A 64-year-old female with earcinoma of esophagogastic junction developed gangrene of left arm after esophagogastrectomy to require amputation of the arm. The patient had no known cardiac disorder before the operation but showed marked arrhythmia during the procedure. The general anesthesia was carried out with penthothal-succinylcholine induction and maintenance with N2O-O2-halothane.
Amputation ; Anesthesia, General* ; Arm ; Arrhythmias, Cardiac ; Female ; Gangrene* ; Hand* ; Humans ; Middle Aged

Paraganglioma is a benign tumor arising in the paraganglion system scattered throughout the body, but its cytopathologic findings arenot well known. We experienced a case of paraganglioma of carotid body diagnosed by fine needle aspiration. The patient was a 30 year-old female who suffered from the left neck mass for 3 years. The mass was 3x3crn in size without pulsation or bruit. Cytologically, the smear revealed aggregated and singly scattered tumor cells having abundant pale cytoplasm and indistinct cell borders. Their nuclei were round to oval, but enlarged nuclei were occasionally observed. The nuclear membrane was smooth with fine clumping of chromatin. Differentiation from metastatic follicular carcinoma of the thyroid gland was difficult.
Adult ; Biopsy, Fine-Needle ; Carotid Body ; Chromatin ; Cytoplasm ; Female ; Glomerulosclerosis, Focal Segmental* ; Humans ; Neck ; Nephrotic Syndrome* ; Nuclear Envelope ; Paraganglioma ; Thyroid Gland

We present a case of a young male with a five year history of a hair-loss patch presenting linear distribution on the scalp. A biopsy specimen revealed a lymphocytic panniculitis and fat degeneration with mucin deposit. Focal hydropic degeneration of basal cells was also evident. Direct immuno-fluorescence revealed peribulbar granular deposits of IgM, IgA and C3. Antinuclear antibody was negative. Clinical appearance was unusual but histological examination revealed linear lupus erythematosus profundus. To our knowledge, only one other case of linear lupus erythematosus profundus on the scalp has been reported in English written literature until now.
Alopecia* ; Antibodies, Antinuclear ; Biopsy ; Humans ; Immunoglobulin A ; Immunoglobulin M ; Male ; Mucins ; Panniculitis ; Panniculitis, Lupus Erythematosus* ; Scalp*

Background/Aims: Asthma is not a single disease but, rather, a heterogeneous inf lammatory disorder with various pathogenic mechanisms. We analyzed the associations between the cellular profile of sputum and the serum levels of inflammatory mediators/cytokines in a cohort of adult asthmatics. Methods: We recruited 421 adult asthmatic patients. All subjects were classified into four groups according to their sputum cellular profiles: G1, eosinophilic; G2, mixed granulocytic; G3, neutrophilic; and G4, paucigranulocytic. Serum levels of cytokines and mediators including periostin, eosinophil-derived neurotoxin (EDN), S100A9, and folliculin were quantified. Results: Among 421 patients, G1 accounted for 149 (35.4%), G2 for 71 (16.9%), G3 for 155 (36.8%), and G4 for 46 (10.9%). Serum periostin and EDN levels were significantly higher in G1 (p = 0.004, and p = 0.031) than in the others. Serum S100A9 levels were elevated in G2 and G3 (p = 0.008). Serum folliculin levels differed significantly among the four groups, with the highest level in G4 (p = 0.042). To identify G1 from G1 plus G2 groups, the optimal serum cut-off levels were 1.71 ng/mL for periostin, and 1.61 ng/mL for EDN. When these two parameters were combined, the sensitivity was 76.0% and the specificity was 64.3% (area under the curve, 0.701; p = 0.004). Conclusions The serum periostin and EDN levels may be used as predictors to discriminate the eosinophilic asthma group from patients having eosinophilic or mixed granulocytic asthma, and the serum folliculin level is significantly elevated in patients with paucigranulocytic asthma compared to those with different inflammatory cell profile.

PURPOSE: The aim of this study was to verify the effects of daily 2% chlorhexidine gluconate (CHG) bathing on the acquisition of multidrug-resistant organisms (MDRO) and healthcare-associated infection (HAI) in a medical intensive care unit (MICU). METHODS: The study was a randomized controlled group posttest only design, involving 91 patients in MICU at a tertiary hospital (47 patients in the experimental group and 44 patients in the control group). The 2% CHG bathing was performed daily according to bathing protocol to the patients in the experimental group, and traditional bath was performed every three days to those in the control group. Fisher's exact test and χ² test were used to analyze the data. RESULTS: MDRO were found in 6 patients of the experimental group and in 15 patients of the control group. The difference was statistically significant (p=.016). HAI occurred in 2 patients of the experimental group and in 7 patients of the control group. The difference was not statistically significant (p=.084). CONCLUSION: The results confirmed that daily bathing with CHG was effective in reducing the incidence of MDRO acquisition. Therefore, it is expected that daily bathing with CHG will be used as an effective nursing intervention to reduce the incidence of MDRO acquisition.
Baths ; Chlorhexidine ; Critical Care ; Cross Infection ; Drug Resistance, Microbial ; Humans ; Incidence ; Intensive Care Units ; Nursing ; Tertiary Care Centers

Asthma is characterized by chronic inflammation of the airways with variable airflow limitation resulting in recurrent wheezing, chest tightness, and cough. Long term management is essential to prevent symptom and asthma exacerbation with using daily controller medications. Asthma control was much improved by combining inhaled corticosteroids with long-acting beta2 agonists. Recent several studies demonstrated the effectiveness of a new asthma management strategy, a single inhaler containing budesonide and formoterol for both maintenance therapy and symptom relief (called SMART) which was approved in GINA guideline, 2006. This SMART strategy could reduce the frequency of severe exacerbations and the need for rescue medicine with systemic steroids as well as improved lung function and asthma controls at relatively lower doses of corticosteroid with lesser costs for treatment.
Adrenal Cortex Hormones ; Asthma* ; Budesonide ; Cough ; Formoterol Fumarate ; Inflammation ; Lung ; Nebulizers and Vaporizers ; Respiratory Sounds ; Steroids ; Thorax

OBJECTIVES: This study was conducted to develop a smartphone application (app) as an educational learning instrument for coronary artery disease (CAD) patients and to assess the users' level of satisfaction. METHODS: This methodological research involves elicited learning content for CAD patients to develop a learning instrument using the smartphone app. The app was developed according to the steps of Assessment, Design, Development, Implementation, and Evaluation, which is a systematic instructional design model. The levels of satisfaction with the developed smartphone app among 30 outpatients with CAD were assessed via a questionnaire during their visits to a cardiology outpatient department. RESULTS: A smartphone app 'Strong Heart' was developed through reviewing the literature associated with education for CAD patients under professional supervision and searching for medical smartphone apps that are already available. The learning contents include six main sections containing essential learning issues in managing CAD and additional information to attract the user's attention, such as patient cases and quizzes. After modification with feedback from experts, the app was finally developed and evaluated by patients who reported that they were satisfied with the usefulness of the app. CONCLUSIONS: The developed smartphone app is available on both the iPhone App Store and the Android Play Store. Patients with CAD may utilize the app for supporting educational material without limitations of time and space.
Cardiology ; Coronary Artery Disease* ; Education ; Educational Technology ; Humans ; Learning ; Mobile Applications ; Organization and Administration ; Outpatients ; Patient Education as Topic ; Surveys and Questionnaires

Erlotinib is a low-molecular-weight quinazoline derivative that inhibits the activation of epidermal growth factor receptor (EGFR) tyrosine kinase through competitive binding of the adenosine triphosphate binding domain of the receptor. Patients undergoing anti-EGFR therapy frequently present with cutaneous reactions like a sterile follicular and pustular rash, xerosis, pruritus, paronychia, hair abnormalities and mucositis, which can cause serious discomfort and negatively affect the compliance with anti-EGFR therapy. We report here on an interesting case of hair abnormalities induced by erlotinib (Tarceva(R)) and this presented as eyelash lengthening and hair curling in a 62-year-old woman.
Adenosine Triphosphate ; Binding, Competitive ; Compliance ; Exanthema ; Female ; Hair ; Humans ; Middle Aged ; Mucositis ; Paronychia ; Polyphosphates ; Protein-Tyrosine Kinases ; Pruritus ; Quinazolines ; Receptor, Epidermal Growth Factor ; Erlotinib Hydrochloride

A neural network system was applied in order to analyze the nutritional and other factors influencing chronic diseases. Five different nutrition evaluation methods including SD Score, %RDA, NAR INQ and %RDA-SD Score were utilized to facilitate nutrient data for the system. Observing top three chronic disease prediction ratio, WHR using SD Score was the most frequently quoted factor revealing the highest predication rate as 62.0%. Other high prediction rates using other data processing methods are as follows. Prediction rate with %RDA, NAR, INQ and %RDA-SD Score were 58.5%(diabetes), 53.5%(hyperlipidemia), 51.6%(diabetes), and 58.0%(diabetes)respectively. Higher prediction rate was observed using either NAR or INQ for obesity as 51.7% and 50.9% compared to the previous result using SD Score. After reviewing appearance rate for all chronic disease and for various data processing method used, it was found that iron and vitamin C were the most frequently cited factors resulting in high prediction rate.
Ascorbic Acid ; Chronic Disease* ; Iron ; Obesity

Chondroid syringoma is an uncommon, benign and adnexal tumor which is composed of a mixture of epithelial cells and mesenchymal tissue. The usual presentation is of an asymptomatic, slowly growing mass, typically located in the head and neck region. We report a case of chondroid syringoma located in the right heel of a 46-year-old male patient. The tumor grew over a 10-year period, increasing rapidly in size over the last few months. It was a skin colored, 4.5x5x4 cm-sized, hyperkeratotic hard pedunculated nodule. The diagnosis of giant chondroid syringoma was made by clinical and histopathological examination, which showed a tubular structure and solid nest composed by more than two layers of epithelial cells embedded in a myxoid-adipoid tissue. The tubular lumina contained small amounts of amorphous, eosinophilic material. Regarding previous reports, this is a quite rare case of benign chondroid syringoma due to it's unusually large size and rare location.
Adenoma, Pleomorphic ; Eosinophils ; Epithelial Cells ; Head ; Heel ; Humans ; Male ; Middle Aged ; Neck ; Skin