Background: This study aimed to improve the clinical course of patients through rapid response by analyzing the characteristics of critically ill patients with confirmed coronavirus disease 2019 (COVID-19) in Busan between December 1, 2020, and December 31, 2021. Methods: We divided patients diagnosed with COVID-19 into mild-to-moderate and critical groups based on their clinical severity. The critically ill patients were further sub-divided into delta and delta variant non-epidemic group. Results: The following factors were significantly more frequent in critically ill patients than in patients with mild-tomoderate symptoms: male sex, age ≥60 years, symptoms at the time of diagnosis, and those with underlying diseases. The following factors were significantly more common in the non-delta variant epidemic group than in the delta variant epidemic group in critically ill patients: male sex, age ≥60 years, underlying diseases, and not being vaccinated. In the delta variant epidemic group, the duration between confirmation of disease and its progression to critically ill status was significantly shorter than that in the non-delta variant epidemic group. Conclusion COVID-19 is characterized by the emergence of new variants and repeated epidemics. Therefore, it is necessary to analyze the characteristics of critically ill patients to efficiently distribute and manage medical resources.

PURPOSE: Tracheostomy is used to aid airway management in perdiatric respiratory care. This study was designed to review causes and outcomes of pediatric tracheostomy. METHODS: We performed a retrospective chart review of 153 patients, less than 18 years of age, who underwent tracheostomy between January 1995 and July 2010. Age at tracheostomy, indications, durations, complications and mortality were evaluated. RESULTS: Subglottic stenosis (19%) was the most common indication for tracheostomy. The median age at tracheostomy was 1.3 years (range, 22 days to 17.8 years). Seventy-three (47.7%) tracheostomies were performed in children under 1 year of age. Respiratory diseases were significantly more prevalent in patients under 1 year of age, while neuromuscular disease were more frequently found in patients older than 1 year (P=0.013). Stoma or tracheal granuloma formation (36.6%) was the most common complication of pediatric tracheostomy. Decannulation was accomplished in 61 (39.9%) patients with median cannulation time of 141 days (range, 1 to 2,529 days). Overall mortality rate was 10.5% (n=16), but only one patient (0.7%) died from tracheostomy-related complications. CONCLUSION: Respiratory diseases, such as subglottic stenosis and neuromuscular disease, are the main cause of pediatric tracheostomy. Although complications, like stoma or tracheal granuloma formation occur, tracheostomy in children is a safe way to aid airway management.
Airway Management ; Catheterization ; Child ; Constriction, Pathologic ; Granuloma ; Humans ; Neuromuscular Diseases ; Retrospective Studies ; Tracheostomy

This study was conducted to establish an in vitro maturation (IVM) system by selection of efficient porcine serum during porcine in vitro production. To investigate the efficient porcine serum (PS), different types of PS [newborn pig serum, prepubertal gilt serum (PGS), estrus sow serum, and pregnancy sow serum] were used to supplement IVM media with or without gonadotrophin (GTH) and development rates of parthenogenetic activation (PA) and in vitro fertilization (IVF) embryos were then compared. The maturation rates of the PGS group was significantly higher when GTH was not added. Additionally, during development of PA embryos without GTH, the PGS group showed significantly higher cleavage and blastocyst formation rates. Moreover, the cleavage rates of IVF embryos were significantly higher in the PGS group, with no significant differences in the blastocyst formation. However, when GTH was supplemented into the IVM media, there were no significant differences among the four groups in the cleavage rates, development rates of the blastocyst, and cell number of the blastocyst after PA and IVF. In conclusion, PGS is an efficient macromolecule in porcine IVM, and GTH supplementation of the IVM media is beneficial when PS is used as macromolecule, regardless of its origin.
Animals ; Blastocyst/*drug effects ; Embryo, Mammalian/drug effects/*embryology/physiology/ultrastructure ; Fertilization in Vitro/veterinary ; Gonadotropins/administration & dosage/*metabolism ; In Vitro Oocyte Maturation Techniques/*methods/veterinary ; Parthenogenesis/*drug effects ; Sus scrofa/*embryology

Hemorrhagic cystitis (HC), a serious form of cystitis, is characterized by diffuse bladder mucosal inflammation with hemorrhage. The known causes of HC are radiation, chemotherapy, drug, and infection. But, most cases happen without definite etiology. Radiation induced HC can be developed at any time from 6 months to 10 years after pelvic irradiation therapy, and can appear as late as 2 decades. The complications of HC are anemia, chronic cystitis, and acute renal failure (ARF). However, HC- induced severe postrenal ARF is rare. We experienced a case of a postrenal ARF caused by hematoma in HC. A 55-year-old woman had past history of pelvic irradiation therapy for carcinoma of the cervix 13 years ago. She was initially treated by bladder catheterization and bladder irrigation with normal saline. HC and renal function were improved. However, HC was recurred shortly after stopping irrigation and serum creatinine was elevated again. Thus, we treated this patient successfully with both percutaneous nephrostomy and antegrade double J stent catheterization.
Acute Kidney Injury ; Anemia ; Catheterization ; Catheters ; Cervix Uteri ; Cinnarizine ; Creatinine ; Cystitis ; Female ; Hematoma ; Hemorrhage ; Humans ; Inflammation ; Middle Aged ; Nephrostomy, Percutaneous ; Stents ; Urinary Bladder

In end stage renal disease, the precise mechanism of metastatic calcification remains unclear, except that it occurs with hyperphosphatemia, increased Ca x P product, and secondary hyperparathyroidism. It involves various organs such as lung, eye, stomach, kidney, and so on. A 62-year-old male patient, who had acute renal failure (ARF), developed gastric calcification in our institution. The ARF had been result of membranoproliferative glomerulonephritis (MPGN), and the metastatic calcification seemed to be caused by increased Ca x P product and hyperphosphatemia. This case shows that metastatic calcification could arise even in ARF.
Acute Kidney Injury ; Eye ; Glomerulonephritis, Membranoproliferative ; Humans ; Hyperparathyroidism, Secondary ; Hyperphosphatemia ; Kidney ; Kidney Failure, Chronic ; Lung ; Male ; Middle Aged ; Stomach

PURPOSE: Vascular access failure is the most common reason for hospitalization among hemodialysis (HD) patients. Cilostazol, which has antiplatelet action and vasodialtory effects, significantly reduces the risk of restenosis after percutaneous coronary intervention in many patients. We conducted this study to evaluate the relationship between the use of antiplatelet agents, especially cilostazol, and arteriovenous fistula (AVF) patency in HD patients. METHODS: A total of 241 patients underwent native AVF creation from January 2001 to December 2008. Among these patients, we selected 86 patients excluding 38 patients (15.8%) with primary technical failure, 49 patients without complete data and 68 patients used cilostazol less than 1 month. Demographic characteristics, medication history and fistula failure rate were collected and analyzed to elucidate the effect of cilostazol to native AVF. RESULTS: From all groups, AVF failure occurred in 24 patients (27.9%). 28 patients received cilostazol (62.3 %) and mean duration of cilostazol therapy was 229.5+/-115.7 days. All patients were classified into two groups according to cilostazol (Cilostazol [n=28, 32.6%] vs. non-Cilostazol [n=58, 67.4%]. There was no statisticallly significant difference in failure rate between the two groups (32.1% vs. 25.9%, p=0.543). In diabetes group, patients who received statin have much lower AVF failure rate (0% vs. 32.4%, p=0.024). Logistic regression analysis showed that female was independent risk factor for access failure (HR 5.549, CI 1.104-27.877, p=0.037). CONCLUSION: Cilostazol and other antiplatelet agent had a no significant association with AVF patency. Female was an independent risk factor for access failure.
Arteriovenous Fistula ; Female ; Fistula ; Hospitalization ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Logistic Models ; Percutaneous Coronary Intervention ; Platelet Aggregation Inhibitors ; Renal Dialysis ; Risk Factors ; Tetrazoles ; Vascular Patency

PURPOSE: Oxidative stress leads to an increased production of lipoxygenase derivatives in diabetic nephropathy. Thus, we hypothesized that lipoxygenase inhibitor, nordihydroguaiaretic acid (NDGA), ha the effects of decreasing proteinuria and preserving renal function in streptozotocin (STZ)-induced diabetic rats. METHODS: 45 Sprague-Dawley rats were divided into three groups; (A) treatment with lipoxygenase inhibitor, NDGA in diabetic nephropathy rats, (B) treatment with dimethyl sulfoxide (DMSO) as a vehicle in STZ-induced diabetic rats, (C) normal control group with subcutaneous injection of normal saline. Diabetes was induced by a single intraperitoneal injection of STZ (65 mg/kg) in rats of group A and B. After the 4th week of STZ injection, NDGA (10 mg/kg) and DMSO were given subcutaneously for another 4 weeks in group A and B respectively. RESULTS: The NDGA-treated diabetic rats exhibited significantly decreased urinary albumin excretion. Serum creatinine and blood urea nitrogen concentrations were increased in both group A and B, and tend to be higher in group B than group A. Twenty-four-hour urine creatinine clearances were increased in both group A and B after injection of STZ. Pathologic alterations of kidney were observed after injection of STZ, and then attenuated after administration of NDGA. CONCLUSION: These results suggest the potential of lipoxygenase inhibitor as a complementary therapy for the prevention and treatment of diabetic nephropathy.
Animals ; Blood Urea Nitrogen ; Creatinine ; Diabetic Nephropathies ; Dimethyl Sulfoxide ; Injections, Intraperitoneal ; Injections, Subcutaneous ; Kidney ; Lipoxygenase ; Nordihydroguaiaretic Acid ; Oxidative Stress ; Proteinuria ; Rats ; Rats, Sprague-Dawley ; Safrole ; Streptozocin

PURPOSE: Cryptococcal meningitis is a relatively common opportunistic infection in human immunodeficiency virus (HIV) patients and it can frequently occur in immunocompetent hosts without any apparent underlying disease. Nevertheless, little is known about cyptococcal meningitis in the Korean population. The purpose of this study was to evaluate the clinical features and initial laboratory findings of cryptococcal meningitis in patients with and without HIV at a tertiary care teaching hospital. MATERIALS AND METHODS: We performed a retrospective study at a tertiary care teaching hospital from January 2001 to December 2009. Eleven HIV positive patients and nine HIV negative patients were included. RESULTS: The most common symptoms were headache and fever in cryptococcal meningitis, and diabetic mellitus, end stage renal disease and liver cirrhosis were the main associated conditions in patients without HIV. Patients with HIV showed lower peripheral CD4+ cell counts (median: 9, range: 1-107) and a higher burden of cryptococcus than patients without HIV. There were no statistically significant differences in serum CRP level and other cerebrospinal fluid parameters between patients with HIV and without HIV. The in-hospital mortality was 10%, and recurrence of cyptococcal meningitis was observed in 3 patients with HIV and this occurred within 5 months of the first episode. CONCLUSION: Cryptococcal meningitis is fatal without treatment, therefore, rapid recognition of symptoms such as fever and headache and diagnosis is required to decrease the mortality. Recurrence of meningitis after treatment should carefully be followed up, especially in advanced HIV patients.
Adult ; Aged ; Comorbidity ; Female ; HIV Infections/*complications ; Hospitals ; Humans ; Male ; Meningitis, Cryptococcal/diagnosis/*epidemiology ; Middle Aged ; Republic of Korea/epidemiology ; Retrospective Studies

BACKGROUND AND OBJECTIVES: Microsurgical resection of intracordal cysts is technically difficult and challenging because the wall of cysts may be tightly attached to underlying vocal ligament and/or overlying epithelium, and therefore their thin wall will easily rupture during surgical dissection. We aimed to evaluate the voice outcomes of standard microflap subepithelial resection and the recurrence rate depending on the intraoperative rupturing of the cyst. MATERIALS AND METHODS: Medical records of Samsung Medical Center, Seoul, Korea, were reviewed for sixty-four consecutive patients who received surgical resection of vocal cyst using microflap subepithelial dissection technique between the year 2004 and 2013. Meticulous dissection was performed to completely remove the cyst wall while preserving the mucosa and the lamina propria as much as possible. Voice outcomes and recurrence rates were compared according to the type, size and the intraoperative rupture of cyst. RESULTS: Presence or absence of cyst rupture was clearly described in the operation records of 41 patients. Intraoperative rupture of the cyst occurred in 32 of 41 (78%) patients. The recurrence was detected in 5 of 64 (7.8%) total cases and 4 of 32 (12.5%) cases of ruptured cyst, but not in 9 cases of intact extirpation. Rupture was more common in case of mucous retention cyst compared with epidermoid cyst (p=0.036). Subjective and objective voice parameters were measured at before and 3 months after surgery, which improved regardless of the cyst rupture. CONCLUSION: Although complete microsurgical extirpation of intracordal cyst while keeping the cyst wall intact is technically difficult, meticulous dissection with maximal preservation of surrounding tissue may warrant the improvement of voice outcomes.
Epidermal Cyst ; Epithelium ; Humans ; Korea ; Medical Records ; Mucous Membrane ; Recurrence ; Rupture ; Seoul ; Vocal Cords ; Voice

Background: and Purpose The purpose of this study was to determine the cardiac and pulmonary management status of patients with Duchenne muscular dystrophy (DMD) in South Korea based on the Korean National Health Insurance database. Methods: This study used data of patients with code G71.0 in the National Health Information database, and also those with the special case of code V012. Cardiac function was assessed based on whether echocardiography and 24-h electrocardiography were performed, as well as the frequency of these investigations. Furthermore, information on the use of angiotensin-converting enzyme inhibitors (ACEi), angiotensin II receptor blockers (ARB), and beta blockers (BB) in the drug benefit list was checked. Medical charge records were also checked regarding the prescription of respiratory functional assessments and treatments. Results: The diagnostic criteria were met by 479 patients, with 41% of these patients receiving a cardiac evaluation, 29.8% being prescribed ACEi at 14.4±3.7 years of age, 59.5% undergoing pulmonary function tests, and 42.1% received pulmonary rehabilitation. The age at receiving ventilator support was 19.4±2.7 years. The frequency of cardiac and respiratory function tests increased with age, but the interval between tests was longer than the recent DMD care recommendations. The trend of taking ACEi, ARB, and BB for cardiac management in South Korea did not change during the study analysis period. Conclusions The findings of this study will contribute to recognizing the current status and the importance of applying an anticipatory approach to cardiopulmonary function in DMD patients.