• Korean Journal of Clinical Pharmacy
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• v.22 no.2
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• pp.181-186
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• 2012

Objective: To report a fatal case of Multidrug-resistant Acinetobacter baumannii (MDR-AB) in a patient with interstitial lung disease (ILD) on high-dose glucocorticoids. Case Summary: A 66-year-old man with a history of coniosis was transferred to the hospital with progressive cough and sputum production. This patient has been diagnosed with pneumonia and ILD on admission, requires antimicrobial therapy and systemic immunosuppressants. He received high dose of methylprednisolone and cyclophosphamide for ILD as well as ceftriaxone and azithromycin for pneumonia. On day 7 in the intensive care units (ICUs), patient had fever and leukocytosis, thus antimicrobials were switched to piperacillin. After 13 days in the ICU, Acinetobacter baumannii and methicillin-resistant Staphylococcus aureus (MRSA) were isolated on transtracheal aspirate (TTA) and meropenem was initiated. However, it was revealed a multidrug-resistant Acinetobacter baumannii (MDR-AB) species, resistant to carbapenem. Patient was administered colistin but expired due to septic shock on day 84. Discussion: Systemic immunosuppressive therapy can result in infections that may compromise patient's survival. MDR-AB has emerged as a serious cause of nosocomial infections in immunocompromised patients. MDR-AB is resistant to most standard antimicrobials and therapeutic options are limited. Conclusion: We report our recent experience with a fatal MDR-AB pneumonia in a patient with ILD, who had to be treated with high dose glucocorticoids and immunosuppressnts.

• The Korean Journal of Physiology and Pharmacology
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• v.20 no.6
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• pp.565-571
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• 2016

Paeoniflorin (PAE) is the most abundant compound in Xuebijing injection widely used to treat sepsis. We aimed to investigate effect of PAE on expression of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in a rat model of sepsis. Wistar rats were divided into Normal, Model, and PAE groups (n=20 each). Endotoxin was administrated at 5 mg/ml/kg in Model and PAE rats to establish rat sepsis model. 1 h after endotoxin administration, PAE was administrated at 4 ml/kg in PAE group once per day for 3 days. Routine blood tests and biochemical indexes were assessed, including aspartate aminotransferase (AST) and creatine kinase-MB (CK-MB). The plasma sTREM-1 level was measured using quantitative ELISA. At the end of experiment, the small intestine, liver, kidney and lung were subjected to pathological examinations. A rat model of sepsis-induced multiple organ dysfunction syndrome (MODS) was established successfully with endotoxin administration (5 mg/ml/kg), evidenced by histo-pathological examinations, routine blood tests and biochemical indexes: platelet count decreased and white blood cell count increased (p<0.05), CK-MB and AST increased (p<0.05). PAE treatment significantly reduced the plasma levels of AST, CK-MB, and sTREM-1, compared to Model group (p<0.05). Meanwhile, sepsis-induced damages in the liver, lung, stomach and intestinal mucosa were also markedly ameliorated by PAE treatment. PAE demonstrated a significantly protective effect in a rat model of sepsis by decreasing plasma sTREM-1 level, reducing inflammation, preventing MODS and protecting organ functions.

• Journal of Chest Surgery
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• v.20 no.1
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• pp.65-70
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• 1987

Empyema thoracis following pneumonia, pulmonary tuberculosis, trauma and surgical procedures continues to be a source of major morbidity and mortality. We retrospectively reviewed the hospital records of 330 patients [child:87, adult243] treated for empyema thoracis at Catholic Medical Center between 1964 and 1986. The causes of empyema in these patients were as follows: pneumonia [C***:66%, A***:30%], pulmonary tuberculosis [C:2%, A:20%], lung abscess [C:3%, A:5%], postoperative complication [C:0%, A:13%], trauma [C:1%, A:4%] and unknown origin [C:23%, A:17%]. Three patients in this series died of sepsis from necrotizing pneumonia. Staphylococcus [29.3%], Streptococcus [8.8%], E. coli [8%], Mycobacterium tuberculosis [7.9%], Klebsiella [7.4%], Pseudomonas [6.4%], Bacteroides [3.4%] were the organisms most commonly isolated. Bacterial isolates were single in 68.3%, multiple 7.5% and absent 24.2%. The type of organism did not correlate with severity of disease or eventual requirement for closed thoracotomy drainage, open thoracotomy drainage [Modified Eloesser*s procedure], thoracoplasty, decortication or pleuropneumonectomy. Successful methods of treatment included aspiration in 44%, tube thoracotomy in 66%, open thoracotomy drainage in 98.7%, thoracoplasty in 98%, decortication in 96% and pleuropneumonectomy in 73%. Initial mode of management in empyema thoracis are thoracentesis and closed thoracotomy drainage. If the initial management was failed, we performed another surgical procedures. Before 1973, we manage with Schede`s thoracoplasty in the postpneumonectomy empyema patients. But thoracoplasty, with or without the use of muscle flaps, is a hazardous operation in the poor-risk patients. The permanent, open thoracotomy drainage is a relatively minor operation which is well tolerated even by cachexic, septic patients. It controls infection, and sometimes results in the bronchopleural fistula closing spontaneously.

• Journal of Chest Surgery
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• v.22 no.1
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• pp.123-133
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• 1989

A clinical evaluation was done on 182 cases of chest trauma which experienced at the Department of Thoracic and Cardiovascular Surgery, National Medical Center, from Sep. 1980 to Dec. 1987. 1] Of 182 cases, 125 cases resulted from non-penetrating chest trauma and 57 cases from penetrating wound. 2] The ratio of male to female was 4.87:1, and age groups between 3rd and 6th decade were 71.9%. 3] The most common causes of chest trauma were traffic accident in non-penetrating and stab wound by knife in penetrating cases. 4] Left thorax was the preferred site of chest injury. 5] The incidences of hemothorax, pneumothorax, and hemopneumothorax were 69.6% in non-penetrating and 91% in penetrating. 6] Rib fractures between 4th rib and 8th rib were 68.8% of total rib fracture cases and left side was preferred site. 7] Methods of treatment were conservative management in 24.7%, closed thoracostomy in 54.9%, open thoracotomy in 14.3%, and etc. 8] The incidence of complications, were 11.5% of total cases, and they were atelectasis [8 cases], empyema [3 cases], pneumonia [3 cases], acute renal failure [2 cases], lung abscess [1 case], and etc. 9] The overall mortality was 6%, and causes of death were hypovolemic shock, renal failure, hepatic failure, respiratory failure, septic shock, and etc.

• Tuberculosis and Respiratory Diseases
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• v.65 no.4
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• pp.334-338
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• 2008

Solitary fibrous tumors of the pleura (SFTPs) are relatively rare tumors that originate from the mesenchymal cells of the submesothelial tissue of the pleura. Patients with SFTPs are often asymptomatic, while some patients experience pleuritic chest pain, cough and/or dyspnea. We report here on a case of SFTP, and the patient presented with septic shock and respiratory failure that required mechanical ventilation. A 68-year-old woman was admitted for the evaluation of her dyspnea and generalized edema. Chest imaging studies showed an 18 cm-sized voluminous mass occupying the right thoracic cavity with anterior displacement of hilar structures and atelectasis of the right lung. Immediately after admission, she developed pneumonia and septic shock that required antibiotics and mechanical ventilation. She displayed a partial response to medical treatment, and then complete excision of the tumor was performed and the pathologic examination revealed benign SFTP. Afterward, she fully improved without evidence of recurrence until now.

• Tuberculosis and Respiratory Diseases
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• v.41 no.5
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• pp.452-461
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• 1994

Background: Tumor necrosis factor(TNF)-$\alpha$ and Interleukin(lL)-$1{\beta}$ are thought to play a major role in the pathogenesis of the septic syndrome, which is frequently associated with adult respiratory distress syndrome(ARDS). In spite of many reports for the role of TNF-$\alpha$ in the pathogenesis of ARDS, including human studies, it has been reported that TNF-$\alpha$ is not sensitive and specific marker for impending ARDS. But there is a possibility that the results were affected by the diversity of pathogenetic mechanisms leading to the ARDS because of various underlying disorders of the study group in the previous reports. The purpose of the present study was to evaluate the roles of TNF-$\alpha$ and IL-$1{\beta}$ as a predictable marker for development of ARDS in the patients with septic syndrome, in which the pathogenesis is believed to be mainly cytokine-mediated. Methods: Thirty-six patients of the septic syndrome hospitalized in the intensive care units of the Asan Medical Center were studied. Sixteens suffered from ARDS, whereas the remaining 20 were at the risk of developing ARDS(acute hypoxemic respiratory failure, AHRF). In all patients venous blood samples were collected in heparin-coated tubes at the time of enrollment, at 24 and 72 h thereafter. TNF-$\alpha$ and IL-$1{\beta}$ was measured by an enzyme-linked immunosorbent assay (ELISA). All data are expressed as median with interquartile range. Results: 1) Plama TNF-$\alpha$ levels: Plasma TNF-$\beta$ levels were less than 10pg/mL, which is lowest detection value of the kit used in this study within the range of the $mean{\pm}2SD$, in all of the normal controls, 8 of 16 subjects of ARDS and in 8 in 20 subjects of AHRF. Plasma TNF-$\alpha$ levels from patients with ARDS were 10.26pg/mL(median; <10-16.99pg/mL, interquartile range) and not different from those of patients at AHRF(10.82, <10-20.38pg/mL). There was also no significant difference between pre-ARDS(<10, <10-15.32pg/mL) and ARDS(<10, <10-10.22pg/mL). TNF-$\alpha$ levels were significantly greater in the patients with shock than the patients without shock(12.53pg/mL vs. <10pg/mL) (p<0.01). There was no statistical significance between survivors(<10, <10-12.92pg/mL) and nonsurvivors(11.80, <10-20.8pg/mL) (P=0.28) in the plasma TNF-$\alpha$ levels. 2) Plasma IL-$1{\beta}$ levels: Plasma IL-$1{\beta}$ levels were less than 0.3ng/mL, which is the lowest detection value of the kit used in this study, in one of each patients group. There was no significant difference in IL-$1{\beta}$ levels of the ARDS(2.22, 1.37-8.01ng/mL) and of the AHRF(2.13, 0.83-5.29ng/mL). There was also no significant difference between pre-ARDS(2.53, <0.3-8.34ngfmL) and ARDS(5.35, 0.66-11.51ng/mL), and between patients with septic shock and patients without shock (2.51, 1.28-8.34 vs 1.46, 0.15-2.13ng/mL). Plasma IL-$1{\beta}$ levels were significantly different between survivors(1.37, 0.4-2.36ng/mL) and nonsurvivors(2.84, 1.46-8.34ng/mL). Conclusion: Plasma TNF-$\alpha$ and IL-$1{\beta}$ level are not a predictable marker for development of ARDS. But TNF-$\alpha$ is a marker for shock in septic syndrome. These result could not exclude a possibility of pathophysiologic roles of TNF-$\alpha$ and IL-$1{\beta}$ in acute lung injury because these cytokine could be locally produced and exert its effects within the lungs.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.16 no.1
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• pp.104-111
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• 1994

Necrotizing fascitis is a severe soft tissue infection characterized by extensive necrosis of superficial fascia, suppurative fascitis, vascular thrombosis, widespread undermining of surrounding tissues. Associated systemic problems are widespread undermining of surrounding tissues, Associated systemic problems are common, with chronic alcoholism and diabetes being most prominent. Most commonly this disease presents in the extremities, trunk, and perineum. Necrotizing fascitis of dental origing is rare and its fulminating clinical course is not well documented in the dental literature. The present report is a case of necrotizing fascitis following vital extirpation of the pulp in a patient with uncontrolled diabetes mellitus and liver cirrhosis. Originally throught to be caused by hemolytic streptococcus organism or stphylococcus aureus, advances in anaerobic culturing have shown it to be a synergistic bacterial infection involving aerobic and ovligate anaerobes. it is relatively rare in relatively rare in haea and neck regions. If it was not diagnosed and treated in early stages, necrotizing fascitis can be potentially fetal, with a mortality rate approaching 40%. It's treatment requires early recognition, prompt and aggressive surgical debriment and proper supportive cares, such as, antibiotic therapy, fluid resuscitation and correction of metabolic and electrolyte disorder, resolving of the underlying systemic disease. Recently, we experienced two cases of necrotizing fascitis in cervicofacial region, One patient was 60 years old male with uncontrolled Diabetes Mellitus and other patient was 48 years old with steroid therapy during 30 years. Local surgical wound healing was successful but, patients were died after admission, because of lung abscess, gastrointestinal bleeding, septic shock and respiration hold.

• Tuberculosis and Respiratory Diseases
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• v.61 no.4
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• pp.389-393
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• 2006

Tsutstugamushi disease is a major febrile disease that generally occurs in the fall in Korea with hemorrhagic fever with renal syndrome and leptospirosis. This disease is often accompanied by interstitial pneumonia, acute renal failure and liver failure. The causative agent, namely Orientia tsutsugamushi, is transmitted to humans through the bite of a laval trombiculid mite, which is commonly known as a chigger. A 78 year old man was admitted in October 2004 with intractable fever and a drowsy mentality. Two weeks earlier, he visited a private clinic complaining of a simple skin rash. He was treated with antihistamine and steroid, but his symptoms were aggravated and he was referred to our hospital. His physical examination and laboratory findings showed a septic shock status. The maculopapular rash had spread over his face, chest, abdomen and extremities. Eschar was observed in lower back area but it was too difficult to distinguish it from other skin rashes. His chest X-ray appeared as diffuse nodular patchy consolidations in the bilateral lung parenchyme. He was treated with a mechanical ventilator and doxycycline under th suspicion of Tsutstugamushi disease. However, he suffered multiorgan failure accompanied by acute respiratory distress syndrome, acute renal failure and acute hepatitis. He was treated in the intensive care unit for approximately 12 weeks and his general condition was recovered.

• The Journal of the Korean bone and joint tumor society
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• v.12 no.1
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• pp.15-22
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• 2006

Purpose: This study was designed to investigate the clinical and oncological results of giant cell tumor, treated with electrocautery as an adjuvant. Materials and Methods: We evaluated 47 giant cell tumors treated in both institution from 1989 to 2004, retrospectively. We treated all 47 cases with intralesional curettage and speed burring and followed electrocautery as an local adjuvant. Results: The mean follow up periods was 44 months and ranged from 12 to 180 months. The local recurrence occurred in 8 patients (17%) and one case lung metastasis was found. There was one case complication (septic knee) associated with electrocautery as an adjuvant. Conclusions: We thought electrocautery was feasible adjuvant treatment method of giant cell tumor, because it is very convenient technique, and the local recurrence rate was similar to any other methods.

• Tuberculosis and Respiratory Diseases
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• v.68 no.6
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• pp.350-353
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• 2010

Here we report the first fatality caused by H1N1 influenza virus infection with acute respiratory distress syndrome in Korea. A 55-year-old man presented at our emergency department with dyspnea, fever, diffuse myalgia and malaise. Bilateral lung air-space consolidation was detected on his initial chest radiograph combined with severe hypoxemia. He was supported by mechanical ventilation and treated with antibiotics. A nasopharyngeal aspirate was positive for influenza A rapid antigen and oseltamivir was started on day 3 of admission. The nasal swab sample was positive for influenza H1N1 virus by real-time reverse-transcriptase polymerase chain reaction. Despite aggressive treatment, he had refractory hypoxemia and uncontrolled septic shock. On day 5 of admission he went into cardiac arrest and expired.