More than half of the cryptococcal infections occur in acquired immune deficiency (AIDS) patients, and more than half of the non-AIDS patients with cryptococcosis are immunocompromised. Most immunocompromised patients have meningoencephalitis at the time of diagnosis. Without the appropriate therapy, this from of the infection is invariably fatal. Death can occur any time from 2 weeks to several years after the onset of symptoms. Pulmonary crytococcosis in immunocompromised patients is usually asymptomatic, but coughing, chest pain, fever, or hemoptysis may occur in immunocompetent patients. Pulmonary cryptococcosis symptoms in immunocompetent patients tend to improve without treatment. Here, we describe the various pulmonary manifestations of cryptococcal pneumoniae in three immunocmpetent patients.
Chest Pain ; Cough ; Cryptococcosis ; Diagnosis ; Fever ; Hemoptysis ; Humans ; Immunocompromised Host ; Meningoencephalitis ; Pneumonia*

Heterotopic partial liver transplantation(HLT) in the rat is relatively simple method to orthotopic liver transplantation. Addition of mesocaval shunt which diverts almost intestinal blood to systemic circulation provides only splenopancreaticoduodenal blood for the graft. The usefulness of our novel model is first, evaluating the pure effect of pancreaticoduodenal blood to liver regeneration, second, evaluating the contribution of splanchnic viscera to liver reperfusion injury. In the first group (conventional HLT, C-HLT), the thirty percent graft liver was transplanted just below the host liver with whole portal blood input. In the second group(mesocaval shunt added HLT, M-HLT), the superior mesenteric vein was diverted to systemic circulation and portal blood from the spleen-pancreas-duodenum supplied the graft. The graft weight at 2 posttransplant weeks was significantly increased in the C-HLT group compared with the M-HLT group, which suggests pancreatic blood alone is not sufficient to regenerate the partial liver grafts. There was no significant difference in the graft survival between two groups, which implies the influence of intestine to postreperfusion injury is negligible.
Animals ; Graft Survival ; Intestines ; Liver Regeneration ; Liver Transplantation* ; Liver* ; Mesenteric Veins ; Models, Animal* ; Rats* ; Reperfusion Injury ; Transplants ; Viscera

PURPOSE:To evaluate the changes of QT dispersion (QTd) in CAPD patients serially from the period before the initiation of CAPD until several years after CAPD, and to find any associated factors. METHODS:We performed a retrospective cohort study with a total of 101 patients who initiated CAPD between 1990 and 1996. All data were recruited from the patients' medical records before CAPD initiation, within one year after CAPD, and between one and three years after CAPD. RESULTS:QTd and Corrected QTd (QTdc) values after CAPD did not show differences in the paired t-test of those before CAPD and within one year after CAPD. There was a definite correlation between the QTds before CAPD and that within one year after CAPD (r=0.530, p<0.001). In addition, the QTds from within one year after CAPD showed a correlation with those taken from one to three years after CAPD (r=0.487, p=0.019). Upon analysis of all-cause mortality, the change rate of QTd after CAPD initiation was revealed as a predicting factor along with the QTd, QTc max, and QTdc within one year after CAPD (RR=1.055, p=0.005). The change rate also remained a predictor of cardiovascular mortality (RR= 1.088, p=0.007). In a multivariate Cox regression, cardiomegaly and previous cardiovascular disease were revealed to be independent factors for the change rate of QTd. CONCLUSION:QTd in CAPD patients did not change after initiation of CAPD, and the change rate of QTd after CAPD initiation was revealed as a risk factor for both all-cause mortality and cardiovascular mortality.
Cardiomegaly ; Cardiovascular Diseases ; Cohort Studies ; Humans ; Medical Records ; Mortality ; Peritoneal Dialysis, Continuous Ambulatory* ; Retrospective Studies ; Risk Factors

Calciphylaxis is a rare, but fatal, condition that is characterized by a rapidly progressive ischemic necrosis of the skin, underlying tissue and other organs, as well as rapid vascular calcification. It results in death due to sepsis, heart or respiratory failure. A 67-year old female was admitted to hospital with the chief complaint of constant pain to both lower legs of 1 week duration. She was treated with calcitonin-salmon due to a prior unexplained hypercalcemia of 2 weeks. On the third day post admission. pain and weakness in the lower legs were aggravated, became painful, with violaceous skin lesions developing on the thigh with findings similar to those of rhabdomyolysis. Because she was suspected of having dermatomyositis, she was treated with methylpredrisolone. However, the skin lesions and symptoms were aggravated, and she died of sepsis due to a skin infection. About 160 cases of calciphylaxis have been reported, with most of these cases being associated with secondary hyperparathyroidism due to end-stage renal disease, but cases of calciphylaxis without renal failure are very rare. We now report a case of calciphylaxis without renal failure, mimicking dermatomyositis, and present a brief review of the pathophysiology and treatments of calciphylaxis inform the relevant literature.
Aged ; Calciphylaxis* ; Dermatomyositis* ; Female ; Heart ; Humans ; Hypercalcemia ; Hyperparathyroidism, Secondary ; Kidney Failure, Chronic ; Leg ; Necrosis ; Renal Insufficiency ; Respiratory Insufficiency ; Rhabdomyolysis ; Sepsis ; Skin ; Thigh ; Vascular Calcification

BACKGROUND: Anesthesiologist must be aware of the common problems that occur in pediatric anesthesia. The purpose of this survey was to collect information to help improve the quality of pediatric anesthesia by comparing the opinions of anesthesiologists that treat children and those that do not treat children. METHODS: A questionnaire surveying the attitudes of 103 anesthesiologists with regard to pediatric problems was analyzed. The questionnaire inquired about the number of years worked in field, the form of work and the responsibilities with regard to the pediatric anesthesia. Each question was rated from 1 (very infrequent) to 5 (very common) for the frequency of problems and from 1 (not importance) to 5 (very important) for the importance of the problem. Then we calculated the average of each item and combined the scores to obtain an average frequency and an average importance. RESULTS: The list of problems had high combined scores for preoperative anxiety (10.62), incision pain (9.59), postoperative agitation (9.53), hypothermia (9.40), and vomiting (9.30) for the pediatric anesthesiologist group. In addition, the problem list had high combined scores for propofol injection pain (11.25), preoperative anxiety (10.92), vomiting (10.17), hypothermia (9.44), and postoperative agitation (9.42) for the non-pediatric anesthesiologist group. CONCLUSIONS: The results of this study showed a difference in the pediatric and non pediatric anesthesiologist groups for propofol injection pain. Differences were noted for the average importance (2.34 : 2.80) compared to the average frequency (3.93 : 4.01). The pediatric anesthesiologists regarded propofol injection pain to be less of a problem than did the anesthesiologists who did not care for pediatric patients.
Anesthesia ; Anxiety ; Child ; Dihydroergotamine ; Humans ; Hypothermia ; Propofol ; Vomiting ; Surveys and Questionnaires

Purpose: Tumors of the foot and ankle account for approximately 3%~5% of all musculoskeletal tumors, and accurate diagnosis is often delayed due to their rare prevalence. Therefore, the authors aimed to analyze the incidence, treatment methods, and prognostic factors of foot and ankle tumors treated at the authors’ hospital. Materials and Methods: A retrospective single-center study examined 342 patients treated for foot and ankle tumors at the authors’ hospital from January 2011 to February 2022. Data were collected from the electronic medical records (EMR) and picture archiving and communication systems (PACS). The information analyzed included gender, age, follow-up period, diagnosis, tumor occurrence and recurrence, treatment, and clinical outcomes. Results: Most cases (93.3%) were benign, but 6.7% were malignant. The main treatment for malignant tumors was surgical resection (91.3%). Approximately 53.1% of benign tumors and 91.3% of malignant tumors were treated with surgery, and two of the malignant tumors that did not undergo surgery had metastatic cancer. After surgery, 8.2% of benign lesions and 19.0% of malignant lesions recurred, and 9.5% of the patients with malignant tumors died after surgery. Conclusion Most foot and ankle tumors are benign tumors, and the prognosis is not poor if treated properly, but most malignant tumors often require amputation. In some cases, however, amputation can be avoided with a combination of chemotherapy and radiation therapy.

To determine the prevalence and clinical relevance of HGV infection in dialysis patients, we performed a cross-sectional study of 61 HD patients and 79 Continuous Ambulatory Peritoneal Dialysis (CAPD) patients. HGV-RNA was identified by reverse-transcription (RT) polymerase chain reaction (PCR) assay with primers from the 5'-untranslated region of the viral genome. The prevalence of HGV infection was similar in HD and CAPD patients (9.8% vs. 12.7%), while that of HCV infection was significantly higher in HD patients compared to CAPD patients (16.4% vs. 1.3%, p < 0.05). The mean age (49.2 +/- 13.4 vs. 46.7 +/- 13.0 years), male to female ratio (2.4:1 vs. 1.3:1), history of transfusion (62.3% vs. 49.4%), history of hepatitis (27.9% vs. 26.6%), mean ALT level during the previous 6 months (22.4 +/- 37.9 vs. 14.0 +/- 7.4 IU/L), and the prevalence of HBsAg (8.2% vs. 6.3%) showed no difference between HD and CAPD patients. In both HD and CAPD patients, the presence of HGV RNA was not related to age, sex, duration of dialysis, history of transfusion, history of hepatitis, or to the presence of HBV or HCV markers. There was no significant difference in the clinical and biochemical data between patients with isolated HGV infection (n = 12) and patients without viremia (n = 106). The clinical feature of patients coinfected with HGV and HBV (n = 2), or HGV and HCV (n = 2) seemed to be similar to those of patients with isolated HBV (n = 8) or HCV (n = 9) infection. In conclusion, the prevalence of HGV infection was not different between HD and CAPD patients, and HGV infections did not seem to be associated with clinically significant hepatitis. The routes of HGV transmission, other than transfusion or contamination during HD procedure, were suspected.
Female ; Hepatitis Agents, GB*/genetics ; Hepatitis C/genetics ; Hepatitis C-Like Viruses/genetics ; Hepatitis, Viral, Human/virology ; Hepatitis, Viral, Human/genetics ; Hepatitis, Viral, Human/etiology* ; Human ; Male ; Middle Age ; Peritoneal Dialysis, Continuous Ambulatory/adverse effects* ; Prevalence ; RNA, Viral/analysis ; Renal Dialysis/adverse effects* ; Viremia/genetics

Background and Objectives: The study sought to investigate the impact of early extracorporeal membrane oxygenation (ECMO) support before revascularization in patients with acute myocardial infarction (AMI) complicated by profound cardiogenic shock after resuscitated cardiac arrest. It is difficult to determine optimal timing of ECMO in patients with AMI complicated by profound cardiogenic shock after resuscitated cardiac arrest. Methods: Among 116,374 patients experiencing out-of-hospital cardiac arrest in South Korea, a total of 184 resuscitated patients with AMI complicated by profound cardiogenic shock, and who were treated successfully with percutaneous coronary intervention (PCI) and ECMO, were enrolled. Patients were divided into 2 groups according to the timing of ECMO: pre-PCI ECMO (n=117) and post-PCI ECMO (n=67). We compared 30-day mortality between the 2 groups. Results: In-hospital mortality was 78.8% in the entire study population and significantly lower in the pre-PCI ECMO group (73.5% vs. 88.1%, p=0.020). Thirty-day mortality was also lower in the pre-PCI ECMO group compared to the post-PCI ECMO group (74.4% vs.91.0%; adjusted hazard ratio [HR], 0.66; 95% confidence interval [CI], 0.47–0.93; p=0.017). Shockable rhythm at the emergency room (HR, 0.57; 95% CI, 0.36–0.91; p=0.019) and successful therapeutic hypothermia (HR, 0.40; 95% CI, 0.23–0.69; p=0.001) were also associated with improved 30-day survival. Conclusions ECMO support before revascularization was associated with an improved short-term survival rate compared to ECMO after revascularization in patients with AMI complicated by profound cardiogenic shock after resuscitated cardiac arrest.

Background and Objectives: The study sought to investigate the impact of early extracorporeal membrane oxygenation (ECMO) support before revascularization in patients with acute myocardial infarction (AMI) complicated by profound cardiogenic shock after resuscitated cardiac arrest. It is difficult to determine optimal timing of ECMO in patients with AMI complicated by profound cardiogenic shock after resuscitated cardiac arrest. Methods: Among 116,374 patients experiencing out-of-hospital cardiac arrest in South Korea, a total of 184 resuscitated patients with AMI complicated by profound cardiogenic shock, and who were treated successfully with percutaneous coronary intervention (PCI) and ECMO, were enrolled. Patients were divided into 2 groups according to the timing of ECMO: pre-PCI ECMO (n=117) and post-PCI ECMO (n=67). We compared 30-day mortality between the 2 groups. Results: In-hospital mortality was 78.8% in the entire study population and significantly lower in the pre-PCI ECMO group (73.5% vs. 88.1%, p=0.020). Thirty-day mortality was also lower in the pre-PCI ECMO group compared to the post-PCI ECMO group (74.4% vs.91.0%; adjusted hazard ratio [HR], 0.66; 95% confidence interval [CI], 0.47–0.93; p=0.017). Shockable rhythm at the emergency room (HR, 0.57; 95% CI, 0.36–0.91; p=0.019) and successful therapeutic hypothermia (HR, 0.40; 95% CI, 0.23–0.69; p=0.001) were also associated with improved 30-day survival. Conclusions ECMO support before revascularization was associated with an improved short-term survival rate compared to ECMO after revascularization in patients with AMI complicated by profound cardiogenic shock after resuscitated cardiac arrest.

OBJECTIVES: We estimated the population prevalence of antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), including unreported infections, through a Korea Seroprevalence Study of Monitoring of SARS-CoV-2 Antibody Retention and Transmission (K-SEROSMART) in 258 communities throughout Korea. METHODS: In August 2022, a survey was conducted among 10,000 household members aged 5 years and older, in households selected through two stage probability random sampling. During face-to-face household interviews, participants self-reported their health status, COVID-19 diagnosis and vaccination history, and general characteristics. Subsequently, participants visited a community health center or medical clinic for blood sampling. Blood samples were analyzed for the presence of antibodies to spike proteins (anti-S) and antibodies to nucleocapsid proteins (anti-N) SARS-CoV-2 proteins using an electrochemiluminescence immunoassay. To estimate the population prevalence, the PROC SURVEYMEANS statistical procedure was employed, with weighting to reflect demographic data from July 2022. RESULTS: In total, 9,945 individuals from 5,041 households were surveyed across 258 communities, representing all basic local governments in Korea. The overall population-adjusted prevalence rates of anti-S and anti-N were 97.6% and 57.1%, respectively. Since the Korea Disease Control and Prevention Agency has reported a cumulative incidence of confirmed cases of 37.8% through July 31, 2022, the proportion of unreported infections among all COVID-19 infection was suggested to be 33.9%. CONCLUSIONS The K-SEROSMART represents the first nationwide, community-based seroepidemiologic survey of COVID-19, confirming that most individuals possess antibodies to SARS-CoV-2 and that a significant number of unreported cases existed. Furthermore, this study lays the foundation for a surveillance system to continuously monitor transmission at the community level and the response to COVID-19.