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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

PURPOSE: With the introduction of H. pylori eradication and proton pump inhibitor, the operative treatments for the acute or chronic complications of peptic ulcer, such as perforation, bleeding and stricture, have decreased. Also owing to the development of non-operative treatment such as interventional endoscopic treatment, the surgical approach to the acute complications, like perforation and bleeding, has diminished. The non-operative treatments for the stricture and obstruction of chronic peptic ulcer in part related to discontinuation of medication have not been satisfactory. We analyzed the clinical outcomes of the patients who underwent operative treatment for outlet obstruction with peptic ulcer. Materials of Methods: From January 1994 to December 2007, we reviewed 31 patients who had been operated on at the National Medical Center for peptic ulcer obstruction. We excluded the cases of adhesive obstructions that were caused by a former ulcer operation and also the cases of obstructions found during emergency operations for treating perforation and bleeding. We classified the surgical treatment group into the bypass operation group and the surgical resection group. We evaluated the effects of the operations by the Visick score. The recurrences were confirmed only by the endoscopic observation of peptic ulcer. RESULTS: The number of patients in the bypass operation group was 6 (19.4%) and that of resection group was 25 (80.6%). The mean age was 57.5 (25~81) years. The number of male patients was 29 (93.5%) and the number of females was 2 (6.5%). The mean symptom duration was 29.6 months. There were 19 smokers (61.3%), 6 NSAID users (19.4%) and 7 H. pylori positive patients (22.6%). Two patients underwent endoscopic balloon dilatation with no success. The locations of lesion were the stomach, the duodenum and both in 9, 20 and 2 cases, respectively. There were operative complications in 13 cases (41.9%), recurrent ulcers in 2 cases (6.5%), and reoperations in 4 cases. The mean Visick score was 1.8 (1~4). There were no statistically significant clinicopathologic differences between the bypass operation group and the resection group. The two groups had 1 case each of recurrence. Although the bypass group had a greater complication rate (83.3%) than the resection group (32%), this was not statistically meaningful (P=0.175). The mean Visick score was 3.0 in the bypass group and 1.6 in the resection group, so the resection group was better (P=0.001). CONCLUSION: For a case of chronic peptic ulcer with outlet obstruction, even though it has been reported that endoscopic balloon dilatation worked well, surgery is still regarded as an important treatment. If you consider the patients' satisfaction and the difficulty of diagnosing malignant ulcers, surgical resection should be recommended more often than a bypass operation.
Adhesives ; Constriction, Pathologic ; Dilatation ; Duodenum ; Emergencies ; Female ; Gastric Outlet Obstruction ; Hemorrhage ; Humans ; Male ; Peptic Ulcer ; Proton Pumps ; Recurrence ; Stomach ; Ulcer

PURPOSE: This study was conducted to analyze the clinical course of patients of gastric cancer with outlet obstruction by comparing them with the gastric cancer patients without outlet obstruction. METHODS: The records of gastric cancer patients with outlet obstruction and who underwent radical gastrectomy from January 1996 to December 2005 were retrospectively reviewed and compared with those patients with gastric cancer and who were without outlet obstruction. RESULTS: The number of the patients who underwent radical gastrectomy was 461. Out of 461 patients, the number of gastric cancer patients with outlet obstruction was 42 (9.1%), and they had nasogastric tube insertion for an average of 4.4 days before operation. These patients showed several significant features such as large tumor size, advanced stage, an increased the number of involved LNs, a low serum albumin level, a frequent antral tumor location and duodenal invasion. There was no difference in complication rates between the two groups, but a higher mortality rate was noted in the gastric cancer patients with outlet obstruction than that in the other patients (P=0.038). The survival rate after the operation was significantly lower among the gastric cancer patients with outlet obstruction (P=0.0008), whereas no difference was found in the survival rate between the above two groups at the same stage (P=0.1951). CONCLUSION: The gastric cancer patients with outlet obstruction showed a comparatively poorer prognosis than those gastric cancer patients without outlet obstruction. However, there was no significant difference in the complication rate and the survival rate for both types of patients who were at the same stage. These results suggest that the patients with outlet obstruction can show the same result as the patients without outlet obstruction by undergoing radical gastrectomy.
Carbamates ; Gastrectomy ; Humans ; Organometallic Compounds ; Prognosis ; Retrospective Studies ; Serum Albumin ; Stomach Neoplasms ; Survival Rate

In surgical treatment of the malignant melanoma, radical resection and a sentinel lymph node biopsy are essential procedures to eradicate the tumor and to minimize the risk of local recurrence. For the reconstruction of skin defect after tumor resection, a skin graft has been generally performed procedure. However, if tendon or bone is exposed after tumor resection, simple skin graft is not enough for the coverage of the defect and additional procedure is mandatory. In this study, we reviewed the clinical results of 16 patients, who had been diagnosed with malignant melanoma of the limb and underwent surgical resection and reconstruction of the defect with various methods. The sentinel lymph node dissection was performed in all patients combined with radical excision of the tumor. In 11 cases of positive sentinel lymph nodes, further elective lymph node dissections were performed. The mean tumor invasion depth was 4.54 mm (2~10 mm), and AJCC stage II was most common (9 cases). The pedicled flaps were performed in 10 cases for the reconstruction of defects. All flaps were successfully survived without significant complications until the last follow up. In conclusion, a pedicled flap coverage is very useful reconstruction strategy for the soft tissue defects after radical resection of malignant melanoma.
Extremities ; Follow-Up Studies ; Humans ; Lymph Node Excision ; Lymph Nodes ; Melanoma ; Nitriles ; Pyrethrins ; Recurrence ; Sentinel Lymph Node Biopsy ; Skin ; Surgical Flaps ; Tendons ; Transplants

OBJECTIVE: Subdural hygroma (SDG) is a complication occurring after head trauma that may occur secondary to decompressive craniectomy (DC). However, the mechanism underlying SDG formation is not fully understood. Also, the relationship between the operative technique of DC or the decompressive effect and the occurrence and pathophysiology of SDG has not been clarified. Purpose of this study was to investigate the risk factors of SDG after DC in our series. METHODS: From January 2004 to December 2008, DC was performed in 85 patients who suffered from traumatic brain injury. We retrospectively reviewed the clinical and radiological features. For comparative analysis, we divided the patients into 2 groups : one group with SDG after craniectomy (19 patients; 28.4% of the total sample), the other group without SDG (48 patients; 71.6%). The risk factors for developing SDG were then analyzed. RESULTS: The mean Glasgow Outcome Scale (GOS) scores at discharge of the groups with and without SDG were 2.8 and 3.1, respectively (p<0.0001). Analysis of radiological factors showed that a midline shift in excess of 5 mm on CT scans was present in 19 patients (100%) in the group with SDG and in 32 patients (66.7%) in the group without SDG (p<0.05). An accompanying subarachnoid hemorrhage (SAH) was seen in 17 patients (89.5%) in the group with SDG and in 29 patients (60.4%) in the group without SDG (p<0.05). Delayed hydrocephalus accompanied these findings in 10 patients (52.6%) in the group with SDG, versus 5 patients (10.4%) in the group without SDG (p<0.05). On CT, compression of basal cisterns was observed in 14 members (73.7%) in the group with SDG and in 18 members of the group without SDG (37.5%) (p<0.007). Furthermore, tearing of the arachnoid membrane, as observed on CT, was more common in all patients in the group with SDG (100%) than in the group without SDG (31 patients; 64.6%) (p<0.05). CONCLUSION: GOS showed statistically significant difference in the clinical risk factors for SDG between the group with SDG and the group without SDG. Analysis of radiological factors indicated that a midline shifting exceeding 5 mm, SAH, delayed hydrocephalus, compression of basal cisterns, and tearing of the arachnoid membrane were significantly more common in patients with SDG.
Arachnoid ; Brain Injuries ; Craniocerebral Trauma ; Decompressive Craniectomy ; Glasgow Outcome Scale ; Humans ; Hydrocephalus ; Membranes ; Retrospective Studies ; Risk Factors ; Subarachnoid Hemorrhage ; Subdural Effusion

OBJECTIVE: It was reported that a few antimicrobial agents influenced on the activity of bacterial iron- uptake system (IUS). In the present study, we tried to investigate the relatedness between the resistance of antibiotics and the activity of the two high-affinity IUS, siderophore-mediated IUS and transferrin-binding protein (SA-tbp)-mediated IUS, of Staphylococcus aureus clinical isolates. METHODS: Total 71 strains including the standard ATCC 6538 strain were used. Seventy strains were isolated from the second or third line general hospitals from 1998 to 1999. Antimicrobial susceptibility test was performed by disk diffusion method. CAS agar diffusion assay was used for the measurement of staphylococcal siderophore. To visualize the expression of SA-tbp, Western blotting using human transferrin conjugated with horseradish peroxidase was performed. RESULTS: Among the nine antimicrobial agents, only the susceptible strains to oxacillin produced more siderophore compared to the resistant strains (P<0.05). There was no statistically significant difference between the antimicrobial susceptibility of the other antimicrobial agents and the production of siderophore (P>0.05). There were no antibiotics related to the expression of SA-tbp (P>0.05). CONCLUSION: These results indicate that only oxacillin (OXAC) influences on the production of staphylococcal siderophore and the further consecutive study about the action mechanism of OXAC is necessary.
Agar ; Anti-Bacterial Agents ; Anti-Infective Agents ; Blotting, Western ; Diffusion ; Horseradish Peroxidase ; Hospitals, General ; Humans ; Oxacillin ; Staphylococcus aureus* ; Staphylococcus* ; Transferrin

Osteoporosis is caused by an imbalance of osteoclasts and osteoblasts, and the major treatment technique for treating osteoporosis is to reduce the activity of osteoclastic bone resorption. Limonium tetragonum (LT) is a medicinal plant that contains bioactive molecules with anti-inflammatory and anti-cancer properties. Its effects on osteoclastogenesis, however, remain unclear.Limonium tetragonum extract (LTE) was examined for its inhibitory effect on osteoclastogenesis by TRAP and pit formation assay. As a result, LTE also significantly reduced TRAP formation, the capability to resorb calcium phosphate-coated plates, and F-actin ring formation.LTE reduced RANKL-induced activation of the MAPKs ERK, JNK, and p38 and the production of the transcription factors c-Fos and NFATc1 required for osteoclastogenesis. LTE also reduced the expression of osteoclastogenesis-related genes such as matrix metalloproteinase-9, tartrate-resistant acid phosphatase, and receptor activator of NF-κB. These findings suggest that LTE might be a promising treatment option for bone disorders caused by aberrant osteoclast production and function.

Although adriamycin (Doxorubicin) is one of the most effective and useful antineoplastic agents for the treatment of a variety of malignancies, its repeated administration can induce irreversible myocardial damage and resultant heart failure. Currently, no marker to detect early cardiac damage is available. The purpose of this study was to investigate whether an assessment of the acoustic properties of the myocardium could enable the earlier detection of myocardial damage after adriamycin chemotherapy. Forty Wistar rats were treated with adriamycin (2 mg/kg, i.v.) once a week for 2, 4, 6 or 8 weeks consecutively. Left ventricular ejection fraction (LVEF) was calculated using M-mode echocardiography data. The magnitude of cardiac cycle dependent variation of integrated backscatter (CVIB) of the myocardium was measured in the mid segment of the septum and in the posterior wall of the left ventricle, using a real time two dimensional integrated backscatter imaging system. LVEF was significantly lower in the adriamycin-treated 8-week group than in the controls (75 +/- 9 vs 57 +/- 8%, p < 0.05). Myocyte damage was only seen in the 8-week adriamycin-treated group. However, no significant changes of CVIB were observed between baseline or during follow-up in the ADR or control group. In conclusion, serial assessment of the acoustic properties of the myocardium may not be an optimal tool for the early detection of myocardial damage after doxorubicin chemotherapy in a rat model.
Animals ; Antibiotics, Antineoplastic/*toxicity ; Cardiomyopathies/*chemically induced/*ultrasonography ; Disease Models, Animal ; Doxorubicin/*toxicity ; *Echocardiography ; Male ; Rats ; Rats, Wistar ; Research Support, Non-U.S. Gov't

The remnant cystic duct or gallbladder neck calculus may rarely result in post-cholecystectomy Mirizzi syndrome. Various managements have been proposed for the treatment of post-cholecystectomy Mirizzi syndrome. Some previous cases of post-cholecystectomy Mirizzi syndrome have been managed with open cholecystectomy and endoscopically. We report a case of a laparoscopic stone removal of post-cholecystectomy Mirizzi syndrome that developed 7 months after laparoscopic cholecystectomy. To our knowledge, this is the first case of laparoscopic management of post-cholecystectomy Mirizzi syndrome. The mechanism, diagnosis and treatment of post-cholecystectomy Mirizzi syndrome are discussed.
Calculi ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cystic Duct ; Gallbladder ; Gallstones ; Mirizzi Syndrome ; Neck