The treatment for full thickness skin defect with the full or split-thickness autograft was often associated with aesthetically poor result, hypertrophic scar or extensive injury on donor site. Because of this donor morbidity, the use of artificial dermis was considered, which was the substrate of collagen or collagen cross-linked with polyglactin or polylactin. Unfortunately this substrate was void of advantages for the artificial dermis but was of easy biodegradability, antigenicity, or cytotoxic property. Currently chitosan is given attention by many investigators for its biochemical properties in wound healing process. Chitosan is the deacetylated derivative of chitin, which is a polymer of 2-amino-2-deoxy glucose with chemically active free amino group. Chitosan facilitates wound healing process, and then stimulates migration of polymorphonuclear cell(PMN) and macrophage, release of IL-8 and accelerates collagen synthesis surely with vascularization. Indeed chitosan supplies the resistance against bacterial infection of the wound. In this study, we have investigated the clinical applicability of the artificial dermal substrate which is cross-linked of collagen and GAG with chitosan, which we have applied on the full thickness skin defect in Fisher rat. The conclusions are as the follows: 1. There was sufficient vascularization in the grafted dermal substrate for STSG after 2 weeks of artificial dermis grafting. 2. Four 4 weeks after artificial dermis grafting, the architecture of the dermal substrate was maintained in about half amounts and the half of dermal skeleton was replaced with the newly formed dermis(neodermis). In conclusion, the dermal substrate used in this study is available enough for wound of full thickness skin defect.
Animals ; Autografts ; Bacterial Infections ; Chitin ; Chitosan ; Cicatrix, Hypertrophic ; Collagen ; Dermis ; Equipment and Supplies ; Glucose ; Humans ; Interleukin-8 ; Macrophages ; Polyglactin 910 ; Polymers ; Rats ; Research Personnel ; Skeleton ; Skin ; Tissue Donors ; Transplants ; Wound Healing ; Wounds and Injuries

BACKGROUND: Emphysematous pyelonephritis (EPN) is a rare and potentially life-threatening condition that requires prompt evaluation and management. However, its clinical presentation and outcomes vary widely. This study was conducted to ascertain the clinical features and prognostic factors regarding EPN. METHODS: All patients diagnosed with EPN radiologically and treated at the emergency department in the university-affiliated, tertiary-referral center, from January 1999 to December 2009 were evaluated. The patients' demographic and clinical characteristics, computed tomographic findings, treatment, and outcomes were analyzed retrospectively. RESULTS: Overall 14 patients diagnosed with EPN were admitted. There were 12 females and 2 males. A history of diabetes was found in 12 (85.7%) patients and was the most common comorbidity. The chief complaint among patients was flank pain (42.9%). Severe sepsis or septic shock was noted in 10 (71.4%) patients. Thirteen cases had unilateral involvement and one case had bilateral involvement. More than half of patients had Escherichia.coli in culture. Mean serum levels of HbA1c, creatinine, C-reactive protein (CRP) were 9.4 +/- 2.7, 2.4 +/- 1.4 mg/dl, and 22.4 +/- 13.1 mg/dl. Eight (57.1%) patients received antibiotic treatment alone and four (28.6%) patients received the concurrent percutaneous drainage as well as antibiotics. Hospital mortality was 7.1%. A higher initial serum CRP level (20.3 vs. 49.8 mg/dl, p = 0.02) and HbA1c level (8.7 vs. 16.4, p = 0.01) was associated with hospital mortality. CONCLUSIONS: Antibiotics alone provide a high success rate for the treatment of EPN. Higher serum CRP and HbA1c level was associated with a higher mortality rate in patients with EPN.
Anti-Bacterial Agents ; C-Reactive Protein ; Comorbidity ; Creatinine ; Diabetes Mellitus ; Drainage ; Emergencies ; Female ; Flank Pain ; Hospital Mortality ; Humans ; Male ; Pyelonephritis ; Sepsis ; Shock, Septic

Hemophagocytic lymphohistiocytosis (HLH) is a rare disorder characterized by fever, pancytopenia, hyperferritinemia, and phagocytosis of hematopoietic cells in bone marrow, liver, or lymph nodes. HLH can occur during the course of systemic lupus erythematosus (SLE), but can also be a presenting manifestation. Because development of pancytopenia occurs in less than 10 percent of SLE cases, investigation for HLH is necessary when otherwise unexplained pancytopenia persists despite adequate treatment. We experienced three cases of secondary HLH associated with SLE. Among the three patients, two patients developed HLH during the clinical course of SLE. The other patient who presented with pancytopenia was first diagnosed with HLH, and later with SLE. In her case, HLH turned out to be a presenting manifestation of SLE. We report on three successfully treated cases, and discuss the prevalence, characteristics, treatments, and prognosis of secondary HLH associated with SLE.
Bone Marrow ; Fever ; Humans ; Liver ; Lupus Erythematosus, Systemic ; Lymph Nodes ; Lymphohistiocytosis, Hemophagocytic* ; Pancytopenia ; Phagocytosis ; Prevalence ; Prognosis

Amyloidosis limited to the tracheobronchial respiratory tract is a relatively rare condition. Fewer than 100 cases of tracheobronchial amyloidosis are reported. It is characterized by deposits of amyloid in airway walls. Bronchoscopy, although carrying a risk of bleeding, is the procedure of choice diagnostically and therapeutically. 49-year old man suffered from cough and exertional dyspnea over 20s years and recently hemoptysis, atelectasis of right middle lobe and postobstructive pneumonia. He was diagnosed as amyloidosis and treated by bronchoscopy with Nd : YAG laser. We discussed this case with review of literatures.
Amyloid ; Amyloidosis* ; Bronchoscopy ; Cough ; Dyspnea ; Hemoptysis ; Hemorrhage ; Humans ; Laser Therapy* ; Lasers, Solid-State ; Middle Aged ; Pneumonia ; Pulmonary Atelectasis ; Respiratory System

ESRD patients have higher cardiovascular mortality risk than the general population. Increased QT dispersion has been shown to be a risk factor for cardiac arrhythmia in chronic hemodialysis patients with diabetes or arterial disease. It is known that QT dispersion is significantly prolonged in postdialysis than in predialysis. It is associated with a decrease in serum potassium. During hemodialysis, serum potassium is decreased and QT dispersion increases. Therefore ventricular arrhythmia frequently occurs in the latter half of dialysis. We report 2 cases of ventricular arrhythmia caused by potassium removal during dialysis in chronic hemodialysis patients.
Arrhythmias, Cardiac* ; Dialysis ; Humans ; Hypokalemia ; Kidney Failure, Chronic ; Mortality ; Potassium* ; Renal Dialysis* ; Risk Factors

Objective: A wireless electroencephalography (EEG) headset was applied to patients with an unclear etiology of an altered mental status suspected of non-convulsive seizures in the emergency department. Methods: The study included patients who presented to the emergency department with an altered mental status from January 1, 2020, to April 30, 2023. The patients with abnormal findings in brain imaging or those with typical seizure movement were excluded. Real-time portable continuous EEG monitoring was conducted on patients with persistent altered consciousness despite receiving conservative treatments and showing improvement in vital signs and blood tests within 3 hours. The baseline characteristics, degree of consciousness alteration and neurological symptoms, initial clinical diagnosis, EEG findings, and medications used in cases where epileptiform discharges were examined. The clinical outcomes were analyzed retrospectively. Results: Among 26 patients, six patients showed epileptiform discharges. The final diagnoses included uremic encephalopathy (n=2), septic encephalopathy due to pneumonia (n=1), urinary tract infection (n=1), diabetic ketoacidosis (n=1), and mental change only (n=1). The associated symptoms were myoclonus in three patients and abnormal eye movements in two patients. Conclusion In cases where the causes of altered mental status remain unexplained despite appropriate evaluations and treatments, particularly when accompanied by myoclonus or abnormal eye movements, it is crucial to consider the possibility of non-convulsive seizures and promptly perform an EEG to differentiate and diagnose the underlying condition, even if initial tests and treatments have been performed.

Objective: A wireless electroencephalography (EEG) headset was applied to patients with an unclear etiology of an altered mental status suspected of non-convulsive seizures in the emergency department. Methods: The study included patients who presented to the emergency department with an altered mental status from January 1, 2020, to April 30, 2023. The patients with abnormal findings in brain imaging or those with typical seizure movement were excluded. Real-time portable continuous EEG monitoring was conducted on patients with persistent altered consciousness despite receiving conservative treatments and showing improvement in vital signs and blood tests within 3 hours. The baseline characteristics, degree of consciousness alteration and neurological symptoms, initial clinical diagnosis, EEG findings, and medications used in cases where epileptiform discharges were examined. The clinical outcomes were analyzed retrospectively. Results: Among 26 patients, six patients showed epileptiform discharges. The final diagnoses included uremic encephalopathy (n=2), septic encephalopathy due to pneumonia (n=1), urinary tract infection (n=1), diabetic ketoacidosis (n=1), and mental change only (n=1). The associated symptoms were myoclonus in three patients and abnormal eye movements in two patients. Conclusion In cases where the causes of altered mental status remain unexplained despite appropriate evaluations and treatments, particularly when accompanied by myoclonus or abnormal eye movements, it is crucial to consider the possibility of non-convulsive seizures and promptly perform an EEG to differentiate and diagnose the underlying condition, even if initial tests and treatments have been performed.

Objective: A wireless electroencephalography (EEG) headset was applied to patients with an unclear etiology of an altered mental status suspected of non-convulsive seizures in the emergency department. Methods: The study included patients who presented to the emergency department with an altered mental status from January 1, 2020, to April 30, 2023. The patients with abnormal findings in brain imaging or those with typical seizure movement were excluded. Real-time portable continuous EEG monitoring was conducted on patients with persistent altered consciousness despite receiving conservative treatments and showing improvement in vital signs and blood tests within 3 hours. The baseline characteristics, degree of consciousness alteration and neurological symptoms, initial clinical diagnosis, EEG findings, and medications used in cases where epileptiform discharges were examined. The clinical outcomes were analyzed retrospectively. Results: Among 26 patients, six patients showed epileptiform discharges. The final diagnoses included uremic encephalopathy (n=2), septic encephalopathy due to pneumonia (n=1), urinary tract infection (n=1), diabetic ketoacidosis (n=1), and mental change only (n=1). The associated symptoms were myoclonus in three patients and abnormal eye movements in two patients. Conclusion In cases where the causes of altered mental status remain unexplained despite appropriate evaluations and treatments, particularly when accompanied by myoclonus or abnormal eye movements, it is crucial to consider the possibility of non-convulsive seizures and promptly perform an EEG to differentiate and diagnose the underlying condition, even if initial tests and treatments have been performed.

Objective: A wireless electroencephalography (EEG) headset was applied to patients with an unclear etiology of an altered mental status suspected of non-convulsive seizures in the emergency department. Methods: The study included patients who presented to the emergency department with an altered mental status from January 1, 2020, to April 30, 2023. The patients with abnormal findings in brain imaging or those with typical seizure movement were excluded. Real-time portable continuous EEG monitoring was conducted on patients with persistent altered consciousness despite receiving conservative treatments and showing improvement in vital signs and blood tests within 3 hours. The baseline characteristics, degree of consciousness alteration and neurological symptoms, initial clinical diagnosis, EEG findings, and medications used in cases where epileptiform discharges were examined. The clinical outcomes were analyzed retrospectively. Results: Among 26 patients, six patients showed epileptiform discharges. The final diagnoses included uremic encephalopathy (n=2), septic encephalopathy due to pneumonia (n=1), urinary tract infection (n=1), diabetic ketoacidosis (n=1), and mental change only (n=1). The associated symptoms were myoclonus in three patients and abnormal eye movements in two patients. Conclusion In cases where the causes of altered mental status remain unexplained despite appropriate evaluations and treatments, particularly when accompanied by myoclonus or abnormal eye movements, it is crucial to consider the possibility of non-convulsive seizures and promptly perform an EEG to differentiate and diagnose the underlying condition, even if initial tests and treatments have been performed.