Most insects including the honeybee cause erythema and edema at the site of a sting in non-allergic individuals. This reaction usually resolves within a few days. However, in certain cases, the persistence of inciting materials in the cutaneous tissue may promote a local inflammatory foreign body reaction. Localized nodular lesions were seen in our two patients and erythemstous patches were present in one patient due to rarely encountered complications induced by retained sting materials. In these cases histopathology showed multiple foci of foreign body granuloma containing yellow refraetile material in the center surrounded by histiocytes and foreign body giant cells. The granulomatous skin lesions in these patients were treated with intralesional injections of triamcinolone acetonide and partial excisions of the nodular masses were performed.
Bites and Stings ; Edema ; Erythema ; Foreign-Body Reaction ; Giant Cells, Foreign-Body ; Granuloma* ; Granuloma, Foreign-Body ; Histiocytes ; Humans ; Injections, Intralesional ; Insects ; Skin ; Triamcinolone Acetonide

No abstract available.

PURPOSE: The purpose of this study was to evaluate the effectiveness of a ventilator-associated pneumonia (VAP) bundle.METHODS: This was a retrospective study that was carried out between June 2010 and October 2015. In this study, 3,224 intubated patients were included. The VAP bundle which was applied to Group 1 patients (n=470) included head-of-bed elevation to 30 degrees, cuff pressure monitorization, prophylaxis of peptic ulcer, and prophylaxis of deep vein thrombosis. The VAP bundle for Group 2 patients (n=1,914) included all the elements of the VAP bundle for Group 1 patients and one additional element which was oral care with 0.12% chlorhexidine. The VAP bundle for Group 3 patients (n=870) added sedative interruption and assessment of readiness to extubate to the VAP bundle for Group 2.RESULTS: The numbers and incidences of VAP were significantly different among the three groups. Moreover, there were significant differences among groups in ICU length of stay and mortality.CONCLUSION: Three different VAP prevention bundles made different effects in patient outcomes.
Chlorhexidine ; Humans ; Incidence ; Infection Control ; Intensive Care Units ; Length of Stay ; Mortality ; Patient Care Bundles ; Peptic Ulcer ; Pneumonia, Ventilator-Associated ; Retrospective Studies ; Venous Thrombosis

BACKGROUND: In general, the outcomes of arthroscopic repair for superior labrum anterior to posterior lesions (SLAP) are favorable, however, persistent pain and limitation of motion are not rare complications. One of the possible cause is a “knot-ache”. This study evaluated the results of reoperation of symptomatic recurrent SLAP lesions and asked whether the knot is associated with postoperative complications. METHODS: Between 2005 and 2015, a total of 11 patients who had undergone arthroscopic SLAP repair were reoperated for recurrent symptomatic SLAP lesion. By retrospective chart review, operative findings, the visual analogue scale for pain (pVAS), the range of motion (ROM), and functional scores were analyzed. RESULTS: The mean age of the study participants was 38.3 years, and the mean follow-up period was 42.5 months. In the primary operation, there were nine cases of repairs with conventional knot-tying anchors and three cases with knotless anchors. Impingement of the knots during abduction and external rotation of the shoulder was observed in the all cases with knot-tying anchors. The mean pVAS, ROM, and functional scores significantly improved with reoperation. At the final follow-up, the mean satisfaction VAS was 8.3. CONCLUSIONS: The knots of suture anchor maybe a possible etiology of the pain, which we termed a “knot-ache”. Considering that reoperation is performed due to pain after primary repair, the use of knotless suture anchor may have benefits of eliminating one of possible cause, “knot-ache”. Therefore, authors suggest the use of knotless anchors during reoperation for recurrent or recalcitrant pain after primary SLAP repair.

BACKGROUND: Chlamydia trachomatis is one of the most common causative agents of the sexual transmitted diseases, and the accurate diagnosis and early treatment are very important to prevent the transmission. So, we evaluated the polymerase chain reaction (PCR) and QuickVue(TM) (Quidel Corp. San Diego, CA) EIA method as a routine clinical laboratory test. METHODS: The 80 cervical swab samples including pelvic inflammatory disease, cervicitis and tube-ovarian abscess were tested using PCR with plasmid specific primers T1, T2 and commercially available QuickVue(TM) EIA kit. RESULTS: The positivities of the PCR and QuickVue(TM) EIA test were 17.5% (14/80 samples) and 12.5% (10/80 samples), respectively. There were 95% (76/80 samples) of positive or negative result concordance rates and 5% (4/80 samples) of disconcordance between the two methods, in which showed PCR positive and EIA negative results. CONCLUSIONS: We assume that PCR and QuickVue(TM) method are highly confident as a routine clinical laboratory diagnostic test for C. trachomatis infection. But more careful interpretation of QuickVue(TM) EIA and the additional study for variable samples will be needed.
Abscess ; Chlamydia trachomatis* ; Chlamydia* ; Diagnosis* ; Diagnostic Tests, Routine ; Female ; Pelvic Inflammatory Disease ; Plasmids ; Polymerase Chain Reaction* ; Uterine Cervicitis

PURPOSE: To evaluate the diagnostic outcomes of patients suspicious for glaucoma referred from the company health screening. METHODS: In this prospective study, 147 (87 male, 60 female) patients for glaucoma suspicious referred from the company health screening were enrolled. They underwent slit-lamp examination, Goldmann applanation tonometry, gonioscopy, optic disc examination, visual field examination and peripapillary retinal nerve fiber layer (RNFL) thickness measurement using optical coherence tomography (StratusOCT) and scanning laser polarimetry (GDx VCC). We analyzed their diagnostic outcomes. RESULTS: The mean age of patients was 43.8 9.6 years. Reasons for glaucoma suspicion and the number of referred patients were 111 (75.5%) high cup/disc ratio, 23 (15.6%) high intraocular pressure and 13 (8.8%) both of these. The diagnostic outcome was as follows: glaucoma, 26 (17.7%); glaucoma suspect, 4 (2.7%); ocular hypertension (OHT), 14 (9.5%); no glaucoma and no ocular hypertension, 89 (60.5%); and normal, 18 (12.2%). CONCLUSIONS: Glaucoma, glaucoma suspect and ocular hypertension were confirmed in 27.2% of patients suspicious for glaucoma referred from the company health screening. Thus, the company health screening appears to be relatively sensitive to detecting glaucoma patients.
Glaucoma* ; Gonioscopy ; Humans ; Intraocular Pressure ; Male ; Manometry ; Mass Screening* ; Nerve Fibers ; Ocular Hypertension ; Prospective Studies ; Referral and Consultation ; Retinaldehyde ; Scanning Laser Polarimetry ; Tomography, Optical Coherence ; Visual Fields

BACKGROUND: Lesions in distal target arteries hinder surgical bypass procedures in patients with peripheral arterial occlusive disease. METHODS: Between April 2012 and October 2015, 16 patients (18 limbs) with lifestyle-limiting claudication (n=12) or chronic critical limb ischemia (n=6) underwent femoral–above-knee (AK) polytetrafluoroethylene (PTFE) bypass grafts with a bridging stent graft placement between the distal target popliteal artery and the PTFE graft. Ring-supported PTFE grafts were used in all patients with no available vein for graft material. Follow-up evaluations assessed clinical symptoms, the ankle-brachial index, ultrasonographic imaging and/or computed tomography angiography, the primary patency rate, and complications. RESULTS: All procedures were successful. The mean follow-up was 12.6 months (range, 11 to 14 months), and there were no major complications. The median baseline ankle-brachial index of 0.4 (range, 0.2 to 0.55) significantly increased to 0.8 (range, 0.5 to 1.0) at 12 months (p<0.01). The primary patency rate at 12 months was 83.3%. The presenting symptoms resolved within 2 weeks. CONCLUSION: In AK bypasses with a diffusely diseased distal target popliteal artery or when below-knee (BK) bypass surgery is impossible, this procedure could be clinically effective and safe when used as an alternative to femoral-BK bypass surgery.
Angiography ; Ankle Brachial Index ; Arterial Occlusive Diseases ; Arteries ; Blood Vessel Prosthesis* ; Extremities ; Follow-Up Studies ; Humans ; Ischemia ; Polytetrafluoroethylene* ; Popliteal Artery* ; Stents* ; Transplants ; Veins

BACKGROUND: Lesions in distal target arteries hinder surgical bypass procedures in patients with peripheral arterial occlusive disease. METHODS: Between April 2012 and October 2015, 16 patients (18 limbs) with lifestyle-limiting claudication (n=12) or chronic critical limb ischemia (n=6) underwent femoral–above-knee (AK) polytetrafluoroethylene (PTFE) bypass grafts with a bridging stent graft placement between the distal target popliteal artery and the PTFE graft. Ring-supported PTFE grafts were used in all patients with no available vein for graft material. Follow-up evaluations assessed clinical symptoms, the ankle-brachial index, ultrasonographic imaging and/or computed tomography angiography, the primary patency rate, and complications. RESULTS: All procedures were successful. The mean follow-up was 12.6 months (range, 11 to 14 months), and there were no major complications. The median baseline ankle-brachial index of 0.4 (range, 0.2 to 0.55) significantly increased to 0.8 (range, 0.5 to 1.0) at 12 months (p<0.01). The primary patency rate at 12 months was 83.3%. The presenting symptoms resolved within 2 weeks. CONCLUSION: In AK bypasses with a diffusely diseased distal target popliteal artery or when below-knee (BK) bypass surgery is impossible, this procedure could be clinically effective and safe when used as an alternative to femoral-BK bypass surgery.
Angiography ; Ankle Brachial Index ; Arterial Occlusive Diseases ; Arteries ; Blood Vessel Prosthesis* ; Extremities ; Follow-Up Studies ; Humans ; Ischemia ; Polytetrafluoroethylene* ; Popliteal Artery* ; Stents* ; Transplants ; Veins

Respiratory syncytial virus (RSV) typically causes lower respiratory tract infections in children, and most patients recover successfully. However, some infants and young children can have a severe course of disease with respiratory failure, and extrapulmonary manifestations can occur in severe RSV disease. We report one case of severe RSV bronchiolitis complicated with acute myocarditis, fulminant hepatic failure, and disseminated intravascular coagulation.
Bronchiolitis ; Child ; Disseminated Intravascular Coagulation ; Humans ; Infant ; Liver Failure ; Liver Failure, Acute ; Myocarditis ; Respiratory Insufficiency ; Respiratory Syncytial Viruses* ; Respiratory Tract Infections

Respiratory syncytial virus (RSV) typically causes lower respiratory tract infections in children, and most patients recover successfully. However, some infants and young children can have a severe course of disease with respiratory failure, and extrapulmonary manifestations can occur in severe RSV disease. We report one case of severe RSV bronchiolitis complicated with acute myocarditis, fulminant hepatic failure, and disseminated intravascular coagulation.
Bronchiolitis ; Child ; Disseminated Intravascular Coagulation ; Humans ; Infant ; Liver Failure ; Liver Failure, Acute ; Myocarditis ; Respiratory Insufficiency ; Respiratory Syncytial Viruses* ; Respiratory Tract Infections