Implication of quantitative culture of bronchoalveolar lavage fluid in the diagnosis of ventilator assocaited pneumonia in patients with antimicrobial therapy / 결핵

BACKGROUNDS: Authors evaluated the quantitative culture of bronchoalveolar lavage fluid(BALF) in patients who were being treated with antimicrobial agents and the characteristics of isolated microorganism. METHOD: A prospective study was done with 25 patients under mechanical ventilation and antimicrobial treatment in ICU and NCU of Yongdong Severance Hospital from Apr. to Sep. 1999. Patients were classified into two groups: control group (n=5) and patients with VAP (n=20). The threshold of quantitative culture of BAL fluid in the diagnosis of VAP was 104 cfu/ml. RESULTS: 1) In gram staining of BALF, one patient in the control group and four in the VAP group showed positive results. Quantitative culture of BALF showed no organisms in the patients in the control group and in 9 VAP patients. Therefore the overall sensitivity was 43.8%. 2) Frequency of isolated organisms cultured above diagnostic threshold was in the following other : E. cloacae, S. aureus, K. pneumoniae, and A. baumani. S. aureus and Staphylococcus coagulase(-) were all resistant to oxacillin. Seven out of 10 isolated G (-) organisms were suspected to be organisms producing extended spectrum β-lactamase (ESBL). 3) The concurrence between gram staining of sputum aspiration and that of BALF was only in 1 case. And the concurrence of culture results was observed in 3 cases. CONCLUSION: The sensitivity of gram staining and quantitative culture of BALF from patients under antibiotic therapy and the concordance rate between conventional tracheal aspiration and BAL were low, facts which were important in interpretation the data. Since the frequency of drug resistance organisms was not different from that of foreign data, antibiotics must be prudently selected and used.

A Case of pasteurella multocida pleural empyema / 결핵

Pasteurella multocida, a Gram-negative coccobacillus, is part of the normal oral flora of many types of animals, including domestic dogs and cats. It is the etiologic agent of a variety of infectious diseases, such as hemorrhagic septicemia in cattle or fowl cholera in chiken. Although this is a primary pathogen in the animal world, infection due to Pasteurella multocida in man has been described with increasing frequency recently. The majority of individuals with pasteurella multocida pulmonary infection possess some underlying pulmonary diseases, most commonly bronchiectasis or COPD. With review of literature, We report a young man who developed the empyema caused by Pasteurella multocida.

The Effect of Positive end Expiratory pressure on the Pulmonary Capillary Pressure in Acute Lung Injury Patients / 결핵

BACKGROUND: Positive end expiratory pressure (PEEP) ventilation is well established as an integral part of the management of patients with the acute lung injury. PEEP is a key element in the treatment of hypoxemia resulting from pulmonary edema. Pulmonary capillary pressure (Pcap) is the most important factor influencing lung edema formation, and an understanding of how Pcap is altered by variations of PEEP or pulmonary arterial occlusion pressure (PAOP) is important to improve the treatment of acute lung injury patients. This study was performed to evaluate the effects of PEEP on the pulmonary capillary pressure in acute lung injury patients. METHODS: This was a prospective study of 11 acute lung injury patients. The effect of PEEP on pulmonary circulation at four different levels (0,4,8, and 12cm H2O) was analyzed. Pcap was estimated visually at bed side with Swan Ganz catheters. The pulmonary vasculature was analyzed by calculating the pressure difference at the arterial and venous parts of the circulation. RESULTS: As PEEP increased from 0 to 12 cm H2O, the mean puhnonary arterial pressure (PAP) and Pcap increased respectively from 22.7 ± 7.4 to 25.3 ± 7.3 mmHg and 15.3 ± 3.3 to 17.8 ±3.2 mmHg (p<0.05). Similarly, PAOP increased from 9.8 ± 2.1 to 12.8 ± 2.1 mmHg and the central venous pressure increased from 6.1 ± 1.6 to 9.3 1: 2.3 mmHg(p<0.05). However, the pressure gradient at the arterial (PAP-Pcap) and venous (Pcap-Pcwp) part of pulmonary circulation remained unchanged at all evaluated PEEP levels. CONCLUSION: Although Pcap increasoo gradually with increased PEEP, the pressure gradient at the arterial and venous part of the pulmonary vasculature remained unchanged at all evaluated PEEP levels in acute lung injury patients.

A Case of Chemical Pneumonitis Induced by Ingestion of Hydrocarbon / 결핵

A 33-year-old woman was presented with dyspnea and chest discomfort after indigesting approximately 500ml of oil paint brush washing fluid. Hypoxic symptoms and radiographic infiltrates rapidly progressed. The patient was intubated and received mechanical ventilation. Bronchoalveolar lavage and transbronchial lung biopsies were performed. The CT scan of the lung showed bilateral extensive pneumonitis with necrosis and the lung tissue pathologic findings showed diffuse alveolar damage with extensive necrosis and numerous lipidladen macrophages. After intensive medical care with mechanical ventilation, her symptoms and radiological findings improved.

Deagnostic Value of Myoglobin in Early Diagnosis of Acute Myocardial Infarction

BACKGROUND: Exact and early diagnosis of acute myocardial infarction (AMI) is essential for the subsequent routine management of this frequent cardiovascular disease. Currently, AMI has been diagnosed using the combination of the history, electrocardiogram(ECG), and biochemical markers of myocardial necrosis. At present, many biochemical markers are used to diagnose AMI. In this study, the predictive values of serum myoglobin and creatine kinase-MB (CK-MB) were compared in the emergency department. METHODS: Fifty-four consecutive patients who presented within 12 hours from onset of chest pain of presumed cardiac origin were enrolled into the study. Patients with trauma or renal failure were excluded. The serial serum myoglobin and CK-MB levels were obtained prospectively at admission and 2, 4, 6, 12, 24 and 48 hours after admission. We compare the levels of serum myoglobin and CK-MB within 2, 4, 6, 8, 10, 12, 24, and 48 hours after symptom onset respectively. And we compare the sensitivity, specificity, positive predictive value, and negative predictive value of myoglobin and CK-MB. RESULTS: Using World Health Organization criteria, 28 AMI patients were identified. Mean time from symptom onset to presentation was 4.1+/-1.3 hours. the predictive values of serum myoglobin were better than those of CK-MB within 6 hours after symptom onset. But, 6 hours after symptom onset, the predictive values of CK-MB were better than those of serum myoglobin. The false positive cases of serum myoglobin were 3-one was lung cancer with pleural effusion and the others were unstable angina. The false positive cases of CK-MB were 6-one case was viral myocarditis and the ohters were unstable angina. CONCLUSION: To compare the serum myoglobin and CK-MB in the diagnosis of AMI, serum myoglobin had better predictive values than CK-MB within 6 hours after symptom onset and useful in the early diagnosis of AMI. But, 6 hours after symptom onset, CK-MB had better predictive values than serum myoglobin and useful in following up.

Clinical Characterization of Reverse Redistribution Pattern in 99mTC-Sestamibi Myocardial Perfusion Scan

BACKGROUND AND OBJECTIVES: Reverse redistribution pattern (RRP), that is defined as the worsening of the perfusion defect at rest image, can be observed in 99mTC-sestamibi (methoxy isobutyl isonitrile) myocardial scan with standard stress-rest protocol. This study was prepared to evaluate the prevalence and clinical characteristics of RRP in stress 99mTc-sestamibi myocardial scan. MATERIALS AND METHODS: We retrospectively reviewed 1304 images of 99mTC-sestamibi myocardial perfusion scan performed between January 1995 and June 1997, and scintigraphic findings were compared with clinical and angiographic data. RESULTS: The prevalence of RRP was 5.2%(68 of 1,304). RRP was noted in 6.0% (41 of 679) of the adenosine study and 4.3% (27 of 625) of the exercise study. The mean coronary artery stenosis at RRP territory was 51.5+/-38.9%. However, normal coronary artery at RRP territory was noted in 45.8% (11 of 24). There was no significant differences in luminal narrowing of coronary arteries, TIMI flow grade and LV wall motion between the patient with RRP positive and RRP negative at the infarct related artery territory. CONCLUSION: Reverse redistribution pattern on 99mTC-sestamibi myocardial SPECT does not seem to indicate the presence of significant coronary artery disease or patency of the infarct related arteries in the patients with acute MI.

Does the Exercise Induced QRS Score Improve the Diagnostic Accuracy for Coronary Artery Disease?

BACKGROUND: In an effort to improve the diagnostic accuracy of the exercise electrocardiography (ECG) to detect coronary artery disease, exercise-induced changes in Q, R and S wave amplitudes has been evaluated in conjunction with or without ST segment changes. We measured the exercise-induced changes in Q, R and S wave amplitudes, and calculated the Athens QRS score to assess its diagnostic value. MATERIALS AND METHOD: Fifty patients who underwent the exercise test and MIBI myocardial scan and were proved to have coronary artery diameter stenosis > or =50% in coronary angiography were included in the patient group. Data of forty-nine persons showing negative findings in the exercise test and MIBI scan were used as control. The exercise test was performed according to the modified Bruce protocol using Marquette case 16. Exercise ECG was positive in 58% (29/50) of the patient group. The Q, R and S wave amplitudes at peak exercise were subtracted from the values of standing position at rest to obtain Athens QRS score. RESULTS: The mean age of patients and control were 54.5+/-9.4 years and 49.8+/-11.4 years respectively (p=NS), and their exercise capacity was 8.5+/-3.1 mets and 9.8+/-1.9 mets respectively (p=NS). The values of delta(R-Q-S)V5 + delta(R-Q-S)aVF and delta(R-Q-S)aVF were significantly lower in patients than the control (0.85+/-6.60 mm vs 3.72+/-5.09 mm, p=0.017, -0.60+/-4.76 mm vs 1.00+/-2.72 mm, p=0.030), and the values of deltaQV5 and deltaSaVF were significantly higher in patients than the control (-0.045+/-0.65 mm vs -0.41+/-0.78 mm, p=0.012, -0.84+/-1.90 mm vs -1.62+/-1.60 mm, p=0.009). However, the values were too widely overlaped between the patients and the control to give diagnostic cutoff points. CONCLUSION: It seems that exercise QRS scores do not have additive diagnostic value for coronary artery disease.

A Case of Well-Differentiated Thymic Carcinoma with Extensive Cystic Degeneration / 결핵

Thymoma is the most common tumor in the compartment of anterior mediastinum. The malignant thymoma is classified into invasive thymoma( category I ) and thymic carcinoma( category II ). Recently, well-differentiated thymic carcinoma is a proposed category 1.5 used to describe a subset of thymic epithelial tumors, allowing for the existence of intermediate form based on the clinical features and the histological characteristics. Thymic cyst is a congenital or a acquired disorder. Congenital thymic cyst may develop due to failure of the thymopharyngeal duct to obliterate and acquired thymic cyst develops from inflammation( multilocular thymic cyst ), or neoplasm( cystic thymoma ). Cystic degeneration in thymoma is a relatively frequent but focal event. In rare cases, the process proceeds to the extent that most or all of the lesion becomes cystic. Until now, well-differentiated thymic carcinoma with extensive cystic degeneration has not been reported in our country. We experienced a case of 14 year-old female patient showing extensive cystic degeneration in well-differentiated thymic carcinoma. and so we report it with review of the articles related.

Localization of Ischemic Area with Exercise Electrocardiography in Angina Pectoris: Correlation with 99mTc-MIBI Myocardial Perfusion Scanning

BACKGROUND: The purpose of the study was to determine the value of exercise electrocardiography in predicting the area of myocardial ischemia. METHOD: Seventy-six anginal patients with a perfusion defect in one vessel territory on exercise 99mTc-MIBI myocardial perfusion scan were studied. Each patient underwent exercise electrocardiograhy using modified Bruce protocol. Exercise electrocardiography was interpreted as abnormal when the horizontal or downsloping depression in ST segment was 0.1 mV or greater at 80 msec after the J point during exercise. Forty-eight patients had exercise induced ST-segment depression. RESULT: Twenty-five patients had exercise induced ST-segment depression in single lead-group and 23 patients had in multiple lead-groups. In 18 patients (18/23) with exercise induced ST-segment depression in multiple lead-groups, the perfusion defect involved the apical area on myocardial perfusion scanning and in 21 patients (21/25) with ST-segment depression in single lead-group, the perfusion defect did not involve the apical area. In patients without perfusion defect in the apical area, ST-segment depression in anterior lead-group (V1 to V4) was associated with myocadial perfusion defects in left anterior descending artery territories in five of five cases (100%), ST-segment depression in lateral lead-group (I, aVL, V5, V6) was associated with defects in left circumflex artery territories in six of six cases (100%), and ST-segment depression in inferior lead group (II, III, aVF) was associated with defects in right coronary artery territories in nine of ten (90%) (p<0.01). In patients with perfusion defect in the apical area, exercise induced ST-segment depressions were observed in multiple lead-groups (18/22). CONCLUSION: ST-segment depression on 12 lead exercise electrocardiography was a good predictor of the site of myocadial ischemia in anginal patients with single vessel territory ischemia when ST-segment depression developed in single lead group. However, ST-segment depressions in mutiple lead-groups suggested that the perfusion defect involved the apical area and did not predict the site of myocardial ischemia.

The Effect of Regional Anesthesia for Premedication of Esophagogastroduodenoscopy on Swallowing Motor Function / 대한소화기내시경학회지

Regianal anesthesia applied by means of a gargle provides satisfactory analgesia for premedication of esophagogastroduodenoscopy (EGD). To access the influence of 2% lidocaine hydrochloride after regional anesthesia on oropharyngeal components of swal- lowing, we used the videofluorographic swallowing study for the evaluation of pharyngeal architecture, time of pharyngeal barium passage, and the submental surface EMG(S-EMG) for the evaluation of functional changes in skeletal muscle. Measurements were made in 10 healthy volunteers without any oropharyngeal problems. There was no liquid aspiration symptoms or signs before and after regional anesthesia application. Also, there were no structural changes in pharyngeal swallowing motion and no significant prolongation of pharyngeal barium transit time. But regional anesthesia affected the eletro-activities in swallowing skeletal muscle, i.e, the swallowing durations, peak amplitudes of peristaltic wave, and area under curves in S-EMG, which returned to pre-anesthesia levels in 60 minute's time. Therefore, it will be recommended to avoid meal within 60 minute's after regional anesthesia for EGD.

Acute gastroparesis in Duchenne's muscular dystrophy

Duchenne's muscular dystrophy (DMD) is an X-linked recessive disease. Clinical descriptions of the disorder focus principally on skeletal muscle degeneration. Another manifestation, which involves the gastrointestinal tract, may be fatal. But its prevalence remains undefined. We report here a case of acute gastroparesis associated with Duchenne's muscular dystrophy. In our case, the patient's symptoms were improved by prokinetic agents and timely decompression in life-threatening acute gastric dilatation.

Myocardial uptake and clearnace of thallium-201 in normal subjects:a comparison between pharmacologic stress with intravenous adenosine, dipyridamole and dobutamine, and exercise stress testing / 대한핵의학회잡지

No abstract available.

The effect of granulocyte colony-stimulating factor in chemotherapy of acute myelogenous leukemia / 대한혈액학회지

No abstract available.

Gastric emptying in patients with diabetes: gastric emptying time, retention rate and effect of cisapride / 대한핵의학회잡지

No abstract available.

Lung/heart uptake ratio and transient dilation ratio of the left ventricle during thallium-201 imaging with dipyridamole / 대한핵의학회잡지

No abstract available.

Outcome of Hemodialysis Treatment on 200 Cases of Chronic Renal Failure

Regular hemodialysis has been established as a way of treatment for end stage renal failure. In adults, hemodialysis 5 hours each time, three times weekly with one square meter hemodialyzer is now widely accepted as a standard, and there are many reports on long term follow up studies. Quite a large difference are present, however, in our community mainly originated from patient's poor compliance in frequent dialysis with short interdialysis interval. The author analyzed 200 cases of chronic renal failure who have received hemodialysis treatments during the 5 year period from July 1976 to June 1981 at the hemodialysis unit of the hanyang University Hospital and the following results are obtained; 1. Actual one year survival rate was much higher in thrice(87.1%) than one(35.1%) or twice(54.1%) weekly dialysis. 2. Long term(more than 6 months) complications were also more frequent in once(85.7%) or twice(70.2%) weekly treatments than in thrice(22.2%). The predominant complications were congestive heart failure, pericarditis, and infections. 3. Those who recieved three times weekly dialysis had better rehabilitation grades than the patients groups of twice or once weekly treatment. 4. Of peridialysis distressful symptoms, nausea, vomiting dizziness were less frequent in the group three times a week dialysis. In contrast, headache, hypotension, muscle cramps, and weakness were not significantly related with frequency of hemodialysis. 5. Those who voided a large amount of urine output had better survival and less frequent requirement of blood transfusions. 6. Main causes of death were due to patient poor compliance, hyperkalemia and cerebrovascular acidents. 7. Economic problems were the major cause of dialysis interruption.