Charcoal has been commonly used for enteral detoxication although it causes few adverse effects. The major causes of morbidity and mortality secondary to activated charcoal therapy are pulmonary aspiration, gastrointestinal complication, and fluid and electrolyte abnormalities. Aspiration of charcoal is associated with pulmonary compromise due to increased microvascular permeability with concomitant lung edema, surfactant depletion, atelectasis, and obliterative bronchiolitis. Herein we report the case of a patient with acute respiratory distress syndrome with chemical pneumonitis after aspiration of activated charcoal in sorbitol with a review of the related literatures.
Bronchiolitis ; Capillary Permeability ; Charcoal ; Edema ; Humans ; Lung ; Pneumonia ; Pulmonary Atelectasis ; Respiratory Distress Syndrome, Adult ; Sorbitol

BACKGROUND: It is difficult to know the actual situation of antibiotic usage in Korea. We investigated the trend of antibiotic production every five years from 1981 to 2003 by using two parameters:the cost and the amount of antibiotics produced in Korea. MATERIALS AND METHODS: We analysed the data from "Annual Products of Medicine" published by Korea Pharmaceutical Manufactures Association. All antibiotics were classified into generic names, and the cost and the amount of antibiotic produced were compared with the results from previous years. RESULTS: The total production cost and the amount of antibiotics increased since 1980 and by 2003, it was 1,306 billion won and 965 tons respectively. However, the increasing rate of production cost has slowed down since 2000. Among all antibiotics produced in Korea, cephalosporins recorded the highest production cost, reaching 595 billion won (45.6%) in 2003. Cephalosporins made the largest portion of the total amount:252 tons (26.2%). Both 3rd and 4th generation cephlosporins have increased gradually. The second most frequently produced antibiotics in terms of amount were penicillins, although it decreased by 25% since 1998. Aminoglycosides showed similar production cost, but the production amount decreased compared to that of 1998. The production amount of quinolones had skyrocketed to 641% from 1998. Tetracyclines, lincosamides, and chloramphenicols insignificantly decreased in both production cost and amount. CONCLUSION: There seems to be an increase of antibiotics in production cost and amount in Korea, but the overall increasing rate of the cost has slowed down since 2000. The newer and more expensive antibiotics have grown in production.
Aminoglycosides ; Anti-Bacterial Agents ; Cephalosporins ; Chloramphenicol ; Korea* ; Lincosamides ; Penicillins ; Quinolones ; Tetracyclines

BACKGROUND: It is difficult to know the actual situation of antibiotic usage in Korea. We investigated the trend of antibiotic production every five years from 1981 to 2003 by using two parameters:the cost and the amount of antibiotics produced in Korea. MATERIALS AND METHODS: We analysed the data from "Annual Products of Medicine" published by Korea Pharmaceutical Manufactures Association. All antibiotics were classified into generic names, and the cost and the amount of antibiotic produced were compared with the results from previous years. RESULTS: The total production cost and the amount of antibiotics increased since 1980 and by 2003, it was 1,306 billion won and 965 tons respectively. However, the increasing rate of production cost has slowed down since 2000. Among all antibiotics produced in Korea, cephalosporins recorded the highest production cost, reaching 595 billion won (45.6%) in 2003. Cephalosporins made the largest portion of the total amount:252 tons (26.2%). Both 3rd and 4th generation cephlosporins have increased gradually. The second most frequently produced antibiotics in terms of amount were penicillins, although it decreased by 25% since 1998. Aminoglycosides showed similar production cost, but the production amount decreased compared to that of 1998. The production amount of quinolones had skyrocketed to 641% from 1998. Tetracyclines, lincosamides, and chloramphenicols insignificantly decreased in both production cost and amount. CONCLUSION: There seems to be an increase of antibiotics in production cost and amount in Korea, but the overall increasing rate of the cost has slowed down since 2000. The newer and more expensive antibiotics have grown in production.
Aminoglycosides ; Anti-Bacterial Agents ; Cephalosporins ; Chloramphenicol ; Korea* ; Lincosamides ; Penicillins ; Quinolones ; Tetracyclines

PURPOSE: As the proportion of patients with diabetes and old age increases, the use of arteriovenous graft (AVG) is increasing. However, there are few data about the comparison of the patency rate of native arteriovenous fistula (AVF) to that of AVG in Korea. We compared the outcome of native AVF to that of AVG with analysis of the factors affecting the patency of the permanent vascular access in use. METHODS: A retrospective database of all vascular access related procedures performed from January 1, 2003 to December 31, 2003 was established. We evaluated the primary unassisted and cumulative access patency rate with analysis of patency-related factors. We also evaluated the primary failure rate of AVF and AVG. RESULTS: 196 new vascular access surgeries were performed during the period. 14 cases were excluded due to loss of follow-up. 142 native arteriovenous fistulas (78%) and 40 grafts (22%) were constructed. The primary failure rate was similar between AVF and AVG group. The primary unassisted (78%, 72%, 68% vs. 62%, 41%, 22% at 1, 2, 3 year; p<0.001) and cumulative patency rate (93%, 88%, 85% vs. 84%, 74%, 73% at 1, 2, 3 year; p=0.087) were better in AVF group than in AVG group. The factors affecting the patency of vascular access were the type of vascular access and planned construction of permanent vascular access. CONCLUSION: Patency of native AVF as the permanent vascular access was better than that of AVG. Planned construction of permanent vascular access improved the patency of the access.
Arteriovenous Fistula ; Follow-Up Studies ; Humans ; Korea ; Renal Dialysis ; Retrospective Studies ; Transplants ; Vascular Patency

Catastrophic antiphospholipid syndrome (APS) is an accelerated subtype of APS that results in multiorgan failure. Although catastrophic APS represents about 0.8% of all APS cases, it is usually a life-threatening medical condition that requires high clinical awareness. Catastrophic APS has been managed by various therapies, including anticoagulation, corticosteroids, plasma exchange and IV immunoglobulin, but it still has a high mortality rate. A few cases treated by anticoagulation and steroids have been reported in Korea. In this paper, we report a case of catastrophic APS that improved after anticoagulation therapy alone. Thus, we consider hat our case shows another clinical aspect of catastrophic APS.
Adrenal Cortex Hormones ; Antiphospholipid Syndrome ; Immunoglobulins ; Korea ; Plasma Exchange ; Steroids

It is generally accepted that one-year post-transplant proteinuria over 0.5 gm per day has a negative impact on renal graft survival. In this study, the effects of minimal proteinuria less than 0.5 g/day were analyzed in 272 renal recipients who had survived for one year with a functioning graft. Recipients were classified by one-year posttransplant proteinuria: no proteinuria group (<0.2 g/day), minimal proteinuria group (0.2-0.5 g/day), and overt proteinuria group (> or =0.5 g/day). Recipients were followed up for 87.1+/-21 months after transplantation and 38 (13.9%) lost their graft during follow-up. Fifteen percent of patients had minimal proteinuria and 7.8% had overt proteinuria. Five-year graft survival in the minimal proteinuria group was 83.0%, and that in the overt proteinuria group was 70%, in contrast to 97.1% in the no proteinuria group (p=0.01 for trend). In a multivariate analysis, the minimal proteinuria group (relative risk [RR], 4.90; 95% confidence interval [CI], 2.09-11.46) and the overt proteinuria group (RR, 8.75; 95% CI, 3.29-23.29) had higher risks of graft failure than the no proteinuria group. Even minimal proteinuria at one year after transplantation was strongly associated with poor graft outcome. Therefore, it appears logical to consider a low level of proteinuria as a risk factor for graft survival in renal recipients.
Adult ; Female ; Graft Rejection ; Graft Survival ; Humans ; Immunosuppressive Agents/therapeutic use ; Kidney Transplantation/*adverse effects ; Living Donors ; Male ; Nephrology/*methods ; Proteinuria/*diagnosis/etiology ; Risk ; Risk Factors ; Time Factors ; Treatment Outcome

PURPOSE: The objective of this study was to investigate the clinical manifestations and risk factors associated with acute graft pyelonephritis (AGPN) and its impact on graft outcome. METHODS: We performed a retrospective study reviewing the medical records of 272 recipients with a graft survival of more than 1 year among 291 recipients that had undergone kidney transplantation between January 1995 and December 1999. RESULTS: Twenty eight (10.3%) patients had at least one episode of AGPN during a follow-up of 7.3 years, and 14 (50%) among them had recurrent episodes. 31.5% of total AGPN episodes had no any urinary signs and symptoms and only had a fever and leukocyturia. Escherichia coli and Klebsiella, the most common pathogens isolated, were susceptible to ciprofloxacin in 48.6% of cases and to ceftriaxone in 94.3% of cases. Acute rejection was not associated with the occurrence of AGPN. However, female gender was a risk factor for acute rejection (risk ratio 7.11, p<0.001). Vesicoureteral reflux in allograft was found in 72.7% of the recipients with an episode of AGPN (16/22). There was a trend toward more frequent development of vesicoureteral reflux in recipients with recurrent AGPN episodes (54.6% in patients with a single episode vs 90.9% in patients with recurrent episodes, p= 0.074). On Cox regression/Time-dependent covariate analysis, AGPN had no significant association with the graft or patient survival. CONCLUSION: AGPN is common after kidney transplantation, especially in women. However, AGPN was not associated with a poor long-term graft outcome.
Ceftriaxone ; Ciprofloxacin ; Escherichia coli ; Female ; Fever ; Follow-Up Studies ; Graft Survival ; Humans ; Kidney ; Kidney Transplantation ; Klebsiella ; Medical Records ; Pyelonephritis ; Rejection (Psychology) ; Retrospective Studies ; Risk Factors ; Transplantation, Homologous ; Transplants ; Vesico-Ureteral Reflux

The Mycobacterium avium-intracellulare complex (MAC) is the most common pathogen in pulmonary disease caused by a nontuberculous mycobacteria. Patients with MAC pulmonary disease tend to be older, are more likely to have underlying lung disease than tuberculosis patients. The insidious nature of MAC pulmonary disease has been emphasized in many reports because symptoms may be present for months or years before a diagnosis can be made. Most patients experience chronic coughing, which is usually productive of purulent sputum. A MAC pulmonary infection is rarely accompanied by acute respiratory symptoms and lobar pneumonic consolidation on chest radiography. We report a very rare case of M. intracellulare pulmonary disease presenting as acute pneumonia.
Cough ; Diagnosis ; Humans ; Lung Diseases ; Mycobacterium avium Complex* ; Mycobacterium avium-intracellulare Infection ; Mycobacterium* ; Nontuberculous Mycobacteria ; Pneumonia* ; Radiography ; Sputum ; Thorax ; Tuberculosis

Amebic liver abscess (ALA) has been diagnosed in travelers to endemic areas or in patients with immunosuppression secondary to human immunodeficiency virus infection since the late 1990s. Further, it is a rare disease in Korea. ALA should be considered in patients present with fever and right upper quadrant pain along with a risk of exposure to amebiasis. We report an 82-year-old man with symptoms of fever, gross hematuria and severe renal impairment as having amebic liver abscess complicated with the obstruction of the inferior vena cava. Amebic liver abscess was successfully treated with antibiotics alone. Also, hematuria disappeared and renal dysfunction improved after treatment.
Aged, 80 and over ; Amebiasis ; Anti-Bacterial Agents ; Fever ; Hematuria ; HIV ; Humans ; Immunosuppression ; Korea ; Liver Abscess, Amebic* ; Rare Diseases ; Renal Insufficiency ; Vena Cava, Inferior*

PURPOSE: Acute renal failure requiring dialysis (ARFD) after coronary intervention is a rare but serious complication, and it is associated with poor prognosis. This study investigated the clinical characteristics and risk factors of ARFD after coronary intervention in patients with chronic kidney disease (CKD). METHODS: This study included 178 adult patients with CKD (baseline serum creatinine of >1.3 mg/dL) undergoing coronary intervention at Samsung Medical Center from April 2003 through June 2007. We retrospectively evaluated the incidence, clinical outcome, and risk factor of ARFD via medical records. ARFD was defined as a decrease in renal function necessitating hemodialysis in the first 7 days after percutaneous coronary intervention. The estimated glomerular filtration rate (eGFR) was obtained using the Levey Modification of Diet in Renal Disease (MDRD) formula. RESULTS: Ten of the 178 patients (5.6%) developed ARFD with a subsequent in-hospital mortality rate of 10% (n=1). According to CKD stage, incidence of ARFD was 0/136 patients (baseline eGFR 30 to 90 ml/min/1.73m2 4/32 (15 to 29,) and 7/10 (<15) respectively (0% vs 9.4% vs 70%, p<0.0001). Multivariate analysis found eGFR (OR=0.5, 95% CI 0.3 to 0.9, p=0.02) to be only independent predictor of ARFD. Of those who developed ARFD (n=10), 2 patients stopped dialysis, 8 had required permanent dialysis. CONCLUSION: Incidence of ARFD increased according to the severity of renal dysfunction. The majority of ARFD patients had required permanent dialysis.
Acute Kidney Injury ; Adult ; Contrast Media ; Coronary Angiography ; Creatinine ; Dialysis ; Diet ; Glomerular Filtration Rate ; Hospital Mortality ; Humans ; Incidence ; Medical Records ; Multivariate Analysis ; Percutaneous Coronary Intervention ; Prognosis ; Renal Dialysis ; Renal Insufficiency, Chronic ; Retrospective Studies ; Risk Factors