A young metastatic lung cancer patient developed empyema due to an infection with carbapenem-resistant Acinetobacter baumannii. Hydropneumothorax was detected and managed by a tube thoracotomy. However, persistent air leakage through the chest tube was observed due to the presence of a bronchopleural fistula (BPF). As hypercapnic respiratory failure had progressed and the large air leak did not diminish by conservative management, a pumpless extracorporeal lung assist (pECLA) device was inserted. The pECLA allowed the patient to be weaned from mechanical ventilation and the BPF to heal. The present case shows the effective application of pECLA in a patient with empyema complicated with BPF and severe hypercapnic respiratory failure. pECLA enabled us to minimize airway pressure to aid in the closure of the BPF in the mechanically ventilated patient.
Acinetobacter baumannii ; Bronchial Fistula ; Carbon Dioxide* ; Carbon* ; Chest Tubes ; Empyema* ; Fistula ; Humans ; Hydropneumothorax ; Hypercapnia ; Lung ; Lung Neoplasms ; Respiration, Artificial ; Respiratory Insufficiency ; Thoracotomy

PURPOSE: Most cases of papillary microcarcinomas of the thyroid (PMC) are not palpable and are clinically asymptomatic. The natural history of the microcarcinoma is unclear and remains debatable. There is continued discussion of whether thyroid microcarcinomas should be treated surgically and to what extent surgical removal should be extended. The main goal of this study was to analyze the clinical features and to determine the appropriate surgical treatment for well differentiated PMC in one lobe of the thyroid with favorable features in regard to consideration of radical surgery. METHODS: We studied 134 patients with the histological diagnosis of PMC from March 2003 to January 2006. The tumor was defined as 10 mm or less in the greatest diameter according to the World Health Organization guidelines. For all patients we confirmed the diagnosis by ultrasoundguided fine-needle aspiration biopsy (US-FNAB) preoperatively. There were 11 men and 123 women. The age at initial treatment ranged from 22 to 74 years (mean 46). Thyroid resection was lobectomy in 31 (23.1%) and total thyroidectomy (TT) in 103 (76.9%). CCND was performed routinely at the time of thyroidectomy. Lateral neck dissection was carried out in eight patients (5.9%) who had biopsy-proven metastatic cervical lymphadenopathy demonstrated clinically or by imaging. Patient records were reviewed retrospectively. Categorical variables were analyzed using the chi-square test or Fisher's exact test. Two-sided Student's t-test was used to compare paired data. RESULTS: The mean tumor size was 6.77 mm. PMC was associated in 36.6% (49/134) with lymph node metastasis, in 20.1% (27/134) with multifocality and in 26.9% (36/134) with capsular invasion. The mean tumor size differences influenced lymph node metastasis (LNM) (P<0.05). Capsular invasion (38.8%, 19/49) and multifocality (30.6%, 15/49) were associated with LNM (P=0.018, 0.022 respectively). The subdivision of primary tumors according to size (5 mm) influenced multifocality (P=0.031). The frequency of LNM, in the contralateral central compartment of patients with lesions in one lobe of thyroid, without capsular invasion, underwent TT with CCND in 1.7% (1/59). CONCLUSION: Currently, thyroidectomy with lymph node dissection has been the recommended first line treatment for microcarcinoma of the thyroid because of the high incidence of multifocality and lymph node metastasis. However, when we excluded patients with aggressive prognostic features we could successfully perform lobectomy and isthmusectomy with ipsilateral CCND based on considerations of radical surgery (98.3%, 58/59). However, subsequent surgery for contralateral nodes or lobe metastasis would not be easy and a longer follow-up period would be required to confirm our hypothesis with regard to the long term recurrence and mortality.
Biopsy, Fine-Needle ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Incidence ; Lymph Node Excision ; Lymph Nodes ; Lymphatic Diseases ; Male ; Mortality ; Natural History ; Neck Dissection ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Thyroid Gland* ; Thyroidectomy ; World Health Organization

Background: In inferomedially rotated zygomatic fractures sticking in the maxillary sinus, it is often difficult to achieve complete reduction only by conventional intraoral reduction. We present a new intraoral reduction technique using a Kirschner wire and its clinical outcome. Methods: Among 39 inferomedially impacted zygomatic fractures incompletely reduced by a simple intraoral reduction trial with a bone elevator, a Kirschner wire (1.5 mm) was vertically inserted from the zygomatic body to the lateral orbital rim in 17 inferior-dominant rotation fractures and horizontally inserted to the zygomatic arch in nine medial-dominant and 13 bidirectional rotation fractures. A Kirschner wire was held with a wire holder and lifted in the superolateral or anterolateral direction for reduction. Following reduction of the zygomaticomaxillary fracture, internal fixation was performed. Results: Fractures were completely reduced using only an intraoral approach with Kirschner wire reduction in 33 cases and through an additional lower lid or transconjunctival incision in six cases. There were no surgical complications except in one patient with undercorrection. Postoperative 6-month computed tomography scans showed complete bone union and excellent bone alignment. Four patients experienced difficulty with upper lip elevation; however, these problems spontaneously resolved after manual tissue lump massage and intralesional steroid (Triamcinolone) injection. Conclusions We completely reduced infraorbital rim fractures, zygomaticomaxillary buttresses, and zygomaticofrontal suture fractures in 84% of patients through an intraoral approach alone. Intraoral Kirschner wire reduction may be a useful option by which to obtain effective and powerful reduction motion of an inferomedially rotated zygomatic body.

Purpose: To investigate the safety of applying therapeutic contact lenses and eye drops after cataract surgery. Methods: Immediately after cataract surgery, 947 eyes (group 1) used therapeutic contact lenses and eye drops and 914 (group 2) applied antibiotic ointment and wore a gauze eye patch for the first postoperative day. Clinical outcomes including best corrected visual acuity (BCVA), IOP, degree of anterior chamber inflammation, wound leakage, and postoperative endophthalmitis were compared in the two groups 1 day, 1 week, and 1 month after surgery. Results: There were no significant differences in the mean pre- and postoperative BCVA and IOP at 1 day, 1 week, and 1 month between groups 1 and 2. There was no difference in anterior chamber inflammation between the two groups at 1 day (p = 0.302), 1 week (p = 0.437), or 1 month (p = 0.960) after surgery. On the first postoperative day, 10 eyes in group 1 and nine eyes in group 2 had wound leakage (p = 1.000). There was no endophthalmitis in either group. Conclusions The risk of postoperative complications in group 1 was not higher than in group 2. Therefore, wearing therapeutic contact lenses and using eye drops is a relatively safe management method after cataract surgery.

PURPOSE: We evaluated whether a 6Fr transurethral catheter affects urinary flow in women undergoing pressure-flow studies. MATERIALS AND METHODS: We retrospectively reviewed urodynamics database of 201 consecutive women referred for the evaluation of lower urinary tract symptoms from January 1997 to June 2000. Before the urodynamic study, all patients voided privately using a standard toilet and free uroflowmetry parameters were recorded. Then, a standard pressure-flow study was performed using 6Fr transurethral catheter. We excluded the patients with inadequate voided volume(<150ml) and volume difference more than 30% between two studies. Urinary flow parameters between the two studies were analysed by paired t-test according to voided volume, main urodynamic diagnosis and uroflowmetry pattern. RESULTS: Of 201 women, 144 were excluded and 57 were subjects of our analysis. According to voided volume, pressure-flow study parameters were significantly different from the equivalent free uroflowmetry parameters: the maximum flow rate and average flow rate were significantly lower and flow time was significantly longer in pressure-flow studies(p<0.01). According to main urodynamic diagnosis categories, the subgroups of patients with normal urodynamic study, bladder outlet obstruction, detrusor instability and others showed significantly lower maximum flow rate and average flow rate in pressure-flow studies(p<0.01). According to uroflowmetry pattern, obstructive patterns such as undulating and intermittent pattern were more common in pressure-flow studies. CONCLUSIONS: The 6Fr transurethral catheter used in pressure-flow studies significantly affects urinary flow parameters. In order to make a accurate diagnosis, we must not merely rely on the results of pressure-flow studies, but we must take into account patient's individual clinical situation and also, if available, the results of free uroflowmetry in addition to pressure flow study parameters.
Catheters* ; Diagnosis ; Female ; Humans ; Lower Urinary Tract Symptoms ; Retrospective Studies ; Urinary Bladder Neck Obstruction ; Urodynamics

PURPOSE: The purpose of this study was to develop a multi-disciplinary self-management intervention based on empowerment theory and to evaluate the effectiveness of the intervention for older adults with chronic illness. METHODS: A randomized controlled trial design was used with 43 Korean older adults with chronic illness (Experimental group=22, Control group=21). The intervention consisted of two phases: (1) 8-week multi-disciplinary, team guided, group-based health education, exercise session, and individual empowerment counseling, (2) 16-week self-help group activities including weekly exercise and group discussion to maintain acquired self-management skills and problem-solving skills. Baseline, 8-week, and 24-week assessments measured health empowerment, exercise self-efficacy, physical activity, and physical function. RESULTS: Health empowerment, physical activity, and physical function in the experimental group increased significantly compared to the control group over time. Exercise self-efficacy significantly increased in experimental group over time but there was no significant difference between the two groups. CONCLUSION: The self-management program based on empowerment theory improved health empowerment, physical activity, and physical function in older adults. The study finding suggests that a health empowerment strategy may be an effective approach for older adults with multiple chronic illnesses in terms of achieving a sense of control over their chronic illness and actively engaging self-management.
Aged ; Aged, 80 and over ; Chronic Disease ; Exercise ; Female ; Health Education ; Humans ; Male ; Motor Activity ; *Power (Psychology) ; *Program Evaluation ; Self Care/*methods ; Self Efficacy

OBJECTIVE: To evaluate the short and medium effect of peripheral repetitive magnetic stimulation therapy on chronic low back pain compared with transcutaneous electrical nerve stimulation therapy. METHOD: Twenty-three subjects with chronic low back pain were allocated randomly to repetitive magnetic stimulation group (n=13) and transcutaneous electrical nerve stimulation group (n=10). Each treatment consisted of 10-minutes sessions each day, totally 10 sessions over 2 weeks. Subjects were evaluated pre-treatment and post-treatment at 8 hours and 2 weeks. Outcome was measured with the Oswestry disability index, McGill pain questionnaire, and daily mean pain numeric rating scale. RESULTS: At 8 hours and 2 weeks post-treatment, transcutaneous electrical nerve stimulation therapy group showed a significant improvement in the mean pain numeric rating scale. Two weeks post-treatment, transcutaneous electrical nerve stimulation therapy group showed a significant improvement in the Oswestry disability index. But there were no significant therapeutic effect of repetitive magnetic stimulation therapy group at all period. CONCLUSION: This study showed that repetitive magnetic stimulation therapy may be less effective than transcutaneous electrical nerve stimulation therapy for the treatment of chronic low back pain.
Low Back Pain ; Magnetic Field Therapy ; Magnetics ; Magnets ; Pain Measurement ; Pilot Projects ; Transcutaneous Electric Nerve Stimulation

BACKGROUND: Accessory auricles (AAs) are common congenital anomalies. We present a new classification according to location and shape, and propose a system for coding the classifications. METHODS: This study was conducted by reviewing the records of 502 patients who underwent surgery for AA. AAs were classified into three anatomical types: intraauricular, preauricular, and buccal. Intraauricular AAs were divided into three subtypes: intracrural, intratragal, and intralobal. Preauricular AAs were divided into five subtypes: precrural, superior pretragal, middle pretragal, inferior pretragal, and prelobal. Buccal AAs were divided into two subtypes: anterior buccal and posterior buccal. AAs were also classified according to their protrusion pattern above the surrounding surface: pedunculated, sessile, areolar, remnant, and depressed.Pedunculated and sessile AAs were subclassified as spherical, ovoid, lobed, and nodular, according to their body shape. Cartilage root presence and family history of AA were reviewed. A coding system for these classifications was also proposed. RESULTS: The total number of AAs in the 502 patients was 1,003. Among the locations, the superior pretragal subtype (27.6%) was the most common. Among the protrusion patterns and shapes, pedunculated ovoid AAs were the most common in the preauricular (27.8%) and buccal areas (28.0%), and sessile lobed AAs were the most common in the intraauricular area (48.7%). The proportion of AAs with a cartilage root was 78.4%, and 11% of patients had a family history. The most common type of preauricular AA was the superior pretragal pedunculated ovoid AA (13.2%) with a cartilage root. CONCLUSIONS: This new system will serve as a guideline for classifying and coding AAs.
Cartilage ; Classification* ; Clinical Coding ; Embryology ; Humans

Background: Fractional carbon dioxide laser (FCL) has been used to treat keloid and hypertrophic scars as monotherapy or combination therapy, including intralesional triamcinolone acetonide (ITAC). However, whether the combination of FCL and ITAC is really effective compared with other treatments, such as ITAC monotherapy in treating keloid and hypertrophic scars, remains unclear.
Objective
To evaluate the effectiveness of FCL plus ITAC compared with ITAC monotherapy in treating keloid and hypertrophic scars. Methods: A computerized search was performed in different databases, including Cochrane, Embase, and PubMed.One randomized controlled trial and two controlled clinical trials were included. Statistical analyses of the extracted outcome data from the studies were then calculated using the Rex Software (version 3.0.1). Results: A total of 203 records were identified by searching databases, including Cochrane, Embase, and PubMed.The meta-analysis results, including three studies, demonstrated that although FCL combined with ITAC showed a slightly pronounced improvement in keloid and hypertrophic scars than ITAC monotherapy, there was no statistical difference (SMD: 0.26, 95% confidence interval [CI]: −0.10∼0.61, p=0.1541). Conclusion FCL combined with ITAC may not be a cost-effective treatment for the treatment of keloid and hypertrophic scars due to similar effectiveness compared with ITAC monotherapy. However, this study had limitations, including insufficiency of published articles and data. Therefore, further investigations are needed.

Background: Monitoring mortality trends can help design ways to improve survival, but observation of national mortality trends in critically ill children is lacking for the Korean population Methods: We analyzed the incidence and mortality trends of children younger than 18 years admitted to an intensive care unit (ICU) from 2012 to 2018 using the Korean National Health Insurance database. Neonates and neonatal ICU admissions were excluded. Multivariable logistic regression analyses were performed to estimate the odds ratio of in-hospital mortality according to admission year. Trends in incidence and in-hospital mortality of subgroups according to admission department, age, presence of intensivists, admissions to pediatric ICU, mechanical ventilation, and use of vasopressors were evaluated. Results: The overall mortality of critically ill children was 4.4%. There was a significant decrease in mortality from 5.5% in 2012 to 4.1% in 2018 (Pfor trend < 0.001). The incidence of ICU admission in children remained around 8.5/10,000 population years (Pfor trend = 0.069). In-hospital mortality decreased by 9.2% yearly in adjusted analysis (P < 0.001). The presence of dedicated intensivists (Pfor trend < 0.001, mortality decrease from 5.7% to 4.0%) and admission to pediatric ICU (Pfor trend < 0.001, mortality decrease from 5.0% to 3.2%) were associated with significant decreasing trends in mortality. Conclusion Mortality among critically ill children improved during the study period, and the improving trend was prominent in children with high treatment requirements. Varying mortality trends, according to ICU organizations, highlight that advances in medical knowledge should be supported structurally.