Alveolar echinococcosis (AE) caused by infection with E. multilocularis metacestode, represents one of the most fatal helminthic diseases. AE is principally manifested with infiltrative, proliferating hepatic mass, resembling primary hepatocellular carcinoma. Sometimes metastatic lesions are found in nearby or remote tissue. AE diagnosis largely depends on imaging studies, but atypical findings of imaging features frequently require differential diagnosis from other hepatic lesions. Serological tests may provide further evidence, while obtaining reliable AE materials is not easy. In this study, alternative antigens, specific to AE were identified by analyzing E. granulosus protoscolex proteins. An immunoblot analysis of E. granulosus protoscolex showed that a group of low-molecular-weight proteins in the range from 14 kDa to 16 kDa exhibited a sensitive and specific immune response to AE patient sera. Partial purification and proteomic analysis indicated that this protein group contained myosin, tubulin polymerization promoting protein, fatty-acid binding protein, uncharacterized DM9, heat shock protein 90 cochaperone tebp P-23, and antigen S. When the serological applicability of recombinant forms of these proteins was assessed using enzyme-linked immunosorbent assay, DM9 protein (rEgDM9) showed 90.1% sensitivity (73/81 sera tested) and 94.5% specificity (172/181 sera tested), respectively. rEgDM9 showed weak cross-reactions with patient sera from the transitional and chronic stages of cystic echinococcosis (3 to 5 stages). rEgDM9 would serve as a useful alternative antigen for serodiagnosis of both early- and advanced-stage AE cases.

Purpose: To report a case of accidental swallowing of nasal packing gauze during silicone tube intubation under local anesthesia.Case summary: A 58-year-old male patient underwent silicone tube intubation for partial nasolacrimal duct obstruction on the right side. In preparing for surgery, six cottonoids soaked were packed in righ nasal cavity, to facilitate anesthesia and prevent bleeding. Strings detectable by X-ray were attached at the cottonoids and cut 5 cm from the nostrils. After surgical hand scrubbing, the strings were not present. One cottonoid was found in the nasal cavity, but five cottonoids could not be detected by endonasal endoscopic exploration. The patient said he swallowed “something like sputum”. He did not notice any discomfort and the surgery was performed as scheduled. Abdominal X-ray performed immediately after surgery showed the presence of the five strings in the stomach. The strings were not seen on X-ray conducted 4 days later. The patient defecated normal stools three times and did not notice any discomfort over the course of 4 days. Conclusions Surgeons need to be aware of the possibility of accidental swallowing of nasal packing gauze during nasolacrimal duct surgery. Use of gauze detectable by X-ray is helpful to determine its location.

PURPOSE: To evaluate the clinical and radiological outcomes, and the complications of unicompartmental knee arthroplasty (UKA) using a fixed bearing prosthesis after 5-year follow-up. MATERIALS AND METHODS: Twenty-six knees (25 patients) that underwent fixed bearing UKA between May 2003 and August 2011 were included. The subjects were 3 males (3 knees) and 22 females (23 knees), and the average age was 63.5 years. The preoperative diagnosis was osteoarthritis (23 knees) and osteonecrosis (3 knees). The mean follow-up duration was 67 months (from 60 to 149 months). The clinical evaluation included pre- and postoperative American knee society knee and function score, and range of motion. The radiology evaluation included standing antero-posterior, lateral view, and fluoroscopic film to analyze the postoperative alignment and osteolysis. RESULTS: The mean American Knee Society knee score and function score were improved from 42.0 and 57.5 to 87.9 and 85.0, respectively (p < 0.001). The mean preoperative and postoperative range of motion was 132.9° and 132.5°, respectively. The mean femorotibial angle were varus 0.5° preoperatively and valgus 2.2° postoperatively. A radiolucent line was observed in 2 knees; one knee had a stable implant, while in the other knee, patellofemoral arthritis was identified during UKA. Diffuse pain of the knee joint with tenderness of the medial joint line was identified at the follow-up, so conversion to total knee arthroplasty was recommended. No other complications, such as osteolysis, infections, postoperative stiffness, and dislocation, were encountered. CONCLUSION: The midterm results of fixed bearing UKA were clinically and radiologically satisfactory.
Arthritis ; Arthroplasty, Replacement, Knee* ; Diagnosis ; Dislocations ; Female ; Follow-Up Studies* ; Humans ; Joints ; Knee ; Knee Joint ; Male ; Osteoarthritis ; Osteolysis ; Osteonecrosis ; Prostheses and Implants ; Range of Motion, Articular

Although the presence of foreign bodies in the common bile duct and T-tube tract is uncommon, it is because of recent developments in endoscopic biliary intervention and percutaneous choledochoscopic procedures that they are found with increasing frequency in the biliary tree. We report two cases in which foreign bodies in the biliary tree were successfully removed using the percutaneous gooseneck snare technique. In one patient a plastic biliary stent was malfunctioning and could not be removed under endoscopic guidance, while in the other, a plastic guidewire had been inserted into the T-tube tract during percutaneous choledochoscopy for the treatment of a common bile duct stone.
Biliary Tract ; Common Bile Duct* ; Foreign Bodies* ; Humans ; Plastics ; SNARE Proteins* ; Stents

A perirenal hematoma very commonly occurs after trauma. Treatment differs according to the degree of renal injury, though many cases are managed conservatively and complications are rare. We report two cases in which successful treatment of a perirenal hematoma involved percutaneous catheter drainage; in one there was bowel obstruction, and in the other the hematoma was infected.
Catheters* ; Drainage* ; Hematoma*

OBJECTIVES: Although there were many studies examining anxiety and depression in hospitalized medically-ill patients, there were few studies in examining anxiety and depression of non-psychiatric outpatients or comparative studies among the disease categories. Therefore, we wanted to explore 1) psychopathologies in the patients with chronic renal failure and those with chronic hepatitis, 2) differences of psychopathologies by severity, 3) differences of psychopathologies by the duration of illness, and 4) psychiatric consultation. This was the second series of the whole project. METHODS: From March to April 1999, 38 patients with chronic renal failure and 26 patients with chronic hepatitis who visited the medical outpatient department are included in the subject group and 116 persons who visited the health examination center in September 1999 are included in the control group. We reviewed the medical records of the patients and inquired what they thought the causes of their illness were. We evaluated the patients with State-trait anxiety inventory, Beck depression inventory, Symptom checklist-90-Revision. RESULTS: In state anxiety, 62.2% of the patients with chronic renal failure fell into the anxious group, which is somewhat greater than the 52.0% of those with chronic hepatitis. The rates in both subjects are significantly higher than that of the control group. 16.7% of the patients with chronic renal failure were depressed, which is somewhat greater than the 9.1% found in chronic hepatitis. The rates in both subjects showed no significant difference from that of the control group. When the state anxiety scores were compared during the duration of the illness, it was found to be relatively higher during the early phase of disease in both the chronic renal failure patients and the chronic hepatitis patients. In the depression, the scores were found to be relatively higher in the chronic renal failure patients when the duration of illness was between 1 to 5 years compared to other duration groups, while the patients of chronic hepatitis were found to be relatively constant. Most frequently, 36.2% of the patients with chronic renal failure and 24.3% of those with chronic hepatitis thought the cause of their illness to be 'psychological', but the rates of psychiatric consultation in both subjects are 5.7%, 7.7% respectively. CONCLUSIONS: Our results suggest that proper psychiatric interventions are not being conducted yet and more cooperative and integrative roles are required among psychiatrists and internists.
Anxiety ; Depression ; Hepatitis, Chronic* ; Humans ; Kidney Failure, Chronic* ; Medical Records ; Outpatients* ; Psychiatry

PURPOSE: To compare the usefulness of gadolinium-enhanced excretory MR urography using breath-hold three-dimensional fast imaging with steady state precession (3-D FISP) with conventional MR urography using the half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequence in the evaluation of obstructive uropathy. MATERIALS AND METHODS: Twenty-three patients in whom ultrasonography (US) and/or intravenous urography(IVU) revealed signs of urinary obstruction were enrolled in this study. Fifteen were men and eight were women, and their mean age was 54 (range, 21 -80) years. All MR images were obtained using a 1.5-T MR unit. MR urography using the HASTE technique (MRU) and gadolinium-enhanced excretory MR urography using the 3D-FISP technique were performed, and in all cases, reconstructions involved maximum intensity projection. For contrast-enhanced MR urography (CEMRU), images were obtained 3, 5, 20, and 30 minutes after the administration of intravenous contrast media, and for selected cases, additional images were obtained until 24 hours after contrast media injection. For qualitative analysis, two experienced radiologists compared CEMRU and MRU in terms of their diagnostic value as regards the level and cause of urinary obstruction, and morphologic accuracy. In addition, signal to noise ratio (SNR) and contrast to noise ratio (CNR) of the urinary tract at each anatomic level were quantitatively analysed. RESULTS: Quantitative analysis showed that in terms of SNR and CNR of the urinary tract at the level of the mid and distal ureter, CEMRU using 3-D FISP was better than MRU using HASTE (p<0.05). Qualitative analysis indicated that for the depiction of the whole length of normal ureter, and detection of the level of obstruction, anatomic anomalies and intrinsic tumors, 3-D FISP was superior to HASTE. There was, however, no difference between these two modalities in the diagnosis of ureteral stone and the degree of hydronephrosis. In addition, 3-D FISP was better than HASTE for the assessment of filling defect, but the difference was not statistically significant. CONCLUSION: Breath hold 3-D FISP is a very valuable tool in the evaluation of obstructive uropathy. It not only depicts very clearly the anatomy of the urinary tract system, but also provides qualitative information on renal function. We believe that CEMRU using 3-D FISP is a valuable diagnostic approach which can be added to those already available for the workup of obstructive uropathy.
Contrast Media ; Diagnosis ; Female ; Humans ; Hydronephrosis ; Male ; Noise ; Signal-To-Noise Ratio ; Ultrasonography ; Ureter ; Urinary Tract ; Urography*

PURPOSE: This study was performed to evaluate clinical manifestations and findings of ultrasonogram of neonatal septic arthritis and osteomyelitis. We tried to determine the value of ultrasonogram as a tool for early diagnosis of septic arthritis and osteomyelitis. METHODS: We reviewed the records of 17 patients, who were diagnosed septic arthritis and/or osteomyelitis in Departments of Pediatrics and Orthopedic Surgery, Han dong University Sunlin Hospital in Pohang between Jan. 1994 and Sep. 1998. Radiologic findings were reviewed retrospectively according to the duration of symptoms at the onset. We compared the sensitivity of ultrasonogram with other radiologic tools done within 7 days of illness. RESULTS: We compared sensitivity of each imaging study done within 7 days of illness. 20%(3/5) had abnormality in plain radiographs, 78.6%(11/14) in ultrasonogram, 28.6%(2/7) in bone scan, and 100,0%(3/3) in MRI. Deep soft-tissue swelling around the bone was the earliest sign of acute osteomyelitis in ultrasonogram. Concurrently early septic arthritis showed deep soft tissue swelling around the joint and increased synovial effusion in ultrasonogram. CONCLUSION: Ultrasonogram is not so expensive, non-invasive, not harmful to patients, and there is no need to sedate patients for examination. Comparing with other imaging studies, the sensitivity of ultrasonogram is relatively high. Ultrasonogram is a useful diagnostic tool of septic arthritis and osteomyelitis in newbom infants.
Arthritis, Infectious* ; Early Diagnosis ; Gyeongsangbuk-do ; Humans ; Infant ; Joints ; Magnetic Resonance Imaging ; Orthopedics ; Osteomyelitis* ; Pediatrics ; Retrospective Studies ; Ultrasonography

OBJECTIVE: Microvascular decompression (MVD) for hemifacial spasm (HFS) is a safe and effective treatment with favorable outcomes. The purpose of this study was to evaluate the incidence of delayed cranirve ( VI, VII, and VIII ) palsy following MVD and its clinical courses. METHODS: Between January 1998 and December 2009, 1354 patients underwent MVD for HFS at our institution. Of them, 100 patients (7.4%) experienced delayed facial palsy (DFP), one developed sixth nerve palsy, and one patient had delayed hearing loss. RESULTS: DFP occurred between postoperative day number 2 and 23 (average 11 days). Ninety-two patients (92%) completely recovered; however, House-Brackmann grade II facial weakness remained in eight other patients (8%). The time to recovery averaged 64 days (range, 16 days to 9 months). Delayed isolated sixth nerve palsy recovered spontaneously without any medical or surgical treatment after 8 weeks, while delayed hearing loss did not improve. CONCLUSION: Delayed cranial nerve (VI, VII, and VIII) palsies can occur following uncomplicated MVD for HFS. DFP is not an unusual complication after MVD, and prognosis is fairly good. Delayed sixth nerve palsy and delayed hearing loss are extremely rare complications after MVD for HFS. We should consider the possibility of development of these complications during the follow up for MVD.
Abducens Nerve Diseases ; Cranial Nerve Diseases ; Cranial Nerves ; Facial Paralysis ; Follow-Up Studies ; Hearing ; Hearing Loss ; Hemifacial Spasm ; Humans ; Incidence ; Isoflurophate ; Microvascular Decompression Surgery ; Paralysis ; Prognosis

Purpose: We sought correlations between the subfoveal choroidal thickness (SCT) and changes in the levels of aqueous humor cytokines before and after anti‐vascular endothelial growth factor (anti‐VEGF) treatment of patients with neovascular age‐related macular degeneration (nAMD) and pachychoroid neovasculopathy. Methods: We measured changes in the SCT and levels of aqueous humor cytokines (VEGF, soluble VEGF receptor‐2 [sVEGFR‐ 2], platelet‐derived growth factor [PDGF]‐AA, monocyte chemoattractant protein 1 [MCP‐1], interleukin [IL]‐6, and IL‐8) after anti‐ VEGF treatment of 11 eyes of 11 nAMD patients and nine eyes of nine pachychoroid neovasculopathy patients. The aqueous humor cytokine levels were compared between the two groups. Results: After anti‐VEGF treatment, the aqueous levels of VEGF and PDGF‐AA decreased significantly, whereas that of sVEGFR‐2 increased. The amount of change in sVEGFR‐2 concentration before and after anti‐VEGF treatment correlated with the SCT and its change after treatment. nAMD patients with relatively thin SCTs and smaller SCT changes after anti‐VEGF treatment showed greater increases in sVEGFR‐2 levels following treatment. We found significant correlations among the MCP‐1, IL‐6, and IL‐8 levels in the nAMD group, and between the sVEGFR‐2 and MCP‐1, and MCP‐1 and PDGF‐AA, levels in the pachychoroid neovasculopathy group. Conclusions Patients with nAMD exhibited significant increases in aqueous sVEGFR‐2 levels following anti‐VEGF treatment and significant correlations among the levels of the inflammatory cytokines MCP‐1, IL‐6, and IL‐8, suggesting that angiogenic factors and inflammatory cytokines may affect the pathophysiologies of the two diseases differently.