Spinal epidural abscesses were evaluated using Gadolinium-enhanced magnetic resonance imaging (MRI) in 19 surgically and clinically confirmed cases, including 13 with tuberculous spondylitis and 6 with pyogenic spondylitis. We observed rim enhancement patterns in 10 patients and diffuse enhancement patterns in 9 patients. The spread patterns were localized to ventral or dorsal epidural space and encircled entire epidural space. We conclude that rim enhancement indicates abscess and diffuse enhancement indicates granulation tissue and fibrosis. Tuberculous epidural abscess spreads to ventral epidural space and pyogenic epidural abscess encircles entire epidural space.
Abscess ; Epidural Abscess* ; Epidural Space ; Fibrosis ; Granulation Tissue ; Humans ; Magnetic Resonance Imaging* ; Spondylitis

A 35 year old woman, gravid 5, multiparous, was admitted to our department at 6 weeks and 5 days of gestation after being diagnosed with cervical pregnancy. Before the evacuation, the uterine arteries were embolized using angiographic techniques. As a result, dilatation and curettage were performed with minimal hemorrhage. We report one case of cervical pregnancy managed, successfully with preoperative uterine artery embolization and evacuation.
Adult ; Dilatation and Curettage ; Female ; Hemorrhage ; Humans ; Pregnancy* ; Uterine Artery Embolization* ; Uterine Artery*

BACKGROUND: Postoperative admission to the surgical intensive care unit (S-ICU) is commonly planned to prevent and treat complications, unnecessary admission to the S-ICU increases medical costs and length of hospital stay. This study aimed evaluated outcome and the predictive factors for mortality in patients admitted to the S-ICU after abdominal surgery. METHODS: The 168 patients admitted to the S-ICU immediately after abdominal surgery were reviewed retrospectively from January to December 2011. RESULTS: The mortality rate of patients admitted to the S-ICU after abdominal surgery was 8.9% (15 of 168). Two preoperative factors (body mass index [BMI] < 18.5 kg/m2 [p < 0.001] and serum albumin < 3.0 g/dL [p = 0.018]), two operative factors (the need for transfusion [p = 0.008] or vasopressors [p = 0.013] during surgery), and three postoperative variables (mechanical ventilation immediately following surgery [p < 0.001], sequential organ failure assessment [p = 0.001] and SAPS II [p = 0.001] score) were associated with mortality in univariate analysis. After adjusting for age, gender, and SAPS II by a Cox regression, which revealed that BMI < 18.5 kg/m2 (p < 0.001, hazard ratio [HR] 9.690, 95% confidence interval [CI] 2.990-25.258) and the use of mechanical ventilation on admission to S-ICU (p < 0.001, HR 34.671, 95% CI 6.440-186.649) were independent prognostic factors. CONCLUSIONS: In patients in S-ICU after abdominal surgery, low BMI and postsurgical mechanical ventilation should be considered important predictors of mortality.
Abdomen* ; Body Mass Index ; Humans ; Critical Care ; Intensive Care Units ; Length of Stay ; Mortality ; Postoperative Complications ; Prognosis* ; Respiration, Artificial ; Retrospective Studies ; Serum Albumin ; Ventilation

PURPOSE: The purpose of this study is to examine how well patients who had hip arthroplasty comply with medical regimens given to them after the operation. METHOD: The subjects of the study were patients who had arthroplasty at P Hospital between April 1. 2001 and August 30, 2002. 20 patients of the subjects experienced complications after the operation and the other 20 did not. Data from a survey using the qustionnaire were statistically analyzed in terms of real number, percentage point, mean and standard deviation by using chi2test. t-test and ANOVA. RESULT: 1) the surveyed patients were significantly different in the compliance of medical regimen among them according to their education background as one of the subjects general characteristics. 2) It was found that the group of complication was higher in the compliance of medical regimen than that of non-complication. The two groups showed statistically significant difference with each other in the degree of compliance with therapeutic instructions than the experimental group in terms of the maintenance of abduction after the operation, training instructions on step-by-step basis, urination cotrol on bed, accurate use of crutch, compliance with medication, balance among medical treatment, training, leisure, rest and nutrition. instructions by physicians, nurses and physical therapists, use of low armchairs and toilet bowels and no bending of the body forward, and use of a non-operated leg in case of go upstairs or downstairs. CONCLUSION: It seems necessary to develop systematic and sessional education programs for improving the compliance of medical regimen. ultimately reducing complications following hip arthroplasty.
Arthroplasty* ; Compliance ; Education ; Hip* ; Humans ; Leg ; Leisure Activities ; Patient Compliance* ; Physical Therapists ; Urination

Milk of calcium located in the breast is typically a benign entity. However, carcinoma may incidentally arise adjacent to or even within milk of calcium. Consequently, the characteristics of all observed calcific particles should be carefully analyzed. In this study, we report a case of carcinoma presented as malignant microcalcifications mixed within milk of calcium in a breast.
Breast Neoplasms/*chemistry/radiography ; Calcium Carbonate/*analysis ; Carcinoma, Ductal/*chemistry/radiography ; Female ; Humans ; Mammography ; Middle Aged

To investigate long term effects of CAPD on the left ventricular function in end-stage renal disease patients, M-mode echocardiographic studies and measurement o fsystolic time intervals were performed in 20 CAPD cases, 28 hemodialysis cases and 29 uremic controls. Compared to the uremic control grup, the patients on CAPD treatment revealed significant improvement of ventricular contractility and reduction of volume. On the other hand in hemodialysis group, even though there was improvement of ventricular contractility, volume control was not adequate. In the systolic time interval measurement, it is postulated that increase of PEP/LVET ratio in CAPD group probably results from reduction of volume(preload) rather than from deranged ventricular function.
Echocardiography ; Hand ; Humans ; Kidney Failure, Chronic* ; Peritoneal Dialysis, Continuous Ambulatory* ; Renal Dialysis* ; Systole ; Ventricular Function ; Ventricular Function, Left

BACKGROUND: Asthmatic patients frequently suffer cold-weather-associated respiratory symptoms. The sensitivity, specificity, accuracy and diagnostic value of isocapnic hyperventilation of cold air(IHCA) using a multistep method was investigated in patients suspected to have asthma. METHOD: One hundred and 29 adult patients who had an IHCA performed between july 1999 and December 2000, had an methacholine bronchoprovocation test because of a clinical suspicion of asthma. RESULTS: According to strict criteria, 50 were defined as asthmatics and 79 as symptomatic nonashmatics. There were no differences in age, sex and smoking state between the asthmatic and symptomatic nonasthmatic groups. There was a significant decrease in the percentage reduction in the forced expiratory volume in 1 second(FEV1) after the IHCA between the asthmatics(-10.0±6.8%) and the symptomatic nonasthmatics(-2.3±2.5%). The factors associated with a reactivity to IHCA were FEV1/FVC, FEF25-75/FVC and FEV1(% of predicted). The accuracy was highest using a 7% fall in FEV1; the sensitivity was 76% and the specificity 96%. CONCLUSION: IHCA is a specific, although not a sensitive, test for diagnosing asthma in adult patients. Furthermore, the diagnostic cut-off value of the different methods of IHCA need to be determined.
Adult* ; Asthma* ; Forced Expiratory Volume ; Humans ; Hyperventilation* ; Methacholine Chloride ; Sensitivity and Specificity ; Smoke ; Smoking

BACKGROUND: A few reports of transudative malignant effusion on a small number of patients have suggested the need to perform routine cytologic examination in all cases of transudative pleural effusion, whether encountered for malignancy or not. The purpose of this study was to investigate whether cytologic examination should be performed in all cases of transudative pleural effusion for the diagnosis of malignancy. METHODS: We performed a retrospective study of 229 consecutive patients with malignant pleural effusion, proven either cytologically or with biopsy. In patients with transudative pleural effusion, we reviewed medical records, results of transthoracic echocardiography, fiberoptic bronchoscopy, chest X-ray, chest CT scan, and ultrasonogram of the abdomen. These data were examined with particular attention to identifying whether or not the malignancy was suggested on chest X-ray, examining the involvement of the superior vena cava, great vessels, and lymph nodes, determining the presence of pericardial effusion, and observing the endobronchial obstruction. RESULTS: Transudative malignant pleural effusion was observed in seven (3.1%) of the 229 patients, and was caused either by the malignancy itself (6 patients) or by coexisting cardiac diseases (1 patient). All the patients showed evidence suggesting the presence of malignancy at the time of initial thoracentesis, which facilitated the decision of most clinicians on whether to perform cytologic examination for the diagnosis of malignancy. CONCLUSION: Therefore, in all cases of transudative pleaural effusion, no clinical implications indicating malignancy were found on cytologic examination.
Biopsy ; Carcinoma/classification/*pathology/*secondary ; Exudates and Transudates ; Human ; Lung Neoplasms/*pathology ; Lymphatic Metastasis ; Neoplasm Staging ; Neoplasms, Unknown Primary/*pathology ; Pleural Effusion, Malignant/metabolism/*pathology ; Retrospective Studies ; Support, Non-U.S. Gov't

Penicillin resistance in Streptococcus pneumoniae has increased sharply within the past few years and extended-spectrum cephalosporins haute been recommended for the empiric therapy of bacterial meningitis. However, therapeutic failure are being reported with increasing frequency due to extended-spectrum cephalosporin-resistant strains. We report two cases of meningitis caused by S. pneumoniae resistant to penicillin and cefotaxime. Both patients were recovered after ceftriaxone and vancomycin treatment, but one of them was left with neurological sequelae because of a delay in the institution of an antibiotic therapy appropriate for resistant pneumococci. This report indicates that extended-spectrum cephalosporin-resistance must be considered In all clinical isolates of S. pneumoniae and in vitro susceptibility testings should be performed promptly and accurately to detect antibiotic resistance.
Cefotaxime ; Ceftriaxone ; Cephalosporins ; Drug Resistance, Microbial ; Humans ; Meningitis* ; Meningitis, Bacterial ; Penicillin Resistance ; Penicillins ; Pneumonia ; Streptococcus pneumoniae* ; Streptococcus* ; Vancomycin

When illuminated by blue light, the human crystalline lens exhibits green autofluorescence. Autofluorescence of the human lens were analyzed quantitatively in vivo as a function of age in 75 healthy individuals{150 eyes) without cataract, ranging in age from 17 to 63 years. Lenses were scanned through the dilated pupil along the optical axis, generating a fluorescence profile consisting of anterior and posterior peaks of lens, using an automated scanning fluorophotometer(Fluorotron master) coupled with a lens system designed for high resolution of the anterior segment structures. Anterior peak autofluorescence increased linearly by 90 ng fluorescein/ml per decade and posterior peak autofluorescence by 70 ng fluorescein/ml per decade. No significant difference between right and left eyes was demonstrated for anterior or posterior peak autofluorescence. We suggest that the quantitative analysis of the autofluorescence of the human lens might be useful to investigate the changes of the aging lens proteins and the pathogenesis of cataract.
Aging* ; Axis, Cervical Vertebra ; Cataract ; Crystallins* ; Fluorescence ; Fluorophotometry ; Humans ; Lens, Crystalline* ; Pupil