No abstract available.
Cyclosporine* ; Humans ; Vitiligo*

No abstract available.
Neurofibromatoses* ; Peripheral Nerves*

No abstract available.
Histiocytosis*

BACKGROUND: Several antibiotics can be used to treat ventilator-associated pneumonia caused by carbapenem-resistant A. baumannii (CRAB-VAP) including high-dose sulbactam. However, the effectiveness of high-dose sulbactam therapy is not well known. We report our experience with high-dose sulbactam for treatment of CRAB-VAP. METHODS: Medical records of patients with CRAB-VAP who were given high-dose sulbactam between May 2013 and June 2015 were reviewed. RESULTS: Fifty-eight patients with CRAB-VAP were treated with high-dose sulbactam. The mean age was 72.0 ± 15.2 years, and the acute physiology and chronic health evaluation II (APACHE II) score was 15.1 ± 5.10 at the time of CRAB-VAP diagnosis. Early clinical improvement was observed in 65.5% of patients, and 30-day mortality was 29.3%. Early clinical failure (odds ratio [OR]: 8.720, confidence interval [CI]: 1.346-56.484; p = 0.023) and APACHE II score ≥ 14 at CRAB-VAP diagnosis (OR: 10.934, CI: 1.047-114.148; p = 0.046) were associated with 30-day mortality. CONCLUSIONS: High-dose sulbactam therapy may be effective for the treatment of CRAB-VAP. However, early clinical failure was observed in 35% of patients and was associated with poor outcome.
Acinetobacter baumannii* ; Acinetobacter* ; Anti-Bacterial Agents ; APACHE ; Diagnosis ; Humans ; Medical Records ; Mortality ; Pneumonia, Ventilator-Associated* ; Sulbactam*

PURPOSE: The aim of this study was to evaluate the results of performing the suprapubic arc (SPARC) procedure during 14 months at our hospital for treating female stress urinary incontinence. MATERIALS AND METHODS: Between October 2002 and December 2003, 114 consecutive women who suffered with stress urinary incontinence underwent the SPARC procedure. All the patients were followed up for at least 1 year. The patients were preoperatively evaluated via taking their medical history, physical examinations, and conducting urinalysis and voiding cystourethrography and urodynamic studies, including determining the Valsalva leak point pressure (VLPP). Evaluations were conducted by questionnaires and interviews for determining the surgical outcome and the patients' satisfaction. RESULTS: The mean age was 48.6 years (30-70), the mean follow-up period was 16.4 months (12-25), the mean hospital stay was 3.8 days (2-10) and the mean operation time was 38.7 minutes. For 114 patients, 92 (80.7%) were cured and 17 (14.9%) were significantly improved. 99 patients (86.8%) were satisfied with the SPARC procedure, and 95 patients (83.3%) would like to recommend the SPARC procedure to others. Intraoperative complications included 9 (7.9%) bladder perforations and 1 (0.9%) urethral injury. Postoperative complications showed 14 cases (12.3%) of urinary retention, 2 cases (1.8%) of vaginal wound infections and 1 case (0.9%) of vaginal erosion due to tape. De novo urge incontinence was noted in 3 patients (2.6%). CONCLUSIONS: Favorable results were obtained from the SPARC procedure. This procedure is an effective and safe technique for the treatment of female stress urinary incontinence in terms of the low morbidity and the high success rate.
Female* ; Follow-Up Studies ; Humans ; Intraoperative Complications ; Length of Stay ; Physical Examination ; Postoperative Complications ; Surveys and Questionnaires ; Treatment Outcome ; Urinalysis ; Urinary Bladder ; Urinary Incontinence* ; Urinary Incontinence, Stress ; Urinary Incontinence, Urge ; Urinary Retention ; Urodynamics ; Wound Infection

PURPOSE: To evaluate clinical features and the effect of parathyroid hormone (PTH) on treatment outcomes of patients with pelvic insufficiency fractures. MATERIALS AND METHODS: Fifteen patients diagnosed with pelvic insufficiency fractures were evaluated retrospectively. All patients had osteoporosis with mean lumbar T score of −3.9 (range, −3.1 to −6.4) and the mean age was 76.5 years. In all cases, simple radiography and computed tomography was used for final diagnosis; additional magnetic resonance imaging and technetium bone scans were used to confirm the diagnosis in 2 and 6 patients, respectively. Initial conservative treatment was used in all cases; treatment with PTH was applied in 5 cases. Radiological follow-up was done every 4 weeks up to 6 months and every 3 months thereafter. Symptom improvement was measured using visual analogue scale (VAS) score. RESULTS: Fractures were located: i) sacrum and pubis (9 cases), ii) isolated sacrum (4 cases) and iii) isolated pubis (2 cases). One case showed fracture displacement and pain aggravation at 4 week follow-up which was treated with percutaneous sacro-iliac fixation using cannulated screws. Duration of bone union was significantly shorter in the patients who used PTH (P<0.05). VAS scores were also lower in the group treated with PTH; however, statistical significance was not reached. CONCLUSION: In patients with osteoporosis, a pelvic insufficiency fracture should be considered if pain is experienced in the pelvic area in the absence of major trauma. While nonoperatic has been shown to be sufficient for treatment, our study shows that PTH therapy shortens treatment period and could be a favorable treatment option.
Diagnosis ; Follow-Up Studies ; Fractures, Stress* ; Humans ; Magnetic Resonance Imaging ; Osteoporosis* ; Parathyroid Hormone ; Pubic Bone ; Radiography ; Retrospective Studies ; Sacrum ; Technetium

BACKGROUND: Cytosolic Ca2+ overload and oxygen derived free radicals may contribute to stunned myocardium. The pnt study was aimed to investigate the effects of nicardipine and sodium nitroprusside (SNP) on the functional recovery of postischemic reperfused myocardium. METHODS: Fifty-seven halothane-anesthetized dogs were subjected to 15 minutes of 1eft anterior descending coronary artery (LAD) occlusion and 3 hours of reperfusion. They were randomly assigned to receive either intracoronary nicardipine (n=11) or SNP (n=10) alone or both (nicardipine plus SNP, n=10). Eleven dogs that received saline i.c. served as the controL Regional myocardial contractility was evaluated by systolic shortening (%SS), the preload recruitable stroke work slope (Mw), and intramyocardial pressure (IMPs). Diastolic function was assessed by time constant of myocardial relaxation (IMP-tau) and postsystolic shortening (%PSS), LAD blood flow was measured by a Doppler flowmeter as well. RESULTS: LAD occlusion produced a significant reduction in systolic as well as diasto1ic functions to similar degrees in all groups. However, %SS was significantly higher in the nicardipine, SNP and nicardipine-SNP groups (67%, 56%, and 68% of baseline values, respectively) than in the controls (20%) at 3 hours of reperfusion. Furthermore, Mw recovered to the baseline with the onset of reperfusian in the three experimental groups. IMP-tau was restored to the baseline during early nperfusion in the SNP-treated groups but was significantly prolonged in the control and nicardipine poups throughout the seperfusion. LAD blood flow during reperfusion was higher in the SNP-treated groups in comparison to the control group. CONCLUSIONS: Treatment with either nicardipine or SNP enhances the recovery of mgional contractile function in the canine model of myocardial stunning. SNP not nicardipine is also beneficial in attenuation of early diastolic dysfunction. Nicardipine combined with SNP improved systolic as well as early diastolic functions more significantly when compared to either nicardipine or SNP alane.
Animals ; Coronary Vessels ; Cytosol ; Dogs* ; Flowmeters ; Free Radicals ; Heart ; Myocardial Stunning* ; Myocardium ; Nicardipine* ; Nitroprusside* ; Oxygen ; Pharmacology ; Relaxation ; Reperfusion ; Sodium* ; Stroke

A 56-year-old man presented with sudden onset of congestive heart failure (New York Heart Association class III to IV) after mild stress and developed various cardiovascular manifestations. At first visit, cardiac enzyme elevation, regional left ventricular (LV) wall motion abnormality and pulmonary edema were evident. However, coronary angiography was normal. LV function was totally recovered at discharge, suspicious of fulminant myocarditis. During the hospital stay, acute non-obstructive stroke without neurologic sequelae occurred. After 3 years, he re-admitted because ventricular tachycardia and severe LV systolic dysfunction (ejection fraction, 15%) were developed. After 3 days of applying percutaneous cardiopulmonary bypass system, the patient was completely recovered. Suspicious of pheochromocytoma, we checked 24-hour urine catecholamines and metanephrines and abdomen computed tomography, which revealed pheochromocytoma. The patient underwent laparoscopic adrenalectomy.
Abdomen ; Adrenalectomy ; Cardiomyopathies ; Cardiopulmonary Bypass ; Catecholamines ; Coronary Angiography ; Heart ; Heart Failure ; Humans ; Length of Stay ; Middle Aged ; Myocarditis ; Pheochromocytoma* ; Pulmonary Edema ; Stroke ; Tachycardia, Ventricular

PURPOSE: To investigate the clinical results and safety of the acellular dermal allograft (SureDerm(R), Hans Biomed co., Korea) as a new spacer graft in anophthalmic socket contracture. METHODS: We grafted SureDerm(R) as the replacing spacer in 8 patients for the treatment of anophthalmic socket contracture. Under local anesthesia, SureDerm(R) was sutured at the levator aponeurosis and upper margin of the tarsus using 6-0 Vicryl in the upper lid. In the lower lid, SureDerm(R) was sutured at the tarsal conjunctiva and lower margin of the incised conjunctiva. The patients were followed-up individually for 6 to 15 months. RESULTS Surgical results in all 8 eyelids (6 lower lids, 2 upper lids) were satisfactory. The grafted SureDerm(R) survived in all patients with little contracture. There were no other complications such as infection, rejection, or exposure. CONCLUSIONS: We consider SureDerm(R) a good replacing spacer material for the treatment of anophthalmic socket contracture.
Allografts* ; Anesthesia, Local ; Ankle ; Conjunctiva ; Contracture ; Eyelids ; Humans ; Polyglactin 910 ; Transplants

PURPOSE: A variety of retropubic and transobturator surgical techniques have been developed to restore support of the urethral sphincteric apparatus, but there is no consensus on the best procedure. The safety and efficacy of the SPARC (SPARC sling system, suprapubic arc, American Medical System) and the MONARC (MONARC subfascial hammock, American Medical System) sling systems for the treatment of female stress incontinence were evaluated in a prospective randomized trial. MATERIALS AND METHODS: Forty three women with stress incontinence were randomly assigned to the SPARC (n=22), or MONARC sling (n=21) procedures, between December 2003 and July 2004. The operative techniques complied with the manufacturers instructions. The patient characteristics and urodynamic evaluations were similar in both groups. The preoperative evaluation included a careful history taking, physical examination, voiding diary, stress & pad test and a comprehensive urodynamic examination. The postoperative evaluation included a questionnaire, stress & pad test and uroflowmetry with postvoid residuals. RESULTS: The mean operative time was shorter in the MONARC group, but this difference was not significant (23 min vs. 26 min). No bladder injury occurred in the MONARC group, versus 4.5% (n=1) in the SPARC group. The rate of postoperative urethral obstruction, including retention, was 27.2% (n=6) in the SPARC group, versus 28.5% (n=6) in the MONARC group, but this was improved by conservative therapy. The rates of cure (81.8% vs. 80.9%), improvement (18.2% vs. 19.1%) and failure (0% vs. 0%) were similar in the SPARC and MONARC groups, respectively. CONCLUSIONS: The MONARC procedure appears to be equally efficient as the SPARC procedure for the surgical treatment of stress urinary incontinence in women over a short-term follow-up. Although further studies are needed to establish its long-term efficacy and safety, the SPARC and MONARC procedures might be attractive alternative tools for the treatment of female stress urinary incontinence.
Consensus ; Female* ; Follow-Up Studies ; Humans ; Operative Time ; Physical Examination ; Prospective Studies* ; Surveys and Questionnaires ; Surgical Mesh ; Urethra ; Urethral Obstruction ; Urinary Bladder ; Urinary Incontinence* ; Urinary Incontinence, Stress ; Urodynamics