Disseminated bone tuberculosis is a rare manifestation of skeletal tuberculosis in adults in which cystlike lesions occur in the axial skeleton, shoulder, and pelvic girdles. Varied nomenclature applied to the entity of multiple cystic bone lesions in bone tuberculosis have been described in the literature. We experienced 2 cases of disseminated bone tuberculosis in adult.
Adult ; Humans ; Shoulder ; Skeleton ; Tuberculosis ; Tuberculosis, Osteoarticular

No abstract available.
Shock, Septic*

This prospective study evaluated the incidence and severity of arterial oxygen desaturation during esophagogastroduodenoscopy (EGD) and assessed clinical factors in relation to arterial oxygen desaturation. Following pulmonary function testing, 192 patients underwent elective EGD with continuous recording of arterial oxygen saturation (SaO2). 62 patients (32.3%) showed arterial oxygen desaturation (SaO2 decrease greater than 4% from baseline SaO2); severe arterial oxygen desaturation (SaO2 less than or equal to 85%) reflecting hypoxemia (arterial oxygen tension less than or equal to 50 mmHg) was found in 17 patients (8.9%). These changes were most frequent at the esophageal stage of EGD but most marked at the gastroduodenal stage of EGD. The incidence of arterial oxygen desaturation was not related to age, sex, preendoscopic pulmonary function tests, smoking, or duration of endoscopy. These data support that continuous monitoring of SaO2 should be standard procedure during endoscopy because there was no identifiable preendoscopic risk factor for arterial oxygen desaturation during EGD. But there was no persistent drop in SaO2 longer than 2 minute. We suppose that oxygen supplement may not be required during EGD even in patients with modestly impaired pulmonary function tests.
Adult ; Arteries ; *Endoscopy, Digestive System ; Female ; Humans ; Male ; Middle Aged ; Oxygen/*blood

Since the mid-2000s, massive blood transfusion protocols and damage control resuscitation have improved the prognosis of trauma patients. As a part of damage control resuscitation, whole blood transfusion, especially using low titer group O whole blood (LTOWB), has been widely accepted in both military and civilian trauma settings based on its safety and significant advantages in terms of efficiency and efficacy. To implement LTOWB effectively, each institution should establish relevant policies which should simultaneously consider safety and accessibility factors, including titer threshold, blood management, blood supply, and transfusion protocols for LTOWB. These policies will need to be revised through continuous audits and monitoring. Additionally, whole blood and LTOWB may benefit hemorrhagic patients in non-trauma contexts, or in rural and pre-hospital settings. Further supporting evidence for these applications is needed.

No abstract available.
Helicobacter pylori* ; Helicobacter* ; Stomach Neoplasms*

BACKGROUND: The impact of volatile induction using large-dose sevoflurane (VI-S) on cerebral blood flow has not been well investigated. The present study compared the changes in cerebral blood flow of middle cerebral artery using transcranial Doppler (TCD) during VI-S and conventional induction using propofol. METHODS: Patients undergoing elective lumbar discectomy were randomly allocated to receive either sevoflurane (8%, Group VI-S, n = 11) or target-controlled infusion of propofol (effect site concentration, 3.0 microg/ml; Group P, n = 11) for induction of anesthesia. The following data were recorded before and at 1, 2, and 3 min after commencement of anesthetic induction (T0, T1, T2, and T3, respectively): mean velocity of the middle cerebral artery (V(MCA)) by TCD, mean blood pressure (MBP), heart rate, bispectral index score (BIS) and end-tidal CO2 (ETCO2). Changes in V(MCA) and MBP from their values at T0 (DeltaV(MCA) and DeltaMBP) at T1, T2, and T3 were also determined. RESULTS: BISs at T1, T2 and T3 were significantly less than that at T0 in both groups (P < 0.05). DeltaVMCA in Group VI-S at T2 and T3 (18.1% and 12.4%, respectively) were significantly greater than those in Group P (-7.6% and -19.8%, P = 0.006 and P < 0.001, respectively), whereas ETCO2 and DeltaMBP showed no significant intergroup difference. CONCLUSIONS: VI-S using large-dose sevoflurane increases cerebral blood flow resulting in luxury cerebral flow-metabolism mismatch, while conventional propofol induction maintains cerebral flow-metabolism coupling. This mismatch in VI-S may have to be considered in clinical application of VI-S.
Anesthesia ; Blood Pressure ; Diskectomy ; Heart Rate ; Humans ; Middle Cerebral Artery ; Propofol*

Traumatic brain injury can cause movement disorders such as tremor, dystonia, myoclonus, parkinsonism and chorea. After the severe traumatic brain injury, movement disorders have been reported in 13 to 66% of patients and 20% of cases combined with weakness, spasticity, cognitive impairment and ataxia. Postural/kinetic tremor, which is the most common type of movement disorder after traumatic brain injury, may be transient or persistent however the other syndromes tend to persist and produce significant impairment in activity of daily living. The symptomatic relief can generally be achieved with medical treatment and some cases with neurosurgical intervention such as functional stereotactic surgery or deep brain stimulation. This article reviews the epidemiology, underlying mechanism, the type and treatment of movement disorders follow traumatic brain injury.
Ataxia ; Brain Injuries ; Chorea ; Deep Brain Stimulation ; Dystonia ; Humans ; Movement Disorders ; Muscle Spasticity ; Myoclonus ; Parkinsonian Disorders ; Tremor

We report an unusual case of Plasmodium vivax malaria that occurred in a 22-year-old ankylosing spondylitis patient after initiating adalimumab therapy. P. falciparum malaria was initially included as a possible differential diagnosis due to hyperparasitemia and similar features in the peripheral blood smear. The patient was successfully treated with conventional therapy for P. vivax malaria.
Antibodies, Monoclonal, Humanized ; Diagnosis, Differential ; Humans ; Malaria ; Malaria, Vivax ; Plasmodium ; Plasmodium vivax ; Spondylitis, Ankylosing ; Young Adult ; Adalimumab

Transesophageal echocardiography (TEE) in addition to the conventional pressure tracing method may enhance a proper insertion of pulmonary artery (PA) catheter by providing information about the real-time location of catheter. We report a case of abrupt air leakage from the balloon of PA catheter during its advancement that was immediately diagnosed by TEE in 54-year-old male with moderate tricuspid regurgitation for elective CABG. Introducer and sheath of PA catheter were inserted in right internal jugular vein. After checking balloon function, connecting distal port to a previously zeroed transducer and confirming the location in right atrium, PA catheter was advanced under direct the visual surveillance by TEE images as well as pressure tracing. During the third trial of catheter advancement through tricuspid valve, multiple air shadows, which convincing balloon leakage, were appeared in right atrium in the view of TEE after inflation of air. We withdrew catheter immediately without any further effort of balloon inflation or advancement, then, balloon leakage and the incapability of balloon expansion were confirmed by saline injection, instead of air, into the balloon port. We replaced the injured PA catheter to new one, and advanced it successfully to the wedged position by the aid of TEE and pressure tracing. We assumed that TEE image might be a beneficial aid to enhancing PA catheter placement in a proper position and preventing possible complications or side effects produced by advancing it with unawareness or delayed recognition of its dysfunction.
Catheters* ; Echocardiography, Transesophageal* ; Heart Atria ; Humans ; Inflation, Economic ; Jugular Veins ; Male ; Middle Aged ; Pulmonary Artery* ; Transducers ; Tricuspid Valve ; Tricuspid Valve Insufficiency

Stenotrophomonas maltophilia is a ubiquitous, Gram-negative organism. It is an emerging causative pathogen for severe hospital- acquired infections, particularly in debilitated or immunocompromised patients because of its resistance to various antibiotics. Soft tissue infection caused by S. maltophilia, however, is uncommon. A patient with leukemia was referred for the evaluation of subcutaneous nodules that developed after chemotherapy. With the pathological finding of neutrophilic panniculitis, S. maltophilia was confirmed in a bacteriological study of the biopsied tissue. The nodules regressed spontaneously with recovery from the neutropenia. We report a case of S. maltophilia infection that manifested as soft tissue nodules, which resolved spontaneously in a patient with leukemia.
Anti-Bacterial Agents ; Humans ; Immunocompromised Host ; Leukemia ; Neutropenia ; Neutrophils ; Panniculitis ; Soft Tissue Infections ; Stenotrophomonas ; Stenotrophomonas maltophilia