BACKGROUND: Continuous monitoring systems have allowed determination of the time-to-positivity (TTP). We evaluated the clinical relevance of TTP in the BACTEC9240 system (Becton-Dickinson, USA). METHODS: A total of 2,354 vials of positive blood cultures were evaluated over 2 months. TTP was monitored from each of BACTEC Plus Aerobic/F (BD) or Pediatric Plus/F and Lytic Anaerobic/F bottles, and the differential time-to-positivity (DTP) for blood samples drawn simultaneously via catheter and a peripheral site was determined. RESULTS: The average TTP of the positive vials was 17.4 hr, and 79.9% and 95.2% of the vials showed positivity within 24 and 48 hr, respectively. While the average TTP values for Aeromonas hydrophila, Bacillus cereus, Acinetobacter baumannii, and Streptococcus pneumoniae were less than 10 hr, those for Candida spp., anaerobes, Propionibacterium acnes, Corynebacterium spp, Bacillus spp. other than cereus, and coagulase-negative staphylococci were 35.3, 27.0, 56.8, 45.8, 23.0, and 26.3 hr, respectively. The negative predictive values of TTP over 24 hr to predict Staphylococcus aureus among staphylococci and S. pneumoniae among alpha-hemolytic streptococci were 76.7% and 100%, respectively. Enterobacteriaceae and Enterococcus faecalis showed shorter TTP in anaerobic vials than in aerobic vials. DTP of more than 2 hr was observed for 27.8%, 72.2%, and 45.5% of S. aureus, S. epidermidis, and Candida spp. CONCLUSIONS: TTP can be used to discriminate pathogens and contaminants. The shorter TTP in anaerobic vials of certain Enterobacteriaceae and Enterococcus spp. would facilitate further identification. DTP is useful for diagnosing catheter-related bloodstream infection by S. aureus, S. epidermidis, and Candida spp.
Bacteremia/*diagnosis ; Bacteria, Aerobic/isolation &purification ; Bacteria, Anaerobic/isolation &purification ; Bacteriological Techniques/instrumentation/methods ; Humans ; Reagent Kits, Diagnostic ; Time Factors

No abstract available.
Female ; Pregnancy ; Pregnancy, Ectopic*

Many organic and nonorganic agents can cause chemical pneumonitis. Chemical pneumonitis induced by inhalation of acetic acid is a rare clinical condition. As acetic acid is a water soluble agent, it causes chemical irritation to respiratory tract and causes variable symptoms. We experienced a case of acute lung injury due to inhalation of acetic acid fume. A 56-year-old male patient was admitted due to dyspnea with vomiting for one day. After he inhaled acetic acid fume in occupational situation, he had chest tightness, chilling sense, and productive cough. Our case was good response to oxygen inhalation, antibiotics, and systemic steroids.
Acetic Acid* ; Acute Lung Injury ; Anti-Bacterial Agents ; Cough ; Dyspnea ; Humans ; Inhalation* ; Male ; Middle Aged ; Oxygen ; Pneumonia* ; Respiratory System ; Steroids ; Thorax ; Vomiting ; Water

In this part the writing group will cover strategies, techniques, and endpoints of atrial fibrillation (AF) ablation. Prior to all, electrical isolation of the pulmonary veins is recommended during all AF ablation procedures. In addition, techniques to be used for ablation of persistent and long-standing persistent AF, adjunctive ablation strategies, nonablative strategies to improve outcomes of AF ablation, and endpoints for ablation of paroxysmal, persistent, and long-standing persistent AF will be reviewed. Currently many technologies and tools are employed for AF ablation procedures. Radiofrequency energy, cryoablation, and other energy sources and tools are in various stages of development and/or clinical investigation. Finally, anticoagulation strategies pre-, during, and postcatheter ablation of AF and technical aspects of ablation to maximize safety are discussed in this section.
Atrial Fibrillation ; Catheter Ablation ; Catheters ; Cryosurgery ; Pulmonary Veins ; Writing

Catheter and surgical ablation of atrial fibrillation (AF) have evolved from investigational procedures to their current role as effective treatment options for patients with AF. Surgical ablation of AF is available in most major hospitals throughout the world. Catheter ablation of AF is even more widely available, and is now the most commonly performed catheter ablation procedure. Management of patients with AF has traditionally consisted of three main components: (1) anticoagulation for stroke prevention; (2) rate control; and (3) rhythm control. With the emergence of large amounts of data, which have both defined and called attention to the interaction between modifiable risk factors and the development of AF and outcomes of AF management, we believe it is time to include risk factor modification as the fourth pillar of AF management. Catheter and surgical ablation of AF are highly complex procedures, therefore a decision to perform catheter or surgical AF ablation should only be made after a patient carefully considers the risks, benefits, and alternatives to the procedure.
Atrial Fibrillation ; Catheter Ablation ; Catheters ; Humans ; Risk Factors ; Stroke

A hemangioma is the most common benign hepatic tumor. Many hepatic hemangioma tend to be found incidentally, but should be differentiated from malignant tumors, especially in patients with a high risk for malignancy. We presented a 52-year-old woman who diagnosed as hepatic hemangioma. The patient was a chronic alcohol abuser and diagnosed as a hepatic C virus carrier for the first time. Contrast enhanced abdominal computed tomography (CT) revealed a 4cm sized hepatic mass involving both segment 5 and 6. Abdominal CT finding suggested hepatic hemangioma, but could not rule out the malignancy. Because the patient had risk factors for hepatocellular carcinoma, abdominal ultrasonography (US) was performed for further evaluation. But abdominal US also showed atypical finding. For the confirmative diagnosis, dynamic magnetic resonance imaging using gadoxetate disodium (primovist(R), Bayer HealthCare, Berlin, Germany) which is the innovative liver cell-specific contrast medium was done, and the patient was diagnosed as hepatic hemangioma.
Berlin ; Carcinoma, Hepatocellular ; Delivery of Health Care ; Diagnosis ; Female ; Hemangioma* ; Hepatitis C ; Hepatitis C, Chronic* ; Hepatitis, Chronic* ; Humans ; Liver ; Magnetic Resonance Imaging* ; Middle Aged ; Risk Factors ; Tomography, X-Ray Computed ; Ultrasonography

An abdominal pregnancy is defined as an ectopic pregnancy, which implants in the peritoneal cavity and can be classified as either primary or secondary. The incidence of abdominal pregnancy is increased after IVF or GIFT, induced abortion, endometriosis, and intrauterine devices may also contribute to an increased incidence. Early diagnosis and appropriate surgical management, regardless of stage of gestation, appear to be important in achieving good results. A case of early primary abdominal pregnancy which was implanted on the left uterosacral ligament. We report the case and brief review of literature.
Abortion, Induced ; Early Diagnosis ; Endometriosis ; Female ; Incidence ; Intrauterine Devices ; Ligaments ; Peritoneal Cavity ; Pregnancy ; Pregnancy, Abdominal* ; Pregnancy, Ectopic

Sorafenib (Nexavar) has been regarded as a treatment for unresectable hepatocellular carcinoma (HCC), with side effects that include hand-foot skin reaction, diarrhea, rash, fatigue, hypertension, nausea, anorexia, weight loss, and alopecia. Thyroid disorder, such as endocrine side effect, has also been reported. However no case involving adrenal insufficiency has been reported. Here, we report a case of adrenal insufficiency which occurred after taking sorafenib in a patient with HCC. A 56-year-old man visited our hospital due to right upper quadrant abdominal pain and he was diagnosed as multiple disseminated and unresectable HCCs with portal vein invasion; therefore transarterial chemoembolization was performed and sorafenib administration was started. Two months later, he was admitted to the hospital complaining of severe fatigue. The laboratory results showed cortisol of <0.2µ g/dL and adrenocorticotropic hormone of <1.00 pg/mL. The patient had no history of taking steroids or herbal medications. Secondary adrenal insufficiency was diagnosed and prednisolone 10 mg per day was started immediately; as a result, fatigue remarkably improved. This may be the first report indicating a possible association between sorafenib and adrenal insufficiency and it implies that the possibility of adrenal insufficiency should be considered in patients taking sorafenib who complain of severe fatigue.
Abdominal Pain ; Adrenal Insufficiency* ; Adrenocorticotropic Hormone ; Alopecia ; Anorexia ; Carcinoma, Hepatocellular* ; Diarrhea ; Exanthema ; Fatigue ; Humans ; Hydrocortisone ; Hypertension ; Middle Aged ; Nausea ; Portal Vein ; Prednisolone ; Skin ; Steroids ; Thyroid Gland ; Weight Loss

BACKGROUND/AIMS: Heat shock proteins (HSPs) protect rats from cerulein-induced acute pancreatitis (AP) by preventing the subcellular redistribution of cathepsin B and the activation of trypsinogen. Autophagy plays a critical role in the secretion of digestive enzymes and triggering of cerulein-induced AP via the colocalization of trypsinogen and lysosomes. Therefore, using a rat cerulein-induced AP model, we investigated whether HSPs prevent AP by regulating autophagy. METHODS: Twelve hours after fed standard laboratory chow and water, the experimental groups (cerulein, water-immersion [WI]-cerulein and heat-shock [HS]-cerulein) and the control groups (control, WI, and HS) received one intraperitoneal injection of cerulein (50 microg/kg) or saline, respectively. All of the rats were sacrificed at 6 hours after injection. The severity of the AP was assessed based on the serum amylase level and the histological and electron microscopy findings. Western blotting was also performed for HSP60/70 and LC3B-II. RESULTS: WI and HS induced HSP60 and HSP70, respectively. The induced HSP60/70 effectively prevented the development of cerulein-induced AP. Autophagy developed in the rats with cerulein-induced AP and was documented by the expression of LC3-II and electron microscopy findings. The WI-stressed rats and HS-treated rats did not develop cerulein-induced autophagy. CONCLUSIONS: HSPs exert protective effects against cerulein-induced AP in rats by inhibiting autophagy.
Amylases ; Animals ; Autophagy ; Blotting, Western ; Caerulein ; Cathepsin B ; Heat-Shock Proteins ; Hot Temperature ; Injections, Intraperitoneal ; Lysosomes ; Microscopy, Electron ; Pancreatitis ; Rats ; Trypsinogen ; Water

PURPOSE: The purpose of this study is to develop a course to teach through problem-based learning the use of antibiotics during an internal medicine clerkship, and to evaluate the responses of students to it. METHODS: The course was designed to teach third-year medical students how to prescribe antibiotics to be given to real patients. A qualitative evaluation for the modified problem-based learning was performed by tutor's observation and focus group interview, and a quantitative evaluation by questionnaires before and after the course. RESULTS: Seventy-nine students experienced the modified problem-based learning during the infectious disease section of an internal medicine clerkship. Most students participated actively and gave a positive evaluation expressing a need for problem-based learning on prescribing antibiotics. The course significantly increased the students' self-confidence in both approaching patients and prescribing antibiotics. CONCLUSION: Modified problem-based learning is a useful educational tool in clinical clerkship.
Anti-Bacterial Agents* ; Clinical Clerkship ; Communicable Diseases ; Evaluation Studies as Topic ; Focus Groups ; Humans ; Internal Medicine* ; Problem-Based Learning* ; Students, Medical ; Surveys and Questionnaires