A spontaneous tension hemothorax due to the rupture of an intercostal artery aneurysm is a rare complication of type I neurofibromatosis. Until now, around 23 cases have been reported. The patient reported here presented with a spontaneous tension hemothorax. At the emergency department, we were faced with a rapidly aggravating hemodynamic compromise after chest tubing. An emergent thoracotomy revealed an actively bleeding huge intercostal artery aneurysm. We intended primarily to repair the bleeding aneurysm, but we failed with because of vascular fragility. Thus we present this case to share our terrible experience to other physicians.
Aneurysm* ; Arteries* ; Emergency Service, Hospital ; Hemodynamics ; Hemorrhage ; Hemothorax* ; Humans ; Neurofibromatoses* ; Rupture* ; Thoracotomy ; Thorax

PURPOSE: Rural emergency medical service (EMS) is inferior to urban EMS. In creating and providing emergency patient care, in rural areas, it is important to consider resources, patient volumes, geography, technology challenges, volunteer and provider issues, medical oversight, polities, education, communications, and financial concerns. In the current environment in Korea, it is necessary to design tailored and self-supporting rural EMS systems. For the development of a self-supporting model for EMS systems in rural areas, we have studied the EMS system in one rural area, Goheung County. METHODS: We obtained data from a health institute center, the Gwangju emergency medical information center, three emergency medical centers, and the fire station in Goheung county. In order to survey resident's perceptions about the local EMS system, we provided a questionnaire to 324 residents in Goheung County in March 2005. The advisory council for the EMS system analyzed problems at each step or component of the EMS service delivery process and suggested a model for self-supporting EMS service in Goheung County. RESULTS: The status of the EMS system in Goheung County is inferior to urban systems. A lack of appropriately trained emergency personnel at every level of care has been identified in this area. It is hard to find public education programs. There are few communication systems available for emergency medical care and there are extended transport times and distance, both for responding to and transporting patients. Resident's perceptions of the EMS system is unfavorable. The advisory council suggested an optimized plan to address the problems of the EMS system in Goheung County. A self-supporting model is suggested by the council. It is necessary to consider residents' participation and to apply available resources in Goheung County. CONCLUSION: An ideal EMS system in Goheung County will be a self-supporting model requiring participation of residents and wise application of available sources. The first consideration in this model is institution of a public education program and recruitment and education of first responders in every village is suggested. The model recommends integration of the EMS communication system to provide quality emergency medical care.
Emergencies ; Emergency Medical Service Communication Systems ; Emergency Medical Services ; Fires ; First Aid ; Geography ; Humans ; Information Centers ; Korea ; Patient Care ; Surveys and Questionnaires ; Rural Health Services

Purpose: Dental implant-associated medication-related osteonecrosis of the jaw has been frequently reported in patients administered bisphosphonates (BPs) to prevent osteoporosis. The aim of this study was to investigate the effect of intermittent administration of parathyroid hormone (PTH) on peri-implant bone in the maxillae of ovariectomized rats systemically administered BPs. Methods: Thirty 8-week-old female Sprague-Dawley rats were randomly divided into 3 groups. The OVX-ZP group included ovariectomized rats administered 60 μg/kg of zoledronate once a week for 6 weeks and 30 μg/kg PTH after implant installation. The OVX-Z group included ovariectomized rats administered 60 μg/kg of zoledronate once a week for 6 weeks and saline after implant installation, and the control group included rats that underwent a sham operation and were then administered saline. Rats were sacrificed 4 weeks after implant placement for histomorphometric and micro-computed tomography (CT) analyses. Results: The average bone area percentage was greater in the OVX-ZP group than in the OVX-Z group (53.4%±4.0% vs. 28.9%±9.5%, P=0.01). The bone-to-implant contact ratio was 50.8%±1.4% in the OVX-ZP group and 16.9%±2.4% in the OVX-Z group (P=0.012). The average bone volume ratio as shown on micro-CT was 31.3%±19.8% in the OVX-ZP group and 19.4%±9.3% in the OVX-Z group (P=0.045). The OVX-ZP and OVX-Z groups displayed similar trabecular thickness (0.06±0.004 mm vs. 0.06±0.002 mm) (P>0.05) and trabecular separation (0.21±0.02 mm vs. 0.29±0.13 mm) (P>0.05). However, the number of trabeculae in the OVX-ZP group was significantly higher than that in the OVX-Z group (4.3±1.33/mm3 vs. 2.2±0.19/mm3) (P=0.024). Conclusions The present findings indicate that intermittently-administered PTH can promote peri-implant bone formation and suggest that PTH administration may aid in effective treatment for medication-related osteonecrosis of the jaw after dental implantation.

PURPOSE: Ionizing radiations have been reported as an apoptosis initiating stimulus in various cells and it has established that sustained elevations in [Ca2+] can lead to DNA fragmentation by Ca2+-dependent endonucleases, ultimately resulting in apoptotic cell death. The previous experiments have been reported by using primarily thymocytes and lymphocytes and the change of [Ca2+] was measured only by minutes or hours respectively. We need to evaluate [Ca2+] in both several minutes and hours after irradiation of radiation of radiation therapy and verify the apoptotic cells. MATERIALS AND METHODS: We have measured [Ca2+] in human gingival epitheloid cancer cell with 10 Gy irradiation, at minutely intervals and hourly intervals using digitized video-intensified fluorescence microscopy and the fluorescent Ca2+ indicator dye, fura-2. In order to find out that the transient rise in [Ca2+] could induced apoptosis, cells were incubated for 1 hour at 37 degrees C with TdT enzyme, rinsed and resuspended containing fluorescence and observed under a confocal fluorescence microscope. MTT assay was done to determine cell activity and LDH assay was done to determine the amount of necrotic cells. RESULTS: After irradiation, the transient and temporal increasing of [Ca2+] in the KB cells was founded. Though, there was no change in the intracellular [Ca2+] at 30 minutes and 2 hours after irradiation. We could detect of DNA fragmented cells at 4 hours after 10 Gy irradiated cells. There were no significant differences between 4 hour, 1 day, 3 day cells. There were no significant differences in MTT and LDH assay between the irradiated group and the control group after 4 hours and 1 day. Though after 3 days there were differences in MTT and LDH assay between the irradiated group was significantly decreased than the control group, in LDH assay the number of necrotic cell death of the irradiated was higher than the control group. CONCLUSION: In KB cells there were incipient and temporal increasing of the [Ca2+] with 10 Gy irradiation and the apoptosis was founded from 4 hours later which was earlier than seeing of the change of the amount of the cellular ability and necrosis.
Apoptosis* ; Cell Death ; DNA ; DNA Fragmentation ; Endonucleases ; Fluorescence ; Fura-2 ; Humans ; KB Cells* ; Lymphocytes ; Microscopy, Fluorescence ; Necrosis ; Radiation, Ionizing ; Thymocytes

Nosocomial opportunistic infections including fungal infections continue to increase with a longer survival of immunocompromised patients. Disseminated candidiasis is the most common nosocomial fungal infection and the frequency of isolation of non-Candida albicans organisms besides C.albicans is increasing as causative organisms. We detected numerous yeast cells incidentally in a peripheral blood smear of an infant with congenital heart disease who was treated with total parenteral nutrition and catheterization, and had a history of antibiotics use during a long hospitalization period. Pichia anomala was isolated from the blood and pleural effusion.
Anti-Bacterial Agents ; Candidiasis ; Catheterization ; Catheters ; Fungi ; Heart Defects, Congenital ; Hospitalization ; Humans ; Immunocompromised Host ; Infant ; Opportunistic Infections ; Parenteral Nutrition, Total ; Pichia* ; Pleural Effusion ; Yeasts

BACKGROUND: There is some evidence linking the infections with common organisms such as Chlamydophila pneumoniae, cytomegalovirus (CMV), Helicobacter pylori and HIV to myocardial infarction (MI). We had performed a serologic study to assess whether C.pneumoniae, CMV, H. pylori and HIV infections are associated with MI. METHODS: Serum samples were obtained from 54 cases of acute MI, 33 cases of old MI, and 60 normal controls. C-reactive protein (CRP) as an inflammation marker was measured and antibodies to C.pneumoniae, CMV, H.pylori and HIV were assayed by ELISA. Odds ratios (OR) were calculated against control group. RESULTS: CRP was significantly higher in the acute MI and old MI group. ORs of C.pneumoniae infection increased considerably in the acute MI (IgM 1.57, IgG 4.80) and old MI group (IgM 2.42, IgG 5.18). ORs of CMV infection were 3.30 in the acute MI and 5.12 in old MI group. ORs of H. pylori infection showed below 1 in the acute MI and old MI. Anti-HIV antibody showed all negative result in three groups, so OR could not be calculated. CONCLUSION: C.pneumoniae and CMV infections appear to be risk factors for MI.
Antibodies ; C-Reactive Protein ; Chlamydial Pneumonia* ; Chlamydophila pneumoniae* ; Chlamydophila* ; Coronary Artery Disease ; Cytomegalovirus* ; Enzyme-Linked Immunosorbent Assay ; Helicobacter pylori* ; Helicobacter* ; HIV Infections* ; HIV* ; Immunoglobulin G ; Inflammation ; Myocardial Infarction* ; Odds Ratio ; Risk Factors

BACKGROUND: Although there are growing evidences linking Chlamydophila pneumoniae infection to myocardial infarction, it remains controversial. The authors intended to assess whether C. pneumoniae infection is associated with myocardial infarction. METHODS: Sera and peripheral mononuclear cells (PMNCs) were collected from 54 cases of acute myocardial infarction (MI), 33 cases of old MI, and 60 normal controls. Anti-C.pneumoniae IgG and IgM antibodies were measured using a microimmunofluorescence (mIF) method, and C.pneumoniae DNA was detected using polymerase chain reaction (PCR). RESULTS: Seropositivity of anti-C.pneumoniae IgM antibody by mIF was shown 5.0% in control group, 29.6% (OR=8.00) in the acute MI and 6.1% (OR=1.23) in old MI group. Seropositivity of anti C.pneumoniae IgG antibody were 60.0 % in control group, 92.6% (OR=8.33) in the acute MI and 87.9% (OR= 4.83) in old MI group. The antibody titers in the acute MI and old MI group tended to be higher compared to those in control group. No C.pneumoniae DNA was detected in any case by PCR. CONCLUSION: The seropositivity and antibody titers were significantly higher in the acute MI and old MI group than in control group, suggesting that C.pneumoniae infection may be a risk factor for myocardial infarction.
Antibodies ; Chlamydial Pneumonia* ; Chlamydophila pneumoniae* ; Chlamydophila* ; DNA ; Immunoglobulin G ; Immunoglobulin M ; Myocardial Infarction* ; Pneumonia ; Polymerase Chain Reaction ; Risk Factors

BACKGROUND: The associations between preterm labor or premature rupture of membrane (PROM) and urogenital infections of pregnant women are reported. Ureaplasma urealyticum and Mycoplasma hominis are well known as important pathogens of urogenital infections in pregnant women. In routine clinical laboratory, conventional culture for these microorganisms has not been made generally because of the requirements for strict growth condition. MYCOFAST(R) Evolution 2 is an easy and rapid liquid microculture method using metabolism of these microorganisms. Author investigated the relationship between U. urealyticum or M. hominis infections and preterm labor or PROM by MYCOFAST Evolution 2 and PCR. Also it was reviewed that the possibility of substitution of MYCOFAST Evolution 2 for conventional culture method by comparing with PCR methods. METHODS: This study was done on 91 pregnant women. They were composed of two groups; group I(n=48) had full-term delivery and group II(n=43) had preterm labor or PROM before the 37th week.Two cervical swabs were made each time. One was used for MYCOFAST(R) Evolution 2 and the other for PCR. RESULTS: The positivity of U. urealyticum was 39.6% in group Iand 58.1% in group IIby MYCOFAST Evolution 2 and 39.6% and 58.1% by PCR method, respectively. The positivity of M. hominis was 4.2% in group Iand 11.6% in group IIby MYCOFAST Evolution 2 and 4.2% and 7.0% by PCR method, respectively. The positivity of U. urealyticum and M. hominis in group IIwas higher than that in group Ibut was not significant statistically. The concordance rates between two methods were 86.8% for U. urealyticum and 97.8% for M. hominis. It showed good correlation between two methods (U. urealyticum, r=0.736; M. hominis, r=0.835). CONCLUSIONS: The infections of U. urealyticum and M. hominis were related to preterm labor or PROM. Considering vertical transmission to fetus or neonates resulting in perinatal morbidity or mortality, the detection of these microorganisms is important. MYCOFAST(R) Evolution 2 was an easy, rapid and reliable method substituting conventional culture method.
Female ; Fetus ; Humans ; Infant, Newborn ; Membranes ; Metabolism ; Mortality ; Mycoplasma hominis* ; Mycoplasma* ; Obstetric Labor, Premature ; Polymerase Chain Reaction* ; Pregnancy ; Pregnant Women* ; Rupture ; Ureaplasma urealyticum* ; Ureaplasma*

In acute phase, cerebral infartion is usually hypodense on CT and hyperintense on T2-weighted MR image. This hyperintensity on T2-weighted MR image gradually approaches an isointensity stage after 2 or 3 weeks of onset. In the later stage, cerebral infarction is observed hyperintense on T2-weighted MR image. This sequential phenomenon is so-called "fogging effect". We experienced two cases of "fogging effect". The first case did not show abnormal signal intensity on TI or T2 weighted MR images taken after 14 days of onset and the second case also did not show abnormal signal intensity after 17 days of onset. Each case revealed hyperintense in T2-weighted image with contrast enhancement taken after 20 weeks and 8 weeks of onset, respectively. We present two cases with MRI and brief review of literatures.
Cerebral Infarction ; Magnetic Resonance Imaging ; Weather*

BACKGROUND/AIMS: In head and neck squamous cell carcinoma, second primary gastrointestinal tumors are not uncommon. However, it is unclear whether a screening endoscopy is needed for detecting gastrointestinal neoplasm in patients with head and neck cancer. Therefore, we analyzed the prevalence and independent risk factors for second primary gastrointestinal neoplasm in head and neck squamous cell carcinoma. METHODS: A consecutive series of 328 patients with primary head and neck squamous cell carcinoma that underwent esophagogastroduodenoscopy or colonoscopy were included using our registry. An age- and sex-matched group of 328 control subjects was enrolled. We assessed risk factors of synchronous gastrointestinal cancer. RESULTS: The prevalence of esophageal cancer with head and neck squamous cell carcinoma was significantly higher than that of the control group (1.5% vs. 0.0%, p=0.011). An age of 54 years or more (OR, 1.033; 95% CI, 1.008-1.059; p=0.009) and male gender (OR, 4.974; 95% CI, 1.648-15.013; p=0.004) were risk factors for concomitant colorectal cancer or adenomas in the head and neck squamous cell carcinoma patients. CONCLUSIONS: Preoperative colonoscopy can be recommended for detecting synchronous second primary colorectal lesions in head and neck squamous cell carcinoma patients with male sex regardless of age, and esophagogastroduodenoscopy is necessary in all head and neck squamous cell carcinoma patients for detecting esophageal cancer.
Adenoma ; Carcinoma, Squamous Cell ; Colonoscopy ; Colorectal Neoplasms ; Diagnosis ; Endoscopy ; Endoscopy, Digestive System ; Endoscopy, Gastrointestinal* ; Esophageal Neoplasms ; Gastrointestinal Neoplasms ; Head and Neck Neoplasms* ; Head* ; Humans ; Male ; Mass Screening ; Neck ; Neoplasms, Second Primary* ; Prevalence ; Risk Factors