Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi that is characterized by focal or disseminated vasculitis and perivasculitis. Scrub typhus can have fatal complications, such as acute respiratory distress syndrome, septic shock, and acute kidney injury. However, there are few reports of fatal myocarditis caused by scrub typhus. We present a case of acute fatal myocarditis combined with acute kidney injury complicating scrub typhus.
Acute Kidney Injury ; Myocarditis* ; Orientia tsutsugamushi ; Respiratory Distress Syndrome, Adult ; Scrub Typhus* ; Shock, Septic ; Vasculitis

PURPOSE: As increasing overseas kidney transplant recipients, the post-transplantation management of these recipients is not unusual. Shortage of donor information and operative findings is an obstacle to post-transplant evaluation and management of overseas transplant recipients. We retrospectively reviewed the post-transplant clinical manifestation of overseas transplant recipient, and compared with those of domestic deceased donor transplant recipient. METHODS: Sixty overseas transplant recipients and 39 deceased donor transplant recipient in our center from January 2002 to August 2006 were enrolled in this study. Among the post-transplant outcomes, we focused the episodes of post-transplant complication, acute rejection and graft functional status. RESULTS: In comparison of pre-transplant clinical manifestation, overseas transplant recipients were more elderly, male predominant and less retransplantation than domestic deceased transplant cases. Remarkable surgical complications (35%, 21/60) were observed in overseas transplant recipients which was significantly higher than those of domestic transplant recipients (5.1%, 2/39 cases)(P=0.03). The urologic complication was major (14 cases) complication, and intraoperative hematoma (5 cases) and vascular complication (2 cases) succeed. Interventional procedure or surgical correction was performed in six recipients with urinary leakage obstruction. Excluding post-transplant acute tubular necrosis, the post-transplant outcomes, such as incidence of acute rejection, graft survival rate and graft function within post-transplant 3 year, of overseas transplant recipient were statistically similar with these of domestic deceased donor recipients. CONCLUSION: Considering that overseas transplant recipient had high incidence of surgical or urologic complication, the initial evaluation of post-transplant recipient was focused on completion of surgical procedure by using radiologic imaging study.
Aged ; Graft Rejection ; Hematoma ; Humans ; Incidence ; Kidney Transplantation* ; Kidney* ; Male ; Necrosis ; Retrospective Studies ; Survival Rate ; Tissue Donors* ; Transplantation ; Transplants

PURPOSE : The aim of this study was to validate the effect and the feasibility of induction chemotherapy in patients with locally advanced non-small cell lung cancer (NSCLC) on multimodality treatment. MATERIALS AND METHODS : From January 2002 to December 2003, 84 chemonaive patients with Stage III NSCLC, median age of 64 years, ECOG perfomance satus 0, 1, or 2, and without other comorbid disease were enrolled this study and received chemotherapy every 3 weeks. After two or three cycles of induction chemotherapy (gemcitabine with cisplatin), patients were reevaluated by chest CT and then underwent resection, radiotherapy, further chemotherapy, or observation. RESULTS : Overall clinical responses were seen in 43 (57%) of the 76 assessable patients. Response rates were 61% and 53% in patients with stage IIIA and IIIB disease, respectively. Twenty-eight patients out of initially unresectable 70 patients (19 of 32 stage IIIA and 9 of 38 stage IIIB) after induction chemotherapy seemed to be resectable. Operation was done in 23 out of 32 patients who achieved clinically resectable stage after induction chemotherapy and 20 (87%) resections were complete and 3 were incomplete including 1 case of open & closure. Thirty-two patients were treated with chest radiation after chemotherapy. Eighteen patients were treated with chemotherapy upto 6 cycles and 6 patients refused further treatment after induction chemotherapy. Median follow up of all patients was 16.2 months, median survival was 16 months, and estimated disease progression free interval was 11 months. Survival and disease progression free interval were different with between induction chemotherapy followed by complete resection subgroup and followed by radiation therapy subgroup (24 vs. 14 months, p=0.04). Grade 3/4 neutropenia and thrombocytopeina were noticed in 29% and 10%, respectively and one chemotherpy related death was also noticed. CONCLUSION : Induction chemotherapy followed by surgery with or without adjuvant radiation might be the recommendable management to improve the survival in locally advanced NSCLC with feasible toxicity
Carcinoma, Non-Small-Cell Lung ; Disease Progression ; Drug Therapy ; Follow-Up Studies ; Humans ; Induction Chemotherapy* ; Neutropenia ; Radiotherapy ; Thorax ; Tomography, X-Ray Computed

BACKGROUND: This study compared the bronchodilator efficacy and safety of tiotropium inhalation capsules (18microgram once daily) with a ipratropium metered dose inhaler (2 puffs of 20microgram q.i.d.) in patients with chronic obstructive pulmonary disease (COPD). METHOD: After the initial screening assessment and a two-week run-in period, patients received either tiotropium 18microgram once daily or ipratropium 40microgram four times daily over a period of 4 weeks in a double blind, double dummy, parallel group study. The outcome measures were the lung function, the daily records of the peak expiratory flow rate (PEFR), the patients' questionnaire, and the use of concomitant salbutamol. The forced expiratory volume in one second (FEV1) and the forced vital capacity (FVC) were measured 5 minutes before inhalation, and 0.5, 1, 2 and 3 hours after inhaling the study drug on days 0, 14 and 28. RESULT: In 16 centers, 134 patients with a mean (SD) age of 66 (7) years and a predicted FEV1 of 42 (12)% were analyzed. The trough FEV1 response was significantly higher in the tiotropium group than in the ipratropium group after a four-week treatment period. The weekly mean morning PEFR of the tiotropium group was consistently higher than that of the ipratropium group during the 4-week treatment period with differences ranging from 12.52 to 13.88 l/min, which were statistically significant. Tiotropium was well tolerated by the COPD patients during the 4-week treatment period and had a similar safety profile to ipratropium. CONCLUSION: This study shows that tiotropium administrated once daily has a superior bronchodilator effect with a similar safety profile in treating COPD patients compared with ipratropium, inhaled four times daily.
Adult* ; Albuterol ; Bronchodilator Agents ; Capsules ; Forced Expiratory Volume ; Humans ; Inhalation ; Ipratropium* ; Lung ; Mass Screening ; Metered Dose Inhalers ; Outcome Assessment (Health Care) ; Peak Expiratory Flow Rate ; Pulmonary Disease, Chronic Obstructive* ; Surveys and Questionnaires ; Vital Capacity ; Tiotropium Bromide

BACKGROUND: The survival benefit associated with first-line chemotherapy in lung cancer has led to the need for second-line chemotherapy, for which Docetaxel (Taxotere(R)) has proven efficacy in both settings. This study evaluated the safety and efficacy of docetaxel in patients with non-small cell lung cancer who had failed first-line platinum- based chemotherapy. METHODS: Thirty one patients with non-small-cell lung cancer, who had failed first-line platinum-based chemotherapy, between March 1999 and August 2003, were enrolled in this study. Patients received intravenous docetaxel, either 75 mg/m2 or 100 mg/m2, with routine premedication every three weeks. RESULTS: Fourteen patients (45.2%) had a partial response. The median survival and progression-free survival times were 12.5 months (95% CI 7.3-17.6) and 3.0 months (95% CI 1.6-4.5), respectively. This study showed 2 factors gave different survival benefits; the age (< 60 years: 20.1 months vs. > or = 60 years: 6.6 months, p = 0.0105) and the histological type (adenocarcinoma: 25.6 months vs. others: 7.9 months, p=0.0055). The predominant toxicity was neutropenia, which occurred as WHO grade 3 or 4 in 38.7 % of patients. One treatment-related death was also reported. Non-hematological toxicity was minor and easily controlled. There were no significant statistical differences in the survival benefit and toxicity between the two doses. CONCLUSION: Docetaxel, as second-line monotherapy, was well tolerated and effective in patients with non-small- cell lung cancer who failed first-line platinum-based chemotherapy.
Carcinoma, Non-Small-Cell Lung* ; Disease-Free Survival ; Drug Therapy ; Humans ; Lung Neoplasms ; Neutropenia ; Premedication

BACKGROUND: Both gemcitabine and vinorelbine are effective anticancer drugs with mild toxicity on non-small cell lung cancer, and monotherapy of these drugs are effective as a second-line chemotherapy. The aim of this trial was to assess the response and toxicity of a combination of gemcitabine and vinorelbine in patients of previously treated for non-small cell lung cancer. MATERIALS AND METHODS: 24 patients, initial stage III A/B,IV and previously treated with platinium and taxane based regimens, were enrolled from June 2000 to March 2004. The regimens consisted of vinorelbine 25mg/m2 followed by an infusion of gemcitabine 1000mg/m2 on day 1 and day 8 every three weeks. This course was repeated more than twice. RESULTS: Twenty-four patients were analyzed for the response, survival rate, and toxicities. The overall response was 17% with a complete remission rate of 4%. The median time-to progression (TTP) was 3.1 months (95%, CI 1-10months), and the survival time was 8.2 months (95%, CI 1-23 months). The grade 3/4 toxicities encountered were neutropenia (12.5%), anemia (0%), thrombocytopenia (0%). Non-hematological 3/4 toxicities were not observed. CONCLUSION: A combination of gemcitabine and vinorelbine in patients previously treated for non-small cell lung cancer provides a relatively good response rate, and a low toxicity profile. However, further study will be needed to confirm its effectiveness.
Anemia ; Carcinoma, Non-Small-Cell Lung* ; Drug Therapy* ; Humans ; Neutropenia ; Survival Rate ; Thrombocytopenia

OBJECTIVE: The aim of the present study was to analyze the relation between p53 mutation and cervical adenocarcinoma without HPV infection. METHODS: From 1998 to 2002, 54 patients were diagnosed with cervical adenocarcinoma and underwent radical hysterectomy at Seoul National University Hospital. Of them, 50 patients were available for review of medical records and histologic examination. Using ABC method, we performed immunohistochemical staining. If there is 10% or more of staining positive, it was read positive. And we used HPVDNAChip for detection of HPV. RESULTS: Of the 50 patients, 45 (90.0%) patients were positive for high risk HPV and 4 patients (8.0%) were p53 positive. In the patients with negative for p53, there were significantly more patient with HPV positive (p=0.04). Advanced stage of cervical adenocarcinoma was related to high rate of positivity of p53, but it was not statistically significant. CONCLUSION: In patients who diagnosed cervical adenocarcinoma without HPV infection, there were over expression of p53. This suggests that abnormality of p53 may be related to pathogenisis of cervical adenocarcinoma without HPV infection.
Adenocarcinoma* ; Cervix Uteri* ; Female ; Humans* ; Hysterectomy ; Medical Records ; Papillomavirus Infections* ; Seoul

BACKGROUND: To find out effectiveness of multimodality treatments based on induction chemotherapy(CTx) in patients with clinical stage IIIA NSCLC METHODS: From 1997 to 2002, 74 patients with clinical stage IIIA NSCLC underwent induction CTx at the hospital of Chungnam National University. Induction CTx included above two cycles of cisplatin-based regimens(ectoposide, gemcitabine, vinorelbine, or taxol) followed by tumor evaluation. In 30 complete resection group, additional 4500-5000cGy radiotherapy(RTx) was delivered in 15 patients with pathologic nodal metastasis. 29 out of 44 patients who were unresectable disease, refusal of operation, and incomplete resection were followed by 60-70Gy RTx in local treatment. Additional 1-3 cycle CTx were done in case of induction CTx responders in both local treatment groups. RESULTS: Induction CTx response rate were 44.6%(complete remission 1.4% & partial response 43.2%) and there was no difference of response rate by regimens(p=0.506). After induction chemotherapy, only 33 out of resectable 55 ones(including initial resectable 37 patients) were performed by surgical treatment because of 13 refusal of surgery by themselves and 9 poor predicted reserve lung function. There were 30(40.5%) patients with complete resection, 2(2.6%) persons with incomplete resection, and 1(1.3%) person with open & closure. Response rate in 27 ones with chest RTx out of non-operation group was 4.8% CR and 11.9% PR. In complete resection group, relapse free interval was 13.6 months and 2 year recur rate was 52%. In non-complete resection(incomplete resection or non-operation) group, disease progression free interval was 11.2 months and 2 year disease progression rate was 66.7%. Median survival time of induction CTx 74 patients with IIIA NSCLC was 25.1months. When compared complete resection group with non-complete resection group, the median survival time was 31.7 and 23.4months(p=0.024) and the 2-year overall survival rate was 80% and 41% . In the complete resection group, adjuvant postoperative RTx subgroup significantly improved the 2-year local control rate(0% vs. 40%, p= 0.007) but did not significantly improve overall survival(32.2months vs. 34.9months, p=0.48). CONCLUSION: Induction CTx is a possible method in the multimodality treatments, especially followed by complete resection, but overall survival by any local treatment(surgical resection or RTx) was low. Additional studies should be needed to analysis data for appropriate patient selection, new chemotherapy regimens and the time when should RTx be initiated.
Chungcheongnam-do ; Disease Progression ; Disulfiram ; Drug Therapy ; Humans ; Induction Chemotherapy ; Lung ; Neoplasm Metastasis ; Patient Selection ; Recurrence ; Survival Rate ; Thorax

BACKGROUND: Although patients with stage IV non-small cell lung cancer areknown to have a poor prognosis, the prognostic factors for survival have not been well evaluated. Such factors may be different from those for overall survival. This study was performed to analyze the prognostic factors for survival and the variation of survival according to metastatic organ, in patients with stage IV non-small cell lung cancer. MATERIALS AND METHODS: From January 1997 to December 2000, 151 patients with confirmed stage IV non-small cell lung cancer were enrolled into this study retrospectively. The clinical and laboratory data were analyzed using univariate Kaplan-Meier and Multivariate Cox regression models. RESULTS: On univariate analysis, age, performance status, serum albumin level, weight loss, forced expiratory volume in one second (FEV1), systemic chemotherapy, the number of metastatic organs and serum lactate dehydrogenase (LDH) level were significant factors (p<0.05). In multivariate analysis, important factors for survival were ECOG performance (relative risk of death [RR]: 2.709), systemic chemotherapy (RR: 1.944), serum LDH level (RR: 1.819) and FEV1 (RR: 1.774) (p<0.05). Metastasis to the brain and liver was also a significant factor on univariate analysis). The presence of single lung metastasis was associated with better survival than that of other metastatic organs (p=0.000). CONCLUSION: We confirmed that performance status and systemic chemotherapy were independent prognostic factors, as has been recognized. The survival of stage IV non-small cell lung cancer patients was different according to the metastatic organs. Among the metastatic sites, only patients with metastasis to the lung showed better survival than that of other sites, while metastasis of the brain or liver was associated with worse survival than that of other sites.
Brain ; Carcinoma, Non-Small-Cell Lung* ; Drug Therapy ; Forced Expiratory Volume ; Humans ; L-Lactate Dehydrogenase ; Liver ; Lung ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Retrospective Studies ; Serum Albumin ; Weight Loss

PURPOSE: To analyze the learning objectives and test items for Fundamentals in Nursing which were established between 1999 and 2000 and to develop these items toward a nationwide faculty workshop for national board examination for Korean nurses. RESULTS: 1. According to Bloom's taxonomy, learning objectives established in 1999 mainly consisted of two domains, comprehension (56.1%), and knowledge (27.7%). The learning objectives established in 2000, mainly consisted of comprehension (45.2%) and application (25.4%). 2. According to McGuire's taxonomy, domain of test items established in 1999 consisted of recall (66.7%), interpretation (28.0%) and problem solving (4.9%). Domain of test items established in 2000, consisted of recall (65.1%), interpretation (22.0%) and problem solving (12.9%). 1) Department of Nursing, Chung-Ang University 2) College of Nursing, Yonsei University 3) College of Nursing, Seoul National University 4) Department of Nursing, Kyung-Hee University 5) College of Nursing, Ewha University 6) College of Nursing, The Catholic University of Korea(corresponding author, Email: sky@catholic.ac.kr) 7) National Medical Center Nursing College 8) Red Cross Nursing College 9) Department of Nursing, Gachun Gil College 3. The proportion of learning objectives in the knowledge and comprehension domains established in 200, decreased from 27.7% to 13.5%, and from 56.1% to 45.2% respectively over that of 1999. But the domain of application increased from 5.3% to 25.4% over that of 1999. 4. With regard to McGuire's taxonomy, the proportion for the recall and interpretation domains established in 2000 decreased from 66.7% to 65.1%, and from 28.0% to 22.0% respectively. But the proportion for the problem solving domain increased from 4.9% to 12.9% over that of 1999. For type of test items, the proportion of A type established in 2000 decreased from 47.2% to 37.6%, and K type increased from 52.1% to 60.8% over that of 1999. CONCLUSION: The learning objectives and test items established in 2000 showed remarkable improvement compared to those established in 1999. For better learning objectives and test items in Fundamentals of Nursing, further research is recommended on essential content and standardization of job analysis for national board examination for nurses in Korea.
Classification ; Comprehension ; Education ; Electronic Mail ; Korea* ; Learning* ; Nursing* ; Problem Solving ; Red Cross ; Seoul