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Background/purpose: The rapid shallow breathing index (RSBI) is a weaning parameter usually measured at the start of a spontaneous breathing trial (SBT). This study investigated the value of RSBI measured at the beginning and termination of SBT as a predictor of weaning outcome., Methods: RSBI was measured during the initial 1 minute (RSBI1) and at termination (RSBI2) of an SBT in 172 patients recovering from acute respiratory failure., Results: Weaning was successful in 106 patients and failed in 66 patients. Among the 66 patients with weaning failure, 12 required reintubation within 48 hours (extubation failure), and the remaining 54 patients could not be extubated after SBT (trial failure). There were no differences between RSBI1 in the three groups (69.4 +/- 27.5, 81.7 +/- 24.4 and 75.5 +/- 26.5, respectively), but RSBI2 was significantly higher in patients with extubation failure (95.9 +/- 20.6) and trial failure (98.0 +/- 50.0) than in patients with weaning success (64.6 +/- 26.3) (both p < 0.001). Logistic regression revealed that RSBI2 was superior to RSBI1 and various physiologic indices in predicting weaning outcome. For the 118 extubated patients, the mean area under the receiver operating characteristic curve for RSBI2 and RSBI1 was 0.83 and 0.63, respectively. Using a threshold value of 105, the sensitivity, specificity, accuracy and likelihood ratio for weaning outcome were 0.91, 0.25, 0.85 and 1.38 for RSBI2 and 0.89, 0.16, 0.60 and 1.06 for RSBI1, respectively., Conclusion: This study found that RSBI measured at the completion of SBT was superior to that measured at the start in predicting weaning outcome in critically ill patients.

Background and Purpose: Urinary incontinence (UI) is a common, distressing, and often disabling condition in the elderly. The objectives of this study were to estimate the prevalence and clinical characteristics of UI among elderly individuals living at home and to explore their perceptions of UI and intention to seek medical care., Methods: A total of 504 elderly subjects aged 65 and older residing in Tungkang town (located in the southwestern part of Taiwan) were randomly sampled and surveyed face to face by registered nurses. The prevalence, clinical types, and perceptions of UI, and intention to seek treatment, were compared with chi-square statistics across various sociodemographic characteristics. Logistic regression analyses were conducted to identify factors associated with UI experience and intention to seek treatment., Results: About 22% of respondents reported that they had experienced involuntary loss of urine in daily life. Women, people who were overweight, and those who were aged 70 years or older were at higher risk of UI. While women were more likely to suffer from stress incontinence, men were at higher risk of urge incontinence. Women, illiterate individuals, and those who perceived UI as a normal part of the aging process showed low intention to seek treatment for UI., Conclusions: The results of this study suggest that public awareness programs about UI and promotion of available treatment options are necessary to increase the intention to seek treatment among the elderly. Culturally sensitive programs should be designed, particularly for female and illiterate elderly, to provide incentives to seek medical care. The increasing availability of various treatment modalities coupled with education to correct commonly held misconceptions about UI might enable more elderly individuals to receive treatment for this common condition.

Osteomyelitis caused by nontuberculous mycobacteria is rarely reported. We describe a case of tenosynovitis and osteomyelitis of the right middle finger and metacarpal bone caused by Mycobacterium marinum in a fish dealer. This 52-year-old woman suffered progressive pain, numbness, tenderness, and erythematous swelling of the right middle finger over a 2-month period. A radiograph of the right hand disclosed osteolytic lesions at the third metacarpal bone and the third proximal phalanx. She was treated successfully with repeated surgical debridement and antimicrobial agents, including clarithromycin, ethambutol, rifampin, and doxycycline for 1 month, followed by ethambutol and clarithromycin. Pathologic examination of the debrided tissue disclosed epithelioid granuloma, caseous necrosis, and numerous acid-fast bacilli, which were later identified as M. marinum using conventional biochemical tests and by the characteristic gas-liquid chromatogram of esterified cellular fatty acid. The wound healed completely after 7 months of treatment. The patient is still under treatment, and clarithromycin and ethambutol will be given for a total of 18 months.

A case of malignant chondroid syringoma on a foot with multiple bone metastases is presented. An 18-year-old male patient first noticed a protruding mass on the plantar surface of his right foot at 9 years of age. A sweat gland tumor of a benign nature was diagnosed and excised at that time. The tumor recurred three times during the 10 years after surgery and was finally diagnosed as malignant chondroid syringoma. Multiple bone metastases involving the calcaneus, talus and fibula of the lesion side were found after extensive radiologic survey. The patient underwent below-knee amputation with total removal of the fibula. However, pelvic bone metastasis developed 1 year after the amputation. He died of this disease due to brain and diffuse bony metastasis 36 months after the amputation. This is a rare case of malignant chondroid syringoma with a long history but ominous outcome. We recommend that sweat gland tumors be carefully examined and treated more radically when there is a suspicion of malignancy.

Laparoscopic procedures have recently been used in the evaluation and treatment of some urogenital diseases. A case of right intraabdominal cryptorchism associated with left varicocele was successfully treated by laparoscopic orchiectomy and ligation of the contralateral internal spermatic vein concomitantly. This new technology can be easily performed and has the advantages of less tissue trauma, easy application for bilateral lesions, and less patient morbidity. We consider laparoscopy is a promising method for the diagnosis and treatment of intraabdominal testis.

Giant hydronephrosis is uncommon. In 1939, Stirling defined it as the presence of more than 1,000 ml of fluid in the collecting system [1]. We herein report 4 cases of giant hydronephrosis containing 1,900 ml, 3,400 ml, 2,100 ml and 3,200 ml, respectively. Only 6 cases with a malignant tumor have been reported in the literature. Our second case with multiple foci of transitional cell carcinoma with squamous metaplasia is presented. This is the first report of this kind of pathological morphology with giant hydronephrosis. An erroneous diagnosis is often made in cases of giant hydronephrosis. For example, 3 of our 4 patients were first diagnosed as ovarian cyst, retroperitoneal hamartoma and hepatic cyst, respectively. We have found 523 cases reported in the literature. It is seen more often in males than in females (2.4:1) and more often on the left side than on the right side (1.8:1). The amount of fluid in the hydronephrotic sac is often between 1 and 2 liters. It is usually secondary to ureteropelvic junction obstruction, stones or congenital abnormality. Nephrectomy is often performed due to severe impairment of renal function. Acute renal failure and cardiopulmonary distress developed in our second case after the operation. The reason may be the sudden decompression of the huge hydronephrotic sac, which resulted in a change in the hemodynamic balance. Therefore, a two-stage procedure with slow decompression by percutaneous nephrostomy before the nephrectomy is preferred in the compromised patient.