BACKGROUND: We reviewed retrospectively the clinical features and contrast material-enhanced computed tomography(CT) after blunt abdominal trauma demonstrated a characteristic hypoperfusion complex. Our purpose were to evaluate the hypothesis that children with this 'hypoperfusion complex' CT finding were associated with a tenuous hemodynamic state, severe injury and a poor outcome. METHODS: Between January 1996 and December 1999, 39 consecutive children who sustained blunt trauma and were suspected clinically of having intraabdominal injury underwent CT. Demographic data, blood pressure, indication for CT, pediatric trauma score(PTS) and Glasgow coma score(GCS) were recorded at the time of the initial examination. RESULTS: Three of the 39 children(8%) demonstrated a characteristic finding at CT which was described as the hypoperfusion complex. The 'hypoperfusion complex' was present in the 3 of the 39 traumatized children(8%), but was the main radiographic finding in the 3 of the 14 children with a severe pediatric trauma score(PTS<8) and in the 3 of the 6 children with a Glasgow coma score(GCS<8) who were examined with CT. CONCLUSION: The CT finding in all children with the hypoperfusion complex by definition included marked, diffuse dilatation of the intestine with fluid; abnormally intense contrast enhancement of the bowel wall, mesentery, kidney and/or pancreas; decreased caliber of the abdominal aorta and inferior vena cava(IVC); and moderate to large peritoneal fluid collection. This 'hypoperfusion complex' is a relatively rarely observed in injured children but appears to be associated with severe injury and a poor outcome. The pediatric trauma score provides a useful profile of injury severity in children. Prompt diagnosis of hypovolemic shock is important so that supportive therapy can be instituted to prevent further metabolic abnormalities and their potential cardiotoxic effects. In summary, the intense multiorgan enhancement pattern seen in the hypoperfusion complex indicates tenuous hemodynamic stability and is associated with a poor outcome.
Aorta, Abdominal ; Ascitic Fluid ; Blood Pressure ; Child* ; Coma ; Diagnosis ; Dilatation ; Hemodynamics ; Humans ; Hypovolemia* ; Intestines ; Kidney ; Mesentery ; Pancreas ; Retrospective Studies ; Shock* ; Tomography, X-Ray Computed*

Radiofrequency lesioning is a valuable tool for third occipital headache. Relative to most neural targets, a radiofrequency lesion is very small. Reliable pre-operative diagnosis of the nociceptive source is critical, as inappropriately placed lesions will not modulate pain. Knowledge of the anatomical courses of nerves and extremely precise electrode placement are required for accurate lesioning. This report describes our experience with RF lesioning in the treatment of chronic pain in two patients who suffered from third occipital headaches. In one patient, satisfactory improvement of the pain was observed after 10 months of follow up.
Chronic Pain ; Diagnosis ; Electrodes ; Follow-Up Studies ; Headache ; Humans ; Mouth*

BACKGROUNDING/AIMS: Although several papers provided evidence of a survival advantage for preoperative transcatheter arterial chemoembolization(TAE), recent studies have revealed that patients with resectable tumors have not been benefited from this adjuvant therapy. This study has been done for investigating the effect of the preoperative TAE with resectable hepatocellular carcinoma(HCC) which were diagnosed and treated by surgery and surgery with TAE by analysis and comparison with patient's survival rate between two different methods of treatment. METHODS: We retrospectively reviewed the medical records of 39 patients who underwent the hepatic resection for hepatocellular carcinoma at Chonnam National University Hospital between 1986 and 1997. Median follow-up period was 28 months. Survival rates were estimated by Kaplan-Meier method and difference was detected by Log-rank test using SPSS program.. RESULTS: Male patients were 28 and female were 11 and their mean age was 54.4 years. The patients treated by operation alone were 17 and by preoperative TAE with operation were 22. A reduction of tumor size was achived in 13 of the 22 patients(59.1%) who underwent preoperative TAE. The cumulative survival rate of 1 year, 2 year, 3 year were 90%, 84%, 70% in patients treated by operation alone, 86%, 75%, 52% in patients treated by preoperative TAE and operation respectively. And the relative risk of death for TAE with operation and operation alone was 0.974. The postoperative mean liver function test of the patients who underwent preoperative TAE was higher than those who did not. CONCLUSIONS: The advantage of preoperative TAE with resectable HCC still remains disputable. However, preoperative TAE has the advantage of reducing tumor size and make it easy to operate and decrease the resection field. But the liver function after TAE may deteriorate in some of the patients with liver dysfunction. In conclusion, preoperative TAE must not be performed for resectable HCC as a routine procedure because the overall survival rate was similar between the two groups.
Carcinoma, Hepatocellular* ; Female ; Follow-Up Studies ; Humans ; Jeollanam-do ; Liver ; Liver Diseases ; Liver Function Tests ; Male ; Medical Records ; Prognosis* ; Retrospective Studies ; Survival Rate

BACKGROUND AND OBJECTIVES: Intraoperative echocardiography (IOE), mostly done by transesophageal methods, provides an important means of accessing cardiac structure and function during cardiac and noncardiac surgery. The purpose of this study was to determine the role of IOE by identifying the frequency of the use of IOE during cardiac surgery, the rate of second pump operations determined by IOE findings, and the results of the operations. SUBJECTS AND METHODS: Sixty-five patients (93 lesions) underwent cardiac surgery with the concomitant IOE done by a cardiologist in a single institution between March 1997 and October 1998. The data was collected retrospectively by reviewing the hospital records and IOE videotapes. IOE was applied to 18.9% of total cardiac operations, primarily being used in MV surgery (48.4%). A pre-pump IOE was done in 2 cases and the post-pump procedure was done in the remainder. A second pump operation was performed in 4 cases (6.25%) and all of these were found to be successful after immediate re-operation. CONCLUSION: IOE was primarily used in valve operations, particularly in procedures involving the mitral valve. IOE appears to be useful in determining the immediate results following cardiac surgery and may contribute to determining the prognosis of the patient.
Echocardiography ; Echocardiography, Transesophageal* ; Hospital Records ; Humans ; Mitral Valve ; Monitoring, Intraoperative ; Prognosis ; Retrospective Studies ; Thoracic Surgery ; Videotape Recording

Complex Regional Pain Syndromes (CRPS) type I and type II are neuropathic pain conditions that are being increasingly recognized in children and adolescents. The special distinctive features of pediatric CRPS are the milder course, the better response to treatment and the higher recurrence rate than that of adults and the lower extremity is commonly affected. We report here on a case of pediatric CRPS that was derived from ankle trauma and long term splint application at the left ankle. The final diagnoses were CRPS type I in the right upper limb, CRPS type II in the left lower limb and unclassified neuropathy in the head, neck and precordium. The results of various treatments such as medication, physical therapy and nerve blocks, including lumbar sympathetic ganglion blocks, were not effective, so implantation of a spinal cord stimulator was performed. In order to control the pain in his left lower limb, one electrode tip was located at the 7th thoracic vertebral level and two electrode tips were located at the 7th and 2nd cervical vertebral levels for pain control in right upper limb, head, neck and right precordium. After the permanent insertion of the stimulator, the patient's pain was significantly resolved and his disabilities were restored without recurrence. The patient's pain worsened irregularly, which might have been caused by psychological stress. But the patient has been treated with medicine at our pain clinic and he is being followed up by a psychiatrist.
Adolescent ; Adult ; Ankle ; Causalgia ; Child ; Complex Regional Pain Syndromes ; Diagnosis ; Electrodes ; Ganglia, Sympathetic ; Head ; Humans ; Lower Extremity ; Neck ; Nerve Block ; Neuralgia ; Pain Clinics ; Psychiatry ; Recurrence ; Spinal Cord Stimulation* ; Spinal Cord* ; Splints ; Stress, Psychological ; Upper Extremity

Cystic fibrosis is a autosomal recessive genetic disease. Among Caucasians, it is the most common cause of pulmonary insufficiency during the first three decades of life. The prevalence of cystic fibrosis varies according to ethnic origin: it is common among Caucasians but rare among Asians. We report a case in which cystic fibrosis with bronchiectasis and hyperaeration was revealed by high-resolution CT, and mutation of the cystic fibrosis conductance transmembrane regulator gene (CFTR) by DNA analysis.
Asian Continental Ancestry Group ; Bronchiectasis ; Cystic Fibrosis* ; DNA ; Genes, Regulator ; Humans ; Prevalence

Granulocyte macrophage-colony stimulating factor (GM-CSF) has immuno-stimulatory effects. We hypothesized that GM-CSF plays an important role both in lipopolysaccharide (LPS)- and hemorrhage-induced acute lung injury (ALI). We also postulated that GM-CSF augments LPS-induced inflammation by priming neutrophils. ALI was induced in GM-CSF-/- or control C57BL mice either by LPS injection or by hemorrhage. Lung inflammation (by lung expression for tumor necrosis factor-alpha (TNF-alpha), macrophage inflammatory protein-2 (MIP-2), interleukin-1beta (IL-1beta), interleukin- 6 (IL-6), and keratinocyte-derived chemokine) and lung injury (by myeloperoxidase and evans blue dye assay) were evaluated after ALI. Incremental doses of LPS (0, 1, 10, and 100 ng/mL) and GM-CSF (0, 1, 10, and 100 ng/mL) were added to bone marrow neutrophils. The expression of TNF-alpha, MIP-2, and IL-1beta was evaluated with enzyme linked immunosorbent assay. The mRNA expression of three cytokines, and the nuclear translocation of nuclear factor kappa B (NF kappa-B) were evaluated by reverse transcriptase-polymerase chain reaction and electropnoretic mobility shift assay, respectively. GM-CSF -/- mice showed decreased neutrophil infiltration, less leakage, and lower expression of cytokines in the lung after LPS or hemorrhage. GM-CSF augmented LPS-induced protein and mRNA expression of TNF-alpha, MIP-2 and IL-1beta, which was mediated by increased intra-nuclear translocation of NF-kappa B. GM-CSF plays an important role in high-dose LPS and hemorrhage-induced ALI, which appears to be mediated by its priming effect on neutrophils.
Animals ; Bone Marrow Cells/cytology ; Chemokine CXCL2/metabolism ; Granulocyte-Macrophage Colony-Stimulating Factor/metabolism/*physiology ; Interleukin-1beta/metabolism ; Lipopolysaccharides/metabolism ; Lung/metabolism/pathology ; *Lung Injury ; Male ; Mice ; Mice, Inbred BALB C ; Mice, Inbred C57BL ; Mice, Transgenic ; Neutrophils/*cytology/metabolism ; Peroxidase/metabolism ; Tumor Necrosis Factor-alpha/metabolism

A 69-year-old female patient visited the emergency room with fever (38.3degrees C) and dyspnea. She had been taking prednisolone (5 mg once per day) and methotrexate (2.5 mg once per week) for rheumatoid arthritis for 2 years. Chest computed tomography (CT) showed bilateral, multifocal ground glass opacity with interlobular septal thickening. Peripheral blood leukocyte count was 6,520/mm3 (neutrophils, 77.4%; eosinophils, 12.1%). During the night, mechanical ventilation was initiated due to the development of severe hypoxemia. Bronchoalveolar lavage fluid showed a high proportion of eosinophils (49%). Her symptoms improved dramatically after commencement of intravenous methylprednisolone therapy. This is the first report of idiopathic acute eosinophilic pneumonia developing in a current user of systemic corticosteroids.
Adrenal Cortex Hormones ; Anoxia ; Arthritis, Rheumatoid ; Bronchoalveolar Lavage Fluid ; Dyspnea ; Emergencies ; Eosinophils ; Female ; Fever ; Glass ; Humans ; Leukocyte Count ; Methotrexate ; Methylprednisolone ; Prednisolone ; Pulmonary Eosinophilia ; Respiration, Artificial ; Respiratory Insufficiency ; Thorax

Invasive aspergillus tracheobronchitis is uncommon manifestation of infection due to Aspergillus species, occurring in severely immunocompromised patients who are generally neutropenic with haematological diseases, AIDS, or after heart and lung transplantation. The pseudomembranous form is the most severe condition and is usually fatal despite treatment with antifungal agents. However, there are a few cases reported with no apparent severe compromise in the host defences. We encountered a pseudomembranous necrotizing bronchial aspergillosis in a 73-year old male patient, who was treated successfully with antifungal agents.
Aged ; Antifungal Agents ; Aspergillosis* ; Aspergillus ; Heart ; Humans ; Immunocompromised Host ; Lung Transplantation ; Male

Early and accurate differentiation between infectious and non-infectious fever is vitally important in the intensive care unit (ICU). In the present study, patients admitted to the medical ICU were screened daily from August 2008 to February 2009. Within 24 hr after the development of fever (>38.3degrees C), serum was collected for the measurement of the procalcitonin (PCT) and high mobility group B 1 levels. Simplified Acute Physiology Score (SAPS) II and Acute Physiology And Chronic Health Evaluation (APACHE) III scores were also analyzed. Sixty-three patients developed fever among 448 consecutive patients (14.1%). Fever was caused by either infectious (84.1%) or non-infectious processes (15.9%). Patients with fever due to infectious causes showed higher values of serum PCT (7.8+/-10.2 vs 0.5+/-0.2 ng/mL, P=0.026), SAPS II (12.0+/-3.8 vs 7.6+/-2.7, P=0.006), and APACHE III (48+/-20 vs 28.7+/-13.3, P=0.039) than those with non-infectious fever. In receiver operating characteristic curve analysis, the area under the curve was 0.726 (95% CI; 0.587-0.865) for PCT, 0.759 (95% CI; 0.597-0.922) for SAPS II, and 0.715 (95% CI; 0.550-0.880) for APACHE III. Serum PCT, SAPS II, and APACHE III are useful in the differentiation between infectious and non-infectious fever in the ICU.
*APACHE ; Adult ; Aged ; Calcitonin/*blood ; Cohort Studies ; Communicable Diseases/complications/*diagnosis ; Female ; Fever/diagnosis/epidemiology/*etiology ; Humans ; *Intensive Care Units ; Male ; Middle Aged ; Prognosis ; Prospective Studies ; Protein Precursors/*blood ; ROC Curve ; *Severity of Illness Index