No abstract available.
Hematoma* ; Hemorrhage* ; Polyarteritis Nodosa*

No abstract available.
Humans ; Kidney Failure, Chronic* ; Renal Dialysis*

Congenital tuberculosis is an infection that is established in the fetus by hematogenous spread or by the aspiration or inhalation of infected amniotic fluid either before or during labor. The diagnosis can be confirmed only if both the tuberculous nature of the lesion and the antenatal origin of the infection can be proved. The authors analysed roentgen findings of two cases of pulmonary tuberculosis, thought to be congenital; 1. Diffuse distribution of nodular densities and some confluent densities were seen in the entire lungs in the inital film.The pulmonary markings were decreased in some degree. 2. Air bronchogram was noted. 3. Hepatosplenomegaly was associated.
Amniotic Fluid ; Diagnosis ; Female ; Fetus ; Inhalation ; Lung ; Tuberculosis ; Tuberculosis, Pulmonary

BACKGROUND: The risk of bleeding during extracorporeal membrane oxygenation (ECMO) is a potential deterrent in performing tracheostomy at many centers. To evaluate the safety of surgical tracheostomy (ST) in critically ill patients supported by ECMO, we reviewed the clinical correlation between preoperative coagulation status and bleeding complication-related ST during ECMO. METHODS: From April 1, 2012 to March 31, 2016, ST was performed on 38 patients supported by ECMO. We retrospectively reviewed and analyzed the medical records including complications related to ST. RESULTS: Heparin was administered to 23 patients (60.5%) for anticoagulation during ECMO, but 15 patients (39.5%) underwent ECMO without anticoagulation. Of the 23 patients administered anticoagulation therapy, heparin infusion was briefly paused in 13 prior to ST. The median platelet count, international normalized ratio, and activated partial thromboplastin time before ST were 126 ×109/L (range, 46 to 434 ×109/L), 1.2 (range, 1 to 2.3) and 62 seconds (27 to 114.2 seconds), respectively. No peri-procedural clotting complications related to ECMO were observed. Two patients (5.3%) suffering from ST-related major bleeding required surgical hemostasis. Minor bleeding after ST occurred in two cases (5.3%). No significant difference was found according to anticoagulation management (P = 0.723). No fatality was attributable to ST. CONCLUSIONS: The complication rates of ST in the patients supported by ECMO were low. Therefore, ST performed by an experienced operator, and with careful optimization of coagulation status, is a relatively safe procedure; the use of ST with ECMO should thus not be dismissed on account of the potential for bleeding caused by the administration of anticoagulants.
Anticoagulants ; Critical Illness ; Extracorporeal Membrane Oxygenation* ; Hemorrhage ; Hemostasis, Surgical ; Heparin ; Humans ; International Normalized Ratio ; Medical Records ; Partial Thromboplastin Time ; Platelet Count ; Retrospective Studies ; Tracheostomy*

In air leak syndrome, a significant portion of the volume delivered during a positive pressure breath can be lost through the leak. HFOV can achieve adequate ventilation at lower peak and/or mean intrapulmonary pressure than conventional mechanical ventilation (CMV) and has been an effective treatment of already established air leak syndrome. We report a 1-day-old male infant with severe respiratory failure from pneumothorax and pneumomediastinum, who was refractory to CMV with chest tube drainage. HFOV was applied to this patient for 114 hours, and improvement of oxygenation and ventilation as well as significant reduction of pneumothorax followed.
Chest Tubes ; Drainage ; Humans ; Infant ; Male ; Mediastinal Emphysema ; Oxygen ; Pneumothorax ; Respiration, Artificial ; Respiratory Insufficiency ; Ventilation*

PURPOSE: To evaluate the long-term clinical outcomes of retinal pigment epithelium (RPE) tears after intravitreal injection of anti-vascular endothelial growth factor (VEGF) agent for the treatment of neovascular age-related macular degeneration (AMD). METHODS: The authors performed a retrospective chart review of 13 eyes of 13 patients who developed RPE tears after intravitreal anti-VEGF injection between February 2009 and June 2013. We investigated continuation of the treatment after tear, visual acuity, presence of cystoid macular edema, and central macular thickness (CMT) using optical coherence tomography (OCT) before and after treatment and visual outcomes depending on foveal sparing. RESULTS: After RPE tear, 12 of 13 patients continued injection of an anti-VEGF agent. The average number of injections was 6.08 +/- 5.18. Mean visual acuity immediately after tear was 1.65 +/- 0.8 log MAR, and that at the last visit was 1.82 +/- 0.88 log MAR. Nine eyes with macular edema in OCT continued receiving injection, and improvement of macular edema was observed in four eyes at the final visit. The final visual acuity of patients with foveal involvement was 2.17 +/- 0.49 log MAR, which was worse than the 1.51 +/- 1.06 log MAR in patients without foveal involvement, although the difference was not significant (p = 0.295). CONCLUSIONS: When anti-VEGF injections were continued after RPE tear, no improvement in visual acuity was observed, although better anatomical outcomes did result. Patients with foveal involvement had worse visual acuity than patients without foveal involvement, but the difference was not significant.
Endothelial Growth Factors ; Humans ; Intravitreal Injections ; Macular Degeneration* ; Macular Edema ; Retinal Pigment Epithelium ; Retinaldehyde* ; Retrospective Studies ; Tomography, Optical Coherence ; Visual Acuity

No abstract available.
Lupus Erythematosus, Systemic* ; Polyarteritis Nodosa*

We investigated the effects of panretinal photocoagulation (PRP)on macular microcirculation in diabetic retinopathy. PRP using argon blue green laser was performed in 23 eyes of 15 patients with early proliferative diabetic etinopathy and very severe nonproliferative diabetic retinopathy without significant macular edema. The changes in volume, flow, velocity of macular microcirculation were measured before PRP, 1 hour, 1 day, 1 week, and 1 month following PRP, using Heidelberg Retina Flowmeter(HRF). Mean volume, flow, velocity of macular microcirculation decreased to a maximal degree 1 hour following PRP, from 14.87+/-0.40, 387.45 +/-101.40, 1.40+/-0.28(before PRP)to 12.44+/-1.39, 347. 33+/-100.39, 1.27+/-0.34(p<0.05). From 1hour to 1 month after PRP, macular microcirculation gradually increased. However, throughout this period, all parameters of macular microcirculation remained lower than pre-PRP level(p<0.05). Our study suggests that panretinal photocoagulation reduces the macular microcirculation in diabetic retinopathy.
Argon ; Diabetic Retinopathy ; Humans ; Light Coagulation* ; Macular Edema ; Microcirculation* ; Retina ; Retinaldehyde*

On the contrary to congenital anomalies of intestinal rotation in pediatric patients, those in adults are generally nonsymptomatic and of little consequence. Occasionally, however, an adult may have midgut nonrotation and complain of chronic or recurrent abdominal pain. Intestinal nonrotation can be divided into complete or partial failure of rotation and into abnormalities affecting the proximal segment, the distal segment or both. We report herein a 43-year old female patient with symptomatic partial, cecocolic nonrotation.
Abdominal Pain ; Adult* ; Female ; Humans

BACKGROUND: It is controversial whether the delay of surgery for acute appendicitis by physician results in higher morbidity. Our present study explores this problem of physician delay on the postoperative outcome of patients with acute appendicitis. MATERIAL AND METHODS: Among 432 patients admitted for the presumptive diagnosis of acute appendicitis between Jan., 1995 and Dec., 1997, 358 patients with pathologically proven acute appendicits were analyzed. Physician delay from the hospital admission to the surgery was evaluated in relation to the stage of the disease at operation and postoperative outcome. RESULTS: Postoperative complications occurred signifficantly higher in advanced appendicitis group, than in simple appendicitis group. Postoperative oral consumption started significantly later and hospital days are significantly prolonged in those group. Both patient and physician delays significantly affect the stage of the disease. The finding that physician delay correlated with the stage, however, was denied by multivariate analysis. CONCLUSION: On the contrary to the patient delay, physician delay does not affect the stage of the acute appendicitis nor lead to increased incidence of postoperative complication. Physician delay to clarify the diagnosis is a reasonable strategy and it does not affect the outcome adversely.
Appendicitis* ; Diagnosis ; Humans ; Incidence ; Multivariate Analysis ; Postoperative Complications