There has been a dramatic increase in the number and type of procedures performed in the field of cardiac intervention in the past decade. Percutaneous intervention is becoming an increasingly recognized modality for the management of prosthetic paravalvular leakages (PVLs) in severely symptomatic non-surgical candidates. Herein, we report our experience of percutaneous closure using the Amplatzer duct occluder for a PVL in a patient who underwent tricuspid valve replacement.
Heart Valve Prosthesis ; Humans ; Septal Occluder Device ; Tricuspid Valve ; Tricuspid Valve Insufficiency

Malaria infection is not uncommon in Korea these days, but there was no report of malaria infection in the patients who had been transplanted his or her kidney. With the immunosuppression, the atypical findings are frequent and make prompt diagnosis difficult. We report a case of malaria which showed atypical clinical course but treated successfully with conventional anti-malarial drug therapy. A 37 year old male patient were transplanted his kidney in Sep. 1997. He was admitted because of fever, which lasted 40 - 50 min every afternoon for 27 days. Numerous trophozoites were found on his peripheral blood smear, which was diagnosed as vivax malaria. Chloroquine and primaquine were given, and fever subsided next day. The patients has been stayed afebrile thereafter. We reported a case of malaria in the renal transplanted patient with the review of literatures.
Adult ; Chloroquine ; Diagnosis ; Drug Therapy ; Fever ; Humans ; Immunosuppression* ; Kidney Transplantation ; Kidney* ; Korea ; Malaria* ; Malaria, Vivax ; Male ; Plasmodium vivax ; Primaquine ; Trophozoites

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is highly prevalent in hospitals in Korea. The overall rate of MRSA in hospitals in Korea was estimated over 60%. Recently hospital infections caused by MRSA are getting increased and problematic in Korea, Our hospital Seoul Paik Hospital, has been trying to solve this problem. We had not applied exact methods for hospital infection control. Therefore, we adapted strict methods under the control of hospital infection control committee (HICC) and assessed the effectiveness of these methods. METHODS: Every month, the number of MRSA isolates was collected and analyzed; the results of the analysis were reported to every ward. All wards were supplied with Microshild(R) (Johnson & Johnson, Australia), Clean N' Fresh(R) (Carroll, USA), and standard paper towels. Health care workers were regularly educated for hospital infection control. The use of antibiotics was controlled by the HICC. We compared MRSA isolation rate between before and after applying the strict infection control methods under the regulation of HICC. Mann-Whitney U test, one-way ANOVA, and Chi-square test were used for statistical analysis of the results. RESULTS: After restricting the uses of antibiotics, glycopeptides and carbapenems were prescribed 15% less (20.3 vs 17.3 DDD /1000 patient-days) and 35% less (9.3 vs 6.0 DDD /1000 patient-days) respectively, compared to before restricting antibiotics. Methicillin resistance rate was decreased from 78% to 69% compared to before the methods(p=0.02). The isolation rate of MRSA was reduced by 31-42% from 2.33 to 1.35-1.60/1000 patient-days compared to before adapting strict infection control methods (p=0.04-0.07). CONCLUSION: This study showed that applying the strict infection control methods in the hospital can be effective to reduce the isolation rate of MRSA.
Anti-Bacterial Agents ; Carbapenems ; Cross Infection* ; Delivery of Health Care ; Dichlorodiphenyldichloroethane ; Glycopeptides ; Infection Control ; Korea ; Methicillin Resistance ; Methicillin* ; Methicillin-Resistant Staphylococcus aureus ; Seoul ; Staphylococcus aureus* ; Staphylococcus*

Malignant fibrous histiocytoma is one of the most common soft tissue sarcomas in late adult life, but its incidence in oral and maxillofacial region is extremely rare. We report a case of malignant fibrous histiocytoma which occurred in the infratemporal fossa. Conventional radiograph of this case showed an ill-defined radiolucent lesion in the alveolar bone of the right maxillary first molar area, the lateral wall of the maxillary sinus, and the ascending ramus of mandible. MRI demonstrated well defined mass of intermediate signal intensitiy in T1 weighted images but T2 weighted images showed two distinctive regions of different characteristics. Infratemporal portion of the lesion was of hyperintense signal but under that region, the signal intensity decreased clearly, which might mean this case composed of two different subtypes, though it couldn't be confirmed by histopathological examination. Biopsy was taken in the only soft tissue of the maxillary posterior alveolar region and confirmed the lesion as the storiform-pleomorphic type of malignant fibrous histiocytoma. Histopathological subtype was well consistent with the relatively aggressive imaging findings of that region. We expect more detailed analysis of the nature of malignant fibrous histiocytoma with improvement of the imaging modality and the identification of the relationship between diagnostic imaging and histopathologic findings.
Adult ; Biopsy ; Diagnostic Imaging ; Histiocytoma, Malignant Fibrous* ; Humans ; Incidence ; Magnetic Resonance Imaging ; Mandible ; Maxillary Sinus ; Molar ; Sarcoma

Our objective is to describe the characteristic CT findings of gastrointestinal (GI) tract perforations at various levels of the gastrointestinal system. It is beneficial to localize the perforation site as well as to diagnose the presence of bowel perforation for planning the correct surgery. CT has been established as the most valuable imaging technique for identifying the presence, site and cause of the GI tract perforation. The amount and location of extraluminal free air usually differ among various perforation sites. Further, CT findings such as discontinuity of the bowel wall and concentrated free air bubbles in close proximity to the bowel wall can help predict the perforation site. Multidetector CT with the multiplanar reformation images has improved the accuracy of CT for predicting the perforation sites.
Gastrointestinal Tract/*radiography ; Humans ; Intestinal Perforation/etiology/*radiography ; Peptic Ulcer Perforation/*radiography ; Tomography, X-Ray Computed

Streptococcus pneumoniae is a major human pathogen that is involved in community-acquired pneumonia. Tumor necrosis factor-alpha (TNF-alpha) is a pro-inflammatory cytokine that activates immune responses against infection, invasion, injury, or inflammation. To study the role of TNF-alpha during S. pneumoniae infection, a murine pneumococcal pneumonia model was used. We intranasally infected C57BL/6J wild-type (WT) and TNF-alpha knockout (KO) mice with S. pneumoniae D39 serotype 2. In TNF-alpha KO mice, continuous and distinct loss of body weight, and low survival rates were observed. Bacterial counts in the lungs and blood of TNF-alpha KO mice were significantly higher than those in WT mice. Histopathological lesions in the spleen of TNF-alpha KO mice were more severe than those in WT mice. In TNF-alpha KO mice, severe depletion of white pulp was observed and the number of apoptotic cells was significantly increased. Interferon-gamma (IFN-gamma), IL-12p70 and IL-10 levels in serum were significantly increased in TNF-alpha KO mice. TNF-alpha is clearly involved in the regulation of S. pneumoniae infections. Early death and low survival rates of TNF-alpha KO mice were likely caused by a combination of impaired bacterial clearance and damage to the spleen. Our findings suggest that TNF-alpha plays a critical role in protecting the host from systemic S. pneumoniae infection.
Animals ; Bacterial Load ; Body Weight ; Humans ; Inflammation ; Interferon-gamma ; Interleukin-10 ; Lung ; Mice ; Pneumonia ; Pneumonia, Pneumococcal ; Spleen ; Streptococcus pneumoniae* ; Survival Rate ; Tumor Necrosis Factor-alpha*

We report an uncommon case of solitary, small hepatic angiosarcoma that was initially considered as a hemangioma. We present the imaging findings, with an emphasis on the initial and follow-up CT and MR findings, as well as report on the more suggestive findings of angiosarcoma than those of a hemangioma.
Contrast Media ; Diagnosis, Differential ; Gadolinium DTPA/diagnostic use ; Hemangioma/diagnosis ; Hemangiosarcoma/*diagnosis/surgery ; Humans ; Liver Neoplasms/*diagnosis/surgery ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Tomography, X-Ray Computed

OBJECTIVE: The purpose of the present study was to evaluate treatment outcomes and prognostic factors in cervical cancer patients with isolated para-aortic lymph node (PALN) metastases. We especially tried to evaluate PALN factors such as size, site and number. METHODS: From August 1994 to December 2009, 40 cervical cancer patients with isolated PALN node metastases at initial diagnosis were selected for analysis. Patients underwent both extended field external beam and intracavitary brachytherapy. Fourteen patients received 5-fluorouracil and cisplatin (FP) and 16 patients received weekly concurrent cisplatin. Information of PALN, such as size, site, and number, was founded before PALN radiotherapy. RESULTS: The median follow-up time after primary treatment was 28.5 months (range, 2 to 213 months). The 3-year overall and progression-free survival rate after primary treatment was 44.3% and 31.3%, respectively. In multivariate analysis including tumor stage, performance status, and chemotherapy, FP regimen concurrent chemoradiotherapy was more effective than radiotherapy alone (p=0.030). The 3-year progression-free survival rate was 41.9% and 11.1% in patients with PALN numbers of < or =1 and > or =2, respectively (p=0.008). The 3-year progression-free survival rate was 42.1% and 19.2% in patients with PALN size of <1.5 cm and > or =1.5 cm, respectively (p=0.031). CONCLUSION: The radiologic features of PALN, such as number or size, can be used to determine prognosis in PALN metastatic cervical cancer patients. Furthermore, FP regimen concurrent chemoradiotherapy was associated with better patient survival than radiotherapy alone. However, more studies are required to confirm possible different treatment outcomes between FP and weekly cisplatin regimens.
Brachytherapy ; Chemoradiotherapy ; Cisplatin ; Disease-Free Survival ; Fluorouracil ; Follow-Up Studies ; Humans ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Treatment Outcome ; Uterine Cervical Neoplasms

No abstract available.
Peripheral Nervous System Diseases*

Incidental pancreatic cysts may show various clinical courses, from benign to invasive malignant lesions. To adequately treat asymptomatic pancreatic cystic tumors, accurate diagnosis is needed. However, in many cases, clinical and imaging findings do not provide a definitive diagnosis. Therefore, if there is any evidence suggestive of a malignant lesion, the lesion should be removed surgically. If not, follow-up should be done continuously. To date, several academic societies have issued guidelines that suggest malignant features and follow-up strategies for incidental pancreatic cysts. These guidelines ultimately aim to increase the cure rate by surgical resection and reduce the likelihood of unnecessary surgery by early and efficient screening of high-risk cases. The purpose of this study is to review the relevant findings for the definitive diagnosis of relatively common pancreatic cystic neoplasms and to discuss guidelines for the management of incidental pancreatic cystic neoplasms.