No abstract available.
Diagnosis* ; Respiratory Distress Syndrome, Adult*

Fat embolism syndrome (FES) is a clinical manifestation that consists of multiple organ dysfunction due to fat emboli. FES occurs as a complication after trauma or procedures such as surgery. The diagnostic criteria of FES have not yet been established, so clinical criteria are used for its diagnosis. The clinical course of acute fulminant FES can be rapid. Liposuction surgery, in which adipocytes are mechanically disrupted, is one cause of FES. As the number of liposuction surgeries increases, clinicians should be aware of the possibility of FES. This was the first report of a case of acute fulminant FES with severe acute respiratory distress syndrome after liposuction surgery, in Korea.
Adipocytes ; Diagnosis ; Embolism, Fat* ; Korea ; Lipectomy* ; Respiratory Distress Syndrome, Adult

Adult respiratory distress syndrome(ARDS) is a descriptive term that has been applied to many acute, diffuse infiltrating lung lesions of various etiology when they are accompanied by severe arterial hypoxemis. Despite the various eiology, clinical symptom and nonspecific pathophsiologic derangement, ARDS has a high mortality rate. But early diagnosis and prompt good management including PEEP therapy will decrease the mortality rate. This report described a case of ARDS following anesthesia and also discussed with literature.
Adult* ; Anesthesia* ; Early Diagnosis ; Humans ; Lung ; Mortality ; Respiratory Distress Syndrome, Adult*

PURPOSE: To describe the high-resolution CT findings of varicella-zoster pneumonia. MATERIALS AND METHODS: Seven adult patients with clinically and serologically diagnosed varicella-zoster pneumonia underwent HRCT scanning. One had undergone a kidney transplant, and the others were immunocompetent. The HRCT findings were retrospectively analyzed by two radiologists in terms of the presence of a nodule, pneumonic consolidation, ground-glass attenuation and pleural effusion, and with regard to the number, size and distribution of nodules. RESULTS: HRCT findings of varicella pneumonia included nodule (n=7), consolidation (n=3), diffuse groundglass attenuation (n=1) and pleural effusion (n=1). Nodules were mostly 2-10 mm in size, and multiple (n=6), and zonal predominancy was not apparent. One case in which HRCT demonstrated diffuse groundglass opacity and slight bilateral pleural effusion involved a patient in whom complications of acute respiratory distress syndrome occured. CONCLUSION: When HRCT demonstrates the presence of nodules 2-10 mm in size multiple nodules, or nodule surrounded by ground-glass attenuation, or the coalescence of nodules and consolidation is observed in adults with chickenpox, the varicella-zoster pneumonia should be included in the differential diagnosis.
Adult ; Chickenpox ; Diagnosis, Differential ; Fluconazole ; Humans ; Kidney ; Pleural Effusion ; Pneumonia* ; Respiratory Distress Syndrome, Adult ; Retrospective Studies

ObjectiveAcute respiratory distress syndrome (ARDS) is a devastating clinical syndrome whose diagnosis and therapy are still in question. The aim of this review was to discuss the current challenge for the diagnosis and treatment of ARDS.

Data SourcesData sources were the published articles in English through December 2017 in PubMed using the following key words: "acute respiratory distress syndrome," "definition", "diagnosis," "therapy," "lung protective strategy," "right ventricular dysfunction," and "molecular mechanism."

Study SelectionThe selection of studies focused on both preclinical studies and clinical studies of therapy of ARDS.

ResultsThe incidence of ARDS is still high, and ARDS causes high intensive care units admissions and high mortality. The Berlin Definition proposed in 2012 is still controversial owing to lack of sensitivity and specificity. ARDS is still under recognition and it is associated with high mortality. Lung protective strategies with low tidal volume (VT) and lung recruitment should consider the physiology of ARDS because ARDS presents lung inhomogeneity; the same low VT might increase local stress and strain in some patients with low compliance, and lung recruitment could injure lungs in ARDS patients with low recruitability and hemodynamic instability. Acute cor pulmonale is common in severe ARDS. ARDS itself and some treatments could worsen acute cor pulmonale. Molecular understanding of the pathogenic contributors to ARDS has improved, but the molecular-associated treatments are still under development.

ConclusionsARDS is a devastating clinical syndrome whose incidence and mortality has remained high over the past 50 years. Its definition and treatments are still confronted with challenges, and early recognition and intervention are crucial for improving the outcomes of ARDS. More clinical studies are needed to improve early diagnosis and appropriate therapy.

H-type tracheoesophageal fistula (TEF) is extremely rare in infants and children, and clinical manifestations of this condition are diverse based on its severity. Some cases of congenital TEF diagnosed in adulthood have been reported, which indicate the difficulty of early diagnosis of this disease. Gastroesophageal reflux (GER) may induce chronic aspiration, pulmonary aspiration, apparent life-threatening events, and failure to thrive. We report a 5-month- old boy whose recurrent pneumonia and wheezing did not improve under usual treatment and led to acute respiratory distress syndrome. He was found to have severe GER on the second-trial of the esophagogram and was eventually revealed to have congenital H-type TEF upon repeated evaluation.
Child ; Early Diagnosis ; Failure to Thrive ; Gastroesophageal Reflux ; Humans ; Infant ; Pneumonia ; Respiratory Distress Syndrome, Adult ; Respiratory Sounds ; Tracheoesophageal Fistula

OBJECTIVE: To study the characteristics of the diagnostic parameters of acute respiratory distress syndrome/multiple organ dysfunction syndrome on plateau (H-ARDS/MODS) and compare the accuracy of the three MODS scoring criteria in predicting the outcome of syndrome. METHODS: Five hundred and forty cases fulfilling the criteria of MODS were divided into four groups according to the altitude of their inhabitation area: control group (on plain, CG, n=113, altitude: <430 m), moderate high altitude group 1 (H1G, n=314, altitude: 1,517 m), moderate high altitude group 2 (H2G, n=78, altitude: 2,261 m to 2,400 m) and high altitude group (HG, n=35, altitude: 2 808 m to 3 400 m). According to the diagnostic criteria of Lushan conference and Marshall (1995) commonly used on plain, and Lanzhou criteria drafted by the authors, three data analyzing models were set up to draw the receiver operating characteristic (ROC) curves, the Yordon Index and the optimum cutoff points of the parameters were calculated and the accuracy of the three respective diagnostic criteria was evaluated in predicting the outcome of ARDS/MODS. Multiple factors affecting the outcome of MODS were analyzed using the method of stepwise forward regress model. RESULTS: Following the increase in altitude, Lanzhou criteria was clearly superior to the other two criteria in the area of ROC, the sensitivity, the specificity, and also for the optimum cutoff points of MODS. Multi-variable regression analysis showed that the impacting factor of Lanzhou criteria was the highest (P<0.05). CONCLUSION: (1)Some parameters of the current diagnostic criteria of ARDS/MODS are not suitable in moderately high or high altitude areas. It is necessary to set up the diagnostic criteria of H-ARDS/MODS. (2)Some clinical characteristics might change in areas 1,500 m altitude or higher. The pathophysiological mechanism might be attributable to peculiar biologic reactions due to hypoxia stress reaction, and it is worth further study.
Altitude ; Multiple Organ Failure/*diagnosis ; Prognosis ; ROC Curve ; Regression Analysis ; Respiratory Distress Syndrome, Adult/*diagnosis ; Severity of Illness Index

We report a cace of 69-year-old man who developed massive pulmonary hemorrhage and subsuquent adult respiratory distress syndrome following intravenous urokinase for acute myocardial infarction. Pulmonary hemorrhage is a rare but a potentially life-threatening complication after thrombolytic therapy and should be considered in the differential diagnosis of pulmonary infiltrates of falling hemoglobin after thrombolytic therapy for acute myocardial infarction with no obvious site of bleeding.
Adult* ; Aged ; Diagnosis, Differential ; Hemorrhage* ; Humans ; Myocardial Infarction* ; Respiratory Distress Syndrome, Adult* ; Thrombolytic Therapy* ; Urokinase-Type Plasminogen Activator

respiratory distress syndrome(ARDS) is severe acute hypoxic respiratory failure state with dynamic impairment in oxygen and carbon dioxide transfer with the need for high levels of supplementary oxygen and a high minute ventilation. This syndrome is caused by pulmonary edema due to increased permeability of the alveolar capillary barrier by various factors. ARDS is an uncommon, but a potentially life-threatening complication. Therefore, immediate diagnosis and appropriate therapy must be performed. The present case is post-extubation ARDS immediately occurred in an orthognathic surgery patient who are healthy 19-year-old man. He rapidly recovered from ARDS without complication by early diagnosis and proper treatment. This Case Report was aimed to describe the process of the development, possible causes and the management of ARDS occurred in an orthognathic surgery patient.]]>
Capillaries ; Carbon Dioxide ; Diagnosis ; Early Diagnosis ; Humans ; Orthognathic Surgery ; Oxygen ; Permeability ; Pulmonary Edema ; Respiratory Distress Syndrome, Adult ; Respiratory Insufficiency ; Ventilation ; Young Adult

BACKGROUND: The morbidity and mortality of Legionnaires' disease are not established in Korea, because patients with community-acquired pneumonia (CAP) have rarely been investigated for Legionella. An assay for Legionella antigen in urine has been approved as one of the diagnostic criteria of Legionnaires' disease. Binax Now(TM) Legionella Urinary Antigen Test (LUA) was introduced in Asan Medical Center in July 2002. The purpose of this study was to evaluate the clinical relevance of positive LUA. METHODS: During the 39-month period from July 2002 to September 2005, the medical records of LUA-positive patients were reviewed for demographic findings, laboratory findings, clinical diagnosis, antimicrobial treatment, outcome, and acquisition of infections. Diagnosis of Legionnaires' disease was based on National Nosocomial Infections Surveillance (NNIS) criteria for defining nosocomial pneumonia. RESULTS: Seven (0.3%) of the 2443 patients tested for LUA were positive. All 7 patients were consistent with the diagnostic criteria of Legionnaires' disease; six patients were diagnosed with CAP and one patient was admitted due to nosocomial pneumonia. Six patients were treated with azithromycin or ciprofloxacin but one patient was not treated for Legionella infection. With the report of LUApositive results, a Legionella-targeted treatment was started in two patients and an inappropriate empirical therapy was ceased in one patient. All patients treated with Legionella-targeted treatment improved clinically except one who died of adult respiratory distress syndrome at the first hospital day. CONCLUSIONS: Positive LUA is useful in diagnosing Legionnaire's disease at an early stage and in helping to initiate appropriate treatments in a tertiary-care hospital in Korea.
Azithromycin ; Chungcheongnam-do ; Ciprofloxacin ; Cross Infection ; Diagnosis ; Humans ; Korea* ; Legionella* ; Legionnaires' Disease ; Medical Records ; Mortality ; Pneumonia ; Respiratory Distress Syndrome, Adult