No abstract available.

BACKGROUND: Unplanned extubation (UE) of patients requiring mechanical ventilation in an intensive care unit (ICU) is associated with poor outcomes for patients and organizations. This study was conducted to assess the clinical features of patients who experienced UE and to determine the risk factors affecting reintubation after UE in an ICU. METHODS: Among all adult patients admitted to the ICU in our institution who required mechanical ventilation between January 2011 and December 2013, those in whom UE was noted were included in the study. Data were categorized according to noninvasive or invasive management after UE. RESULTS: The rate of UE was 0.78% (the number of UEs per 100 days of mechanical ventilation). The incidence of self-extubation was 97.2%, while extubation was accidental in the remaining patients. Two cases of cardiac arrest combined with respiratory arrest after UE were noted. Of the 214 incidents, 54.7% required invasive management after UE. Long duration of mechanical ventilation (odds ratio [OR] 1.52; 95% confidence interval [CI] 1.32-1.75; p = 0.000) and high ICU mortality (OR 4.39; 95% CI 1.33-14.50; p = 0.015) showed the most significant association with invasive management after UE. In multivariate analysis, younger age (OR 0.96; 95% CI 0.93-0.99; p = 0.005), medical patients (OR 4.36; 95% CI 1.95-9.75; p = 0.000), use of sedative medication (OR 4.95; 95% CI 1.97-12.41; p = 0.001), large amount of secretion (OR 2.66; 95% CI 1.01-7.02; p = 0.049), and low PaO2/FiO2 ratio (OR 0.99; 95% CI 0.98-0.99; p = 0.000) were independent risk factors of invasive management after UE. CONCLUSIONS: To prevent unfavorable clinical outcomes, close attention and proper ventilatory support are required for patients with risk factors who require invasive management after UE.
Adult ; Heart Arrest ; Humans ; Incidence ; Intensive Care Units* ; Critical Care* ; Mortality ; Multivariate Analysis ; Respiration, Artificial ; Risk Factors

The estimated incidence of duodenal Crohn,s disease ranges from 0.5-4% of the patients with Crohn,s disease. However, isolated involvement of Crohn,s disease in the duodenum is very rare, and most duodenal Crohn's disease is accompanied with it elsewhere in the gastrointestinal tract. As clinical, radiographic, and endoscopic features may overlap with those of peptic ulcer disease, patients presenting with isolated duodenal involvement may be perplexing diagnostically. The initial treatment for duodenal Crohn,s diease is medical, but if complications such as gastric outlet obstrution, intractable pain during medical therapy, or hemorrhage occur, surgical intervention is necessary. We experienced one case of isolated duodenal Crohn,s disease showing gastric outlet obstruction without any lesion elsewhere in the gastrointestinal tract and report the case with a review of the literature.
Crohn Disease* ; Duodenum ; Gastric Outlet Obstruction ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Incidence ; Pain, Intractable ; Peptic Ulcer

Conventional medical therapies have not been very successful in treating adults with refractory septic shock. The effects of direct hemoperfusion using polymyxin B and veno-arterial extracorporeal membrane oxygenation (ECMO) for refractory septic shock remain uncertain. A 66-year-old man was admitted to the emergency department and suffered from sepsis-induced hemodynamic collapse. For hemodynamic improvement, we performed direct hemoperfusion using polymyxin B. Computed tomography scan of this patient revealed emphysematous pyelonephritis (EPN), for which he underwent emergent nephrectomy with veno-arterial ECMO support. To the best of our knowledge, this is the first report of successful treatment of EPN with refractory septic shock using polymyxin B hemoperfusion and nephrectomy under the support of ECMO.
Adult ; Aged ; Emergency Service, Hospital ; Endotoxins ; Extracorporeal Membrane Oxygenation* ; Hemodynamics ; Hemoperfusion ; Humans ; Nephrectomy* ; Polymyxin B ; Pyelonephritis ; Shock, Septic*

Small hepatoma is defined as hepatocellular carcinoma less than 3cm in maximum diameter and fewer than 3 innumber. To assess the ability of ultrasound to detect small hepatomas, a prospectively study was done in a groupof patients with HBsAg-positive chronic hepatitis and liver cirrhosis. Herein, we present 4 hypoechoic smallhepatomas detected on ultrasound and emphasize the role of real-time ultrasonography as a practical test formonitoring hepatoma high-risk, subjects.
Carcinoma, Hepatocellular ; Hepatitis, Chronic ; Humans ; Liver Cirrhosis ; Mass Screening ; Prospective Studies ; Ultrasonography

Mucormycosis is an uncommon opportunistic fungal infection mostly affecting immunocompromised patients and gastrointestinal mucormycosis is a rare and life-threatening. We describe a 31-year-old man with a history of idiopathic cyclic neutropenia who developed perforations of the stomach and intestine and intra-abdominal bleeding due to disseminated gastrointestinal mucormycosis after the initial operation.
Adult ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Immunocompromised Host ; Intestines ; Mucormycosis* ; Neutropenia ; Stomach

No abstract available.
Thumb*

No abstract available.
Facial Nerve* ; Paralysis*

Advances in medical technology and health insurance coverage policies have significantly promoted radiological examinations in Korea. In 2019, the number of computed tomography examinations performed in Korea was approximately 1.5-times higher than the Organisation for Economic Co-operation and Development average. This surge in radiological examinations has raised concerns regarding inappropriate imaging practices that may lead to unnecessary radiation exposure and increased healthcare cost.Current Concepts: Two fundamental principles guide the radiation safety practices in medicine: Optimization and justification. Optimization, represented by the “As Low As Reasonably Achievable” principle, minimizes the radiation dose while maintaining the diagnostic quality. Justification ensures that the benefits of radiological procedures outweigh their potential risks. Evidence-based clinical imaging guidelines, such as the UK iRefer guidelines and USA American College of Radiology Appropriateness Criteria, have been internationally proposed to implement these principles. In Korea, collaborative efforts between the National Evidence-based Healthcare Collaborating Agency and Korean Society of Radiology have led to the development of Korean evidence-based clinical imaging guidelines.Discussion and Conclusion: Implementation of evidence-based imaging guidelines is crucial to reduce unnecessary radiation exposure and optimize resource utilization. However, various challenges, including the adaptation of the guidelines to individual patient needs and successful integration of rapidly advancing medical technologies, remain. Continuous updates, professional education, and system-wide support are essential to ensure the effective implementation of these guidelines. Future studies should focus on enhancing the precision and applicability of these guidelines in clinical practice to improve the patient safety and healthcare efficiency.

Advances in medical technology and health insurance coverage policies have significantly promoted radiological examinations in Korea. In 2019, the number of computed tomography examinations performed in Korea was approximately 1.5-times higher than the Organisation for Economic Co-operation and Development average. This surge in radiological examinations has raised concerns regarding inappropriate imaging practices that may lead to unnecessary radiation exposure and increased healthcare cost.Current Concepts: Two fundamental principles guide the radiation safety practices in medicine: Optimization and justification. Optimization, represented by the “As Low As Reasonably Achievable” principle, minimizes the radiation dose while maintaining the diagnostic quality. Justification ensures that the benefits of radiological procedures outweigh their potential risks. Evidence-based clinical imaging guidelines, such as the UK iRefer guidelines and USA American College of Radiology Appropriateness Criteria, have been internationally proposed to implement these principles. In Korea, collaborative efforts between the National Evidence-based Healthcare Collaborating Agency and Korean Society of Radiology have led to the development of Korean evidence-based clinical imaging guidelines.Discussion and Conclusion: Implementation of evidence-based imaging guidelines is crucial to reduce unnecessary radiation exposure and optimize resource utilization. However, various challenges, including the adaptation of the guidelines to individual patient needs and successful integration of rapidly advancing medical technologies, remain. Continuous updates, professional education, and system-wide support are essential to ensure the effective implementation of these guidelines. Future studies should focus on enhancing the precision and applicability of these guidelines in clinical practice to improve the patient safety and healthcare efficiency.