No abstract available.
Encephalitis, Arbovirus*

BACKGROUND: Colistin (polymyxin E) is active against multidrug-resistant Gram-negative bacteria (MDR-GNB). However, the effectiveness of inhaled colistin is unclear. This study was designed to assess the effectiveness and safety of aerosolized colistin for the treatment of ventilator-associated pneumonia (VAP) caused by MDR-GNB. METHODS: In this retrospective longitudinal study, we evaluated the medical records of 63 patients who received aerosolized colistin treatment for VAP caused by MDR-GNB in the medical intensive care unit (MICU) from February 2012 to March 2014. RESULTS: A total of 25 patients with VAP caused by MDR-GNB were included in this study. The negative conversion rate was 84.6% after treatment, and acute kidney injury (AKI) occurred in 11 patients (44%, AKI group). The average length of MICU stay and colistin treatment- related factors, such as daily and total cumulative doses and administration period, were not significantly different between groups. In-hospital mortality tended to be higher in the AKI group (p = 0.07). Multivariate analysis showed that a body mass index less than 18 was an independent risk factor of mortality (odds ratio [OR] = 21.95, 95% confidence interval [CI] 1.59-302.23; p = 0.02). Notably, AKI occurrence was closely related to the administration of more than two nephrotoxic drugs combined with aerosolized colistin (OR = 15.03, 95% CI 1.40-161.76; p = 0.025) and septic shock (OR = 8.10, 95% CI 1.40-161.76; p = 0.04). CONCLUSIONS: The use of adjunctive aerosolized colistin treatment appears to be a relatively safe and effective option for the treatment of VAP caused by MDR-GNB. However, more research on the concomitant use of nephrotoxic drugs with aerosolized colistin will be necessary, as this can be an important risk factor of development of AKI.
Acute Kidney Injury ; Body Mass Index ; Colistin* ; Drug Resistance, Microbial ; Gram-Negative Bacteria ; Hospital Mortality ; Humans ; Intensive Care Units ; Longitudinal Studies ; Medical Records ; Mortality ; Multivariate Analysis ; Pneumonia* ; Pneumonia, Ventilator-Associated ; Retrospective Studies ; Risk Factors ; Shock, Septic ; Treatment Outcome*

No abstract available.
Epinephrine*

No abstract available.
Epinephrine*

Vaginal intraepithelial neoplasia III, is a relatively rare disease. Consequently standard treatments for this disease were not established until recently. Although several convenient methods, such as laser ablation, 5-fluorouracil topical injection, and radiation therapy, have been applied for treating these lesions, surgical treatments, including vaginectomy, have not yet been attempted, as they would likely be accompanied by technical difficulties and various complications. Herein, we report a case of refractory vaginal intraepithelial neoplasia III in the vaginal vault that was successfully treated with a total vaginectomy.
Fluorouracil ; Laser Therapy ; Rare Diseases

No abstract available.
Hepatitis*

Nandrolone decanoate(ND), one of the anabolic steroids, has been used by athletes to build muscle mass and enhance weight-lifting performance and has also shown to be useful in malnourished ESRD patients. However, ND has several adverse effects including edema. After we experienced a case of severe edema and transient ultrafiltration failure(TUF) requiring more frequent number of dialysis during ND treatment, we prospectively studied the incidence and clinical characteristics of TUF during ND treatment. Among 30 ND-treated patients, 7 patients developed TUF. All TUF+ patients were female and had sigificantly higher number of patients with congestive heart failure, more use of minoxidil and moderate to severe malnutrition than TUF- patients. There were no significant differences in age, duration of dialysis, and number of diabetics between TUF+ and TUF- group. In ND-treated male patients, the number of patients with CHF and moderate to severe malnutrition and with use of minoxidil were significantly lower than TUF+ ones. Body weight and serum albumin concentrations were significantly increased 2-3 months after ND treatment in TUF+ patients. But there were no differences in body weight and serum albumin in TUF-patients. In TUF+ patients, frequency of HD increased from 3 times to 4 to 6 times a week. CAPD patients with TUF+ had more frequently used 4.25% dialysate and number of exchanges were increased. In most TUF+ patients, severe edema and TUF were disappeared about 2 weeks after treatment. Most TUF+ patients returned to previous schedle of dialysis. In conclusion, ND seems to induce TUF in ESRD patients who had risk for volume regulation such as CHF, hypoalbuminemia, or the use of minoxidil.
Athletes ; Body Weight ; Dialysis* ; Edema ; Female ; Heart Failure ; Humans ; Hypoalbuminemia ; Incidence ; Kidney Failure, Chronic* ; Male ; Malnutrition ; Minoxidil ; Nandrolone* ; Peritoneal Dialysis, Continuous Ambulatory ; Prospective Studies ; Renal Dialysis ; Serum Albumin ; Steroids ; Ultrafiltration*

In previous studies, the synergistic antiproteinuric effect of the combination therapy of ACE inhibitors and angiotensin II receptor antagonists (ATRAs) has been inconsistent in relation to underlying renal diseases. The influence from the blood pressure (BP) - reducing effect in some studies might also contribute to this inconclusiveness. To examine the possibility of the benefit being different according to underlying renal diseases, we undertook a crossover therapeutic trial of the combination therapy in two selected homogenous groups of patients with diabetic and non-diabetic renal diseases. The BP-reducing effect was excluded during the study. Nineteen biopsy-proven IgA nephropathy, as examples of non-diabetic renal diseases, and 24 type 2 diabetic nephropathy patients were selected as the study subjects. The subjects had to meet the follow criteria: a creatinine clearance (Ccr) between 25 - 90 ml/min/1.73 m2, 24-hr urinary protein excretion rate over 1.0 g/day and a BP maintained at less than 130/80 mmHg, with more than six-month therapy of ramipril, (5.7 +/- 0.4 mg/day, 13 +/- 2 month). The baseline data between the two groups showed no significantly differences. After a 12-week stabilization period (control period), 4 mg, once daily, dose of candesartan (combination period) followed by a placebo (placebo period), or vice versa, were administered in addition to the ramipril, for 12 weeks. The combination, with candesartan, did not change the Ccr, BP, serum and urinary electrolytes or the urea. The 24 hour urinary protein excretion rate was significantly reduced by the combination therapy in the patients with IgA nephropathy (3.1 +/- 0.3 g/day in combination, 4.2 +/- 0.3 in control, and 4.3 +/- 0.2 in placebo; p < 0.05). However, the patients with diabetic nephropathy showed no reduction in their proteinuria with the combination therapy (3.8 +/- 0.2 g/day in combination, 3.9 +/- 0.3 in control, and 4.1 +/- 0.3 in placebo; p=NS). The changes in proteinuria showed no relationship with the changes in the BP in IgA nephropathy. In conclusions, the benefit of combination therapy of its antiproteinuric effect was different between IgA and diabetic nephropathy over the 12-week trial. The difference in the pathophysiological role, and the importance of the renin- angiotensin system, between the two diseases might contribute to the discrepancy in the result. We suggest the discrimination of the underlying renal diseases in the study subjects is an important prerequisite for future studies on this issue.
Adult ; Angiotensin-Converting Enzyme Inhibitors/*therapeutic use ; Cross-Over Studies ; Diabetic Nephropathies/*urine ; Double-Blind Method ; Drug Therapy, Combination ; Female ; Glomerulonephritis, IGA/*urine ; Human ; Male ; Middle Aged ; Proteinuria/*drug therapy/*etiology ; Receptors, Angiotensin/*antagonists & inhibitors ; Treatment Outcome

During the last 7 years from Jan. 1973 to Dec. 1979, 106 cases of typhoid fever has been admitted to the department of Pediatrics of Won Ju Christian Hospital and evaluated clinicaIly. The results were summarized as follows 1. Tota1 number of the patients was 106, of which 62 were male and 44 were female. The peak age group was over 11 years of age and the youngest case was 6 month old male patient. The seasonal incidence was high in July to September. 2. The clinical symptoms on admission were as follows: fever(93.4%), abdominal pain(56.6%), headache(26.4%), nausea and vomiting(25.5%), diarrhea(20.3%) and cough(16.0%) The physical findings were as follows: fever(68.9~), injected throat(56. 690), hepatomegaly(50.0%), coated tongue(45.3%), abdominal tenderness(33.0%), splenomegaly(20.8%) and bradyeardie(16.0%). 3. Anemia was 41.590 and leukopenia was 27.4%. Widal test was positive in 73.6% of all 129 tests. The positive bacteriologic cultures were 56.9% in blood and 10.4% in stool, respectively. 4. The average days of defevervescence was 3. 66 days in CM, 3. 88 days in ampicillin, 2.80days in CM combined with ampicillin and 2.71 days in ampicillin with prednisolone, of each. The doplication was noted in 24 cases(22.6%), which included pneumonia(7 cases), intestinal perforation(7 cases) and intestinal hemorrhage(3 cases).
Ampicillin ; Anemia ; Female ; Gangwon-do ; Humans ; Incidence ; Infant ; Leukopenia ; Male ; Nausea ; Pediatrics ; Prednisolone ; Seasons ; Typhoid Fever*

Peritonitis is one of the major complication of continuous ambulatory peritoneal dialysis (CAPD) and the most common cause of hospital admission and for termination of peritoneal dialysis. We retrospectively analyzed the incidences and causative organisms of CAPD peritonitis according to season/month of the year under the hypothesis that climate factors, increased temperature and humidity, may changes the incidences and causative organisms of peritonitis. There were a few studies about this issue and in most cases the result was inconclusive because of the limitation in the limited range of climate factors such as temperature and humidity. Wide annual differences of temperature (-3.4-25.4 degrees C) and humidity (61-81%) may affect the rate of peritonitis episode in the area where the current study was performed. Data from 80 patients(49 male, 31 female), with a mean age 48.3+/-14.5 years and mean CAPD period 14.0+/-9.0 months, followed from September 1996 to July 1999, were reviewed. Fifty-three cases of peritonitis were found in 1,123 patient-months, a rate of 0.56 episode/patients- year, and 0.047 episode/patient-month. The months in which the incidence of peritonitis above average was March (5.05%), May(7.96%), July (10.8%), August (6.25%), September (6.06%). The incidence of peritonitis was the lowest in November (1.31%). The incidence in hot season (May-September : average temperature for three years 21.9degrees C, humidity 74%) was 0.065 episodes/patient-month, which was significantly higher than in cold season (October-February : 5.9degrees C, 64.4%)(p<0.05). Average temperature for three years in the study area was 13.2degrees C with maximal temperature of 25.4degrees C (August) and minimal of -3.4 degrees C (January). Average humidity for three years in the study area was 68.4% with maximal humidity of 81% (July) and minimal of 61% (April). The incidence of peritonitis paralleled with temperature and humidity, highest in July (0.080/pt-month) and lowest in November (0.013/pt-month) and were directly correlated with temperature (r=0.53, p<0.05) and humidity (r=0.59, p<0.05). Among 53 episodes of peritonitis, gram positive peritonitis, gram negative peritonitis and culture negative peritonitis were 36.9%, 15.0% and 45.2%, respectively. From March to August, gram positive peritonitis was 50% and culture negative peritonitis was 42.4%. From September to February, culture-negative peritonitis was 52.9% and gram negative peritonitis organisms was 29.4%. In contrast to gram positive organisms which showed increased in hot weather, gram negative organisms showed uniform distribution throughout the year. There were no significant monthly differences in peritoneal fluid WBC count on admission and negative conversion period of that. Our data suggest that high temperature and humidity can adversely affect the incidence of CAPD peritonitis and may change the distribution of causative organisms.
Ascitic Fluid ; Climate* ; Humans ; Humidity ; Incidence ; Male ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis* ; Retrospective Studies ; Seasons ; Weather