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: The aim of this study was to examine the volume differences of human brain 3-D MR images obtained by automatic segmentation methods depending on brain templates and image acquisition conditions, respectively. MATERIALS AND METHODS: 3D T1-weighted MR images oriented in coronal and sagittal plane were acquired from eight healthy subjects (29.5+/-5.66 years) using two identical 3T MR scanners at different sites. Caucasian brain template and Korean elderly brain template were applied for the same subject to segment brain structural region. Volumetric differences and variation of gray matter, white matter and hippocampus depending on scan orientations and brain template types were statistically evaluated. RESULTS: Volumetric measurements have some different results for the same subject images depending on scan orientation in identical MR scanners but not significantly. However, all segmented volumes relied upon brain templates were significantly different (p<0.05). Small variation of the volume in gray matter, white matter (coefficient of variation, CV< or =1%) and hippocampus (CV< or =3%) were obtained. Comparing the mean CV in all segmented regions, variation of scan orientation was not significantly different with inter scanner variation but variation relied upon brain templates were significantly different (p<0.001). CONCLUSION: Authors found that brain template regarding the specific properties of the subjects is required to reduce the errors of brain volumetry.
Aged ; Brain ; Hippocampus ; Humans ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Orientation

No abstract available.
Hair* ; Hypopigmentation* ; Scalp* ; Ureter*

No abstract available.
Humans ; Lupus Erythematosus, Systemic* ; Skin*

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

BACKGROUND AND OBJECTIVES: The purpose of the study was to evaluate the time-dependent progress and the delayed improvement in patients who were already treated by combination therapy including oral steroid for idiopathic sudden sensorineural hearing loss. SUBJECTS AND METHOD: This study examined patients presenting with idiopathic sudden sensorineural hearing loss at a secondary referral and a university-based center over 10 years. This retrospective study included only those patients who could be followed up for at least 3 months. RESULTS: Of 121 patients who recovered over the 3 months of follow-up period, 9.9% showed a delayed recovery of later than 1 month after discharge. Of 55 patients who did not recover until the discharge but recovered thereafter, 78.2% recovered within 1 month, 5.5% recovered between 1 to 2 months, 12.7% recovered between 2 to 3 months, and 3.6% recovered 3 months later after the discharge. The delayed recovery was found frequently in partial or slightly recovery groups by Siegel's criteria. CONCLUSION: This study demonstrated the presence of delayed recovery in patients who were treated by combination therapy, including oral steroid for idiopathic sudden sensorineural hearing loss, although this result should be further studied by additional research.
Follow-Up Studies ; Hearing Loss, Sensorineural* ; Hearing Loss, Sudden ; Humans ; Recovery of Function ; Referral and Consultation ; Retrospective Studies

PURPOSE: The aim of this study was to evaluate the variations of brain volumetry between the different MR scanners or the different institutes. MATERIALS AND METHODS: Ten normal subjects were scanned at four different MR scanners, two of them were the same models, to measure inter-MR scanner variations using intraclass correlation coefficient (ICC), coefficient of variation (CV) and percent volume difference (PVD) and to calculate minimal thresholds to detect the significant volumetric changes in gray matter and subcortical regions. RESULTS: Averaged statistical reliability (ICC = 0.837) and volumetric variation (CV = 4.310%) in all segmented regions were observed on overall MR scanners. Comparing the segmented volumes with PVD between two MR scanners, volumetric differences on same models were the lowest (PVD = 3.611%) and volume thresholds were calculated with 7.168%. PVD results and thresholds values on systemically different MR scanners were evaluated with 5.785% and 11.340% respectively. CONCLUSION: Authors conclude that the reliability of brain volumetry is not so high. Calibration studies of MRI system and image processing are essential to reduce the volumetric variability. Additionally, frameworks comprised of database and algorithms with high-speed image processing are also required for the efficient image data management.
Brain ; Calibration

PURPOSE: A skin-sparing mastectomy (SSM) with immediate reconstruction can give psychological and cosmetic benefits to patients requiring a mastectomy, but a risk of pulmonary thromboembolism (PTE) also exists due to longer operative time. The purpose of this study was to evaluate the clinical characteristics of symptomatic PTE following a SSM with immediate reconstruction. METHODS: Of 216 breast cancer patients underwent a SSM with immediate reconstruction at the Asan Medical Center, between December 2003 and July 2005, 7 in whom postoperative symptomatic PTE developed were included in this study. The ventilation/perfusion scan, embolism CT and serum D-dimer level were checked for those suspected of PTE. RESULTS: The prevalence of symptomatic PTE was 3.2% (7/216). Mean patient age and BMI were 41 years and 24.9 kg/m2, respectively. All patients had undergone TRAM reconstruction, with mean operative time of 562.1 minutes. Postoperative bleeding developed in 4 cases. The pathological stages included 0, I and IIA, which were observed in 1, 4 and 2 cases, respectively. Most common symptom of PTE was dyspnea, which developed in all patients on the second or third postoperative day; followed by chest discomfort and tachypnea. The ventilation/perfusion scans showed 6 with high probabilities. All seven patients were diagnosed as PTE on embolism CT. One patient had DVT on the lower extremities. The most common site of PTE was the superior lobar artery and the segmental branches of the right pulmonary artery. All patients recovered, or were recovering, after the LMWH and warfarin treatment. CONCLUSION: This study has shown that SSM with immediate reconstruction possesses a considerable risk of postoperative PTE. Further study on preoperative prophylaxis and the risk factors is warranted to prevent PTE.
Arteries ; Breast Neoplasms* ; Breast* ; Chungcheongnam-do ; Dyspnea ; Embolism ; Hemorrhage ; Heparin, Low-Molecular-Weight ; Humans ; Lower Extremity ; Mastectomy* ; Operative Time ; Prevalence ; Pulmonary Artery ; Pulmonary Embolism* ; Risk Factors ; Tachypnea ; Thorax ; Warfarin

Wegener's granulomatosis is a necrotizing,granulomatous vasculitis that involves multiple organs including the upper and lower respiratory tract and the kidney.The kidney initially exhibits focal necrotizing glomerulonephritis,which progresses to crescentic glomerulonephritis in Wegener's granulomatosis.We experienced a case of Wegener's granulmatosis which was associated with a thin glomerular basement membrane disease.The patient suffered from nasal stuffiness,recurrent serous otitis media,and tinnitus.Despite antibiotic therapy and ventral tube insertion,symptoms did not improve and hearing difficulty was aggravated.Ulcerative,necrotizing granulomatous inflammations with multinucleated giant cells were seen on nasal biopsy.She had recurrent microscopic hematuria and the renal biopsy findings by light and immunofluorescent microscopy did not reveal any abnormalities but diffuse thinning of the glomerular basement membrane (226nm)was observed by electronmicroscopy. With the above clinical findings and biopsy results,we diagnosed Wegener's granulmatosis with thin glomerular basement membrane disease.Thin glomerular basement membrane disease,also called benign recurrent hematuria,is characterized by diffuse thinning of the glomerular basement membrane and hematuria. Weekly low-dose methotrexate together with prednisone was used as treatment regimen because nonglomerular microscopic hematuria may be the first sign of cyclophosphamide-induced renal toxicity.With the above combination therapy, she felt well-being sense and her hearing difficulty was also much improved. She has been treated as an outpatient with glucocorticoid.
Biopsy ; Giant Cells ; Glomerular Basement Membrane* ; Glomerulonephritis ; Hearing ; Hematuria ; Humans ; Inflammation ; Kidney ; Methotrexate ; Microscopy ; Otitis ; Outpatients ; Prednisone ; Respiratory System ; Vasculitis ; Wegener Granulomatosis*

A nodular density was detected on a chest radiograph taken from a 57-year-old Korean woman who was visiting a hospital for a routine check. Chest computed tomography revealed a 4.8 cm lobulated mass in the right lung and another focal nodular lesion in the left lung; biopsies of both lungs revealed adenocarcinoma. We conducted DNA sequencing and peptide nucleic acid clamping to investigate the potential double primary lung cancer. The results verified that the mass in the right lung had a mutation in the epidermal growth factor receptor, whereas the nodule in the left lung had a wild-type sequence, showing that these two were genetically different cancers from one another. Thus, we demonstrate that genetic testing is useful in determining double primary lung cancer, and we herein report on this case.
Adenocarcinoma* ; Biopsy ; Constriction ; Diagnosis, Differential ; Epidermal Growth Factor* ; Female ; Genetic Testing ; Humans ; Lung Neoplasms ; Lung* ; Middle Aged ; Radiography, Thoracic ; Receptor, Epidermal Growth Factor* ; Sequence Analysis, DNA ; Thorax