BACKGROUND: The criteria established by Light et al in 1972 have been used widely for the differential diagnosis of the pleural effusions in transudates and exsudates. However, in recent years, several reports have agreed that these criteria misclassified an important number of effusions. For this reason, different parameters have been proposed for differentiation the transudates from exudates. Nevertheless, all these alternative parameters have not been better than the past criteria of Light et al. In response the usefulness of two parameters for differentiation pleural transudate from exudates were evaluated : pleural fluid cholinesterase level and pleural fluid to serum cholinesterase ratio. METHODS: A total of forty-three patient with know causes of the pleura effusion by diagnostic thoracentesis were studied. The following criteria for differentiating the pleural effusions in transudates and exsudates were analyzed : Light's criteria, the pleural fluid cholesterol level, the pleural fluid to serum cholesterol ratio. the pleural fluid cholinesterase level, and the pleural fluid to serum cholinesterase ratio. RESULTS: The conditions of forty-three patients were diagnosed. Ten were classified as having transudates and thirty-three as exudates. The percentage of effusions misclassified by each parameter was as follows : Light's criteria, 9.3% ; pleural fluid cholesterol, 2.3% ; pleural fluid to serum cholesterol ratio, 2.3% ; pleural fluid cholinesterase, 4.7% ; and pleural fluid to serum cholinesterase ratio, 2.3%. CONCLUSIONS: The pleural fluid to serum cholinesterase ratio is one of the accurate criteria for differentiating pleural transudates from exudates. If further studies confirm these results, the cholinesterase ratio could be used as the first step in the evaluation of pleural effusion and if evaluated together with the other criteria, the differentiation of pleural transudate from exsudates will become more accurate.
Cholesterol ; Cholinesterases* ; Diagnosis, Differential* ; Exudates and Transudates* ; Humans ; Pleura ; Pleural Effusion

A 32-year-old man was transferred to an intensive care unit due to respiratory difficulties with a 4-day history of progressive areflexic quadriparesis following acute hepatitis A. A nerve-conduction study revealed inexcitability of most nerves. The cerebrospinal fluid showed albuminocytologic dissociation, suggesting Guillain-Barre syndrome (GBS). The patient appeared brain dead on day 4, showing absent brainstem reflexes, respiratory failure, and fully dilated and fixed pupils. This case is an example of how GBS can evolve and simulate a brain-dead state from fulminant deafferentation following acute hepatitis A.
Adult ; Brain Death ; Brain Stem ; Cerebrospinal Fluid ; Guillain-Barre Syndrome* ; Hepatitis A* ; Hepatitis* ; Humans ; Intensive Care Units ; Pupil Disorders ; Quadriplegia ; Reflex ; Respiratory Insufficiency

In closed calcaneus fractures, the occurrence of FHL interposition in subtalar joint is relatively rare and difficult to diagnosis preoperatively. But careful physical examination and significant radiologic findings could be useful tools to diagnosis preoperatively. This findings is shearing off a superior medial fragment made up of the sustentaculum talus connected to a significant portion of the medial wall and medial aticular surface of the posterior facet.
Calcaneus* ; Diagnosis ; Physical Examination ; Subtalar Joint ; Talus ; Tendons*

No abstract availble
Antimetabolites, Antineoplastic/*adverse effects/therapeutic use ; Colon/pathology/radiography ; Colonoscopy ; Enterocolitis, Pseudomembranous/diagnosis/*etiology ; Fluorouracil/*adverse effects/therapeutic use ; Humans ; Male ; Middle Aged ; Rectal Neoplasms/*drug therapy ; Tomography, X-Ray Computed

Turnip yellow mosaic virus (TYMV) is a spherical plant virus that has a single 6.3 kb positive strand RNA as a genome. Previously, we have made the recombinant TYMV construct containing a 0.7 kb eGFP gene or a 1.8 kb GUS gene. The genomic RNAs from these constructs were efficiently encapsidated. To examine in more detail whether size constraint exists for replication and packaging of TYMV, we have inserted into the TY-GUS an extra sequence derived from either eGFP or GUS. We also made a recombinant containing RNA1 sequence of Flock house virus. These TYMV recombinants were introduced into Nicotiana benthamiana leaves by agroinfiltration. Northern blot analysis of the viral RNAs in the agroinfiltrated leaves showed that the genomic RNA band from the recombinant TYMV became weaker as longer sequence was inserted. The result also showed that the efficiency of genomic RNA encapsidation decreased sharply when an extra sequence of 2.2 kb or more was inserted. In contrast, the recombinant subgenomic RNA containing an extra sequence of up to 3.2 kb was efficiently encapsidated. Overall, these results show that size constraint exists for replication and encapsidation of TYMV RNA.
Blotting, Northern ; Genome ; Genome Size* ; Plant Viruses ; Product Packaging* ; RNA ; RNA, Viral ; Tobacco ; Tymovirus*

PURPOSE: Laparoscopic totally extraperitoneal herniorrhaphy (TEP) was developed as an alternative treatment of inguinal hernias to open hernia repair. This study evaluated 92 cases of laparoscopic surgery to determine the effectiveness and safety of laparoscopic TEP. METHODS: Laparoscopic TEP was performed on 92 patients with inguinal hernias from January 2008 to December 2010. Through a retrospective study of these patients, information om TEP repair was collected including the patients' characteristics, operation time, hospital stay, analgesic use and related complications. RESULTS: Laparoscopic herniorrhaphy were performed on a total of 92 patients (85 men and 7 women, age ranging from 16 to 83 years, with a mean of 56 years). The mean operation time for a unilateral inguinal hernia and bilateral inguinal hernia was 58.7 and 84.2 min, respectively. The mean postoperative hospital stay was 4.0 days (range, 2~9 days). Thirty nine patients were discharged without an analgesic injection, whereas 36 patients were injected with analgesic on the day of surgery. Of these 92 procedures, 10 complications were recorded; one granuloma complication, two patients with operation site discomfort, five with urinary retention issues, one patient with a scrotal seroma, and one patient with scrotal edema. CONCLUSION: TEP repairs have minimal morbidity and are more effective with less pain than the open procedure. TEP repair can be considered a favorable procedure for patients who request minimally invasive procedures for inguinal hernia repairs.
Female ; Granuloma ; Hernia ; Hernia, Inguinal ; Herniorrhaphy ; Humans ; Laparoscopy ; Length of Stay ; Male ; Pyrazines ; Retrospective Studies ; Seroma ; Urinary Retention

PURPOSE: Although a fasciocutaneous perforator artery as a vascular pedicle has previously been shown to be predominant in the anterolateral thigh (ALT) flap, recent studies have shown that a myocutaneous perforator artery is predominant. We have attempted to attain a clinical understanding of the vascular variations in the ALT flap. MATERIALS AND METHODS: We confirmed the origin of a perforator artery in 11 cases of ALT flap. We then reviewed the variations of the descending branch of the lateral femoral circumflex artery, known as the major origin of the flap, and the overall variations associated with an ALT flap. RESULTS: In a total of 11 cases, there were 18 perforator arteries of the ALT flaps. In addition, there were 9 fasciocutaneous perforator arteries and another 9 myocutaneous ones. However, depending on the origin, there was great variability in the perforator artery. That is, there were unique variants in the descending branches of the lateral femoral circumflex artery, the major origin of the perforator artery, in 3 of the total 11 cases. CONCLUSION: Our results showed that (1) a perforator artery accounts for the high proportion of fasciocutaneous ones, (2) a perforator artery might not originate from the descending branch of the lateral femoral circumflex artery and (3) there might be unique variants in the descending branch. If considering this, surgeons would successfully elevate an ALT flap.
Arteries ; Perforator Flap ; Thigh

PURPOSE: To find out the consequences of the surgical treatment of acromioclavicular joint dislocation, using modified Phemister technique with Mersilene tape augmentation. MATERIALS AND METHODS: We chose 26 patients who were able to follow up 1 year or more among the patients who were diagnosed as acromioclavicular joint dislocation in our hospital through February 2001 to March 2003 and took modified Phemister surgery with Mersilene tape augmentation. Patients with clavicle fracture were excluded. Evaluation of the surgical results was done with the condition or pain, function, range of motion by using Imatani evaluation system, and preoperative, postoperative and last follow up radiographs. RESULTS: Most of the cases showed satisfactory result. Clinical evaluations were 16 excellent (62%), 10 good (38%), radiological evaluations were 14 excellent (54%), 10 good (38%), 2 fair (8%), and no poor group. On the final follow up six cases showed vertical translation, but none had clinical symptoms. Seven cases showed a little inflammation at where pin were inserted, but after the removal of the pin, the inflammation was gone. CONCLUSION: The modified Phemister surgery for acromioclavicle dislocation is simple, but we can obtain strong fixation, and there is no burden of the removal of the metal plate, or complication of re- dislocation after the removal of the pin, so it is thought as a very effective surgery.
Acromioclavicular Joint* ; Clavicle ; Dislocations* ; Follow-Up Studies ; Humans ; Inflammation ; Range of Motion, Articular

BACKGROUND: Kidney transplant recipients inevitably take a life-long immunosuppressive medication to prevent graft rejection. Non-compliance to immunosuppressive medication is one of the main causes leading to acute and chronic rejection and diminished renal function, resulting in a return to dialysis, increased morbidity, or mortality with an additional health care cost and poor quality of life. The purpose of this study was to investigate actual medication compliance and its related factors. METHODS: A total of 222 functioning kidney transplant recipients were surveyed in a single center, and 25 patients were excluded due to incomplete responses. We reviewed medical records retrospectively, and the data were statistically analyzed with SPSS version 13.0. RESULTS: Among 197 patients, 113 (57.4%) were compliant to the immunosuppressive agents, and 84 (42.6%) recipients were non-compliant. Non-compliant patients were significantly younger (P=0.004), highly educated (P=0.004), employed (P=0.005), more likely to live alone (P=0.035), and drank more (P=0.001) than the compliant patients. Regarding psychosocial factors, more barriers (P=0.015), weak beliefs about the necessity of taking medications (P=0.001), strong beliefs about specific concerns related to medications (P=0.038), and low self efficacy (P=0.003) were identified in the non-compliant group compared with the compliant group. CONCLUSIONS: This study revealed that multiple factors affected medication compliance in patients taking immunosuppressants. It would be helpful to identify potential recipients with a risk for non-compliance based on their general characteristics and psychosocial factors, so they can be provided a specialized education program to promote compliance. This strategy may help produce more favorable long-term outcomes among kidney transplant recipients.
Compliance ; Dialysis ; Graft Rejection ; Health Care Costs ; Humans ; Immunosuppressive Agents ; Kidney ; Kidney Transplantation ; Medical Records ; Medication Adherence ; Quality of Life ; Rejection (Psychology) ; Retrospective Studies ; Self Efficacy

With the increased use of implantable cardiac devices, the incidence of hardware problems has also increased. Some of the hardware problems might be induced by patient factors. We experienced recurrent pacemaker lead fracture and dislocation after permanent pacemaker implantation. The patient was a bus driver who used his left arm vigorously when he turned the steering wheel. After a new lead was inserted via an axillary vein approach and the patient changed his occupation, no more lead problems have occurred. When a recurrent hardware problem with an implantable pacemaker or defibrillator occurs, patient factors related to anatomy or behavior must be considered.
Arm ; Atrioventricular Block ; Axillary Vein ; Defibrillators ; Dislocations ; Humans ; Incidence ; Occupations