No abstract available.
Yersinia enterocolitica* ; Yersinia*

Follow-Up Studies ; Muscles ; Orbit ; Orbital Fractures

BACKGROUND: The risk of bleeding during extracorporeal membrane oxygenation (ECMO) is a potential deterrent in performing tracheostomy at many centers. To evaluate the safety of surgical tracheostomy (ST) in critically ill patients supported by ECMO, we reviewed the clinical correlation between preoperative coagulation status and bleeding complication-related ST during ECMO. METHODS: From April 1, 2012 to March 31, 2016, ST was performed on 38 patients supported by ECMO. We retrospectively reviewed and analyzed the medical records including complications related to ST. RESULTS: Heparin was administered to 23 patients (60.5%) for anticoagulation during ECMO, but 15 patients (39.5%) underwent ECMO without anticoagulation. Of the 23 patients administered anticoagulation therapy, heparin infusion was briefly paused in 13 prior to ST. The median platelet count, international normalized ratio, and activated partial thromboplastin time before ST were 126 ×109/L (range, 46 to 434 ×109/L), 1.2 (range, 1 to 2.3) and 62 seconds (27 to 114.2 seconds), respectively. No peri-procedural clotting complications related to ECMO were observed. Two patients (5.3%) suffering from ST-related major bleeding required surgical hemostasis. Minor bleeding after ST occurred in two cases (5.3%). No significant difference was found according to anticoagulation management (P = 0.723). No fatality was attributable to ST. CONCLUSIONS: The complication rates of ST in the patients supported by ECMO were low. Therefore, ST performed by an experienced operator, and with careful optimization of coagulation status, is a relatively safe procedure; the use of ST with ECMO should thus not be dismissed on account of the potential for bleeding caused by the administration of anticoagulants.
Anticoagulants ; Critical Illness ; Extracorporeal Membrane Oxygenation* ; Hemorrhage ; Hemostasis, Surgical ; Heparin ; Humans ; International Normalized Ratio ; Medical Records ; Partial Thromboplastin Time ; Platelet Count ; Retrospective Studies ; Tracheostomy*

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) strategy is proposed to reduce the ventilator-induced lung injury in acute respiratory distress syndrome (ARDS). As ECMO use has increased, a number of studies on prognostic factors have been published. Age is estimated to be an important prognostic factor. However, clinical evidences about ECMO use in elderly patients are limited. Therefore, we investigated clinical courses and outcomes of ECMO in elderly patients with ARDS. METHODS: We reviewed medical records of patients with severe ARDS who required ECMO support. Study patients were classified into an elderly group (> or = 65 years) and a non-elderly group (< 65 years). Baseline characteristics, ECMO related outcomes and associated factors were retrospectively analyzed according to group. RESULTS: From February 2011 to June 2013, a total of 31 patients with severe ARDS were treated with ECMO. Overall, 14 (45.2%) were weaned from ECMO, 9 (29.0%) survived to the general ward and 7 (22.6%) survived to discharge. Among the 18 elderly group patients, 7 (38.9%) were weaned from ECMO, 4 (22.2%) were survived to the general ward and 2 (11.1%) were survived to discharge. Overall intensive care unit survival was inversely correlated with concomitant acute kidney injury or septic shock. CONCLUSIONS: In this study, ECMO outcome was poor in severe ARDS patients aged over 65 years. Therefore, the routine use of ECMO in elderly patients with severe ARDS is not warranted except in highly selective cases.
Acute Kidney Injury ; Aged* ; Extracorporeal Membrane Oxygenation ; Humans ; Intensive Care Units ; Medical Records ; Patients' Rooms ; Respiratory Distress Syndrome, Adult* ; Retrospective Studies ; Shock, Septic ; Ventilator-Induced Lung Injury

STATEMENT OF PROBLEM: The use of zirconia prostheses fabricated with CAD/CAM system is on an increasing trend in dentistry. However, evaluation of the fit related to internal relief and marginal reproducibility of zirconia has not been reported. PURPOSE: This study was to evaluate the fit related to internal relief and marginal reproducibility of zirconia core fabricated with CAD/CAM system. Materials and methods: The evaluation was based on 30 zirconia cores and 5 IPS-Empress2 cores. Zirconia cores were fabricated in different conditions of internal relief(0, 10, 20, 30, 40 and 50 micrometer), and IPS-Empress2 cores were fabricated in accordance with the manufacturer's instructions. Before cementation, the marginal discrepancies of cores were measured on metal die. And then, each core was cemented to stone die, embedded in an acrylic resin and sectioned in two planes(mesiodistally and labiopalatally). The internal gaps were measured at the margin and axial surface. Measurements for the marginal discrepancies, the internal marginal gaps and the internal axial gaps were performed under a measuring microscope(Compact measuring microscope STM5; Olympus, Japan) at a magnification of *100. In addition, the marginal configurations of metal die, zirconia core and IPS-Empress2 core were examined with SEM(S-2700, Hitachi, Japan). RESULTS: Within the limits of this study the results were as follows. 1. Compared with IPS-Empress2 cores, the marginal discrepancies of zirconia cores had no significant differences, the internal marginal gaps were statistically smaller and the internal axial gaps were statistically larger in each condition of internal relief. 2. The marginal discrepancies and the internal marginal gaps of zirconia cores had no significant differences related to the conditions of internal relief(P>0.05). 3. The internal axial gaps of zirconia cores with 0.20micrometer for internal relief were significantly larger than that with 50micrometer(P<0.0001). 4. SEM micrographs showed favorable marginal reproducibility of zirconia core and smooth texture on the milling surface. CONCLUSION: The marginal discrepancy and the internal gaps of zirconia core were clinically acceptable and the milling surface was showed smooth texture. For fabrication of the durable esthetic restoration, further investigations on complex design of core, milling accuracy, compatability of enamel porcelain and porcelain firing seems to be needed.
Cementation ; Dental Enamel ; Dental Porcelain ; Dentistry ; Fires ; Prostheses and Implants

Here, we report a case of newly diagnosed diabetes, with concurrent pancreatic cancer manifested as hyperglycemic crisis, and aggravated by urinary tract infection. We summarize the initial clinical manifestations and pertinent laboratory, radiologic, and clinical findings in an elderly patient with hyperglycemic emergency. A review of the documents involving pancreatic tumors and hyperglycemic hyperosmolar state, which is an acute complication of diabetes mellitus, is presented. In the absence of other identifiable conditions, it is reasonable to speculate that some factor (or factors) produced by the tumor had a role in the metabolic decompensation. In addition, this discussion should be more carefully considered in the aged people group.
Aged ; Diabetes Mellitus ; Emergencies ; Humans ; Pancreatic Neoplasms ; Urinary Tract Infections

The distribution and extent of traumatic lesions were evaluated with MRI in 31 patients with diffuse axonal injuries(DAI). Authors also analyzed patients with diffuse axonal injury, clinically. The patients with DAI showed statistically significant lower incidence of lucid interval, fracture of the skull and intracranial hematoma. Combined injuries, intracrnial hematomas and distribution of lesions were proved to be poor prognostic factors of DAI. Diffuse axonal injury is most commonly involved in the white matter of the frontal and temporal lobes and the splenium of the corpus callosum. Patients with lesions in brainstem and cerebellum revealed worst prognosis. In our studies, the sensitivities of the imaging techniques for diffuse axonal injuries were 7.3% with CT scan, 75.6% with T1WI, and with 97.6% in T2WI of MRI, respectively. The authors concluded that MRI has clear advantages over CT in evaluating diffuse axonal injuries.
Axons ; Brain Stem ; Cerebellum ; Corpus Callosum ; Diffuse Axonal Injury* ; Hematoma ; Humans ; Incidence ; Magnetic Resonance Imaging* ; Prognosis ; Skull ; Temporal Lobe ; Tomography, X-Ray Computed

PURPOSE: Severe burn injury produces a catabolic state and several studies have evaluated the efficacy of recombinant human growth hormone (rhGH, GH) in burn treatment. This study aimed to investigate whether GH administration in severely burned patients can reverse or attenuate the catabolic state and can increase the serum level of insulin-like growth factor-I (IGF-I). The study also evaluated the efficacy of the early use of GH in major burn patients. METHODS: A randomized, controlled trial was carried out with 39 patients with severe burns (more than 40% of the total body surface burned or more than 20% full-thickness burns), of whom 24 completed the study protocol and were analysed. Fourteen patients received standard conservative treatment only, while the other 10 additionally received GH (0.1 mg/kg/day) over 3 weeks. Urinary urea nitrogen (UUN), transferrin, total body surface area burned (TBSAB) and IGF-I were measured. RESULTS: Additional GH treatment resulted in a significantly changed ratio (%) of UUN (P=0.010, P=0.011) and transferrin (P=0.012, P=0.031) at 1 week and 2 weeks, compared to no-GH treatment. These parameters showed significant change during the study period within the GH group. Furthermore, GH treatment showed a 3-fold elevation in IGF-I, while no-GH treatment did not show any significant change (P=0.021). TBSAB was decreased significantly in GH treatment compared to no-GH treatment at 2 weeks (P=0.046), but there was no significant difference at 1 week and 3 weeks. CONCLUSION: These results indicate that GH attenuates thecatabolic state and that short-term GH treatment in addition to standard burn treatment appears to have benefits for severely burned patients.
Body Surface Area ; Burns* ; Growth Hormone ; Human Growth Hormone* ; Humans ; Insulin-Like Growth Factor I ; Nitrogen ; Transferrin ; Urea

Fifty nine patients who had been admitted to Seoul National University Hospital from April to October in 1986 were prospectively examined by a pulsed Doppler echocardiography on one day before cardiac catheterization. The sample volume was placed both just proximal and distal to pulmonic valve on 2-D echocardiogram. 1) Among the three morphologic patterns of the flow velocity, triangular and intermediate types indicate pulmonary hypertension (sensitivity 84%, specificity 86%), and round type indicates normal pulmonary arterial pressure (sensitivity 86%, specificity 84%). 2) In the group with pulmonary hypertension acceleration time and ejection time were measured shorter (P<0.01), and prejection period was measured longer than the group without pulmonary hypertension (P<0.05). 3) The best correlation was obtained between PEP/AT and mean pulmonary arterial pressure (r=0.77). Acceleration time alone also correlated well with mean arterial pulmonary pressure(r=-0.69). 4) In STI measurement and its correlation with pulmonary arterial pressure, no significant difference was observed when recorded in main pulmonary artery or right ventricular outflow tract. But in the latter position, late, systolic fluttering and variation in curve morphology occured less likely. 5) Our results indicate that the pulsed Doppler echocardiography is useful not only in the diagnosis of pulmonary hypertension but also in the quantitative estimation of pulmonary arterial pressure in different heart diseases. Futhermore this method may be a good tool for follow-up evaluation after surgical or medical treatment of patients with pulmonary hypertension.
Acceleration ; Arterial Pressure* ; Cardiac Catheterization ; Cardiac Catheters ; Diagnosis ; Echocardiography, Doppler ; Echocardiography, Doppler, Pulsed* ; Heart Diseases ; Humans ; Hypertension, Pulmonary ; Prospective Studies ; Pulmonary Artery ; Sensitivity and Specificity ; Seoul

PURPOSE: To evaluate injury patterns of facet joints and associated soft tissue injuries in patients withacute traumatic cervical facet joint injuries. MATERIALS AND METHODS: From among patients with cervical spinetrauma, 27 with facet joint injuries, as seen on CT and MRI, were chosen for this study. CT scans were analyzedwith regard to the location of facet joint injury, the presence or absence of facet dislocation or fracture, andother associated fractures. MR images were analyzed with regard to ligament injury, intervertebral disc injury,intervertebral disc herniation, and spinal cord injury. RESULTS: The most common location of facet joint injurywas C6-7 level(n=10), followed by C5-6(n=8). Among these 27 patients with facet joint injuries, 12(44%) hadbilateral injuries and 15(56%) unilateral injuries. Facet fractures were present in 17 cases(63%) and the fractureof inferior facet was more frequent than superi-or. Patterns of fracture were vertical, transverse, or comminuted,but vertical fracture was the most common. Various degrees of dislocation were observed in patients with facetfractures. Fractures other than facet includ-ed pillar(n=11), lamina(n=6), transverse process(n=14), body(n=13),and spinous process(n=3). On MR im-ages, anterior longitudinal ligament injury was found in 8 patients(30%),posterior longitudinal ligament injury in 4(15%), and interspinous ligament injury in 20(74%). Twelvepatients(44%) had spinal cord injuries includ-ing edema(n=8) and hemorrhage(n=4). Among patients with discabnormalities, 11(41%) had intervertebral disc injuries, and traumatic disc herniations were found in nine. CONCLUSION: Traumatic cervical facet joint injuries were manifested as various patterns and frequentlyassoci-ated with other fractures or soft tissue injuries. Analysis of CT and MR findings of these injury patternshelped formulate a therapeutic plan and determine of prognosis.
Dislocations ; Humans ; Intervertebral Disc ; Ligaments ; Longitudinal Ligaments ; Magnetic Resonance Imaging* ; Prognosis ; Soft Tissue Injuries ; Spinal Cord Injuries ; Spine* ; Tomography, X-Ray Computed ; Zygapophyseal Joint*