No abstract available.
Finite Element Analysis* ; Plastics* ; Titanium*

Mucormycosis is an uncommon opportunistic fungal infection mostly affecting immunocompromised patients and gastrointestinal mucormycosis is a rare and life-threatening. We describe a 31-year-old man with a history of idiopathic cyclic neutropenia who developed perforations of the stomach and intestine and intra-abdominal bleeding due to disseminated gastrointestinal mucormycosis after the initial operation.
Adult ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Immunocompromised Host ; Intestines ; Mucormycosis* ; Neutropenia ; Stomach

Mucormycosis is an uncommon opportunistic fungal infection mostly affecting immunocompromised patients and gastrointestinal mucormycosis is a rare and life-threatening. We describe a 31-year-old man with a history of idiopathic cyclic neutropenia who developed perforations of the stomach and intestine and intra-abdominal bleeding due to disseminated gastrointestinal mucormycosis after the initial operation.
Adult ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Immunocompromised Host ; Intestines ; Mucormycosis ; Neutropenia ; Stomach

Traumatic carotid-cavernous fistula (TCCF) is a pathologic communication between the internal carotid artery and cavernous sinus, and is associated with craniomaxillofacial trauma. TCCF are very rare, occurring in 0.17~0.27% of craniomaxillofacial trauma cases. We describe a 76-year-old woman treated for multiple fractures including the skull base, left temporal bone, right tibia and fibula, left clavicle, and fifth and seventh rib fractures. She developed symptoms of TCCF two weeks after the initial trauma. We successfully treated her by endovascular occlusion of the internal carotid artery.
Aged ; Carotid Artery, Internal ; Carotid-Cavernous Sinus Fistula* ; Cavernous Sinus ; Clavicle ; Endovascular Procedures ; Female ; Fibula ; Fistula ; Fractures, Multiple ; Humans ; Intracranial Hemorrhages* ; Radiology, Interventional ; Rib Fractures ; Skull Base ; Temporal Bone ; Tibia

Ischemic stroke is a common complication of infective endocarditis (IE), occurring in 20-40% of left side IE cases. In these subsets, anticoagulation therapy may provoke hemorrhagic transformation (HT) of ischemic stroke, and complications of this magnitude deteriorate the clinical course for IE patients. However, in cases of IE complicated with a mechanical prosthetic valve, the physician can be concerned over the maintenance of anticoagulation due to the risk of thrombotic complication. According to our retrospective review, HT of ischemic stroke in prosthetic valve endocarditis occurred 13.8% (4/29) of the time in a variety of situations. Some of these even arose in patients with a subtherapeutic range of prothrombin time.
Anticoagulants ; Cerebral Hemorrhage ; Endocarditis ; Heart Valve Prosthesis ; Humans ; Prothrombin Time ; Retrospective Studies ; Stroke

OBJECTIVETo evaluate the safety and efficacy of intraoperative argon/helium cryosurgery in surgical resection of advanced hepatic carcinoma.

METHODSEighty-six surgical patients with advanced hepatic carcinoma were enrolled in this study, including 14 undergoing argon cryosurgery for tumor removal and 72 receiving cryosurgery in addition to surgical tumor reduction. Portal vein or hepatic arterial pump placement was performed in 15 patients for chemotherapy.

RESULTSNo death occurred in the operation or during the postoperative hospitalization period in these patients. Improvement of the clinical symptoms was observed in 66 cases (76.74%) and 43 (78.18%) patients showed significantly decreased blood AFP levels after the surgeries. Postoperative CT demonstrated obviously reduced tumor size in 58 cases (67.44%). Of the 70 patients available for the follow-up, 28 survived with a survival rate of 40%. The 0.5-, 1-, 3 and 5-year survival rates were 44/48 (91.67%), 35/48 (72.92%), 28/48 (58.33%), and 20/48(41.67%) in the patients with primary hepatic carcinoma (PHC), respectively, as compared with those of 21/22 (95.45%), 18/22 (81.82%), 13/22 (50.09%), and 8/22 (36.36%) in patients with metastasis hepatic carcinoma (MHC). The 1-, 3- and 5-year survival rates of the patients undergoing surgical tumor resection and cryosurgery were 65/72 (90.27%), 47/60 (78.33%) and 24/58 (41.38%), respectively, significantly higher than the rates of 10/14 (71.43%), 8/12 (66.67%) and 4/12 (33.33%) in the patients receiving cryosurgery only (P<0.05).

CONCLUSIONSArgon cryosurgery offers an effective and safe option for management of advanced hepatic carcinoma, and its combination with other therapeutic approaches may achieve better clinical effects.

Adult ; Aged ; Argon ; Carcinoma, Hepatocellular ; surgery ; Combined Modality Therapy ; Cryosurgery ; Female ; Helium ; Humans ; Liver Neoplasms ; secondary ; surgery ; Male ; Middle Aged ; Survival Analysis

Pericardiectomy is the standard treatment in patients with chronic constrictive pericarditis who have persistent symptoms. However, myocardial atrophy with prolonged pericardial constriction and abrupt increase in venous return can lead to heart failure with volume overload after pericardial decompression, especially in the right ventricle (RV). We experienced a 44 year old male patient who developed transient RV failure after pericardiectomy for constrictive pericarditis. Echocardiography revealed a markedly dilated RV with decreased peak systolic velocity of the tricuspid annulus, suggesting severe RV dysfunction. After treatment with inotropics and diuretics, a follow-up echocardiography revealed an improved systolic function with decreased RV chamber size. This case demonstrates the importance of volume overload and RV dysfunction in patients with constrictive pericarditis undergoing pericardiectomy.
Atrophy ; Constriction ; Decompression ; Diuretics ; Echocardiography ; Follow-Up Studies ; Heart Failure ; Heart Ventricles ; Humans ; Male ; Pericardiectomy ; Pericarditis, Constrictive ; Ventricular Dysfunction, Right

PURPOSE: Transplant patients under immunosuppression are susceptible to mycobacterium tuberculosis infection. We analyzed renal transplant recipients, to evaluate the risk factors, clinical characteristics, and long-term outcomes of post- transplant tuberculosis (TB). METHODS: This study is based on the records of renal allograft recipients from October 1991 to June 2006 in two transplant centers in Korea. The demographic data, clinical manifestations, and long-term outcomes of this cohort of patients were retrospectively analyzed. RESULTS: Total 617 patients were enrolled in this study. Eighteen cases of TB (2.92%) occurred with a mean interval from transplant to diagnosis of TB of 33.1 (range: 1~121) months. Most of post-transplant TB were pulmonary TB (including pleural) (13/18), and extrapulmonary TB occurred in 5/18. There was no difference in the prevalence of diabetes mellitus, hepatitis B or C, and immunosuppressive agents between the patients who had developed post- transplant TB and who had not. However, there was higher incidence of acute rejection in post-transplant TB group (0.9+/-1.1 vs. 0.4+/-0.6, P=0.043), and post-transplant TB group had a tendency toward more past history of TB infection (P=0.096). Thirteen patients were successfully treated, 2 patients have been under treatment and 3 patients died. The patient survival was significantly reduced by post- transplant TB in multivariate analysis (relative risk=3.355, P=0.038). CONCLUSION: Post-transplant TB is a serious problem, which is associated with poor outcomes in renal transplant patients. Therefore, high index of suspicion is warranted to ensure early diagnosis and prompt initiation of treatment.
Cohort Studies ; Diabetes Mellitus ; Dietary Sucrose ; Early Diagnosis ; Hepatitis B ; Humans ; Immunosuppression ; Immunosuppressive Agents ; Incidence ; Kidney Transplantation ; Korea ; Multivariate Analysis ; Mycobacterium ; Mycobacterium tuberculosis ; Prevalence ; Prognosis ; Rejection (Psychology) ; Retrospective Studies ; Risk Factors ; Transplantation, Homologous ; Transplants ; Tuberculosis

OBJECTIVE: The purpose of this study was to evaluate the risk of cesarean section in nulliparous women who undergone induction at postterm pregnancy. METHODS: The retrospective study was conducted from March, 1997 to March, 2005 by reviewing 331 nulliparous patients more than 41 weeks' gestation delivered after induction at our Hospital. The evaluated variables to assess the risk of cesarean section were maternal age, body mass index (BMI), gestational age (GA), Bishop scores (BS), fetal body weight (FBW), fetal head circumference (FHC) and fetal sex. t-test and x2-test were used to compare these categorical variables. RESULTS: The study included 331 nulliparous singleton pregnant women undergoing elective induction for postterm pregnancy: 127 (38.4%) delivered babies by cesarean section due to induction failure, progression failure and fetal distress, whereas 204 (61.6%) delivered vaginally. The mean maternal ages were 27.59+/-2.57 in cesarean delivery group and 26.99+/-2.61 in vaginal delivery group. The average values of BMI at postterm in cesarean and vaginal delivery groups were 26.70+/-2.82 and 25.75+/-2.67 kg/m2. GA was 41.36+/-0.27 weeks in cesarean delivery group, whereas 41.20+/-0.19 weeks in vaginal delivery group. The average FBW and FHC were 3460.31+/-358.22 g and 34.59+/-1.18 cm in cesarean delivery group, compared to 3363.95+/-361.22 g and 34.03+/-1.34 cm in vaginal delivery group. CONCLUSION: The BMI, FBW and FHC have linked to the risk of cesarean delivery in nulliparous women who underwent elective induction. Thus, these information would provide the useful tools to assess the risk of cesarean section in postterm nulliparous patients for planning an induction.
Body Mass Index ; Cesarean Section* ; Female ; Fetal Distress ; Fetal Weight ; Gestational Age ; Head ; Humans ; Maternal Age ; Pregnancy ; Pregnancy* ; Pregnant Women ; Retrospective Studies

Although it is well known that cerebral vasospasm is caused by the breakdown of blood products extravasated during subarachnoid hemorrhage(SAH), it is still controversial whether its persistence is caused by the continuing contraction of the smooth muscle of vessels or by morphologic change in the vessel wall. The purpose of this study is to evaluate the reversibility of vasospasm induced by intra-arterial papaverine injection and to evaluate morphological change in the vessel wall in SAH induced in rabbits. In each of 18 rabbits, vertebral angiography was performed 7 days before the induction of artificial SAH was made by injection of autologous arterial blood around the basilar artery through a silicone catheter placed in the prepontine cistern. Before and after the injection of papaverine, further vertebral angiograms were obtained on days 1(n=1), 2(n=2), 3(n=1), 4(n=2), 5(n=4), 6(n=1), 7(n=2), 8(n=1), 14(n=1), 16(n=1) and 30(n=1) after the creation of SAH. Immediately after this further angiography, the rabbits were sacrificed and portions of the basilar artery were prepared for electron microscopic(EM) study and immunohistochemical staining. Vasospasm of the basilar artery was most severe in the rabbit sacrificed one day after SAH(54.1% of pre-SAH diameter) and maintained until 30 days thereafter(61.0% of the pre-SAH diameter). Five days after SAH, the diameter of the basilar artery following papaverine injection was 78.6% of its pre-SAH diameter, suggesting a decrease in the reversibility of papaverine-induced effects. The ultrastructural changes seen on EM study were most remarkable on post-SAH days 1 and 2 and tended to be gradually milder on later days. Immunohistochemical staining showed diffuse strong positive reactivity for smooth muscle actin in the media at 1, 5, 7, and 14 days after SAH, and strong positive reactivity for vimentin in the intima and media at 2, 5, and 30 days after SAH. When the reversibility of papaverine-induced arterial contraction decreased, findings of increased immunoreactivity to the cytoskeletal protein of smooth muscle of the basilar artery suggested that morphological changes in the artery wall had contributed to the maintenance of vasospasm.
Actins ; Angiography ; Arteries ; Basilar Artery ; Catheters ; Cerebral Arteries* ; Cytoskeleton ; Immunohistochemistry ; Muscle, Smooth ; Papaverine ; Rabbits ; Silicones ; Subarachnoid Hemorrhage ; Vasospasm, Intracranial ; Vimentin