BACKGROUND: With the recent development in arterial reconstructive procedure such as percutaneous transluminal coronary angioplasty or atherectomy, the incidence of vascular complications involving femoral artery is increasing due to greater use of larger percutaneous instruments(including arterial sheath) and periprocedural anticoagulant therapy. Femoral pseudoaneurysm requires rapid diagnosis and management to prevent limb ischemia, worsening of the arterial injury or repair of the arterial defect. Recently, accurate diagnosis of these injuries can be made nonivasively with duplex sonography and Doppler color flow imaging, and nonsurgical treatment may be possible by using external compression guided by ultrasound even in patients requiring prolonged anticoagulant therapy. METHOD: Three patients, one undergoing coronary angiography and two undergoing percutaneous transluminal coronary angioplasty, developed expansile groin masses at the vascular access sites diagnosed as femoral artery pseudoaneurysm s by Doppler ultrasound. All patients were hypertensives, taking aspirin and two patients who underwent PTCA received intravenous heparin after procedure. After diagnosis of femoral pseudoaneurysm, all patients underwent mechanical(C-clamp) external compression guided by ultrasound for 3 hours. RESULT: Follow up color flow scans were obtained after 24 hours and in one patients, blood flow in the tract was eliminated but persistent blood flow was observed in two patients who underwent PTCA. Before closure of pseudoaneurysm, one patient needed another 6 hours of ultrasound guided compression and the other needed more 12 hours. All patients were discharged without complication or recurrence of pseudoaneurysm. CONCLUSION: These cases suggest that nonsurgical closure of femoral pseudoaneurysms is feasible even in patients requiring prolonged antiplatelet and anticoagulant therapy.
Aneurysm, False* ; Angioplasty, Balloon, Coronary ; Aspirin ; Atherectomy ; Cardiac Catheterization* ; Cardiac Catheters* ; Coronary Angiography ; Diagnosis ; Extremities ; Femoral Artery ; Follow-Up Studies ; Groin ; Heparin ; Humans ; Incidence ; Ischemia ; Recurrence ; Ultrasonography

BACKGROUND: Several antibiotics can be used to treat ventilator-associated pneumonia caused by carbapenem-resistant A. baumannii (CRAB-VAP) including high-dose sulbactam. However, the effectiveness of high-dose sulbactam therapy is not well known. We report our experience with high-dose sulbactam for treatment of CRAB-VAP. METHODS: Medical records of patients with CRAB-VAP who were given high-dose sulbactam between May 2013 and June 2015 were reviewed. RESULTS: Fifty-eight patients with CRAB-VAP were treated with high-dose sulbactam. The mean age was 72.0 ± 15.2 years, and the acute physiology and chronic health evaluation II (APACHE II) score was 15.1 ± 5.10 at the time of CRAB-VAP diagnosis. Early clinical improvement was observed in 65.5% of patients, and 30-day mortality was 29.3%. Early clinical failure (odds ratio [OR]: 8.720, confidence interval [CI]: 1.346-56.484; p = 0.023) and APACHE II score ≥ 14 at CRAB-VAP diagnosis (OR: 10.934, CI: 1.047-114.148; p = 0.046) were associated with 30-day mortality. CONCLUSIONS: High-dose sulbactam therapy may be effective for the treatment of CRAB-VAP. However, early clinical failure was observed in 35% of patients and was associated with poor outcome.
Acinetobacter baumannii* ; Acinetobacter* ; Anti-Bacterial Agents ; APACHE ; Diagnosis ; Humans ; Medical Records ; Mortality ; Pneumonia, Ventilator-Associated* ; Sulbactam*

OBJECTIVE : To analyze the methylenetetrahydrofolate reductase (MTHFR) mutation in recurrent spontaneous abortion associated with hyperhomocysteinemia. MATERIAL AND METHOD: The blood Sample of habitual aborter with high fasting homocysteine level was tested by PCR-RFLP method. RESULTS: The patient was found to be a homozygosity for MTHFR gene mutation that was confirmed by the finding which is consistent with the mutation at the nucleotide 677 C to T, Corresponding to Ala to Val. CONCLUSIONS: Hyperhomocysteinemia due to MTHFR mutation is a cause of recurrent spontaneous abortion. Therefore, the MTHFR mutation should be examined in the workup of recurrent spontaneous abortion showing hyperhomocysteinemia.
Abortion, Spontaneous* ; Fasting ; Female ; Homocysteine ; Humans ; Hyperhomocysteinemia* ; Methylenetetrahydrofolate Reductase (NADPH2)* ; Pregnancy

BACKGROUND: The stomach is the most common extra nodal site for non-Hodgkin's lymphoma: primary gastric lymphomas are uncommon, constituting only 1% to 5% of malignant gastric lesions. METHODS: To elucidate the clinicopathologic features of this lymphoma, we retrospectively analyzed 33 patients with primary gastric lymphoma who had been treated at our hospital from Jan. 1986 to Dec. 1995. RESULTS: Primary gastric lymphomas were 1.2% of all gastric cancers. The mean age 46 years (range 25 to 68 years). There were 23 men and 10 women. The most frequent chief complaint was epigastric pain. The most common location was the gastric antrum and body. According to the working formulation, the malignancy grades were 4 low, 26 intermediate, and 3 high. The overall 5-year survival rate was 60%. Survival of five years according to the TNM stage of the disease was as follows: stage 1, 88%; stage II, 71%; stage III, 33%; and stage IV, 29%. Patient with stage I, II disease had a 5-survival rate of 80% versus 35% for stage III, IV disease (p<0.05). Tumor serosal involvement and 5-year survival was follows: no perigastric serosal involvement, 93%; serosal infiltration, 33% (p=0.0016). In cases undergoing a subtotal gastrectomy, 5-year survival rate was 70%, whereas patients undergoing a total gastrectomy had a 5-year survival rate of 30% (p<0.05). Those with tumors smaller than 7 centimeters had a 5-year survival rate of 66% versus 38% for larger neoplasms (p=0.09). CONCLUSIONS: By univariate analysis, the stage, operation methods, and serosa involvement were significant prognostic factors. However, in multivariate analysis, only the serosa involvement was significant prognostic factor.
Female ; Gastrectomy ; Humans ; Lymphoma* ; Lymphoma, Non-Hodgkin ; Male ; Multivariate Analysis ; Pyloric Antrum ; Retrospective Studies ; Serous Membrane ; Stomach ; Stomach Neoplasms ; Survival Rate

Intrahepatic portosystemic venous shunt(IPVS) is an uncommon pathologic condition which occurs mostly in adult patients with portal hypertension and cirrhosis of the liver with only scattered reports are on children. However, asymptomatic IPVS have been detected in an increasing number of patients with recent advances in imaging techniques, such as sonography, CT, MR imaging, and color Doppler sonography. The cause of IPVS remains unknown, but two probable origins have been proposed, congenital and acquired origin. In the congenital origin, it has been proposed that the IPVS develops from embryologic vascular remnants. Acquired IPVS can develop into intrahepatic collateral pathway in the presence of portal hypertension and cirrhosis of the liver. We report a case of congenital IPVS with suspicious sepsis in a 6-day-old female patient. An abdominal ultrasonography and color Doppler sonography demonstrated an aneurysmal type of anomalous shunt connecting the right portal vein to the right hepatic vein. The patient continued to be symptomatic after discharge and a follow-up ultrasonography 3 months later revealed the disappearance of the previous IPVS.
Adult ; Aneurysm ; Child ; Female ; Fibrosis ; Follow-Up Studies ; Hepatic Veins ; Humans ; Hypertension, Portal ; Liver ; Magnetic Resonance Imaging ; Portal Vein ; Sepsis ; Ultrasonography

Two 4-day-old Thoroughbred foals with acute clinical signs of depression, elevated pulse and respiratory rates, anemia, and jaundice were referred to the equine hospital of Korea Racing Authority. The foals were seemingly normal at birth, but showed clinical signs such as abnormal behavior, jaundice and anemia suddenly after ingestion of the mare's colostrum, followed by death at 4 days after birth. According to the results of the hematology, serum chemistry analysis, jaundice foal agglutination test, and blood groups test, the foals were diagnosed as neonatal isoerythrolysis (NI) caused by the mare's antibodies. These results suggested that the pregnant mares have a potential for NI.
Agglutination Tests ; Anemia ; Antibodies ; Blood Group Antigens ; Colostrum ; Continental Population Groups ; Depression ; Eating ; Hematology ; Humans ; Jaundice ; Korea ; Parturition ; Respiratory Rate

PURPOSE: Interferon gamma release assays (QuantiFERON-TB Gold in Tube test [QFT-GIT]); Cellestis Limited, Victoria, Australia) have been studied for diagnosing pulmonary tuberculosis (TB) or latent TB but there have been no reports on the usefulness of this assay in diagnosing tuberculous anal fistula in actual clinical practices. In this study, we evaluated its diagnostic usefulness in patients with suspected tuberculous anal fistula. METHODS: We conducted a retrospective analysis of 119 patients with suspected tuberculous anorectal fistula from May 2007 to May 2009. Diagnosis of tuberculous fistula was concluded by identification of acid-fast bacilli, typical caseating granuloma and successful clinical response to anti-TB chemotherapy. All patients underwent the QFT-GIT and all patients diagnosed with tuberculous anal fistula were analyzed. RESULTS: Of the 119 patients with suspected TB fistula, 51 (43%) patients were classified as having TB fistula, including 31 with confirmed tuberculosis and 20 with probable tuberculosis, and other 68 (57%) were classified as not having tuberculosis. Among the 51 patients with TB fistula, Chronic caseating granuloma, acid-fast bacilli stain, and successful clinical response to anti-TB treatment were positive in 27 (52.9%), 4 (7.8%), and 20 (39.2%), respectively. Of the 51 with TB fistula, 44 had positive QFT-GIT results and 7 had negative results. The sensitivity and specificity of the assay were 86% and 85%, and positive predictive value (PPV) and negative predictive value (NPV) were 81% and 89%, respectively. CONCLUSION: QFT-GIT is a simple, sensitive, and specific method for the diagnosis of clinically highly suspected TB fistula.
Diagnosis* ; Drug Therapy ; Fistula* ; Granuloma ; Humans ; Interferon-gamma ; Interferon-gamma Release Tests* ; Rectal Fistula ; Retrospective Studies ; Sensitivity and Specificity ; Tuberculosis ; Tuberculosis, Pulmonary ; Victoria

Sweet's syndrome is an acute febrile neutrophilic dermatosis that occurs with malignant disease, mainly myeloid hemopathies, in about 20% of cases. When associated with myelodysplasia, clinical and histologic features of Sweet's syndrome can be atypical; however its significance is still debated. We encountered a case of Sweet's syndrome associated with myelodysplastic syndrome in a 63-year-old woman. The clinical presentation strongly suggested Sweet's syndrome but, histopathologic examination showed dense histiocytic infiltration with prominent upper dermal edema and little neutrophil infiltration. In the evaluation for atypical histopathology and laboratory abnormalities, she was diagnosed with myleodysplastic syndrome by peripheral blood smear and bone marrow biopsy. Histiocytoid Sweet's syndrome is a currently accepted concept and probably has a close relation with underlying myeloid hemopathies.
Biopsy ; Bone Marrow ; Edema ; Female ; Humans ; Middle Aged ; Myelodysplastic Syndromes* ; Neutrophil Infiltration ; Sweet Syndrome*

OBJECTIVE: The purpose of this study was to compare the results of different agents for bronchial artery embolization of hemoptysis. MATERIALS AND METHODS: From March 1992 to December 2006, a bronchial artery embolization was performed on 430 patients with hemoptysis. The patients were divided into three groups. Group 1 included 74 patients treated with a gelfoam particle (1x1x1 mm), while group 2 comprised of 205 patients treated with polyvinyl alcohol (PVA) at 355-500 micrometer, and group 3 included 151 patients treated with PVA at 500-710 micrometer. We categorized the results as technical and clinical successes, and also included the mid-term results. Retrospectively, the technical success was compared immediately after the procedure. The clinical success and mid-term results (percentage of patients who were free of hemoptysis) were compared at 1 and 12 months after the procedure, respectively. RESULTS: Neither the technical successes (group 1; 85%, 2; 85%, 3; 90%) nor the clinical successes (group 1; 72%, 2; 74%, 3; 71%) showed a significant difference among the 3 groups (p > 0.05). However, the mid-term results (group 1; 45%, 2; 63%, 3; 62%) and mid-term results excluding the recurrence from collateral vessels in each of the groups (group 1; 1 patient, 2; 4 patients, 3; 2 patients) showed that group 1 was lower than the other two groups (p < 0.05). No significant difference was discovered for the mid-term results between groups 2 and 3. Moreover, the same results not including incidences of recurrence from collateral vessels also showed no statistical significance between the two groups (p > 0.05). CONCLUSION: Polyvinyl alcohol appears to be the more optimal modality compared to gelfoam particle for bronchial artery embolization in order to improve the mid-term results. The material size of PVA needs to be selected to match with the vascular diameter.
Adolescent ; Adult ; Aged ; Angiography ; *Bronchial Arteries ; Embolization, Therapeutic/*methods ; Female ; Gelatin Sponge, Absorbable/*therapeutic use ; Hemoptysis/etiology/radiography/*therapy ; Hemostatics/*therapeutic use ; Humans ; Male ; Middle Aged ; Polyvinyl Alcohol/*therapeutic use ; Treatment Outcome

PURPOSE: To evaluate the dynamic enhancement patterns of focal hepatic lesions using breath-hold dynamic MR imaging for differential diagnosis. MATERIALS AND METHOD: Thirty three patients (24 men and 12 women, mean age of 55 years) with 56 known liver masses on CT scan and US underwent MR imaging with 1.5T. After Tl-weighted fast multiplanar spoiled gradient recalled (FMPSPGR) imaging, breath-hold FMPSPGR images were obtained at 0, 1, 3, 5, and 10 minutes after bolus injection of Gd-DTPA. The cases consisted of 16 hepatocellular carcinomas, 24 hemangiomas, 6 metastases, 3 cholangiocellular carcinomas, and 7 hepatic cysts. The dynamic enhancement patterns were evaluated on the basis of initial enhancement study and, the degree of enhancement was also levaluaied. RESULTS: Of 24 hemangiomas, most cases showed centripetal filling-in pattern of enhancement except 3 cases which showed homogeneous enhancement pattern on the early dynamic phase. All hemangiomas showed very high signal intensity which persisted to the delayed phase. The eccentric enhancement pattern was the most common type in hemangiomas (63%). Hepatocellular carcinomas had heterogeneous enhancement pattern on early and delayed phase (81, 88%) and showed diminished signal intensity on the delayed images. 14 of 16 hepatocellular carcinomas (88%) had peritumoral halo. Variable enhancement pattern was observed in metastases including progressive centripetal filling-in pattern (67%). All metastases showed prominent peritumoral halos and low signal intensity. Cholangiocellular carcinomas showed early centripetal filling-in and heterogeneous enhancement pattern on delayed phase. None of hepatic cysts showed enhancement. CONCLUSIONS: Dynamic breath-hold MR imaging with Gd enhancement allows accurate assessment of hemodynamic status of hepatic lesions and is useful in differential diagnosis of focal hepatic lerions.
Carcinoma, Hepatocellular ; Cholangiocarcinoma ; Diagnosis, Differential ; Female ; Gadolinium DTPA ; Hemangioma ; Hemodynamics ; Humans ; Liver ; Magnetic Resonance Imaging* ; Male ; Neoplasm Metastasis ; Tomography, X-Ray Computed