No abstract available.
Diagnosis, Differential* ; Seasons*

No abstract available.
Tuberculosis, Pulmonary*

No abstract available.
Respiratory Distress Syndrome, Adult*

Community-acquired pneumonia (CAP) is defined as an acute infection of pulmonary parenchyma in a patient who has contracted the infection in the community. Diagnostic process includes history taking, physical examination, chest radiograph, blood tests, and microbiologic tests. Common clinical features are cough, sputum, fever, pleuritic chest pain, and dyspnea. There are systemic symptoms such as nausea, vomiting, diarrhea, and changes of mental status. The presence of an infiltrate on chest X-ray is the mainstay for the diagnosis of CAP, although exceptions are early CAP, dehydration, and neutropenia. Prevalent radiographic findings are lobar pneumonia, interstitial infiltrates, and cavitation. Performing diagnostic testing for the microbiologic etiology remains controversial particularly in outpatient settings. The tests are recommended only when pathogens that would not respond to usual empirical antibiotic regimens are suspected. However, for hospitalized patients, routine pursuit of etiologic agents should be done for all occasions. Apart from Gram stain and culture of sputum, blood culture, serologic tests, urine antigen tests, and polymerase chain reactions are being performed in hospitalized patients. Among these, the combination of a good sputum specimen for Gram stain and culture plus urinary antigen testing is most useful for the rapid diagnosis of CAP. The positivity rate of blood culture is relatively low, which makes the test less dependable. We should always consider Mycobacterium as an unpredicted cause of pulmonary infiltrates in Korea. We should also bear in mind unusual pathogens that have an epidemiologic significance or need different regimens from empirical antibiotics. These include Influenza, Legionella, communityacquired methicillin-resistant Staphylococcus aureus, and agents of bioterrorism. In conclusion, any diagnostic tests should not delay the administration of proper antibiotics. Comprehensive knowledge regarding the relevant diagnostic tests is required for the appropriate implementation of diagnostic procedures and empirical antibiotics.
Anti-Bacterial Agents ; Bioterrorism ; Chest Pain ; Cough ; Dehydration ; Diagnosis* ; Diagnostic Tests, Routine ; Diarrhea ; Dyspnea ; Fever ; Hematologic Tests ; Humans ; Influenza, Human ; Korea ; Legionella ; Methicillin-Resistant Staphylococcus aureus ; Mycobacterium ; Nausea ; Neutropenia ; Outpatients ; Physical Examination ; Pneumonia* ; Polymerase Chain Reaction ; Radiography, Thoracic ; Serologic Tests ; Sputum ; Thorax ; Vomiting

No abstract available.
Pleural Effusion*

The prevalence of chronic obstructive pulmonary disease (COPD) in Korea is reported to be 17.5% in aged over 45 years. The overall approach should be individualized and dependent upon the severity of the disease and clinical status of the patient. Objectives of COPD treatment are improvement of airflow obstruction, prevention and management of co-morbidity and complication of COPD and upgrading in the quality of life. Pharmacologic therapy includes bronchodilators such as beta-2 agonists, anticholinergic and theophylline. Another key pharmacologic agent is glucocorticosteroid which reduces acute exaceerbation and inflammatory burden in COPD airways. Non-pharmacologic management is not less important. Education including smoking cessation, rehabilitation, home oxygen therapy along with appropriate vaccination. More importantly, doctor-patient-patron relationship plays a central role in long-term management of COPD.
Aged ; Bronchodilator Agents ; Humans ; Korea ; Oxygen ; Prevalence ; Pulmonary Disease, Chronic Obstructive ; Quality of Life ; Smoking Cessation ; Theophylline ; Vaccination

We report a case of Fournier's gangrene following long-term use of an unqualified vacuum erection device in a 40-year-old man.
Adult ; Fournier Gangrene* ; Humans ; Male ; Penis* ; Scrotum* ; Vacuum*

No abstract available.
Sputum*

BACKGROUND: Acid-base derangement are commonly encountered in critically ill patients. This study is to investigate underlying mechanisms of acid-base imbalance and also to examine whether they can predict mortality in burn patients. METHODS: We retrospectively reviewed 73 severely burned patients who had admitted to burn intensive care unit, from January to July in 2004. All the patients had inhalation injury, identified by bronchoscopic examination. We analyzed the type and nature of the acid-base imbalances from arterial blood gas analysis, electrolytes and other biological tests between survivors and non-survivors for 30 days after admission. RESULTS: Acidosis was the most common disorder during the early and late hospital periods. Large fractions of those showed decreased strong ion difference (SID), increased anion gap corrected by albumin (AGc) and [Cl-]corrected. Mixed disorder and alkalosis emerged after the 7(th) hospital day. As time went by, albumin, PaO2/FiO2 ratio, pH and SID were more decreased in non-survivors (n=28) than in survivors (n=45) while [Cl-] corrected, alveolar-arterial oxygen tension gradients, peripheral WBC counts and CRP were more increased in non-survivors than in survivors. In the area under the receiver operating characteristic curves for mortality prediction, APACHE II score and % of total body surface area (%TBSA) burn were high: 0.866 (95% CI; 0.785~0.946) for APACHE II score, 0.817 (95% CI; 0.717~0.918) for %TBSA burn. CONCLUSIONS: In burned patients with inhalation injury, various types of acid-base imbalances and electrolytes abnormalities emerged after resuscitation and so, more careful attentions pursued for correcting underlying acid-base derangement.
Acid-Base Equilibrium ; Acid-Base Imbalance* ; Acidosis ; Alkalosis ; APACHE ; Attention ; Blood Gas Analysis ; Body Surface Area ; Burns* ; Critical Illness ; Diagnosis* ; Electrolytes ; Humans ; Hydrogen-Ion Concentration ; Inhalation* ; Intensive Care Units ; Mortality* ; Oxygen ; Resuscitation ; Retrospective Studies ; ROC Curve ; Sudden Infant Death ; Survivors

When a glaucoma filtering operation fails, the causes may be categorized as intraocular, scleral, or extraocular. Some authors have implicated that extraocular causes of failure are due to closure of the external opening by connective tissue. This histologic investigation was undertaken to examine the surgical wounds of 8 experimental subjects including 4 albino and 4 pigmented rabbits. Under general anesthesia by pentothal sodium, a single punch sclerectomy was performed on each right eye. A trabeculectomy was performed on the left eye. Seven and ten days following surgery, globes were removed and immediately fixed in Karnovsky's fixation solution. Following fixation, globes were bisected through surgical wounds, and one-half was studied using standard light microscopy. The other one-half specimens were blocked and processed for transmission electron microscopy. The results of the evaluations were as follows: 1. Full thickness sclerectomy wounds healed by ingrowth of fibroblasts from subconjunctival and episcleral tissue, but trabeculectomy wounds showed no communication with extrascleral tissue. 2. Quantitatively, proliferation of fibroblasts were more exuberant in the sclerectomied eyes compared to trabeculectomies. 3. There was no evidence of significant difference between albino and pigmented rabbits. 4. The granulation tissue composed mainly of fibroblasts resembles smooth muscle cell(myofibroblasts) and extracellular collagen constituents. Ultrastructurally, these cells showed massive bundles of intracytoplasmic microfilaments with scattered dense bodies, wrinkled and folded nuclei indicative cellular contraction, and abundant cisternae of rough endoplasmic reticulum informative activity of cellular proliferation. From those results, author conclude that smooth muscle antagonists may inhibit the proliferation of myofibroblasts after glaucoma filtering operations.
Actin Cytoskeleton ; Anesthesia, General ; Cell Proliferation ; Collagen ; Connective Tissue ; Endoplasmic Reticulum, Rough ; Fibroblasts ; Glaucoma ; Granulation Tissue ; Microscopy ; Microscopy, Electron, Transmission ; Muscle, Smooth ; Myofibroblasts ; Rabbits ; Sodium ; Thiopental ; Trabeculectomy ; Wounds and Injuries*