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

OBJECTIVES: The purpose of this study to examine if the levels of anxiety(emotional, cognitive, and behavioral measures) during performance are influenced by interaction of both achievement related self discrepancy(=psychological vulnerability variable) and evaluative threat stress(=stressor) based on vulnerabilitystress model in order to identify the mechanism of development of performance anxiety and furthermore to suggest psychological intervention strategies to reduce and prevent it effectively. METHOD: High and low self discrepancy subjects consisted of students from the upper(n=40) and lower 15%(n=40) on achievement related self discrepancy scale, respectively. They were randomly assigned to either evaluative threat condition or neutral condition, and then all subjects took intellective task(verbal reasoning test and digit symbol test). RESULTS: The results were as follows; 1) High self discrepancy subjects under evaluative threat reported significantly higher level of state anxiety during performance than low self discrepancy subjects under any condition and also experienced higher degreee of state anxiety with marginal significance than high self discrepancy subjects under neutral condition, whereas there were no significant effects on the anxiety level of group variable under neutral condition or of stress variable in low self discrepancy subjects. 2) High self discrepancy subjects reported more cognitive interference during performance than low self discrepancy subjects regardless of the level of stress. 3) High self discrepancy subjects performed marginally significantly more poorly in digit symbol test than low self discrepancy subjects regardless of the level of stress, whereas there were no significant effects on verbal reasoning test. CONCLUSION: The hypothesis that performance anxiety could be affected by achievement related self discrepancy and stress, and specially by interaction between self discrepancy and stress was relatively strongly supported by the results on emotional measure of performance anxiety. In addition, this hypothesis received partial support by the results on cognitive and behavioral measures. We might conclude that it is important to consider achievement-related self discrepancy and evaluative threat stress together to understand the mechanism of development of performance anxiety and to reduce or prevent this anxiety effectively.
Anxiety ; Humans ; Performance Anxiety*

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*

Organophosphate fungicides include edifenphos, iprobenfos and tolclofos-methyl. Edifenphos inhibits cell wall synthesis by reduction in chitin synthase activity and inhibits the action of acetylcholinesterase. Thus, exposure to this chemical results in excessive salivation, lacrimation, urination, defecation, gastrointestinal motility and emesis symptoms, just like other organophosphate insecticides. Although edifenphos is an organophosphate fungicide, it is the only agricultural chemical which inhibits the action of pralidoxime and atropine, an activity which in turn, inhibits treatment. Thus, we have to treat these cases as soon as possible with atropine and pralidoxime, using the same approach as used for exposure to other organophosphate insecticides. In this report we evaluate the results of treatment of 4 patients who were intoxicated by fungicides (3 cases with edifenphos and 1 case with iprobenfos).
Acetylcholinesterase ; Atropine ; Cell Wall ; Chitin Synthase ; Defecation ; Gastrointestinal Motility ; Humans ; Insecticides ; Organothiophosphorus Compounds ; Pralidoxime Compounds ; Salivation ; Urination ; Vomiting

PURPOSE: High dose definitive radiation therapy (RT) alone is recommended to patients with cT1-3N0 non-small cell lung cancer, who are unfit for surgery or stereotactic RT. This study was conducted to evaluate the clinical outcomes and cost-effectiveness following RT alone using two different modest hypofractionation dose schemes. MATERIALS AND METHODS: Between 2001 and 2014, 124 patients underwent RT alone. From 2001 till 2010, 60 Gy in 20 fractions was delivered to 79 patients (group 1). Since 2011, 60 Gy in 20 fractions (group 2, 20 patients), and 60 Gy in 15 fractions (group 3, 25 patients) were selectively chosen depending on estimated risk of esophagitis. RESULTS: At follow-up of 16.7 months, 2-year rates of local control, progression-free survival, and overall survival were 62.6%, 39.1%, and 59.1%, respectively. Overall survival was significantly better in group 3 (p=0.002). In multivariate analyses, cT3 was the most powerful adverse factor affecting clinical outcomes. Incidence and severity of radiation pneumonitis were not different among groups, while no patients developed grade 2 esophagitis in group 3 (p=0.003). Under current Korean Health Insurance Policy, RT cost per person was 22.5% less in group 3 compared with others. CONCLUSION: The current study demonstrated that 60 Gy in 15 fractions instead of 60 Gy in 20 fractions resulted in comparable clinical outcomes with excellent safety, direct cost saving, and improved convenience to the patients with tumors located at ≥ 1.5 cm from the esophagus.
Appointments and Schedules* ; Carcinoma, Non-Small-Cell Lung* ; Cost Savings ; Disease-Free Survival ; Dose Fractionation ; Esophagitis ; Esophagus ; Follow-Up Studies ; Humans ; Incidence ; Insurance, Health ; Multivariate Analysis ; Radiation Pneumonitis ; Radiotherapy

BACKGROUND & OBJECTIVES: Some components of ground substances are known to be involved in developing nasal polyp. The fibroblasts are a major component of the ground substances in nasal polyp and have many immunologic roles. Heterogeneity of fibroblasts has been observed in other anatomical sites including the nasal mucosa. The aim of this study was to investigate the heterogeneity of fibroblasts of nasal polyps in non-allergic rhinitis and allergic rhinitis. MATERIALS & METHODS: Using the third passage of the fibroblasts taken from polyps of allergic and non-allergic patients, we measured the proliferating potential by comparing the cell growth in the culture system of fibroblasts and calculated the doubling time of the cell growth. We also compared the proliferating potentials between the two groups after stimulation with histamine or IL-4. RESULTS: Morphologic differences were examined by transmission electron microscopy. In the non-stimulated experiment, proliferation of fibroblasts was increased in the non-allergic polyp group (NAPG). When the fibroblasts were stimulated with histamine, the proliferation was not significantly changed on day 6 in both groups. When the fibroblasts were stimulated with IL-4, the proliferation was significantly increased in NAPG. Morphologic differences were demonstrated between the NAPG and the APG. CONCLUSION: The differences in cell proliferation potentials and morphological changes between both groups suggest that there is a heterogeneity of fibroblasts between them.
Cell Proliferation ; Fibroblasts* ; Histamine ; Humans ; Interleukin-4 ; Microscopy, Electron, Transmission ; Nasal Mucosa ; Nasal Polyps* ; Polyps ; Population Characteristics* ; Rhinitis*