A close relationship has emerged between obstructive sleep apnea (OSA) and cardiac arrhythmia. However, transient sinus arrest or atrioventricular (AV) conduction disturbance during rapid eye movement (REM) sleep was rarely reported. This sleep stage specific arrhythmia has been referred to as REM sleep-related bradyarrhythmia syndrome. The differential diagnosis between OSA-related arrhythmia and REM sleep-related bradyarrhythmia syndrome is important in determining the treatment strategy for the underlying disease and its complication, especially in patient with a history of OSA. Here, we report a case with both REM sleep-related AV block and severe OSA, whose REM sleep-related AV block was not improved with continuous positive airway pressure treatment.
Arrhythmias, Cardiac ; Atrioventricular Block ; Bradycardia ; Continuous Positive Airway Pressure ; Diagnosis, Differential ; Humans ; Sleep Apnea, Obstructive ; Sleep Stages ; Sleep, REM

PURPOSE: To compare various breath-hold T2 weighted sequences in imaging normal pancreas with a phased-arraycoil. MATERIALS AND METHODS: Eighteen patients without pancreatic disease were studied with breath-hold turbo spinecho (TSE) (TR/TE/ETL, 3500/138/29), TSE with fat suppression (FS-TSE), half-Fourier acquisition single-shot turbospin echo (HASTE) (TE/ETL, 87/128) and HASTE with fat suppression (FS-HASTE) at 1.0T magnet strength and using aphased-array coil. Signal difference-to-noise ratio (SD/N) between the pancreas and peripancreatic fat wasmeasured ; the delineation of the pancreatic border and pancreatic duct, and the amount of artifact were evaluatedby two radiologists who reached a consensus. RESULTS: HASTE showed a higher SD/N than TSE or FS-HASTE (p < 0.01),TSE was superior to FS- TSE or HASTE in the delineation of pancreatic border(p < 0.001). HASTE was superior to TSEin the delineation of pancreatic duct(p < 0.001). TSE showed more artifacts than FS-TSE(p < 0.001) ; HASTE andFS-HASTE showed no artifact. CONCLUSION: TSE is better than HASTE for the delineation of pancreatic margin but HASTE shows less artifacts and a more conspicuous pancreatic duct. Fat suppression decreases artifacts but makes the pancreatic margin indistinct.
Artifacts ; Consensus ; Humans ; Magnetic Resonance Imaging* ; Pancreas* ; Pancreatic Diseases ; Pancreatic Ducts

PURPOSE: Snowboarding accidents may cause severe injury due to the advanced skills required of Olympic athletes and the faster speed compared to many other sports. The aim of this study was to describe environmental characteristics of snowboarding injuries and to determine the level of medical support using injury analysis. METHODS: A descriptive epidemiology study was conducted with collection of data from the Federation Internationale de Ski (FIS) Snowboard Competition from January 14 to 24 in 2009. Data from the Competition Operation Committee records, medical records and competition regulations were selected for analysis. RESULTS: In this study, 31/524 competitors reported injuries, predominantly sprains and contusions (21 cases), including eight fractures. Analysis of the physical distribution of these injuries indicated ten injuries of an upper extremity (32%), seven of a lower extremity (23%), six in the head/neck region (19%), and five spinal injuries (16%). The majority (23/31) of these injuries occurred during the snowboard cross (SBX) events. Environmental factors including the course visibility and slope conditions impacted the frequency of injury during the competition. In addition, the arrival times of medical teams were longer for the SBX events (260+/-92 sec) than for the Parallel Giant Slalom (202+/-54 sec) and other snowboarding events (<60 sec). CONCLUSION: The frequency and severity of injuries were highest in the SBX competition. For injury prevention, we recommend increased focus on safety on the SBX course, consideration of weather and other environmental conditions, and a rapid emergency medical support response for injury management.
Athletes ; Contusions ; Emergencies ; Epidemiology ; Humans ; Lower Extremity ; Medical Records ; Medical Staff ; Skiing ; Social Control, Formal ; Spinal Injuries ; Sports ; Sprains and Strains ; Upper Extremity ; Weather ; Wounds and Injuries

We report a hemolytic transfusion reaction with acute intravascular hemolysis due to anti-Jkb in a 49-year-old woman with uterine myoma. A patient experienced chills, fever, and red color urine following the transfusion of 1.25 units of packed red cells, shown to be compatible by the conventional cross-matching tube method. She had been received two units transfusion 3 weeks ago and there was no transfusion reaction at that time. One day after transfusion, her laboratory data showed total bilirubin 2.7 mg/dL, LDH 2,310 IU/L, and a trace positive direct antiglobulin test. Irregular antibody screening test was negative by the conventional tube methods but anti-Jkb was identified by column agglutination method. The presence of anti-Jkb provided an explanation for the acute hemolytic reaction. The hemolytic transfusion reaction was secondary responses following the previous transfusion. She showed severe hemoglobinuria, but renal failure did not develop and she was fully recovered with maintaining adequate renal output with IV diuretics.
Agglutination ; Bilirubin ; Blood Group Incompatibility* ; Chills ; Coombs Test ; Diuretics ; Female ; Fever ; Hemoglobinuria ; Hemolysis ; Humans ; Leiomyoma ; Mass Screening ; Middle Aged ; Renal Insufficiency

No abstract available.
Aconitum* ; Arrhythmias, Cardiac* ; Cardiopulmonary Resuscitation*

"Tumor-to-tumor" metastasis is a rare event; meningioma has been reported as the most common primary intracranial tumor to harbor cancer metastases. Several hypotheses have been previously proposed to explain this occurrence, but the exact mechanism by which these metastases develop into meningiomas is not yet understood. Magnetic resonance imaging and spectroscopy have been valuable diagnostic tools, but preoperative diagnosis of metastasis to meningioma remains highly difficult. We present a case report of a metastasis of non-small cell lung cancer into an intracranial meningioma.
Carcinoma, Non-Small-Cell Lung ; Carcinoma, Small Cell ; Lung Neoplasms ; Magnetic Resonance Imaging ; Meningioma ; Neoplasm Metastasis ; Spectrum Analysis

BACKGROUN: Neointimal hyperplasia is major cause of instent restenosis in coronary artery and stenosis in arteriovenous fisula for hemodialysis. Erythropoietin is known to show proliferative effect on vascular smooth muscle cells in vitro study, but there is few in vivo study. This study investigated the effect of erythropoietin given subcutaneously to injured carotid arteries of rats on neointimal hyperplasia. METHODS: Sprague-Dawley rat underwent common carotid artery (CCA) balloon injury. Erythropoietin was given subcutaneously to balloon-injured rats (n=6) in 100 U/Kg/week by dividing three times. The control group (n=6) was treated with normal saline only. Two weeks later, the lumen and the neointimal area were obtained and compaired. Actively proliferating cells of neointimal area were observed by microscopy using PCNA staining method. RESULTS: Luminal area was 0.233 +/- 0.073 mm2, 0.112 +/- 0.047 mm2 in the control and the erythropoietin treated group respectively. The area was significantly smaller in the treatment group (p<0.05). Neointimal area and neointimal area/medial area ratio were 0.148 +/- 0.029 mm2, 0.226 +/- 0.056 mm2 and 1.169 +/- 0.146 min, 1.953 +/- 0.465 min in the control and the erythropoietin treated group respectively (p<0.05), but no significant difference was observed in medial area between the control and the erythropoietin treated group. Actively proliferating cells of neointimal area were more commonly observed in erythropoietin treated group. CONCLUSION: Erythropoietin increases neointimal cell proliferation in the rat carotid artery injury model. So, erythropoietin treatment may contributes to the development of arteriovenous fistula stenosis caused by neointimal hyperplasia but, further studies are required to elucidate the mechanism and the effect of erythropoietin at various time and dose in neointimal hyperplasia.
Animals ; Arteriovenous Fistula ; Carotid Arteries* ; Carotid Artery Injuries* ; Carotid Artery, Common ; Cell Proliferation ; Constriction, Pathologic ; Coronary Vessels ; Erythropoietin* ; Hyperplasia* ; Microscopy ; Muscle, Smooth, Vascular ; Phenobarbital ; Proliferating Cell Nuclear Antigen ; Rats* ; Rats, Sprague-Dawley ; Renal Dialysis

The 12th rib syndrome is a disease that causes pain between the upper abdomen and the lower chest. It is assumed that the impinging on the nerves between the ribs causes pain in the lower chest, upper abdomen, and flank. A 74-year-old female patient visited a pain clinic complaining of pain in her back, and left chest wall at a 7 on the 0-10 Numeric Rating scale (NRS). She had a lateral fixation at T12-L2, 6 years earlier. After the operation, she had multiple osteoporotic compression fractures. When the spine was bent, the patient complained about a sharp pain in the left mid-axillary line and radiating pain toward the abdomen. On physical examination, the 10th rib was not felt, and an image of the rib-cage confirmed that the left 10th rib was severed. When applying pressure from the legs to the 9th rib of the patient, pain was reproduced. Therefore, the patient was diagnosed with 9th rib syndrome, and ultrasound-guided 9th and 10th intercostal nerve blocks were performed around the tips of the severed 10th rib. In addition, local anesthetics with triamcinolone were administered into the muscles beneath the 9th rib at the point of the greatest tenderness. The patient's pain was reduced to NRS 2 point. In this case, it is suspected that the patient had a partial resection of the left 10th rib in the past, and subsequent compression fractures at T8 and T9 led to the deformation of the rib cage, causing the tip of the remaining 10th rib to impinge on the 9th intercostal nerves, causing pain.
Abdomen ; Abdominal Pain ; Aged ; Anesthetics, Local ; Female ; Fractures, Compression ; Humans ; Intercostal Nerves ; Leg ; Muscles ; Neuralgia ; Pain Clinics ; Physical Examination ; Ribs* ; Spine ; Thoracic Wall ; Thorax ; Triamcinolone

PURPOSE: To analyze the optical coherence tomographic patterns and clinical courses of patients with diabetic macular edema (DME) after treatment. METHODS: The charts of 65 patients with DME were retrospectively reviewed. Baseline optical coherence tomographic patterns of DME were categorized into the 4 groups: group 1 (9 eyes, 13.8%) showed diffuse retinal thickening, group 2 (21 eyes, 32.3%) had cystoid macular edema (CME), group 3 (13 eyes, 20.0%) demonstrated serous retinal detachment (SRD) and group 4 (22 eyes, 33.9%) had combined CME and SRD. Treatments for DME included intravitreal bevacizumab/triamcinolone injection, focal laser photocoagulation and vitrectomy. During 12 months of follow-up, changes in the patterns of DME were assessed. Additionally, the central retinal thickness (CRT) and best-corrected visual acuity (BCVA) were measured at baseline, 6 and 12 months. RESULTS: During 12 months of follow-up, 21 eyes (32.3%) showed changes in the DME pattern: 2 eyes (22.2%) in group 1, 3 (14.3%) in group 2, 4 (30.8%) in group 3 and 12 (54.5%) in group 4. A significantly greater proportion of eyes with changes in DME pattern underwent vitrectomy compared with those without changes in DME pattern (p = 0.012). There was a significant difference in CRT among the 4 groups; group 4 demonstrated the largest CRT at baseline, 6 and 12 months (p < 0.001, 0.002 and 0.029, respectively). However, there were no significant differences in BCVA among the 4 groups at baseline, 6 or 12 months (p = 0.879, 0.375 and 0.246, respectively). CONCLUSIONS: Clinical courses varied according to the tomographic patterns of DME after treatment, and the poorest anatomic outcome was found in group 4. Change in tomographic pattern of DME was correlated with the treatment of DME, which might suggest a poorer outcome in those patients than in the patients who maintained their DME patterns.
Follow-Up Studies ; Humans ; Light Coagulation ; Macular Edema* ; Prognosis ; Retinal Detachment ; Retinaldehyde ; Retrospective Studies ; Tomography, Optical Coherence ; Visual Acuity ; Vitrectomy

No abstract available.
Humans ; Rehabilitation* ; Renal Dialysis*