Retroperitoneal duodenal rupture is rare and is often difficult to diagnose on the plain abdominal x-ray. From a review of the plain abdomen films of 21 cases with retroperitoneal duodenal rupture, confirmed by operation, pneumoretroperitoneum was revealed in 16 cases; Air in the peritoneum was manifested as a bubbly shadow in 12 cases, a renal halo in 9 cases, air shadow along the right psoas margin in 2 cases, air along the diaphragmatic crus in 2 cases and air in the right properitoneal fat in 2 cases, US and CT also revealed air bubbles and fluid collection around the right kidney. We recommend the plain abdomen as a useful diagnostic method for detection of pneumoretroperitoneum.
Abdomen* ; Kidney ; Methods ; Peritoneum ; Retropneumoperitoneum ; Rupture*

To present CT and clinical features of active tuberculomas, we analyzed retrospectively CT findings of 14 tuberculomas (n=14) in 13 patients which appeared as solitary pulmonary nodules on plain radiographs and evaluated the response of tuberculomas to antituberculous chemotherapy. Nine tuberculomas (64%) were ovoid in shape and 10 (72%) showed smooth margin. Twelve(86%) tuberculomas were shown as low density lesions on unenhanced or enhanced CT scans. Calcification and cavitation were noted in three (21%) and eight (57%) tuberculomas respectively. Seven (50%) tuberculomas were accompanied by satellite nodules. Acid-fast bacilli (AFB) was positive in all tuberculomas in sputum, lavage fluid, or percutaneous transhoracic needle aspiration (PTNA). Smear and culture of lavage fluid and PTNA aspirate were superior to the detection of AFB than sputum examination. Follow-up study with antituberculous chemotherapy in 14 tuberculomas resulted in complete disappearance in three, decrease in size in seven, and no visible change in the remaining four. These observations suggest that tuberculomas are well-defined, ovoid, and low-density nodules containing calcifications and/or cavitations. Tuberculomas are relatively indolent even with threatment.
Drug Therapy ; Follow-Up Studies ; Humans ; Needles ; Retrospective Studies ; Solitary Pulmonary Nodule ; Sputum ; Therapeutic Irrigation ; Tomography, X-Ray Computed ; Tuberculoma*

Polyarteritis nodosa (PAN) is a necrotizing angitis that predominantly affects small-and medium-sized arteries in which microaneurysm or occlusion of the visceral arteries can be seen by arteriography. Patients with PAN may have non-specific symptoms at the beginning of their illness, but progression can be sudden and result in severe, even life threatening, complications. These include central nervous system hemorrhages, gastrointestinal hemorrhages or perforation, acute appendicitis, liver infarcts, acute renal failure, renal perirenal hematomas, and cardiac failure. A diagnosis of PAN should be considered when multiple small-sized aneurysms are detected by angiography, even if a biopsy is negative. Involvement of gastrointestinal and renal arteries is frequent in polyarteritis nodosa. The most common complications of gastrointestinal involvement are mucosal ulceration, bowel infarction, perforation, cholecystitis and hepatitis. Another rare but potentially life-threatening complication is perirenal hematoma caused by spontaneous rupture of renal aneurysm. Because of this possibility, rapid evaluation of these patients is necessary to make early diagnosis and treatment possible. We describe an extremely rare case of polyarteritis nodosa with development of spontaneous perirenal hematoma due to rupture of renal aneurysm, which was evaluated with immediate angiography and treated by coil embolization.
Acute Kidney Injury ; Aneurysm* ; Aneurysm, Ruptured ; Angiography ; Appendicitis ; Arteries ; Biopsy ; Central Nervous System ; Cholecystitis ; Diagnosis ; Early Diagnosis ; Embolization, Therapeutic ; Emergencies* ; Emergency Service, Hospital* ; Gastrointestinal Hemorrhage ; Heart Failure ; Hematoma ; Hemorrhage ; Hepatitis ; Humans ; Infarction ; Liver ; Polyarteritis Nodosa* ; Renal Artery* ; Rupture* ; Rupture, Spontaneous ; Ulcer

Objective: A suicide attempt by self-poisoning is a common cause of admissions to the emergency department (ED). Management of such intentiona poisoning often requires complicated medical procedures, resulting in a longer length of stay (LOS) as compared to other cases that require treatment in the ED. This study aimed to determine the factors affecting a longer LOS in self-poisoning patients. Methods: This was a retrospective study wherein all the medical charts of patients who visited the ED of one hospital, from August 2016 to July 2019, because of intentional self-poisoning, were reviewed. Results: Most of the patients visited the ED involuntarily and there were almost twice as many female patients as males. Almost half of the patients were referred to the psychiatry department. A comparison of various factors within the LOS groups revealed significant differences in mental status, guardian co-visitation, patient gender, psychiatric referral, and poisoning substance. Moreover, the LOS had a stronger association with the pre-consultation period than the consultation to decision-making period. Conclusion To reduce the LOS, it seems important to make a rapid decision on whether to observe the patient in the ED and wait until the workup is completed or to admit and then evaluate the patient in the ward. If the clinicians cannot obtain enough information to evaluate the patient for appropriate management, short-term admission may be an option to reduce the LOS and to provide a stable evaluation.

BACKGROUND: We evaluated the efficacy of the cardiopulmonary exercise test as an objective indicator of functional status and as a pre-operative prognostic indicator in patients with mitral regurgitation (MR) and aortic regurgitation (AR). METHODS: Cardiopulmonary exercise tests and echocardiography were performed in 47 patients (MR: 30, AR: 15, MR + AR: 2) before surgery and repeated one year after surgery. We compared the New York Heart Association (NYHA) functional class, peak oxygen consumption rate (VO2peak), exercise duration, left ventricular dimension and ejection fraction, before and after surgery. RESULTS: Initial VO2peak and exercise duration were significantly different according to NYHA class. A year later, NYHA functional class improved from 2.1+/-0.1 to 1.4+/-0.1 (p< 0.001). The VO2peak was significantly increased (21.7+/-1.0 to 23.7+/-1.0 mL/kg per min, p=0.008) and exercise duration also increased (521.7+/-35.9 to 623.3+/-35.7 seconds, p< 0.001). When patients were analysed according to their post-operative NYHA functional class, those with class I showed significantly different pre-operative VO2peak (class I: 23.7+/-1.1, II: 18.3+/-1.5 mL/kg per min, p=0.005) and exercise durations (class I: 587.5+/-43.2, II: 415.6+/-55.7 seconds, p=0.02). Patients with higher pre-operative VO2peak (19.0 mL/kg per min) more frequently became NYHA functional class I than those with a lower pre-operative VO2peak (76.7% vs. 35.3%, p=0.02). But baseline left ventricular dimension and ejection fraction by echocardiography were not different between post-operative class I and II group. CONCLUSION: VO2peak and exercise duration are excellent parameters to evaluate the subjective functional class and to predict the post-operative functional class of patients with MR and/or AR. Patients with a pre-operative VO2peak of 19.0 mL/kg per min or more will have a better functional status one year after surgery.
Adult ; Aortic Valve Insufficiency/diagnosis/*surgery ; Chi-Square Distribution ; Cohort Studies ; Exercise Test ; Exercise Tolerance ; Female ; Follow-Up Studies ; Heart Valve Prosthesis Implantation/*methods ; Humans ; Male ; Middle Aged ; Mitral Valve Insufficiency/diagnosis/*surgery ; Oxygen Consumption ; Postoperative Period ; Preoperative Care ; Probability ; Prospective Studies ; Pulmonary Gas Exchange ; Severity of Illness Index ; Statistics, Nonparametric ; Stroke Volume ; Treatment Outcome

Moyamoya disease is characterized by progressive cerebrovascular occlusion at the peripheral internal carotid artery and development of abnormal collateral circulation at the cerebral basal region. Although abnormal thrombogenesis, inflammation and autoimmune process might be involved in the etiology, the genetic pathogenesis of Moyamoya disease is still unknown. To evaluate the association of Moyamoya disease with HLA alleles in the Korean population, we investigated HLA class I and class II alleles in 28 Moyamoya patients and 198 unrelated healthy controls. The frequency of HLA-B35 allele was significantly increased in the patients compared to the controls (32.1% vs. 10.1%, RR=4.2, p<0.008). Further analysis of HLA-B35 on onset age and sex showed that this allele was significantly increased compared to the controls in both late-onset and female group. Especially, HLA-B35 was the most significantly increased in female of late-onset group compared to the controls. These results suggest that HLA-B35 may be an useful genetic marker for Moyamoya disease, and particularly in females of late onset group in the Korean population.
Adolescent ; Adult ; Age of Onset ; Aged ; Child ; Child, Preschool ; Female ; Gene Frequency ; *Genes, MHC Class I ; *Genes, MHC Class II ; Genetic Markers ; Genetic Predisposition to Disease ; Genotype ; HLA Antigens/*genetics ; Human ; Korea ; Male ; Middle Aged ; Moyamoya Disease/*genetics/*immunology ; Retrospective Studies ; Support, Non-U.S. Gov't

PURPOSE: We sought to determine the impact of the factors that affect the mortality of critically ill patients with sepsis or septic shock. METHODS: We performed a retrospective cohort study of adult patients admitted with sepsis or septic shock from April 1, 2006, to December 31, 2007, at a single, urban academic emergency department (ED). The primary outcome was patients' death. Predictor variables were the EDLOS, the time from registration to order for antibiotics administration, number of hospital days, initial systolic blood pressure, systolic blood pressure after hydration, heart rate, respiration rate, body temperature, serum white blood cell count, and serum lactic acid level. Cox's proportional hazard model was used to elucidate the relationship of predictor variables to patients' death. Data were analyzed with SPSS version 12.0. RESULTS: The overall mortality rate was 56.2%. Average length of stay was 204.5+/-90.6 minutes in the survival group and 166.6+/-81.8 minutes in the death group (p=0.041). The mortality was not shown to be significantly different between patients spending less than 4 hours and patients spending over 4 hours. The relative risk (RR) for patients' death was significantly higher in patients with hypotension persisting despite adequate fluid resuscitation. CONCLUSION: EDLOS did not affect mortality for the patients admitted with sepsis or septic shock. The patients' prognoses were mainly related to the systolic blood pressure after hydration.
Adult ; Anti-Bacterial Agents ; Blood Pressure ; Body Temperature ; Cohort Studies ; Critical Illness ; Emergencies ; Heart Rate ; Humans ; Hypotension ; Lactic Acid ; Length of Stay ; Leukocyte Count ; Prognosis ; Proportional Hazards Models ; Respiratory Rate ; Retrospective Studies ; Sepsis ; Shock, Septic

BACKGROUND AND OBJECTIVE: Mahuangbujaseshintang (MBST) and soshihotang (SST) have been used for treatment of chronic disease of respiratory tract. It is necessary to clarify the mechanism of anti-allergic effects and to standardize the extracts. MATERIALS AND METHODS: The effects of MBST and SST were evaluated on histamine release in rat mast cells ex vivo. Several hours after administration of the extracts, mast cells were stimulated by DNP-ascaries and histamine contents were measured. Time course structural change of the cells was examined by dynamic study. In order to evaluate the effect of the extracts on the nasal patency, acoustic rhinometry was performed after administering of leukotriene D4 to both nasal cavities of guinea pig (GP). We examined the effects of the extracts with double-blind study, and also studied change of nasal patency after challenge of antigen by acoustic rhinometry in patients with allergic rhinitis. RESULTS: MBST at 4 hr and SST at 3 hr after oral administration remarkably inhibited histamine release from rat mast cells in a dose-dependent manner. MBST-treated GPs failed to show bi-phasic phenomena which indicated to reduce nasal volume at the time of early and late phases in allergic inflammation. Both groups of patients who took MBST and SST for 1 week or 2 weeks showed significant decreased symptom severity index (SSI) from treatment week 2 (p<0.05). The percent volume change after challenge of the antigen was decreased in 31 patients who took the extracts for 2 weeks. CONCLUSION: We can conclude that the herb medicine of MBST and SST may be effective for allergic rhinitis.
Administration, Oral ; Animals* ; Chronic Disease ; Double-Blind Method ; Guinea Pigs ; Histamine ; Histamine Release ; Humans ; Inflammation ; Leukotriene D4 ; Mast Cells ; Models, Animal* ; Nasal Cavity ; Rats ; Respiratory System ; Rhinitis* ; Rhinometry, Acoustic

OBJECTIVES: Since the 1990s, drug-resistant bacteria have become common pathogens of hospital-acquired infections. In recent years, healthcare-associated infections have come to the fore, and it is reported that distribution rates of these bacteria are comparable to those of hospital-acquired infections. However, there have been few studies on differences in resistant bacteria depending on the size of hospitals. Thus, the authors studied differences in drug-resistant bacteria between a tertiary hospital and smaller medical institutions. METHODS: We retrospectively analyzed the clinical findings and sputum culture results of patients transferred from tertiary hospitals (group A, n=74) and those transferred from smaller medical institutions (group B, n=65). RESULTS: The number of patients with malignancy was higher in group A than in group B. The length of intensive care unit stay was longer in group A than in group B. Antibiotic therapy and mechanical ventilation were more frequently used in group A than in group B. There were no significant differences between the 2 groups in bacterial species (Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa) and their resistance rates to carbapenem, while there were significant differences between the 2 groups in the bacterial species (Acinetobacter baumannii) and its resistance rate to carbapenem. CONCLUSION: In this study, there were significant differences between the 2 groups in the bacterial species and resistance rates to carbapenem for A. baumannii infection unlike other bacterial infections. Further studies on risk factors and patient classification are needed to confirm our results.
Acinetobacter baumannii ; Bacteria ; Bacterial Infections ; Drug Resistance, Bacterial* ; Escherichia coli ; Humans ; Intensive Care Units ; Klebsiella pneumoniae ; Pseudomonas ; Respiration, Artificial ; Retrospective Studies ; Risk Factors ; Tertiary Care Centers*

No abstract available.
Lung Neoplasms* ; Lung* ; Proliferating Cell Nuclear Antigen*