BACKGROUND: Admission blood glucose (BG) level is a predictor of mortality in critically ill patients with various conditions. However, limited data are available regarding this relationship in critically ill patients with cardiovascular diseases according to diabetic status. METHODS: A total of 1,780 patients (595 with diabetes) who were admitted to cardiac intensive care unit (CICU) were enrolled from a single center registry. Admission BG level was defined as maximal serum glucose level within 24 hours of admission. Patients were divided by admission BG level: group 1 (< 7.8 mmol/L), group 2 (7.8–10.9 mmol/L), group 3 (11.0–16.5 mmol/L), and group 4 (≥ 16.6 mmol/L). RESULTS: A total of 105 patients died in CICU (62 non-diabetic patients [5.2%] and 43 diabetic patients [7.9%]; P = 0.105). The CICU mortality rate increased with admission BG level (1.7%, 4.8%, 10.3%, and 18.8% from group 1 to group 4, respectively; P < 0.001). On multivariable analysis, hypertension, mechanical ventilator, continuous renal replacement therapy, acute physiology and chronic health evaluation II (APACHE II) score, and admission BG level significantly influenced CICU mortality in non-diabetic patients (group 1 vs. group 3: hazard ratio [HR], 3.31; 95% confidence interval [CI], 1.47–7.44; P = 0.004; group 1 vs. group 4: HR, 6.56; 95% CI, 2.76–15.58; P < 0.001). However, in diabetic patients, continuous renal replacement therapy and APACHE II score influenced CICU mortality but not admission BG level. CONCLUSION: Admission BG level was associated with increased CICU mortality in critically ill, non-diabetic patients admitted to CICU but not in diabetic patients.
APACHE ; Blood Glucose ; Cardiovascular Diseases ; Critical Care ; Critical Illness ; Diabetes Mellitus ; Humans ; Hypertension ; Intensive Care Units ; Mortality ; Prognosis ; Renal Replacement Therapy ; Ventilators, Mechanical

Limited data are available on improved outcomes after initiation of neurointensivist co-management in neurosurgical intensive care units (NSICUs) in Korea. We evaluated the impact of a newly appointed neurointensivist on the outcomes of neurosurgical patients admitted to an intensive care unit (ICU). This retrospective observational study involved neurosurgical patients admitted to the NSICU at Samsung Medical Center between March 2013 and May 2016. Neurointensivist co-management was initiated in October 1 2014. We compared the outcomes of neurosurgical patients before and after neurointensivist co-management. The primary outcome was ICU mortality. A total of 571 patients were admitted to the NSICU during the study period, 291 prior to the initiation of neurointensivist co-management and 280 thereafter. Intracranial hemorrhage (29.6%) and traumatic brain injury (TBI) (26.6%) were the most frequent reasons for ICU admission. TBI was the most common cause of death (39.0%). There were no significant differences in mortality rates and length of ICU stay before and after co-management. However, the rates of ICU and 30-day mortality among the TBI patients were significantly lower after compared to before initiation of neurointensivist co-management (8.5% vs. 22.9%; P = 0.014 and 11.0% vs. 27.1%; P = 0.010, respectively). Although overall outcomes were not different after neurointensivist co-management, initiation of a strategy of routine involvement of a neurointensivist significantly reduced the ICU and 30-day mortality rates of TBI patients.
Brain Injuries ; Cause of Death ; Critical Care Outcomes ; Critical Care* ; Humans ; Intensive Care Units* ; Intracranial Hemorrhages ; Korea ; Mortality ; Neurosurgery ; Observational Study ; Retrospective Studies

BACKGROUND: FcRgamma-deficient natural killer (NK) cells (g-NK cells) have been associated with cytomegalovirus (CMV) infection. However, the frequency of g-NK cells in a CMV-endemic area (i.e., Korea) has not yet been studied. We examined the frequency of g-NK cells and expression of CD57 on NK cells in cord blood (CB) and adult blood (AB). METHODS: Of the 24 AB samples collected, 95.8% (23/24) were CMV IgG+/IgM-, while 100% of the 13 healthy CB samples were CMV IgG+/IgM-. We performed whole-blood flow cytometry assays to analyze intracellular FcRgamma and CD3zeta expression of CD3-/CD56dim NK cells from 13 CB and 24 AB samples, and surface CD57 expression on CD3-/CD56dim/CD16+ NK cells from 13 CB and 19 AB samples. RESULTS: All CMV seropositive AB samples contained g-NK cells (23/23), and the median proportion of g-NK cells in the CD3-/CD56dim NK cell pool was 35.0% (range: 11-77%). CD57+ NK cells in the CD3-/CD56dim/CD16+ NK cell population were detected in all 19 AB samples tested, but not in any CB samples. CONCLUSIONS: Our data suggest that g-NK cells and CD57+ NK cells are present at a very high frequency in CMV-seropositive AB, but rare in CMV-naive CB.
Adult* ; Cytomegalovirus ; Fetal Blood* ; Flow Cytometry ; Humans ; Killer Cells, Natural*

PURPOSE: It is well known that testicular germ cell tumors arise with increased frequency in patients with cryptorchidism. In addition, intratubular germ cell neoplasia (ITGCN) is a precursor lesion to testicular germ cell tumor. Approximately 50% of patients with ITGCN will develop an invasive of testicular germ cell tumors within 5 years. Therefore, we evaluated that the incidence of ITGCN in postpubertal cryptorchidism. MATERIALS AND METHODS: Between January 2002 and August 2012, orchiectomy specimens from 31 postpubertalpatients (aged 12 or over) with cryptorchid testis were reviewed. The specimens were evaluated for ITGCN using immunohistochemical stains of placental-like alkaline phosphatase and Oct 3/4 with routine hematoxylin-eosin stain. Additionally, the degree of spermatogenesis was assessed using the Johnsen score. RESULTS: Mean age was 34 years (range, 17 to 74 years) at surgery. All patients were diagnosed as unilateral cryptorchidism. One patient (3.2%) of 20-year-old had ITGCN in surgical specimen with all positive markers. Histological assessment of spermatogenesis showed that mean Johnsen score was 3.42 (range, 1 to 9). Majority of patients (27 of 31) presented impaired spermatogenesis with low Johnsen score lesser than 5. CONCLUSIONS: Considering the risk of malignancy and low spermatogenesis, we should perform immunohistochemical stains and discuss preventative orchiectomy for the postpubertal cryptorchidism.
Adolescent ; Adult ; Aged ; Alkaline Phosphatase/metabolism ; Biomarkers, Tumor/metabolism ; Carcinoma in Situ/diagnosis/*etiology/pathology ; Cryptorchidism/*complications/surgery ; Disease Progression ; Humans ; Infertility, Male/etiology ; Isoenzymes/metabolism ; Male ; Middle Aged ; Neoplasms, Germ Cell and Embryonal/diagnosis/*etiology/pathology/prevention & control ; Orchiectomy ; Puberty ; Retrospective Studies ; Spermatogenesis ; Testicular Neoplasms/diagnosis/*etiology/pathology/prevention & control ; Young Adult

PURPOSE: We determined the effects of alpha-blockers and quinolone in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) classified by National Institute of Health (NIH) consensus group. MATERIALS AND METHODS: Data from a total of 111 patients who were diagnosed with CP/CPPS between June 2010 and June 2012 were analyzed retrospectively. The patients were classified into group 1 (category IIIA, n=40) and group 2 (category IIIB, n=71). Treatment using alfuzosin and levofloxacin was given to both groups for 6 weeks. International Prostate Symptom Score (IPSS) and NIH Chronic Prostatitis Symptom Index were measured before and after therapy. RESULTS: Group 1 had a significant decrease in total IPSS score, CPSI pain score, CPSI quality of life (QoL) score, and total CPSI score (p=0.043, p=0.006, p=0.015, and p=0.006, respectively). Group 2 had a significant decrease in IPSS voiding symptom score, IPSS storage symptom score, total IPSS, CPSI pain score, CPSI voiding score, CPSI QoL score, and total CPSI score (p=0.002, p=0.004, p=0.001, p=0.001, p=0.006, p=0.001, and p=0.001, respectively). The CPSI score was reduced by 6 points or more in 50.0% of patients (n=18) in group 1 and in 51.6% of patients (n=32) in group 2. However, there was no statistically significant difference between the changes in IPSS and CPSI scores across the 2 groups. CONCLUSIONS: Although combination treatment reduced the CPSI score in both groups, there was no significant difference between the groups after combination treatment. We suggest that factors other than inflammation also contribute to symptoms associated with CP/CPPS.
Anti-Bacterial Agents ; Classification* ; Consensus ; Humans ; Inflammation ; Leukocytes ; Levofloxacin ; National Institutes of Health (U.S.)* ; Pelvic Pain* ; Prostate ; Prostatitis ; Quality of Life ; Retrospective Studies

Acute scrotal pain is a common urologic presentation and critical pathology due to the possibility of organ loss in the emergency department. Referred pain in the lower quadrant of the abdomen may accompany testicular torsion. Of 58 patients with testicular torsion between January 2001 and March 2011, three visited the emergency department with abdominal pain alone. The median age of the patients was 16 years (range, 13-19). Median duration of abdominal pain to first medical examination and proper diagnosis by an urologist was 14 hours (range, 2-168) and 77 hours (range, 57-240), respectively. All patients underwent orchiectomy. Due to symptomatic variations for testicular torsion, all clinicians providing emergency care to patients who have referred pain in the lower abdomen without scrotal pain should consider the constellation of symptoms in order to avoid superfluous diagnostic delay.
Abdomen ; Abdomen, Acute* ; Abdominal Pain ; Diagnosis ; Emergency Medical Services ; Emergency Service, Hospital ; Humans ; Orchiectomy ; Pain, Referred ; Pathology ; Spermatic Cord Torsion*

Acute scrotal pain is a common urologic presentation and critical pathology due to the possibility of organ loss in the emergency department. Referred pain in the lower quadrant of the abdomen may accompany testicular torsion. Of 58 patients with testicular torsion between January 2001 and March 2011, three visited the emergency department with abdominal pain alone. The median age of the patients was 16 years (range, 13-19). Median duration of abdominal pain to first medical examination and proper diagnosis by an urologist was 14 hours (range, 2-168) and 77 hours (range, 57-240), respectively. All patients underwent orchiectomy. Due to symptomatic variations for testicular torsion, all clinicians providing emergency care to patients who have referred pain in the lower abdomen without scrotal pain should consider the constellation of symptoms in order to avoid superfluous diagnostic delay.
Abdomen ; Abdomen, Acute* ; Abdominal Pain ; Diagnosis ; Emergency Medical Services ; Emergency Service, Hospital ; Humans ; Orchiectomy ; Pain, Referred ; Pathology ; Spermatic Cord Torsion*

OBJECTIVES: Adoption of hospital information systems offers distinctive advantages in healthcare delivery. First, implementation of consolidated hospital information system in Seoul National University Hospital led to significant improvements in quality of healthcare and efficiency of hospital management. METHODS: The hospital information system in Seoul National University Hospital consists of component applications: clinical information systems, clinical research support systems, administrative information systems, management information systems, education support systems, and referral systems that operate to generate utmost performance when delivering healthcare services. RESULTS: Clinical information systems, which consist of such applications as electronic medical records, picture archiving and communication systems, primarily support clinical activities. Clinical research support system provides valuable resources supporting various aspects of clinical activities, ranging from management of clinical laboratory tests to establishing care-giving procedures. CONCLUSIONS: Seoul National University Hospital strives to move its hospital information system to a whole new level, which enables customized healthcare service and fulfills individual requirements. The current information strategy is being formulated as an initial step of development, promoting the establishment of next-generation hospital information system.
Adoption ; Confidentiality ; Delivery of Health Care ; Electronic Health Records ; Hospital Information Systems ; Information Systems ; Management Information Systems ; Quality of Health Care ; Radiology Information Systems ; Referral and Consultation

BACKGROUND: We analyzed T cell receptor beta chain (TCRB) gene to investigate the presence of putative T cell clones and its clinicopathologic implications in Korean patients with aplastic anemia (AA). METHODS: Twenty-nine bone marrow specimens were collected from 20 AA patients, 19 specimens from initial diagnosis and 10 from follow-up. T cell clonality assay was performed using IdentiClone(TM) TCRB Gene Clonality Assay kit (InVivoScirbe Technology, USA) and automatic genetic analyzer. Patients' clinical information and laboratory parameters were also analyzed. RESULTS: Five patients had definitive underlying factors related with aplastic anemia, such as hepatitis B virus (4 cases) and benzene exposure (1 case). Putative T cell clones were detected in bone marrow specimens of 11 (58%) out of 19 patients at diagnosis. The location of putative T cell clones of TCRB gene (diversity region, Dbeta; joining region, Jbeta; variable region, Vbeta) was distributed in Dbeta2+Jbeta2 (6 cases), Dbeta1+Jbeta1 (3 cases), Vbeta+Jbeta1 (2 cases), and Dbeta1+Jbeta2 (2 cases). Interestingly, among seven patients who underwent stem cell transplantation, five patients with no T cell clones detected at diagnosis developed new T cell clones during the follow-up. CONCLUSIONS: Putative pathogenetic T cell clones were detected in most of AA patients in the current study. T cell clonality assay would be useful for investigating the pathophysiology of acquired AA.
Adolescent ; Adult ; Aged ; Anemia, Aplastic/*diagnosis/genetics/therapy ; Bone Marrow Transplantation ; Female ; Humans ; Male ; Middle Aged ; Reagent Kits, Diagnostic ; Receptors, Antigen, T-Cell, alpha-beta/*genetics ; Republic of Korea ; T-Lymphocytes/*cytology/immunology

Systemic lupus erythematosus(SLE) is autoimmune disease in which involves systemic organs. Hematological manifestations are common in patients with SLE but aplastic anemia is very rare and, although various immunosuppressants have been tried, there is no established treatment in aplastic anemia associated with SLE. Furthermore, disease course and prognosis may be different from other aplastic anemia. A 42-year-old woman presented with fever, chilling, myalgia, general weakness, pancytopenia. Her bone marrow aspirate and biopsy revealed almost acellular bone marrow with rare foci of hematopoietic elements and she was diagnosed with SLE simultaneously. High-dose methyprednisolone, prednisolone and cyclophosphamide therapies had been unsuccessful in controlling pancytopenia. Cyclosproine was started and the aplastic anemia was responded. Now she was free of transfusion with more than 10 g/dL of hemoglobin.
Adult ; Anemia, Aplastic* ; Autoimmune Diseases ; Biopsy ; Bone Marrow ; Cyclophosphamide ; Cyclosporine* ; Female ; Fever ; Humans ; Immunosuppressive Agents ; Lupus Erythematosus, Systemic* ; Myalgia ; Pancytopenia ; Prednisolone ; Prognosis