BACKGROUND: Several antibiotics can be used to treat ventilator-associated pneumonia caused by carbapenem-resistant A. baumannii (CRAB-VAP) including high-dose sulbactam. However, the effectiveness of high-dose sulbactam therapy is not well known. We report our experience with high-dose sulbactam for treatment of CRAB-VAP. METHODS: Medical records of patients with CRAB-VAP who were given high-dose sulbactam between May 2013 and June 2015 were reviewed. RESULTS: Fifty-eight patients with CRAB-VAP were treated with high-dose sulbactam. The mean age was 72.0 ± 15.2 years, and the acute physiology and chronic health evaluation II (APACHE II) score was 15.1 ± 5.10 at the time of CRAB-VAP diagnosis. Early clinical improvement was observed in 65.5% of patients, and 30-day mortality was 29.3%. Early clinical failure (odds ratio [OR]: 8.720, confidence interval [CI]: 1.346-56.484; p = 0.023) and APACHE II score ≥ 14 at CRAB-VAP diagnosis (OR: 10.934, CI: 1.047-114.148; p = 0.046) were associated with 30-day mortality. CONCLUSIONS: High-dose sulbactam therapy may be effective for the treatment of CRAB-VAP. However, early clinical failure was observed in 35% of patients and was associated with poor outcome.
Acinetobacter baumannii* ; Acinetobacter* ; Anti-Bacterial Agents ; APACHE ; Diagnosis ; Humans ; Medical Records ; Mortality ; Pneumonia, Ventilator-Associated* ; Sulbactam*

PURPOSE: Surgeons serve one of the most challenging and stressful professions. Ineffective control of occupational stress leads to burnout of the surgeon. The aim of this study was to obtain preliminary data on the sources and the degree of stress of surgeons and to determine the feasibility of the survey. METHODS: A total of 63 surgeons in our three affiliated hospitals were enrolled in this study. Fifty-five questions were used to assess the demographics, characteristics and Korean occupational stress scale (KOSS), which were prepared and validated by the National Study for Development and Standardization of Occupational Stress. RESULTS: Forty-seven of the 63 surgeons participated in this study (74.6%). The mean KOSS score of the survey was 50.9 +/- 8.55, which was significantly higher than that of other professions (P < 0.01). Drinking and smoking habits were not related to the KOSS score. Doing exercise was related to a low KOSS score in terms of low KOSS total score (P < 0.01). Average duty hours (P < 0.01) and night duty days per week (P = 0.01) were strongly related to higher KOSS in the linear regression analysis. CONCLUSION: This is the first study to evaluate job stress of surgeons in Korea. This study showed that Korean Surgeons had higher occupational stress than other Korean professions. A larger study based on this pilot study will help generate objective data for occupational stress of Korean Surgeons by performing a survey of the members of the Korean Surgical Society.
Demography ; Drinking ; Korea ; Linear Models ; Pilot Projects ; Smoke ; Smoking

Achondroplasia is a congenital disorder resulting from a specific disturbance in endochondral bone formation. The ophthalmic features reportedly associated with achondroplasia are telecanthus, exotropia, inferior oblique overaction, angle anomalies and cone-rod dystrophy. This is first report of chorioretinal coloboma in achondroplasia. An 8-year-old female was diagnosed with a developmental delay, known as achondroplasia, seven months after birth. Upon her initial visit, visual acuity was 0.3 in both eyes. The patient had telecanthus but normal ocular motility. Findings were normal upon anterior segment examination. Fundus examination of both eyes revealed about 1,500 microm sized chorioretinal coloboma inferior to the optic nerve head. Upon fluorescent angiography, there was chorioretinal coloboma without any other lesions. Afterward, there was no change in the fundus lesion, and best corrected visual acuity was 0.6 in both eyes. Chorioretinal coloboma is associated with choroidal and retinal detachment. As chorioretinal coloboma and achondroplasia are developmental disorders in the embryonic stage, early detection and regular ophthalmologic examination would be essential in patients with achondroplasia.
Achondroplasia/*complications/diagnosis ; Child ; Choroid/*abnormalities ; Choroid Diseases/*complications/diagnosis ; Coloboma/*complications/diagnosis ; Female ; Humans ; Ophthalmoscopes ; Tomography, Optical Coherence ; Visual Acuity

OBJECTIVES: The purposes of this study are to investigate the reliability and validity of shortened premenstrual assessment form and the applicability to internet interface. METHOD: The total of 55 subjects were included in this study. Among them, 28 subjects had premenstrual dysphoric disorder, and the other 27 subjects did not. All subjects performed the shortened premenstrual assessment form through internet interface in the homepage of Severance Woman Clinic. The diagnosis of premenstrual dysphoric disorder was determined by prospective assessment for 2 months. RESULTS: The shortened premenstrual assessment form consists of 3 factors: affect, pain and water retention. The test-retest reliability of this scale was 0.80, and internal consistency (Cronbach alpha) was 0.91. The correlation coeffeciecy between scores of the premenstrual assessment form and the shortened premenstrual assessment form was 0.92. The difference of the scores of the shortened premenstrual assessment form between the group of premenstrual dysphoric disorder and the group of non-premenstrual dysphoric disorder was significant (t=5.57, p<0.001). Discriminant analysis also revealed that the shortened premenstrual assessment form was useful to differentiate between premenstrual dysyphoric disorder and non-premenstrual dysphoric disorder (eigenvalue: 0.60, canonical correlation coefficiency: 0.61, Wilk's lambda: 0.63). The cut-off point to differentiate between two groups was 27, and sensitivity (75.0%) and specificity (76.9%) of this scale for premenstrual dysphoric disorder was acceptable. CONCLUSION: In summary, the shortened premenstrual assessment form appeared to be reliable and valid for the assesment of premenstrual dysphoric disorder. And the results of this study also suggest that the shortened premenstrual assessment form is a useful tool for internet interface application.
Diagnosis ; Equidae ; Female ; Humans ; Internet* ; Prospective Studies ; Reproducibility of Results ; Sensitivity and Specificity ; Water

The authors report two cases of intramedullary metastasis from breast cancer and melanoma respectively. Both patients presented with rapidly progressing paraparesis. They were treated by laminectomy with microsurgical extirpation of the tumor and whole spine irradiation. The patient with melanoma died at 3 months postoperatively and the other with breast cancer is still alive for 40 months after being diagnosed of spinal cord metastasis. The prognosis of intramedullary spinal cord metastasis is known to be poor, however, early diagnosis and radical surgery before irreVersible deterioration of neurologic status can prolong functional survival.
Breast Neoplasms ; Early Diagnosis ; Humans ; Laminectomy ; Melanoma ; Neoplasm Metastasis* ; Paraparesis ; Prognosis ; Spinal Cord* ; Spine

Intestinal obstruction is not uncommon in infants. The common causes of intestinal obstruction in the neonatal period are Hirschsprung disease, intestinal atresia, meconium ileus, and intussusception. However, small bowel obstruction caused by a congenital band is very rare. We report a 27-day-old baby who was admitted with abdominal distension and fever. The abdominal X-ray revealed massive bowel dilatation and the contrast gastrografin enema suggested a distal small bowel obstruction. The explolaparotomy showed small bowel entrapment due to an unusual anomalous congenital band.
Diatrizoate Meglumine ; Dilatation ; Enema ; Fever ; Hirschsprung Disease ; Humans ; Ileus ; Infant ; Intestinal Atresia ; Intestinal Obstruction ; Intussusception ; Meconium

OBJECTIVES: The cognitive model has been suggested to explain the pathogenesis of premenstrual syndrome. In this model, it is suggested that negative cognitive style may contribute to the experience of severe premenstrual symptoms. We conducted this study to examine the relationship among cognitive style, perceived stress, and premenstrual symptoms. METHOD: Eighty six reproductive aged women older than 18 years were included in this study, to complete the Premenstrual Assessment form, Korean version of automatic thoughts Ques-tionnaire-Positive, Korean version of Automatic Thoughts Questionnaire-Negative, Korean version of Dysfunctional Attitude Scale, Perceived Stress Questionnaire. Among the subjects, twenty one were diagnosed to have a premenstrual dysphoric disorder which was determined by prospective assessment for two months. The relationships among the variables were analyzed by examining Pearson correlation coefficiency. REULTS: In the subjects without premenstrual dysphoric disorder, there exist significant correlation between the premenstrual symptom and the score of Korean-version of automatic thoughts Questionnaire-Negative(r=.36, p<.01). In the subjects with premenstrual dysphoric disorder, premenstrual symptoms had significant correlation to automatic thoughts Questionnaire-Negative(r=.65, p<.01) and Perceived Stress Questionnaire(r=.52, p<0.01). CONCLUSION: Our findings show the significant relationship between negative cognitive style and premenstrual symptoms. This relationship was more prominent in the subjects with premenstrual dysphoric disorder compared to ones without it. Our findings suggest that cognitive style and stress perception may influence on the severity of symptoms of premenstrual syndrome or premenstrual dysphoric disorder, and that cognitive behavior therapy is a possible effective therapeutic strategy for those with severe premenstrual symptoms.
Cognitive Therapy ; Female ; Humans ; Premenstrual Syndrome ; Prospective Studies ; Surveys and Questionnaires

PURPOSE: To evaluate the pattern VEP in adult amblyopic patients seen in consultation for ophthalmic evaluation as a past of physical examinations for conscription. METHODS: We retrospectively analyzed, 67 men, 20-year-old or older, who had pattern VEP done for the diagnosis of amblyopia from January 2004 to May 2009. P100 latency and P100 amplitude were analyzed. RESULTS: Thirteen patients were non-amblyopic, and 54 patients had amblyopia. Binocular amblyopia and monocular amblyopia were found in 23 and 31 patients, respectively. In the binocular amblyopic patients, four patients were hyperopic, seven patients were myopic, and 12 patients were astigmatic amblyopia. In the monocular amblyopic patients, 15 patients were anisometropic, 12 patients were strabismic, and four patients had organic amblyopia. The value of P100 latency and P100 amplitude were statistically significantly different between non-amblyopic and amblyopic eyes, with check size of 32x32. However, the types of amblyopia among the patients were not different at a statistically significant level. Visual acuity and P100 amplitude were significantly positively correlated. CONCLUSIONS: VEP might be a useful tool for diagnosis of adult amblyopia, especially using a 32x32 check size. This tool may impart the ability to decide relationship between amblyopia and visual acuity by analyzing P100 latency and amplitude values.
Adult ; Amblyopia ; Eye ; Humans ; Male ; Military Personnel ; Physical Examination ; Retrospective Studies ; Telescopes ; Visual Acuity ; Young Adult

PURPOSE: Non-blood transfusion is of increasing interest as more patients are refusing a blood transfusion because of religious belief, infection, or fear of a blood-transmitted disease such as AIDS. This study analyzed clinical findings to help the treatment and management of patients who want a non-blood transfusion. METHODS: Of the 83 patients who visited the non-blood transfusion center in Chosun University Hospital from June 2001 to December 2003, 59 patients had a sufficient clinical record, and these were reviewed retrospectively. We investigated sex, age, the reason for the visit, the reason for refusing a blood transfusion, the degree of anemia, the necessity of the blood transfusion, the histories of transfusion and attempted non-blood transfusion, and the histories of visits to emergency departments and the outcomes. RESULTS: The male-to-female ratio was 1:2.93, and the most prevalent ages of the patients were in the forties (26 patients) and thirties (10 patients). The reasons for refusing a blood transfusion were religion (48 patients, 81.4%), risk of infection (1 patients, 1.7%), and other (10 patients, 16.9%). Among the specialty departments, the proportions of patients from the departments of obstetrics and gynecology, internal medicine, general surgery and orthopedics were 40.7% (24 patients), 25.4%, 11.9%, and 6.8%, respectively. Of the patients, 28 patients (47.5%) were admitted directly to the emergency department, and 39 patients (66.1%) were operated on. A blood transfusion was considered to be necessary for 16 patients (27.1%), but only a 2 patients (3.4%) actually received a blood transfusion. Of those 14 patients, 3patients (21.4%) died. After admission, 17 patients (29.8%) received a non-blood transfusion. CONCLUSIONS: Most of the patients visited the non-blood transfusion center for religious reasons, and the majority of the patients were admitted from the Department of Obstetrics and Gynecology. Many of the patients medically should have received blood transfusion, but only a few actually did.
Anemia ; Blood Transfusion* ; Emergency Service, Hospital ; Gynecology ; Humans ; Internal Medicine ; Obstetrics ; Orthopedics ; Religion ; Retrospective Studies

PURPOSE: The aim of the study was to clarify the anatomy of the male rat urethra, and to establish a more accurate and consistent method for analyzing external urethral sphincter (EUS) contractility based on this clarified anatomy by comparing different muscle strip orientations. MATERIALS AND METHODS: The whole urethra in male rats was investigated histologically using H/E and immunohistochemical staining. The contractility of the spiral (S) orientation of the entire proximal urethral (EUS) was then compared with the transverse (T) and the ring (R) orientations of the optimal portion, via electrical stimulation in an organ bath. RESULTS: In male rats, the urethral tract consisted of following parts: proximal urethra, transient urethra, urethral diverticula, and penile urethra. Throughout the proximal urethra, a layer of striated muscle fibers encircled the smooth muscle layers. The EUS contraction of the S, TM (Transverse, Middle of proximal urethra) and RM (Ring, Middle of proximal urethra) groups were 4.66+/-0.33mN, 2.92+/-0.33mN and 2.47+/-0.38mN, respectively. The strength of the EUS contraction of the S group was significantly higher than that of the TM. Group, but after adjusting the length, there was no statistically significant difference between the two groups. CONCLUSIONS: Unlike previous studies, showing striated muscle fibers limited to the lower half of the proximal urethra, we noted them throughout the whole proximal urethra. From our results, the spiral orientation of the entire urethra was found to be the optimal configuration for evaluating the contractility of the EUS using fast twitch muscle contractile testing.
Animals ; Baths ; Diverticulum ; Electric Stimulation ; Humans ; Male* ; Muscle, Smooth ; Muscle, Striated ; Rats* ; Urethra*