Case Control Study Identifying the Predictors of Unplanned Intensive Care Unit Readmission After Discharge / 중환자간호학회지

PURPOSE: This study was performed to identify the influencing factors of unplanned intensive care unit (ICU) readmission.METHOD: The study adopted a Rretrospective case control cohort design. Data were collected from the electronic medical records of 844 patients who had been discharged from the ICUs of a university hospital in Incheon from June 2014 to December 2014.RESULTS: The study found the unplanned ICU readmission rate was to be 6.4%(n=54). From the univariate analysis revealed that, major symptoms at 1(st) ICU admission, severity at 1(st) ICU admission (CPSCS and APACHEII), duration of applying ventilator application during 1(st) ICU admission, severity at 1(st) discharge from ICU (CPSCS, APACHEII, and GCS), and application of FiO₂ with oxygen therapy, implementation of sputum expectoration methods, and length of stay of ICU at 1(st) ICU discharge were appeared to be significant; further, decision tree model analysis revealed that while only 4 variables (sputum expectoration methods, length of stay of ICU, FiO₂ with oxygen therapy at 1(st) ICU discharge, and major symptoms at 1(st) ICU admission) were shown to be significant.CONCLUSION: Since sputum expectoration method was the most important factor to predictor of unplanned ICU readmission, a assessment tool for the patients' capability of sputum expectoration needs to should be developed and implemented, and standardized ICU discharge criteria, including the factors identified from the by empirical evidences, might should be developed to decrease the unplanned ICU readmission rate.

Subepithelial Lesion of the Gastric Fundus Caused by an Accessory Spleen / 대한내과학회지

When a submucosal lesion is discovered at the gastric fundus by gastroscopy, it may be difficult to distinguish a gastric external compression from a true submucosal tumor (SMT). The stomach is a hollow organ centrally placed in the upper abdomen, and it is possible to have a protruding external compression at the fundus, particularly from an enlarged spleen or splenic artery. An accessory spleen or splenosis is not a very unusual finding but may rarely produce such external compression at the gastric fundus. We experienced a case of an accessory spleen mimicking a gastric SMT diagnosed through a gastroscopy after a splenectomy.

Subepithelial Lesion of the Gastric Fundus Caused by an Accessory Spleen / 대한내과학회지

When a submucosal lesion is discovered at the gastric fundus by gastroscopy, it may be difficult to distinguish a gastric external compression from a true submucosal tumor (SMT). The stomach is a hollow organ centrally placed in the upper abdomen, and it is possible to have a protruding external compression at the fundus, particularly from an enlarged spleen or splenic artery. An accessory spleen or splenosis is not a very unusual finding but may rarely produce such external compression at the gastric fundus. We experienced a case of an accessory spleen mimicking a gastric SMT diagnosed through a gastroscopy after a splenectomy.

Clinical Characteristics of Bleeding Peptic Ulcer in Elderly Patients: Experience at a Single Secondary Referral Center / 대한소화기내시경학회지

BACKGROUND/AIMS: Bleeding peptic ulcer in elderly patients is believed to differ from that found in younger patients. The purpose of this study was to evaluate the characteristics of bleeding peptic ulcer in elderly Korean patients. METHODS: We retrospectively evaluated 113 patients who were admitted to an emergency room for peptic ulcer bleeding from January 2006 to August 2008. For each patient, we investigated the clinical manifestations, the treatments and the hospital course. RESULTS: Peptic ulcer bleeding was more prevalent in elderly patients (n=63) than in younger patients (n=50). The elderly group had a higher incidence of comorbidities such as hypertension, stroke and ischemic heart disease, which might have be attributable to higher usage of aspirin and antiplatelet agents. There were no differences in the chief complaints or laboratory findings. The rate of Helicobacter pylori infection was lower in the elderly patients than that in the younger patients (41.3% vs. 62.0%, respectively, p=0.029). Four elderly patients and one younger patient died while in hospital, with one patient in each group dying due to bleeding. CONCLUSIONS: Peptic ulcer bleeding in elderly patients was associated with higher usage of aspirin and antiplatelet agents. There were no significant differences between the elderly and younger patients for the initial clinical presentation, the hospital course or the mortality due to bleeding.

A Case of Polycythemia Vera Combined with Focal Segmental Glomerulosclerosis / 대한혈액학회지

Polycythemia vera (PV) is a myeloproliferative disorder that results from clonal expansion of a transformed hematopoietic stem cell, and this is associated with a prominent overproduction of erythrocytes, and to a lesser extent, expansion of the granulocytic and megakaryocytic elements. Secondary polycythemia is occasionally associated with renal diseases such as renal tumors, cysts, hydronephorosis, renal transplantation, renal artery stenosis and Bartter's syndrome, and it is rarely associated with nephritic syndrome, nephrosclerosis, chronic glomerulonephritis (GN) and membranous nephropathy. Although cases of erythrocytosis with concomitant GN have occasionally been reported, there are few reports regarding PV. Focal segmental glomerulosclerosis (FSGS) is one of the most frequent forms of GN. However, its association with PV has rarely been described. We report here on one patient with concomitant PV and FSGS along with a review of the previously reported literature.

Cognitive Dysfunction in non-hypoxemic COPD Patients / 결핵및호흡기질환

BACKGROUND: The cognitive function is impaired in patients with hypoxemic chronic obstructive pulmonary disease (COPD). However, there are conflicting results regarding the cognitive function in patients with non-hypoxemic COPD. COPD patients also have sleep disorders. This study examined the cognitive function in non-hypoxemic COPD patients, and nocturnal sleep was assessed in COPD patients with a cognitive dysfunction. METHODS: Twenty-eight COPD patients (mean age, 70.7 years) with an oxygen saturation > 90%, and 33 healthy control subjects (mean age, 69.5 years) who had visited for a routine check-up were selected. The neurocognitive tests were performed using the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease (CERAD-K) Neuropsychological Battery. RESULTS: The scores of the word list recall test (p=0.03) and the word list recognition test (p=0.006) in the COPD group were significantly lower than those in the control group. Nine patients showed a significantly impaired cognitive function. Seven of these underwent polysomnography, which revealed apnea-hypopnea indices > or = five per hour in five patients. The median oxygen desaturation index and median limb movement index were 3.6/h and 38.6/h, respectively. CONCLUSION: These results suggest that the verbal memory function is impaired in non-hypoxemic COPD patients. Six out of seven COPD patients with an impaired cognitive function had sleep disorders of sleep apnea and/or periodic limb movements during sleep.

Serum adiponectin level and cardiovascular disease in patients with end-stage renal disease / 대한내과학회지

BACKGROUND: Adiponectin is a fat-based protein that alters the insulin sensitivity, has anti-inflammatory properties, and reduces the incidence of cardiovascular disease (CVD). However, this connection is unclear in patients with chronic wasting disease, such as heart failure or end-stage renal disease (ESRD). Therefore, this study examined the relationship between adiponectin and the cardiovascular risk/predictive factors in ESRD patients. METHODS: The serum concentrations of adiponectin and leptin were measured in 48 adult patients on maintenance hemodialysis. In addition, the blood levels of B-type natriuretic peptide (BNP) and cardiac troponin T (cTnT) as cardiovascular biomarkers were measured, and the CVD history was reviewed in order to determine if there was any correlation with adiponectin. RESULTS: There was a significant correlation between the adiponectin levels and the serum concentrations of HDL-cholesterol (r=0.456, p=0.001), triglyceride (r=-0.528, p<0.001), and leptin (r=-0.427, p=0.002) and an inverse correlation with the body mass index (BMI) (r=-0.326, p=0.024). The BNP levels were positively correlated with the adiponectin concentrations (r=0.372, p=0.009) and negatively correlated with the BMI (r=-0.310, p=0.032), and there was a slight positive correlation between cTnT and adiponectin (r=0.276, p=0.058). Patients with a history of CVD had higher levels of cTnT (p=0.012) and BNP (p=0.017), and a lower BMI (p=0.026) than patients without such a history. There was no significant difference in the adiponectin levels between the two patient groups. CONCLUSIONS: A higher adiponectin level is related to a favorable lipid profile. However, adiponectin is not directly associated with a history of CVD, and there was a correlation between a higher adiponectin level and a higher BNP and lower BMI, which are cardiovascular predictive factors, in ESRD patients. However, further research with more patients will be needed to properly determine the complicated relationship between adiponectin and the development of CVD.

Difference in Protein Markers According to the Survival of Sepsis Patients using Protein Chips / 결핵및호흡기질환

BACKGROUND: Several clinical scoring systems are currently being used to predict the outcome of sepsis, but they all have certain limitations. Therefore, we sought to identify the proteomic biomarkers, with wsing proteomic tools, that differed according to the outcome of sepsis patients. METHODS: Upon admission to the ICU, blood samples were obtained from the 16 patients with sepsis who were enrolled in this study. Surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF MS) was used to identify the markers that could predict the outcome of sepsis. RESULTS: We found six peaks, by using cation and anion chips, that statistically differed between those patients who died and those who survived. CONCLUSION: The biomarkers we found by using proteomic tools may help predict the prognosis and also plan the treatment of sepsis.