Central venous catheterization is a common diagnostic and therapeutic procedure in modern clinical practice. Pseudoaneurysms of the subclavian artery are rare and usually occur immediately after the causative event, whether the cause was trauma or a medical procedure. Here we report the rare case of a 71-year-old woman with delayed presentation of catheter-related subclavian pseudoaneurysm. The patient was treated for aspiration pneumonia with respiratory failure in another hospital. The patient's chest wall swelling began two weeks after the initial catheterization in the other hospital, probably because of slow leakage of blood from the injured subclavian artery caused by incomplete compression of the puncture site and uremic coagulopathy. She was successfully treated with ultrasound-guided thrombin and angiography-guided histoacryl injection without stent insertion or surgery. Her condition improved, and she was discharged to her home.
Aged ; Aneurysm, False* ; Catheterization ; Catheterization, Central Venous ; Catheters ; Central Venous Catheters ; Enbucrilate ; Female ; Humans ; Pneumonia, Aspiration ; Punctures ; Respiratory Insufficiency ; Stents ; Subclavian Artery* ; Thoracic Wall ; Thrombin

BACKGROUND: MAGE(melanoma antigen gene) has been named as cancer/testis specific antigens since its expression is only detected in the testis or cancer cells. Because of its relatively specific expression in cancer cells, it has been considered as a marker for the early diagnosis of several cancers, or as an appropriate target for a specific immunotherapy mediated by cytotoxic T lymphocytes. Therefore, there have been many reports concerning the expression of MAGE genes in various types of malignant tumors, although only a few reports in human thyroid neoplasms. The purpose of this study was to determine whether the MAGE-1, -2, -3, -4, -5, and -10 genes expressed in different histological types of thyroid tumors and to elucidate the clinical usefulness of MAGE genes on the diagnosis of thyroid tumors. METHODS: Thirty-eight patients who had undergone thyroidectomy at Kosin Medical Center between January and August, 1999 were included in the study. Of the 38 patients enrolled, 26 exhibited papillary carcinoma, 3 papillary carcinoma with lymph node metastasis, 1 follicular carcinoma, 1 medullary carcinoma, 5 nodular hyperplasia, 1 adenomatous goiter, and 1 follicular carcinoma. In the twelve normal control thyroid tissues, total cellular mRNA was extracted from 31 cancer tissues and 7 benign tissues, RT-PCR was run in 35 cycles, with specific primers of the subtypes of MAGE genes. With probes confirmed by DNA sequencing, the isolates were reevaluated by Southern blot hybridization. RESULTS: In the 26 papillary carcinomas, MAGE-1,-2,-3,-4,-5 and -10 genes were expressed in 88.5%, 92.3%, 3.8%, 26.9%, 26.9%, and 0% by RT-PCR respectively. In the three papillary carcinomas with regional lymph node metastasis, MAGE-1, -2 and -5 genes expressed in two of the three, and MAGE-4 in one of the three cases. In the one medullary carcinoma, the MAGE-1,-2,-4, and MAGE-5 genes were expressed, and in the one case of follicular carcinoma, only the MAGE-2 gene was expressed. In contrast, none of the 7 benign tumors and 12 normal control tissues expressed any of these MAGE genes. The sensitivity of MAGE-1,-2,-3,-4,-5 and -10 genes in thyroid tumors was 83.8%, 90.3%, 3%, 29.0%, 32.3%, and 0%, respectively and the specificity was 100%. CONCLUSION: These results demonstrate that MAGE genes were expressed in the malignant thyroid tumors but not in the benign tumors and normal tissues. Among the MAGE gene families, MAGE-1 and -2 genes were more sensitive than MAGE-3, 4,-5 and -10 genes. However, in order to demonstrate if the MAGE genes could be used for the diagnosis of follicular carcinoma and distant metastasis in thyroid tumors, further study is required.
Blotting, Southern ; Carcinoma, Medullary ; Carcinoma, Papillary ; Diagnosis ; Early Diagnosis ; Goiter ; Humans ; Hyperplasia ; Immunotherapy ; Lymph Nodes ; Neoplasm Metastasis ; RNA, Messenger ; Sensitivity and Specificity ; Sequence Analysis, DNA ; T-Lymphocytes, Cytotoxic ; Testis ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroidectomy

Conjoined twinning is a rare congenital malformation, accounting for 1% monozygotic twins. Conjoined twins result if twining is initiated after the embryonic disc and rudimentary amniotic sac have been formed and if division of the embryonic disc is incomplete. Recently we experienced a case of conjoined twins, dicephalus dipus dibrachius, who had died at 3 hours of life, and performed autopsy. Autopsy revealed a total duplication of the heads, spines up to sacrum, small bowels, thymus and lungs. Two hearts existed within a common pericardium.
Autopsy ; Head ; Heart ; Humans ; Lung ; Pericardium ; Sacrum ; Spine ; Thymus Gland ; Twins, Conjoined* ; Twins, Monozygotic

Human cytomegalovirus (HCMV) is a ubiquitous human pathogen and contains double stranded DNA genome with approximately 230 kbp. Molecular genomic studies of HCMV have been attempted in order to understand the pathogenesis and evolution of HCMV. However, studies on HCMV strains of Asian origin are limited. In this study, it was attempted to understand the genomics of HCMV isolated from Korea. Clinical strain LCW isolated from Korean patient was passaged in vitro cell culture, and subjected to next-generation sequencing. Complete genome sequence was obtained and compared with other HCMV strains. The LCW genome was found to contain 170 open reading frames (ORFs) and two ORF (RL5A and RL13) of the strain LCW were found to be truncated due to early stop codon. Phylogenetic analysis suggested that the strain LCW was closely related with Asian strains such as HCMV strains JHC and HAN. Common nucleotide sequences among the 3 Asian strains distinguishable from other strains were detected at 197 sites including 104 sites in ORFs.
Animals ; Asian Continental Ancestry Group ; Base Sequence ; Cell Culture Techniques ; Codon, Terminator ; Cytomegalovirus* ; DNA ; Ecthyma, Contagious ; Genome* ; Genomics ; Humans* ; In Vitro Techniques ; Korea ; Open Reading Frames

Endobronchial tuberculosis is defined as a tuberculous infection of the tracheobronchial tree and has a prevalence of up to 50% in active pulmonary tuberculosis cases. The most common complication of endobronchial tuberculosis is bronchial stenosis; benign fistula formation by endobronchial tuberculosis is rare, especially inter-bronchial fistula formation. We reported a rare case of a 73-year-old woman with a fistula between the right upper bronchus and bronchus intermedius. A diagnosis of inter-bronchial fistula caused by endobronchial tuberculosis was based on the results of chest computed tomography scans, bronchoscopy, and microbiological and pathological tests. The patient was treated with anti-tuberculous medication, and her symptoms gradually improved.
Aged ; Bronchi* ; Bronchoscopes ; Bronchoscopy ; Constriction, Pathologic ; Diagnosis ; Female ; Fistula* ; Humans ; Prevalence ; Thorax ; Tomography, X-Ray Computed ; Tuberculosis* ; Tuberculosis, Pulmonary

Central venous catheterization is a common diagnostic and therapeutic procedure in modern clinical practice. Pseudoaneurysms of the subclavian artery are rare and usually occur immediately after the causative event, whether the cause was trauma or a medical procedure. Here we report the rare case of a 71-year-old woman with delayed presentation of catheter-related subclavian pseudoaneurysm. The patient was treated for aspiration pneumonia with respiratory failure in another hospital. The patient's chest wall swelling began two weeks after the initial catheterization in the other hospital, probably because of slow leakage of blood from the injured subclavian artery caused by incomplete compression of the puncture site and uremic coagulopathy. She was successfully treated with ultrasound-guided thrombin and angiography-guided histoacryl injection without stent insertion or surgery. Her condition improved, and she was discharged to her home.
Aged ; Aneurysm, False ; Catheterization ; Catheterization, Central Venous ; Catheters ; Central Venous Catheters ; Enbucrilate ; Female ; Humans ; Pneumonia, Aspiration ; Punctures ; Respiratory Insufficiency ; Stents ; Subclavian Artery ; Thoracic Wall ; Thrombin

Bupivacaine is frequently used for pain control and local anesthesia. However, it is associated with certain acute and fatal side effects, although rare, including cardiac and central nervous system toxicities. In particular, bupivacaine-induced cardiac toxicity may be fatal. This condition can be diagnosed as bupivacaine-induced cardiotoxicity by excluding other causes and determining a history of bupivacaine administration. However, in emergency situations, recognizing bupivacaine toxicity can be difficult due to the physician's lack of awareness regarding the condition or in the absence of clear communication regarding the patient's medical history. In the current case report, we describe our experience with strong suspected bupivacaine-induced cardiotoxicity in a patient who underwent cesarean section along with a review of the literature.
Anesthesia, Local ; Bupivacaine* ; Cardiomyopathies* ; Cardiotoxicity ; Central Nervous System ; Cesarean Section* ; Emergencies ; Female ; Humans ; Peripartum Period* ; Pregnancy

PURPOSE: This study was aimed to compare hydration status between young and elderly end-stage renal disease (ESRD) patients on hemodialysis (HD) and to analyze factors related to overhydration. METHODS: We measured fluid status before a mid-week HD session in clinically stable 47 patients on maintenance HD using bioimpedance spectroscopy (BIS) device. In addition, weight and blood pressure (BP) were recorded during the treatment. RESULTS: Participants were divided into young (<65 years, n=32) and elderly (> or =65 years, n=15) patients. In elderly patients, pre-HD diastolic BP, intracellular water (ICW), and lean tissue index (LTI) were significantly lower and extracellular water (ECW)/total body water (TBW) was significantly higher than in young patients. However, there were no differences in pre-HD body mass index (BMI), ultrafiltration volume, pre-HD systolic BP, TBW, ECW, and fat tissue index between the two groups. ECW/TBW ratio and LTI were significantly correlated with age. In a multivariate regression analysis, age and pre-HD pulse pressure were significantly associated with ECW/TBW. CONCLUSION: Although BMI and TBW of elderly ESRD patients were similar to those of young patients, ICW and LTI were lower and ECW/TBW was higher in elderly patients than in young patients. Therefore, clinical manifestations related to overhydration may develop more frequently in elderly patients compared with young patients.
Aged ; Blood Pressure ; Body Composition ; Body Mass Index ; Body Water ; Edema ; Humans ; Kidney Failure, Chronic ; Renal Dialysis ; Spectrum Analysis ; Ultrafiltration ; Water

PURPOSE: Macrovascular complications are the main cause of mortality in type 1 diabetes mellitus (T1DM). The purpose of this study was to clarify the presence of early vascular changes and to assess the risk factors of macrovascular complications in young adults with T1DM diagnosed in childhood and adolescence. METHODS: Seventy-two patients (23.9+/-2.4 years) with T1 DM diagnosed before 18 years of age and twenty normal controls were included. The incidence of hypertension, dyslipidemia, and other risk factors of macrovascular complication were reviewed. Flow-mediated vasodilation (FMD) and mean intima-media thickness (IMT) measured by ultrasound were compared between patients and control subjects, and their correlations with macrovascular risk factors were analyzed. RESULTS: Of the 72 patients, 32 (44.4%) had hypertension. The proportions of maleness (P=0.03) and mean body mass index (P=0.04) were higher in the hypertensive patients than in normotensive patients. Thirty-one (N=69, 44.9%) patients had dyslipidemia and LDL-cholesterol was positively correlated with mean HbA1c (r=0.32, P=0.008) and total daily insulin dose (r=0.27, P=0.02). The mean IMT was significantly higher in patients than in control subjects (0.43+/-0.06 mm vs 0.39+/-0.06 mm, P=0.03). There was no difference in the value of FMD between patients and controls, but the duration of the disease after pubertal onset was negatively correlated with FMD (r=-0.34, P=0.01). CONCLUSION: Hypertension, dyslipidemia and atherosclerotic vascular change were observed in young adults with T1DM diagnosed during childhood and adolescence; this strongly suggests that meticulous screening of macrovascular complications and control of their risk factors should be conducted.
Adolescent ; Atherosclerosis ; Body Mass Index ; Diabetes Mellitus, Type 1 ; Dyslipidemias ; Humans ; Hypertension ; Incidence ; Insulin ; Male ; Mass Screening ; Risk Factors ; Vasodilation ; Young Adult

Recently it has been discovered that anomalous union of pancreaticobiliary duct (AUPBD) may play an important role in the pathogenesis of bile duct cancer. Similar to this fact, there were a few reports on the clinical significance of the low junction of the cystic duct (LJCD). LJCD refers to the situation whereby the cystic duct enters the common duct at a low position between the upper margin of the pancreas and the duodenal opening of the bile duct. The pathogenetic mechanism in LJCD is similar to AUPBD in that the pancreatic juice refluxes to the bile duct, mixes with biles, and then generates the mutagens, which act as inflammatory substances and carcinogens on the epithelium of the bile duct. A 51-year-old male who experienced dyspepsia was hospitalized due to his abnormally functioning liver and dilated common bile duct. We confirmed primary cholangiocarcinoma on the common hepatic duct and gallbladder carcinoma associated with LJCD by ERCP and pathologic review of surgical specimen. We report a case of synchronous type double primary cancer associated with LJCD with a brief review of the literatures.
Bile ; Bile Duct Neoplasms ; Bile Ducts ; Carcinogens ; Cholangiocarcinoma ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct ; Cystic Duct* ; Dyspepsia ; Epithelium ; Gallbladder ; Hepatic Duct, Common ; Humans ; Liver ; Male ; Middle Aged ; Mutagens ; Pancreas ; Pancreatic Juice