A biloma is an extrahepatic or intrahepatic bile collection caused by traumatic, iatrogenic, or spontaneous rupture of the biliary tree. Prior reports have documented an association of a biloma with abdominal trauma and surgery, but spontaneous bile leakage associated with other primary causes has rarely been reported. A 72-year-old man was admitted to our hospital with the complaint of epigastric pain and yellowish discoloration of the sclera. Ultrasonography and computed tomography revealed a large fluid collection in the abdominal cavity. Endoscopic retrograde cholangiography demonstrated leakage of contrast medium from a distended segmental biliary branch in the left lobe of the liver. A perihepatic biloma was confirmed by sonographically guided percutaneous aspiration, and the patient underwent a left lateral segmentectomy of the liver, a cholecystectomy and T-tube choledochostomy. Histological examination showed left lateral bile duct hyperplasia, with abscess formation and chronic cholecystitis. Herein, a case of a biloma associated with choledocholithiasis is reported, with a review of the literatures.
Abdominal Cavity ; Abscess ; Aged ; Bile ; Bile Ducts ; Bile Ducts, Intrahepatic* ; Biliary Tract ; Cholangiography ; Cholecystectomy ; Cholecystitis ; Choledocholithiasis* ; Choledochostomy ; Humans ; Hyperplasia ; Liver ; Mastectomy, Segmental ; Rupture* ; Rupture, Spontaneous ; Sclera ; Ultrasonography

This erratum is being published to correct of title.

We report a case of autologous breast reconstruction in which a thoracodorsal vessel was used as a recipient vessel after a hypoplastic internal mammary vessel was found on preoperative computed tomography (CT) angiography. A 46-year-old woman with no underlying disease was scheduled to undergo skin-sparing mastectomy and breast reconstruction using a deep inferior epigastric artery perforator flap. Preoperative CT angiography showed segmental occlusion of the right subclavian artery with severe atherosclerosis and calcification near the origin of the internal mammary artery, with distal flow maintained by collateral branches. The thoracodorsal artery was selected to be the recipient vessel because CT showed that it was of adequate size and was not affected by atherosclerosis. The patient experienced no postoperative complications, and the flap survived with no vascular complications. The breasts were symmetrical at a 6-month follow-up. This case highlights that preoperative vascular imaging modalities may help surgeons avoid using diseased vessels as recipient vessels in free flap breast reconstructions.

Background: Oral ivermectin is an effective alternative to topical agents for scabies infestation, and may be beneficial in the treatment of crusted scabies in case of failure or impracticability of topical therapy. Objective: The present study aims to evaluate treatment outcomes of patients with scabies treated with oral ivermectin. Furthermore, we analyzed the efficacy and safety of oral ivermectin based on clinical characteristics. Methods: Overall, 16 patients with scabies received 200 μg/kg of ivermectin and topical scabicide (5% permethrin or 10% crotamiton) at 1-week intervals. Treatment outcome was evaluated by mineral oil test and medical examination at intervals of 1 or 2 weeks. If no improvement was observed at the follow-up, treatment was repeated. Results: All patients achieved a clinical response. The average number of administrations of ivermectin was 2.69, and the mode was 3 (n=8). The average number of administrations was higher for those over 70 years of age than for those under 70 years of age (2.80 vs. 2.50), but this was not statistically significant (p=0.558). There were no significant differences based on clinical type. The mean time from the first administration of ivermectin to the negative conversion of the mineral oil examination was 18.43±7.26 days. No adverse events were observed. Conclusion Oral ivermectin is an effective and safe therapy for treating human scabies.

Objectives: This study aimed to assess the antibacterial, bactericidal, and mouth freshener effects of lysozyme hydrochloride 0.01%, sodium fluoride 0.02%, and cetylpyridinium chloride 0.05%. Methods: Eight oral disease-related bacteria were cultivated anaerobically. Four samples were prepared with or without 0.5% cetylpyridinium chloride, 0.2% sodium fluoride, and 0.1% lysozyme hydrochloride. Antimicrobial activity was tested in 96-well microplates. After assessing the bacterial count, the bacterial suspension was mixed with samples and spread on agar. The bactericidal rate was calculated by counting and comparing treated and untreated colonies. Results: Lysozyme hydrochloride 0.01%, sodium fluoride 0.02%, and cetylpyridinium chloride 0.05% mouth fresheners sterilized 99.99% of 8 oral bacteria, including Streprococcus mutans. Lysozyme hydrochloride 0.01%, sodium fluoride 0.02%, and cetylpyridinium chloride 0.05% mouth fresheners showed 99.97% bactericidal activity against Lactobacillus acidophilus. Conclusions Lysozyme hydrochloride 0.01%, sodium fluoride 0.02%, and cetylpyridinium chloride 0.05% mouth fresheners confirmed the sterilization and antibacterial effects on oral disease-causing bacteria.

Supraclavicular lymph node (SCLN) flap is a common donor site for vascularized lymph node transfer for the treatment of lymphedema. Chyle leakage is a rare but serious complication after harvesting SCLN flap in the neck. We report a case of chyle leakage at the SCLN donor site and its successful management. A 52-year-old woman underwent SCLN transfer for treatment of lower extremity lymphedema. After starting a regular diet and wheelchair ambulation on the 3rd postoperative day, the amount of drainage at the donor site increased (8–62 mL/day) with the color becoming milky, which suggested a chyle leak. Despite starting a low-fat diet on the 4th postoperative day, the chyle leakage persisted (70 mL/day). The patient was started on fat-free diet on the 5th postoperative day. The amount of drainage started to decrease and the drain color became more clear within 24 hours. The drainage amount remained less than 10 mL/day from the 8th postoperative day, and we removed the drain on the 12th postoperative day. There was no seroma or other wound complications at follow-up 4 weeks after the operation. The current case demonstrates that a fat-free diet can be a first-line treatment for low output chyle leakage after a SCLN flap.

Background: The purpose of this study was to compare the anatomical features of the internal mammary vessels (IMVs) at the second and third intercostal spaces (ICSs) with regard to their use as recipient vessels in deep inferior epigastric artery perforator (DIEP) flap breast reconstruction. Methods: A total of 38 consecutive DIEP breast reconstructions in 36 patients were performed using IMVs as recipient vessels between March 2017 and August 2018. The intraoperative findings and postoperative complications were analyzed. Anatomical analyses were performed using intraoperative measurements and computed tomography (CT) angiographic images. Results: CT angiographic analysis revealed the mean diameter of the deep inferior epigastric artery to be 2.42±0.27 mm, while that of the deep inferior epigastric vein was 2.91±0.30 mm. A larger mean vessel diameter was observed at the second than at the third ICS for both the internal mammary artery (2.26±0.32 mm vs. 1.99±0.33 mm, respectively; P=0.001) and the internal mammary vein (IMv) (2.52±0.46 mm vs. 2.05±0.42 mm, respectively; P<0.001). Similarly, the second ICS was wider than the third (18.08±3.72 mm vs. 12.32±2.96 mm, respectively; P<0.001) and the distance from the medial sternal border to the medial IMv was greater (9.49±2.28 mm vs. 7.18±2.13 mm, respectively; P<0.001). Bifurcations of the IMv were found in 18.4% of cases at the second ICS and in 63.2% of cases at the third ICS. Conclusions The IMVs at the second ICS had more favorable anatomic features for use as recipient vessels in DIEP flap breast reconstruction than those at the third ICS.

No abstract available.
Acromegaly* ; Octreotide* ; Somatostatin*

BACKGROUND: Epidemiologic and clinical features of infective endocarditis have been changing with increasing longevity, new predisposing factors, and increase in nosocomial infections. MATERIALS AND METHODS: All consecutive cases of infective endocarditis from 1995 to 2003 at the Samsung Medical Center, Seoul, Korea, were evaluated. Epidemiologic and clinical characteristics of patients were analysed by review of medical records. Changing features of endocarditis were compared between Group I (1995-1999) and Group II (2000-2003). RESULTS: Total number of cases was 152; 64 cases in Group I and 88 cases in Group II. Mean age was 46+/-19 years with no difference between two groups. Blood cultures were positive in 119 of 152 cases(78.3%). Streptococcus viridans (39.4%) and Staphylococcus aureus (32.8%) were the most common pathogens of infective endocarditis followed by Staphylococcus epidermidis (8.4%), Enterococcus (7.6%), and Gram negative organism (5.9%). Pathogen distribution was not different between two groups. Medical procedures, such as hemodialysis (0%:12.5%, P=0.003) and intrvenous catheter insertion (1.6%:15.9%, P=0.003), were more frequently performed in Group II and the incidence of nosocomial endocarditis was significantly higher in Group II (3.1% versus 21.6%, P=0.001). Surgical treatment was performed in 53.3% of cases. The overall mortality rate in patients with infective endocarditis was 9.2%. The mortality rate among patients with community-acquired endocarditis was 6.9% and that among nosocomial endocarditis was 23.8%. CONCLUSION: Epidemiological and clinical features of infective endocarditis over the past years have been changing, and clinicians should be aware of these differences when treating patients with endocarditis.
Catheters ; Causality ; Cross Infection ; Endocarditis* ; Enterococcus ; Humans ; Incidence ; Korea ; Longevity ; Medical Records ; Mortality ; Renal Dialysis ; Seoul ; Staphylococcus aureus ; Staphylococcus epidermidis ; Viridans Streptococci

BACKGROUND: Epidemiologic and clinical features of infective endocarditis have been changing with increasing longevity, new predisposing factors, and increase in nosocomial infections. MATERIALS AND METHODS: All consecutive cases of infective endocarditis from 1995 to 2003 at the Samsung Medical Center, Seoul, Korea, were evaluated. Epidemiologic and clinical characteristics of patients were analysed by review of medical records. Changing features of endocarditis were compared between Group I (1995-1999) and Group II (2000-2003). RESULTS: Total number of cases was 152; 64 cases in Group I and 88 cases in Group II. Mean age was 46+/-19 years with no difference between two groups. Blood cultures were positive in 119 of 152 cases(78.3%). Streptococcus viridans (39.4%) and Staphylococcus aureus (32.8%) were the most common pathogens of infective endocarditis followed by Staphylococcus epidermidis (8.4%), Enterococcus (7.6%), and Gram negative organism (5.9%). Pathogen distribution was not different between two groups. Medical procedures, such as hemodialysis (0%:12.5%, P=0.003) and intrvenous catheter insertion (1.6%:15.9%, P=0.003), were more frequently performed in Group II and the incidence of nosocomial endocarditis was significantly higher in Group II (3.1% versus 21.6%, P=0.001). Surgical treatment was performed in 53.3% of cases. The overall mortality rate in patients with infective endocarditis was 9.2%. The mortality rate among patients with community-acquired endocarditis was 6.9% and that among nosocomial endocarditis was 23.8%. CONCLUSION: Epidemiological and clinical features of infective endocarditis over the past years have been changing, and clinicians should be aware of these differences when treating patients with endocarditis.
Catheters ; Causality ; Cross Infection ; Endocarditis* ; Enterococcus ; Humans ; Incidence ; Korea ; Longevity ; Medical Records ; Mortality ; Renal Dialysis ; Seoul ; Staphylococcus aureus ; Staphylococcus epidermidis ; Viridans Streptococci