BACKGROUND: Many physicians hesitate to discuss do-not-resuscitate (DNR) orders with patients or family members in critical situations. In the intensive care unit (ICU), delayed DNR decisions could cause unintentional cardiopulmonary resuscitation, patient distress, and substantial cost. We investigated whether the timing of DNR designation affects patient outcome in the medical ICU. METHODS: We enrolled retrospective patients with written DNR orders in a medical ICU (13 bed) from June 1, 2014 to May 31, 2015. The patients were divided into two groups: early DNR patients for whom DNR orders were implemented within 48 h of ICU admission, and late DNR patients for whom DNR orders were implemented more than 48 h after ICU admission. RESULTS: Herein, 354 patients were admitted to the medical ICU and among them, 80 (22.6%) patients had requested DNR orders. Of these patients, 37 (46.3%) had designated DNR orders within 48 hours of ICU admission and 43 (53.7%) patients had designated DNR orders more than 48 hours after ICU admission. Compared with early DNR patients, late DNR patients tended to withhold or withdraw life-sustaining management (18.9% vs. 37.2%, p = 0.072). DNR consent forms were signed by family members instead of the patients. Septic shock was the most common cause of medical ICU admission in both the early and late DNR patients (54.1% vs. 37.2%, p = 0.131). There was no difference in in-hospital mortality (83.8% vs. 81.4%, p = 0.779). Late DNR patients had longer ICU stays than early DNR patients (7.4 ± 8.1 vs. 19.7 ± 19.2, p < 0.001). CONCLUSIONS: Clinical outcomes are not influenced by the time of DNR designation in the medical ICU. The late DNR group is associated with a longer length of ICU stay and a tendency of withholding or withdrawing life-sustaining treatment. However, further studies are needed to clarify the guideline for end-of-life care in critically ill patients.
Advance Directives ; Cardiopulmonary Resuscitation ; Consent Forms ; Critical Illness* ; Hospital Mortality ; Humans ; Intensive Care Units ; Resuscitation Orders* ; Retrospective Studies ; Shock, Septic

No abstract available.
Emergencies* ; Emergency Medical Services*

No Abstract Available.
Carpal Tunnel Syndrome* ; Collagen* ; Humans ; Ligaments*

Ganglion is the most common soft tissue tumor which occurs mainly in hand, but it can also occur in any part of the extremity. It is not always necessary to excise the tumor because it seldom cause symptoms severe enough to take operation. We reviewed the patients with ganglion treated surgically. Exculding the cases which were operated under local anesthesia and Bakers cyst, 42 patients were treated surgically from 1983 to 1992. Females were 33, and males 9. Average age at the time of operation, was 40 years (16 to 67). All the cases were analysed retrospectively in terms of surgical indication, anatomical location, size, duration of symptoms, relationship between recurrence and size, and complication. The average duration of follow-up was 1 year 7 months, ranging from 1 year to 4 years. The causes of operation were, cosmetic problem in 6996 (29 cases); pain in 19% (8 cases); and both comesis and pain in 12% (5 cases). The locations were, wrist in 4696 (19 cases); knee 29% (12 cases); foot 12% (5 cases); hand 7% (3 cases); forearm 2% (1 case); ankle 2% (1 case); and elbow 296 (1 case). The size of mass was less than 2.5 cm in 30 cases (71%), and more than 2.5 cm in 12 (29%). (Total average of size was 2.4 cm)The average duration of symptoms were 28 months (1 month 15 years). The recurrence was found in 7 cases: 3 of them (10%) occurred among 30 cases the diameter of which was less than 2.5 cm, and other four (33%) occurred among 12 cases, larger than 2.5 cm. There were no other complications.
Anesthesia, Local ; Ankle ; Elbow ; Extremities ; Female ; Follow-Up Studies ; Foot ; Forearm ; Ganglion Cysts ; Hand ; Humans ; Knee ; Male ; Recurrence ; Retrospective Studies ; Wrist

Background/Aims: Secondary infection with influenza virus occurs in critically ill patients and is associated with substantial morbidity and mortality; however, there is limited information about it in patients with severe coronavirus disease 2019 (COVID-19). Thus, we investigated the clinical outcomes of and risk factors for secondary infections in patients with severe COVID-19. Methods: This study included patients with severe COVID-19 who were admitted to seven hospitals in South Korea between February 2020 to February 2021. Multivariate logistic regression analyses were performed to assess factors associated with the risk of secondary infections. Results: Of the 348 included patients, 104 (29.9%) had at least one infection. There was no statistically significant difference in the 28-day mortality (17.3% vs. 12.3%, p = 0.214), but in-hospital mortality was higher (29.8% vs. 15.2%, p = 0.002) in the infected group than in the non-infected group. The risk factors for secondary infection were a high frailty scale (odds ratio [OR], 1.314; 95% confidence interval [CI], 1.123 to 1.538; p = 0.001), steroid use (OR, 3.110; 95% CI, 1.164 to 8.309; p = 0.024), and the application of mechanical ventilation (OR, 4.653; 95% CI, 2.533 to 8.547; p < 0.001). Conclusions In-hospital mortality was more than doubled in patients with severe COVID-19 and secondary infections. A high frailty scale, the use of steroids and application of mechanical ventilation were risk factors for secondary infection.

Although uncommon, hemorrhage can be a complication of low grade glioma with an unfavorable prognosis such as transformation to higher grade glioma. To our knowledge, hemorrhagic recurrence of World Health Organization Grade II, diffuse astrocytoma without malignant transformation has not been reported. Thus, we report a case of diffuse astrocytoma with hemorrhagic recurrence without malignant transformation. The patient had undergone craniotomy and tumor removal 7 years previously. Annual follow-up MRIs had shown evidence of slow tumor recurrence. With the sudden onset of seizure, the patient was diagnosed as hemorrhagic recurrence and underwent second tumor removal highly suspecting malignant change into higher grade glioma. Histopathology confirmed diffuse astrocytoma without malignant changes. As the patient's postoperative condition was excellent, we plan to withhold chemotherapy and radiation therapy for use as a later treatment option.
Astrocytoma* ; Craniotomy ; Drug Therapy ; Follow-Up Studies ; Glioma ; Hemorrhage ; Humans ; Magnetic Resonance Imaging ; Prognosis ; Recurrence* ; Seizures ; World Health Organization

The double pylorus is a rare condition consisting of a double communication between gastric antrum and duodenal bulb. Some investigators postulate that the doubling of the pyloric channel is a congenital phenornenon, but others believe that it is an acquired lesion. A 72 year-old-man was admitted to this hospital because of epigastric pain for 1 month. Upper G-I series revealed thickened rnucosal folds of pylorus and duodenal bulb and dilated, deformed duodenal bulb filled with barium materials. Endoscopic findings also showed two ovoid large openings of the pyloric channel divided by smooth thickened septum and multiple gastroduodenal ulcers. We thought that this case was an acquired lesion. The relevant literatures on the subject were reviewed.
Barium ; Duodenal Ulcer ; Humans ; Peptic Ulcer ; Pyloric Antrum ; Pylorus* ; Research Personnel ; Stomach Ulcer

Eosinophilic gastroenteritis (EGE) is a rare disease characterized by focal or diffuse eosinophilic infiltration of the gastrointestinal tract, especially the stomach and duodenum. EGE has vague, nonspecific symptoms, including nausea, vomiting, abdominal pain, diarrhea, weight loss, ascites, and malabsorption. Here, we report a patient with EGE presenting with concurrent acute pancreatitis and ascites. A 68-year-old woman was admitted with abdominal pain, nausea, vomiting, and watery diarrhea. Laboratory findings revealed elevated serum titers of amylase, lipase, and peripheral blood eosinophil count. An abdominopelvic computed tomography scan showed a normal pancreas, moderate amount of ascites, and duodenal thickening. A esophagogastroduodenoscopy showed patchy erythematous mucosal lesions in the 2nd portion of the duodenum. Biopsies from the duodenum indicated eosinophilic infiltration in the lamina propria. The patient was successfully treated with prednisolone and montelukast. Despite its unusual occurrence, EGE may be considered in the differential diagnosis of unexplained acute pancreatitis, especially in a patient with duodenal edema on imaging or peripheral eosinophilia.
Acute Disease ; Aged ; Ascites/*etiology ; Enteritis/*complications ; Eosinophilia/*complications ; Female ; Gastritis/*complications ; Humans ; Pancreatitis/*etiology ; Tomography, X-Ray Computed

The dynamic performance of a skeletal muscle depends on the length-force and force-velocity relationships. The length-force relationship of muscle was described by Blix for the first time. The contractile elements of muscles produce the active length-force curve. The objective of this study is to determine the length-force relationship of the rabbit's soleus muscle and changes of tetanic force according to the position of ankle joint. The amount of excursion of the soleus muscle for full range of motion of the ankle joint was 25 mm. The ratio of excursion compared to the length of neutral position was 24%. That means that the soleus muscle has large amount of excursion that is responsible for producing active force throughout the whole range of ankle motion. The length at which active force of the muscle is maximal is called optimum length(Lo). The ratio of the optimum length compared to the length of neutral position was 98%. This means that the active force of the soleus muscle was maximal at the position of slight plantarflexion(about 2 degrees of plantarflexion). The value of the tetanic force was 3.1kg/cm2 in average, and the active length-force curve showed asymmetrical shape. The effective range is a length change from minimal point of zero active force to maximal point of zero active force. In this study, the minimal point of zero active force was 11mm shorter and maximal point of zero active force was 13mm longer than optimum length. Therefore, the effective range was 24mm. Active force increased abruptly at which muscle length was 90% of neutral length. At that point, active force was less than 20% of maximal tetanic force.
Ankle Joint* ; Ankle* ; Muscle, Skeletal* ; Muscles ; Range of Motion, Articular

PURPOSE: The purpose of this study is to evaluate the radiologic and clinical outcomes after tension band wire fixation of Neer type II distal clavicle fractures. MATERIALS AND METHODS: Twenty-six patients with Neer type II distal clavicle fractures who underwent tension band wire fixation from March 2002 to May 2011 were included in the study. Fifteen cases were classified as Neer type IIa and 11 cases as type IIb. The postoperative mean follow-up period was 14.3 months. Clinical and radiologic evaluation was performed at two weeks, six weeks, three months, six months, and 12 months postoperatively. RESULTS: Bony union on X-rays was observed at an average of 11.7 weeks (range 8-20 weeks) postoperatively. The overall visual analogue scale score for pain was 1.23+/-2.75 postoperatively. The overall postoperative University of California at Los Angeles score increased to 33.5+/-2.15 from the preoperative score of 21.6+/-1.91 (p<0.05). CONCLUSION: Among various methods of treatment for Neer type II distal clavicle fracture, K-wire and tension band fixation was used and relatively satisfactory radiological and clinical results were obtained. This surgical method yields excellent clinical results, owing to its relatively easy technique, fewer complications, and allowance of early rehabilitation.
California ; Clavicle* ; Follow-Up Studies ; Humans ; Rehabilitation