Delirium is described as a manifestation of acute brain injury and recognized as one of the most common complications in intensive care unit (ICU) patients. Although the causes of delirium vary widely among patients, delirium increases the risk of longer ICU and hospital length of stay, death, cost of care, and post-ICU cognitive impairment. Prevention and early detection are therefore crucial. However, the clinical approach toward delirium is not sufficiently aggressive, despite the condition's high incidence and prevalence in the ICU setting. While the underlying pathophysiology of delirium is not fully understood, many risk factors have been suggested. As a way to improve delirium-related clinical outcome, high-risk patients can be identified. A valid and reliable bedside screening tool is also needed to detect the symptoms of delirium early. Delirium is commonly treated with medications, and haloperidol and atypical antipsychotics are commonly used as standard treatment options for ICU patients although their efficacy and safety have not been established. The approaches for the treatment of delirium should focus on identifying the underlying causes and reducing modifiable risk factors to promote early mobilization.
Antipsychotic Agents ; Brain Injuries ; Critical Care ; Delirium* ; Early Ambulation ; Haloperidol ; Humans ; Incidence ; Intensive Care Units* ; Length of Stay ; Mass Screening ; Prevalence ; Risk Factors

Endoscopic nasobiliary drainage(ENBD) has been developed as a safe and effective noninvasive biliary drainage method for initial decompression in the benign or malignant biliary obstruction, dissolution of biliary stones by injection of litholytic agents through the tube, and proper causative diagnosis of biliary obstruction by cytologic, bacteriologic and parasite investigation of drained bile. Generally, endoscopic sphicterotomy (EST) is performed before the insertion of an ENBD tube in order to make the procedure easy and to prevent acute pancreatitis that may develop by compression of the pancreatic orifice of the inserted tube. Nevertheless, in some cases EST is difficult to perform or should not be performed due to their coagulopathy. In such cases, ENBD without EST may be necessary. To evaluate the safety, successfullness and effectiveness of ENBD without EST, ENBD without EST using 5, 6 or 7 Fr pigtail tubes were performed in 81 cases(49 malignant, 32 benign). ENBD without EST was successfully performed in 78 out of 81 cases(96.3%). This effectiveness for decompression of bile duct, evaluated by decreasing total bilirubin values, was good in 66 out of 73 casee (90. 2%). The complications of this procedure were noted in 6 out of 78 cases(7. 7%). e. g. cholangitis in 3, migration of ENBD tube in 2, acute pancreatitis in 1 case. Particularly, regardless of our concern that ENBD without EST may develop acute pancreatitis acute panereatitis was noted in only one case. In conclusion, ENBD without EST is a safe and effective method which can be applied to the cases who have benign or malignant obstructive jaundice.
Bile ; Bile Ducts ; Bilirubin ; Cholangitis ; Decompression ; Diagnosis ; Drainage* ; Jaundice, Obstructive ; Pancreatitis ; Parasites

No abstract available.
Hemoglobin A* ; Humans ; Mothers* ; Postpartum Period*

Bladder stone formation is secondarily associated with bladder outlet obstruction, such as neurogenic bladder and benign prostatic hyperplasia, and intravesical foreign body. 1. A case of unexpected giant bladder stone weighed 580gm associated with missed intravesical bullet after gun shut injury during Korean War in a 55-year-old man. 2. A case of giant bladder stone weighed 260gm associated with urinary stasis and urinary tract infection due to neurogenic bladder in a 46-year-old woman. 3. A case of multiple bladder stone, total number of 107, associated bladder outlet obstruction due to benign prostatic hyperplasia in a 63-year-old man.
Female ; Foreign Bodies ; Humans ; Korean War ; Middle Aged ; Prostatic Hyperplasia ; Urinary Bladder Calculi* ; Urinary Bladder Neck Obstruction ; Urinary Bladder* ; Urinary Bladder, Neurogenic ; Urinary Tract Infections

Neurofibromatosis is an autosomal dominant abnormality that may affect multiple organ systems. The eyelids, the orbits, the adjacent tissues and bones may be involved with varying frequency and severity. The management of orbitotemporal neurofibromatosis depends very much on the type and severity of the orbital involvement and on the functional state of the eye. Experience with surgical management of orbitotemporal neurofibromatosis involved in the orbit, the temporal soft tissue and bone with blind eye is reported. The goal of surgery is tumor resection, reconstruction of the orbital socket, aesthetic eyelids, and insertion of the artificial prosthesis. A two stage approach is recommended. In the first stage, tumor is resected and the orbital socket is reconstructed with titanium mesh plate and cranial bone graft. After reconstruction of the orbital socket, galeal flap is rotated posteriorly to cover the mesh plate and canthopexy is accomplished. Mask lift is performed to enhance aesthetics. In the second stage, correction of the bulky eyelids is achieved and orbital space for insertion of the artificial prosthesis is reconstructed. Authors have managed a orbitotemporal neurofibromatosis with blind eye of a 41-year-old male using titanium mesh plate and bone graft with satisfactory results.
Adult ; Esthetics ; Eyelids ; Humans ; Male ; Masks ; Neurofibromatoses* ; Neurofibromatosis 1 ; Orbit ; Prostheses and Implants ; Titanium ; Transplants

Gougerost-Blum syndrome is a rare disease and characterized by lichenoid papules in association with purpuric lesions. So far as we know there has been no report of, in literatures, Gougerot-Blum syndrome with leukemia. We experienced a case of typical Gougerrot_Blum syndrome with acute myeloblastic leukemia in a 30 year-old female patient. This patient complained of rashes on whole body for 2 months, and frequent epistaxis and gum bleeding for 20 days. The skin revealed miliary to rice sized rusty colored lichenoid papules on whole body especially on legs and arms. Histopathologically the skin showed the picture of Gougerot-Blum syndrome. On peripheral blood examination and bone marrow aspiration myeloblastic leukemia was confirmed. The patient was treated with 6-mercaptopurine, cytoxan and prednisolone with slight improvement of skin lesions, but no improvement of leukumia itselt.
6-Mercaptopurine ; Adult ; Arm ; Bone Marrow ; Cyclophosphamide ; Epistaxis ; Exanthema ; Female ; Gingiva ; Granulocyte Precursor Cells ; Hemorrhage ; Humans ; Leg ; Leukemia* ; Leukemia, Myeloid, Acute ; Prednisolone ; Rare Diseases ; Skin

No abstract available.
Child* ; Glomerulonephritis* ; Humans

The use of a cultured autologous keratinocyte sheet has become a recognized method for the coverage of extensive bums during recent years. The disadvantages of these sheet grafts are a long time-lag until keratinocyte sheets are available, the fragility and difficulty in handling of grafts, an unpredictable take rate and extremely high costs. In this study we investigated the transplantation of cultured keratinocytes as single cells suspended in autologous fibrin glue. In a rat model with standardized full thickness wounds, this new transplantation technique was evaluated and compared directly to the conventional keratinocyte sheet grafting technique. After transplantation, wounds were evaluated for the degree of epithelial coverage, and then microscopic structures were evaluated under light and electron microscopy. The results were as follows: 1) The fibrinogen solution prepared from autologous blood had 12 times more fibrinogen compared to the original blood. 2) After transplantation of cultured keratinocyt-es in fibrin glue, the degree of epithelial coverage was 79% at 2 weeks, which was comparable to 17% for cultured keratinocyte sheet graft 3) Typical basement membrane structures were consistently found at 2 weeks after transplantation of keratinocytes in fibrin glue. 4) Rete ridges were found at 4 weeks after transplantation of keratinocytes in fibrin glue. In conclusion, the transplantation technique of keratinocytes in fibrin glue is available earlier than sheet grafts, it transfers actively proliferating cells and it simplifies the grafting procedure. As well, this technique leads to an earlier epithelial covering and an earlier restoration of the dermo-epidermal junction than sheet grafting.
Basement Membrane ; Fibrin Tissue Adhesive* ; Fibrin* ; Fibrinogen ; Keratinocytes* ; Microscopy, Electron ; Models, Animal ; Transplants ; Wounds and Injuries

No abstract available.
Anesthesia* ; Mediastinal Emphysema*

Breast reconstruction following mastectomy has, become increasingly popular in recent years. Reconstruction surgeons have responded to patients' needs for effective and versatile procedures that will restore the normal shape and symmetry of breasts. Among the various techniques for these purpose, transverse rectus abdominis myocutaneous(TRAM) flap is now cosidered as the most acceptable technique. However, there are some limitations to use the TRAM flap, such as heavy smoker, obesity, and previous abdominal surgery. Also TRAM flaps are not good candidates for the patients with absent anterior axillary fold. In these respects, latissimus dorsi flap can be used as an alternative method for successful breast reconstuction. Latissiomus dorsi flaps have several advantages as compared to TRAM flaps, such as reliable blood supply, versatility of skin paddle orientation, and low donor site morbidity. It is also available for patients without anterior axillary fold, such as radical mastectomy defect or Poland syndrome. Latissimus dorsi flaps, however, and implants to obtain projection and symmetry of the reconstructed breast. Main disadvantages of latissimus dorsi flap method are difference in color and texture between skins of flap and chest, and capsular contracture resulted in high riding implant or distortion of breast contour. In this study, we performed latissimus dorsi flap for reconstruction fo breast and anterior axillary fold in 10 cases. To minimize the above problems more fullness and natural shape, implants were completely covered with muscle and overexpanded for more than 3-months and then deflated to the desired volume. These maneuvers produced aesthetically acceptable results during the latissimus dorsi breast reconstruction.
Breast* ; Contracture ; Female ; Humans ; Mammaplasty* ; Mastectomy ; Mastectomy, Radical ; Obesity ; Poland Syndrome ; Rectus Abdominis ; Skin ; Superficial Back Muscles* ; Thorax ; Tissue Donors