No abstract available.
Cesarean Section* ; Female ; Myotonic Dystrophy* ; Pregnancy

Fractures of the lateral process of the talus (LPT) are considered rare, accounting for less than 1% of all ankle injuries in the general population. These fractures are nearly 15 times more likely to occur in snowboarders. Recently, the number of population who started enjoying cable-wakeboard is increasing and this sport may cause fracture of the LPT by axial loading occur on the LPT while boarding or trick. We report on a case of involving LPT fracture during cable-wakeboard trick with successful screw osteosynthesis.
Ankle Injuries ; Skiing ; Sports ; Talus

Opioid-induced chest wall rigidity is an uncommon complication of opioids. Because of this, it is often difficult to make a differential diagnosis in a mechanically ventilated patient who experiences increased airway pressure and difficulty with ventilation. A 76-year-old female patient was admitted to the intensive care unit (ICU) after surgery for periprosthetic fracture of the femur neck. On completion of the surgery, airway pressure was increased, and oxygen saturation fell below 95% after a bolus dose of fentanyl. After ICU admission, the same event recurred. Manual ventilation was immediately started, and a muscle relaxant relieved the symptoms. There was no sign or symptom suggesting airway obstruction or asthma on physical examination. Early recognition and treatment should be made in a mechanically ventilated patient experiencing increased airway pressure in order to prevent further deterioration.
Aged ; Airway Obstruction ; Analgesics, Opioid ; Asthma ; Diagnosis, Differential ; Female ; Femur Neck ; Fentanyl* ; Humans ; Intensive Care Units ; Lung Diseases, Obstructive ; Muscle Rigidity ; Oxygen ; Periprosthetic Fractures ; Physical Examination ; Thoracic Wall* ; Thorax* ; Ventilation

Background: Non-convulsive status epilepticus (NCSE), in which continuous epileptiform dis-charges occur without seizure-like movement, is rare and unfamiliar to anesthesiologists, both of which make this condition overlooked in patients with decreased levels of consciousness following general anesthesia.Case: We report on an elderly female patient who developed NCSE in the immediate postoperative period after the spine surgery. Initially, delayed emergence from anesthesia was suspected, but the electroencephalogram confirmed NCSE, and anticonvulsant therapy was initiated. Conclusions Delayed emergence is commonly attributed to cerebrovascular events or residual anes-thetic effects, but NCSE must be included in the differential diagnosis, especially in elderly pa-tients. Anticonvulsant therapy should be initiated as soon as possible for a better prognosis.

Transoral endoscopic thyroid surgery vestibular approach (TOETVA) is now widely performed globally with good cosmetic outcomes. However, there are complications related to this approach which surgeons should be aware of. We report here a 41-year-old female patient who had an unusual ocular complication after total thyroidectomy via TOETVA. She was diagnosed with papillary thyroid carcinoma and received total thyroidectomy via TOETVA. She complained of floating particles in her right eye immediately after the operation. Fundus examination revealed intraocular hemorrhage in her right eye. At one-month follow-up, all of the intraocular hemorrhage was improved by fundus examination, resolving her chief complaint. Surgeons and anesthesiologists should be aware of increased intracranial pressure during the TOETVA and possible ocular complications after the surgery, although they are rare.

PURPOSE: We evaluated the psychometric properties of a questionnaire on the acceptance of the quality improvement information system (QIIS) among long-term care workers (mostly nurses). METHODS: The questionnaire composes of 21 preliminary questions with 5 domains based on the Technology Acceptance Model and related literature reviews. We developed a prototype web-based comprehensive resident assessment system, and collected data from 126 subjects at 75 long-term care facilities and hospitals, who used the system and responded to the questionnaire. A priori factor structure was developed using an exploratory factor analysis and validated by a confirmatory factor analysis; its reliability was also evaluated. RESULTS: A total of 16 items were yielded, and 5 factors were extracted from the explanatory factor analysis: Usage Intention, Perceived Usefulness, Perceived Ease of Use, Social Influence, and Innovative Characteristics. The five-factor structure model had a good fit (Tucker-Lewis index [TLI]=.976; comparative fit index [CFI]=.969; standardized root mean squared residual [SRMR]=.052; root mean square error of approximation [RMSEA]=.048), and the items were internally consistent(Cronbach's α=.91). CONCLUSION: The questionnaire was valid and reliable to measure the technology acceptance of QIIS among long-term care workers, using the prototype.
Health Information Systems ; Information Systems* ; Intention ; Long-Term Care* ; Psychometrics* ; Quality Improvement*

BACKGROUND: A cartilage wedge block and covering flap are standard procedures for firm elevation of the ear in microtia correction. However, using costal cartilage for elevation of the reconstructed auricle can be insufficient, and the fixed cartilage wedge block may be absorbed or may slip out. Furthermore, elevating covering flaps is time-consuming and uses up fascia, a potential source of reconstruction material. Therefore, we propose an innovative method using autologous onlay rib bone graft for auricular elevation of microtia. METHODS: From February 1995 to August 2012, 77 patients received a first stage operation with a rib cartilage framework graft. In the second stage operation, a small full thickness of rib bone was harvested through the previous donor scar. The bihalved rib bone was inserted into the subperiosteal pocket beneath the cartilage framework. RESULTS: The follow-up time ranged from 1 month to 17 years, with a mean of 3 years. All of the patients sustained the elevation of their ears very well during the follow-up period. Donor site problems, except for hypertrophic scars, were not observed. Surgery-related complications, specifically skin necrosis, infection, or hematoma, occurred in 4 cases. CONCLUSIONS: Onlay rib bone graft used to elevate the reconstructed auricle is a more anatomically appropriate material than cartilage, due to the bone-to-bone contact between the bone graft and the temporal bone. Postoperative minor correction of the elevation degree is straightforward and the skin graft survives better. Therefore, reconstructed auricle elevation using onlay rib bone graft is a useful and valuable method.
Bone Transplantation ; Cartilage ; Cicatrix ; Cicatrix, Hypertrophic ; Congenital Abnormalities ; Ear ; Ear Auricle ; Fascia ; Follow-Up Studies ; Hematoma ; Humans ; Inlays ; Necrosis ; Ribs ; Skin ; Temporal Bone ; Tissue Donors ; Transplants

Choroid plexus tumors are uncommon brain tumors that primarily occur in children. Most of these tumors originate from the intraventricular area, and the most common clinicalpresentation is increased intracranial pressure. Dissemination through the cerebrospinal fluid space is the inevitable natural course of the disease. Here, we present 2 rare cases of adult choroid plexus carcinoma (CPC), each with distinct clinical presentation and progression. The first case was a 40-year-old male who presented with multiple intraventricular masses. After surgical biopsy, radiation and intrathecal chemotherapy failed to elicit any response. The patient progressed with spinal cord dissemination and expired 1 year later. The second case presented with visual disturbance, and brain MRI revealed a large ovoid juxtaventricular mass with peritumoral edema. This 49-year-old female patient underwent craniotomy for what was thought to be a high-grade glioma; however, the mass was connected to the choroid plexus at the operative field. Her pathology specimen was diagnosed as CPC, and adjuvant systemic chemotherapy was administered. She has now been free of recurrence for 10 months. The description of the presentation and progression of these rare adult-onset CPC provides insight for the diagnosis and treatment of other rare instances of choroid plexus tumors.
Adult ; Biopsy ; Brain ; Brain Neoplasms ; Cerebrospinal Fluid ; Child ; Choroid Plexus Neoplasms ; Choroid Plexus ; Choroid ; Craniotomy ; Diagnosis ; Drug Therapy ; Edema ; Female ; Fourth Ventricle ; Glioma ; Humans ; Intracranial Pressure ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pathology ; Recurrence ; Spinal Cord

Hickman catheters are tunneled central venous catheters used for long-term venous access in children with malignancies. The appropriate management for various kinds of catheter related complications has become a major issue. We retrospectively analyzed the clinical, demographic, and surgical characteristics in 154 pediatric hemato-oncology patients who underwent Hickman catheter insertion between January 2005 and December 2009. There were 92 boys and 62 girls. The mean age at surgery was 7.6+/-5.1 years old. The mean operation time was 67.4+/-21.3 minutes and C-arm fluoroscopy was used in 47(30.5%). The causes of Hickman catheter removal were termination of use in 82 (57.3%), catheter related bloodstream infection in 44(30.8%), mechanical malfunction in 11(7.7%), and accidents in 6(4.2%). Univariate and multivariate analysis for associated factors with catheter related bloodstream infection showed that there were no statistically significant associated factors with catheter related infection complications. All cases except two showed clinical improvement with catheter removal and relevant antibiotics treatment. The mean catheter maintenance period in patients of catheter removal without complications was 214.9+/-140.2 days. And, The mean catheter maintenance period in patients of late catheter related bloodstream infection was 198.0+/-116.0 days. These data suggest that it is important to remove Hickman catheter as soon as possible after the termination of use. When symptoms and signs of complications were noticed, prompt diagnostic approach and management can lead to clinical improvements.
Anti-Bacterial Agents ; Catheters ; Central Venous Catheters ; Child ; Fluoroscopy ; Humans ; Multivariate Analysis ; Retrospective Studies

Coronary stent loss is a rare but serious complication during interventional cardiology. This complication occurs not only in the intracoronary area but also in the extracoronary area, such as the aortic root or the left ventricle. An 83-year-old man with stable angina had a stent inserted into a heavy calcific left anterior descending artery. The stent was lost twice during the procedure. The first stent was dislodged from the left main coronary artery to the proximal left anterior descending artery, and the second stent migrated to the aortic root following separation from the balloon. We successfully redeployed the first stent at the dislodged site and retrieved the second stent using a goose-neck snare after moving the stent to the descending aorta. These steps circumvented the need for the patient to undergo emergency cardiovascular surgery.
Angina, Stable ; Aorta, Thoracic ; Arteries ; Cardiology ; Coronary Vessels ; Emergencies ; Heart Ventricles ; Humans ; Percutaneous Coronary Intervention ; SNARE Proteins ; Stents