INTRODUCTION: Despite adhering to criteria for extubation, up to 20% of intensive care patients require re-intubation, even with use of post-extubation high-flow nasal cannula (HFNC). This study aims to identify independent predictors and outcomes of extubation failure in patients who failed post-extubation HFNC. METHODS: We conducted a multicentre observational study involving 9 adult intensive care units (ICUs) across 5 public hospitals in Singapore. We included patients extubated to HFNC following spontaneous breathing trials. We compared patients who were successfully weaned off HFNC with those who failed HFNC (defined as re-intubation ≤7 days following extubation). Generalised additive logistic regression analysis was used to identify independent risk factors for failed HFNC. RESULTS: Among 244 patients (mean age: 63.92±15.51 years, 65.2% male, median APACHE II score 23.55±7.35), 41 (16.8%) failed HFNC; hypoxia, hypercapnia and excessive secretions were primary reasons. Stroke was an independent predictor of HFNC failure (odds ratio 2.48, 95% confidence interval 1.83-3.37). Failed HFNC, as compared to successful HFNC, was associated with increased median ICU length of stay (14 versus 7 days, CONCLUSION Post-extubation HFNC failure, especially in patients with stroke as a comorbidity, remains a clinical challenge and predicts poorer clinical outcomes. Our observational study highlights the need for future prospective trials to better identify patients at high risk of post-extubation HFNC failure.
Adult ; Airway Extubation ; Cannula ; Critical Care ; Female ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Respiratory Insufficiency/therapy* ; Singapore/epidemiology*

BACKGROUND AND OBJECTIVES: The purpose of this study is to determine the prevalence of abnormalities in the sinuses among the common population, and to correlate this with clinical data. MATERIALS AND METHODS: We retrospectively evaluated a total of five hundred patients who visited the Health Promotion Center, Asan Medical Center, to undergo MRI scan to screen for intracranial pathology from January to April, 2003. Patients who have been treated for nasal or sinus diseases and who had previous history of nasal or sinus operations were excluded. The sinus abnormalities found through the MRI were classified into 2 types as follows; sinusitis group and retention cyst group. RESULTS: Among the five hundred patients studied, ninety-six (19.2%) patients showed abnormality in one or more sinus groups; ninety patients displayed symptoms of sinusitis and nine patients exhibited signs of retention cyst. Three patients showed symptoms of both. Sinus abnormalities were most commonly observed in the maxillary sinus. Seven patients had symptoms of the sinusitis group, and one patient had symptoms of the retention cyst group. CONCLUSION: Incidental sinus abnormalities detected among the common population were relatively common. However, pathologic condition which demanded treatment among these abnormalities were rare. Therefore, it would be important not to overestimate these signs and one should evaluate their clinical correlations carefully through complete physical examinations before applying any treatment for these lesions.
Chungcheongnam-do ; Health Promotion ; Humans ; Magnetic Resonance Imaging* ; Maxillary Sinus ; Pathology ; Physical Examination ; Prevalence* ; Retrospective Studies ; Sinusitis

BACKGROUND: The thalamus has multiple connections with areas of the cerebral cortex involved in arousal and cognition. Thalamic damage has been reported to be associated with variable neuropsychological dysfunctions and dementia. This study investigates the changes of regional cerebral blood flow (rCBF) by using SPM analysis of 99mTc-ECD SPECT and examining the neuropsychological abnormalities of 4 patients with anterior thalamic infarctions. METHODS: Four patients with left anterior thalamic infarctions and eleven normal controls were evaluated. K-MMSE and the Seoul Neuropsychological Screening Battery were performed within 2 days after stroke. The normalized SPECT data of 4 patients were compared to those of 11 controls for the detection of areas with decreased rCBF by SPM analysis. RESULTS: All 4 patients showed anterograde amnesia in their verbal memory, which was not improved by recognition. Dysexecutive features were occasionally present, such as decreased word fluency and impaired Stroop test results. SPM analysis revealed decreased rCBF in the left supramarginal gyrus, the superior temporal gyrus, the middle and inferior frontal gyrus, the medial dorsal and anterior nucleus of the left thalamus. CONCLUSIONS: The changes of rCBF in patients with left anterior thalamic infarctions may be due to the remote suppression on metabolism by the interruption of the cortico-subcortial circuit, which connects the anterior thalamic nucleus and various cortical areas. The executive dysfunction and dysnomia may be caused by the left dorsolateral frontal dysfunction of the thalamocortical circuit. Anterograde amnesia with storage deficit may be caused by the disruption of mamillothalamic tract.
Amnesia, Anterograde ; Anomia ; Arousal ; Cerebral Cortex ; Cognition ; Dementia ; Humans ; Infarction* ; Mass Screening ; Memory ; Metabolism ; Seoul ; Stroke ; Stroop Test ; Thalamus ; Tomography, Emission-Computed, Single-Photon*

PROPOSE: This study was designed to compare the efficacy of a synthetic surfactant (Exosurf) and a modified bovine surfactant (SurfactenR) in the treatment of neonatal respiratory distress syndrome. METHODS: A total of 90 infants with respiratory distress syndrome who were admitted to neonatal intensive care unit at Samsung Medical Center between October 1994 to September 1996 were includeeach surfactant. RESULTS: There was no significant difference in between two groups regarding birth weight, gestational age, and initiation of treatment after birth. ExosurfR group received less supplemental oxygen therapy and ventilator care. Survival rate were 81.3R in Exosurf group and 79.2% in SurfactenR group. The incidences of patent ctus arteriosus in the ExosurfR and SurfactenR groups were 75% and 62.5%, grade 3-4 intcular hemorrhage were 18.8% and 10.4%, respectively,' retinopathy of prematurity were 9.4% and 18.8%, respectively. There was significant improvernent of a/APO2 and VI at 30 minutes and 2 hours after the treatment in SurfactenR group', 2 hours and 6 hours after the treatment in ExosurfR group, however, dynamic compliance and respiratory resistance did not improve during 24 hours. CONCLUSION: Although SurfactenR treatment appears to induce faster improvement in oxygenation and pulmonary function than ExosurfR treatment, this study does not reveal any difference in clinical outcomes among those who received two different surfactant preparations.
Birth Weight ; Compliance ; Gestational Age ; Hemorrhage ; Humans ; Incidence ; Infant ; Infant, Newborn ; Intensive Care, Neonatal ; Oxygen ; Parturition ; Respiratory Distress Syndrome, Newborn* ; Retinopathy of Prematurity ; Survival Rate ; Ventilators, Mechanical

BACKGROUND: Since the bioavailability of itraconazole capsule is influenced by patients gastric acidity, it results in treatment failure due to its low dissolution and subsequent low absorption when administered in fasting. Itraconazole Melt-Extrusion tablet has been lately developed in order to improve its dissolution profile. It is the first clinical study to evaluate the efficacy and safety of itraconazole Melt-Extrusion tablet in Korea. OBJECTIVE: This study was conducted to evaluate the efficacy and safety of itraconazole melt-extrusion tablet 400mg daily for 1 week(pulse therapy) for hyperkeratotic type of tinea pedis and manus. METHODS: A clinical and mycological investigation was made of 812 outpatients with hyperkeratotic type of tinea pedis and/or tinea manus who had visited at 52 general hospitals under the lead of the Korean Dermatological Association from June to December, 1998. Patients confirmed by clinically and microscopically as hyperkeratotic type of tinea pedis and/or tinea manus were administered 2 tablets twice a day for one week and followed up for 8 weeks from the start of the medication. RESULTS: The results were summarized as follows; 1. Clinical symptoms of hyperkeratotic type of tinea pedis and/or tinea mauns were significantly improved at the end of study, week 8(p<0.001). 2. Clinical response rate, defined as more than 50% decrease of the sum of the clinical symptom scores, was 79.3%(512/646). 3. Mycological cure rate, dafined as both culture and KOH negative at week 8, was 78.2%(244 /312). 4. 40(5.5%) patients, of the 727 patients evaluable for drug safety evaluation, were reported to have adverse event. CONCLUSION: Itraconazole Melt-Extrusion tablet 400mg/day for 1 week (pulse therapy) is effective and safe in the treatment of hyperkeratotic type of tinea pedis and/or tinea manus.
Absorption ; Biological Availability ; Fasting ; Gastric Acid ; Hospitals, General ; Humans ; Itraconazole* ; Korea ; Outpatients ; Tablets ; Tinea Pedis* ; Tinea* ; Treatment Failure

Congenital intrahepatic portosystemic shunt is a rare entity and is mostly reported in adults. In embryonic period, the vitelline vein is broken up into the vitelline sinusoids, which become the intrahepatic portal vein branches and the hepatic veins. The portosystemic venous shunts may develop from embryonic vascular remnants, including the vitelline vein and ductus venosus. We report for the first time in Korea a case of congenital intrahepatic portosystemic shunt in a newbom infant presenting with congestive heart failure and hepatomegaly, successfully treated by coil embolization via umbilical vein.
Adult ; Embolization, Therapeutic* ; Heart Failure ; Hepatic Veins ; Hepatomegaly ; Humans ; Infant ; Infant, Newborn ; Korea ; Portal Vein ; Portasystemic Shunt, Surgical* ; Umbilical Veins* ; Veins ; Vitellins

PURPOSE: Although advances in neonatal intensive care have led to improved survival of very low birth weight(VLBW) infants, nosocomial sepsis continues to be an important cause of morbidity and death among these infants. Our study was carried out to estimate the incidence of nosocomial sepsis and to identify the attributable risk factors for sepsis. METHODS: The results of blood cultures taken from 182 infants with their birth weights less than 1,500 gram who were admitted to the NICU at Samsung Medical Center from October 1994 to December 1997 were retrospectively reviewed. A multiple logistic regression was performed to identify which factors were independently associated with sepsis. RESULTS: Of 166 infants who survived beyond 3 days, 57(34.3%) had nosocomial sepsis(positive blood culture at age greater than 3 days and antibiotic therapy for more than 5 days). The incidence of nosocomial sepsis was 1.8/100 hospital days and the interval between admission and onset of sepsis was 18.4+17.8 days(meanSD). Coagulase negative staphylococci(35.3%) were the most common organism in nosocomial sepsis. On multiple logistic regression analysis, several risk factors appeared to be independently associated with sepsis. The risk of nosocomial sepsis rose with decreasing gestational age, with increasing ventilator duration, UAC(umbilical venous catheter) duration, PCVC(percutanous central venous catheter) duration, nasal prong duration. And infants with nosocomial sepsis were more likely to be outborn, resuscitated at delivery room and to have bronchopulmonary dysplasia. CONCLUSION: Directing quality improvement efforts toward decreasing exposure to invasive vascular catheter and reducing ventilator days may decrease the incidence of nosocomial sepsis in VLBW infants.
Birth Weight ; Bronchopulmonary Dysplasia ; Coagulase ; Delivery Rooms ; Gestational Age ; Humans ; Incidence* ; Infant* ; Infant, Newborn ; Infant, Very Low Birth Weight* ; Intensive Care, Neonatal ; Logistic Models ; Parturition ; Quality Improvement ; Retrospective Studies ; Risk Factors* ; Sepsis* ; Vascular Access Devices ; Ventilators, Mechanical

Neurenteric cyst is a rare bronchopulmonary foregut malformation, originating from notochord defect. Characteristics of this anomaly are the intrathoracic cyst associated with vertebral abnormalities, such as hemivertebrae, anterior and posterior spina bifida, absence of vertebrae and diastematomyelia. The most common symptom is respiratory distress and treatment is surgical excision of mass. We report a case of neurenteric cyst in a neonate presented with asymptomatic huge mediastinal cystic mass.
Humans ; Infant, Newborn ; Mediastinal Cyst ; Neural Tube Defects* ; Notochord ; Spinal Dysraphism ; Spine

PURPOSE: To evaluate the usefulness of pulmonary function test for the prediction of successful weaning and extubation from the ventilator in very low birth weight(VLBW) infants with chronic lung disease. METHODS: This study included 15 VLBW infants(<1,500 g) with chronic lung disease who were admitted to Neonatal Intensive Care Unit of Samsung Medical Center from July, 1995 to June, 1996. They had extubation failure more than one time. This study was performed by reviewing of patients records retrospectively. The extubation criteria were based on clinical status, ABGA profiles and ventilatory parameters. At the time of last extubation failure and final success, we analyzed the distribution of age and weight of infants, ventilator profiles, ABGA profiles, dynamic and static pulmonary function test profiles measured by Bicore CP-100R from the infant with ventilator assistance daily in line monitoring. The paired T-test and linear logistic regression analysis were used to compare the variables between the evets of extubation failure and success. RESULTS: At the time of successful extubation, expiratory airway resistance was significantly lower and minute volume was significantly higher in dynamic pulmonary function test and respiratory system resistance was significantly lower in static pulmonary function test(P<0.05). In ventilator parameter, Fi02 and respiratory rate were lower at successful extubation(P<0.05). No statistically significant differences in ABGA profiles were seen between unsuccessful and successful extubation. CONCLUSION: The pulmonary function test is a useful predictor for successful weaning and extubation in VLBW infants with chronic lung disease. Among various parameters of pulmonary function test, expiratory airway resistance, minute ventilation and respiratory system resistance are suggested as successful weaning parameters.
Airway Resistance ; Bronchopulmonary Dysplasia ; Humans ; Infant* ; Infant, Newborn ; Infant, Very Low Birth Weight* ; Intensive Care, Neonatal ; Logistic Models ; Lung Diseases* ; Lung* ; Parturition ; Respiratory Function Tests* ; Respiratory Rate ; Respiratory System ; Retrospective Studies ; Ventilation ; Ventilators, Mechanical ; Weaning*