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*

No abstract available.
Helicobacter pylori* ; Helicobacter* ; Peptic Ulcer* ; Prevalence* ; Stomach Neoplasms*

Heteratopic or ectopic pancreas is found in 0.5% to 13% autopsy series and also found one in approximately every 500 operations in abdominal surgery. The mast common sites are stomach (esp, greater curvature of the antrum), duodenum and proximal jejunum. Many ar most of these lesions do not cause clinical symptoms and the symptoms with heterotopie pancreas are nonspecific. When it produces complication(hemorrhage, pancreatitis, pyloric or CBD obstruction, pseudocyst, cancer etc.), the symytoms depend on the site of lesion, the size of mass, and the primary pathologic processes occurring within the heterotopic pancreatic tissue. Gaetrofiberoscopy revealed a small round, submucosal projection with a central niche or umblication, but this characteristic umbilication is not always present. The lesions are frequently confused with polyp, leiomyoma, intramural neoplasm, gastric ulcer and early gastric cancer, The tumors are predominantly intramural masses; 75 percent are submuicosal and the others are either intrsmuscular or subserosal. We have recently experienced a case of heterotopic pancreas on the antrum of greater curvature of stomach in 54-year-old man, who visited our hospital for melena. Gastrofiberoscopy revealed a 2 x 2 cm sized submucosal mass without bleeding focus and local excision was performed. Histologic finding showed a pancreatic acini within the gastric poper muscle layer.
Autopsy ; Duodenum ; Hemorrhage ; Humans ; Jejunum ; Leiomyoma ; Melena ; Middle Aged ; Pancreas* ; Pancreatitis ; Pathologic Processes ; Polyps ; Stomach ; Stomach Neoplasms ; Ulcer

Bronchial asthma is a disease characterized by the condition of airway hyper-responsiveness, which serves to produce narrowing of the airway secondary to airway inflammation and/or various spasm-inducing stimulus. Nonspecific bronchoprovocation testing is an important method implemented for the purpose of diagnosing asthma; this test measures the actual degree of airway hyper-responsiveness and utilizes direct and indirect bronchoprovocation testing. Direct bronchoprovocation testing using methacholine or histamine may have superior sensitivity as these substances directly stimulate the airway smooth muscle cells. On the other hand, this method also engenders the specific disadvantage of relatively low specificity. Indirect bronchoprovocation testing using mannitol, exercise, hypertonic saline, adenosine and hyperventilation serves to produce reactions in the airway smooth muscle cells by liberating mediators with stimulation of airway inflammatory cells. Therefore, this method has the advantage of high specificity and also demonstrates relatively low sensitivity. Direct and indirect testing both call for very precise descriptions of very specific measurement conditions. In addition, it has become evident that challenge testing utilizing each of the various bronchoconstrictor stimuli requires distinct and specific protocols. It is therefore important that the clinician understand the mechanism by which the most commonly used bronchoprovocation testing works. It is important that the clinician understand the mechanism of action in the testing, whether direct stimuli (methacholine) or indirect stimuli (mannitol, exercise) is implemented, when the testing is performed and the results interpreted.
Adenosine ; Asthma ; Bronchial Provocation Tests ; Hand ; Histamine ; Hyperventilation ; Inflammation ; Mannitol ; Methacholine Chloride ; Methods ; Myocytes, Smooth Muscle ; Respiratory Hypersensitivity ; Sensitivity and Specificity

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*