BACKGROUND: Malpositioning of the endotracheal tube within airway after intubation may results in serious complications, such as accidental extubation and inadvertent endobronchial intubation. Therefore, early detection of malposioning of the endotracheal tube is very impotant for deciding patient's prognosis. METHODS: We assessed the distance from the tip of the endotracheal tube to the carina according to the patient's age, sex, and the time, the location, and the route of intubation. The chest x-ray was taken for 333 patients (men, 226: women, 107) who were admitted to the intensive care unit of Wonju Christian Hospital from march 1, 1995 to February 28, 1996. Chest x-ray was obtained after intubation to verify endotracheal tube position. Appropriate endotracheal tube position on chest x-ray was defined as between 2 and 6 cm above the carina. RESULTS: Of the 333 intubations, 106 (31.8%) endotracheal tubes were inappropriately placed according to the chest x-ray. The percentage of malpositioned endotracheal tubes (<2 cm) was higher in women than in men (11.2% vs. 5.3%, p<0.05), with higher in night (7 PM to 7 AM) than in day (7 AM to 7 PM) (42% vs. 24%, p<0.05). Distance from the carina to the tip of endotracheal tube is 4.34 +/- 1.77cm in women and 5.23 +/- 1.64cm in men. Thus, position of the endotracheal tube in women is deeper than men (p<0.001). CONCLUSIONS: We conclude that the chest x-ray for confirmation of endotracheal tube position after endotracheal intubation may remain the standard of practice. And endotracheal tube position should be carefully assessed immediately after tracheal intubation, particularly in women and at night.
Female ; Gangwon-do ; Humans ; Incidence* ; Intensive Care Units ; Intubation ; Intubation, Intratracheal* ; Male ; Prognosis ; Thorax*

No abstract available.
Castration ; Granuloma ; Granuloma, Foreign-Body

BACKGROUND: Silver has been used for disinfection and sterilization. We aimed to confirm the in-vitro antibacterial effects of nanocrystalline silver-coated gauze. METHODS: Fourteen clinical isolates each of Escherichia coli and Acinetobacter baumannii were used. Bacterial suspensions made in tryptic soy broth were exposed to Ordinary and silver-coated gauze. Bacteria were then harvested from the gauze immediately and after 24 h incubation, cultured on blood agar plates and eunmerated for viable counts. The number of colonies was converted into common logarithms for comparison. RESULTS: The number of colonies recovered from silver-coated gauze was significantly lower than those recovered from ordinary gauze when harvested immediately after exposure (E. coli, 3.06 vs 1.73; A. baumannii, 3.13 vs 1.98; P<0.001). After 24 h incubation of exposed gauze, silver-coated gauze produced less than 1 CFU/mL, whereas ordinary gauze produced a number of colonies significantly higher than it did immediately after exposure (E. coli, 4.13; A. baumannii, 4.46; P<0.001). Conclusion: Compared with ordinary gauze, silver-coated gauze was shown to have 99.99% antibacterial effect.
Acinetobacter baumannii ; Agar ; Bacteria ; Disinfection ; Escherichia coli ; Silver ; Sterilization ; Suspensions

Intrapulmonary percussive ventilation(IPV), developed by Forrest M. Bird, M.D., delivers high flow mini-bursts of air along with bronchodilator to the lung at a rate of more than 200 times per minute and has the theoretical potential for aiding in expectoration of secretions through internal percussion. To evaluate effects of IPV on respiratory therapy, we compared IPV with conventional chest physical therapy in patients with excess or retained pulmonary secretions. The results are follows. 1) There were no significant differences among the experimental group with respect to blood pressure, heart rate and respiratory rate. 2) Arterial oxygen tension was significantly increased after IPV. 3) ICU stay was slightly shortened in the experimental group as compared with that in the control group. However, there was no statistical significance. These results indicate that IPV may be effective in respiratory care of patients with excess or retained airway secretions.
Birds ; Blood Pressure ; Heart Rate ; Humans ; Lung ; Oxygen ; Percussion ; Respiratory Rate ; Respiratory Therapy ; Thorax ; Ventilation*

To deterrnine the applicability of the Acute Physiology and Chronic Health Evaluation (APACHE II) scoring system in ICU, 552 ICU patients who had been admitted from March 1, 1992 to February 28, 1993 were analysed. The mean APACHE II score of nonsurvivors was significantly higher than that of survivors (p<0.01) and there was significant relationship between mortality rate and APACHE II score [Mortality rate(%) =2.994XAPACHE II score-14.987 (r=0.97, p<0.001)). However, the majority of postoperative patients had scores less than 20 points and the postoperative patients were more unevenly distributed. These results suggest that the APACHE II score may be useful for analyses of ICU patients but its application in postoperative patients must take into consideration the patient's clinical condition.
APACHE* ; Humans ; Intensive Care Units* ; Critical Care* ; Mortality ; Survivors

We present a very rare case of spontaneous cervical spondylodiscitis and epidural abscess caused by Klebsiella pneumonia. A 45-year-old man presented with severe posterior neck pain radiating down both arms with decreased range of motion of the neck. He also complained of paresthesia of the upper extremities and a subjective weakness of his right arm. Magnetic resonance imaging (MRI) revealed spondylodiscitis and epidural abscess on the C5 and C6. In order to obtain adequate drainage of the abscess and complete removal of granulation tissues we performed a total decompressive corpectomy of C5 and C6. After drainage of the abscess, single stage autologous iliac bone graft was performed. The patient was followed by three months with antibiotic treatment confirmed to be sensitive to the organism. Klebsiella pneumonia was cultured postoperatively from the surgical biopsy samples. The patient recovered with no complications and the postoperative MRI showed improvement of the lesions.
Abscess ; Arm ; Biopsy ; Decompression ; Discitis ; Drainage ; Epidural Abscess ; Granulation Tissue ; Humans ; Klebsiella ; Magnetic Resonance Imaging ; Middle Aged ; Neck ; Neck Pain ; Paresthesia ; Pneumonia ; Range of Motion, Articular ; Transplants ; Upper Extremity

Synovial hemangioma is a vascular malformation that usually involves the knee. This paper presents the diagnostic ultrasound findings of a synovial hemangioma that could be mistaken for a medial meniscus cyst in a 37-year-old man and report the clinical result of the meniscal repair after an open excision.

Knowledge of the epidemiologic characteristics of end-stage kidney disease (ESKD) patients is essential. The trends in the prevalence, incidence, and mortality rates of ESKD were analyzed retrospectively using the Korean National Health Insurance ServiceNational Sample Cohort database between 2006 and 2015. From 2006 to 2015, the incidence of ESKD decreased from 28.6 to 24.0 per 100,000 people and showed a decreasing pattern with or without diabetes mellitus. However, the incidence of those aged ≥75 years increased, as did the mean age at the onset of ESKD. From 2007 to 2015, the prevalence of ESKD increased in all age groups, but particularly in those aged ≥75 years. The prevalence of ESKD differed by sex and diabetes mellitus status and this gap widened over time. Mortality rates in ESKD patients remained relatively constant throughout the study period. However, mortality rates in ESKD without diabetes decreased over the same period.

PURPOSE: Antivenin is a standard therapy in snakebite victims. While the required antivenin dose can be easily estimated, based on the initial symptoms, this strategy may be unsuccessful if the initial symptoms progressively worsen. The purpose of this study was to identify the progression rate of the initial symptoms following snakebite and its associated factors. METHODS: The medical records of 44 patients treated for snakebite from give the actual dates of the study period were retrospectively examined. Thirty-two of these patients were enrolled. Demographic data, local wound grade and local effect score at initial presentation (G-0 and LES-0, respectively) and 12 hours after admission (G-12 and LES-12, respectively) were reviewed, along with laboratory data. RESULTS: The 32 patients had an average age of 54.0+/-14.5 years and were predominantly male (n=26) and presented mainly during summer. Compared to G-0 and LES-0, re-evaluated G-12 and LES-12 were significantly increased despite initial administration of proper antivenin dosage (p=0.001 and p=0.000, respectively). Total amounts of antivenin correlated with LES-12 (correlation co-efficiency 0.558, p<0.05). However, factors associated with symptom progression were not revealed. CONCLUSION: Initial snakebite symptoms might progressively worsen within hours despite acceptable initial antivenin therapy. Therefore, re-evaluation within several hours must be considered if when the initial snakebite symptoms are minimal or mild.
Antivenins ; Chronology as Topic ; Disease Progression ; Humans ; Male ; Medical Records ; Retrospective Studies ; Snake Bites

BACKGROUND/AIMS: The purpose of this study was to identify predictive factors for erlotinib treatment in non-small cell lung cancer (NSCLC) patients following gefitinib failure. METHODS: Forty-five patients with NSCLC who were treated with erlotinib following gefitinib failure at Seoul National University Hospital between August 2005 and November 2011 were enrolled. Epidermal growth factor receptor (EGFR) mutation status, pathologic findings and other clinical factors, including response to tyrosine kinase inhibitors (TKIs) and progression-free survival (PFS), were evaluated. RESULTS: Of the 45 patients, 40 patients (88.8%) had adenocarcinoma. The following EGFR mutations were observed: five patients with a deletion of exon 19, six patients with an L858R mutation, three patients with wild-type EGFR, and 31 patients with unknown mutations. The response rate of erlotinib was 4.4%, and stable disease was 42.2%. The median PFS for erlotinib was 2.6 months (95% confidence interval, 1.4 to 3.7). Patients with a PFS > or = 4 months during previous gefitinib treatment had a significantly longer PFS with erlotinib (3.3 months vs. 1.6 months, respectively; p < 0.01) than patients with PFS < 4 months with gefitinib. According to multivariate analyses, PFS > or = 4 months for previous gefitinib treatment was significantly associated with prolonged PFS with erlotinib (p = 0.04). However, the response rate of gefitinib and treatment sequence were not associated with prolonged PFS with erlotinib (p = 0.28 and p = 0.67, respectively). CONCLUSIONS: Following rechallenge with the EGFR TKI erlotinib following gefitinib failure, patients who showed prolonged PFS with gefitinib benefit from erlotinib. However, further prospective studies are needed to confirm these findings.
Adult ; Aged ; Aged, 80 and over ; Antineoplastic Agents/*therapeutic use ; Carcinoma, Non-Small-Cell Lung/*drug therapy/genetics/pathology ; Chi-Square Distribution ; Disease-Free Survival ; Erlotinib Hydrochloride/*therapeutic use ; Female ; Hospitals, University ; Humans ; Kaplan-Meier Estimate ; Lung Neoplasms/*drug therapy/genetics/pathology ; Male ; Middle Aged ; Multivariate Analysis ; Mutation ; Proportional Hazards Models ; Protein Kinase Inhibitors/*therapeutic use ; Quinazolines/*therapeutic use ; Receptor, Epidermal Growth Factor/antagonists & inhibitors/genetics ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Salvage Therapy ; Time Factors ; Treatment Failure