BACKGROUND: Tsutsugamushi disease is an acute, rashed febrile disease that shows widely varying prognoses from unsymptomatic infection to death. Early diagnosis and treatment lead to speedy recovery. Otherwise, many complications develop. This research was carried out to analyze the factors that affect the development of complications by comparing Tsutsugamushi patients with complicaions with those without complications. METHODS: Among the acute febrile disease patients who visited the emergency center of Chosun University Hospital from January to December 2000, 41 patients were clinically and serologically confirmed as having Tsutsugamushi disease. They were divided into two groups; 14 patients with complications and 27 patients without complications. We analyzed the two groups for correlations between complications and sex, age, period of occurrence, transfer or not, vital signs, laboratory findings, period before treatment, and checks for the existence of underlying disease, eschar, eruption, chest Xrays, and early diagnosis. RESULTS: 1) The aged have a high incidence of the disease, but there was no correlation between age and complications. Also, there was no correlation based on sex. 2) Although fall has a high incidence of the disease, the other seasons have higher complication rates. 3) The complication incidence rate has no correlation with either blood pressure or heart rate, also it does no correlate with eschar and skin rashes. 4) In the laboratory findings, hemoglobin and platelet, and Bun/Cr correlate with the complicaton incidence rate, but the white blood cell count and AST/ALT do not. 5) The complication incidence rate was high when treatment was started 10 days after the onset of Tsutsugamushi disease and no early diagnosis had been given. CONCLUSION: Early diagnosis and treatment are most important in preventing complications of Tsutsugamushi disease because the factors that affect the developement of complications of Tsutsugamushi disase are found during early diagnosis. Patients with doubtful clinical symptoms and abnormal lab findings should be started on a program of antibiotic treatment.
Blood Platelets ; Blood Pressure ; Early Diagnosis ; Emergencies ; Exanthema ; Heart Rate ; Humans ; Incidence ; Leukocyte Count ; Prognosis ; Scrub Typhus ; Seasons ; Thorax ; Vital Signs

OBJECTIVES: The purpose of this study was to investigate the abnormality of cerebrovascular reactivity in patients with dementia of Alzheimer's type by the acetazolamide brain SPECT, which has been used in the assessment of cerebrovascular diseases. METHODS: Eighteen patients with dementia of Alzheimer's type, as diagnosed by the criteria of DSM-IV and NINCDS-ADRDA, and ten normal comparison subjects were recruited. They were rated by Mini-Mental Status Examination, Mattis Ddementia Rating Scale, and Hamilton Depression Rating Scale. Acetazolamide brain SPECT scans of dementia patients and comparison subjects were analyzed by 3-dimensional volume of interest method. RESULTS: The results were as follows. There were significant differences in the values of cerebrovascular reactivity between the two groups. The cerebrovascular reactivity of dementia patients was significantly decreased in the right frontal lobes, and increased in left temporal lobe, compared to comparison subjects(p<0.05). CONCLUSION: These results imply the possible role of the abnormality of cerebrovascular reactivity in the pathophysiology of dementia of Alzheimer's type.
Acetazolamide ; Brain* ; Dementia* ; Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Frontal Lobe ; Humans ; Temporal Lobe ; Tomography, Emission-Computed, Single-Photon*

The Peutz-Jeghers syndrome, characterized by mucocutaneous pigmentation and gastrointestinal polyposis, appeares to be transmitted in an autosomal dominant fashion. This syndrome is clinically important because of complications caused by gastrointestinal polyps, such as abdominal pain, gastrointestinal bleeding and intussusception often leading to intestinal obstruction. The possibility of malignany change in the polyp has been a controversial issue. The hamatomatous polyps is not regarded to be premalignanct lesion, generally. But in patients with this syndrome, increased rates of both intestinal and extraintestinal malignancies has been reported. This report is concerned with our experience with a case of 46-year old male patients with Peutz-Jeghers syndrome who had an metastatic adenocarcinoma with unknown primary origin.
Abdominal Pain ; Adenocarcinoma* ; Hemorrhage ; Humans ; Intestinal Obstruction ; Intussusception ; Male ; Middle Aged ; Peutz-Jeghers Syndrome* ; Pigmentation ; Polyps

PURPOSE: For malignant diseases, predictions about tumor behavior and determination of appropriate therapy are based on the primary tumor sites, but 2-9% of cancer patients are diagnosed without identifiable primary tumor sites. Metastatic tumors of unknown primary origin (MUO) are a heterogeneous group of tumors with variable natural histories. The majority of these patients fall outside of treatable subjects and seldom respond to therapy. To define further the natural history of MUO and identify prognostic factors, we undertook a clinical analysis of 141 consecutive patients with a presumed diagnosis of MUO. MATERIALS AND METHODS: One hundred forty-one patients were diagnosed with unknown primary tumor from Jan. 1, 1992 through Aug. 31, 1995. The primary end point for the study was survival, which was calculated from the first day of patient registration diagnosed histologically. The survival curves were estimated using the Kaplan-Meier method and compared using the log-rank test. To identify important prognostic factors, univariate and multivariate analyses were conducted. RESULTS: Most of the 141 patients had histologic or cytologic evidence of adenocarcinoma and had more than one site metastatically involved. The predominant sites of tumor involvement were lymph node, peritoneum, bone, liver, lung, and pleura. Univariate and multivariate analyses identified numerous important prognostic factors with a significant influence on survival, including performance status (P 0.0001), specific organ sites involved (lung P 0.0076 or liver P 0.0310), and chemotherapy group (P- 0.0480). CONCLUSION: This study validated clinical courses and important prognostic factors that had an impact on survival in MUO.
Adenocarcinoma ; Diagnosis ; Drug Therapy ; Humans ; Liver ; Lung ; Lymph Nodes ; Multivariate Analysis ; Natural History ; Neoplasms, Unknown Primary ; Peritoneum ; Pleura

We surveyed on the infection status of zoonotic trematode metacercariae (ZTM) in freshwater fishes from Soyang-cheon (a branch stream of Mangyeong-gang) in Wanju-gun, Jeollabuk-do, the Republic of Korea. A total of 927 fishes were individually examined with the artificial digestion method during 2013-2015 (462 fish in 15 spp.) and 2018-2019 (465 fish in 25 spp.). Clonorchis sinensis metacercariae were detected in 207 (31.4%) out of 659 fishes in 14 positive fish species (PFS), and their mean intensity was 114 per fish infected (PFI). Metagonimus spp. metacercariae were found in 302 (37.4%) out of 808 fishes in 21 PFS, and their mean intensity was 12 PFI. Centrocestus armatus metacercariae were detected in 222 (59.0%) out of 376 fishes in 12 PFS, and their mean intensity was 383 PFI. Echinostoma spp. metacercariae were found in 139 (22.1%) out of 628 fishes in 10 PFS, and their mean intensity was 7 PFI. Clinostomum complanatum metacercariae were detected in 14 (6.5%) out of 214 fishes in 4 PFS, and their mean intensity was 2.4 PFI. Metorchis orientalis metacercariae were detected in 36 (13.5%) out of 267 fishes in 5 PFS, and their mean intensity was 4.3 PFI. Conclusively, the prevalence and infection intensity of ZTM is generally not so high in fishes from Soyang-cheon. However, those of C. sinensis metacercariae are more or less higher in 2 fish species, Pungtungia herzi and Sarcocheilichthys variegatus wakiyae.

We surveyed on the infection status of zoonotic trematode metacercariae (ZTM) in freshwater fishes from Soyang-cheon (a branch stream of Mangyeong-gang) in Wanju-gun, Jeollabuk-do, the Republic of Korea. A total of 927 fishes were individually examined with the artificial digestion method during 2013-2015 (462 fish in 15 spp.) and 2018-2019 (465 fish in 25 spp.). Clonorchis sinensis metacercariae were detected in 207 (31.4%) out of 659 fishes in 14 positive fish species (PFS), and their mean intensity was 114 per fish infected (PFI). Metagonimus spp. metacercariae were found in 302 (37.4%) out of 808 fishes in 21 PFS, and their mean intensity was 12 PFI. Centrocestus armatus metacercariae were detected in 222 (59.0%) out of 376 fishes in 12 PFS, and their mean intensity was 383 PFI. Echinostoma spp. metacercariae were found in 139 (22.1%) out of 628 fishes in 10 PFS, and their mean intensity was 7 PFI. Clinostomum complanatum metacercariae were detected in 14 (6.5%) out of 214 fishes in 4 PFS, and their mean intensity was 2.4 PFI. Metorchis orientalis metacercariae were detected in 36 (13.5%) out of 267 fishes in 5 PFS, and their mean intensity was 4.3 PFI. Conclusively, the prevalence and infection intensity of ZTM is generally not so high in fishes from Soyang-cheon. However, those of C. sinensis metacercariae are more or less higher in 2 fish species, Pungtungia herzi and Sarcocheilichthys variegatus wakiyae.

The infection status of zoonotic trematode metacercariae (ZTM) was surveyed in freshwater fishes from the water systems of Geum-gang (River) in the Republic of Korea (Korea). A total of 1,161 freshwater fishes from 6 local sites of Geum-gang were examined with the artificial digestion method for 4 years (2012-2015). Clonorchis sinensis metacercariae were detected in 122 (37.2%) out of 328 fishes in the positive fish species from 4 surveyed areas, and their mean intensity was 43 per fish infected. Metagonimus spp. metacercariae were found in 432 (51.7%) out of 835 fishes in the positive fish species from all 6 surveyed areas, and their mean intensity was 30 per fish infected. Centrocestus armatus metacercariae were detected in 285 (75.0%) out of 380 fishes in the positive fish species from 6 surveyed areas, and their mean intensity was 2,100 per fish infected. Echinostoma spp. metacercariae were found in 56 (19.7%) out of 284 fishes in the positive fish species from 5 surveyed areas, and their mean intensity was 10 per fish infected. Clinostomum complanatum metacercariae were detected in 98 (57.3%) out of 171 fishes in the positive fish species from only 2 surveyed areas, and their mean intensity was 11 per fish infected. Conclusively, the endemicity of ZTM is not so high in fishes from water systems of Geum-gang in Korea although it is more or less different by fish species, surveyed areas and ZTM species.

Small cell carcinoma is most frequently described as occurring in the bronchial tree. Extrapulmonary small cell carcinoma is a very rare disease and it has been reported in the esophagus, stomach, small intestine, pancreas, uterus, salivary gland and prostate. Primary esophageal small cell carcinoma with gastric metastasis and without regional lymph node involvement is very rare. We have experienced a case of primary esophageal small cell carcinoma with gastric metastasis and without regional lymph node involvement. The patient was treated with chemotherapy and this patient is alive at 40 months after the treatment.
Carcinoma, Small Cell ; Esophagus ; Humans ; Intestine, Small ; Lymph Nodes ; Neoplasm Metastasis ; Pancreas ; Prostate ; Rare Diseases ; Salivary Glands ; Stomach ; Uterus

Background and Objectives: Identifying patients with high bleeding risk (HBR) is important when making decisions for antiplatelet therapy strategy. This study evaluated the impact of ticagrelor monotherapy after 3-month dual antiplatelet therapy (DAPT) according to HBR in acute coronary syndrome (ACS) patients treated with drug eluting stents (DESs). Methods: In this post-hoc analysis of the TICO trial, HBR was defined by 2 approaches: meeting Academic Research Consortium for HBR (ARC-HBR) criteria or Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent DAPT (PRECISEDAPT) score ≥25. The primary outcome was a 3–12 months net adverse clinical event (composite of major bleeding and adverse cardiac and cerebrovascular events). Results: Of the 2,980 patients without adverse events during the first 3 months after DES implantation, 453 (15.2%) were HBR by ARC-HBR criteria and 504 (16.9%) were HBR by PRECISE-DAPT score. The primary outcome rate was higher in HBR versus non-HBR patients (by ARC-HBR criteria: hazard ratio [HR], 2.87; 95% confidence interval [CI], 1.76– 4.69; p<0.001; by PRECISE-DAPT score: HR, 3.09; 95% CI, 1.92–4.98; p<0.001). Ticagrelor monotherapy after 3-month DAPT was associated with lower primary outcome rate than ticagrelor-based 12-month DAPT regardless of HBR by ARC-HBR criteria, with similar magnitudes of therapy effect for HBR and non-HBR patients (p-interaction=0.400). Results were consistent by PRECISE-DAPT score (p-interaction=0.178). Conclusions In ACS patients treated with DESs, ticagrelor monotherapy after 3-month DAPT was associated with lower rate of adverse clinical outcomes regardless of HBR, with similar magnitudes of therapy effect between HBR and non-HBR.Trial Registration: ClinicalTrials.gov Identifier: NCT02494895

There is no well-stated practical guideline for mechanically ventilated patients with or without acute respiratory distress syndrome (ARDS). We generate strong (1) and weak (2) grade of recommendations based on high (A), moderate (B) and low (C) grade in the quality of evidence. In patients with ARDS, we recommend low tidal volume ventilation (1A) and prone position if it is not contraindicated (1B) to reduce their mortality. However, we did not support high-frequency oscillatory ventilation (1B) and inhaled nitric oxide (1A) as a standard treatment. We also suggest high positive end-expiratory pressure (2B), extracorporeal membrane oxygenation as a rescue therapy (2C), and neuromuscular blockage for 48 hours after starting mechanical ventilation (2B). The application of recruitment maneuver may reduce mortality (2B), however, the use of systemic steroids cannot reduce mortality (2B). In mechanically ventilated patients, we recommend light sedation (1B) and low tidal volume even without ARDS (1B) and suggest lung protective ventilation strategy during the operation to lower the incidence of lung complications including ARDS (2B). Early tracheostomy in mechanically ventilated patients can be performed only in limited patients (2A). In conclusion, of 12 recommendations, nine were in the management of ARDS, and three for mechanically ventilated patients.
Extracorporeal Membrane Oxygenation ; Humans ; Incidence ; Lung ; Mortality ; Nitric Oxide ; Positive-Pressure Respiration ; Prone Position ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult* ; Steroids ; Tidal Volume ; Tracheostomy ; Ventilation ; Ventilators, Mechanical