Botulism is a rare neuroparalytic disease caused by neurotoxins of Clostridium species. A ten-year-old girl and her mother were admitted to a hospital with symptoms of progressive dizziness, blurred vision, slurred speech, constipation and difficulty in swallowing. These characteristic manifestations and clinical course prompted an examination of the possibility of botulism. Mouse bioassay performed with mother's stool demonstrated type A botulinum toxin and culture of the mother's stool was positive for Clostridium botulinum type A. This is the first case of botulism in Korea.
Animals ; Biological Assay ; Botulinum Toxins ; Botulism* ; Clostridium ; Clostridium botulinum ; Clostridium botulinum type A ; Constipation ; Deglutition ; Dizziness ; Female ; Humans ; Korea* ; Mice ; Mothers ; Neurotoxins

We report a case of a 44-year-old patient with paralysis of the left leg who had a thoracic epidural catheterization after general anesthesia for abdominal surgery. Sensory losses below T10 and motor weakness of the left leg occurred after the surgery. Magnetic resonance image study demonstrated a well-defined intramedullary linear high signal intensity lesion on T2-weighted image and low-signal intensity on T1-weighted image in the spinal cord between T9 and L1 vertebral level, and enhancements of the spinal cord below T8 vertebra and in the cauda equina. Electrodiagnostic examination revealed lumbosacral polyradiculopathy affecting nerve roots below L4 level on left side. We suggest that the intrinsic spinal cord lesion and nerve root lesion can be caused by an epidural catheterization with subsequent local anesthetic injection.
Analgesia, Epidural ; Anesthesia, General ; Catheterization ; Catheters ; Cauda Equina ; Humans ; Leg ; Magnetic Resonance Spectroscopy ; Paralysis ; Polyradiculopathy ; Spinal Cord ; Spinal Cord Injuries ; Spine

Systolic coronary arterial narrowing, secondary to myocardial bridging which is capable of producing chest pain, myocardial infarction and ventricular fibrillation is a known but an uncommon entity. A supra-arterial myotomy in a case of myocardial bridge causing medication-refractory angina is described. Under the partial sternotomy incision, we performed a supra-arterial myotomy in the left anterior descending coronary artery without cardiopulmonary bypass. The postoperative course was uneventful.
Cardiopulmonary Bypass* ; Chest Pain ; Coronary Vessels ; Myocardial Bridging* ; Myocardial Infarction ; Sternotomy ; Ventricular Fibrillation

BACKGROUND: All currently available mechanical and bioprosthetic valves are associated with various types of deterioration leading to dysfunction and/or valvular complications. Reoperation on prosthetic heart valves is increasingly under consideration for both clinical and prophylactic indications. This review was conducted to determine the factors affecting the risk of reoperation for prosthetic valve replacement. MATERIAL AND METHOD: From January 1985 to July 1996, 124 patients underwent reoperation on prosthetic heart valves, and 3 patients had a second valve reoperation. The causes of reoperation were prosthetic valve failure (96 cases, 77.4%), prosthetic valve thrombosis (16 cases, 12.9%), prosthetic valve endocarditis (7 cases, 5.6%) and paravalvular leak (5 cases, 4.1%). This article is based on the analysis of the experience with particular emphasis on the preoperative risks affecting the outcome of the reoperation. RESULT: Overall hospital mortality rate was 8.9% (11/124). Low cardiac output was the most common cause of death (70.6%). Left ventricular systolic dimension (p=0.001), New York Heart Association functional class IV (p=0.003) and serum creatinine level (p=0.007) were the independent risk factors, but age, sex and cardiothoracic ratio did not have any influence on the operative mortality. Follow-up period was ranged from 3 to 141 months (mean, 50.6 months). A late mortality rate was 1.8%. CONCLUSION: The surgical risk of reoperation on heart valve prostheses in the advanced NYHA class patients is higher, therefore reoperation is recommended before the hemodynamic impairment become severe.
Cardiac Output, Low ; Cause of Death ; Creatinine ; Endocarditis ; Follow-Up Studies ; Heart Valve Prosthesis* ; Heart Valves* ; Heart* ; Hemodynamics ; Hospital Mortality ; Humans ; Mortality ; Reoperation ; Risk Factors ; Thrombosis

No abstract available.
Macular Edema*

BACKGROUND: Thirty children ranging from 3 to 15 years of age underwent cardiac valve replacement at Dongsan Medical Center from 1982 to 1997. MATERIAL AND METHOD: There were 16 boys and 14 girls. The mean age was 12.1. The underlying pathological cause for valve replacement was congenital heart disease in 17 children and acquired heart disease in 13. The valve replaced was mitral in 15 children, aortic in 11, tricuspid in 3, and combined aortic and mitral in 1. Twenty-one mechanical and 10 tissue valves were placed: primary mechanical valve have been utilized since 1985. Eight of ten patients with tissue valves have had successful second valve replacements 4 to 11 years after the initial operation. RESULT: The operative mortality was 6.7%, but mortality was higher among patients less than 5 years of age and patients who had previous cardiac operations. Of the 28 operative survivors, 4 patients were lost to follow-up: the remaining patients were observed for a total of 2091 patient/months(mean 74.7 months, maximum 187 months). There was one late death from dilated cardiomyopathy after mitral valve replacement in 7 year-old patient with atrioventricular septal defect. After the operation, all patients with mechanical valves were placed on a strict anticoagulant regimen with Coumadin. The actuarial survival rate was 96% at the end of the follow-up. No instance of thromboembolism or major bleeding were observed in the survivors. CONCLUSION: These results indicate that valve replacement can be performed with low mortality in children, and with satisfactory long-term survival.
Cardiomyopathy, Dilated ; Child* ; Female ; Follow-Up Studies ; Heart Defects, Congenital ; Heart Diseases ; Heart Valves ; Hemorrhage ; Humans ; Lost to Follow-Up ; Mitral Valve ; Mortality ; Survival Rate ; Survivors ; Thromboembolism ; Warfarin

PURPOSE: The aim of this study is to evaluate the safety and usefulness of indocyanine green (ICG) angiography in laparoscopic colorectal surgery and to explore its educational benefits in surgical beginners. METHODS: From July to October of 2015, a total of 21 patients with colorectal cancer underwent laparoscopic surgery using the fluorescence-guided imaging system, IMAGE1 S™ (Karl Storz, Germany). Real-time ICG fluorescence images and red inversion images were juxtaposed with standard white-light images for assessment of colonic perfusion. A surgical beginner group comprised of medical students (n=11) and surgical residents (n=11) were then questioned postoperatively about the colonic transection line and mesenteric vascular integrity across various image modes to determine the most proper view for surgical decision. RESULTS: A total of 21 patients underwent laparoscopic colorectal surgery using ICG angiography. Mean patient age was 69.7 years (52~77 years). Mean time-to-detection for the marginal arteries and colonic wall were 26.7 (range, 4~45) and 47.3 (range, 20~77) seconds, respectively. No injection-related adverse events were observed. Rate of change in the colonic transection line across modes was 59.9% (33.3~66.7%) in the surgical beginners. Decisions made by surgical beginners on the transection line were varied with the standard image, but converged to 81.8% in the ICG with red inversion mode. Surgical beginners preferred ICG with red inversion mode for assessment of mesenteric vascular integrity. CONCLUSION: ICG angiography seems to be safe and useful in evaluating colonic perfusion for transection decisions and could have educational benefits for surgical beginners in training to make surgical decisions.
Angiography* ; Arteries ; Colon ; Colorectal Neoplasms ; Colorectal Surgery* ; Fluorescence ; Humans ; Indocyanine Green* ; Laparoscopy ; Perfusion ; Students, Medical

BACKGROUND: For the safety of blood resources, the Blood Donor Health Questionnaire (DHQ) should be modified and improved allowing donors to answer questions with further accuracy. To accomplish this, it is essential to identify any part of this questionnaire that is donors find inconvenient. METHODS: The problems of the current DHQ were examined through a poll of donors at the Korean Red Cross and other hospital blood service centers from November 2008. We also compared the structure and contents of the Korean DHQ to similar document in eight other countries. RESULTS: Donors thought that the current DHQ was too complicated, took too much time (27.3%) and probed too much into a donors private life (51.2%), making it difficult to answer honestly. The Korean DHQ focuses on a deferral period and uses special medical terminology in order for an interviewer to make easy decisions regarding donor eligibility. In contrast, other questionnaires tend to focus on a donor's recall of memory, use simple vocabulary, and emphasize donor's duties, and therefore, these documents are easy for donors to understand and complete CONCLUSION: Donor-oriented DHQs using simply terminology, help donors with memory recall and emphasize a donor's duty. Also, such a document allows donors to answer frankly. Therefore donor-oriented DHQs provide a great degree of blood resource safety than interviewer-oriented DHQs.
Blood Donors ; Humans ; Memory ; Red Cross ; Tissue Donors ; Vocabulary ; Surveys and Questionnaires

BACKGROUND: Myocardial cell death after myocardial infarction or reperfusion is classified into necrosis and apoptosis. Bcl-2 protein is a cytoplasmic protein, which inhibits apoptosis and is expressed in acute stage of myocardial infarction but not in normal heart. This study was performed to investigate whether Bcl-2 protein was expressed respectively to the reperfusion time. MATERIALS AND METHODS: Thirty nine New Zealand white rabbits weighing 1.5-4.8 kg (mean, 2.9kg) were alloted into 7 groups (n=5 in each group) which underwent left anterior descending coronary artery (LAD) occlusion for 30 minutes, followed by reperfusion. The animals were sacrificed at 1, 4, 8, 12, 24 hours, and 3, 7 days after occlusion. Ventricle was excised immediately after intervention. Tissues were fixed in 10% buffured formalin and embedded in paraffin. Bcl-2 protein was detected by immunohistochemical stain with using monoclonal antibody against Bcl-2 protein. RESULTS: The positive immunohistochemical reactivity for Bcl-2 protein was observed in 12, 24 hours, and 3 days reperfusion groups. Bcl-2 protein was detected in salvaged myocytes surrounding the infarcted area. CONCLUSIONS: Bcl-2 protein is expressed at the late acute stage of infarct. Therefore, the expression of Bcl-2 protein may not protect acute cell death, but may play a role in the prevention of late cell death after myocardial is chemia-reperfusion.
Animals ; Apoptosis ; Cell Death ; Coronary Vessels ; Cytoplasm ; Formaldehyde ; Heart ; Muscle Cells ; Myocardial Infarction ; Myocardial Reperfusion ; Myocardium* ; Necrosis ; Paraffin ; Rabbits ; Reperfusion

Hepatic portal venous gas (HPVG), a rare radiologic finding, is associated in some cases with severe or lethal conditions requiring urgent surgical intervention. Computed tomography has recently demonstrated a wider range of clinical conditions associated with HPVG, some of which are benign and do not necessarily require surgery. However, HPVG remains an ominous sign in cases of bowel ischemia or necrosis. We report on a case of massive HPVG caused by a fatal intestinal infarction, which showed rapid disease progression, eventually resulting in death due to septic shock. The HPVG in this case was huge and could therefore be confused with an air-biliarygram.
Colitis, Ischemic ; Disease Progression ; Infarction ; Ischemia ; Mesenteric Veins ; Necrosis ; Portal Vein ; Shock, Septic