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 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

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

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

BACKGROUND: Osteoporosis is a significant comorbidity in patients with chronic obstructive pulmonary disease (COPD). This study examined the prevalence and risk factors associated with osteoporosis in patients with COPD. METHODS: The bone mineral densities (BMDs) of the lumbar spine and femoral bone were measured in 53 patients with clinically stable COPD and 41 age- and gender-matched control subjects showing a normal lung function. Osteoporosis was defined as a T-score < or =-2.5. The subjects' clinical characteristics and laboratory data were reviewed, and multiple logistic regression analysis was used to identify the risk factors associated with osteoporosis in COPD patients. RESULTS: The prevalence of osteoporosis was 47% and 32% in the COPD patients and controls, respectively. In particular, using the femoral neck T-score, the prevalence of osteoporosis in COPD patients was higher than that in the controls (26% vs. 5%; p=0.006). The average T-score of the lumbar spine (p=0.025) and femoral neck of COPD patients were significantly lower than those of the controls (p=0.001). The forced expiratory volume in the 1 second (FEV1) % predicted (p=0.019; odds ratio [OR], 0.955; 95% confidence interval [CI], 0.919-0.993) and age (p=0.024; OR, 1.144; 95% CI, 1.018-1.287) were independently associated with osteoporosis in patients with COPD. CONCLUSION: Using the femoral neck T-score, the prevalence of osteoporosis in patients with COPD was higher than the age-and gender-matched controls. A lower FEV1 and older age further increase the risk of osteoporosis in patients with COPD.
Bone Density ; Comorbidity ; Femur Neck ; Forced Expiratory Volume ; Humans ; Logistic Models ; Lung ; Odds Ratio ; Osteoporosis ; Prevalence ; Pulmonary Disease, Chronic Obstructive ; Risk Factors ; Spine

PURPOSE: Attention deficit hyperactivity disorder (ADHD) is a syndrome characterized by inattention, impulsive disruptive behavior, impaired concentration, and motor restlessness. This study examined the relationships among electroencephalographic (EEG) findings, stimulant use, and seizure occurrence in children with ADHD. METHODS: We retrospectively studied 308 children with ADHD who visited the neuropsychiatric clinic of our hospital from January 2001 to December 2005. We retrospectively analyzed age distribution, etiology, abnormal EEG findings, and use of CNS stimulants. Among these children, brain waves was recorded in 84 patients. RESULTS: Eighty-four children (72 males, 85.7%, 9.3 years mean age; 12 females, 14.3%, 8.0 years mean age) with ADHD had electroencephalograms (EEGs) performed at our institute. Nineteen patients (22.6%) demonstrated epileptiform abnormalities, and 65 (77.4%) demonstrated normal EEGs. Stimulant therapy was applied to 59 of 84 patients (70.2%). Seizures occurred in 1 of 65 patients with a normal EEG (incidence, 1.5%) and 3 of 19 treated patients with epileptiform EEGs (incidence, 15.7%). CONCLUSION: These data suggest that patients with normal EEGs have minor risk for seizure. In contrast, patients with epileptiform EEGs have higher risk for seizure than patients with normal EEGs.
Age Distribution ; Attention Deficit Disorder with Hyperactivity ; Brain ; Brain Waves ; Central Nervous System ; Central Nervous System Stimulants ; Child ; Electroencephalography ; Female ; Humans ; Male ; Methylphenidate ; Psychomotor Agitation ; Retrospective Studies ; Seizures

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

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