Primary iliopsoas abscess, without a causative infection focus, is a very rare kind of retroperitoneal abscess. Immunocompromised patient, such as elderly patients, diabetics and patients with chronic disease, are susceptible to this kind of infection. Because early diagnosis of priiliopsoas abscess is usually delayed due to nonspecific clinical presentation, proper treatment is also delayed which causes high mortality and morbidity. Recently we experienced three cases of primary iliopsoas abscess due to Staphylococcus aureus. Diagnosis of these cases was belatedly confirmed by using a abdominal-pelvic computerized tomography (CT) scan. Open surgical drainage via an extraperitoneal approach and administration of appropriate systemic antibiotics were required to save these patients. Based on a review of the literature, we evaluated the diagnosis and treatment of primary iliopsoas abscess.
Abscess ; Aged ; Anti-Bacterial Agents ; Chronic Disease ; Diagnosis ; Drainage ; Early Diagnosis ; Humans ; Immunocompromised Host ; Mortality ; Psoas Abscess* ; Staphylococcus aureus* ; Staphylococcus*

Preoperative and postoperative echocardiography were performed in 33 patients with isolated ostium secondum atial septal defect(ASD), confirmed by right heart catheterization and operation at Seoul National University Hospital from November 1980 to June 1982. The ratio of right ventricular enddiastolic dimension to leftventricular enddiastolic dimension(RVED/LVED) was compared to the pattern of interventricular septum, before and after operation. In patients with persistent paradoxical septal motion during 2wks after operation, repeated echocardiograms were performed upto 9 months, postoperatively. The results obtained are as follows: 1) The ratio of RVED/LVED in patients with ASD, was 0.95+/-0.35(mean+/-standard deviation), which was significantly larger than that of 14 normal subjects(p<0.005). 2) There was statistically correlation between the ratio of pulmonary blood flow to systemic blood flow(QP/QS) and the ratio of RVED/LVED(r=0.44, p<0.025). 3) Thirty three patients were divided into 3 groups according to the pattern of intervent ricular septal motion.(Group "M": Patients with normal septal motion, Group "B": Patients with paradoxical type B septal motion, Group "A": Patients with paradoxical type A septal motion) Preoperatively, the ratio of RVED/LVED was 0.68+/-0.28 in Group "N" (N=9), and 0.88+/-0.23 in Group B (N=9) and 1.14+/-0.34 io Group "A" (N=15). In Group "A, the ratio of RVED/LVED was significantly larger than of Group "N" (p<0.005). Postoperatively, the ratio of RVED/LVED was 0.51+/-0.13 in Group "N" (n=23), and 0.68+/-0.15 in Group "B" (n=7), and 0.79+/-0.14 in Grop "A" (n=3). In Group "A" and Group "B, the ratio of RVED/LVED was significantly larger than that of Group "N" (p<0.005, p<0.01). 4) Postoperative RVED index(18.9+/-4.9) was significantly decreased, compared with preoperative RVED index(27.6+/-8.9) (p<0.005). But there was no significant change in LVED index, before and after operation. 5) Among 10 patients with persistent paradoxical septal motion, repeated echocardiograms were performed in 5 patients. Interventricular septal motion was normalized in 4 out of 5 patients. Thus the ratio of RVED/LVED has significant correlation with QP/QS and the pattern of interventricular septal motion. These results suggest the evidence that interventricular septal motion is determined by septal position at enddiastiole.
Cardiac Catheterization ; Cardiac Catheters ; Echocardiography* ; Heart Septal Defects, Atrial* ; Humans ; Seoul

PURPOSE: Combined chemoradiotherapy is standard management for locally advanced non-small cell lung cancer (LA-NSCLC), but standard treatment for elderly patients with LA-NSCLC has not been confirmed yet. We evaluated the feasibility and efficacy of concurrent chemoradiotherapy (CCRT) for elderly patients with LA-NSCLC. MATERIALS AND METHODS: Among patients older than 65 years with LA-NSCLC, 36 patients, who underwent CCRT were retrospectively analyzed. Chemotherapy was administered 3-5 times with 4 weeks interval during radiotherapy. Thoracic radiotherapy was delivered to the primary mass and regional lymph nodes. Total dose of 54-59.4 Gy (median, 59.4 Gy) in daily 1.8 Gy fractions and 5 fractions per week. RESULTS: Regarding the response to treatment, complete response, partial response, and no response were shown in 16.7%, 66.7%, and 13.9%, respectively. The 1- and 2-year overall survival (OS) rates were 58.2% and 31.2%, respectively, and the median survival was 15 months. The 1- and 2-year progression-free survivals (PFS) were 41.2% and 19.5%, respectively, and the median PFS was 10 months. Regarding to the toxicity developed after CCRT, pneumonitis and esophagitis with grade 3 or higher were observed in 13.9% (5 patients) and 11.1% (4 patients), respectively. Treatment-related death was not observed. CONCLUSION: The treatment-related toxicity as esophagitis and pneumonitis were noticeably lower when was compared with the previously reported results, and the survival rate was higher than radiotherapy alone. The results indicate that CCRT is an effective in terms of survival and treatment related toxicity for elderly patients over 65 years old with LA-NSCLC.
Aged ; Carcinoma, Non-Small-Cell Lung ; Chemoradiotherapy ; Disease-Free Survival ; Esophagitis ; Humans ; Lymph Nodes ; Pneumonia ; Retrospective Studies ; Survival Rate

BACKGROUND: A central venous catheter (CVC) is commonly used for administering chemotherapy to cancer patients. The institutional guideline of the Gyeongsang National University Hospital (GNUH) for blood culture analysis of indwelling CVC patients recommended 6 sets (2 from the periphery and 4 from each lumen). We analyzed the usefulness of this guideline, because complying with this recommendation requires an abundant amount of the sample and it is both inconvenient and expensive. METHODS: Adult patients (age: > or =18 yr old) who were admitted to the cancer center of GNUH between January 2011 and April 2012 were requested to have their blood culture analysis done. The positive rate, contamination rate, and distribution of microorganisms were compared according to the number of requested sets. The positive results of the stipulated 6 sets were analyzed. RESULTS: A total of 5,263 blood cultures were analyzed during the study period; of them, 74.4% were requests of 2 sets and 20.0% were requests of 6 sets. The positive rates in 2 set requests and 6 set requests were 8.0% and 14.3%, respectively (P<0.001). The requests for 6 sets were repeated about 5 times. All 6 sets showed positive in 16 cases (9.1%), whereas a part of the 6 sets was positive in 18 cases (10.3%). CONCLUSIONS: Although the positive rate was relatively high in the 6 set-requested groups, they had to be repeatedly requested. Microbial growth in a part of the 6-set requests was observed in a very small proportion (10.3%) of the patients, indicating that the benefit of blood culture of 6 sets is very low.
Adult ; Central Venous Catheters ; Humans ; Sepsis

To evaluate the coronary vasomotor tone in vasospasic angina, we compared the diameters of non-spastic segments of vasospastic group with those of control group. The internal diameters of each segment of three major coronary arteries were measured on the basal coronary angiogram, and nitroglycerin administration after provocation with ergonovine or acetylcholine. The vasospastic angina group consisted of 26 patients(20 males, 6 females, mean age of 54 years) and control group consisted of 25 patients (7 males, 18 females, mean age of 55 years). The basal coronary arterial diameters in vasospastic angina group were smaller than those in control group(p<0.05) except the distal segment of right coronary artery. The percent dilation ratio in vasospastic angina group was greater than that in control group(p<0.05). In vasospastic angina group there was no significant difference in the degree of constriction after provocation with ergonovine or acetylcholine between proximal and distal segment. These observations suggest that in vasospastic angina, basal coronary arterial tone is increased in the entire coronary arterial tree and the localized spasm may reflect local hyperrespon siveness.
Acetylcholine ; Constriction ; Coronary Vessels ; Ergonovine ; Female ; Humans ; Male ; Nitroglycerin ; Spasm

BACKGROUND: Lipoprotein(a)(Lp(a))is known as an independent risk factor of the coronary artery disease(CAD). However, it is not clear whether the level of the Lp(a) is elevated in the presence of atherosclerotic peripheral vascular disease(PVD) of lower extremities. MATERIALS AND METHODS: Considering high prevalence of the coronary artery disease in PVD, the association between the serum level of Lp(a) and the presence of PVD was investigated by comparing Lp(a) level in PVD patients with CAD(PVD+CAD group, N=15), PVD patients without CAD(PVD-CAD group, N=12), and control group who had normal coronary angiograms and no clinical evidence of PVD(Control group, N=22). In all PVD patients coronary angiograms were performed simultaneously with peripheral angiograms. Clinical characteristics, lipid profiles and the level of lipoprotein(a) were compared between two PVD group. The serum level of Lp(a) was measured with ELISA technique. RESULTS: Serum levels of lipoprotein(a) in patients with PVD as a whole(20.4+/-18.7mg/dl, mean standard deviation) were not significantly higher than those in control group(14.9+/-10.5mg/dl). In patients with PVD and CAD, the levels were significantly higher(27.0+/-20.2mg/dl) than those in patients with PVD but without CAD(12.2+/-13.3mg/dl). There was no significant difference between two groups with PVD in age, sex, association of hypertension, smoking, and other lipid profiles. CONCLUSIONS: Lipoprotein(a) level might not be related to the presence of PVD, but rather associated with CAD.
Coronary Artery Disease ; Coronary Vessels ; Enzyme-Linked Immunosorbent Assay ; Humans ; Hypertension ; Lipoprotein(a)* ; Lower Extremity* ; Peripheral Vascular Diseases* ; Prevalence ; Risk Factors ; Smoke ; Smoking

No abstract available.
Abdominal Wall ; Herpes Zoster

Trendelenburg position has been used for the low abdominal and pelvic surgery or for the management of the hypotensive patients. But, various adverse effects can also occur in steep Trendelenburg position, of which brachial plexus injury has been known as the most common nerve injury during this position under the general anesthesia especiaUy when the shoulder braces are used. We experienced a case of brachial plexus palsy in a 53 year old woman who had a laparas-copy assisted vaginal hysterectomy(LAVH) under the general anesthesia for myoma uteri for four and a half hours. During the operation she was in a 30 degree-tilting Trendelenburg and combined lithotomy position with her arms tucked at her side with drawsheet and shoulder braces were placed over the acromioclavicular joints bilaterally. In the morning of the postoperative 1st day, she complained the right shouder pain and the right arm tingling sensation and weakness. After needle electromyography and nerve conduction study, it was decided that she got an intraoperative brachial plexus injury mainly involving the lateral cord of the brachial plexus, resulting from the nerve compression caused by shoulder braces in Trendelenburg position. The symptoms were improved after the physical therapy and she was recommended to take more physical therapy after discharge.
Acromioclavicular Joint ; Anesthesia, General ; Arm ; Braces ; Brachial Plexus* ; Electromyography ; Female ; Head-Down Tilt ; Humans ; Hysterectomy, Vaginal* ; Middle Aged ; Myoma ; Needles ; Neural Conduction ; Paralysis* ; Sensation ; Shoulder ; Uterus

No abstract available.
Adult* ; Humans ; Urinary Tract Infections* ; Urinary Tract*

Cardiac myxoma is rare and has protean clinical manifestations mimicking various disease. Unless clinician has a high index of suspicion, the diagnosis can be easil missed. However diagnosis is all the more important since surgery can be dramatically successful, where as untreated myxoma invariably leads to death. Cardiac myxoma accounts for 50% of primary cardiac tumor and mainly originates in left atrium.(75%). The features of myxoma can be described under the three headings : Constitutional, obstructive, and embolic. From 1977 to 1985, the authors have experienced 30 cases of cardiac myxoma, one of which recurred. Of 29 patients, 8 were male and 21 were female. Their ages ranged from 11 to 55 years with average of 39.8 years. Constitutional manifestation was found in 25 of the 27 patients, obstructive manifestation in 27, and embolic phenomenon in 5. The diagnosis of myxoma was made on the basis of 2-D echocardiography. The sensitivity was 100%. Except 1 case who refused operation, all received surgical treatment. Immediate postoperative complication occurred in 6 patients(23%). Among them serious complication could be found only in 2 cases(7.7%). During long term follow up there was one recurrence and one patient with right ventricular myxoma has tricuspid regurgitation. In other cases, we could not found any problems.
Diagnosis ; Echocardiography ; Female ; Follow-Up Studies ; Head ; Heart Neoplasms ; Humans ; Male ; Myxoma* ; Postoperative Complications ; Recurrence ; Tricuspid Valve Insufficiency