No abstract available.
Intensive Care Units ; Sepsis ; Critical Illness ; Chronic Disease ; Hospital Mortality

BACKGROUND: Maintenance of normal arterial carbon dioxide tension (PaCO2) is not generally a problem if the same tidal volume can be maintained when changing from two-lung(TLV) to one-lung ventilation(OLV). However, there have been a few studies on the use of capnography in monitoring the adequacy of ventilation during one-lung anesthesia. We have therefore studied how closely end-tidal PCO2 (PETCO2) values reflect changes in PaCO2 in patients undergoing thoracoscopic sympathectomy during TLV and after transition to OLV. METHODS: We have measured arterial oxygen tension(PaO2), PaCO2, PETCO2, and (PaCO2-PETCO2) in 24 adult, either sex, patients by infra-red spectrometry. They were measured after induction of anesthesia, in supine position(TLVsup), after a lateral decubitus position(TLVlat), at 15 minutes after left OLV(OLVLt), after right OLV(OLVRt), and at 10 minutes in the supine position re-positioned at the end of the operation(TLVrep). Data were analyzed with a one-way analysis of variance with repeated measures followed by multiple comparision. The correlation between PaCO2 and PETCO2 were tested using linear regression. RESULTS: PaCO2 did not significantly change, whereas PETCO2 significantly decreased at OLVLt, OLVRt compared with TLVsup value (OLVLt, 29.7 mmHg OLVRt, 30.5 mmHg and TLVsup, 33.6 mmHg; P< 0.05). Compared with TLVsup(0.2 mmHg), (PaCO2-PETCO2) significantly increased at OLVLt, OLVRt, TLVrep(3.7 mmHg, 2.3 mmHg, 3.5 mmHg). The correlation between PaCO2 and PETCO2 in these series is consistent. (r>0.65, P<0.0006) CONCLUSIONS: In the patients undergoing thoracoscopic sympathectomy with TLV or OLV in the lateral decubitus position, PETCO2 is a reliable estimate of the PaCO2. However, when the operative time is prolonged the arterial PCO2 may be more reliable than PETCO2.
Adult ; Anesthesia ; Capnography ; Carbon Dioxide ; Humans ; Linear Models ; One-Lung Ventilation* ; Operative Time ; Oxygen ; Spectrum Analysis ; Supine Position ; Sympathectomy ; Thoracoscopy* ; Tidal Volume ; Ventilation

BACKGROUND: Aging is a significant issue worldwide, and Korea is one of the most rapidly aging countries. Along with the demographic transition, the age structure of intensive care unit (ICU) patients changes as well. METHODS: The aim of this study was to analyze the change in age distribution of the ICU patients over the last 10 years and its effect on clinical outcomes. Single-center, retrospective analysis of all patients aged ≥18 years admitted to either the medical or surgical ICU at St. Paul's Hospital, The Catholic University of Korea, between January 2005 and December 2014 was conducted. For clinical outcome, in-hospital mortality, duration of ICU stay, and hospital stay were analyzed. Cost analysis was performed to show the economic burden of each age strata. RESULTS: A total of 10,366 ICU patients were admitted to the chosen ICUs during the study period. The proportion of elderly patients aged ≥65 years increased from 47.9% in 2005 to 63.7% in 2014, and the proportion of the very elderly patients aged ≥80 years increased from 12.8% to 20.7%. However, this increased proportion of elderly patients did not lead to increased in-hospital mortality. The percent of ICU treatment days attributable to elderly patients increased from 51.1% in year 2005 to 64.0% in 2014. The elderly ICU patients were associated with higher in-hospital mortality compared to younger age groups. CONCLUSIONS: The proportion of elderly patients admitted to ICUs increased over the last decade. However, overall in-hospital mortality has not increased during the same period.
Age Distribution ; Aged* ; Aging ; Costs and Cost Analysis ; Critical Care* ; Hospital Mortality ; Humans ; Intensive Care Units* ; Korea* ; Length of Stay ; Mortality ; Population Dynamics ; Retrospective Studies*

PURPOSE: Cow's milk-specific IgE (CM-IgE) has been proposed as one of the valuable markers for diagnosis of clinical cow's milk (CM) allergy. In this study, we evaluated the additional usefulness of casein-specific IgE (casein-IgE) and IgG (casein-IgG) for the diagnosis of clinical CM allergy. METHODS: Fifty-eight subjects, aged from 3 months to 154 months, were enrolled. Thirty-four patients showed immediate-type of clinical CM allergy, and 24 patients were atopic controls. The serum levels of CM-IgE, casein-IgE, and casein-IgG were measured. Patients were divided into 2 groups: those aged under 12 months and those aged 12 months or over. The diagnostic values of each antibody were analyzed and compared using the Mann-Whitney U-test and receiver operating characteristic curves. RESULTS: CM allergy had significantly higher levels of CM-IgE and casein-IgE, and lower levels of casein-IgG/IgE ratio when compared to atopic controls in both age groups (P<0.05). CM-IgE and casein-IgE were shown to be better predictive markers for immediate-type CM allergy in patients under 12 months, while casein-IgG/IgE ratio was a more useful marker in those aged 12 months or over. Considering 100% positive predictive values, cutoff points were 1.04 kU/L for CM-IgE, 0.11 kU/L for casein-IgE, 19.5 for casein-IgG/IgE ratio in patients aged under 12 months, and 7.1 kU/L for CM-IgE, 1.41 kU/L for casein-IgE, 12.51 for casein-IgG/IgE ratio in those aged 12 months or over. CONCLUSION: CM-IgE, casein-IgE, and casein-IgG/IgE ratio are useful markers for predicting immediate-type CM allergy. Further studies are needed on diagnostic decision points for CM allergy using combination of cutoff values of these 3 markers.
Anaphylaxis ; Antibodies* ; Caseins* ; Diagnosis ; Humans ; Hypersensitivity ; Immunoglobulin E* ; Immunoglobulin G* ; Milk ; Milk Hypersensitivity* ; ROC Curve

STATEMENT OF PROBLEM: In order to increase preload with reducing the friction coefficient, abutment screws coated with pure gold and Teflon as dry lubricant coatings have been introduced. But the reported data indicate that if screw repeated tightening and loosening cycle, an efficiency of increasing preload was decreased by screw surface wearing off. PURPOSE: This study was to evaluate the influence of tungsten carbide/carbon coating, which has superior hardness and frictional wear resistance, on the preload of abutment screws and the stability of coating surface after repeated closures. MATERIAL AND METHOD: The rotational values of abutment screws and the compressive forces between abutment and fixture were measured in implant systems with three different joint connections, one external butt joint and two internal cones. Moreover, the stability and the alteration of coating surface were examined by comparison of the compressive force and the removable torque values during 10 consecutive trials, observation with scanning electron microscope and analyzed the elemental composition with energy dispersive x-ray spectroscopy. RESULTS AND CONCLUSION: 1. Application of coating resulted in significant increase of compressive force in all implant systems(P<.05). The increasing rate of compressive force by coating in external butt joint was greater than those in internal cones(P<.05). 2. Coated screw showed the significant additional rotation compared to non-coated screw in all implant systems(P<.05). There were no significant differences in the increasing rate of rotation among implant systems(P>.05). 3. Removable torque values were greater with non-coated screw than that with coated screw (P<.05). 4. Coated screw showed insignificant variations in the compressive forces during 10 consecutive trials(P>.05). 5. After repeated trials, the surface layer of coated screw was maintained relatively well. However, surface wearing and irregular titanium fragments were found in non-coated screw.
Friction ; Hardness ; Joints ; Polytetrafluoroethylene ; Spectrometry, X-Ray Emission ; Titanium ; Torque ; Tungsten*

OBJECTIVES: The object of this study was to indentify characteristics of cardiovascular disease in the employed population in comparson with the non-employed group. METHODS: The study subjects were patients aged 20~65 from 3 university based hospital emergency centers and a structured questionnaire were used for comparing the characteristics of cardiovascular disease according to employment status. Multivariate logistic regression was used to analyze the association between employment status and cardiovascular disease risk factors. RESULTS: Among the patients, 573 people were employed (482 males, 91 females) and 251 were non-employed (117 males, 134 females). Compared to the non-employed group, the employed group was distinctive in that it contained patients of younger age, had a male dominant gender distribution, and a higher proportion of smoking and drinking patients. The employed group was less likely to be previously-diagnosed with diabetes, hypertension, chronic renal failure, cardiovascular disease, or cerebrovascular disease. The employed group was generally more stressed out but there was no significant differences in sleeping time. Infarction was more frequent in the employed group, but hemorrhage was more frequent in the non-employed group. According to the multivariate logistic regression analysis results, the odds ratio of drinking and stress was 1.89(95% CI: 1.25~2.86) and 2.68(95% CI: 1.80~3.99) respectively. CONCLUSIONS: Infarction was more frequent in the employed group. Drinking and stress were also more frequent in the employed group. The results of this study don't necessarily mean that stress and drinking are more important than other risk factors but, it means stress and drinking control are more important in the employed group compared to the non-employed group.
Aged ; Cardiovascular Diseases ; Drinking ; Emergencies ; Employment ; Hemorrhage ; Humans ; Hypertension ; Infarction ; Kidney Failure, Chronic ; Logistic Models ; Male ; Odds Ratio ; Questionnaires ; Risk Factors ; Smoke ; Smoking

OBJECTIVE: The present study aimed to evaluate the efficacy of low frequency (LF) repetitive transcranial magnetic stimulation (rTMS) over the right dorsolateral prefrontal cortex (DLPFC) for the treatment of obsessive-compulsive disorder (OCD). METHODS: Twenty-seven patients with treatment resistant OCD were randomly assigned to 3 week either active (n=14) or sham (n=13) rTMS. The active rTMS parameters consisted of 1 Hz, 20-minute trains (1,200 pulses/day) at 100% of the resting motor threshold (MT). OCD symptoms, mood, and anxiety were assessed at baseline and every week throughout the treatment period. RESULTS: A repeated-measures analysis of variance (ANOVA) was used to evaluate changes on the Yale-Brown Obsessive Compulsive Scale (YBOCS). Our results revealed a significant reduction in YBOCS scores in the active group compared with the sham group after 3 weeks. Similarly, a repeated-measures ANOVA revealed significant effect of time and time×group interaction on scores on the Hamilton Depression Rating Scale and the Clinical Global Impression-Severity scale. There were no reports of any serious adverse effects following the active and sham rTMS treatments. CONCLUSION: LF rTMS over the right DLPFC appeared to be superior to sham rTMS for relieving OCD symptoms and depression in patients with treatment-resistant OCD. Further trials with larger sample sizes should be conducted to confirm the present findings.
Anxiety ; Depression ; Humans ; Obsessive-Compulsive Disorder* ; Prefrontal Cortex* ; Sample Size ; Transcranial Magnetic Stimulation*

STUDY DESIGN: Retrospective comparative study. OBJECTIVES: The aim of this study was to compare the efficacy of prophylactic antibiotics in spinal surgery for the occurrence of postoperative surgical site infection (SSI) and host immune reactions depending on various administration regimens and protocols. SUMMARY OF LITERATURE REVIEW: The superiority of one regimen or protocol of prophylactic antibiotics over others for SSI in spinal surgery has not been clearly demonstrated. We designed a controlled clinical trial to compare the occurrence of SSI with the changes of hematologic results depending on prophylaxis regimens and protocols. MATERIALS AND METHODS: Between January 2007 and February 2011, two hundred consecutive patients who had undergone thoracolumbar/lumbar surgery for degenerative or traumatic disease were included. Postoperative protocol was altered for each group of fifty consecutive patients; 1st generation cephalosporins for 5-days (group A), 2nd generation cephalosporins for 5-days (group B), 1st generation cephalosporins for 3-days (group C), and 2nd generation cephalosporins for 3-days (group D). Preoperative antibiotic prophylaxis was administrated within 1 hour prior to surgical incision with the same trial antibiotics. Intraoperative bacterial culture was performed from the surgical site. The occurrences of SSI were evaluated as either incisional or organ/space SSI. Serial changes in hematologic inflammatory markers (WBC, ESR, CRP) and DIC markers (fibrinogen, FDP, D-dimer) were compared until postoperative 2 weeks. RESULTS: The study groups were homogeneous regarding age, sex, body mass index, estimated blood loss, diabetes mellitus, smoking, diagnosis, baseline laboratory values, and type of surgery including instrumentation. Overall, 13 cases of incisional SSI (6.5%) and 3 cases (1.5%) of organ/space SSI occurred. There was no difference in the occurrence of incisional and organ/space SSI among the 4 groups (P=0.690, 0.799). Laboratory results revealed that postoperative changes in hematologic inflammatory markers and DIC markers were not influenced by prophylaxis regimens and protocols (all P>0.05). CONCLUSIONS: The occurrences of SSI and host immune responses were not influenced by postoperative antibiotics regimens and protocols. Hematologic investigation revealed that host immune responses did not depend on the type of prophylactic antibiotics.
Anti-Bacterial Agents ; Antibiotic Prophylaxis ; Body Mass Index ; Cephalosporins ; Dacarbazine ; Diabetes Mellitus ; Formycins ; Humans ; Retrospective Studies ; Ribonucleotides ; Smoke ; Smoking

PURPOSE: To evaluate the clinical outcome of high-dose-rate (HDR) interstitial brachytherapy (IBT) in patients with oral cavity cancer. MATERIALS AND METHODS: Sixteen patients with oral cavity cancer treated with HDR remote-control afterloading brachytherapy using 192Ir between 2001 and 2013 were analyzed retrospectively. Brachytherapy was administered in 11 patients as the primary treatment and in five patients as salvage treatment for recurrence after the initial surgery. In 12 patients, external beam radiotherapy (50-55 Gy/25 fractions) was combined with IBT of 21 Gy/7 fractions. In addition, IBT was administered as the sole treatment in three patients with a total dose of 50 Gy/10 fractions and as postoperative adjuvant treatment in one patient with a total of 35 Gy/7 fractions. RESULTS: The 5-year overall survival of the entire group was 70%. The actuarial local control rate after 3 years was 84%. All five recurrent cases after initial surgery were successfully salvaged using IBT +/- external beam radiotherapy. Two patients developed local recurrence at 3 and 5 months, respectively, after IBT. The acute complications were acceptable (< or =grade 2). Three patients developed major late complications, such as radio-osteonecrosis, in which one patient was treated by conservative therapy and two required surgical intervention. CONCLUSION: HDR IBT for oral cavity cancer was effective and acceptable in diverse clinical settings, such as in the cases of primary or salvage treatment.
Brachytherapy* ; Humans ; Mouth Neoplasms ; Mouth* ; Radiotherapy ; Recurrence ; Retrospective Studies

Lung lavage is an accepted modality for treatment of pulmonary alveolar proteinosis. The procedure can be accomplished by the use of double lumen endobronchial tube, with lavaging of one lung while the other is ventilated. As lung lavage is an intentional drowning, particular attention must be paid to potentially serious complications such as severe hypoxemia. We report a case of lung lavage in a patient with secondary pulmonary alveolar proteinosis performed safely by careful monitoring of oxygenation and hemodynamics.
Anoxia ; Bronchoalveolar Lavage* ; Drowning ; Hemodynamics ; Humans ; Lung ; Oxygen ; Pneumoconiosis* ; Pulmonary Alveolar Proteinosis*