BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) infection is a severe and life-threatening disease in patients with community-onset (CO) pneumonia. However, the current guidelines lack specificity for a screening test for MRSA infection. METHODS: This study was retrospectively conducted in elderly patients aged ≥65 years, who had contracted CO-pneumonia during hospitalization at the Jeju National University Hospital, between January 2012 and December 2014. We analyzed the risk factors of MRSA in these patients and developed a scoring system to predict MRSA infection. RESULTS: A total of 762 patients were enrolled in this study, including 19 (2.4%) with MRSA infection. Healthcare-associated pneumonia (HCAP) showed more frequent MRSA infection compared to community-acquired pneumonia (4.4% vs. 1.5%, respectively; p=0.016). In a multivariate logistic regression analysis, admissions during the influenza season (odds ratio [OR], 2.896; 95% confidence interval [CI], 1.022–8.202; p=0.045), chronic kidney disease (OR, 3.555; 95% CI, 1.157–10.926; p=0.027), and intensive care unit admission (OR, 3.385; 95% CI, 1.035–11.075; p=0.044) were identified as predictive factors for MRSA infection. However, the presence of HCAP was not significantly associated with MRSA infection (OR, 1.991; 95% CI, 0.720–5.505; p=0.185). The scoring system consisted of three variables based on the multivariate analysis, and showed moderately accurate diagnostic prediction (area under curve, 0.790; 95% CI, 0.680–0.899; p<0.001). CONCLUSION: MRSA infection would be considered in elderly CO-pneumonia patients, with three risk factors identified herein. When managing elderly patients with pneumonia, clinicians might keep in mind that these risk factors are associated with MRSA infection, which may help in selecting appropriate antibiotics.
Aged* ; Anti-Bacterial Agents ; Community-Acquired Infections ; Hospitalization ; Humans ; Influenza, Human ; Intensive Care Units ; Logistic Models ; Mass Screening ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Mortality ; Multivariate Analysis ; Pneumonia* ; Renal Insufficiency, Chronic ; Retrospective Studies ; Risk Factors ; Seasons ; Sensitivity and Specificity

Endoscopic endoprosthesis is well established as a cheap, fast and durable procedure for palliation of malignant dysphagia. But the placement of conventional endoprosthesis is difficult and is associated with significant complications such as hemorrhage, perforation and dysfunction of the prosthesis. Recently, self -expand- able metal prosthesis have also been utilized for malignant esophageal stenosis, and palliation of this modality seems to be more effective than other modalities. However the main problems with these metal stents are tumor ingrowth leading to reobstruction, migration, and eophageal trauma by the distal, hard skirt of the stent. EsophaCoil stent is a simple coil with close loops made from a single flat wire of nickel titanium alloy. The radial force of this material is much stronger than stainless steel, expansion time is faster and the stent is able to dilate even extremely resistant strictures. This new metalic stent seems to have several advantages over the current commnerically available ones. We report our experiences with this EsophaCoil stent and review of literature.
Alloys ; Constriction, Pathologic ; Deglutition Disorders ; Esophageal Stenosis* ; Hemorrhage ; Nickel ; Prostheses and Implants* ; Stainless Steel ; Stents ; Titanium

The purpose of this study was to identify the biomechanical factors that correlate with plantar fasciitis in non-obese patients whose body mass index were below 25 kg/m2. The subjects were non-obese patients who were diagnosed as plantar fasciitis by clinical appearance, physical examination, and ultrasonographic findings (n=48), and non-obese control persons without clinical diagnosis of plantar fasciitis (n=30). The two groups were compared on fat pad thickness, ankle dorsiflexion range of motion (ROM), resting calcaneal stance position (RCSP), incidence of calcaneal spur, and calcaneal pitch. The results showed that, there were statistically significant differences between two groups in ankle dorsiflexion ROM, RCSP, and calcaneal pitch (p<0.05). Multiple logistic regression analysis showed ankle dorsiflexion ROM and RCSP strongly correlated with presence of plantar fasciitis as independent predictors (p<0.05). In conclusion, reduced ankle dorsiflexion ROM and negative RCSP (valgus tendency in rear foot) may be the biomechanical factors associated with plantar fasciitis in non-obese patients.
Adipose Tissue ; Animals ; Ankle ; Body Mass Index ; Fasciitis, Plantar ; Heel Spur ; Humans ; Incidence ; Logistic Models ; Physical Examination ; Range of Motion, Articular

OBJECTIVES: To determine the level of aircraft noise exposure and how it relates to hearing loss, and to investigate the association between noise exposure and anxiety and depression in subjects residing adjacent to a military airbase. METHODS: The study was conducted upon 898 inhabitants between the ages of 30-79, living near the military airbase in Jeonra-do. The subjects were divided into three noise-exposure groups: high-exposure, low-exposure, and a control group. The cut-values were 80 and 60 on the Weighted Equivalent Continuous Perceived Noise Level scale. A self-administered questionnaire including the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory (BDI) were completed. Pure tone audiometry tests were performed. RESULTS: Hearing loss prevalence was defined by a >40 dB loss in bilateral ears or in one ear; the difference of <15 dB compared to the better side was 30.8%. The mean BAI/BDI score was 18.9+/-14.3/18.7+/-11.6, the number of abnormal subjects with BAIs > or =22 was 317 (35.3%), with BDIs > or =21 was 347 (38.6%). The pure tone average, BAI, and BDI scores were higher in the noise-exposure groups compared to the control. The BAI/BDI abnormal subjects showed a higher hearing threshold shift level compared to the normal scored subjects. The odd ratios for anxiety was significantly high in both noise exposure groups and the hearing loss, for depression was significantly high in high-exposure group and hearing loss. CONCLUSIONS: Anxiety and depression were higher when exposure to high-level noise and further complicated by hearing loss. Further investigation is needed to determine the cause-effect relationship.
Aircraft ; Anxiety ; Audiometry ; Depression ; Ear ; Hearing ; Hearing Loss ; Humans ; Military Personnel ; Noise ; Prevalence ; Questionnaires

PURPOSE: To evaluate the enhancing patterns of nodular hepatocellular carcinomas (HCCs) in the arterial-andportal-dominant phases of spiral CT. MATERIALS AND METHODS: A retrospective analysis of enhancing patterns was performed in 100 patients with HCCs diagnosed by pathologic findings (n=30) or clinical and radiological findings. CT images were obtained 30 seconds(arterial-dominant phase) and 65 seconds(portal-dominant phase) after beginning injection of contrast medium (120mL, 3mL/sec). After transarterial chemoembolization, 179 tumors detected oniodized oil-CT were divided into four groups according to their largest diameter, as follows ; group I(smallerthan 1cm, n=51), II(1-2cm, n=46), III(2-3cm, n=32), IV(larger than 3cm, n=50). The enhancing patterns of tumorscompared with attenuation of surrounding liver parenchyma, were divided into four types, namely high, iso, low andmixed. RESULTS: Each group showed a different enhancing pattern ; group I showed iso-attenuation in both arterial- and portal-dominant phases (n=41, 80% and n=50, 98%), group II showed high-attenuation in the arterial-dominant phase (n=38, 83%) and iso-attenuation in the portal-dominant phase(n=34, 74%), group III showed high-attenuation in the arterial-dominant phase(n=19, 59%) and low-attenuation in the portal-dominant phase(n=17,53%), and group IV showed mixed-attenuation in both arterial- and portal-dominant phases(n=30, 60% and n=26, 52%). CONCLUSION: Hepatocellular carcinomas showed variable enhancing patterns on two-phase spiral CT according to thesize of tumors, and this reflected their hemodynamic characteristics.
Carcinoma, Hepatocellular* ; Hemodynamics ; Humans ; Liver ; Retrospective Studies ; Tomography, Spiral Computed*

We report two cases of cleidocranial dysplasia, which was managed without significant craniofacial osteotomy. A mother and daughter, both of normal intelligence, presented with central forehead depression, mid-face hypoplasia, and blepharoptosis. The fact that they have an identically deformed face implied a genetic basis. In both patients, radiologic evaluation revealed the underdeveloped maxilla, persistent fontanelle opening, and cleidal aplasia. Clinical findings and radiologic studies were consistent with the diagnosis of cleidocranial dysplasia. Both patients underwent forehead plasty via bicoronal approach, augmentation rhinoplasty using tip plasty, and epicanthoplasty. In addition, the mother underwent malar augmentation using Medpor implantation and reduction genioplasty. The patients did not experience any postoperative complication and remained satisfied with the operation at 6-year follow-up.
Blepharoptosis ; Clavicle ; Cleidocranial Dysplasia* ; Depression ; Diagnosis ; Follow-Up Studies ; Forehead ; Genetic Diseases, Inborn ; Genioplasty ; Humans ; Intelligence ; Maxilla ; Mothers ; Nuclear Family ; Osteotomy ; Postoperative Complications ; Rhinoplasty

Scrub typhus is an acute febrile illness with focal or general vasculitis that is caused by Orientia tsutsugamushi. The spectrum of clinical severity ranges from mild to severe with potentially fatal complications including acute renal failure, gastrointestinal bleeding, meningitis, myocarditis, and pneumonia. However, myofascitis with scrub typhus has not been reported to date. We report a case of pneumonia, meningitis, and myofascitis in a 56-year-old male patient with scrub typhus due to the Taguchi strain of O. tsutsugamushi.
Acute Kidney Injury ; Fasciitis ; Hemorrhage ; Humans ; Male ; Meningitis ; Middle Aged ; Myocarditis ; Orientia tsutsugamushi* ; Pneumonia ; Scrub Typhus* ; Vasculitis

Since coronary arteriovenous fistula(CAVF) was first reported by Krause in 1865, more than 400 cases have been reported. It is relatively rare disease and originates more commonly in the right than in the left coronary artery. We report a case of CAVF between right coronary artery and right ventricular inflow tract with significant left to right shunt in a 34-year old female who was admitted for the cardiomegaly on routine chest X-Ray. It was detected by transthoracic and transesophageal echocardiography, and confirmed by cardiac catheterization and coronary angiography. The opening of the fistula draining into the right ventricle was obliterated with sutures. There was no significant shunt in postoperative cardiac catheterization and coronary angiography.
Adult ; Arteriovenous Fistula* ; Cardiac Catheterization ; Cardiac Catheters ; Cardiomegaly ; Coronary Angiography ; Coronary Vessels ; Echocardiography ; Echocardiography, Transesophageal* ; Female ; Fistula ; Heart Ventricles ; Humans ; Rare Diseases ; Sutures ; Thorax

BACKGROUND: This study was to clarify the influence of collapse and re-ventilation of lung on the development of pulmonary edema in rabbit. METHODS: Animals were randomly assigned to one of three groups: Sham group receiving two lung ventilation (n=14), Collapse group receiving collapse of right lung (n=14), Reventilation group receiving collapse of right lung for 3 hours followed by reventilation of collapsed right lung for 3 hours (n=14). The lung of rabbits were ventilated with 50% oxygen through the tracheostomy. Right main bronchus was secured by thoracotomy in all animal. Collapse and reventilation were performed using by bulldog forcep. Mean arterial pressure, heart rate, arterial oxygen tension (PaO2), peripheral blood leukocyte and platelet counts were recorded at 0, 1, 2, 3, 4, 5 and 6 hour after the start of experiment. The wet to dry (W/D) weight ratio of lung, lung injury score and leukocyte counts, percentage of polymorphonuclear leukocyte (PMNL), concentration of albumin, and interleukin-8 (IL-8) in bronchoalveolar lavage fluid (BALF) were measured 6 hour after the start of experiment in both lung. RESULTS: W/D weight ratio of lung, lung injury score and leukocyte counts, percentage of PMNL, concentration of albumin and IL-8 in BALF were significantly increased in both lung of reventilation group. And the degree of increases is more significant in right than left lung. CONCLUSIONS: These findings suggest that reventilation of collapsed lung causes the bilateral pulmonary edema in rabbit mainly by activating neutrophil and IL-8 responses, which may play a central role in non cardiogenic pulmonary edema.
Animals ; Arterial Pressure ; Bronchi ; Bronchoalveolar Lavage Fluid ; Heart Rate ; Interleukin-8 ; Leukocyte Count ; Leukocytes ; Lung Injury ; Lung* ; Neutrophils ; Oxygen ; Platelet Count ; Pulmonary Edema* ; Rabbits ; Surgical Instruments ; Thoracotomy ; Tracheostomy ; Ventilation

Premature infants often face oral feeding problems. The videofluoroscopic swallow study (VFSS) is a commonly used method to detect subglottic aspiration. However, there is no consensus to date regarding the association of aspiration observed on VFSS and incidence of aspiration pneumonia in preterm infants. This study investigated the occurrence of aspiration pneumonia in preterm infants on oral feeds after aspiration has been confirmed by VFSS. This study included 50 preterm infants who had undergone VFSS. Among them, 13 patients with no aspiration, two patients who were lost to follow-up, and nine patients with massive aspiration were excluded from the analysis. In VFSS, the frequency and amount of aspiration, nasal penetration, suck-swallow ratio, and sucking power were assessed. We analyzed 26 patients with aspiration confirmed on VFSS but who had initiated oral feeding. The frequency of aspiration (percentage of the number of aspirations to the total number of swallowing) was 10.22±3.62 (%). The mean amount of aspiration was 2.28±1.02 (%). One preterm infant, born with very low-birthweight developed aspiration pneumonia 10days after the initiation of full oral feeding. He was diagnosed with respiratory distress syndrome and had weak sucking power. In the absence of massive aspiration, most infants with aspiration confirmed on VFSS tolerated oral feeding, especially when oral feeding was partially initiated.