BACKGROUND: Postoperative admission to the surgical intensive care unit (S-ICU) is commonly planned to prevent and treat complications, unnecessary admission to the S-ICU increases medical costs and length of hospital stay. This study aimed evaluated outcome and the predictive factors for mortality in patients admitted to the S-ICU after abdominal surgery. METHODS: The 168 patients admitted to the S-ICU immediately after abdominal surgery were reviewed retrospectively from January to December 2011. RESULTS: The mortality rate of patients admitted to the S-ICU after abdominal surgery was 8.9% (15 of 168). Two preoperative factors (body mass index [BMI] < 18.5 kg/m2 [p < 0.001] and serum albumin < 3.0 g/dL [p = 0.018]), two operative factors (the need for transfusion [p = 0.008] or vasopressors [p = 0.013] during surgery), and three postoperative variables (mechanical ventilation immediately following surgery [p < 0.001], sequential organ failure assessment [p = 0.001] and SAPS II [p = 0.001] score) were associated with mortality in univariate analysis. After adjusting for age, gender, and SAPS II by a Cox regression, which revealed that BMI < 18.5 kg/m2 (p < 0.001, hazard ratio [HR] 9.690, 95% confidence interval [CI] 2.990-25.258) and the use of mechanical ventilation on admission to S-ICU (p < 0.001, HR 34.671, 95% CI 6.440-186.649) were independent prognostic factors. CONCLUSIONS: In patients in S-ICU after abdominal surgery, low BMI and postsurgical mechanical ventilation should be considered important predictors of mortality.
Abdomen* ; Body Mass Index ; Humans ; Critical Care ; Intensive Care Units ; Length of Stay ; Mortality ; Postoperative Complications ; Prognosis* ; Respiration, Artificial ; Retrospective Studies ; Serum Albumin ; Ventilation

The long-term clinical issues in Kawasaki disease are concerned with the coronary artery lesions that result in aneurysmal formation, thrombotic occlusion, progression to ischemic heart disease, and premature atherosclerosis. We here report a 3 month old infant with Kawasaki disease complicated by giant coronary aneurysm with thrombosis. After urokinase(10,000 IU/kg) and heparin(400 IU/kg) were injected for two days as thrombolytic agents, thrombi were successfully dissolved. Even though long-term oral anticoagulation with low-dose aspirin, dipyridamole and coumadin were administered, thrombosis of the left main coronary artery was slowly increased. five years later, coronary angiography showed nearly total occlusion of the left anterior descending artery and collaterals from the right posterior branch and radionuclide scan demonstrated complete reversible perfusion defect of several portions of the left ventricle.
Aneurysm ; Arteries ; Aspirin ; Atherosclerosis ; Child* ; Coronary Aneurysm* ; Coronary Angiography ; Coronary Vessels ; Dipyridamole ; Fibrinolytic Agents ; Follow-Up Studies* ; Heart Ventricles ; Humans ; Infant ; Mucocutaneous Lymph Node Syndrome* ; Myocardial Ischemia ; Perfusion ; Thrombolytic Therapy* ; Thrombosis* ; Warfarin

The authors analysed 2,653 cases of transthoracic fine needle aspiration cytology of the lung to evaluate the diagnostic accuracy and its limitation. A comparison was made between the original cytologic and the final histologic diagnoses on 1,149 cases from 1,074 patients. A diagnosis of malignancy was established in 38.3% benign in 48.1%, atypical lesion in 2.3%, and inadequate one in 11.9% of the cases. Statistical data on cytologic diagnoses were as follows; specificity 98.9%: sensitivity of procedure, 76.8%: sensitivity of diagnosis, 95.5%: false positive 5 cases: false negative 18 cases: predictive value for malignancy, 98.8%: predictive value for benign lesion, 79.5%: overall diagnostic efficiency, 87.5%: typing accuracy in malignant tumor, 80%.
Biopsy, Fine-Needle ; Diagnosis ; Diarrhea* ; Hemolytic-Uremic Syndrome* ; Humans ; Lung ; Sensitivity and Specificity

The Third Report of the National Cholesterol Education Program Adult Treatment Panel III emphasized the importance of management of the metabolic syndrome. However, little information is available about the effect of weight reduction on the metabolic syndrome in obese patients among Koreans. A longitudinal clinical intervention study from the 12-week of weight reduction program, including life style modification and adjuvant appetite suppressants, in 78 obese persons was performed. Anthropometry and metabolic risk factors were measured before and after weight reduction. Visceral (VAT), subcutaneous (SAT), and total adipose tissue (TAT) on abdomen were determined by CT scan. Moderate decrease in weight (9.3%) induced significant reduction of waist circumference, systolic and diastolic blood pressure, and triglyceride. Weight reduction also resulted in significant decrease in total cholesterol, LDL-C, uric acid, fasting insulin, and HOMA score. The subjects with metabolic syndrome showed more improvements of metabolic components than those without metabolic syndrome through weight reduction. The reductions of visceral-subcutaneous fat ratio (VSR) and waist circumference were observed as for the predictable variables related to the improvement of metabolic component and insulin resistance in Korean obese patients.
Abdomen ; Adipose Tissue/metabolism ; Adolescent ; Adult ; Female ; Human ; Insulin Resistance ; Korea ; Lipids/blood ; Male ; Metabolic Syndrome X/*diet therapy/*epidemiology/metabolism ; Middle Aged ; Obesity/*diet therapy/*epidemiology/metabolism ; Risk Factors ; Risk Reduction Behavior ; *Weight Loss

Background: Triggering receptor expressed on myeloid cells 1 protein (TREM-1) is a cell surface molecule expressed on neutrophils and monocytes, and it plays an important role in myeloid cell-activated inflammatory response. The aim of this study was to investigate the diagnostic efficiency of soluble (s) TREM-1 in the patients who had pleural effusion from various causes. Methods: Forty-five patients with exudative pleural effusion were included in this study. The level of sTREM-1 was measured in both the serum and pleural fluids by immunoblot assay with using human-sTREM-1 antibody. Results: The pleural fluid sTREM-1 was significantly different in the three groups of exudative pleural effusion (p=0.011). Particularly, the patients with parapneumonic effusion were found to have significantly higher pleural fluid levels of sTREM-1 than patients with tuberculous (p<0.05) and malignant effusion, respectively (p<0.05). However, the serum sTREM-1 did not show a significant difference in the three groups. In order to evaluate the diagnostic utility of pleural fluid sTREM-1, the receiver operating characteristic (ROC) curve was constructed and the area under the curve (AUC) was 0.818 (p=0.001). Using a cutoff value of 103.5 pg/mL for the pleural fluid sTREM-1, the sensitivity and specificity were 73% and 81%, respectively, for differentiating parapneumonic effusion from tuberculous or malignant effusions. Conclusion: Pleural fluid sTREM-1 can be an additional marker for making the differential diagnosis of pleural effusion.
Diagnosis, Differential ; Exudates and Transudates ; Humans ; Monocytes ; Myeloid Cells* ; Neutrophils ; Pleural Effusion* ; ROC Curve

Intracranial cavernous hemangioma is one of vascular malformations composed of thin walled sinusoidal spaces lined with endothelium. The authors described 7 cases of cavernous hemangioma that were verified histologically and 5 lesions that were diagnosed only with symptoms, radiological and magnetic resonance imaging(MRI) findings. The clinical features are as follows:7 patients had seizures, 3 focal neurological signs and 2 intracaranial hematomas. Computed tomography(CT) usually demonstrated nodular or irregular hyperdense lesions without significant mass effect. MRI usually revealed central area of mixed signal intensity and peripheral rim of low signal intensity. Angiography usually showed an avascular area or normal angiographic appearance. The combination of a clinical history with CT, angiography and MRI findings would suggest cavernous hemangioma. Four epilepsy patients underwent surgical procedures, resulting in improved seizure control and/or lessened neurological deficit.
Angiography ; Endothelium ; Epilepsy ; Hemangioma, Cavernous* ; Hematoma ; Humans ; Magnetic Resonance Imaging ; Seizures ; Vascular Malformations

BACKGROUND/AIMS: In patients with chronic obstructive pulmonary disease (COPD), left ventricular (LV) systolic dysfunction and structural changes are rare, while right ventricular (RV) dysfunction and structural alteration and/or LV diastolic dysfunction are common. We evaluated the cardiac structure and function in patients with COPD using echocardiography. METHODS: Echocardiography examinations were performed in 69 patients with clinically stable COPD and without a history of heart disease; 22 control subjects with normal lung function were enrolled for comparison. Echocardiography parameters of the COPD patients were compared with those of the controls, and assessed according to the COPD stage classified using the Global initiative for chronic Obstructive Lung Disease (GOLD) criteria. RESULTS: Patients with COPD had significantly lower body weight (p=0.001) and higher pack-years of smoking than did the controls (p=0.002). The echocardiogram showed that LV end diastolic diameter (p<0.001), LV end systolic diameter (p=0.020), left atrial (LA) diameter (p=0.026), and LV mass in the COPD patients were significantly decreased compared to the controls (p=0.003). However, there were no differences between the COPD patients and controls in the parameters reflecting LV diastolic function and mean RV systolic pressure (RVSP). According to the COPD stage, body weight (p<0.001), body mass index (BMI) (p<0.001), and LV mass were significantly different (p=0.011). In patients with COPD, LV mass (r=0.432) (p<0.001) and BMI were significantly correlated with FEV1% predicted (r=0.600) (p<0.001). CONCLUSIONS: Patients with COPD had lower LV mass and LA and LV diameters than did the controls, even though both groups had normal LV function. In particular, the LV mass appeared to correlate with the lung function in the patients with COPD.
Blood Pressure ; Body Mass Index ; Body Weight ; Echocardiography ; Heart ; Humans ; Hypertension ; Lung ; Lung Diseases ; Pulmonary Disease, Chronic Obstructive ; Smoke ; Smoking

Hemangiopericytoma is a relatively uncommon vascular tumor. It was first described by Stout and Murray in 1942. Here, we report a case of a primary prostatic hemangiopericytoma, which has been reported approximately <10 cases. This may be the first case of a prostatic hemangiopericytoma in Korea. A 35-year-old male patient presented with an episode of dysuria and perineal discomfort over the past 3 months. The radiological and histological features indicated a malignant hemangiopericytoma. Systemic chemotherapy was selected as the primary treatment. After 5 cycles of chemotherapy, the size of masses of the prostate and lung decreased. Four months after then, the patient died from hemoptysis.
Adult ; Drug Therapy ; Dysuria ; Hemangiopericytoma* ; Hemoptysis ; Humans ; Korea ; Lung ; Male ; Prostate

Hemangiopericytoma is a relatively uncommon vascular tumor. It was first described by Stout and Murray in 1942. Here, we report a case of a primary prostatic hemangiopericytoma, which has been reported approximately <10 cases. This may be the first case of a prostatic hemangiopericytoma in Korea. A 35-year-old male patient presented with an episode of dysuria and perineal discomfort over the past 3 months. The radiological and histological features indicated a malignant hemangiopericytoma. Systemic chemotherapy was selected as the primary treatment. After 5 cycles of chemotherapy, the size of masses of the prostate and lung decreased. Four months after then, the patient died from hemoptysis.
Adult ; Drug Therapy ; Dysuria ; Hemangiopericytoma* ; Hemoptysis ; Humans ; Korea ; Lung ; Male ; Prostate

Although failure of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR TKI) is generally believed to be associated with cross-resistance to other EGFR TKI, the benefit of administering erlotinib as a second EGFR TKI after resistance of gefitinib as the first TKI has been well known. However, good response to gefitinib after an initial response to erlotinib has been rare. We report that a 45-year-old woman (never smoked), with lung adenocarcinoma and EGFR mutation, showed an initial response to erlotinib, and then responded to gefitinib again.
Adenocarcinoma ; Female ; Humans ; Lung ; Lung Neoplasms ; Middle Aged ; Protein-Tyrosine Kinases ; Quinazolines ; Receptor, Epidermal Growth Factor ; Erlotinib Hydrochloride