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

PURPOSE: To evaluate changes in total cerebral blood flow (tCBF) with aging, parenchymal volume changes and vascular abnormalities, using 2 dimensional (D) phase-contrast magnetic resonance imaging (PC MRI). MATERIALS AND METHODS: Routine brain MRI including T2 weighted image, time-of-flight (TOF) MR Angiography (MRA) and 2D PC MRI were performed in 73 individuals, including 12 volunteers. Normal subjects (12 volunteers, and 21 individuals with normal MRI and normal MRA) were classified into groups according to age (18 -29, 30 -49 and 50 -66 years). For the group with abnormalities in brain MRIs, cerebral parenchymal volume changes were scored according to the T2 weighted images, and atherosclerotic changes were scored according to the MRA findings. Abnormal groups were classified into 4 groups: (i) mild reduction in volume, (ii) marked reduction in volume by parenchymal volume and atherosclerotic changes, and (iii) increased volume and (iv) Moya-moya disease. Volumetric flow was measured at the internal carotid artery (ICA) and vertebral artery bilaterally using the velocity-flow diagrams from PC MRI, and combined 4 vessel flows and tCBF were compared among all the groups. RESULTS: The age-specific distribution of tCBFs in normal subjects were as follows: 12.0 +/- 2.1 ml/sec in 18 -29 years group, 11.8 +/- 1.9 ml/sec in 30 -49 years group, 10.9 +/-2.2 ml/sec in 50 -66 years group. The distribution of tCBFs in the different subsets of the abnormal population were as follows: 9.5 +/-2.5 ml/sec in the group with mild reduction in volume, 7.6 +/-2.0 ml/sec in the group with marked reduction in volume, and 7.3 +/-1.2 ml/sec and 7.0 +/- 1.1 ml/sec in the increased parenchymal volume and Moya-moya disease groups respectively. CONCLUSION: Total cerebral blood flow decreases with increasing age with a concomitant reduction in parenchymal volumes and increasing atherosclerotic changes. It is also reduced in the presence of increased parenchymal volume and Moya-moya disease. 2D PC MRI can be used as a tool to evaluate tCBF with aging and in the presence of various conditions that can affect parenchymal volume and cerebral vasculature.
Aging* ; Angiography ; Brain ; Carotid Artery, Internal ; Magnetic Resonance Imaging* ; Moyamoya Disease ; Vertebral Artery ; Volunteers

No abstract available.
Heart Neoplasms*

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

OBJECTIVE: To report an observational investigation of small high attenuated foci in computed tomography (CT) scan followed by brain parenchymal catheterization. METHODS: From January 2011 to March 2015, we retrospectively reviewed the 381 patients who had undergone brain catheterization in our clinic and enrolled the patients who had newly developed high attenuation foci in the postoperative CT scans. The brain CT scans were reviewed about the lesion location, Hounsfield Unit (HU) and the time of appearance. RESULTS: Twenty seven of 381 patients had high attenuation foci in CT scans after the procedure. The location of high density lesions was as follows: parenchyma in 9 (33.3%) cases, ventricle in 5 (18.5%), combined in parenchyma and ventricle in 13 (48.1%). The lesions were identified in the catheter tract in parenchymal type, and catheter-lodged frontal horn or choroid plexus in ventricular type. We could not find the calcific foci before the catheter removal, and those were found after removal in all cases. The time of appearance after the removal was variable from 0 to 14 days (mean 4.2, median 3). The regular rules of HU change in CT scans were not found as times go on. CONCLUSION: The high attenuation foci in CT scans were bone dust originated from skull during operation. Although these lesions did not make troubles, we should clean the operation field before the insertion of brain catheter and we may use another material, like Surgicel to seal up the burr hole instead of bone dust in the end of operation.
Animals ; Bone Transplantation ; Brain* ; Calcinosis ; Catheterization* ; Catheters* ; Choroid Plexus ; Dust ; Horns ; Humans ; Retrospective Studies ; Skull ; Tomography, X-Ray Computed

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

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