Eleven cervical myelograms were perfomed by lateral cervical puncture using Metrizamide. So, following resultswere obtained: 1. Site of lateral cervial puncture; Posterior one third of bony cervical canal at C 1-2 level. 2.Advantages as compared with lumbar puncture for cervial myelogram; 1) Small amount of contrast media 2) Excellentimage 3) Less position change 4) Short time 5) Well visualization of superior margin of obstructive lesion inspinal canal 3. Cessation of lateral cervical puncture, when; 1) Pain during injection of contrast media 2)Localized collection of contrast media
Contrast Media ; Metrizamide ; Myelography ; Punctures ; Spinal Puncture

Secondary opportunistic central nervous system infections occur in approximately one-third of patients with acquired immune deficiency syndrome. With the introduction of highly active antiretroviral therapy, the number of opportunistic infection cases has significantly decreased. However, the number of progressive multifocal leukoencephalopathy (PML) cases caused by opportunistic human JC polyomavirus has not decreased at a noticeable rate. In this report, seven patients with PML were evaluated at the infectious disease unit of the National Medical Center. Six of the 7 patients were not on antiretroviral therapy at the time of diagnosis. The mean patient age of the 6 men and 1 woman was 39 years. The individual CD4 cell counts were 58, 6, 18, 73, 90, 252, and 94 cells/microliter. The mean CD4 cell count was 84 cells/microliter. The most common clinical manifestation was focal weakness and the temporal lobe was mainly involved. Two of the patients died 52 days after the diagnosis was made. Three patients survived for more than 1 year without disease progression. We conclude that one must take a careful patient history, perform a neurological examination, and examine brain magnetic resonance images in patients with human immunodeficiency virus who show neurological symptoms.
Acquired Immunodeficiency Syndrome ; Antiretroviral Therapy, Highly Active ; Brain ; CD4 Lymphocyte Count ; Central Nervous System Infections ; Communicable Diseases ; Disease Progression ; Female ; HIV ; Humans ; JC Virus ; Leukoencephalopathy, Progressive Multifocal ; Magnetic Resonance Spectroscopy ; Male ; Neurologic Examination ; Opportunistic Infections ; Temporal Lobe

BACKGROUND: In the Korean healthcare system, medical care for HIV patients was provided by a few university affiliated hospitals. Access to these tertiary hospitals by homeless people living with HIV was difficult due to socioeconomic reasons. Consequently, proper treatment for homeless subjects living with HIV was not delivered in a timely manner. This study compares the degree of disease progression of HIV infection/AIDS between homeless and non-homeless patient groups. MATERIALS AND METHODS: Out of 605 HIV/AIDS patients who visited the Center for Infectious Disease, National Medical Center, Seoul, Korea from August 2003 to May 2010, 295 subjects were included for this study. Referred cases (n=310) were excluded. The study subjects were further classified into three socioeconomic groups: National Health Insurance beneficiaries, Medical Aids beneficiaries, and the homeless. Status of HIV/AIDS disease progress was evaluated by peripheral blood CD4 cell count and the presence of AIDS defining illnesses at the first visit. RESULTS: There were 220 National Health Insurance beneficiaries (male 94.1%), 45 Medical Aids beneficiaries (male 88.9%), and 30 homeless people (male 96.7%). CD4 cell counts of the homeless (median: 119/microL, interquartile range: 44-383/microL) were significantly lower than those of the National Health Insurance beneficiaries (median: 267/microL, interquartile range: 159-397/microL; P=0.024). In addition, the proportion of patients whose CD4 cell counts <200/microL was significantly higher in homeless subjects (53.3%) compared to those in the National Health Insurance beneficiaries (27.3%) and the Medical Aids beneficiaries (28.9%) (P=0.004; P=0.033 respectively). Also, the frequency of AIDS defining illnesses was higher in the homeless (73.3%) than for those in other groups (the Health Insurance beneficiaries: 24.5%; the Medical Aids beneficiaries: 40.0%) (P<0.001; P<0.005 respectively). CONCLUSIONS: Homeless people living with HIV tend to seek medical care in far advanced stage, which may attribute to poor prognoses. More organized and strategic interventions are necessary to find and treat homeless people living with HIV at the early stage.
Acquired Immunodeficiency Syndrome ; CD4 Lymphocyte Count ; Communicable Diseases ; Delivery of Health Care ; Disease Progression ; HIV ; Homeless Persons ; Humans ; Insurance, Health ; Korea ; National Health Programs ; Prognosis ; Tertiary Care Centers

PURPOSE: We tried to compare the accuracy of using bony landmarks and inguinal crease landmarks for performing femoral artery puncture and to determine an ideal puncture site. MATERIALS AND METHODS: We studied ninety consecutive patients who underwent femoral arterial puncture for performing angiogram. For the evaluation of bony landmarks, the pelvis and inguinal areas were divided into 8 zones according to 7 lines that were drawn parallel to the line drawn between the anterior superior iliac spine and the pubic tubercle. For evaluation of the inguinal crease as a landmark, the 8 zones above and 4 zones below the inguinal crease were determined. The zones were divided by 11 lines drawn parallel to the inguinal crease, and the interval between each line was 1cm. Locations of the inguinal ligament and femoral bifurcation were recorded for every patient according to the above zones, and an ideal zone for the femoral arterial puncture was decided upon. The ideal zone was considered if the locations of all of inguinal ligaments were above the zone and the least possibility to puncture was below the femoral bifurcation. RESULTS: On the bony landmark, the femoral bifurcations were located at zone 3 in 1 patient (1.1%), at zone 4 in 2 patients (2.2%), at zone 5 in 3 patients (3.3%), at zone 6 in 24 patients (26.7%), and at zone7 in 44 patients (48.9%). Inguinal ligaments were at zone 1 in 2 patients (3.0%), at zone 2 in 34 patients (50.7%), at zone 3 in 25 patients (37.3%), and at zone 4 in 6 patients (8.9%). When the inguinal creases were used as a landmark, the femoral bifurcations were located at zone 4 in 4 patients (4.4%), at zone 3 in 19 patients (21.1%), at zone 2 in 30 patients (33.3%), at zone 1 in 19 patients (21.1%), at zone -1 in 13 patients (14.4%), at zone -2 in 3 patients (3.3%) and at zone-4 in 2 patients (2.2%). Inguinal ligaments were at zone 8 in 7 patients (10.4%), at zone 7 in 11 patients (16.4%), at zone 6 in 19 patients (28.4%), at zone 5 in 20 patients (29.9%), at zone 4 in 7 patients (10.4%), and at zone 3 in 3 patients (4.5%). Therefore, the best zone for femoral arterial puncture was zone 5 with using bony landmarks and zone 2 with using inguinal crease landmarks. In terms of zone 5 on the bony landmark, every locations of inguinal ligaments was above it and 84 patients (93.4%) had their femoral bifurcation below it, excluding the 6 patients who had their femoral bifurcations at zones 3, 4, and 5. Therefore, zone 5 with using the bony landmarks was a good indicator for femoral arterial puncture. In case of zone 2 on the inguinal crease landmark, although every location of the inguinal ligament was above it, 53 patients (58.8%) had their femoral bifurcation above it at zones 4, 3, and 2. So, it was not a good indicator for femoral arterial puncture. CONCLUSION: Bony landmarks are more accurate indicators for performing femoral arterial puncture than the inguinal crease landmark. Zone 5 on the bony landmark is an ideal location for femoral arterial puncture.
Angiography ; Femoral Artery ; Humans ; Ligaments ; Pelvis ; Punctures* ; Spine

This study was carried out to assess the effects of intracavitary injection of urokinase in the early liver abscess (ELA) of the rabbits. ELAs were induced on 25 in 47 New Zealand rabbits, which were divided into two groups, with 15 in group A, and 10 in group B. Urokinase was injected into the ELA of group A, and normal physiologic saline into those of group B. One and a half hours after the injections, the rabbits were sacrificed and evaluated by pathologists for the degree of fibrosis of the ELA wall, and fibrinolysis in the ELA itself. Statistical analyses were performed between the two groups. The following ELA sizes for each group were obtained: Group A, 4.3 X 2.9-10.1 X 7.2 mm (mean 7.1 X 4.1 mm); Group B, 4.6 X 2.7-15.0 X 9.7 mm (mean 8.5 X 4.57 mm). Eleven (73%) in group A showed grade II fibrosis of ELA wall, and 8 (80%) in group B showed grade III fibrosis of ELA wall (p=0.002). On pathological analysis, 5 (46%) in group A showed grade II fibrin, and 8 (80%) in group B showed grade III fibrin, of the ELA (p=0.09). In conclusion, injection of urokinase, into the ELAs, can reduce the degree of fibrosis of abscess walls.
Animal ; Fibrinolytic Agents/*administration & dosage/therapeutic use ; Fibrosis ; Injections ; Liver Abscess/*drug therapy/pathology ; Rabbits ; Support, Non-U.S. Gov't ; Suppuration ; Urinary Plasminogen Activator/*administration & dosage/therapeutic use

BACKGROUND/AIMS: Effective bowel preparation is essential for accurate diagnosis of colon disease. We investigated efficacy and safety of 2 L polyethylene glycol (PEG) solution with 90 mL sodium phosphate (NaP) solution compared with 4 L PEG method. METHODS: Between August 2009 and April 2010, 526 patients were enrolled who visited Seoul National University Bundang Hospital for colonoscopy. We allocated 249 patients to PEG 4 L group and 277 patients to PEG 2 L with NaP 90 mL group. Detailed questionnaires were performed to investigate compliance, satisfaction and preference of each method. Bowel preparation quality and segmental quality were evaluated. Success was defined as cecal intubation time less than 20 minutes without any help of supervisors. RESULTS: Both groups revealed almost the same baseline characteristics except the experience of operation. PEG 4 L group's compliance was lower than PEG 2 L with NaP 90 mL group. Success rate and cecal intubation time was not different between two groups. Overall bowel preparation quality of PEG 2 L with NaP 90 mL group was better than PEG 4 L group. Segmental bowel preparation quality of PEG 2 L with NaP 90 mL group was also better than PEG 4 L group in all segments, especially right side colon. Occurrence of hyperphosphatemia was higher in PEG 2 L with NaP 90 mL group than PEG 4 L group. However, significant adverse event was not reported. CONCLUSIONS: PEG 2 L with NaP 90 mL method seems to be more effective bowel preparation than PEG 4 L method.
Administration, Oral ; Adult ; Aged ; Colonic Diseases/diagnosis ; Colonoscopy/*methods ; Humans ; Male ; Middle Aged ; Patient Compliance ; Phosphates/*administration & dosage ; Polyethylene Glycols/*administration & dosage ; Questionnaires ; Solutions ; Therapeutic Irrigation