Intraaortic balloon counterpulsation (IAB) has been shown to prolong survival in the critically ill cardiac patients. Originally developed for use in the patients with cardiogenic shock, the indications have been expanded. But despite technical advances, the complication rate associated with IAB remains high. The most commonly reported complications include damage to the femoral artery and distal embolization. Other reported major complications are balloon rupture, limb loss, bleeding, systemic infection and bowel infarction. We report a patient complicated by ischemic colitis causing stenosis and intestinal obstruction after IAB insertion.
Colitis, Ischemic* ; Constriction, Pathologic* ; Counterpulsation* ; Critical Illness ; Extremities ; Femoral Artery ; Hemorrhage ; Humans ; Infarction ; Intestinal Obstruction ; Rupture ; Shock, Cardiogenic

Cystic parathyroid adenoma is one of the rare causes of hyperparathyroidism, and is usually located in neck and mediastinum. This type of adenoma tends to cause increased serum level of parathyroid hormone and alkaline phosphatase, similar serum calcium level when compared to those of solid adenoma. Thanks to current radioimmunoassay and easy accessibility to serum autoanalyzer, serum calcium level and parathyroid hormone level are more easily measured, which in turn lead to more easier diagnosis of hyperparathyroidism. Also improvement in imaging and nuclear diagnostic method of parathyroid lesion are suggested to enable easy diagnosis of cystic parathyroid adenoma. A 35-year-old male presented with easy fatigability for 12 months. The serum calcium, phosphate, alkaline phosphotase were 11.5mg/dL, 1.4mg/dL, 194IU/L respectively and his parathyroid hormone level in serum was 126.42pg/mL. Neck CT showed enlargement of right lobe of thyroid gland with well defined inhomogenously enhanced density inside the right thyroid gland. The patient was diagnosed of hyperparathyroidim due to parathyroid adenoma and was surgically removed. The surgical biopsy showed cystic parathyroid adenoma. After operation his general condition was improved and serum calcium, phosphate, parathyroid hormone level were normalizd. We report a case of hyperparathyroidism caused by cystic parathyroid adenoma with brief review of literature.
Adenoma ; Adult ; Alkaline Phosphatase ; Biopsy ; Calcium ; Diagnosis ; Humans ; Hyperparathyroidism* ; Male ; Mediastinum ; Neck ; Parathyroid Hormone ; Parathyroid Neoplasms* ; Radioimmunoassay ; Thyroid Gland

Post-traumatic pisotriquetral osteoarthritis is an unusual condition and its diagnosis is not easy to make. This disease must be distinguished from other conditions that cause ulnar side wrist pain. We experienced a case of post-traumatic pisotriquetral osteoarthritis treated by pisiformectomy.
Diagnosis ; Osteoarthritis* ; Wrist

BACKGROUND: In the authors clinical experience, delirium during recovery from sevoflurane anesthesia is more common in younger children than in older children. The aim of the present study was to assess the recovery quality after sevoflurane anesthesia in school and preschool children. METHODS: Thirty children, ASA 1, scheduled for elective surgery were assigned into two groups of preschool (n = 15) or school (n = 15). All children were premedicated with midazolam (0.05 mg/kg) and glycopyrrolate (0.04 mg/kg) an hour before anesthesia induction. Thiopenthal sodium (5 mg/kg) and vecuronium bromide (0.1 mg/kg) were used for the induction of anesthesia, and it was maintained by inhalation of sevoflurane in N2O/O2 50/50 via an endotracheal tube. Recovery characteristics and agitation characteristics on emergence were also compared between the two groups. RESULTS: Emergence delirium occurred more frequently in preschool children (P < 0.01). Duration of emergence delirium was also longer in preschool children (P < 0.01). CONCLUSIONS: Emergence delirium after sevoflurane anesthesia was more common and longer in preschool children.
Anesthesia* ; Child ; Child, Preschool* ; Delirium* ; Dihydroergotamine ; Glycopyrrolate ; Humans ; Incidence* ; Inhalation ; Midazolam ; Sodium ; Vecuronium Bromide

PURPOSE: The inferior orbital wall is the most vulnerable to injury and inadequate reconstruction of inferior orbital fracture result in postoperative complications include enophthalmos, ocular dystopia and diplopia. Although the anatomical reconstruction of the inferior orbital wall is necessary to prevent these complications, the complexity of inferior orbital wall makes it difficult. We fabricated and remodeled the titanium micro-mesh plate for the anatomical reconstruction of inferior orbital wall. METHODS: Twenty-nine patients with inferior orbital wall blow-out fracture were operated and twelve of them presented large extensive fracture. We intraoperatively fabricated and remodeled the Titanium-micro mesh to angulated lazy S shape similar to contralateral uninjured orbit. The preoperative and postoperative facial CT scan verified the 3-dimensional and anatomical reconstruction of the fractures. The mean follow-up was 19.7 months and postoperative complications was evaluated. RESULTS: All cases showed the exact anatomical reconstruction, but there were minor complications in two cases. one patient had postoperative diplopia until 3months after surgery and the other patient had persistent enophthalmos(2mm), but no further surgical correction was required. CONCLUSION: The comprehensive understanding of orbital convexity is the most important factor for anatomical reconstruction of inferior orbital fracture. We could prevent postoperative complications after inferior orbital wall reconstruction by intraoperative fabrication and anatomical remodeling of Titanium micro-mesh.
Diplopia ; Enophthalmos ; Follow-Up Studies ; Humans ; Orbit ; Orbital Fractures ; Postoperative Complications ; Titanium

PURPOSE: The inferior orbital wall is the most vulnerable to injury and inadequate reconstruction of inferior orbital fracture result in postoperative complications include enophthalmos, ocular dystopia and diplopia. Although the anatomical reconstruction of the inferior orbital wall is necessary to prevent these complications, the complexity of inferior orbital wall makes it difficult. We fabricated and remodeled the titanium micro-mesh plate for the anatomical reconstruction of inferior orbital wall. METHODS: Twenty-nine patients with inferior orbital wall blow-out fracture were operated and twelve of them presented large extensive fracture. We intraoperatively fabricated and remodeled the Titanium-micro mesh to angulated lazy S shape similar to contralateral uninjured orbit. The preoperative and postoperative facial CT scan verified the 3-dimensional and anatomical reconstruction of the fractures. The mean follow-up was 19.7 months and postoperative complications was evaluated. RESULTS: All cases showed the exact anatomical reconstruction, but there were minor complications in two cases. one patient had postoperative diplopia until 3months after surgery and the other patient had persistent enophthalmos(2mm), but no further surgical correction was required. CONCLUSION: The comprehensive understanding of orbital convexity is the most important factor for anatomical reconstruction of inferior orbital fracture. We could prevent postoperative complications after inferior orbital wall reconstruction by intraoperative fabrication and anatomical remodeling of Titanium micro-mesh.
Diplopia ; Enophthalmos ; Follow-Up Studies ; Humans ; Orbit ; Orbital Fractures ; Postoperative Complications ; Titanium

Acute necrotizing encephalopathy predominantly affects young children and infants living in Japan and Taiwan, and is characterised by acute encephalopathy with seizures and decreased level of consciousness. The Hallmark of the disease is diffuse and symmetrical CNS lesions of both thalami, brainstem tegmentum, cerebral periventricular white matter and cerebellar medula. The clinical, radiological and pathological features of this disease, a disease entity established recently, is proposed by Masashi Mizuguchi et al in 1995. The aetiology is unknown but infectious or parainfectious process seems likely. The diagnosis can be made without difficulty on the basis of the combination of a typical clinical figures and characteristic radiologic findings. There is no specific therapy or prevention. The prognosis was poor in the 1980s but has improved recently. We experienced a case of 6-month-old female infant with acute necrotizing encephalopathy and a thalamic hemorrhage. We report this case with a review of the related literatures.
Brain Stem ; Child ; Consciousness ; Diagnosis ; Female ; Hemorrhage* ; Humans ; Infant ; Japan ; Prognosis ; Seizures ; Taiwan

PURPOSE: Ceftriaxone, a parenteral third-generation cephalosporine, is widely used in the treatment of various bacterial infections. It possesses high calcium-binding affinity, forming complexes with calcium in bile salts to develop precipitate that mimics gallstone on ultrasonography. Biliary pseudolithiasis resolves completely with cessation of therapy, but several symptomatic patients have undergone cholesystectomy. We prospectively evaluated the incidence, risk factors and dose- related comparison with ultrasonography. METHODS: Between November 1998 and August 1999, 81 cases of inpatients on ceftriaxone treatment in Dongguk University Pohang Hospital were enrolled for this study. They were divided according to dose of ceftriaxone, high-dose and low-dose groups. Repeated sonography was performed on 1, 3, 5 and 7 days after initiation of ceftriaxone treatrnent and then weekly until pseudolithiasis were resolved. RESULTS: Thirty-eight percent of the subjects acquired pseudolithiasis. Sonographic abnormalities appeared from 1 to 10 days after ceftriaxone therapy and completely resolved from 1 to 24 days after cessation of ceftriaxone therapy. The incidence of pseudolithiasis was significantly higher in the high-dose group(P<0.001). In the high-dose group, fasting over a day was a significant risk factor of pseudolithiasis(P<0.01). Sex, age, duration of ceftriaxone therapy, laboratory findings, type of infection or chief complaint were not significant risk factors for pseudolithiasis. CONCLUSION: We suggest that abdominal ultrasonography should be considered in all children who receive high dose ceftriaxone with fasting over a day. If pseudolithiasis was developed, we can detect the most of resolution after 30 days of cessation of therapy.
Bacterial Infections ; Bile Acids and Salts ; Calcium ; Ceftriaxone ; Child ; Fasting ; Gallstones ; Gyeongsangbuk-do ; Humans ; Incidence ; Inpatients ; Prospective Studies* ; Risk Factors ; Ultrasonography

PURPOSE: The axillary web syndrome(AWS) is a self-limiting cause of morbidity in the early postoperative period after axillary surgery. This article presents a rare complication developed after surgical treatment for axillary osmidrosis. METHODS: A 55-year-old male patient underwent surgical excision of skin and glandular tissue for axillary osmidrosis. Three weeks after the surgery, he visited our department due to a visible web of left axillary skin overlying palpable cord extends into the medial ipsilateral arm. There was a taut and tender cord of tissue under the skin and shoulder abduction was limited to less than 90degrees degrees. He was diagnosed with AWS and treated with conservative management. RESULTS: Four months later, AWS resolved completely without any treatment and patient was free of pain or motion restriction. CONCLUSION: Axillary web syndrome has been described as frequent complication after axillary lymph node dissection or sentinel node biopsy, but not after surgical treatment of axillary osmidrosis. Surgeons must be aware of the risk of axillary web syndrome after treatment of axillary osmidrosis.
Arm ; Biopsy ; Humans ; Hyperhidrosis ; Lymph Node Excision ; Male ; Middle Aged ; Nitriles ; Postoperative Complications ; Postoperative Period ; Pyrethrins ; Shoulder ; Skin

PURPOSE: This study was conducted to know the applications and limitations of three dimensional volume rendering virtual endoscopy of the ossicles using a multi-row detector CT. MATERIALS AND METHODS: This study examined 25 patients who underwent temporal bone CT using a 16-row detector CT as a result of hearing problems or trauma. The axial CT scan of the temporal bone was performed with a 0.6 mm collimation, and a reconstruction was carried out with a U70u Sharp of kernel value, a 1 mm thickness and 0.5-1.0 mm increments. After observing the ossicles in the axial and coronal images, virtual endoscopy was performed using a three dimensional volume rendering technique with a threshold value of -500 HU. The intra-operative otoendoscopy was performed in 12 ears, and was compared with the virtual endoscopy findings. RESULTS: Virtual endoscopy of the 29 ears without hearing problems demonstrated hypoplastic or an incomplete depiction of the stapes superstructures in 25 ears and a normal depiction in 4 ears. Virtual endoscopy of 21 ears with hearing problems demonstrated no ossicles in 1 ear, no malleus in 3 ears, a malleoincudal subluxation in 6 ears, a dysplastic incus in 5 ears, an incudostapedial subluxation in 9 ears, dysplastic stapes in 2 ears, a hypoplastic or incomplete depiction of the stapes in 16 ears and no stapes in 1 ear. In contrast to the intra-operative otoendoscopy, 8 out of 12 ears showed a hypoplastic or deformed stapes in the virtual endoscopy. CONCLUSION: Volume rendering virtual endoscopy using a multi-row detector CT is an excellent method for evaluation the ossicles in three dimension, even though the partial volume effect for the stapes superstructures needs to be considered.
Ear ; Endoscopy* ; Hearing ; Humans ; Incus ; Malleus ; Stapes ; Temporal Bone ; Tomography, X-Ray Computed