Balloon-tipped, flow-directed (Swan-Ganz) catheters are used commonly for monitoring of cardiac function in patients undergoing cardiac surgical procedures. We report a case of pulmonary hypertension with hypoxemia which may be caused by incorrect positioning of pulmonary artery catheter (PAC) during CABG. Pulmonary arterial pressure (PAP) of 70/40 mmHg which was nearly high as systemic pressure was measured when we tried to wean patient from cardiopulmonary bypass. But, TEE (transesophageal echocardiography) showed nonspecific finding. PAP decreased soon and maintained about 33/16 mmHg for a few minutes. But, the PAP elevated high to 70/40 mmHg again and the arteral oxygen tension (PaO2) decreased to 61.2 mmHg. When we withdrew the PAC to the depth of 35 cm, the PAP and systolic pressure returned to normal range and PaO2 elevaed to 320 mmHg. End tidal CO2 was elevated from 30 mmHg to 35 mmHg.
Anoxia* ; Arterial Pressure ; Blood Pressure ; Cardiac Surgical Procedures ; Cardiopulmonary Bypass ; Catheters* ; Coronary Artery Bypass* ; Coronary Vessels* ; Humans ; Hypertension, Pulmonary* ; Oxygen ; Pulmonary Artery ; Reference Values

Lyme disease is a common vector-borne disease caused by Borrelia burgdorferi. Erythema migrans represents the most common manifestation during the early phase of this disease;however, systemic manifestations involving the nervous system, joints, or heart are known to occur. We report a case of Lyme disease accompanied by cardiac complications in a 13-year-old Korean male adolescent. The patient developed annular erythematous lesions on his lower extremities after a field trip during his visit to Connecticut, USA, for a boarding school camp, and his skin lesions were consistent with erythema migrans. Indirect immunofluorescence assay and Western blot analysis for Lyme immunoglobulin M showed positive results. Electrocardiography revealed a first-degree atrioventricular block, and he was diagnosed with Lyme carditis and received a 4-week course of oral doxycycline. Follow-up electrocardiography performed a week later revealed normal findings, and the patient showed an uneventful recovery. Lyme carditis often presents as an asymptomatic heart block that can progress to an advanced heart block; however, this condition is reversible with appropriate antibiotic treatment.

Lyme disease is a common vector-borne disease caused by Borrelia burgdorferi. Erythema migrans represents the most common manifestation during the early phase of this disease;however, systemic manifestations involving the nervous system, joints, or heart are known to occur. We report a case of Lyme disease accompanied by cardiac complications in a 13-year-old Korean male adolescent. The patient developed annular erythematous lesions on his lower extremities after a field trip during his visit to Connecticut, USA, for a boarding school camp, and his skin lesions were consistent with erythema migrans. Indirect immunofluorescence assay and Western blot analysis for Lyme immunoglobulin M showed positive results. Electrocardiography revealed a first-degree atrioventricular block, and he was diagnosed with Lyme carditis and received a 4-week course of oral doxycycline. Follow-up electrocardiography performed a week later revealed normal findings, and the patient showed an uneventful recovery. Lyme carditis often presents as an asymptomatic heart block that can progress to an advanced heart block; however, this condition is reversible with appropriate antibiotic treatment.

Bites and Stings ; Bone Screws ; Humans ; Lip ; Mandible ; Mastication ; Orthodontics ; Osteogenesis, Distraction ; Osteotomy ; Tooth ; Tooth Mobility ; Walking

Hemangioma is the most common soft tissue tumor in the body. Though it may occur anywhere in the body, hemangioma of the uterus is a very rare tumor. Hemangioma is almost asymptomatic, but it is sometimes clinically important because it can cause massive hemorrhage and this is a life-threatening condition. We report here on the magnetic resonance imaging and pathologic findings of cavernous hemangioma of the uterus in a 32-year-woman with menorrhagia.
Female ; Hemangioma ; Hemangioma, Cavernous* ; Hemorrhage ; Magnetic Resonance Imaging* ; Menorrhagia ; Uterine Neoplasms ; Uterus*

PURPOSE: Vancomycin-resistant enterococci (VRE) are now nosocomial pathogens in Korea. But little is known about the prevalence of stool colonization with VRE in neonates in Korea. So we studied the prevalence and risk factors of VRE colonization in the Neonatal Intensive Care Unit (NICU). METHODS: From January 2000 to December 2004, the medical records of 294 neonates (127 cases of VRE group and 167 cases of non-VRE group, according to the results of stool culture) were reviewed retrospectively. We studied the annual prevalence of VRE and risk factors of VRE colonization in neonates. RESULTS: From 2000 to 2003, the prevalence rate of VRE in NICU increased. After preventing VRE transmission, the prevalence rate of VRE has decreased. CONCLUSION: VRE colonization increased recently. Risk factors of VRE colonization were prematurity, lower birth weight, longer hospitalization and use of vancomycin or 3rd generation cephalosporin, compared with the non-VRE group. To prevent VRE transmission among newborns, aggressive infection control strategies by NICU staffs must be implemented immediately for all babies.
Birth Weight ; Colon* ; Hospitalization ; Humans ; Infant, Newborn* ; Infection Control ; Intensive Care, Neonatal ; Korea ; Medical Records ; Prevalence* ; Retrospective Studies ; Risk Factors* ; Vancomycin

BACKGROUND: Human chorionic plate-derived mesenchymal stem cells (CP-MSCs) isolated from the placenta have been reported to demonstrate therapeutic effects in animal models of liver injury; however, the underlying epigenetic mechanism of this effect has not been elucidated. Thus, we investigated whether CP-MSCs influence epigenetic processes during regeneration of the injured liver. METHODS: CP-MSCs were engrafted into a carbon tetrachloride (CCl4)-injured rat model through direct transplantation into the liver (DTX), intrasplenic transplantation (STX), and intravenous transplantation via the tail vein (TTX). Non-transplanted (NTX) rats were maintained as sham controls. Liver tissues were analyzed after transplantation using immunohistochemistry, western blot analysis, and quantitative methylation-specific polymerase chain reaction. Proliferation and human interleukin-6 (hIL-6) enzyme-linked immunosorbent assays were performed using CCl4-treated hepatic cells that were co-cultured with CP-MSCs. RESULTS: The Ki67 labeling index, cell cyclins, albumin, IL-6, and gp130 levels were elevated in the CP-MSC transplantation groups. The concentration of hIL-6 in supernatants and the proliferation of CCl4-treated rat hepatic cells were enhanced by co-culturing with CP-MSCs (p<0.05), while the methylation of IL-6/IL-6R and STAT3 by CP-MSC transplantation decreased. CONCLUSION: These results suggest that administration of CP-MSCs promotes IL-6/STAT3 signaling by decreasing the methylation of the IL-6/SATA3 promoters and thus inducing the proliferation of hepatic cells in a CCl4-injured liver rat model. These data advance our understanding of the therapeutic mechanisms in injured livers, and can facilitate the development of cell-based therapies using placenta-derived stem cells.
Animals ; Blotting, Western ; Carbon Tetrachloride ; Chorion ; Cyclins ; DNA Methylation ; Enzyme-Linked Immunosorbent Assay ; Epigenesis, Genetic ; Epigenomics* ; Hepatocytes ; Humans ; Immunohistochemistry ; Interleukin-6 ; Liver Regeneration ; Liver* ; Mesenchymal Stromal Cells ; Methylation ; Models, Animal* ; Placenta ; Polymerase Chain Reaction ; Rats ; Regeneration* ; Stem Cells* ; Veins

PURPOSE:This study was performed to determine the clinical course of BCG lymphadenitis. METHODS:Between May 2005 and April 2009, the medical records of 33 patients with BCG lymphadenitis were retrospectively reviewed. If needed, needle aspiration was recommended without surgical resection or antituberculous medication. RESULTS:Of the 33 patients who were identified, 21 were males and 12 were females. Among the 33 patients, 32 were full-term babies. The mean age was 6 months (range, 2-35 months) and the most prevalent site of the lesion was the left axilla. BCG lymphadenitis was observed 1-34 months after BCG vaccination, mostly 1-6 months after vaccination. The size of the enlargement was generally 1-3 cm. The strains were identified as French (n=14), Danish (n=7), and Tokyo (n=12). BCG lymphadenitis regressed spontaneously in 19 patients. After 1-5 needle aspirations, 14 patients recovered completely. Complete regression of lymphadenitis was recorded over an average period of 4 months. CONCLUSION:Clinicians need to be aware of the clinical features of BCG lymphadenitis. For management of BCG lymphadenitis, regular follow-up with observation should be the mainstay. Needle aspiration is a safe and easy treatment for suppurative BCG lymphadenitis.
Aspirations (Psychology) ; Axilla ; BCG Vaccine ; Female ; Follow-Up Studies ; Humans ; Lymphadenitis ; Male ; Medical Records ; Mycobacterium bovis ; Needles ; Retrospective Studies ; Tokyo ; Vaccination

OBJECTIVE: To compare the accuracy of three-dimensional (3-D) ultrasound-assessed fetal thigh volumetry in predicting birth weight with that of other commonly used formulas composed of biparietal dimeter (BPD), abdominal circumference (AC), and femur length (FL) by two-dimentional (2-D) ultrasonography. METHODS: From May 1999 to February 2000 we performed a prospective study of ultrasonography on 100 pregnant women. We assessed the thigh volume of 100 fetuses using 3-D ultrasonography. Meanwhile their BPD, AC, and FL were measured by 2-D ultrasonography. All infants were delivered within 48 hours after the ultrasound examinations. RESULTS: The thigh volume assessed by 3-D ultrasonography was highly correlated with birth weight (r=0.414, n=100, p<0.0001). The 3-D formula had small mean values of absolute mean error (gm) (64.26), absolute mean error (%) (10.20+/-0.80). As well, the 2-D formulas had similar mean values. However, no significant differences in predicting birth weight were found between 3-D formula and 2-D formulas. CONCLUSION: The 3-D ultrasound method assessed by thigh volume showed better accuracy in predicting birth weight than 2-D methed. Further studies may be needed to confirm our conclusions.
Birth Weight* ; Female ; Femur ; Fetus ; Humans ; Infant ; Parturition* ; Pregnant Women ; Prospective Studies ; Thigh* ; Ultrasonography*

PURPOSE: Transcatheter closure of the patent ductus arteriosus (PDA) is a well established alternative to surgical treatment. The aim of this study was to analyze safety, efficacy and follow up results of percutaneous closure of a moderate-to-large sized PDA. METHODS: Between November 1999 and October 2004, eighty-two patients underwent attempted transcatheter closure of a moderate to-large sized PDA. Age at intervention ranged from 9 months to 68 years (18.4+/-18.3 years). Body weight ranged from 7.8 kg to 74 kg (34.0+/-21.3 kg). RESULTS: The mean PDA diameter was 4.5+/-1.3 mm. The type of PDA was conical (72 patients), tubular (9 patients), other (1 patient, dumbbell shape). The devices used were Amplatzer Ductal Occluder (ADO(R), 64 cases), Detachable Coil (14 cases), and Duct Occlud (3 cases). Total complete closure rate was 93%. Complete closure was achieved in 58 patients (78%) at the end of procedure, 8 patients (11%) at 1week, 4 patients (5%) at 1 month, and 4 patients (5%) at 1 year, respectively. A residual shunt was present in three patients (4%). Complications occurred in eight patients: stenosis of left pulmonary artery (4 patients), hemolytic anemia (2 patients), infective endocarditis (1 patient), and device embolization (1 patient). CONCLUSION: Transcatheter closure of a moderate to-large sized PDA using the device is a safe and effective treatment with a favorable short and mid-term results. For optimal results, appropriate devices should be selected in relevance to PDA morphology and diameter, age, body weight, and +++economical factor.
Anemia, Hemolytic ; Body Weight ; Constriction, Pathologic ; Ductus Arteriosus, Patent* ; Endocarditis ; Follow-Up Studies ; Humans ; Pulmonary Artery