BACKGROUND: Postoperative admission to the surgical intensive care unit (S-ICU) is commonly planned to prevent and treat complications, unnecessary admission to the S-ICU increases medical costs and length of hospital stay. This study aimed evaluated outcome and the predictive factors for mortality in patients admitted to the S-ICU after abdominal surgery. METHODS: The 168 patients admitted to the S-ICU immediately after abdominal surgery were reviewed retrospectively from January to December 2011. RESULTS: The mortality rate of patients admitted to the S-ICU after abdominal surgery was 8.9% (15 of 168). Two preoperative factors (body mass index [BMI] < 18.5 kg/m2 [p < 0.001] and serum albumin < 3.0 g/dL [p = 0.018]), two operative factors (the need for transfusion [p = 0.008] or vasopressors [p = 0.013] during surgery), and three postoperative variables (mechanical ventilation immediately following surgery [p < 0.001], sequential organ failure assessment [p = 0.001] and SAPS II [p = 0.001] score) were associated with mortality in univariate analysis. After adjusting for age, gender, and SAPS II by a Cox regression, which revealed that BMI < 18.5 kg/m2 (p < 0.001, hazard ratio [HR] 9.690, 95% confidence interval [CI] 2.990-25.258) and the use of mechanical ventilation on admission to S-ICU (p < 0.001, HR 34.671, 95% CI 6.440-186.649) were independent prognostic factors. CONCLUSIONS: In patients in S-ICU after abdominal surgery, low BMI and postsurgical mechanical ventilation should be considered important predictors of mortality.
Abdomen* ; Body Mass Index ; Humans ; Critical Care ; Intensive Care Units ; Length of Stay ; Mortality ; Postoperative Complications ; Prognosis* ; Respiration, Artificial ; Retrospective Studies ; Serum Albumin ; Ventilation

PURPOSE: We studied to determine whether the degenerative spondylolisthesis has rotary deformity in addition to forward displacement. MATERIALS AND METHODS: We have made an analysis of difference of rotary deformity between the 31 study groups of symptomatic degenerative spondylolisthesis and 31 control groups without any symptom,statistically. We also reviewed CT findings in 15 study groups. RESULTS: The mean rotary deformity in study groups was 6.1 degree(the standard deviation is 5.20), and the mean rotary deformity in control groups was 2.52 degree(the standard deviation is 2.16)(p <0.01) CONCLUSION: The rotary deformity can be accompanied with degenerative spondylolisthesis. We may consider the rotary deformity as a cause of symptomatic degenerative spondylolisthesis in case that any other cause is not detected.
Congenital Abnormalities* ; Spondylolisthesis*

A case of gonadoblastoma with dysgerminoma and choriocarcinoma in the right ovary of a 23-year-old woman is reported. A case of gonadoblastoma without a Y chromosome is very rare. She had a 46XX chromosomes, normal genitalia, no history of menstrual irregularities, thereby differing from the other reproted case. The patient had a normal term pregnancy 2 years after surgery and chemotherapy. It is suggested that gonadoblastoma may occur in functionally and morphologically normal gonads. There have been no signs of recurrence or metastasis for 3 years after the first operation.
Choriocarcinoma* ; Drug Therapy ; Dysgerminoma* ; Female ; Genitalia ; Gonadoblastoma* ; Gonads ; Humans ; Karyotype* ; Neoplasm Metastasis ; Ovary* ; Pregnancy ; Recurrence ; Y Chromosome ; Young Adult

PURPOSE: Attention deficit hyperactivity disorder (ADHD) is a syndrome characterized by inattention, impulsive disruptive behavior, impaired concentration, and motor restlessness. This study examined the relationships among electroencephalographic (EEG) findings, stimulant use, and seizure occurrence in children with ADHD. METHODS: We retrospectively studied 308 children with ADHD who visited the neuropsychiatric clinic of our hospital from January 2001 to December 2005. We retrospectively analyzed age distribution, etiology, abnormal EEG findings, and use of CNS stimulants. Among these children, brain waves was recorded in 84 patients. RESULTS: Eighty-four children (72 males, 85.7%, 9.3 years mean age; 12 females, 14.3%, 8.0 years mean age) with ADHD had electroencephalograms (EEGs) performed at our institute. Nineteen patients (22.6%) demonstrated epileptiform abnormalities, and 65 (77.4%) demonstrated normal EEGs. Stimulant therapy was applied to 59 of 84 patients (70.2%). Seizures occurred in 1 of 65 patients with a normal EEG (incidence, 1.5%) and 3 of 19 treated patients with epileptiform EEGs (incidence, 15.7%). CONCLUSION: These data suggest that patients with normal EEGs have minor risk for seizure. In contrast, patients with epileptiform EEGs have higher risk for seizure than patients with normal EEGs.
Age Distribution ; Attention Deficit Disorder with Hyperactivity ; Brain ; Brain Waves ; Central Nervous System ; Central Nervous System Stimulants ; Child ; Electroencephalography ; Female ; Humans ; Male ; Methylphenidate ; Psychomotor Agitation ; Retrospective Studies ; Seizures

BACKGROUND/AIMS: In patients with chronic obstructive pulmonary disease (COPD), left ventricular (LV) systolic dysfunction and structural changes are rare, while right ventricular (RV) dysfunction and structural alteration and/or LV diastolic dysfunction are common. We evaluated the cardiac structure and function in patients with COPD using echocardiography. METHODS: Echocardiography examinations were performed in 69 patients with clinically stable COPD and without a history of heart disease; 22 control subjects with normal lung function were enrolled for comparison. Echocardiography parameters of the COPD patients were compared with those of the controls, and assessed according to the COPD stage classified using the Global initiative for chronic Obstructive Lung Disease (GOLD) criteria. RESULTS: Patients with COPD had significantly lower body weight (p=0.001) and higher pack-years of smoking than did the controls (p=0.002). The echocardiogram showed that LV end diastolic diameter (p<0.001), LV end systolic diameter (p=0.020), left atrial (LA) diameter (p=0.026), and LV mass in the COPD patients were significantly decreased compared to the controls (p=0.003). However, there were no differences between the COPD patients and controls in the parameters reflecting LV diastolic function and mean RV systolic pressure (RVSP). According to the COPD stage, body weight (p<0.001), body mass index (BMI) (p<0.001), and LV mass were significantly different (p=0.011). In patients with COPD, LV mass (r=0.432) (p<0.001) and BMI were significantly correlated with FEV1% predicted (r=0.600) (p<0.001). CONCLUSIONS: Patients with COPD had lower LV mass and LA and LV diameters than did the controls, even though both groups had normal LV function. In particular, the LV mass appeared to correlate with the lung function in the patients with COPD.
Blood Pressure ; Body Mass Index ; Body Weight ; Echocardiography ; Heart ; Humans ; Hypertension ; Lung ; Lung Diseases ; Pulmonary Disease, Chronic Obstructive ; Smoke ; Smoking

Although failure of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR TKI) is generally believed to be associated with cross-resistance to other EGFR TKI, the benefit of administering erlotinib as a second EGFR TKI after resistance of gefitinib as the first TKI has been well known. However, good response to gefitinib after an initial response to erlotinib has been rare. We report that a 45-year-old woman (never smoked), with lung adenocarcinoma and EGFR mutation, showed an initial response to erlotinib, and then responded to gefitinib again.
Adenocarcinoma ; Female ; Humans ; Lung ; Lung Neoplasms ; Middle Aged ; Protein-Tyrosine Kinases ; Quinazolines ; Receptor, Epidermal Growth Factor ; Erlotinib Hydrochloride

BACKGROUND: Osteoporosis is a significant comorbidity in patients with chronic obstructive pulmonary disease (COPD). This study examined the prevalence and risk factors associated with osteoporosis in patients with COPD. METHODS: The bone mineral densities (BMDs) of the lumbar spine and femoral bone were measured in 53 patients with clinically stable COPD and 41 age- and gender-matched control subjects showing a normal lung function. Osteoporosis was defined as a T-score < or =-2.5. The subjects' clinical characteristics and laboratory data were reviewed, and multiple logistic regression analysis was used to identify the risk factors associated with osteoporosis in COPD patients. RESULTS: The prevalence of osteoporosis was 47% and 32% in the COPD patients and controls, respectively. In particular, using the femoral neck T-score, the prevalence of osteoporosis in COPD patients was higher than that in the controls (26% vs. 5%; p=0.006). The average T-score of the lumbar spine (p=0.025) and femoral neck of COPD patients were significantly lower than those of the controls (p=0.001). The forced expiratory volume in the 1 second (FEV1) % predicted (p=0.019; odds ratio [OR], 0.955; 95% confidence interval [CI], 0.919-0.993) and age (p=0.024; OR, 1.144; 95% CI, 1.018-1.287) were independently associated with osteoporosis in patients with COPD. CONCLUSION: Using the femoral neck T-score, the prevalence of osteoporosis in patients with COPD was higher than the age-and gender-matched controls. A lower FEV1 and older age further increase the risk of osteoporosis in patients with COPD.
Bone Density ; Comorbidity ; Femur Neck ; Forced Expiratory Volume ; Humans ; Logistic Models ; Lung ; Odds Ratio ; Osteoporosis ; Prevalence ; Pulmonary Disease, Chronic Obstructive ; Risk Factors ; Spine

OBJECTIVE: There is no proven regimen to reduce the severity of stroke in patients with acute cerebral infarction presenting beyond the thrombolytic time window. Ozagrel sodium, a selective thromboxane A2 synthetase inhibitor, has been known to suppress the development of infarction. The antiplatelet effect is improved when aspirin is used together with a thromboxane synthetase inhibitor. METHODS: Patients with non-cardiogenic acute ischemic stroke who were not eligible for thrombolysis were randomly assigned to two groups; one group received ozagrel sodium plus 100 mg of aspirin (group 1, n=43) and the other 100 mg of aspirin alone (group 2, n=43). Demographic data, cardiovascular risk factors, initial stroke severity [National Institute of Health Stroke Scale (NIHSS) and motor strength scale] and stroke subtypes were analyzed in each group. Clinical outcomes were analyzed by NIHSS and motor strength scale at 14 days after the onset of stroke. RESULTS: There were no significant differences in the mean age, gender proportion, the prevalence of cardiovascular risk factors, stroke subtypes, and baseline neurological severity between the two groups. However, the clinical outcome for group 1 was much better at 14 days after the onset of stroke compared to group 2 (NIHSS score, p=0.007, Motor strength scale score, p<0.001). There was one case of hemorrhagic transformation in group 1, but there was no statistically significant difference in bleeding tendency between two groups. CONCLUSION: In this preliminary study, thromboxane A2 synthetase inhibitor plus a low dose of aspirin seems to be safe and has a favorable outcome compared to aspirin alone in patients with acute ischemic stroke who presented beyond the thrombolytic time window.
Aspirin ; Cerebral Infarction ; Hemorrhage ; Humans ; Infarction ; Methacrylates ; Prevalence ; Risk Factors ; Sodium ; Stroke ; Thromboxane A2 ; Thromboxane-A Synthase ; Tissue Plasminogen Activator

Background: Triggering receptor expressed on myeloid cells 1 protein (TREM-1) is a cell surface molecule expressed on neutrophils and monocytes, and it plays an important role in myeloid cell-activated inflammatory response. The aim of this study was to investigate the diagnostic efficiency of soluble (s) TREM-1 in the patients who had pleural effusion from various causes. Methods: Forty-five patients with exudative pleural effusion were included in this study. The level of sTREM-1 was measured in both the serum and pleural fluids by immunoblot assay with using human-sTREM-1 antibody. Results: The pleural fluid sTREM-1 was significantly different in the three groups of exudative pleural effusion (p=0.011). Particularly, the patients with parapneumonic effusion were found to have significantly higher pleural fluid levels of sTREM-1 than patients with tuberculous (p<0.05) and malignant effusion, respectively (p<0.05). However, the serum sTREM-1 did not show a significant difference in the three groups. In order to evaluate the diagnostic utility of pleural fluid sTREM-1, the receiver operating characteristic (ROC) curve was constructed and the area under the curve (AUC) was 0.818 (p=0.001). Using a cutoff value of 103.5 pg/mL for the pleural fluid sTREM-1, the sensitivity and specificity were 73% and 81%, respectively, for differentiating parapneumonic effusion from tuberculous or malignant effusions. Conclusion: Pleural fluid sTREM-1 can be an additional marker for making the differential diagnosis of pleural effusion.
Diagnosis, Differential ; Exudates and Transudates ; Humans ; Monocytes ; Myeloid Cells* ; Neutrophils ; Pleural Effusion* ; ROC Curve

BACKGROUND: Serum lactate is a potentially useful biomarker to risk-stratify patients with severe sepsis and septic shock. However, there are only a few studies on the association of serum lactate levels and prognosis in septic shock patients with initial low lactate levels. METHODS: To evaluate whether initial and follow-up lactate levels associated with mortality in septic shock patients with low lactate level, we conducted a retrospective observational study of patients with septic shock, who were hospitalized through the emergency department in February-July 2008. Initial lactate level was stratified as low (<4 mmol/L) or high (> or =4 mmol/L). The primary outcome was 28-day mortality and multiple logistic regression analysis was used to adjust for potential confounders in the association between lactate clearance and mortality. RESULTS: Of 90 patients hospitalized with septic shock during the study period, 68 (76%) patients had low initial lactate. Mortality at 28 days was 18% in patients with low lactate level. In these patients, initial lactate level was not associated with mortality (p = 0.590). However, increased lactate at follow-up and lactate clearance were associated with mortality (p = 0.006, p = 0.002, respectively). In a multiple logistic regression analysis, increased mortality rate independently associated with age (OR 1.162, 95% CI 1.041-1.298) and lactate clearance (OR 0.654, 95% CI 0.498-0.859). CONCLUSIONS: In septic shock patients with a low lactate level, lactate clearance independently associated with a decreased mortality rate. Therefore, lactate clearance could be useful for predicting the outcome in these patients.
Emergencies ; Follow-Up Studies ; Humans ; Lactic Acid ; Logistic Models ; Prognosis ; Retrospective Studies ; Sepsis ; Shock, Septic