Localized cystic degeneration of peripheral arteries represents and unusual cause of arterial insufficiency. It frequently occurs in patient without generalized arteriosclerosis. It has been reported in patients from age 11 to 62 years. Cystic adventitial disease is most common in the popliteal artery. At least 115 cases have been reported worldwide, but none in Korea. We report a case of cystic adventitial disease involving the left popliteal artery. This 64-year-old man presented with an 18-month history of cramping pain of sudden onset in the left calf and claudication. Angiographic findings showed a 6 cm length of luminal obliteration of the popliteal artery. Segmentally resected popliteal artery showed two longitudinally directed cystic masses measuring 3.5x1.5 cm and 2.5x1.5 cm in the adventitia. Microscopic examination revealed cystic space in the arterial adventitia compressing arterial lumen. There were a number of foamy histiocytes collected along the cystic lumen.
Male ; Humans

Scapholunate advanced collapse (SLAC) deformity most often occurs with chronic rotary scaphoid instability from scaphoiunate ligament tear and scaphoid fracture. Prior to 1984 when Watson HK reported his concept on SLAC wrist deformity, the most popular procedure for this pathology was scaphoid implant arthroplasty with or without midcarpal fusion. We have reviewed 15 cases of SLAC deformity treated with scaphoid excision and midcarpal fusion from 1984 to 1993. Among them, scaphoid implants made of silicone were inserted in 4 cases. Scaphoid implant arthroplsty without carpal fusion has been excluded. The mean period of follow-up was 8.8 years and the mean age of patients was 47.5 years. Males and right wrists were predominant. Wrist motion was 56% and grip power was 71% of the normal opposite side. On the average overall, 8 patients had no pain and 7 patients had mild pain. The grade of pain was minimal, 0.5 in grade (Rating system: no pain-0, mild- 1, moderate-2, severe-3). However, all of the 4 cases of limited carpal fusion with a scaphoid implant developed silicone particulate induced synovitis and pain. The procedure appears to be effective in maintaining function of the hand with minimal pain up to 5.8 years. However, silicone scaphoid implant appears not to be necessary and is not recommended with a limited carpal fusion for this pathology.
Arthroplasty ; Congenital Abnormalities ; Follow-Up Studies ; Hand ; Hand Strength ; Humans ; Ligaments ; Male ; Pathology ; Silicones ; Synovitis ; Wrist

Advanced heart failure (HF) is defined as the persistence of severe symptoms despite the use of optimized medical, surgical, and device therapies. These patients require timely advanced treatments, such as heart transplantation or long-term mechanical circulatory support (MCS). Inotropic agents are often used to reduce congestion and increase cardiac output, while renal replacement therapy may be beneficial if necessary. Cardiac resynchronization therapy has clear benefits in patients with HF with reduced ejection fraction, particularly with left bundle branch block (QRS duration > 130 ms). The role of implantable cardioverter-defibrillators in advanced HF patients requires further investigation considering the introduction of novel HF medications. In selected patients with significant secondary mitral regurgitation, transcatheter edge-to-edge repair can help delay heart transplantation or long-term MCS. In later stages, the appropriateness of heart transplantation should be evaluated, and the use of short- or long-term MCS may be considered. A multidisciplinary HF management program is crucial for patients with advanced HF. Recent treatment advances, including drugs, devices, and MCS, have broadened the options available to patients with advanced HF and this trend is expected to continue.

Purpose: This study was performed to identify the risk factors for oral mucosa pressure ulcer development in intubated patients in adult intensive care unit. Methods: Comparative descriptive study design using prospective observational design and medical record review was used. The inclusion criteria of case was that a) patients of 18 years in their age, b) patients with endotracheal tube.Data of 34 patients were analysed. Descriptive statistics, chi-square test, Fisher’s exact test, Mann-whitney test, Spearman’s rho correlation coefficients, and multiple logistic regression analysis were used. Resampling methods such as bootstrap was used in this study because of small number of patients. Results: Oral mucosa pressure ulcer developed in 44.1% of the intubated patients. The risk factors of oral mucosa pressure ulcer were steroid use, biteblock use and serum albumin level. Compared to the non-user of steroid, user of steroid had 32.59 times (95% CI: 1.47-722.44) higher risk of developing oral mucosa pressure ulcer. The user of biteblock had 18.78 times (95% CI: 1.00-354.40) and albumin level had 0.03 times (95% CI: 0.00-0.80) higher risk of oral mucosa pressure ulcer incidence. Conclusion Based on the results of this study, tailored pressure relief strategies considering sex and therapeutic condition should be provided to decrease oral mucosa pressure ulcer.

Human herpesvirus-6 (HHV-6) often causes mild illnesses, but is rarely associated with encephalitis or other fatal neurological conditions. We report a girl who died of a intractable status epilepticus from HHV-6. A 14-month-old girl presented with focal motor seizures in right extremities evolving to generalized convulsive status epilepticus. She had a history of mild diarrhea for 4 days and high fever for 2 days. Although she was treated with lorazepam, phenytoin, phenobarbital, and continuous midazolam infusion, generalized seizures continued for 3 hours after arrival. She became seizure free, but remained unconscious and ended up to death at the 44 days of hospitalization. The CSF HHV-6 DNA PCR turned out to be positive.
Brain Death ; Diarrhea ; DNA ; Encephalitis ; Extremities ; Fever ; Herpesvirus 6, Human ; Hospitalization ; Humans ; Infant ; Lorazepam ; Midazolam ; Phenobarbital ; Phenytoin ; Polymerase Chain Reaction ; Seizures ; Status Epilepticus ; Unconscious (Psychology)

PURPOSE: To compare the clinical characteristics and laboratory finding between adenoviral and group A streptococcal (GAS) pharyngitis. METHODS: A retrospective review of medical records was performed in the patients with adenovirus infection among those who were admitted for febrile respiratory disease from January 2011 to July 2013 and GAS pharyngitis among those who visited for symptoms of scarlet fever from August 2006 to July 2013. RESULTS: 179 patients (AV1 group) were diagnosed with adenoviral pharyngitis and 37 (AV2 group) of these patients had adenovirus single infection. 26 patients (GAS group) were diagnosed with scarlet fever. Adenoviral infection (AV2 group) developed in younger patients compared to GAS group (2.8+/-2.1 years vs. 5.4+/-1.8 years, P=0.000). Total durations of fever and admission were longer in AV2 (6.3+/-2.6 days vs. 3.3+/-1.9 days, P=0.000; 4.1+/-1.2 days vs. 1.9+/-1.8 days, P=0.000, respectively). WBC counts were higher in AV2 (11,449+/-5,680 cells/mm2 vs. 6,722+/-6,941 cells/mm2, P=0.000). CRP was not significantly different between AV2 and GAS group (3.8+/-3.2 mg/dL vs. 5.2+/-5.1 mg/dL, P=0.368). No difference was found between two groups in the percentage of antibiotics use (91.9% vs. 100%, P=0.261). CONCLUSION: Clinical characteristics and measures of inflammation in the laboratory findings were similar between adenoviral and GAS pharyngitis group. It is necessary to conduct the test for respiratory virus and bacteria in early stage to differentiate in the pharyngitis patients with leukocytosis and elevation of CRP level.
Adenoviridae ; Adenoviridae Infections ; Anti-Bacterial Agents ; Bacteria ; Child* ; Fever ; Humans ; Inflammation ; Leukocytosis ; Medical Records ; Pharyngitis* ; Retrospective Studies ; Scarlet Fever

The neuromuscular blocking effect of pipecuronium was evaluated in 35 patients under N2O-O2-isoflurane anesthesia with visual and/or tactile counts for the twitch of the adductor pollicis muscle in response to train-of-tour(TOF) stimulation of the ulnar nerve at the wrist. Group I, II and III were classified according to the initial dose of pipecuronium of 50, 80 and 100ug/kg, respectively. The additional dose, 30 ug/kg, was given in all three groups when the first twitch of TOF(T) reappeared. The onset time in Group I, II and III was 361.4+/-98.6, 218.7+/- 80.8 and 239.0+/-73.7 seconds, respectively. The onset time in Group I was significantly slower(p<0.005) than those in the other groups. All three doses of pipecuronium provided good to exceUent intubating condition in about 4 to 6 minutes after the administration of the initial dose. The time interval from the disappearance of T1 to the reappearance of T1 was 39.0+/-20.8 min in Group I, which was significantly longer(p<0.05) in Group II(67.7+/-26.4 min) or III(63.8+/-20.8 min). The cumulative effect of pipecuronium was evaluated by comparing the mean time intervals of an additional dose to the succeeding ones. The intervals between additional doses were independent of the size or duration of the initial dose. There were no significant differences in the intervals between additional doses. Heart rates, rhythms and mean arterial blood pressures were not significantly changed in any groups following the administration of pipecuronium In conclusion, pipecuronium bromide can be recommended as a long-acting neuromuscular blocking agent with an absence or minimum of cumulative and cardiovascular effects for patients in whom a long operation is scheduled and the cardiovascular stability is required.
Anesthesia ; Arterial Pressure ; Heart Rate ; Humans ; Neuromuscular Blockade ; Pipecuronium* ; Ulnar Nerve ; Wrist

No abstract available.
Gastrointestinal Diseases*

A 25 years old woman was adrnitted to the department of neurosurgery for a right hemifacial spasm. She was undertaken microvascular decompression in the Fukushima lateral position. Following completion of operation, she began to complain of dyspnea, but the phonation was not changed. Mild weakness and paresthesia on left upper extremity was complained, too. Severe swelling on the left side of face and neck expending to left shoulder was noted simultaneously. Immediate computerized tomography was taken to reveal the cause of respiratory distress, which suggested that venous and/or lymphatic congestion on the left side of neck. As respiratory distress was getting more severe, emergent tracheostomy was taken. The cause of above symptoms was suspected to an extreme rotation and flexion of the head resulting in direct contact of mandibular body to clavicle. A month after operation, there was still remained mild paresthesia on left thumb and index finger.
Adult ; Airway Obstruction* ; Brachial Plexus* ; Clavicle ; Dyspnea ; Estrogens, Conjugated (USP) ; Female ; Fingers ; Head ; Hemifacial Spasm ; Humans ; Microvascular Decompression Surgery* ; Neck ; Neurosurgery ; Paresthesia ; Phonation ; Shoulder ; Thumb ; Tracheostomy ; Upper Extremity

Motor evoked potentials(MEP) have been recently introduced as intraoperative monitoring of descending motor pathways. Transcranial electrical or magnetic MEP have been using clinically, but there are still some limitations of using in operating room. Furthermore, according to anesthetic regimens, MEP responses vary significantly. The authors observed the effects of the various anesthetics (thiopental, fentanyl, ketamine, nitrous oxide and isoflurane) on electocortical MEP in a patient who had been previously undertaken electrocortico-graphic grid insertion operation for seizure monitoring. Electromyographic responses were recorded from contralateral arm flexor and extensor using needle type electrode. Most anesthetics except ketamine decreased the amplitude of MEPs reversibly and there were differences in electromyographic responses according to measuring compound muscles.
Anesthetics* ; Arm ; Efferent Pathways ; Electrodes ; Evoked Potentials, Motor ; Fentanyl ; Humans ; Isoflurane ; Ketamine ; Monitoring, Intraoperative ; Muscles ; Needles ; Nitrous Oxide ; Operating Rooms ; Seizures ; Thiopental