In community-acquired Klebsiella pneumoniae infection, pyogenic liver abscess is common as a primary site of infection, particularly in Asia, that can progress to bacteremia. Diabetes mellitus is a usual predisposing factor. Pneumonia as primary site of infection by community-acquired Klebsiella pneumoniae infection is not common but carries a poor outcome. Early administration of appropriate antibiotics is extremely important to avoid the development of bacteremia and septicemia. An infective endocarditis caused by community-acquired Klebsiella pneumoniae infection is very rare; particularly, such a case of endocarditis in which pneumonia was the primary site of infection has never been reported previously. In this report we described a case of community-acquired Klebsiella pneumoniae infection that started with pneumonia and progressed to bacteremia, leading to endocarditis, liver abscess, and other systemic septic complications. Delayed administration of appropriate antibiotics may have played a role in this case.
Abscess ; Anti-Bacterial Agents ; Asia ; Bacteremia ; Diabetes Mellitus ; Endocarditis ; Klebsiella ; Klebsiella pneumoniae ; Liver Abscess ; Liver Abscess, Pyogenic ; Pneumonia ; Sepsis ; Shock, Septic

PURPOSE: Blind individuals who have photoreceptor loss are known to perceive phosphenes with electrical stimulation of their remaining retinal ganglion cells. We proposed that implantable lateral geniculate body (LGB) stimulus electrode arrays could be used to generate phosphene vision. We attempted to refine the basic reference of the electrical evoked potentials (EEPs) elicited by microelectrical stimulations of the optic nerve, optic tract and LGB of a domestic pig, and then compared it to visual evoked potentials (VEPs) elicited by short-flash stimuli. METHODS: For visual function measurement, VEPs in response to short-flash stimuli on the left eye of the domestic pig were assessed over the visual cortex at position Oz with the reference electrode at Fz. After anesthesia, linearly configured platinum wire electrodes were inserted into the optic nerve, optic track and LGB. To determine the optimal stimulus current, EEPs were recorded repeatedly with controlling the pulse and power. The threshold of current and charge density to elicit EEPs at 0.3 ms pulse duration was about ±10 microA. RESULTS: Our experimental results showed that visual cortex activity can be effectively evoked by stimulation of the optic nerve, optic tract and LGB using penetrating electrodes. The latency of P1 was more shortened as the electrical stimulation was closer to LGB. The EEPs of two-channel in the visual cortex demonstrated a similar pattern with stimulation of different spots of the stimulating electrodes. We found that the LGB-stimulated EEP pattern was very similar to the simultaneously generated VEP on the control side, although implicit time deferred. CONCLUSIONS: EEPs and VEPs derived from visual-system stimulation were compared. The LGB-stimulated EEP wave demonstrated a similar pattern to the VEP waveform except implicit time, indicating prosthetic-based electrical stimulation of the LGB could be utilized for the blind to perceive vision of phosphenes.
Animals ; Electric Stimulation ; Electrodes, Implanted ; Evoked Potentials, Visual/*physiology ; Geniculate Bodies/*physiology ; Male ; Optic Nerve/physiology ; Optic Tract/physiology ; Photic Stimulation ; Sus scrofa ; Visual Cortex/*physiology

PURPOSE: Despite recent advances in the surgical and postoperative management of infants with congenital heart disease, nutritional support for this population is often suboptimal. The purpose of this study was to develop a nutritional program for the postoperative period for infants who have had cardiac surgery and to evaluate effects of the program. METHODS: A quasi-experimental design with pretest and posttest measures was used. A newly developed nutritional program including a feeding protocol and feeding flow was provided to the study group (n=19) and usual feeding care to the control group (n=19). The effects of the feeding program were analyzed in terms of total feed intake, total calorie intake, gastric residual volume, and frequency of diarrhea. RESULTS: Calorie intake and feeding amount in the study group were significantly increased compared to the control group. However, the two groups showed no significant differences in gastric residual volume and frequency of diarrhea. CONCLUSION: The results indicate that the nutritional program used in the study is an effective nursing intervention program in increasing feeding amount and calorie intake in infants postoperative to cardiac surgery and does not cause feeding-related complications.
Diarrhea/complications/etiology ; Enteral Nutrition/*methods/standards ; Female ; Heart Diseases/*surgery ; Humans ; Infant ; Infant, Newborn ; Male ; Nutritional Requirements ; *Postoperative Care/methods ; Postoperative Complications ; Program Development ; Program Evaluation

BACKGROUND: Propofol, a new intravenous anesthetic agent, is now used for brief operation and day surgery for its rapid recovery and controllability. Propofol, rapid acting sedatives hypnotics, is known to no analgesic effect. This study was taken to evaluate the analgesic effect of propofol, compared to those of fentanyl. METHODS: Forty patients (ASA physical status 1, 2) scheduled for surgery of short duration (within 1 hour) were randomly allocated into two groups. Induction of anesthesia was performed by injection of thiopental (5 mg/kg) and succinylcholine (1 mg/kg) and ventilated with O2-N2O (50%) after endotracheal intubation. Maintenance of anesthesia was performed by vecuronium (1 mg/kg) and continuous infusion of propofol (group I) or fentanyl (group II). RESULTS: There was no significant differences in systolic and diastolic blood pressure in both groups. In heart rate, there was significant difference at preincision and postincision between two groups. Time to extubation (4.5 +/- 4.6 vs 6.3 +/- 4.6 min), time to eye open (7.5 +/- 7.1 vs 6.6 +/- 5.4 min), time to complain pain after stop dropping at recovery room (30.5 +/- 8.0 vs 35.5 +/- 17.9 min), the average flow rate of drugs (6.0 +/- 2.2 mg/kg/hr vs 6.7 +/- 2.4 microgram/kg/hr) has no significant difference between two groups. CONCLUSIONS: A single continuous infusion of propofol is applied as one of general anesthesia methods with O2-N2O, muscle relaxants. Propofol has a appropriate and similar analgesic effect compared with fentanyl in operation of little hemodynamic changes and short operation, and rapid recovery compared with fentanyl.
Ambulatory Surgical Procedures ; Anesthesia ; Anesthesia, General ; Blood Pressure ; Fentanyl* ; Heart Rate ; Hemodynamics ; Humans ; Hypnotics and Sedatives ; Intubation, Intratracheal ; Propofol* ; Recovery Room ; Succinylcholine ; Thiopental ; Vecuronium Bromide

PURPOSE: The aim of this study was to explore characteristics of and risk factors for accidental inpatient falls. METHODS: Participants were classified as fallers or non-fallers based on the fall history of inpatients in a tertiary hospital in Seoul between June 2014 and May 2015. Data on falls were obtained from the fall report forms and data on risk factors were obtained from the electronic nursing records. Characteristics of fallers and non-fallers were analyzed using descriptive statistics. Risk factors for falls were identified using univariate analyses and logistic regression analysis. RESULTS: Average length of stay prior to the fall was 21.52 days and average age of fallers was 61.37 years. Most falls occurred during the night shifts and in the bedroom and were due to sudden leg weakness during ambulation. It was found that gender, BMI, physical problems such elimination, gait, vision and hearing and medications such as sleeping pills, antiarrhythmics, vasodilators, and muscle relaxant were statistically significant factors affecting falls. CONCLUSION: The findings show that there are significant risk factors such as BMI and history of surgery which are not part of fall assessment tools. There are also items on fall assessment tools which are not found to be significant such as mental status, emotional unstability, dizziness, and impairment of urination. Therefore, these various risk factors should be examined in the fall risk assessments and these risk factors should be considered in the development of fall assessment tools.
Accidental Falls* ; Dizziness ; Gait ; Hearing ; Humans ; Inpatients* ; Leg ; Length of Stay ; Logistic Models ; Nursing Records ; Patient Safety ; Risk Assessment ; Risk Factors* ; Seoul ; Tertiary Care Centers* ; Urination ; Vasodilator Agents ; Walking

Autoinflammatory disease (AID) is a newly proposed category of disorders characterized by unprovoked episodes of inflammation without any infectious or autoimmune evidence. We aimed to characterize the clinical and genetic features of patients who had recurrent fever and multi-system inflammation but remain unclassified for any established AIDs. Medical records of 1,777 patients who visited our Rheumatology Clinic between March 2009 and December 2010 were reviewed to identify those who met the following criteria; 1) presence of fever, 2) inflammation in two or more organ systems, 3) recurrent nature of fever or inflammation, 4) no evidence of infection or malignancy, 5) absence of high titer autoantibodies, and 6) failure to satisfy any classification criteria for known AIDs. Genotyping was performed for common missense variants in MEFV, NOD2/CARD15, and TNFRSF1A. A small number of patients (17/1,777, 0.95%) were identified to meet the above criteria. Muco-cutaneous and musculoskeletal features were most common, but there was a considerable heterogeneity in symptom combination. Although they did not satisfy any established classification criteria for AIDs, substantial overlap was observed between the clinical spectrum of these patients and known AIDs. According to the newly proposed Eurofever criteria for periodic fevers, eleven of them were classified as TNF receptor-associated periodic syndrome and two as mevalonate kinase deficiency. However, no examined genetic variants including those in TNFRSF1A were found in these patients. A new set of classification criteria needs to be developed and validated for Asian patients with unclassified AIDs.
Adolescent ; Adult ; Cytoskeletal Proteins/genetics ; Female ; Fever/*etiology ; Genotype ; Hereditary Autoinflammatory Diseases/classification/*diagnosis/genetics ; Humans ; Inflammation/*etiology ; Male ; Middle Aged ; Mutation, Missense ; Nod2 Signaling Adaptor Protein/genetics ; Polymorphism, Single Nucleotide ; Receptors, Tumor Necrosis Factor, Type I/genetics ; Recurrence ; Republic of Korea ; Retrospective Studies ; Young Adult

Autoinflammatory disease (AID) is a newly proposed category of disorders characterized by unprovoked episodes of inflammation without any infectious or autoimmune evidence. We aimed to characterize the clinical and genetic features of patients who had recurrent fever and multi-system inflammation but remain unclassified for any established AIDs. Medical records of 1,777 patients who visited our Rheumatology Clinic between March 2009 and December 2010 were reviewed to identify those who met the following criteria; 1) presence of fever, 2) inflammation in two or more organ systems, 3) recurrent nature of fever or inflammation, 4) no evidence of infection or malignancy, 5) absence of high titer autoantibodies, and 6) failure to satisfy any classification criteria for known AIDs. Genotyping was performed for common missense variants in MEFV, NOD2/CARD15, and TNFRSF1A. A small number of patients (17/1,777, 0.95%) were identified to meet the above criteria. Muco-cutaneous and musculoskeletal features were most common, but there was a considerable heterogeneity in symptom combination. Although they did not satisfy any established classification criteria for AIDs, substantial overlap was observed between the clinical spectrum of these patients and known AIDs. According to the newly proposed Eurofever criteria for periodic fevers, eleven of them were classified as TNF receptor-associated periodic syndrome and two as mevalonate kinase deficiency. However, no examined genetic variants including those in TNFRSF1A were found in these patients. A new set of classification criteria needs to be developed and validated for Asian patients with unclassified AIDs.
Adolescent ; Adult ; Cytoskeletal Proteins/genetics ; Female ; Fever/*etiology ; Genotype ; Hereditary Autoinflammatory Diseases/classification/*diagnosis/genetics ; Humans ; Inflammation/*etiology ; Male ; Middle Aged ; Mutation, Missense ; Nod2 Signaling Adaptor Protein/genetics ; Polymorphism, Single Nucleotide ; Receptors, Tumor Necrosis Factor, Type I/genetics ; Recurrence ; Republic of Korea ; Retrospective Studies ; Young Adult

Dental Implants ; Female ; Follow-Up Studies ; Gingivitis ; Humans ; Male ; Membranes ; Prognosis ; Prosthodontics ; Retrospective Studies ; Sinusitis ; Survival Rate ; Tooth ; Transplants

Gout attacks are often accompanied by systemic inflammatory response. The aim of the retrospective study was to compare gout patients in different age groups in terms of their clinical features at gout attacks. Patients, who were treated for gout attack in two tertiary medical centers between January 2000 and April 2014, were divided into young (≤ 50 years), middle-aged, and elderly (> 65 years) groups. Patients in three age groups were compared in terms of presence of fever (> 37.8°C), C-reactive protein (CRP) levels, and erythrocyte sedimentation ratio (ESR) at the gout attacks. Monocytes, which were isolated from 10 consecutive patients who previously experienced gout attacks, were stimulated with monosodium urate (MSU) crystals and cytokine production was measured by flow cytometry. Among 254 patients analyzed in this study, 48 were young, 65 were middle-aged, and 141 were elderly. The elderly patients were more likely to have fever (51.1%) during the attack than the young (20.8%) and middle-aged (30.8%) patients (P < 0.001 by χ² test). They were also more likely to have higher ESR and CRP levels than the young patients (P = 0.002 for ESR, P < 0.001 for CRP). Patients' age correlated significantly with CRP and ESR levels (both P < 0.001). After stimulation with MSU, the production of interleukin-1β by monocytes increased with patients' age (r = 0.670, P = 0.03). In conclusion, gout attacks in elderly patients are associated with fever and higher ESR and CRP levels, often resembling a septic arthritis.
Aged* ; Aging ; Arthritis, Infectious ; Blood Sedimentation ; C-Reactive Protein ; Fever ; Flow Cytometry ; Gout* ; Humans ; Inflammation ; Monocytes ; Retrospective Studies ; Uric Acid

Nasal obstruction is one of the most frequent symptoms of chronic sinusitis. Since 1989, acoustic rhinometry has proven to be relatively accurate in evaluating the severity of nasal obstruction in a clinical setting. This study was conducted to evaluate the efficacy of acoustic rhinometry before and after endoscopic surgery in relieving nasal obstruction in patients with chronic sinusitis. Nasal airway patency was measured by acoustic rhinometry, preoperatively and postoperatively, in 48 patients with chronic sinusitis. Total volume (TV), distances and areas of the first and second notches, and areas at 3.3 cm (A(3.3)), 4.0 cm (A(4.0)) and 6.4 cm (A(6.4)) from nose pieces were measured. The patients were divided into 4 groups according to the duration of their postoperative follow-up period. Group 1 had a postoperative follow-up period less than 1 year ; group 2, between 1 and 2 years ; group 3, between 2 and 3 years ; group 4, between 3 and 4 years. There was a significant increase in TV, A(4.0), and A(6.4) postoperatively (p<0.05, paired t-test). Postoperative values including TV, A(4.0), and A(6.4) increased significantly in group 1, group 2, and group 3, but decreased in group 4 (p<0.05, ANOVA). However, there was no significant difference between groups in distances and areas of the first and second notches. These results suggest that endoscopic sinus surgery is effective in relieving nasal obstruction of patients with chronic sinusitis and that acoustic rhinometry may be a useful tool in objectifying symptomatic improvement in patients with nasal obstruction following endoscopic sinus surgery.
Acoustics* ; Follow-Up Studies ; Humans ; Nasal Obstruction ; Nose ; Rhinometry, Acoustic* ; Sinusitis*