Central venous catheterization is well used to provide a large mount of fluid and monitor central venous pressure. However, the procedure accompany various complication including pneumothorax, vascular injury, nerve injury and arrhythmia. To verify correct position of catheter, we checked free regurgitation of blood during catheterization. We experienced a case report of right hemothorax that occurred after right central venous catheterization nevertheless checking correct position by free regurgitation.
Arrhythmias, Cardiac ; Catheterization ; Catheterization, Central Venous ; Catheters ; Central Venous Catheters ; Central Venous Pressure ; Displacement (Psychology) ; Hemothorax ; Organothiophosphorus Compounds ; Pneumothorax ; Vascular System Injuries

It is necessary to distinguish between pyogenic and tuberculous spondylitis of infectious spondylitis, if it is pyogenic spondylitis, antimicrobial therapy should be directed against an identified microorganism and clinical assessment should be done at 4 weeks. But if microorganism is a anaerobic bacteria, especially Peptostreptococcus anaerobius, combination antibiotic therapy should be considered bacause it may be a component of mixed infections as a passenger and have abilities to induce abscesses, other bacterial growth as a synergy effect. In addition, echocardiography may be necessary because pyogenic spondylitis is associated with infective endocarditis about 12%. We report a 64-year-old man who was treated for infectious spondylitis accompanied by Peptostreptococcus anaerobius bacteremia, but had to undergo heart surgery because an attack of infective endocarditis with systemic embolism during hospitalization.
Abscess ; Bacteremia ; Bacteria, Anaerobic ; Coinfection ; Echocardiography ; Embolism ; Endocarditis ; Hospitalization ; Peptostreptococcus ; Spondylitis ; Thoracic Surgery

Multicentric reticulohistiocytosis (MRH) is a rare disease characterized by nodular skin lesions and severe erosive polyarthritis which is associated with malignancy in some cases. The diagnosis is confirmed by the presence of oncocytic histiocytes and multinucleated giant cells on histopathology of the cutaneous nodules and the synovial membrane. It usually remits spontaneously after 5-8 years but it can provoke destructive arthritis. We report a case of a 49-year-old female who presented with numerous nodules on the both hands, face and abdomen and progressive destructive polyarthritis of 3 years duration and has been diagnosed with rheumatoid arthritis. The lesion showed large histiocytes with ground-glass eosinophilic cytoplasm, typical of MRH. Clinical manifestation and radiological pattern of MRH may be misdiagnosed as other disease like rheumatoid arthritis and psoriatic arthritis, but histopathologic findings of our case can differentiate MRH from any other conditions.
Abdomen ; Arthritis ; Arthritis, Psoriatic ; Arthritis, Rheumatoid ; Cytoplasm ; Eosinophils ; Female ; Giant Cells ; Hand ; Histiocytes ; Humans ; Rare Diseases ; Skin ; Synovial Membrane

Klinefelter' syndrome is a disorder of sexual differentiation in males, characterized by the presence of two or more X-chromosomes, hypogonadism, and lack of secondary sexual characteristics. The association between Klinefelter' syndrome and glomerulonephritis has been reported, while cases of glomerulonephritis associated with Klinefelter' syndrome are rare. We report the Korean case: a 31-year-old man with Klinefelter' syndrome who developed glomerulonephritis. The patient's urine analysis shows microscopic hematuria and the result of kidney biopsy was minimal change disease. The onset and course of his disease might have been influenced by the sex hormone imbalance.
Biopsy ; Glomerulonephritis ; Hematuria ; Humans ; Hypogonadism ; Kidney ; Male ; Nephrosis, Lipoid ; Sex Differentiation

4 liters of polyethylene glycol (PEG) solution is commonly used to evacuate the colon before colonoscopy. This substance, however, is known to cause electrolyte abnormalities such as hyponatremia. Seizures caused by hyponatremia associated with bowel preparation have only rarely been reported. We report the case that a 75-year-old woman with no prior history of seizures was developed severe hyponatremia (112 mEq/L) with generalized tonic-clonic seizure and mental change after ingestion of 4L of PEG solution. Past medical history was notable for thiazide diuretics. Her symptoms are improved during intravenous administration of hypertonic saline for the correction of hyponatremia. Patients with impaired ability to excrete free water those with renal insufficiency, hypothyroidism, mineralocorticoid deficiency, liver cirrhosis, or heart failure as well as those taking drugs which including thiazide diuretics, NASIDs, and ACE inhibitors have risk of hyponatremia following bowel preparation for colonoscopy. We conclude that physicians should check patient's condition and electrolyte abnormalities before colonoscopy procedures.
Administration, Intravenous ; Angiotensin-Converting Enzyme Inhibitors ; Colon ; Colonoscopy ; Eating ; Female ; Heart Failure ; Humans ; Hyponatremia ; Hypothyroidism ; Liver Cirrhosis ; Polyethylene ; Polyethylene Glycols ; Renal Insufficiency ; Seizures ; Sodium Chloride Symporter Inhibitors ; Water

Thyrotoxic periodic paralysis is an acute muscle weakness of the limbs associated with hypokalemia. It can occur with any form of thyrotoxicosis. Thyrotoxic periodic paralysis associated with transient thyrotoxicosis due to thyroiditis is very rare. We experienced a case of thyrotoxic periodic paralysis associated with transient thyrotoxicosis. A 39-yr-old man was referred to our hospital because of paralysis of upper and lower extremity. The laboratory results were hypokalemia and mild thyrotoxicosis. A thyroid scan with Tc-99m revealed decreased uptake in the thyroid area compatible with destructive thyroiditis. The paralytic attack did not recur after the patient recovered to euthyroid state.
Extremities ; Humans ; Hypokalemia ; Lower Extremity ; Muscle Weakness ; Paralysis ; Thyroid Gland ; Thyroiditis ; Thyrotoxicosis

Spontaneous rupture of the urinary bladder is a rare clinical entity, with the incidence reported as 1 in 126,000 hospital admissions. It is often associated with malignancy, inflammatory lesions, irradiation, calculus, diverticulum, binge alcohol drinking, continuous bladder irrigation, and neurogenic bladder. In rare instances, bladder rupture occurs without obvious causes. This rare clinical condition is difficult to diagnose because of vague symptoms. High index of suspicion is needed as the mortality rate is high if untreated. A 37-year-old woman with uncontrolled type 2 diabetes, was admitted to the emergency room complaining of progressive abdominal distension and discomfort. She had a past history of tubo-ovarian and bladder abscess, and had undergone multiple surgical operations. From ascites fluid study, she was diagnosed as spontaneous bladder rupture. A transurethral catheter was inserted and the symptoms and signs resolved. Bladder rupture, mimicking acute kidney injury of diabetic nephropathy was disclosed without surgery.
Abscess ; Acute Kidney Injury ; Alcohol Drinking ; Ascites ; Calculi ; Catheters ; Diabetes Mellitus, Type 2 ; Diabetic Nephropathies ; Diverticulum ; Emergencies ; Female ; Humans ; Incidence ; Rupture ; Rupture, Spontaneous ; Urinary Bladder ; Urinary Bladder, Neurogenic

OBJECTIVES: Medical doctors require outstanding communication skills when meeting with their patients. Thus medical student need to education and training about medical communication skill. More attention is being given to the subject but not many studies have been done in the medical education field. As communication skills are provided to students as a subject in medical educational curriculum, the assessment of its effectiveness needs to be undertaken. METHODS: In the year 2010 and 2011, first-year medical students at The Kosin University College of Medicine took 'Communication skills' course in total, 154 first-year medical students survey results was the modified and translated version of 'Beyer-Fetzer's Essential Elements of Communication Skills Assessment Sheet'. The assessment sheets were used as the pre-test and post-test to analyse the differences, which were put through the paired t-test. RESULTS: All categories of communication skills showed an improvement. For year 2010, a statistically significant difference was shown into the 22 questions, whereas in 2011, improvements were shown in all questions. CONCLUSIONS: From the result, it is clear that in order to create an effective communication skills program, the content should be more structured and focused on the program objectives.
Curriculum ; Education, Medical ; Humans ; Students, Medical

OBJECTIVES: To investigate the time course of the development of acquired and experimental lymphedema. METHODS: We studied an experimental model of acute post - surgical lymphedema in the tails of female hairless mice. The procedures that remove the skin and subcutaneous tissue in tails of the mice (5-10 mm from tail base) were performed, and then the murine has acquired lymphatic insufficiency. We measured volume of the tails in 2 times per week for 5 weeks, histological biopsy, and lymphoscintigraphy to assess lymphatic flow. RESULTS: There was gradually increased volume of the tails and observed twice volume at post - surgical 18 days. In lymphoscintigraphy, we identified decreased lymphatic flow and dermal back flow in the tails. Histological biopsy showed inflammatory response that was edema and increased neutrophils in epidermis and subdermis, and lymphatic microvascular dilatation. CONCLUSIONS: We have a mouse model of acute acquired lymphedema. This post - surgical murine tail model of lymphedema can be used to simulate an attribute of human lymphedema and provides knowledge about functional and structural alterations of lymphedema.
Animals ; Biopsy ; Edema ; Epidermis ; Female ; Humans ; Lymphedema ; Lymphoscintigraphy ; Mice ; Mice, Hairless ; Models, Animal ; Models, Theoretical ; Neutrophils ; Skin ; Subcutaneous Tissue ; Tail

OBJECTIVES: Clinical features according to the frequency of phototherapy and clinical risk factors on the number of phototherapy were investigated in premature births with gestation <35 weeks and birth weight < or =2,500 g. METHODS: The 186 infants with gestation <35 weeks and birth weight < or =2,500 g were admitted to the neonatal intensive care unit of Kosin University Gospel Hospital from March 2009 to August 2010. The 171 infants were alive and had jaundice requiring phototherapy. Phototherapy was usually started to 50-70% of the maximal bilirubin level. They were divided into two groups according to the frequency of phototherapy as single phototherapy group (group I) and multiple phototherapy group (group II). We retrospectively reviewed the medical records of all patients. RESULTS: The mean gestational age and birth weight of group I were 31.0+/-2.9 weeks and 1,596+/-485 g and those of group II were 31.1+/-2.6 weeks and 1,592+/-430 g. Compared with group I, albumin and Apgar score at 1 minute of group II were significantly higher and the day of peak bilirubin was also late. Duration of phototherapy in group II was statistically longer than that group I but duration of ventilator and aminophylline use for apnea was significantly shorter. The frequency of antibiotic use, incidence of bronchopulmonary dysplasia (BPD), and intraventricular hemorrhage (IVH) of group II were significantly lower than those of group I. CONCLUSIONS: The day of peak bilirubin was late and the frequency of antibiotic use, incidence of BPD, and IVH were low in group II. The aggressive phototherapy may be considered in premature births with jaundice.
Aminophylline ; Apgar Score ; Apnea ; Bilirubin ; Birth Weight ; Bronchopulmonary Dysplasia ; Gestational Age ; Hemorrhage ; Humans ; Incidence ; Infant ; Infant, Newborn ; Intensive Care, Neonatal ; Jaundice ; Medical Records ; Parturition ; Phototherapy ; Pregnancy ; Premature Birth ; Retrospective Studies ; Risk Factors ; Ventilators, Mechanical