BACKGROUND: Several antibiotics can be used to treat ventilator-associated pneumonia caused by carbapenem-resistant A. baumannii (CRAB-VAP) including high-dose sulbactam. However, the effectiveness of high-dose sulbactam therapy is not well known. We report our experience with high-dose sulbactam for treatment of CRAB-VAP. METHODS: Medical records of patients with CRAB-VAP who were given high-dose sulbactam between May 2013 and June 2015 were reviewed. RESULTS: Fifty-eight patients with CRAB-VAP were treated with high-dose sulbactam. The mean age was 72.0 ± 15.2 years, and the acute physiology and chronic health evaluation II (APACHE II) score was 15.1 ± 5.10 at the time of CRAB-VAP diagnosis. Early clinical improvement was observed in 65.5% of patients, and 30-day mortality was 29.3%. Early clinical failure (odds ratio [OR]: 8.720, confidence interval [CI]: 1.346-56.484; p = 0.023) and APACHE II score ≥ 14 at CRAB-VAP diagnosis (OR: 10.934, CI: 1.047-114.148; p = 0.046) were associated with 30-day mortality. CONCLUSIONS: High-dose sulbactam therapy may be effective for the treatment of CRAB-VAP. However, early clinical failure was observed in 35% of patients and was associated with poor outcome.
Acinetobacter baumannii* ; Acinetobacter* ; Anti-Bacterial Agents ; APACHE ; Diagnosis ; Humans ; Medical Records ; Mortality ; Pneumonia, Ventilator-Associated* ; Sulbactam*

Native valve endocarditis (NVE) without preexisting structural valve or congenital cardiac malformation especially in pediatric group is rare. A case of isolated tricuspid valve endocarditis in a 7-year-old child without any cardiac malformation is described. This child had suffered from fever and productive cough for 3 weeks. Blood culture grew Staphylococcus aureus. Fever was not controlled even with proper antibiotic treatment. Transthoracic echocardiogram and lung perfusion scan revealed a large vegetation on the tricuspid valve with multiple embolism Surgical procedures included vegetectomy partial cusps resection and pericardial patch valvuloplasty. Th patient was in NYHA class I during follow up.
Child ; Cough ; Embolism ; Endocarditis* ; Endocarditis, Bacterial ; Fever ; Follow-Up Studies ; Humans ; Lung ; Perfusion ; Staphylococcus aureus ; Tricuspid Valve*

Airway difficulties are a major concern for anesthesiologists. Even though fiberoptic intubation is the generally accepted method for management of difficult airways, it is not without disadvantages-requires patient cooperation, and cannot be performed on soiled airway or upper airways with pre-existing narrowing pathology. Additionally, fiberoptic bronchoscopy is not available at every medical institution. In this case, we encountered difficult airway management in a 71-year-old man with a high Mallampati grade and a thick neck who had undergone urologic surgery. Several attempts, including a bronchoscope-guided intubation, were unsuccessful. Finally, blind nasal intubation was successful while the patient's neck was flexed and the tracheal cartilage was gently pressed down. We suggest that blind nasal intubation is a helpful alternative in difficult airway management and it can be a lifesaving technique in emergencies. Additionally, its simplicity makes it a less expensive option when advanced airway technology (fiberoptic bronchoscopy) is unavailable.
Aged ; Airway Management ; Bronchoscopy ; Cartilage ; Emergencies ; Humans ; Intubation* ; Methods ; Neck ; Pathology ; Patient Compliance ; Soil

Airway difficulties are a major concern for anesthesiologists. Even though fiberoptic intubation is the generally accepted method for management of difficult airways, it is not without disadvantages-requires patient cooperation, and cannot be performed on soiled airway or upper airways with pre-existing narrowing pathology. Additionally, fiberoptic bronchoscopy is not available at every medical institution. In this case, we encountered difficult airway management in a 71-year-old man with a high Mallampati grade and a thick neck who had undergone urologic surgery. Several attempts, including a bronchoscope-guided intubation, were unsuccessful. Finally, blind nasal intubation was successful while the patient's neck was flexed and the tracheal cartilage was gently pressed down. We suggest that blind nasal intubation is a helpful alternative in difficult airway management and it can be a lifesaving technique in emergencies. Additionally, its simplicity makes it a less expensive option when advanced airway technology (fiberoptic bronchoscopy) is unavailable.
Aged ; Airway Management ; Bronchoscopy ; Cartilage ; Emergencies ; Humans ; Intubation* ; Methods ; Neck ; Pathology ; Patient Compliance ; Soil

OBJECTIVE: To measure the lumbar segmental range of motion (ROM) with 3-dimensional motion analysis system and compare the results with radiologic ROM measurements. METHOD: Ten healthy adult volunteers were included. We attached surface markers at the corresponding skin surface of each lumbar vertebral bodies and measured lumbar segmental ROM in flexion-extension, right bending, left bending, axial rotation with 3-D motion analysis. We compared some of the results with radiologic segmental ROM measurements. RESULTS: In 3-D motion analysis, segmental ROM of flexion and extension, right bending, left bending, right rotation, left rotation were, respectively: 10.1degrees, 45degrees, 3.5degrees, 1.7degrees and 1.9degrees(L1-L2); 17.9degrees, 6.2degrees, 5.1degrees, 1.4degrees and 1.1degrees (L2-L3); 15.0degrees, 7.2degrees, 4.9degrees, 2.1degrees and 1.1degrees (L3-L4); 14.9degrees, 5.8degrees, 4.6degrees, 1.7degree and 1.6degree (L4-L5); 10.6degrees, 4.9degrees, 3.8degree, 2.6degree and 0.8degree (L5-S1). There was no statistically significant difference in segmental ROM between 3-D motion analysis measurements and radiologic measurements except L5-S1 right bending, L2-L3 and L5-S1 left bending. No statistical significant difference in lumbar flexion and bending ROM was found between two methods. CONCLUSION: 3-D motion analysis is a useful method when measuring the lumbar segmental range of motion and it has an advantage to analyze segmental lumbar motion with three directions simultaneously.
Adult* ; Humans ; Range of Motion, Articular* ; Skin ; Volunteers

The authors reported 100 cases of acute subdural hematomas confirmed by operation from Jan. 1972 to Sept. 1975. We discussed the relationship of the type of operation to mortality in acute subdural hematomas. The types of surgical operations were divided in 4 groups. The surgical mortality rate was 19% for frontotemporoparietal craniotomy, 29% for multiple burr holes technique, 42% for craniectomy and 48% for subtemporal decompression with burr holes and total over-all mortality was 36% in our cases. The authors reviewed the literatures described the surgical operative method and it's mortality and so we thought large frontotemporoparietal craniotomy is more valuable method for operation of the acute subdural hematomas.
Craniotomy ; Decompression ; Hematoma, Subdural, Acute* ; Mortality

BACKGROUND: Although cardiopulmonary resuscitation(CPR) is a very effective therapy in cardiac arrest, it is hard to prove the true effectiveness of CPR. Several studies about out-of-hospital and emergency department CPR exist, but only a few reports about in-hospital CPR are available. This study was designed to investigate in-hospital cardiac arrest, to analyze the result of CPR, and to evaluate the problems associated with in-hospital CPR. METHODS: A clinical analysis of 71 cases of in-hospital CPR announcement from January 2000 to August 2000 was performed. The initial rhythm on cardiac arrest, return of spontaneous circulation(ROSC), and the survivals were analyzed in the case of the 46 true cardiac arrest patients. RESULTS: During 8 months, there were 71 cases of in-hospital CPR announcement. Among them, there were 46 cases of true cardiac arrest and 25 cases of non-cardiac arrest. Of the 46 true cardiac-arrest cases, 27(58.7%) experienced ROSC, 15(32.6) survived for over 24 hours, and 7(15.2%) survived to be discharged. The initial rhythms on cardiac arrest were 30 cases(65.2%) of asystole, 14(30.4%) of PEA(pulseless electrical activity), and 2(4.3%) of ventricular fibrillation, with ROSC being 17 cases(56.7%), 9(64.3%) and 1(50.0%) cases and discharged survivors being 4 cases(13.3%), 3(21.4%) and 0(0.0%) cases, respectively. CONCLUSION: Extraordinarily high proportions of asystole and PEA were seen in the initial rhythm of cardiac arrest, and those were associated with high survival rates. Although further study is needed to evaluate the course leading to this high proportion of asystole and PEA, this result suggests that if the EMS system in the hospital is activated promptly and systematically, a better outcome will be achieved in case of cardiac arrest with asystole and PEA.
Cardiopulmonary Resuscitation* ; Emergency Service, Hospital ; Heart Arrest ; Humans ; Peas ; Survival Rate ; Survivors ; Tertiary Care Centers* ; Ventricular Fibrillation

Background/Aims: Noninvasive methods have become increasingly critical in the diagnosis of fibrosis in chronic liver diseases. Herein, we compared the diagnostic performance of serum Mac2 binding protein glycosylation isomer (M2BPGi) and other serological panels for fibrosis in patients with nonalcoholic fatty liver disease (NAFLD) and proposed an improved two-step diagnostic algorithm for advanced fibrosis. Methods: We enrolled 231 patients diagnosed with NAFLD who underwent a liver biopsy. We subsequently evaluated the diagnostic performance of serological panels, including serum M2BPGi, a fibrosis index based on four factors (FIB-4), aspartate aminotransferase-to-platelet ratio index (APRI), and NAFLD fibrosis score (NFS), in predicting the stage of liver fibrosis. We then constructed a two-step algorithm to better differentiate advanced fibrosis. Results: The areas under the receiver operating characteristic curves of serum M2BPGi, FIB-4, APRI, and NFS for advanced fibrosis (≥F3) were 0.823, 0.858, 0.779, and 0.827, respectively. To reduce the performance of unnecessary liver biopsy, we propose a two-step algorithm using FIB-4 as an initial diagnostic tool and serum M2BPGi (≥0.6) as an additional diagnostic method for patients classified as intermediate (23%). Using the proposed algorithm, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 0.812, 0.814, 0.814, 0.600, and 0.927, respectively. Conclusions Serum M2BPGi is a simple and effective test for advanced fibrosis in patients with NAFLD. Application of the two-step algorithm based on FIB-4 and M2BPGi proposed here can improve diagnostic performance and reduce unnecessary tests, making diagnosis easily accessible, especially in primary medical centers.

BACKGROUND: In athlete's heart, functional and structural alteration are main features. We studied electrocardiograms(ECG's) and echocardiograms(UCG's) in soccer players before and after intensive training. METHODS: Fifteen soccer players with the mean age and career of 19.3 and 8.5 years,respectively,underwent intensive training for 5-5.5 months, which included running of 2 km daily during the last 2-2.5 months. Comparisons of ECG's and UCG's recorded before and after the training were made. RESULTS: The major abnormal finding in pre-training ECG's was high voltage being seen in 40% of the cases, and in UCG's left ventricular(LV) dilatation and/or hypertrophy or asymmetrical septal hypertrophy(ASH) were noted in approximately 80% of the cases. The incidences of these finding after the intensive training were essentially unchanged, and the mean of pre-and post-training fractional shortening(FS) and LV and left atrial dimensions were similar. The high voltage in ECG's showed no close correlation with LV dilatation or hypertrophy on UCG's. After the training, however, the mean values of the thickness of LV posterior wall and ventricular septum along with LV mass were significantly increased, and the right ventricular dimension was significantly decreased. CONCLUSIONS: The most frequent finding in ECG's and UCG's in soccer players, before and after intensive training,were high voltage, LV dilatation and /or hyperophy with or without ASH. The intensive training of 5-5.5 months duration caused no change in F8,but caused significant increase in the thickness of LV posterior wall and ventricular septum, and LV mass.
Dilatation ; Electrocardiography* ; Heart ; Hypertrophy ; Incidence ; Running ; Soccer* ; Ventricular Septum

Although a vascular tumor of the spinal cord is a fairly common lesion, and is often asymptomatic, it was recently found more frequently by contrast myelography and selective spinal angiography. The first report on an angioma of the spinal cord was made by Hebold in 1885. They may be classified as malformation composed of masses of tortuous interlacing vessels. A benign vascular tumor of the spinal cord may occur at any level and within the structures of the spinal canal. The cord involved directly by portions of the varix, foci of infarction of the involved cord may be thrombosis of the vessels of the angioma. Vascular tumors of the cord are difficult to treatment. An attempt can be made to reduce the size of the angioma by ligation or resection, but it is imperative that the blood supply to the spinal cord or nerve roots should not be injured. Roentgen therapy may be of value. We have experienced in 3 patients with vascular tumor involving the spinal epidural space. They had paraparesis or paraplegia with sensory level and urinary difficulity. Roentgenograms show perpendicular striations in the vertebral body owing to coarse trabeculations surrounding the dilated vascular spaces. Myelogram shows subarachnoid blockade in the epidural space by a tumor mass. Total laminectomy was performed, and the vascular tumor mass was removed, thereafter the neurological signs were some improved.
Angiography ; Epidural Space ; Hemangioma ; Humans ; Infarction ; Laminectomy ; Ligation ; Myelography ; Paraparesis ; Paraplegia ; Spinal Canal ; Spinal Cord ; Spine* ; Thrombosis ; Varicose Veins