BACKGROUND AND PURPOSE: Manganese could be toxic to the human nervous system. Therefore, it is important to detect the over-exposed patients in their early course of intoxication. The aim of this study is to find a valuable methods of clinical examination and applicable parameters for early detection of manganese intoxication. METHODS: we investigated the 35 men who had been exposed to manganese over 5 years. All the subjects were examined and video monitored by three physicians. We separated them into the two groups(Group A: clinically suspicious, Group B: clinically normal) in terms of their motor functions, gait, posture, expression. Motor functions(finger and foot tapping, rapid alternating movement, pegboard exam, writing and walking velocity etc.), MRIs, and biochemical data were measured and compared. RESULTS: No one showed significant effects of manganese intoxication . Also there were no significant differences between the two groups for their biochemical data except for elevated serum Adenosine deaminase(ADA) in clinically suspicious group. But there was a trend that motor functions were decreased especially for the finger and foot tapping, walking velocity and stride, writing velocity. A large number of subjects showed MRI changes in both groups. So MRI is not necessarily correlated with clinical findings and not a specific diagnostic tool for manganese intoxication but a sensitive one for the exposed subjects to manganese. CONCLUSION: From this study, the decreased motor functions were the only clinically significant neurologic manifestation in those who over-exposed subjects to manganese. The level of serum ADA and brain MRI could be a helpful supportive diagnostic tools for the over-exposure. Even if the subjects with these positive results do not show any significant sign of intoxication , we ought to modify their working environment to reduce further exposure.
Adenosine ; Brain ; Fingers ; Foot ; Gait ; Humans ; Magnetic Resonance Imaging ; Male ; Manganese* ; Nervous System ; Neurologic Manifestations ; Posture ; Walking ; Writing

PURPOSE: The purpose of this study was to identify the knowledge, perception and hand hygiene performance rate of hospital nurses and to identify any correlation between them.METHOD: Data were collected from 205 nurses working in a university hospital in Chungcheong-do. A self-report survey method was utilized. Participants completed the hand hygiene knowledge questionnaire.RESULTS: The average knowledge of hand hygiene was 11.76 (out of 18 points), and the average perception of hand hygiene was 35.55 (out of 96). The hand hygiene performance rate was 85.62%. Knowledge of hand hygiene showed significant differences according to age (F = 75.821, p < .001), gender (t = 25.049, p < .001) and working period (F = 24.843, p < .001). The most important explanatory factor in hand hygiene performance was hand hygiene perception (β= .26), followed by working period (β= .14). These variables accounted for 10.0% of subjects' hand hygiene performance.CONCLUSION: The results of this study suggest that continuous and effective education is needed to strengthen knowledge and perception of the importance of hand hygiene practice for nurses to prevent healthcare-associated infections.
Cross Infection ; Education ; Hand Hygiene ; Hand ; Methods ; Surveys and Questionnaires

Thirteen year old boy who had been stabbed in his left chest by the knife was transferred to our department from a general hospital, because of the massive bleeding from the intercostal tube drainage. Chest X-ray showed homogeneous density in the left lung field. He was confused and his vital signs were unstable. He was moved into a operating room as soon as possible. After resuscitation, his lacerated left ventricle wound was sutured through median sternotomy. The interventricular shunt was detected with intraoperative transesophageal echocardiography. The traumatic ventricular septal defect was closed via left ventricle using Dacron patch. His postoperative course was uneventful, and he was discharged with small residual shunt.
Drainage ; Echocardiography ; Echocardiography, Transesophageal ; Heart Septal Defects ; Heart Septal Defects, Ventricular* ; Heart Ventricles ; Hemorrhage ; Hospitals, General ; Humans ; Lung ; Male ; Operating Rooms ; Polyethylene Terephthalates ; Resuscitation ; Sternotomy ; Thoracic Injuries* ; Thorax* ; Vital Signs ; Wounds and Injuries

This study was carried out to investigate the relationship between brain magnetic resonance imaging (MRI) and neurological findings in welders exposed to manganese fume. Thirty five welders from a bus manufacturing factory who were occupationally exposed to low dose manganese fume were examined. We collected the information on the demo graphic factors and welding careers. Laboratory investigations included blood and urine manganese concentration and blood chemistry. Brain MRI was checked, and high signal intensity of the globus pallidus was graded from 0 to 3 compared to the white matter of the frontal lobe. Neurologic examination wart carried out. The results were as follows ; 1. The mean age of workers was 48.3+/-5.7 years, mean duration of welding was 21.4 +/-5.6 Years. 2. On brain MRI, high signal intensity in the globes pallidus was observed in 27 workers (77.1%) Among them, 18 cases (66.7%) showed remarkably high signal intensity (grade 2) Mean concentration of blood manganese was higher in those with high signal intensity and correlated to the grade of high signal intensity (p=0.02) 3. On neurologic examination, no workers showed the finding of typical parkinsonism. But 11 workers (31.4%) showed subtle neurological abnormalities such as gait without associated arm movement, postural instability, intention tremor, and so on. Blood manganese concentration of neurologically abnormal group was 2.4+/-0.7 microgram/dL, which was significantly higher, compared to 1.8+/-0.7 microgram/dL of neurologically normal group (p=0.03). 4. Among 27 workers who showed high signal intensity on brain MRI, 10 workers (37%) were neurologically abnormal. Higher grade of signal intensity on globus pallidus showed higher rate of neurologic abnormality (p<0.05) Especially postural instability and gait without associated arm movement were prominent findings. These bindings suggest that high signal intensity on brain MRI might be associated with a prodromal sign of manganese intoxication. Careful neurologic examination should be tool lowed up on welders showing high signal intensity in the golbus pallidus of brain MRI.
Arm ; Brain* ; Chemistry ; Frontal Lobe ; Gait ; Globus Pallidus ; Magnetic Resonance Imaging* ; Manganese* ; Neurologic Examination ; Neurologic Manifestations* ; Occupations ; Parkinsonian Disorders ; Prodromal Symptoms ; Tremor ; Warts ; Welding

BACKGROUND/AIMS: Real-time, convex probe endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is used for the staging of malignant mediastinal lymph nodes. We evaluated the diagnostic efficacy and safety of EBUS-TBNA when used as an initial diagnostic tool. METHODS: We retrospectively studied 56 patients who underwent EBUS-TBNA as an initial diagnostic tool between August 2010 and December 2011. Procedure purpose were classified into four categories: 1) intrathoracic masses adjacent to the central airway; 2) enlarged lymph nodes for concurrent diagnosis and staging in suspected malignancy; 3) enlarged lymph nodes in suspected malignancy cases with inability to perform percutaneous core needle biopsy (PCNB); and 4) solely mediastinal masses/lymph nodes in lieu of mediastinoscopy. RESULTS: The diagnostic accuracy of EBUS-TBNA regardless of procedure purpose was calculated to be 83.9%. Furthermore, the diagnostic accuracy of malignant disease was significantly higher than benign disease (93.9% vs. 70.6%, p < 0.001). The diagnostic accuracy of EBUS-TBNA for each disease is as follows: tuberculosis, 50%; sarcoidosis, 60%; aspergillosis, 100%; lung abscess, 100%; lung cancer, 93%; and lymphoma, 100%. There were minor complications in seven patients during the EBUS-TBNA procedure. The complications included mild hypoxia and bleeding. CONCLUSIONS: In conclusion, EBUS-TBNA is a useful initial diagnostic tool for both benign and malignant diseases. EBUS-TBAN is also a very safe procedure and less invasive compared to mediastinoscopy or PCNB.
Adult ; Aged ; Aged, 80 and over ; Biopsy, Large-Core Needle ; *Endoscopic Ultrasound-Guided Fine Needle Aspiration/adverse effects ; Female ; Humans ; Lung Diseases/*pathology/radiography ; Lung Neoplasms/pathology ; Lymph Nodes/*pathology/radiography ; Lymphatic Metastasis ; Male ; Mediastinoscopy ; Middle Aged ; Neoplasm Staging ; Predictive Value of Tests ; Retrospective Studies ; Risk Factors ; Tomography, X-Ray Computed ; Young Adult

BACKGROUND: The correlation between levels of brain natriuretic peptide (BNP) and the effect of pulmonary resection on the right ventricle of the heart is not yet widely known. This study aims to assess the relationship between the change in hemodynamic values of the right ventricle and increased BNP levels as a compensatory mechanism for right heart failure following pulmonary resection and to evaluate the role of the BNP level as an index of right heart failure after pulmonary resection. MATERIAL AND METHOD: In 12 non small cell lung cancer patients that had received a lobectomy or pnemonectomy, the level of NT-proBNP was measured using the immunochemical method (Elecsys 1010(R), Roche, Germany) which was compared with hemodynamic variables determined through the use of a Swan-Ganz catheter prior to and following the surgery. Echocardiography was performed prior to and following the surgery, to measure changes in right ventricular and left ventricular pressures. For statistical analysis, the Wilcoxon rank sum test and linear regression analysis were conducted using SPSSWIN (version 11.5). RESULT: The level of postoperative NT-proBNP (pg/mL) significantly increased for 6 hours, then for 1 day, 2 days, 3 days and 7 days after the surgery (p=0.003, 0.002, 0.002, 0.006, 0.004). Of the hemodynamic variables measured using the Swan-Ganz catheter, the mean pulmonary artery pressure after the surgery when compared with the pressure prior to surgery significantly increased at 0 hours, 6 hours, then 1 day, 2 days, and 3 days after the surgery (p=0.002, 0.002, 0.006, 0.007, 0.008). The right ventricular pressure significantly increased at 0 hours, 6 hours, then 1 day, and 3 days after the surgery (p=0.006, 0.009, 0.044, 0.032). The pulmonary vascular resistance index [pulmonary vascular resistance index=(mean pulmonary artery pressure-mean pulmonary capillary wedge pressure)/cardiac output index] significantly increased at 6 hours, then 2 days after the surgery (p=0.008, 0.028). When a regression analysis was conducted for changes in the mean pulmonary artery pressure and NT-proBNP levels after the surgery, significance was evident after 6 hours (r=0.602, p=0.038) and there was no significance thereafter. Echocardiography displayed no significant changes after the surgery. CONCLUSION: There was a significant correlation between changes in the mean pulmonary artery pressure and the NT-proBNP level 6 hours after a pulmonary resection. Therefore, it can be concluded that changes in NT-proBNP level after a pulmonary resection can serve as an index that reflects early hemodynamic changes in the right ventricle after a pulmonary resection.
Brain* ; Capillaries ; Catheters ; Echocardiography ; Heart ; Heart Failure ; Heart Ventricles ; Hemodynamics* ; Humans ; Linear Models ; Natriuretic Peptide, Brain* ; Pulmonary Artery ; Small Cell Lung Carcinoma ; Vascular Resistance ; Ventricular Pressure

OBJECTIVE: To investigate the value of ultrasound-guided tattooing localization (US-tattoo) using a charcoal suspension for breast lesions. MATERIALS AND METHODS: One hundred sixty-four nonpalpable breast lesions in 134 patients (mean age 47 years; range 30-74 years) were marked with a charcoal suspension under US guidance. The medical records associated with the US-tattoo, the pathology results and the follow-up US results were reviewed. RESULTS: The average size of the localized lesions was 1.0 cm. The procedure time was < 5 minutes (range, 2-10 minutes) per lesion. The US-tattoo was well tolerated in all cases. The only technical difficulty encountered was a needle tip blockage caused by a large charcoal particle (4.9%). The surgeon easily identified the tattoo with the exception one case. In addition, surgery could be safely delayed from one to 57 days after the making US-tattoo. The pathology result was benign in 108 cases, borderline in five, and malignant in 51. The excised specimen was < 4 cm in 76.6% (82/107) of the benign cases (mean; 2.7 cm). The pathologist could identify the mass around the tattoo and was able to make a specific diagnosis in 81.3% (87/107) of benign lesions. The only complication encountered was residual charcoal marking along the incision scar (3.6%). All follow-up US documented the removal of the lesions. CONCLUSION: An US-tattoo for nonpalpable breast lesions is a very simple and accurate method that can help surgeons design and schedule an open biopsy.
Adult ; Aged ; Biopsy, Fine-Needle/methods ; Breast/*pathology/surgery ; Breast Neoplasms/*diagnosis/surgery ; Charcoal/diagnostic use ; Female ; Humans ; Injections, Intralesional ; Middle Aged ; Tattooing/*methods ; *Ultrasonography, Interventional

Transcatheter interventions are widely used for diagnosis and treatment of congenital heart disease. Complications associated with transcatheter interventions are uncommon. However, when they occur they are most often self- limited. Rarely, however, serious catheter related complications occur that may require emergent surgical intervention. In this case, the right common iliac artery was disrupted during transcatheter balloon valvuloplasty during the treatment of congenital aortic stenosis in a 2-week-old baby. After immediate surgical intervention with bleeding control using two balloon catheters the baby did well. Here we report this case and review the medical literature.
Aortic Valve Stenosis ; Balloon Valvuloplasty ; Catheters ; Heart Diseases ; Hemorrhage ; Iliac Artery ; Rupture

BACKGROUND AND OBJECTIVES: Polyinosinic-polycytidylic acid (Poly I:C) is structurally similar to double-stranded RNA, and is known to induce various inflammatory mediators and to cause inflammatory reactions in airway epithelial cells. However, the effect of Poly I:C on secretion of mucins in human airway epithelial cells has been very rarely reported. In this study, the effect and brief signaling pathway of Poly I:C on the expression of mucin genes were investigated in human airway epithelial cells. MATERIALS AND METHOD: In mucin-producing human NCI-H292 airway epithelial cells and the primary cultures of normal human nasal epithelial cells, the effect and signaling pathway of Poly I:C on expression of mucin genes were investigated using reverse transcriptase-polymerase chain reaction, real-time PCR, enzyme immunoassay, and immunoblot analysis with specific inhibitors and small interfering RNA (siRNA) for mitogen-activated protein kinase (MAPK). RESULTS: Poly I:C induced the MUC5B expression, and activated the phosphorylation of ERK1/2 and p38 MAPK. U0126 (ERK1/2 MAPK inhibitor) and SB203580 (p38 MAPK inhibitor) inhibited the Poly I:C-induced MUC5B expression. In addition, the knockdown of ERK2 and p38 MAPK by siRNA significantly blocked the Poly I:C-induced MUC5B mRNA expression. CONCLUSION: Poly I:C induces the MUC5B expression via ERK2 and p38 MAPK signaling pathways in human airway epithelial cells. Therefore, Poly I:C may play a role in the regulation of mucus hypersecretion through MAPK signaling pathways in the human airway epithelial cells.
Epithelial Cells* ; Humans* ; Immunoenzyme Techniques ; Mucins ; Mucus ; p38 Mitogen-Activated Protein Kinases ; Phosphorylation ; Poly I-C* ; Protein Kinases ; Real-Time Polymerase Chain Reaction ; RNA, Double-Stranded ; RNA, Messenger ; RNA, Small Interfering

We report an extremely severe case of dysphagia in an elderly patient. Tracheostomy alone was found to be the cause of severe upper esophageal opening dysfunction. An 84-year-old woman was admitted with dyspnea. During hospitalization, she had respiratory failure and underwent a tracheostomy. On day 41 in the hospital, she complained of dysphagia and was a swallowing evaluation was done at the rehabilitation department. We ruled out other etiologies of upper esophageal dysfunction through a brain magnetic resonance imaging (MRI) and endoscopic evaluation. Through follow-up tests, it was found retrospectively that extreme dysphagia could have occurred through the following mechanism: the airway was not protected at the time of the tracheostomy because the movement of the epiglottis did not appear to be normal. This was due to the reduction in laryngeal function affecting the upper esophageal opening after the tracheostomy, and at the same time, the power to push the bolus was weak. After 6 months, at the third test, she had improved enough to ingest a soft diet and fluid with thickeners, so she was able to start an oral diet without decannulation. It is thus important to recognize that tracheostomy alone can cause extremely severe aspiration. If these findings are observed in patients undergoing tracheostomy, it is necessary to check the movements of the epiglottis properly and evaluate whether the condition can be improved by rehabilitation treatment.