To evaluate the CT and MR findings of cerebral paragonimiasis (PW) and to assess the diagnostic value of the specific antibody test by enzyme-linked immunosorbent assay (ELISA) for PW, 55 CT scans and 13 MR images of 57 patients with cerebral PW were reviewed retrospectively, and correlated with the serum/CSF antibody levels. We divided the into three groups, early active(n=21), chronic(n=32), and combined stage (n=4), on the basis of CT/MR findings. In the group of early active stage the most common and characteristic findings was multiple, conglomerated, ring-like enhancing lesions in the unilateral cerebral hemisphere, which was seen in 52% on CT and 44% on MR. Other non-specific findings included a solitary ring-like or irregular enhancing lesions, ill-defined low density lesions without enhancement, localized hemorrhage with or without enhancing lesions. In the group of chronic stage there were multiple calcifications of various shapes, most commonly 1-2cm sized round shape, and associated encephalomalacia. MR was superior to CT in detecting hemorrhage and in characterizing the central contents of ring-shaped calcifications, while it was inferior to CT in identifying small calcifications. Antibody levels of serum and CSF were positive in 86% and 82% in early active group, and in 48% and 31% in chronic sgage respectively. The positive rate was significantly different between the two groups (P=0.001). CT/MR findings were characteristic in only approximately half the cases in early active cerebral PW which can be cured by traziquantel therapy. Therefore, antibody test by ELISA is recommended as a complementary tool, particularly in patients with non-specific imaging findings.
Cerebrum ; Diagnosis* ; Encephalomalacia ; Enzyme-Linked Immunosorbent Assay* ; Hemorrhage ; Humans ; Paragonimiasis* ; Praziquantel ; Retrospective Studies ; Tomography, X-Ray Computed

To evaluate the CT and MR findings of cerebral paragonimiasis (PW) and to assess the diagnostic value of the specific antibody test by enzyme-linked immunosorbent assay (ELISA) for PW, 55 CT scans and 13 MR images of 57 patients with cerebral PW were reviewed retrospectively, and correlated with the serum/CSF antibody levels. We divided the into three groups, early active(n=21), chronic(n=32), and combined stage (n=4), on the basis of CT/MR findings. In the group of early active stage the most common and characteristic findings was multiple, conglomerated, ring-like enhancing lesions in the unilateral cerebral hemisphere, which was seen in 52% on CT and 44% on MR. Other non-specific findings included a solitary ring-like or irregular enhancing lesions, ill-defined low density lesions without enhancement, localized hemorrhage with or without enhancing lesions. In the group of chronic stage there were multiple calcifications of various shapes, most commonly 1-2cm sized round shape, and associated encephalomalacia. MR was superior to CT in detecting hemorrhage and in characterizing the central contents of ring-shaped calcifications, while it was inferior to CT in identifying small calcifications. Antibody levels of serum and CSF were positive in 86% and 82% in early active group, and in 48% and 31% in chronic sgage respectively. The positive rate was significantly different between the two groups (P=0.001). CT/MR findings were characteristic in only approximately half the cases in early active cerebral PW which can be cured by traziquantel therapy. Therefore, antibody test by ELISA is recommended as a complementary tool, particularly in patients with non-specific imaging findings.
Cerebrum ; Diagnosis* ; Encephalomalacia ; Enzyme-Linked Immunosorbent Assay* ; Hemorrhage ; Humans ; Paragonimiasis* ; Praziquantel ; Retrospective Studies ; Tomography, X-Ray Computed

BACKGROUND: It has been known that bed rest after spinal anesthesia for benign anorectal surgery helps to reduce the incidence of postdural puncture headache, but the bed rest position is thought to have a negative effect on urinary retention, as a result of anxiety, anal distention, bladder distention and pain-induced reflex inhibition of the urinary bladder detrusor muscle. We investigate the effect of early ambulation after spinal anesthesia on postdural puncture headache and on urinary retention compared with bed rest for 24 hours. METHODS: One hundred and fifty-three ASA Physical Status I patients received spinal anesthesia for scheduled benign anorectal surgery. We applied hyperbaric 0.5% tetracaine 6 mg (1.2 ml) using 25 gauge Quincke needles with the cutting bevel parallel to the dural fibers at the patients' sitting position. All patients were randomly divided into an early ambulation group or bed rest group. We investigated the incidence of urinary retention and headache. The duration of operation, the perioperative intravenous fluid volume, surgical technique and postoperative pain regimen were standardized. RESULTS: The incidence of urinary retention in the early ambulation group (16/75, 21.3%) was lower than that in bed rest group (32/78, 41.0%). There was no difference in any parameters between the two groups. CONCLUSIONS: To reduce the incidence of urinary retention, early ambulation after spinal anesthesia for benign anorectal surgery is recommended over bed rest with no increase in the incidence of postdural puncture headache.
Anesthesia, Spinal* ; Anxiety ; Bed Rest ; Early Ambulation* ; Headache ; Humans ; Incidence* ; Needles ; Pain, Postoperative ; Post-Dural Puncture Headache ; Reflex ; Tetracaine ; Urinary Bladder ; Urinary Retention*

A 61-year-old man was diagnosed with aortic stenoinsufficiency with periannular abscess, which involved the aortic root of noncoronary sinus (NCS) that invaded down to the central fibrous body, whole membranous septum, mitral valve (MV), and tricuspid valve (TV). The open complete debridement was executed from the aortic annulus at NCS down to the central fibrous body and annulus of the MV and the TV, followed by the left ventricular outflow tract reconstruction with implantation of a mechanical aortic valve by using a leaflet of the half-folded elliptical bovine pericardial patch. Another leaflet of this patch was used for the repair of the right atrial wall with a defect and the TV.
Abscess* ; Aortic Valve ; Debridement ; Endocarditis ; Humans ; Middle Aged ; Mitral Valve* ; Tricuspid Valve*

BACKGROUND: Deep neck infections (DNI) can originate from infection in the potential spaces and fascial planes of the neck. DNI can be managed without surgery, but there are cases that need surgical treatment, especially in the case of mediastinal involvement. The aim of this study is to identify clinical features of DNI and analyze the predisposing factors for mediastinal extension. MATERIALS AND METHODS: We reviewed medical records of 56 patients suffering from DNI who underwent cervical drainage only (CD group) and those who underwent cervical drainage combined with mediastinal drainage for descending necrotizing mediastinitis (MD group) from August 2003 to May 2009 and compared the clinical features of each group and the predisposing factors for mediastinal extension. RESULTS: Forty-four out of the 56 patients underwent cervical drainage only (79%) and 12 patients needed both cervical and mediastinal drainage (21%). There were no differences between the two groups in gender (p=0.28), but the MD group was older than the CD group (CD group, 44.2+/-23.2 years; MD group, 55.6+/-12.1 years; p=0.03). The MD group had a higher rate of co-morbidity than the CD group (p=0.04). The CD group involved more than two spaces in 14 cases (32%) and retropharyngeal involvement in 12 cases (27%). The MD group involved more than two spaces in 11 cases (92%) and retropharyngeal involvement in 12 cases (100%). Organism identification took place in 28 cases (64%) of the CD group and 3 cases of (25%) the MD group (p=0.02). The mean hospital stay of the CD group was 21.5+/-15.9 days and that of the MD group was 41.4+/-29.4 days (p=0.04). CONCLUSION: The predisposing factors of mediastinal extension in DNI were older age, involvement of two or more spaces, especially including the retropharyngeal space, and more comorbidities. The MD group had a longer hospital stay, higher mortality, and more failure to identify causative organisms of causative organisms than the CD group.
Comorbidity ; Drainage ; Humans ; Hypogonadism ; Length of Stay ; Mediastinitis ; Medical Records ; Mitochondrial Diseases ; Neck ; Ophthalmoplegia ; Stress, Psychological

BACKGROUND: It is necessary to reduce hyperexcitable sensations induced by painful stimulus by preventing central sensitization, so called preemptive analgesia. We observed the effect of butorphanol on postoperative pain after hysterectomy so as to direct analgesic action based on elucidation of the preemptive effect. METHODS: We selected thirty-six patients undergoing elective total abdominal hysterectomy, ASA Physical Status I or II, and employed a double-blind cross-over design. Patients were randomly allocated to one of both groups, receiving intravenous butorphanol 2 mg, either preincisionally or postoperatively. Anesthesia was induced with thiopental and maintained with isoflurane. Patients received meperidine on request for postoperative pain. Patients checked the VAS of spontaneous incisional pain and movement-associated pain by themselves.The time of first demand for postoperative meperidine and the amount of postoperative meperidine for the first 6 hours and 6 to 48 hours were recorded. RESULTS: At 5 hours after surgery, the postoperative VAS score of the preincisional group was lower than that of the postoperative group, and at 24 hours after surgery, the former was also lower than the latter. The first time of demand for postoperative meperidine was earlier in the postoperative group than in the preincisional group. The amount of meperidine for the postoperative first 6 hours was less in the preincisional group than in the postoperative group. CONCLUSIONS: Preincisional intravenous butorphanol reduced the intensity of spontaneous incisional pain and movement-associated pain, regarded as a preemptive effect of butorpahnol, in the early postoperative period.
Analgesia* ; Anesthesia ; Butorphanol* ; Central Nervous System Sensitization ; Cross-Over Studies ; Humans ; Hysterectomy* ; Isoflurane ; Meperidine ; Pain, Postoperative ; Postoperative Period ; Sensation ; Thiopental

BACKGROUND: Laparoscopic cholecystectomy is of benefit to reduce postoperative pain but many patients suffer from considerable pain after the surgery. The aim of this study was to investigate whether the preoperative infiltration of bupivacaine at the trocar site reduced the intensity of the postoperative pain or not. METHODS: Sixty patients who underwent elective laparoscopic cholecystectomy were selected. In a randomozed study, patients were divided into three groups. General anesthesia was induced with pentothal and succinylcholine, and maintained with vecuronium and isoflurane. After induction, the preincisional group (n = 20) received 0.25% bupivaciane 20 ml infiltration before skin incision and the postoperative group (n = 20) was given 0.25% bupivacaine 20 ml after peritoneal closure. The control group (n = 20) did not receive bupivacaine at any time. The first time of demand for analgesics and the amount of analgesics given during postoperative 48 hours were checked and recorded. The degree of postoperative pain was assessed hourly by visual analogue scale (VAS) score until 9 hours and checked once more at 24 hours postoperatively. RESULTS: The first times of demand for analgesics were significantly delayed in the preoperative group (12.1+/-6.0 hours) as compared with the control (2.9+/-1.6 hours) and postoperative groups (6.2+/-3.9 hours). The demand for analgesics until 9-hour postoperation by the preincisional group (10.5+/-14.7) was significantly less than that of the control (42.0 20.4) and postoperative groups (31.5+/-22.8). The VAS score of the preoperative group was lower than that of the control or postoperative groups during the postoperative 24 hours. CONCLUSIONS: Local infiltration of 0.25% bupivacaine into the trocar site preincisionally could reduce the early postoperative pain after laparoscopic cholecystectomy.
Analgesia* ; Analgesics ; Anesthesia, General ; Bupivacaine* ; Cholecystectomy, Laparoscopic* ; Humans ; Isoflurane ; Pain, Postoperative ; Skin ; Succinylcholine ; Surgical Instruments ; Thiopental ; Vecuronium Bromide

Stress-induced cardiomyopathy is caused by emotional or physical stressors and mimics acute myocardial infarction, though Stress-induced cardiomyopathy is characterized by reversible left ventricular (LV) apical ballooning in the absence of significant coronary artery disease. We describe a 51-year-old male who underwent left upper lobectomy for non-small cell lung cancer, and during which cardiogenic arrest occurred due to stress-induced cardiomyopathy, successfully managed by intra-aortic balloon pumping and extracorporeal membrane oxygenation.
Carcinoma, Non-Small-Cell Lung ; Cardiomyopathies ; Coronary Artery Disease ; Extracorporeal Membrane Oxygenation ; Humans ; Intra-Aortic Balloon Pumping ; Male ; Middle Aged ; Myocardial Infarction

Stress-induced cardiomyopathy is caused by emotional or physical stressors and mimics acute myocardial infarction, though Stress-induced cardiomyopathy is characterized by reversible left ventricular (LV) apical ballooning in the absence of significant coronary artery disease. We describe a 51-year-old male who underwent left upper lobectomy for non-small cell lung cancer, and during which cardiogenic arrest occurred due to stress-induced cardiomyopathy, successfully managed by intra-aortic balloon pumping and extracorporeal membrane oxygenation.
Carcinoma, Non-Small-Cell Lung ; Cardiomyopathies ; Coronary Artery Disease ; Extracorporeal Membrane Oxygenation ; Humans ; Intra-Aortic Balloon Pumping ; Male ; Middle Aged ; Myocardial Infarction

A 39-year-old woman was admitted to the hospital due to a pulsatile mass on her right inner thigh that was evident for two months. She did not exhibit any risk factors of atherosclerosis, no evidence of vasculitis, or any signs of previous trauma history. Ultrasound and computed tomography revealed an adult fist-sized aneurysm on the distal superficial femoral artery. The aneurysm was resected and peripheral circulation was restored with the interposition of a saphenous vein graft. The resected aneurysm had three layers that showed atherosclerosis on histological examination.
Adult ; Aneurysm ; Arteries ; Atherosclerosis ; Female ; Femoral Artery ; Humans ; Risk Factors ; Saphenous Vein ; Thigh ; Transplants ; Vasculitis