Pulmonary artery rupture with a flow-directed balloon tipped pulmonary artery catheter (Swan-Ganz catheter)is a rare complication with high mortality. This report concerns a case of this complication with hemothorax leading to fatal exsanguination. Emphasis is placed on the safety guidelines to prevent this. Also, possible causes and managements are presented. A high index of suspicion is necessary whenever a patient with the catheter has hemoptysis or unexplained hemodynamic or respiratory changes.
Arteries* ; Catheters* ; Exsanguination ; Hemodynamics ; Hemoptysis ; Hemothorax ; Humans ; Mortality ; Pulmonary Artery ; Rupture*

Pulmonary artery rupture with a flow-directed balloon tipped pulmonary artery catheter (Swan-Ganz catheter)is a rare complication with high mortality. This report concerns a case of this complication with hemothorax leading to fatal exsanguination. Emphasis is placed on the safety guidelines to prevent this. Also, possible causes and managements are presented. A high index of suspicion is necessary whenever a patient with the catheter has hemoptysis or unexplained hemodynamic or respiratory changes.
Arteries* ; Catheters* ; Exsanguination ; Hemodynamics ; Hemoptysis ; Hemothorax ; Humans ; Mortality ; Pulmonary Artery ; Rupture*

Cutis verticis gyrata(CVG) is a morphologic syndrome of the scalp characterized by folds and furrows resembling the surface of brain. The primary form of cutis verticis gyrata is commonly associated with a neuropsychiatric condition and a secondary form occurs as a response of inflammatory or neoplastic process. The patient was a 1-day-old girl, who had a 15x11 cm sized, convoluted mass over whole scalp. Skin biopsy from the lesion was consistent with cerebriform intradermal nevus. The baby girl was followed up as an outpatient with monitoring of the scalp lesion for 2 years and showed improvement of folds and furrows of the lesion.
Biopsy ; Brain ; Female ; Humans ; Infant, Newborn* ; Nevus, Intradermal* ; Outpatients ; Scalp ; Skin

Acute hemorrhagic edema of infancy is an unusual form of leukocytoclastic vasculitis occuring in children from the age 4 months to 2 years. The etiology remains unknown. Numerous studies, however, suggest acute hemorrhagic edema of infancy as an immune-mediated vasculitis in response to a variety of antigenic stimuli. We report a case of an acute hemorrhagic edema of infancy; 11-month-old boy with a history of fever for 3 days and a history of purpuric rash on the extremities, trunk, buttock and oral mucosa for 2 days.
Acute Disease ; Biopsy ; Edema/immunology/*pathology ; Exanthema/immunology/pathology ; Hemorrhage/immunology/*pathology ; Human ; Infant ; Male ; Vasculitis, Hypersensitivity/immunology/*pathology

OBJECTIVES: To evaluate retrospectively, the possible difference in diffusion tensor imaging (DTI) metric of fractional anisotropy (FA) between good and poor surgical outcome cochlear implantation (CI) patients using investigator-independent voxel-wise analysis. METHODS: Eighteen patients (11 males, 7 females; mean age, 5.9 years) with profound sensorineural hearing loss underwent DTI scans using a 3.0 Tesla magnetic resonance scanner. Among the 18 patients, 10 patients with categories of auditory performance (CAP) score over 6 were classified into the good outcome group and 8 patients with CAP score below 6 were classified into the poor outcome group. The diffusion tensor scalar measure was calculated from the eigenvalues of the tensor on a voxel-by-voxel basis from each subject and two-sample t-test evaluation between good and poor outcome subjects were performed for each voxel of FA values, across the entire brain, with a voxel-wise intensity threshold of P<0.0005 (uncorrected) and a contiguous cluster size of 64 voxels. Individual values of FA were measured by using the region-of-interest based analysis for correlation analysis with CAP scores, open sentence and open word scores. RESULTS: Two-sample t-test evaluation using SPM voxel-wise analysis found significantly higher FA values at the several brain areas including Broca's area, genu of the corpus callosum, and auditory tract in good outcome subjects compared to poor outcome subjects. Correlation analyses between FA and CAP scores, open sentence and open word scores revealed strong correlations at medial geniculate nucleus, Broca's area, genu of the corpus callosum and auditory tract. CONCLUSION: Investigator-independent voxel-based analysis of DTI image demonstrated that good outcome subjects showed better neural integrity at brain areas associated with language and auditory functions, suggesting that the conservation of microstructural integrity of these brain areas is important. Preoperative functional imaging may be helpful for CI.
Anisotropy ; Brain ; Cochlear Implantation ; Cochlear Implants ; Corpus Callosum ; Diffusion ; Diffusion Tensor Imaging ; Hearing Loss ; Hearing Loss, Sensorineural ; Humans ; Magnetic Resonance Spectroscopy ; Male ; Retrospective Studies

BACKGROUND: To evaluate the effects of thoracic epidural anesthesia, with or without bilateral vagotomy, epinephrine-induced arrhythmias were studied in 31 rabbits anesthetized with 1 MAC enflurane. METHODS: Logdose protocol was used for the infusion of epinephrine; its arrhythmic dose being defined as the smallest infusion rate produced four or more continuous or intermittent arrhythmias within 15 seconds. RESULTS: The values (geometric mean) of arrhythmic doses and the plasma concentration of epinephrine during arrhythmia were as follows: 10.21 g.kg 1.min 1 and 83.16 ng/ml in epidural control group; 118.90 g.kg 1.min 1 and 677.76 ng/ml in epidural lidocaine group (p<0.05); 6.34 g.kg-1.min 1 and 96.42 ng/ml in intravenous lidocaine group; 8.65 g.kg 1.min-1 and 44.64 ng/ml in vagotomized-epidural control group; and 12.03 g.kg 1.min 1 and 95.35 ng/ml in vagotomized- epidural lidocaine group. CONCLUSIONS: The data suggest that thoracic epidural anesthesia raises the threshold for enflurane- epinephrine arrhythmias in rabbits and that this effect is eliminated by bilateral vagotomy.
Anesthesia, Epidural* ; Arrhythmias, Cardiac* ; Enflurane ; Epinephrine ; Lidocaine ; Plasma ; Rabbits* ; Vagotomy*

PURPOSE: As life expectancy increases, elderly colorectal cancer patients are also increasing. Compared to younger patients, the elderly manifest higher co-morbidity with more advanced and emergent disease. However, recent studies have reported similar surgical approaches irrespective of age distribution. We evaluated the outcome and propriety of surgical treatment of colorectal cancer in the elderly. METHODS: The medial records of 464 colorectal patients, who underwent surgery during 2003 to 2007 in Ewha Womans University Mokdong Hospital were reviewed retrospectively. The patients were divided into three groups according to age: I (younger than 70), II (71~80), III (older than 81). Clinical and histological characteristics, surgical outcomes and survival rates were analyzed. RESULTS: Three hundred and thirty-eight patients belonged to group I, and 104 patients to group II, and group III included 22 patients. Although, male patients were more prevalent in all three groups, female distribution was slightly higher in group III. Clinical characteristics among the three groups did not reveal specific differences except TNM stage distribution. In group I and II, patients with stage II were more common compared to group III, whereas the latter showed most frequently stage III. Histological characteristics and postoperative morbidity rates did not show any difference among the three groups. The survival rate was lowest in group III. However, emergency operation was more frequent in group III, in accordance with increased postoperative complications. CONCLUSION: The elderly demonstrated comparable operative morbidity and mortality to the younger patients. Emergency operation was the only significantly influencing factor in the surgical outcome. Therefore, in colorectal cancer patients, surgical treatment in the elderly should be no longer contraindicated.
Age Distribution ; Aged ; Colorectal Neoplasms ; Emergencies ; Female ; Humans ; Life Expectancy ; Male ; Retrospective Studies ; Survival Rate

We present two patients with clinical features suggestive of a hyperkinetic form of encephalitis lethargica described by von Economo. While undergoing treatment for viral meningoencephalitis, they both developed comatose mentality, oromandibular dyskinesia, chorea, myoclonic jerk, oculogyric crisis, opistotonus, respiratory failure, and autonomic dysfunction. One patient died of autonomic failure while the other improved several months later. In both patients, cerebrospinal fluid exmamination revealed only pleocytosis. A brain MRI and EEG showed no specific findings. In order to control severe hyperkinetism and autonomic failure, medical treatments including L-dopa, clonazepam, and steroid pulse therapy were administereed in both cases while electroconvulsive therapy was tried in one of the cases. However, they all failed. These cases and previous reports informed us of the presence of sporadic form of encephalis.
Brain ; Cerebrospinal Fluid ; Chorea ; Clonazepam ; Coma ; Dyskinesias ; Electroconvulsive Therapy ; Electroencephalography ; Encephalitis* ; Encephalitis, Viral ; Humans ; Leukocytosis ; Levodopa ; Magnetic Resonance Imaging ; Meningoencephalitis ; Myoclonus ; Respiratory Insufficiency

BACKGROUND: In Korea, 17-alpha-hydroxyprogesterone (17-OHP) neonatal screening for congenital adrenal hyperplasia (CAH) has a high false positive rate. Preterm infants have higher levels of 17-OHP than term infants. We established the separate cutoff values of 17-OHP under the guideline of the Clinical and Laboratory Standard Institute C28-A3 to reduce a false positive rate. METHODS: The 17-OHP enzyme-immunoassay was used in blood spots of 22,601 newborns. To decide whether to partition cutoff values based on sex, sampling date and birth weight was assessed by Z-test and standard deviation (SD) ratio. If the result was significant, we estimated the cutoff value with 90% confidence intervals (CIs) using the nonparametric method. RESULTS: In the subclasses based on sex and sampling date, the results were not significant. However, the birth weight-adjusted subclasses (SD ratio > 1.5) showed that it was necessary to distinguish low-birth-weight infants from the others. We selected the subclass categories to reflect the concept of low- or very-low-birth-weight infant. The maximum percentile to define a 90% CI was chosen in each subclass. After applied the re-estimated cutoff value, the recall rate was decreased from 0.6% to less than 0.2%. CONCLUSIONS: The birth weight-adjusted cutoff value of 17-OHP in neonatal screening for CAH can be reduced the false positive rate of low-birth-weight infants. This approach would decrease unnecessary blood draws, medical evaluation, parental anxiety and burden on health care resources.
17-alpha-Hydroxyprogesterone ; Adrenal Hyperplasia, Congenital ; Anxiety ; Birth Weight ; Delivery of Health Care ; Humans ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Korea ; Neonatal Screening ; Parents ; Parturition

PURPOSE: We evaluated the diagnostic implications and therapeutic efficacy of antithrombin III(AT III) in the disseminated intravascular coagulation(DIC) of premature infants. METHODS: Ninety-two premature infants diagnosed with DIC and treated with AT III from March, 2000 to May, 2003 were retrospectively reviewed. Clinical manifestations, complete blood counts, coagulation tests, and AT III levels were compared between the two groups:definite DIC if clinical signs of DIC and AT III <70% with more than two abnormal laboratory parameters were present, and suspected DIC if not more than two abnormal laboratory parameters were present. RESULTS: AT III was given for an average of 3.2 days and no side effects related to the treatment were reported. The AT III levels increased significantly more than four fold with treatment in both groups. The clinical signs and laboratory values improved significantly after treatment. CONCLUSION: AT III level is a sensitive parameter in the diagnosis of DIC in premature infants, and it is useful as a treatment modality since it improves the clinical symptoms and the laboratory parameters without significant side effects.
Antithrombin III* ; Blood Cell Count ; Dacarbazine ; Diagnosis* ; Disseminated Intravascular Coagulation* ; Humans ; Infant, Newborn ; Infant, Premature* ; Retrospective Studies