The coracoclavicular joint is a rare genetical anatomic variants. The joint occurs at the junction of a bony projection extending inferiorly form the outer third of the clavicle at the site of the conoid tubercle and a bony projection extending superiorly form the coracoid process of the scapula. In our study we reviewed the radiological incidence of the coracoclavicular joint in Korean adults. The materials consist of 4,625 routine chest films, 9,250 sides. Sex distribution were 3,000 males and 1,625 females. The authors observed coracoclavicular joint on 17 persons (0.37%) and 25 sides (0.26%) and among them, 8 persons (47%) were bilateral and in 9 (53%) it was unilateral. The joint when unilateral occures frequently on left side, and there was no significant sex difference. There were statistically significant differences in the incidence of coracoclavicular joints among Korean, Japanese and Chinese.
Adult ; Asian Continental Ancestry Group ; Clavicle ; Female ; Humans ; Incidence ; Joints ; Male ; Scapula ; Sex Characteristics ; Sex Distribution ; Thorax

Visualization of falx cerebri on non-enhanced CT of children with severe head injuries (the falx sign) has been regarded as an evidence of subarachnoid hemorrhage. On the contrary, other authors have reported reverse results. To evaluate clinical significance of the falx sign, authors studied frequency of visualization and CT number of falx cerebri and dural sinuses in 65 children with head injury and 65 children without head injury examined by cranial CT at the Dep. of Radiology, St. Paul's Hospital, Catholic Medical College from March to Sept. 1981. All patients with head trauma were studied within 1 week of the traumatic event. Visualization of falx cerebri was observed at slice in the region of lateral ventricle and slice near to vertex respectively. On the slice in the region of lateral ventricle, falx cerebri was identified in 82% of all of the children examined, of which 92%showed partial visualization of falx cerebri and remaining 8% totally. On the slice near to vertex, falx cerebri was identified in 92% of all the children examined, of which 38% showed partial visualization of falx cerebri and remaining 62% totally. In head trauma group, frequency of visualization of falx cerebri was 78% on the slice in the region of lateral ventricle and 89% on the slice near to vertex; in non-traumatic group, frequency of visualization of falx cerebri was 86% and 94% respectively. The highest numerical value of the falx densities averaged 47 Hounflieds (range, 32-63) in non-traumataic group, averaged 49 Housfields (range, 32-69) in head trauma group. All or a portion of the superior sagittal sinus was visualized in 59% of all of the cases studied, 50% in head trauma group, and 69% in nontraumatic group. The straight sinus was identified in 45% of all of the cases studied, 39% in head trauma group, and 51% in non-traumatic group. In conclusion, there was no distinction between head trauma and non-traumatic group in visualization of falx cerebri and dural sinuses, and we could frequently identify the falx density in normal. Also we could find that frequency for visualization of falx cerebri and drual sinuses increased as the age increased.
Child ; Craniocerebral Trauma ; Humans ; Lateral Ventricles ; Spinal Cord ; Subarachnoid Hemorrhage ; Superior Sagittal Sinus

No abstract available.
Humans

Thymic size can be affected by both exogenous and endogenous glucocorticoids. Development of the respiratory distress syndrom (RDS) is influenced by adernal cortical function. thus, thymic size in RDS is considered to been larged due to decreased adrenal cortical function. To find whether the presence of RDS correlates with thethymus, the size and shape of the thymus were evaluated in the radiographs of premature infants with RDS, without RDS(control prematurity) and normal infants. The subjects were consisted of chest films of Korean premature infants, 120 with RDS, 60 without RDS, and 60 of normal infants taken at the Departement of Radiology, Our Lady of Mercy Hospital during the period of 62 months since January 1978. Relative size of the thymus was determined bycardiothymic/thoracic ratio(CT/T ratio). Grading and locaiton of the thymic prominence as well as incidence of the shape were examined. And all the relations among the radiographs of RDS, control prematurity and normal infants were analyzed. The results were as follows; 1. The CT/T ratio of premature infants with RDS was significantly greater than that of control prematurity and normal infants (P<0.01). 2. The incidence of bilateral thymicprominence was more frequent in premature infants with RDS than in control prematurity and normal infants(P<0.05).3. The frequency of thymic prominence was greater in the right than left side in all the three groups (P<0.05). 4.As in the shape of the thymus, a rounded type was most frequent, and a triangular type was least frequent in allthe three groups. 5. Incedence of RDS was very low(9.8%) when the CT/T ratio is below 0.3 and it was very high(90.9%) when the CT/T ratio is above 0.49.
Glucocorticoids ; Humans ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature ; Thorax ; Thymus Gland

PURPOSE: The increasing incidence and mortality of Methicillin-resistant Staphylococcus aureus (MRSA) colonization or blood-stream infection is an important problem in neonatal intensive care unit (NICU). The aims of this study are to evaluate the effective eradication of MRSA through the aggressive isolation program with or without the use of 2% chlorhexidine-gluconate (CHG) and to investigate significant risk factors of MRSA colonization in NICU. METHODS: This study is a retrospective collected data among 414 neonates admitted to a NICU from June 1, 2007, through October 31, 2009. We divided the groups into 3 periods according to isolation program or the use of 2% CHG. RESULTS: The aggressive isolation program decreased the incidence of MRSA colonization and the additional use of 2% CHG has reduced much more the incidence of MRSA colonization and bacteremia. Days of hospitalization, use of central line, days of using central line, presence of respiratory distress syndrome (RDS) or bronchopulmonary dysplasia (BPD), isolation program, and isolation program + use of CHG were significant factors associated with MRSA colonization or bacteremia in univariate logistic regression analysis. Days of using central line and isolation program + use of CHG were significant after in multivariate logistic regression analysis. CONCLUSION: Hand hygiene, active MRSA surveillance culture, isolation, contact isolation, nursing/doctor cohorts and the use of 2% CHG as skin sterilizer were effective in eradicating to MRSA. The effort of shortening the days of using central line is also necessary.
Bacteremia ; Bronchopulmonary Dysplasia ; Chlorhexidine ; Cohort Studies ; Colon ; Hand Hygiene ; Hospitalization ; Humans ; Incidence ; Infant, Newborn ; Infection Control ; Intensive Care, Neonatal ; Logistic Models ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Retrospective Studies ; Risk Factors ; Skin

The syndrome of the sinking skin flap was introduced to explain the phenomenon of neurological deterioration after decompressive craniectomy. A 37-year-old man was admitted with acute subdural hematoma and traumatic intraparenchymal hematoma. After decompressive craniectomy, the patient suffered from hydrocephalus for which a ventriculoperitoneal (V-P) shunt was inserted. Following this procedure, the depression of the skin flap became remarkable and his mentation was deteriorated. The patient recovered uneventfully after temporary elevating of valve pressure and cranioplasty. We present a patient who was successfully managed with elevation of valve pressure and cranioplasty for the syndrome of the sinking scalp flap with review of a pertinent literature.
Adult ; Decompressive Craniectomy ; Depression ; Hematoma ; Hematoma, Subdural, Acute ; Humans ; Hydrocephalus ; Scalp ; Skin ; Ventriculoperitoneal Shunt

Cavernous hemangiomas are rarely found in the adrenal gland. Most of the tumors are nonfunctioning, and the patients present with no clinical symptoms. Although rare, the presence of adrenal hemangiomas should be kept in mind in the differential diagnoses of adrenal tumors. We report a case of an adrenal cavernous hemangioma that was removed by laparoscopic adrenalectomy in a 71-year-old female patient. The chief complaint was right flank pain. The patient was pathologically diagnosed as a having a cavernous hemangioma of the adrenal glands.
Female ; Humans ; Diagnosis, Differential ; Hemangioma

BACKGROUND: Inducible MLS(B) (macrolide-lincosamide-streptogramin B) resistance in staphylococci is not detected by standard susceptibility test methods. Failure to identify inducible MLS(B) resistance may lead to clinical failure during clindamycin therapy. We determined the prevalence of inducible MLS(B) resistance in erythromycin-resistant staphylococcal isolates. MATERIALS AND METHODS: We evaluated all 2,792 non-duplicate staphylococcal strains: 1,402 Staphylococcus aureus and 1,390 coagulase-negative staphylococci (CoNS) isolated from May 2008-June 2009 at one-unoversity hospital. Testing for inducible MLS(B) was accomplished by the disk approximation test (D-test) in accordance with the recommendations of the Clinical and Laboratory Standards Institute (CLSI). RESULTS: Of the 2,792 staphylococcal isolates, 892 S. aureus isolates and 740 CoNS isolates were resistant to erythromycin. Among the 892 erythromycin-resistant S. aureus isolates, the overall prevalence of inducible MLS(B) was 21.3% (16.2% of MRSA and 76.3% of methicillin-susceptible S. aureus). Among the 740 erythromycin-resistant CoNS isolates, the overall prevalence of inducible MLS(B) was 16.5% (16.0% of methicillin-resistant CoNS and 18.7% of methicillin-susceptible CoNS). The D-test was positive in 88.8% of S. aureus and 28.4% of CoNS isolates, which were erythromycin-resistant and clindamycin-susceptible. CONCLUSIONS: There are some variations in the prevalence of inducible MLS(B) resistance in clinical staphylococcal isolates. It is important that clinical laboratories report inducible MLS(B) resistance for erythromycin-resistant and clindamycinsusceptible staphylococcal isolates.
Clindamycin ; Erythromycin ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Prevalence ; Staphylococcus ; Staphylococcus aureus

BACKGROUND: For the diagnosis of essential thrombocythemia (ET), no single clinical or laboratory finding of diagnostic value is available and a differential diagnosis of other myeloproliferative neoplasms or reactive thrombocytosis (RT) is needed. Following recent developments in automated blood cell analyzers, various platelet indices can now be measured. In this study, we analyzed whether platelet counts and 6 platelet indices can be used for the differentiation of ET from RT in patients with a platelet count of 600x10(3)/microliter or more. METHODS: The subjects studied were 31 patients with ET and 224 patients with RT. The platelet counts, mean platelet volume (MPV), plateletcrit (PCT), platelet distribution width (PDW), mean platelet mass (MPM), mean platelet component concentration (MPC) and large platelets (LPLT) were measured by ADVIA 120 (Bayer Diagnostics, USA). The mean values of each item were compared between the two patient groups and the sensitivity and specificity of each item in the diagnosis of ET were determined by ROC curve analysis. RESULTS: In essential thrombocythemia, all parameters except MPC were significantly higher than in reactive thrombocytosis. For the diagnosis of ET, the sensitivity and specificity were: 74.2% and 84.4%, when the platelet count was > or = 820x10(3)/microliter; 80.6% and 80.0%, when the plateletcrit was > or =0.63%; and 64.5% and 99.1%, respectively, when LPLT was > or = 23x10(3)/microliter. CONCLUSIONS: The platelet counts and platelet indices are useful for the differential diagnosis of thrombocytosis. The plateletcrit and LPLT are particularly useful for the diagnosis of ET when the platelet count is markedly increased.
Aged ; Aged, 80 and over ; Diagnosis, Differential ; Female ; Humans ; Male ; Middle Aged ; Platelet Count/*instrumentation/methods ; ROC Curve ; Sensitivity and Specificity ; Thrombocythemia, Essential/*diagnosis ; Thrombocytosis/*diagnosis

BACKGROUND: In January 2008, the Clinical and Laboratory Standards Institute (CLSI) published revised penicillin breakpoints for Streptococcus pneumoniae according to clinical presentation and the route of penicillin administration. The aim of this study was to evaluate the impacts of the new penicillin breakpoints on the susceptibility rates of S. pneumoniae isolated from blood. METHODS: A total of 156 non-duplicated S. pneumoniae strains recovered from blood of hospitalized patients were collected between January 2003 and December 2008. Penicillin and cefotaxime susceptibility tests were performed using an E-test (AB Biodisk, Solna, Sweden). Results of the penicillin susceptibility tests were analyzed using the former and new CLSI guidelines. RESULTS: Of the 156 S. pneumoniae strains isolated from blood, penicillin susceptibility under the former CLSI guidelines resulted in 42.3% susceptible, 42.3% intermediate, and 15.4% resistant states. According to the new CLSI guidelines (nonmeningitis, parenteral), 87.8% of isolates were susceptible, 9.6% were intermediate, and 2.6% were resistant to penicillin. CONCLUSION: When the new CLSI guidelines are applied, the penicillin susceptibility rate of S. pneumoniae strains isolated from blood is considerably increased. This suggests that penicillin should still be useful for the treatment of nonmeningeal pneumococcal infections and that the use of broad-spectrum antimicrobials should not replace this treatment.
Cefotaxime ; Humans ; Penicillins ; Pneumococcal Infections ; Pneumonia ; Streptococcus ; Streptococcus pneumoniae