76
|
Kim JJ, Hyun SY, Hwang SY, Jung YB, Shin JH, Lim YS, Cho JS, Yang HJ, Lee G. Hormonal responses upon return of spontaneous circulation after cardiac arrest: a retrospective cohort study. Crit Care 2011; 15:R53. [PMID: 21299901 PMCID: PMC3221984 DOI: 10.1186/cc10019] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Revised: 12/29/2010] [Accepted: 02/07/2011] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Cardiac arrest is often fatal and can be extremely stressful to patients, even if spontaneous rhythm is returned. The purpose of this study was to analyze the hormonal response after return of spontaneous circulation (ROSC). METHODS This is a retrospective review of the chart and laboratory findings in a single medical facility. The patients admitted to the intensive care unit after successful resuscitation after out-of-hospital cardiac arrest were retrospectively identified and evaluated. Patients with hormonal diseases, patients who received cortisol treatment, those experiencing trauma, and pregnant women were excluded. Serum cortisol, adrenocorticotropic hormone (ACTH), and anti-diuretic hormone (ADH (vasopressin)) were analyzed and a corticotropin-stimulation test was performed. Mortality at one week and one month after admission, and neurologic outcome (cerebral performance category (CPC)) one month after admission were evaluated. RESULTS A total of 117 patients, including 84 males (71.8%), were evaluated in this study. One week and one month after admission, 87 (74.4%) and 65 patients (55.6%) survived, respectively. Relative adrenal insufficiency, and higher plasma ACTH and ADH levels were associated with shock-related mortality (P = 0.046, 0.005, and 0.037, respectively), and ACTH and ADH levels were also associated with late mortality (P = 0.002 and 0.004, respectively). Patients with relative adrenal insufficiency, ACTH ≧5 pg/mL, and ADH ≧30 pg/mL, had a two-fold increased risk of a poor outcome (shock-related mortality): (odds ratio (OR), 2.601 and 95% confidence interval (CI), 1.015 to 6.664; OR, 2.759 and 95% CI, 1.060 to 7.185; OR, 2.576 and 95% CI, 1.051 to 6.313, respectively). Thirty-five patients (29.9%) had a good CPC (1 to 2), and 82 patients (70.1%) had a bad CPC (3 to 5). Age ≧50 years and an ADH ≧30 pg/mL were associated with a bad CPC (OR, 4.564 and 95% CI, 1.794 to 11.612; OR, 6.568 and 95% CI, 1.918 to 22.483, respectively). CONCLUSIONS The patients with relative adrenal insufficiency and higher blood levels of ACTH and ADH upon ROSC after cardiac arrest had a poor outcome. The effectiveness of administration of cortisol and ADH to patients upon ROSC after cardiac arrest is uncertain and additional studies are needed.
Collapse
|
77
|
Song HJ, Choi GS, Shin JH. Preservation of melanoblasts of white hair follicles of segmental vitiligo lesions: A preliminary study. J Eur Acad Dermatol Venereol 2010; 25:240-2. [PMID: 20497288 DOI: 10.1111/j.1468-3083.2010.03710.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
78
|
Kim JJ, Yang HJ, Lim YS, Kim JK, Hyun SY, Hwang SY, Shin JH, Park JB, Lee G. Effectiveness of each target body temperature during therapeutic hypothermia after cardiac arrest. Am J Emerg Med 2010; 29:148-54. [PMID: 20825779 DOI: 10.1016/j.ajem.2009.08.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Revised: 08/10/2009] [Accepted: 08/10/2009] [Indexed: 11/19/2022] Open
Abstract
PURPOSE According to the 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation, unconscious adult patients with a return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest should be cooled to 32°C to 34°C for 12 to 24 hours. However, it is unclear which target temperature is more adequate. In this study, we prospectively evaluated the outcome and adverse effects following 3 target temperatures (32°C, 33°C, and 34°C) during therapeutic hypothermia with ROSC after out-of-hospital cardiac arrest. METHODS This is a prospective study of patients with ROSC (>24 hours) after out-of-hospital cardiac arrest who were admitted to the intensive care unit in a tertiary hospital and underwent therapeutic hypothermia during a 22-month period between March 2007 and December 2008. RESULTS Sixty-two patients were included. The number of male patients was 44. The mean (SD) ages of the patients was 54.61 (2.002) years. There were 13, 22, and 28 patients who were enrolled in the target temperatures (32°C, 33°C, and 34°C, respectively). There were no significant differences after each target temperature with respect to mortality and neurologic outcomes. Regarding adverse effects, hypotension during the maintenance of therapeutic hypothermia significantly increased when the target temperature was 32°C (P = .023). Based on multivariate analysis, hypotension during the maintenance of therapeutic hypothermia was increased more than 6 times at 32°C compared with 33°C (odds ratio, 6.800; 95% confidence interval, 1.428-32.373). CONCLUSION When performing therapeutic hypothermia in patients with ROSC after an out-of-hospital cardiac arrest, the target temperature would be set to 33°C or 34°C, rather than 32°C. Further multicenter randomized controlled studies may be needed in the future.
Collapse
|
79
|
Shin JH, Choi BH, Lim YG, Jeong DU, Park KS. Automatic ballistocardiogram (BCG) beat detection using a template matching approach. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2009; 2008:1144-6. [PMID: 19162866 DOI: 10.1109/iembs.2008.4649363] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This paper suggests a beat detection method for ballistocardiogram (BCG) from an unconstrained cardiac signal monitoring devices. A fiducial peak point of BCG is an I-J-K complex which corresponds with ventricle contraction and Electrocardiogram (ECG) QRS complex. The goal of the method is extraction of J peak without ECG synchronization. The detection method is based on a "template matching" rule evaluated using a correlation function in a local moving-window procedure. The total beat detection algorithm operates in two stages, template definition stage and beat detection stage with defined template in previous stage. In the first stage, the BCG template is constructed by the expert with an empirical analysis of BCG signal and measurement device. In the second stage, the correlation function calculates an accuracy of template with BCG signal using a local moving-window. The data analysis has been performed on the subjects tested at Seoul National University Hospital Sleep Medicine Center and presents 95.16% of sensitivity and 94.76% of positive predictivity value for the J peak detection.
Collapse
|
80
|
Shin JH, Kim YS, Worley PF, Linden DJ. Depolarization-induced slow current in cerebellar Purkinje cells does not require metabotropic glutamate receptor 1. Neuroscience 2009; 162:688-93. [PMID: 19409231 DOI: 10.1016/j.neuroscience.2009.01.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2008] [Revised: 01/21/2009] [Accepted: 01/23/2009] [Indexed: 11/16/2022]
Abstract
Activation of cerebellar Purkinje cells by either brief depolarizing steps or bursts of climbing fiber synaptic activation evokes a slow inward current, which we have previously called depolarization-induced slow current or DISC. DISC is triggered by Ca influx via voltage-sensitive Ca channels and is attenuated by inhibitors of vacuolar ATPase or vesicle fusion. This led us to suggest that DISC required vesicular release of glutamate from the somatodendritic region of Purkinje cells. Furthermore, we found that DISC was attenuated by the mGluR1 antagonist 7-(hydroxyimino)cyclopropa[b]chromen-1a-carboxylate ethyl ester (CPCCOEt), indicating that DISC required autocrine activation of metabotropic glutamate receptor 1 (mGluR1). Here, we have revisited the role of mGluR1 and found that it is, in fact, not required for DISC. CPCCOEt, but not three other specific mGluR1 antagonists (JNJ16259685, alpha-amino-5-carboxy-3-methyl-2-thiopheneacetic acid (3-MATIDA), Bay 36-7620), attenuated DISC, even though all four of these drugs produced near-complete blockade of current evoked by puffs of the exogenous mGluR1/5 agonist DHPG. Cerebellar slices derived from mGluR1 null mice showed substantial DISC that was still attenuated by CPCCOEt. mGluR5 is functionally similar to mGluR1, but is not expressed at high levels in cerebellar Purkinje cells. 2-Methyl-6-(phenylethynyl)pyridine hydrochloride (MPEP), an mGluR5 antagonist, did not attenuate DISC, and DISC was still present in Purkinje cells derived from mGluR1/mGluR5 double null mice. Thus, neither mGluR1 nor mGluR5 is required for DISC in cerebellar Purkinje cells.
Collapse
|
81
|
Park BS, Park YJ, Kim YJ, Kang SW, Kim YH, Shin JH, Yoon YC, Kim YW. A case of disseminated Nocardia farcinica diagnosed through DNA sequencing in a kidney transplantation patient. Clin Nephrol 2008; 70:542-545. [PMID: 19049715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Nocardia is a rare gram-positive bacteria causing opportunistic infection, and belongs to the aerobic Actinomycetes group. As the mortality in the immunocompromised patients with nocardiosis is high, early diagnosis and treatment is very important. However, clinical manifestations of infection caused by Nocardia are very variable and early diagnosis is limited by the difficulty in obtaining specimens and its isolation. Rapid diagnosis of Nocardia infection may allow for earlier effective therapy, thus improving patient outcome. We report a case of Nocardia farcinica diagnosed by DNA sequencing through blood culture in a renal transplant recipient with severe pneumonia and multiple brain abscesses.
Collapse
|
82
|
Doo EY, Shin JH, Kim JH, Song HY. Oesophageal strictures caused by the ingestion of corrosive agents: effectiveness of balloon dilatation in children. Clin Radiol 2008; 64:265-71. [PMID: 19185656 DOI: 10.1016/j.crad.2008.10.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2008] [Revised: 09/26/2008] [Accepted: 10/05/2008] [Indexed: 12/17/2022]
Abstract
AIM To evaluate the safety and clinical effectiveness of balloon dilatation in children for oesophageal strictures caused by the ingestion of corrosive agents. MATERIALS AND METHODS The study comprised 11 children (median age 6 years; range 1-14 years) with oesophageal strictures caused by corrosive agents, who underwent a total of 36 balloon dilatation sessions. The technical and clinical success, recurrence of dysphagia, complications, and primary and secondary patency rates were retrospectively evaluated. RESULTS Technical success was achieved in 91% of patients and in 97% of balloon dilatation sessions. Clinical success (defined as improved food intake and reduced dysphagia within 1 month of the first balloon dilatation session) was achieved in 64% of patients (7/11). During the mean 35-month follow-up period (range 1-89 months), 10 (91%) patients experienced recurrence. Oesophageal rupture (types 1 or 2) occurred in 45% of patients and in 31% of balloon dilatation sessions. Primary patency rates at 6 months and 1, 2, 3, 4, and 5 years were 36, 27, 14, 14, 14, and 14%, respectively. Secondary patency rates at 6 months and 1, 2, 3, 4, and 5 years were 82, 82, 82, 56, 42, and 42%, respectively. The secondary patency rate was higher than the primary patency rate (p<0.05). CONCLUSION The present study examined oesophageal balloon dilatation for paediatric oesophageal strictures caused by the ingestion of corrosive agents. Although the technical success rate was high and there were no deaths, the clinical success rate was low owing to a high recurrence rate. However, repeated balloon dilatations resulted in an acceptable secondary patency rate.
Collapse
|
83
|
Lee KE, Shin JH, Song HY, Kim SB, Kim KR, Kim JH. Management of airway involvement of oesophageal cancer using covered retrievable nitinol stents. Clin Radiol 2008; 64:133-41. [PMID: 19103342 DOI: 10.1016/j.crad.2008.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2008] [Revised: 07/18/2008] [Accepted: 08/01/2008] [Indexed: 10/21/2022]
Abstract
AIM To assess the efficacy and safety of covered retrievable nitinol stents in oesophageal cancer patients with airway involvement. MATERIALS AND METHODS Under fluoroscopic guidance, covered retrievable nitinol airway stents were placed in 23 oesophageal cancer patients with airway stricture and/or oesophagorespiratory fistula (ERF) over a long period of 12 years. Six patients only had aspiration by ERF and three patients had both airway stricture and asymptomatic ERF. Technical aspects, dyspnoea improvement, and/or resolution of ERF symptoms, complications, reinterventions, and survival data were evaluated. RESULTS A total of 27 airway stents (14 tracheal, 11 bronchial, and two hinged) were placed successfully in 23 patients with airway stricture or ERF. Dyspnoea score decreased significantly after stent placement (p<0.001). ERF were sealed off in all nine patients. Complications included stent migration or expectoration (n=4), haemoptysis (n=2), sputum retention (n=7), and tumour overgrowth (n=1). All three migrated stents were easily removed. Twenty-one patients died, with the median survival period of 76 days (range 2-197 days). CONCLUSION Placement of covered retrievable expandable nitinol stents was safe and effective for the palliative treatment of airway strictures and/or ERF, with a reasonable range of complications, in patients with advanced oesophageal cancer.
Collapse
|
84
|
Kim K, Rhee JE, Lee CC, Kim KS, Shin JH, Kwak MJ, Kim JH, Suh GJ, Hahn SK, Singer AJ. Impact of helical computed tomography in clinically evident appendicitis. Emerg Med J 2008; 25:477-81. [PMID: 18660392 DOI: 10.1136/emj.2006.044552] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine the utility of multidetector computed tomography (MDCT) in patients with clinically evident acute appendicitis and to compare the test characteristics of overall clinical impression, Alvarado scores, and MDCT in suspected appendicitis. METHODS A prospective observational cohort study was conducted in two urban emergency departments (ED). Consecutive patients with suspected acute appendicitis were clinically evaluated by an emergency physician who was asked to determine whether appendicitis was clinically evident or not. Elements of the Alvarado scores were collected and all patients then underwent MDCT and a decision to operate, observe, or discharge the patients was made by a surgeon. The final diagnosis was based on surgical pathology or clinical follow-up. The test characteristics of clinical impression, Alvarado scores and MDCT were then calculated and the rates at which acute appendicitis was falsely diagnosed based on clinical impression and MDCT were compared using McNemar's test. RESULTS Of 157 study patients, 71 were considered to have clinically evident appendicitis before MDCT and 91 had findings of acute appendicitis on MDCT. 19 of the 71 patients with clinically evident appendicitis did not have appendicitis. 14 of 52 patients with an Alvarado score > or = 8 also did not have appendicitis. Three of 91 patients with acute appendicitis based on MDCT did not have appendicitis. The specificities of clinical impression and Alvarado score > or = 8 were 71.6% and 79.1%, respectively, and these were significantly lower than that of MDCT (95.5%, p<0.05). CONCLUSION The performance of abdominal MDCT in patients with a high degree of clinical suspicion for acute appendicitis reduces the number of false positives and has the potential to reduce negative appendectomies.
Collapse
|
85
|
Lee HS, Song HJ, Hong WK, Shin JH, Choi GS. Pseudoxanthoma elasticum-like papillary dermal elastolysis with solar elastosis. J Eur Acad Dermatol Venereol 2008; 22:368-9. [DOI: 10.1111/j.1468-3083.2007.02318.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
86
|
Yang ZQ, Shin JH, Song HY, Kwon JH, Kim JW, Kim KR, Kim JH. Fluoroscopically guided percutaneous jejunostomy: outcomes in 25 consecutive patients. Clin Radiol 2007; 62:1061-5; discussion 1066-8. [PMID: 17920864 DOI: 10.1016/j.crad.2007.02.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2006] [Revised: 01/17/2007] [Accepted: 02/24/2007] [Indexed: 01/28/2023]
Abstract
AIM To assess the feasibility and safety of fluoroscopically guided percutaneous jejunostomy. MATERIAL AND METHODS Between May 1999 and August 2006 percutaneous jejunostomy was attempted in 25 patients. A 5 F vascular catheter (n=20) or a 7.5 F multifunctional coil catheter (n=5) was used to insufflate the jejunum. The distended jejunum was punctured using a 17 G needle (n=19) or a 21 G Chiba needle (n=6) with the inserted catheter as a target. A 12 or 14 F loop feeding tube was inserted after serial dilations. The technical success, complications, 30-day mortality, and in-dwelling period of the feeding tube placement were evaluated. RESULTS The technical success rate was 92% (23/25). Technical failures (n=2) resulted from the inability to insufflate the jejunum secondary to failure to pass the catheter through a malignant stricture at the oesophagojejunostomy site and thus subsequent puncture of the undistended jejunum failed, or failure to introduce the Neff catheter into the jejunum. Pericatheter leakage with pneumoperitoneum was a complication in three patients (12%) and was treated conservatively. The 30-day mortality was 13% (3/23); however, there was no evidence that these deaths were attributed to the procedure. Except for four patients who were lost to follow-up and two failed cases, 15 of the 19 jejunostomy catheters were removed because of patient death (n=12) or completion of treatment (n=3), with a mean and median in-dwelling period of 231 and 87 days, respectively. CONCLUSIONS Fluoroscopically guided percutaneous jejunostomy is a feasible procedure with a high technical success and a low complication rate. In addition to a 17 G needle, a 21 G needle can safely be used to puncture the jejunum.
Collapse
|
87
|
Shin JH, Song HK, Lee JH, Kim WK, Chu MK. Paroxysmal stabbing headache in the multiple dermatomes of the head and neck: a variant of primary stabbing headache or occipital neuralgia? Cephalalgia 2007; 27:1101-8. [PMID: 17725653 DOI: 10.1111/j.1468-2982.2007.01395.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A paroxysmal stabbing or icepick-like headache in the multiple nerve dermatomes, especially involving both trigeminal and cervical nerves, has not been fully explained or classified by the International Classification of Headache Disorder, 2(nd) Edition (ICHD-II). Of patients with acute-onset paroxysmal stabbing headache who had visited the Hallym University Medical Center during the last four years, 28 subjects with a repeated stabbing headache involving multiple dermatomes at the initial presentation or during the course were prospectively enrolled. All patients were neurologically and otologically symptom free. A coincidental involvement of both trigeminal and cervical nerve dermatomes included seven cases. Six cases involved initially the trigeminal and then cervical nerve dermatomes. Five cases showed an involvement of the cervical and then trigeminal nerve dermatomes. The remaining patients involved multiple cervical nerve branches (the lesser occipital, greater occipital and greater auricular). Pain lasted very shortly and a previous history of headache with the same nature was reported in 13 cases. Preceding symptom of an infection and physical and/or mental stress were manifested in seven and six subjects, respectively. All patients showed a self-limited benign course and completely recovered within a few hours to 30 days. Interestingly, a seasonal gradient in occurrence of a stabbing headache was found in this study. A paroxysmal stabbing headache manifested on multiple dermatomes can be explained by the characteristics of pain referral, and may be considered to be a variant of primary stabbing headache or occipital neuralgia.
Collapse
|
88
|
Song HY, Kim JH, Shin JH, Kim HC, Yu CS, Kim JC, Kang SG, Yoon CJ, Lee JY, Koo JH, Lee KH, Kim JK, Kim DH, Shin TB, Jung GS, Han YM. A dual-design expandable colorectal stent for malignant colorectal obstruction: results of a multicenter study. Endoscopy 2007; 39:448-54. [PMID: 17516352 DOI: 10.1055/s-2007-966270] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND STUDY AIMS It is known that metal stent placement is safe, easy, and effective for the treatment of malignant colorectal obstruction, but these stents are associated with delayed complications of tumor ingrowth and stent migration. The aim of this study was to prospectively investigate the technical feasibility, clinical effectiveness, and safety of a dual-design colorectal stent (consisting of an outer stent and an inner bare nitinol stent) in patients with malignant colorectal obstruction. PATIENTS AND METHODS Placement of the dual stent using a 4.5-mm stent delivery system was attempted in 151 patients with malignant colorectal obstruction, either before surgery (n = 50) or for palliation (n = 101). Multivariate logistic regression analysis was used to identify risk factors associated with complications. RESULTS Stent placement was technically successful in 145/151 patients (96%). Of the patients who had a technically successful placement, bowel obstruction resolved within 2 days after stent placement in 48/50 (96%) of the patients in the bridge-to-surgery group and in 87/95 (92%) of the patients in the palliative group. Perforation occurred in 16 patients, incomplete stent expansion in eight patients, stent migration in four patients, tumor overgrowth in five patients, severe rectal pain in five patients, and bleeding in eight patients. Complete obstruction was the only significant risk factor for perforation (odds ratio 6.88, 95% CI 2.04-23.17, P = 0.002). In the palliative group, the median survival was 152.0 days and the mean survival was 263.8 days. CONCLUSIONS The dual stent with a 4.5-mm stent delivery system is easy to insert, safe, and reasonably effective for the palliative treatment of malignant colorectal obstruction. However, a great deal of care is needed in its deployment because of the high rate of perforation.
Collapse
|
89
|
Shin JH, Lee EJ, Lee HR, Ryu SM, Kim HR, Chang CL, Kim YJ, Lee JN. Prevalence of non-tuberculous mycobacteria in a hospital environment. J Hosp Infect 2007; 65:143-8. [PMID: 17174440 DOI: 10.1016/j.jhin.2006.10.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2006] [Accepted: 10/12/2006] [Indexed: 11/27/2022]
Abstract
In recent years, non-tuberculous mycobacteria (NTM) have emerged as an important cause of opportunistic nosocomial infections but there is little known about the isolation and identification of NTM in Korea. The aim of this study was to assess the prevalence of NTM in the hospital environment and identify the species. A total of 150 samples were collected from different parts of the hospital. NTM were isolated and identified by restriction fragment length polymorphism analysis of the gene encoding rpoB and partial sequencing analysis of hsp65 and rpoB. In this study, 60 strains of NTM were isolated from 50 of the 150 samples. Half of the tap water samples (50 of 100) were positive for mycobacteria. An estimated 73.3% of the isolates were saprophytic, 21.7% were potentially pathogenic and 5% were unidentified. The presence of NTM in hospital tap water is not uncommon. Such water isolates might cause true nosocomial infection in immunocompromised patients, in addition to the risk of false-positive culture results.
Collapse
|
90
|
Kim JJ, Lim YS, Shin JH, Yang HJ, Kim JK, Hyun SY, Rhoo I, Hwang SY, Lee G. Relative adrenal insufficiency after cardiac arrest: impact on postresuscitation disease outcome. Am J Emerg Med 2006; 24:684-8. [PMID: 16984836 DOI: 10.1016/j.ajem.2006.02.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2006] [Revised: 02/16/2006] [Accepted: 02/16/2006] [Indexed: 02/07/2023] Open
Abstract
UNLABELLED The purpose of this study is to prospectively evaluate the cortisol response and determine the relative adrenal insufficiency after return of spontaneous circulation (ROSC). METHODS This is a prospective cohort study describing the prevalence of relative adrenal insufficiency in consecutive patients admitted to an intensive care unit following ROSC (>24 hours) after cardiac arrest. The study institution is a 1,300-bed urban hospital with an annual intensive care unit census of 80. Descriptive statistics is used to report results. RESULTS This study included 30 patients over a 1-year period. The mean patient age was 52 years, and there were 15 (50%) males. The most common etiology for cardiac arrest was unknown, and the most common initial rhythm was asystole. There were 16 (53%) witnessed arrests. The mean time from arrest to cardiopulmonary resuscitation was 8 minutes, and the mean time from arrest to ROSC was 23 minutes. Relative adrenal insufficiency (incremental response to corticotrophin test < 9 microg/dL) at initial 12 to 24 hours and >24 to 48 hours occurred in 13 (43%) and 10 (33%) patients, respectively. All basal cortisol values were normal to high. Nineteen (58%) patients survived. The mean cortisol values at the initial 12 to 24 hours and >24 to 48 hours were similar among survivors and nonsurvivors. Relative adrenal insufficiency was present in only 5 (26%) survivors. CONCLUSION Relative adrenal insufficiency may be associated with the increased mortality rate in patients with return of circulation after cardiac arrest. Although basal cortisol values were normal to high, treatment of relative adrenal insufficiency with corticosteroids may decrease the mortality rate. Additional studies are needed to confirm this association and to determine the effectiveness of treating relative adrenal insufficiency.
Collapse
|
91
|
Shin JH, Choi HY, Lee SN, Kim YJ. Microinvasive ductal carcinoma arising within a fibroadenoma: A case report. Acta Radiol 2006; 47:643-5. [PMID: 16950696 DOI: 10.1080/02841850600698838] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Fibroadenomas are among the most common benign breast tumors in which carcinomas rarely develop. We report the imaging findings of a microinvasive ductal carcinoma arising within a fibroadenoma in a 51-year-old woman. This mass showed coarse heterogeneous microcalcifications within a circumscribed mass on mammography, a heterogeneous hypoechoic mass on ultrasound, and an early enhancing mass on magnetic resonance imaging. Although a fibroadenoma in an older woman appears benign-looking, the presence of any unusual signs should raise concerns about malignancy.
Collapse
|
92
|
Kim JW, Shin JH, Ko GY, Yoon HG, Song HY, Sung KB. A case of successful embolotherapy for gastric ulcer bleeding from the intercostal artery after oesophagectomy and gastric reconstruction. Br J Radiol 2006; 79:e96-8. [PMID: 16940369 DOI: 10.1259/bjr/61547332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We report a successful treatment with coil embolisation of an intercostal artery for ulcer bleeding in a gastric tube in a 70-year-old man who underwent a total oesophagectomy and gastric tube reconstruction for oesophageal cancer. This case teaches us to search aberrant feeding vessels when active bleeding is suspected in reconstructed gastric tube in the patient with oesophagectomy and oesophagogastrostomy.
Collapse
|
93
|
Kim JH, Kim YH, Shin JH, Sung DJ, Shim TS, Cho SB, OH YM, Chung KB, Song HY, Cha SH, Park HS, Um JW. Deep tracheal laceration after balloon dilation for benign tracheobronchial stenosis: case reports of two patients. Br J Radiol 2006; 79:529-35. [PMID: 16714758 DOI: 10.1259/bjr/17839516] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
We report two cases of deep tracheal laceration in female patients after balloon dilation for benign tracheobronchial stenosis. Immediate post-procedure bronchoscopy and CT including 3D reconstructions showed deep lacerations in the posterior tracheal wall. Clinically, the patients' dyspnoea subsided and there has been no recurrence during follow-up after balloon dilation. On the follow-up 3D-reconstructed CT scans obtained 2 months and 8 months following balloon dilation, respectively, the lacerations had healed completely and there was considerable improvement in lumen size.
Collapse
|
94
|
Ko K, Han BK, Shin JH, Choe YH, Chung HW, Lee EH, Choi SJ. The axillopectoral muscle seen on mammography. Clin Radiol 2006; 61:625-9. [PMID: 16784950 DOI: 10.1016/j.crad.2006.03.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2006] [Accepted: 03/06/2006] [Indexed: 11/30/2022]
|
95
|
Shin JH, Han BK, Ko K, Choe YH, Oh YL. Value of repeat ultrasound-guided fine-needle aspiration in nodules with benign cytological diagnosis. Acta Radiol 2006; 47:469-73. [PMID: 16796308 DOI: 10.1080/02841850600635921] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To assess the value of repeat ultrasound-guided fine-needle aspiration (US-FNA) in nodules with benign cytological diagnosis. MATERIAL AND METHODS One-hundred-and-eighty-seven patients undergoing repeat US-FNA were included after a benign cytological diagnosis had been made by the initial US-FNA. They were divided into a re-aspiration group, who underwent repeat US-FNA within 6 months for a discordant pathological and clinico-radiological result, and a follow-up aspiration group, who underwent repeat US-FNA after 6 months without any clinical or radiological suspicion. The cancer rate in each group and the US findings of the later-diagnosed malignant nodules were assessed. RESULTS Nine malignancies were verified in the 187 cases (4.8%) by repeat US-FNA or surgery. In 44 patients in the re-aspiration group, 6 malignancies were identified (13.6%), compared with 3 malignancies in the 143 patients in the follow-up aspiration group (2.1%) (P<0.05). The later-diagnosed malignant nodules were an average of 1.0 cm in diameter; 66.7% were round; 66.7% were circumscribed; 100% were solid; 88.9% were hypoechoic; and 55.6% contained calcifications on US. CONCLUSION The follow-up of nodules with benign cytological diagnosis without clinicoradiological suspicion of malignancy is warranted using imaging surveillance rather than repeated US-FNA.
Collapse
|
96
|
Nam DH, Shin JH, Song HY, Jung GS, Han YM. Malignant esophageal-tracheobronchial strictures: parallel placement of covered retrievable expandable nitinol stents. Acta Radiol 2006; 47:3-9. [PMID: 16498926 DOI: 10.1080/02841850500334989] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To assess the safety and clinical effectiveness of the parallel placement of covered retrievable expandable metallic stents in the palliative treatment of malignant esophageal and tracheobronchial strictures. MATERIAL AND METHODS Under fluoroscopic guidance, parallel stents were placed in 12 symptomatic patients with both malignant esophageal and tracheobronchial strictures. Seven of these 12 patients also had an esophagorespiratory fistula (ERF) and one patient had an esophagocutaneous fistula. Technical success, clinical improvement, complications, and survival rates were evaluated. RESULTS A total of 28 esophageal and airway stents were successfully placed. The grade of dysphagia and dyspnea score significantly decreased after stent placement (P=0.002 and 0.003, respectively). ERF and esophagocutaneous fistula were sealed off in all eight patients after esophageal stent placement; however, the esophagocutaneous fistula reopened 1 month later. Complications included stent migration or expectoration (n=3), tracheal compression by the esophageal stent (n=3), new fistula development due to covering membrane degradation of the esophageal stent (n=1), and symptomatic sputum retention (n=1). Stent removal was easily performed for two stents; one migrated stent and the other with covering membrane degradation. All 12 patients died within the mean survival period of 72.50 days (range 7-375 days). CONCLUSION Parallel placement of covered retrievable expandable metallic stents is safe and effective for the palliative treatment of malignant esophageal and tracheobronchial strictures.
Collapse
|
97
|
Shin JH, Kim H, Lim D, Jeon M, Han BK, Park TS, Kim JK, Lillehoj HS, Cho BW, Han JY. Analysis of chicken embryonic gonad expressed sequenced tags. Anim Genet 2006; 37:85-6. [PMID: 16441308 DOI: 10.1111/j.1365-2052.2006.01411.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
98
|
Cho D, Lee JS, Yazer MH, Song JW, Shin MG, Shin JH, Suh SP, Jeon MJ, Kim JY, Park JT, Ryang DW. Chimerism and mosaicism are important causes of ABO phenotype and genotype discrepancies. Immunohematology 2006; 22:183-7. [PMID: 17430077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Discrepancies between blood group genotype and RBC phenotype are important to recognize when implementing DNA-based blood grouping techniques. This report describes two such cases involving the ABO blood group in the Korean population. Propositus #1 was a 22-year-old healthy man undergoing pretransfusion testing for minor surgery. Propositus #2 was a 23- year-old male blood donor. RBCs from both propositi were determined to be group AB and demonstrated unusual agglutination patterns on forward typing, which were inconsistent with their ABO genotype determined by allele-specific (AS) PCR. RBCs from propositus #1 demonstrated mixed field agglutination with both anti-A and -B, while RBCs from propositus #2 demonstrated mixed field only with anti-A reagents. Both had B/O genotypes by AS-PCR. Cloning and sequencing of ABO exons 6 and 7 revealed three alleles in both propositi: propositus #1: A102/B101/O04; propositus #2: A102/B101/O01. A panel of nine short-tandem repeat (STR) loci was tested on DNA extracted from blood, buccal mucosal cells, and hair from the propositi and on DNA isolated from their parents' blood. In all tissues tested from propositus #1, three loci demonstrated a double paternal and a single maternal DNA contribution, indicating that he was a chimera or a mosaic; in those from propositus # 2, one STR locus demonstrated a double paternal DNA contribution, indicating that he was a tetragametic chimera. Chimerism and mosaicism are uncommon but important causes of ABO genotype and phenotype discrepancies. The evaluation of patients and donors with unusual or unexpected serology in pretransfusion testing and consensus ABO alleles may include the evaluation of STR loci to detect these phenomena.
Collapse
|
99
|
Cho D, Shin MG, Yazer MH, Kee SJ, Shin JH, Suh SP, Jeon MJ, Song JW, Ki CS, Ryang DW. The genetic and phenotypic basis of blood group A subtypes in Koreans. Transfus Med 2005; 15:329-34. [PMID: 16101812 DOI: 10.1111/j.0958-7578.2005.00598.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A serological and genetic study of Korean blood donors with phenotypic group A subtypes was performed. There were 176 donors with phenotypic A subtypes identified. Exons 6 and 7 from 57 representative donors were sequenced. The A(var) allele (784 G > A) was cloned and sequenced, and a family study demonstrating its inheritance and unusual serological characteristics was performed. The A102 allele was the most frequently identified allele in phenotypically A2 (58%, 11/19) and A2B (68%, 17/25) donors. Anti-A1 was rarely present amongst A2 and A2B donors. The family study revealed that the A(var) allele was expressed as phenotype A(weak)B in A(var)/B heterozygote members, but as phenotype O in A(var)/O heterozygotes. The most frequent allele in Korean donors with the A2 phenotype differs from its Caucasian counterpart, as does the frequency of anti-A1. The A(var) allele demonstrates allelic enhancement in A(var)/B heterozygotes.
Collapse
|
100
|
Yoon SZ, Shin JH, Hahn S, Oh AY, Kim HS, Kim SD, Kim CS. Usefulness of the carina as a radiographic landmark for central venous catheter placement in paediatric patients † †Presented, in part, at the 2005 Annual Meeting of European Society of Anaesthesiologists, Vienna, Austria. Br J Anaesth 2005; 95:514-7. [PMID: 16040638 DOI: 10.1093/bja/aei199] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Several reports have proposed radiographic landmarks for the proper positioning of central venous catheters (CVC). The carina is one of the proposed landmarks in adults. Here, we evaluate the possibility of using the carina as a radiographic landmark for the identification of proper positioning of the CVC tip in paediatric patients. METHODS We studied 57 right internal jugular vein catheterizations in infants and children undergoing surgery for the treatment of congenital heart disease. After placing the CVC tip at the junction of the superior vena cava and the right atrium (SVC-RA junction) via intraoperative transoesophageal echocardiography, and by taking postoperative anterior-posterior chest radiographs, we measured the longitudinal distance from the carina to the SVC-RA junction, using the Picture Archiving and Communicating System. RESULTS The average distance between the carina and the SVC-RA junction was 1.5 cm (95% CI 1.3-1.8 cm). No catheter tip was above the carina. Although there was no particular relationship between this distance and the patient's age, height, or weight, the distance between the carina and the SVC-RA junction tended to be more variable in younger and smaller children. CONCLUSIONS The carina can be used as a radiographic landmark for the proper CVC tip placement in paediatric patients. If the tip of the CVC is not distal to the carina the chances are minute that it is in the right atrium.
Collapse
|