One of the complication during or after subclavian vein cannulation is intravascular catheter or wire embolization. Although some studies have reported safety of retaining foreign body embolization, and even death. The intravascular foreign body can be removed surgically or non-surgically. With improvement in instrument technology and technique, percutaneous retrieval of intravascular foreign bodies has become a relatively common procedure. Commonly used methods to remove intravascular foreign bodies are loop snare and basket technique. Sometimes biopy forcep can be used. We have experienced 2 cases of non-surgical removal of intravascular foreign bodies. One of the foreign bodies was 7cm wire fragment in right atrium(RA), the other was a 50cm guide wire. We used the standard loop snare technique for removal of 7cm wire fragment in RA and stone removal basket and 3.0mm ACS PTCA balloon to remove the 50cm short guide wire.
Catheterization ; Catheters ; Foreign Bodies* ; SNARE Proteins ; Subclavian Vein ; Surgical Instruments

We report a case of a 59 year-old female with hyperlipoproteinernia who had xanthoma tuberosum, xanthoma tendinosurn and xanthoma planum. Yellowish nodules appeared on the right elbow 26 years ago and the lesions gradually increased in size and spread to the elbow, hand, knee, foot and achilles tendon. Except for the skin lesion, she was normal on physical examination. The laboratory findings showed that the serum cholesterol, beta lipoprotein and total lipid were increased. The beta band was rnarkedly elevated on electrophoresis, which suggested type IIa hyperlipoproteinemia. Histopathological findings shc wed many aggregates of foam cells and foreign body giant cells were seen in the dermis.
Achilles Tendon ; Cholesterol ; Dermis ; Elbow ; Electrophoresis ; Female ; Foam Cells ; Foot ; Giant Cells, Foreign-Body ; Hand ; Humans ; Hyperlipoproteinemia Type II* ; Knee ; Lipoproteins ; Middle Aged ; Physical Examination ; Skin ; Temazepam* ; Xanthomatosis*

Usually fungal infections caused by opportunistic and pathogenic fungi had been an important cause of morbidity and mortality among immunocompromised patients. However clinical data and investigations for immunocompetent pathogenic fungal infections had been rare and neglected into clinical studies. Especially Cryptococcal brainstem abscess cases mimicking brain tumors were also much more rare. So we report this unusual case. This 47-year-old man presented with a history of progressively worsening headache and nausea for 1 month and several days of vomituritions before admission. Neurological and laboratory examinations performed demonstrated no abnormal findings. Previously he was healthy and did not have any significant medical illnesses. A CT and MRI scan revealed enhancing 1.8x1.7x2.0 cm mass lesion in the left pons having central necrosis and peripheral edema compressing the fourth ventricle. And also positron emission tomogram scan demonstrated a hot uptake of fluoro-deoxy-glucose on the brainstem lesion without any evidences of systemic metastasis. Gross total mass resection was achieved with lateral suboccipital approach with neuronavigation system. Postoperatively he recovered without any neurological deficits. Pathologic report confirmed Cryptococcus neoformans and he was successively treated with antifungal medications. This is a previously unreported rare case of brainstem Cryptococcal abscess mimicking brain tumors in immunocompetent host without having any apparent typical meningeal symptoms and signs with resultant good neurosurgical recovery.
Abscess* ; Brain Neoplasms* ; Brain Stem* ; Cryptococcus ; Cryptococcus neoformans ; Edema ; Electrons ; Fourth Ventricle ; Fungi ; Headache ; Humans ; Immunocompromised Host ; Magnetic Resonance Imaging ; Middle Aged ; Mortality ; Nausea ; Necrosis ; Neoplasm Metastasis ; Neuronavigation ; Pons

PURPOSE: To investigate of the histological characteristics of the lattice degeneration of the human peripheral retina. METHODS: The histological characteristics of the lattice degeneration of the retina was checked by flat preparation and serial section of the lattice lesion in three eyes was investigated by transmission electron microscopy. RESULTS: Flat preparation showed lattice lesion with a hole at the lateral margin with overlying sclerotic vessel and pigment clumping within the lesion. The ultrastructural initial findings showed that the collagen filament in the vitreous cavity was continuous with Muller fiber of the retina with the defect of the inner retina. The full-thikness defect of the sensory retina leaded to the retinal hole. The vascular wall was replaced and occluded by fine fibrillar collagen. The glial cell proliferated into the neural tissue of the sensory retina. These glial cells may secrete long spacing collagen (LSC) and curvilinear material shown at the area of the sensory retinal defect and near the vitreoretinal interface. CONCLUSIONS: These results suggest that the thinning of the retina occurs from the inner retina leading to retinal hole as the lattice degeneration progresses. LSC and curvilinear material are suggestive of derivatives derived from the extracellular material secreted from the glial cell.
Collagen ; Fibrillar Collagens ; Humans ; Microscopy, Electron ; Microscopy, Electron, Transmission ; Neuroglia ; Retina* ; Retinal Perforations ; Retinaldehyde*

Arteriovenous fistula of the scalp is relatively rare disease. We report a traumatic arteriovenous fistula of the scalp treated with complete surgical excision and review the literature with regard to etiology, pathogenesis, and management of these unusual lesions.
Arteriovenous Fistula* ; Rare Diseases ; Scalp*

PURPOSE: We aimed to investigate the clinical and phylogenetic characteristics of Escherichia coli Urinary Tract Infections (E. coli UTI). METHODS: We enrolled patients with culture-proven E. coli UTI, who were admitted at the study hospital from September 2008 to August 2009. We investigated clinical data of patients with E. coli UTI and characteristics of isolated E. coli strains. The phylogenetic groups were classified using triplex polymerase chain reaction (PCR), and the distribution of nine virulent genes was determined by multiplex PCR. RESULTS: A total of 47 patients have participated in this study. Thirty (63.8%) were under 6 months; eight (17.0%) were between 6-12 months; and nine (19.1%) were over 12 months. We compared two age groups between under 6-month and over 6-month. In the age group under 6-month, higher proportion of male (P=0.002) and group B2 strains (P=0.020) were observed. In contrast, higher proportion of female and group non-B2 strains were observed in age group over 6-month. Frequencies of papC, papGII, papGIII, sfa/foc, hlyC, cnf1, fyuA, iroN and iucC were estimated as 68.1%, 57.4%, 42.6%, 46.8%, 46.8%, 31.9%, 87.2%, 48.9% and 63.8%, respectively. In the comparison of phylogenetic groups, group B2 showed higher distribution of virulent genes, while group D included more strains resistant to trimethoprim/sulfamethoxazole (TMP/SMZ) than other groups. CONCLUSION: We showed the age group-specific difference in the distribution of sex ratios and phylogenetic groups; more male and group B2 strains in age group under 6-month, while more female and group non-B2 in age group over 6-month. However, further evaluation including larger number of patients will be necessary to confirm above thesis in future molecular epidemiological studies.
Epidemiologic Studies ; Escherichia ; Escherichia coli ; Female ; Humans ; Infant ; Iron ; Male ; Multiplex Polymerase Chain Reaction ; Sex Ratio ; Urinary Tract ; Urinary Tract Infections

No abstract available.
Congenital Abnormalities ; Pregnancy* ; Prevalence* ; Single Umbilical Artery*

PURPOSE: This study was done to develop an integrated breast health program for prevention and early detection of breast cancer, integrating primary and secondary prevention factors using cognitive-behavioral strategies. METHODS: This methodological study conducted as follows; Selection of components for the program through a literature review, survey to identify women's knowledge and risk perception of breast cancer and diet, and building prototype for the program using discussion based on findings. Using structured questionnaires, interviews were done with 130 women aged 40-59 who lived in a rural area. RESULTS: Primary prevention (diet pattern, knowledge about breast cancer, and risk perception) and secondary prevention (early detection behaviors) factors were identified through the literature review. The survey showed that women lack knowledge and awareness about the risks of breast cancer, and have a low compliance rate for early detection behavior. Based on these results, a program was developed utilizing counseling and models to provide education and practice related to diet, breast cancer, and early detection behaviors. CONCLUSION: Use of this integrated and tailored breast health program with women at risk will contribute to better breast health, but further study is needed to verify the effects.
Aged ; Breast ; Breast Neoplasms ; Compliance ; Counseling ; Diet ; Female ; Humans ; Primary Prevention ; Program Development ; Surveys and Questionnaires ; Secondary Prevention

BACKGROUND: Low-dose intrathecal opioid has been used for early postoperative pain co1ntrol. This study was designed to assess effect intrathecal morphine on postoperative pain control for total knee arthroplasty (TKA) under combined spinal-epidural analgesia (CSE) in elderly patients. METHODS: Fifty four patients over 60 years, undergoing TKA were randomly allocated to three groups. M(0) group for control group did not received intrathecal morphine, M(50) and M(100) group received intrathecal morphine 50microgram and 100microgram respectively. The pain scores (verbal numeric rating scale, VNRS) at rest and coughing, analgesic consumption, patient satisfaction and side effects such as nausea, vomiting, pruritus, headache, dizziness, sedation, respiratory depression, and urinary retention were recorded immediately before and at 1, 3, 6, 12, 24, 48 hour after the initiation of patient-controlled epidural analgesia (PCEA). RESULTS: VNRS were low at each time, and were not exceeding 2 in all groups. M(50) and M(100) group revealed significantly less analgesic consumption compared to M(0) group (P < 0.05). PCEA first injection time after PCEA connection was shortest in M(0) group compared to M(50) and M(100) group. The incidence of pruritus increased in M(50) and M(100) group with dose-dependence, but no significant differences were noticed in other side effects. CONCLUSIONS: Intrathecal morphine use showed no significant analgesic effect except pruritus compared to control group. Further studies are required into the effective intrathecal morphine without side effects in elderly patients for TKA.
Aged* ; Analgesia ; Analgesia, Epidural ; Arthroplasty* ; Arthroplasty, Replacement, Knee* ; Cough ; Dizziness ; Headache ; Humans ; Incidence ; Knee ; Morphine* ; Nausea ; Pain, Postoperative ; Patient Satisfaction ; Pruritus ; Respiratory Insufficiency ; Urinary Retention ; Vomiting

A staphylococcal brain abscess admixed with aspergillosis occurred after operation for the olfactory groove meningioma at remote site. We report the rare case and consider the clinical pathogenesis. Bifrontal craniotomy for the olfactory groove meningioma was done in a 61-year-old female. She was bedridden for one month after craniotomy. During that period, panhypopituitarism occurred and was corrected with hormonal replacement. Sore in the occipital scalp which had occurred during the bedridden state was cared by dressing. After 60 days of treatment, he was discharged with ambulatory status. During postoperative period, we found left parieto-occipital brain abscess in the brain computed tomography(CT) at 3 months. And then craniotomy and abscess resection was performed. Vancomycin and itraconazole antibiotic therapy was instituted after the identification of staphylococcus and aspergillus in the cystic fluid, and aspergillus hyphae in the solid wall portion of the abscess. After the confirmation of resolution of brain abscess on the postoperative 3 weeks' brain CT, the patient was discharged with oral itraconazole medication.
Abscess ; Aspergillosis ; Aspergillus* ; Bandages ; Brain Abscess* ; Brain* ; Coinfection* ; Craniotomy ; Female ; Humans ; Hyphae ; Itraconazole ; Meningioma ; Middle Aged ; Postoperative Period ; Scalp ; Staphylococcus* ; Vancomycin