No abstract available.
Head* ; Necrosis*

We present a case of recurrent left atrial myxoma which occurred 7 years and 10 months after initial operation despite resection of originaltumor and adjacent atrial septum. This is the first case report of recurrence in Korea. Among the possible causes of recurrence, regrowth from pretumorous focus seems to be the most suggesting one in this case. Histopathologic findings of recurrent myxoma showed increased cellularity with active proliferation and nuclear hyperchromasia. These findings, together with the rapidity of regrowth, suggest that recurrent myxoma may have 'wilder' behavior. Prolonged postoperative observation is important, even if ample resection was done at the initial operation including atrial septum.
Atrial Septum ; Korea ; Myxoma* ; Recurrence*

BACKGROUND: Significant improvements in the treatment of acute myelogenous leukemia (AML) has been contributed by the development of remission induction and consolidation chemotherapy. But the infection is one of the most important and fatal complications in patients with AML. Therefore the effective treatment and preventive strategies of these infections are essential in order that more patients may achieve a complete remission and long-term disease free-survival. The purpose of this study was to determine the recent incidence of infections and to evaluate response for the empiric antibiotic treatment during chemotherapy. METHODS: The records of 102 patients from a consecutive series of 206 admission episodes between April 1985 to December 1997 were reviewed retrospectively. When fever was developed, samples for microbiologic cultures and radiologic studies were done. Fine needle aspiration and/or biopsy from suspected lesions were done, if the studies mentioned above are unrevealing. RESULTS: Febrile episodes were developed in 123 of 206 admission session. The microbiologically defined infection (MDI) and clinically defined infection (CDI) were developed in 51.2% and 37.4% of episodes, respectively. Fever was developed in 80.7%, 30.2%, and 77.8% in cases receiving remission induction chemotherapy, standard dose-consolidation therapy, and intensified consolidation therapy, respectively. The most frequent sites of infections were lung (27.8%) and blood (27.8%). Staphylococcus epidermidis was the most common causative organism of bacteremia. The initial antimicrobial therapy was not modified in 8 of 123 febrile episodes. The rate of overall response to antimicrobial therapy was 65%. The rate of overall response to antimicrobial therapy during remission induction chemotherapy, standard dose-consolidation therapy, and intensified consolidation therapy was 70.4%, 89.4%, 71.4%, respectively. CONCLUSION: Infection has been a major cause of morbidity and mortality in acute myelogenous leukemia. Thus, intensive treatment needs for infection. More effective approaches should be evaluated by using more effective prophylactic and treatment modalities including new antimicrobials and by considering the changing spectrum of microbials.
Adult* ; Bacteremia ; Biopsy ; Biopsy, Fine-Needle ; Consolidation Chemotherapy ; Drug Therapy ; Fever ; Humans ; Incidence ; Leukemia, Myeloid, Acute* ; Lung ; Mortality ; Remission Induction ; Retrospective Studies ; Staphylococcus epidermidis

BACKGROUND: The start-up behavior of syringe and syringe pump is known to be one of the causes of inaccurate intravenous infusion. This study evaluated the method of priming the infusion system (PRIMING), and its impact on the target-controlled infusion (TCI) of two remifentanil diluents. METHODS: PRIMING was performed using an evacuation of 2.0 ml to the atmosphere prior to TCI. Forty-eight TCI, using 50 microg/ml (Remi50) or 20 microg/ml (Remi20) of diluents, were performed targeting 4.0 ng/ml of effect-site concentration (Ceff), with PRIMING or not. The gravimetrical measurements of the delivered infusates reproduced actual Ceff. The bolus amount and time to reach 95% target were compared. RESULTS: Without PRIMING, Remi50 infused less bolus (43 +/- 23 %) than Remi20 (19 +/- 9 %) (P = 0.003), and showed more delayed increase of Ceff (11.2 +/- 4.0 min) than Remi20 (7.4 +/- 0.4 min) (P = 0.028). However, PRIMING significantly decreased the deficit of the bolus (2 +/- 1%), as well as the delay of the increase of Ceff in Remi50 (1.2 +/- 0.2 min) (both P < 0.001). In addition, with PRIMING, the start-up bolus showed minimal difference to the nominal bolus (1 and 2%), and Ceff were increased to 4.0 +/- 0.1 ng/ml at the expected time of peak effect, irrespective of the diluents. CONCLUSIONS: Proper operation of the syringe pump used in the priming of the syringe may be helpful in reduction of the inaccuracy of TCI, particularly during the early phase of infusion, or the infusion of a more concentrated diluent.
Atmosphere ; Infusions, Intravenous ; Piperidines ; Syringes

We experienced a case of lumbar epidural lipomatosis patient who had been treated with several epidural steroid injection for the management of lower back pain. This 67-years-old man, complained of lower back pain and radiating paresthetic pain to the dorsum of left foot. Epidural lipomatosis is a rare condition of focal or multiple deposition of excessive adipose tissue in epidural space. Since excessive deposited adipose tissue compresses the spinal cord or spinal root, patients complaint the atypical low back pain and low extremity radiculopathy which mimics the symptoms of spinal stenosis or herniated nucleus pulposus. In managing of lower back pain patient, especially who had been treated with steroid previously, we should consider that epidural lipomatois would be one of the cause.
Adipose Tissue ; Epidural Space ; Extremities ; Foot ; Humans ; Lipomatosis* ; Low Back Pain* ; Radiculopathy ; Spinal Cord ; Spinal Nerve Roots ; Spinal Stenosis

Patellar fractures in children occur rarely in approximately 1% of all pediatric fractures and 57% of these are osteochondral or cartilaginous avulsion fractures, a type of sleeve fracture. They may be missed in diagnosis due to small bony fragment on simple radiographs, and they always occur ipsilaterally; however, only a few cases of bilateral patellar fracture of the inferior pole have been reported. We experienced an 11 year-old patient an athlete, who suffered repetitive minor trauma, with a stress fracture, which occurred at the inferior pole of the patella bilaterally, and we report on this unusual case with a literature review.
Athletes* ; Child ; Diagnosis ; Fractures, Stress* ; Humans ; Patella*

The differentiation between Malignancy-Related Ascites(MRA) and Non-Malignant Ascites (NMA) is important for further diagnostic and therapeutic procedures. Althought many parameters were investigated, none has provided a complete distinction between MRA and NMA. We investigated several ascitic fluid parameters to determine the differential power, and to ifferentiate malignant-related from nonmalignant-related ascites with a sequence of sensitive parameters followed by specific parameters. For the present sturdy, 80 patients with ascites were divided into two groups: MRA and NMA. The MRA group was consisted of 27 patients with proven malignancy by image study, biopsy, and follow up; 21 of these patients had peritoneal carcinomatosis, but the remaining 6 showed no evidence of peritoneal carcinomatosis. The NMA group was consisted of 53 patients with no evidence of malignancy; among these patients, one had SLE, and others had liver cirrhosis. The samples of blood and ascites were obtained simultaneously, and then the levels of ascites cholesterol, CEA, protein, LDH, cytology, albumin gradient, ascites/serum concentration ratios of LDH(LDH A/S), and ascites/serum concentration ratios of protein(protein A/S) were measured. Applying cut-off limits for determined parameters, we estimated the diagnostic efficacy of each parameter. Among the eight parameters investigated, ascites fluid cholesterol yielded the best sensitive value of 93%(cut-off value 30mg/dl), and cytologic examination and the protein A/S(cut-off value 0.5) showed the most specific value of 100% and 96%, respectively. Based on the above result, the diagnostic sequence with cholesterol as a sensitive parameter, followed by the combination of cytologic examination and protein A/S as specific parameters, was tested in 80 patients. This diagnostic sequence identified 81.5% of patients with malignancy, and all patients with peritoneal carcinomatosis were classified as malignancy-related ascites. In spite of many limitations, this proposed diagnostic sequence may permit a cost-effective and simple differentiation of malignacy-related ascites from nonmalignant ascites
Ascites* ; Ascitic Fluid* ; Biopsy ; Carcinoma ; Cholesterol ; Follow-Up Studies ; Humans ; Liver Cirrhosis

Background and Objectives: A large-scale community-based study of the general population has not been conducted. There have been no studies on the relationship between decreased renal function and the degree of hearing loss. Thus, the purpose was to evaluate the relationship between hearing loss and impaired renal function with a large number of populations.Subjects and Method We performed a cross-sectional population-based cohort study by enrolling 470718 adults, 18 to 80 years old with pure tone audiometry tests who had regular health screening between 2013 and 2018. Hearing loss was defined as a pure-tone average of thresholds at 500, 1000, and 2000 Hz in both right and left ears. Kidney function was evaluated based on eGFR. Chronic kidney disease (CKD) was diagnosed as an eGFR<60 mL/ min/1.73 m². Other predictor variables including noise and age that can affect hearing were also used to evaluate correlation factors. Results: Of Participants with CKD, 14.2% had any hearing loss (>25 dB) and 5.0% had above moderate hearing loss (>40 dB). But those with normal kidney function, 2.0% either had any hearing loss and 0.4% had above moderate hearing loss. The odds ratio (OR) of above moderate hearing loss for participants with CKD was 1.51 (95% confidence interval [CI]: 1.15-2.00, p=0.003) but the OR of mild hearing loss for participants with CKD was 0.82 (95% CI: 0.67- 1.02, p=0.073). The result suggested that CKD and above moderate hearing loss were related even after correcting for potential confounders, but had no statistical significance with mild hearing loss. Conclusion Decreased kidney function is associated with above moderate hearing loss.

Tuberculous meningitis is a well-known cause of hypothalamic pituitary dysfunction. However, deficiencies of anterior pituitary hormones may only become evident years after recovery because symptoms are of insidious-onset and nonspecific. Pituitary hormones are essential for normal growth and sexual development in childhood, and for maintenance of healthy body composition. In addition, pituitary hormones and vitamin D are important for cardiovascular and bone health. Although evidence of the relationship between hypovitaminosis D and hypopituitarism is limited, some studies suggested that the incidence of vitamin D deficiency increased in hypopituitarism. We describe herein an unusual case of hypopituitarism and severe hypovitaminosis D presenting as osteoporotic fracture after cured tuberculous meningitis.
Body Composition ; Hypopituitarism* ; Incidence ; Osteoporotic Fractures* ; Pituitary Hormones ; Pituitary Hormones, Anterior ; Sexual Development ; Tuberculosis, Meningeal* ; Vitamin D ; Vitamin D Deficiency

We report two patients who suffered from hemolytic transfusion reactions due to anti-Jkb antibody: one showed acute- and the other showed delayed-type hemolysis. The first patient was a 40-year-old man who suffered from epilepsy after the operation for arteriovenous malformation 16 years ago. He received five units of red blood cells (RBC) after right temporal lobectomy. On the fifteenth postoperative day, fever and chill developed during transfusion of one unit of packed RBC, followed by dark urine and oliguria. The polyethylene glycol-Coombs test and enzyme test revealed anti-Jkb antibody which had not been detected on the pretransfusion specimen. The second patient was a 41-year-old man who was admitted for the reoperation of the prosthetic mitral valve. Because hemoglobin was 5.9g/dL at admission, he received five units of packed RBCs. Oliguria and laboratory findings consistent with hemolytic anemia were observed from the third day of transfusion. Anti-Jkb antibody was detected on antiglobulin phase. Both patients developed acute renal failure (ARF) and hemodialysis with conservative management were done. They finally recovered from ARF without any residual complications. Implementation of more sensitive pretransfusion tests should be considered to prevent rare, but serious hemolytic transfusion reactions.
Acute Kidney Injury ; Adult ; Anemia, Hemolytic ; Arteriovenous Malformations ; Blood Group Incompatibility* ; Epilepsy ; Erythrocytes ; Fever ; Hemolysis ; Humans ; Mitral Valve ; Oliguria ; Polyethylene ; Renal Dialysis ; Reoperation