from surveillance cultures were of the identical or very similar pattern. beta-Lactamase activities were transferable by conjugation in all but one isolate. No additional case of multiresistant. K. pneumoniae infection had been reproted for 6 months since the introduction of strict barrier precautious and other infection control measures. CONCLUSION: The outbreak was caused by ESBL-producing K. pneumoniae which appeared to be introduced into the NICU from multiple sources as was indicated by PFGE patterns. An optimal laboratory method for screening for ESBL remain to be developed as the double disk synergy test and ESBL Etest did not show complete agreement. As for infoction control our results emphasize the necessity of early recognition of outbreaks, cohorting of not only infected but also colonized patients and reinforcement of the barrier precuations for the prevention of further spread of cross-infections.
Agar ; beta-Lactamases* ; Cefotaxime ; Chungcheongnam-do ; Cohort Studies ; Colon ; Cross Infection* ; Disease Outbreaks ; DNA ; Escherichia coli ; Humans ; Infant, Newborn ; Infection Control ; Intensive Care Units ; Intensive Care, Neonatal* ; Internship and Residency ; Isoelectric Focusing ; Klebsiella pneumoniae* ; Klebsiella* ; Mass Screening ; Pneumonia ; Sepsis

OBJECTIVE: The hematopoietic cytokine, erythropoietin (EPO) is known to have neuroprotective effects including promotion of neuronal survival and regeneration after ischemic injury. This study was to investigate the effects of EPO on synaptogenesis and neural restoration in the ischemic condition on neuronal differentiated SH-SY5Y cells and on the behaviors in rat animal model induced by middle cerebral artery occlusion. METHODS: We analyzed the neurite outgrowth and the gene expression of differentiated human neuroblastoma SH-SY5Y cells after the hypoxic stress. Moreover, we performed the motor functional behavior test in EPO treatment of Sprague Dawley rats following cerebral ischemia induced by middle cerebral artery's occlusion (MCAO). RESULTS: Treatment of 2 and 10 units EPO for 1 week showed increase of neurite outgrowth SH-SY5Y cells, compared with non-treatment group (p < 0.05). The results of reverse transcriptase-polymerose chain reaction (RT-PCR) also showed that both synaptophysin (SYP) genes and Growth Associated protein 43 (GAP43) genes in EPO treated cells were significant increased compared with non-treated ischemic group, respectively. The foot fault behavior was recovered in MCAO with EPO treatment group than MCAO group, significantly. CONCLUSION: The elongation of neurite and the increased expressions of SYP and GAP43, and recovered behavioral evidence in the EPO treatment are involved in possible role in neural restoration and synaptogenesis in hypoxic injuried brain. In this study, we suggest that EPO treatment will be may supportive medication to stroke patients to improve the functional brain disturbance.
Animals ; Anoxia ; Brain ; Brain Ischemia ; Erythropoietin ; Foot ; GAP-43 Protein ; Gene Expression ; Humans ; Ischemia ; Middle Cerebral Artery ; Models, Animal ; Neurites ; Neuroblastoma ; Neurons ; Neuroprotective Agents ; Rats ; Rats, Sprague-Dawley ; Regeneration ; Stroke ; Synaptophysin

BACKGROUND: Aspirin/NSAIDs can release cysteinyl-leukotriene (cys-LTs) into airways and precipitate asthmatic symptoms in aspirin - induced asthma(AIA). It has been reported that there is profound overexpression of LTC4 synthase in their bronchial mucosa, compared to aspirin-tolerant asthma. Objective : We observed whether genetic polymorphism of LTC4 synthase may be predisposed to LTC4 synthase overexpression in AIA. Subject and METHOD: Forty - four AIA patients having positive responses on lysin aspirin bron choprovocation tests and 47 non - aspirin induced asthma ( non - AIA ) patients having negative challenges and 32 healthy controls were enrolled. The genotypes of the promoter LTC4 synthase gene ( A,C transversion ) were determined by polymerase chain reaction and restriction fragment length polymorphism ( RFLP ) method. RESULTS: LTC4 synthase promoter polymorphism ( A444C btransversion) was not significantly different between non - AIA and AIA patients (p>0.05). Conclusion These findings suggest that genetic polymorphism of LTC4 synthase promoter may not be predisposed to LTC, synthase overexpression in AIA.
Aspirin* ; Asthma* ; Asthma, Aspirin-Induced ; Genotype ; Humans ; Leukotriene C4* ; Mucous Membrane ; Polymerase Chain Reaction ; Polymorphism, Genetic ; Polymorphism, Restriction Fragment Length

BACKGROUND: The control of multidrug-resistant microorganisms (MDROs) is important in preventing healthcare-associated infections. We performed a survey to evaluate the current system for control of MDROs in general hospitals in Korea. METHODS: A questionnaire consisted of queries about infection control systems, personnel, antibiotic use monitoring systems, isolation and barrier precautions, and obstacles to and opinions about MDROs. The questionnaire was mailed to 145 hospitals with more than 300 beds in November 2005. RESULTS: One hundred and two of the 145 (70.3%) hospitals responded; 65.3% of the responded hospitals had antibiotics control programs and 96.0% of those had control programs for MDROs. Surveillance cultures for vancomycin-resistant enterococcus (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) were taken in 21.6% and 16.7% of the hospitals, respectively. Over 90% of the hospitals had guidelines with respect to wearing gloves, collecting infectious wastes, and cleaning the environment for MRSA and VRE, but less than a half of the hospitals had the same standard for extended-spectrum beta-lactamase-producing gram-negative bacteria and carbapenem-resistant gram-negative bacteria. Most hospitals recommended gowning when contamination or invasive procedures were anticipated, but for VRE patients, gowns were used more strictly whenever there was contact with MDROs. Major obstacles related to isolation of patients infected or colonized with MDROs were the cost for isolation rooms (37.3%), and proposed solutions were reimbursement from the medical insurance company (86.3%), construction of a nationwide management system (61.8%), and effort by individual hospitals (58.8%) for MDROs infection control. CONCLUSION: Most of the hospitals have adopted control programs, but more needs to be done. Further efforts, including periodic reporting of antibiotic resistance, sufficient cost reimbursement, and providing education and increased awareness are urgently needed.
Anti-Bacterial Agents ; Colon ; Drug Resistance, Microbial ; Education ; Enterococcus ; Gram-Negative Bacteria ; Hospitals, General* ; Humans ; Infection Control* ; Insurance ; Korea* ; Methicillin-Resistant Staphylococcus aureus ; Postal Service ; Surveys and Questionnaires

The medulloblastoma, a neoplastic emtity which was first identified and described in 1925 by Bailey and Cushing, is a highly malignant, rapidly growing tumor mainly confined to the first decade of life. The medulloblastoma rarely calcifies. Many investigator have reported that medulloblastoma may exhibit calcification only on microscopic examination. Roentgenographic evidence of calcification was found in one case of 54 patients with medulloblastomas by McRae, and in only one case of 96 patients with medulloblastomas by Kalan. A twelve-year-old Korean male was admitted to Seoul National University Hospital on May 1, 1972 with the complaints of severe occipital headache, vomiting, and unsteady gait of five months duration. Neurological examination revealed bilateral papilledema of 3 diopters, signs of cerebellar dysfunction on the left side including truncal ataxia, adiadochokinesia, positive Romberg test and markedlv distured tandem gait. Horizontal nystagmus with quick component directed to the left side was also found. Plain skull films showed suture separation and an abnormal calcific shadow measuring about 2 by 2.5cm in the posterior fossa. Reflux brachial angiogram showed marked bowing of anterior cerebral artery, and elevation of middle and posterior cerebral arteries suggesting a large mass in the posterior fossa causing obstruction of CFS pathways resulting in marked dilatation of ventricular system. Exploring the posterior fossa, a soft grayish tumor mass was removed partially. Microscopic diagnosis was medulloblastoma of desmoplastic type with calcification. Postoperatively CSF leakage through the incision site was encountered, but was controlled to be healed up by compression bandage. The patient showed no significant change of neurological status by the time of discharge. The patient was scheduled to undergo Co60 radiation therapy after discharge.
Anterior Cerebral Artery ; Ataxia ; Cerebellar Diseases ; Compression Bandages ; Diagnosis ; Dilatation ; Gait ; Gait Disorders, Neurologic ; Headache ; Humans ; Male ; Medulloblastoma* ; Neurologic Examination ; Nystagmus, Pathologic ; Papilledema ; Posterior Cerebral Artery ; Research Personnel ; Seoul ; Skull ; Sutures ; Vomiting

A Clinical analysis was carried out with 340 cases of craniocerebral injuries under 15 years of age, admitted at the Department of Neurosurgery, Seoul National University Hospital in 12 years between Jan., 1987 and Dec., 1969. The matrial was classified four groups according to main lesions, i.e. (1) mild cerebral contusion without skull fractures. (2) moderate or severe cerebral contusion without skull fractures. (3) various types of skull fractures. (4) intracranial hemorrhagic lesions, representing such lesions as follows: a. epidural hematoma, b. subdural hematoma, c. subdural hygroma, d. intracerebral hematoma, e. traumatic subarachnoid hemorrhage. The results were as follows: 1) The age incidence was greatest in 6 years of age, and 120 cases (32.6% of the total) were included in the age group between four and six. 2) Males outnumbered females by almost 2 to 1. 3) The accident occurred mostly between 1 p.m. and 4 p.m. in a day. 4) The craniocerebral injuries were caused by traffic accident(173 cases; 50.8%), falls from heights(108 cases; 31.8%), hit(55 cases; 10.9%), firearms(2 cases; 0.6%) and birth injury (2 cases; 0.6%). 5) Early convulsion was the frequent symptom in the age group between 2 and 7. It was felt that convulsions frequently occurred in epidural and subdural hematoma patients. 6) Forty eight per cent of patients had no deterioration of consciousness on admission examination. 7) Epidural hematoma was the common finding in most of the depressed skull fracture cases. 8) The location of skull fractures in the order of frequency were parietal, temporal, frontal and occipital bone. 9) The epidural hematoma was most common lesion in the 13 to 15 year-old group. 10) The over-all mortality rate was 7.1%. In the surgical group(79 cases) the operative mortality was 11.4%(9 cases): the mortality rate of the subdural hematoma, 25.0%(3 cases); the epidural hematoma, 11.1%(2 cases); the compound depressed fracture, 7.8%(2 cases). In the non-surgical group(261 cases) it was 5.8%. The mortality rate of those who and been unconscious after injuries was significantly high(75.0%). 11) The period of hospitalization was two weeks on an average.
Adolescent ; Birth Injuries ; Child* ; Consciousness ; Contusions ; Craniocerebral Trauma* ; Female ; Hematoma ; Hematoma, Subdural ; Hospitalization ; Humans ; Incidence ; Infant* ; Male ; Mortality ; Neurosurgery ; Occipital Bone ; Rabeprazole ; Seizures ; Seoul ; Skull Fracture, Depressed ; Skull Fractures ; Subarachnoid Hemorrhage, Traumatic ; Subdural Effusion