A young metastatic lung cancer patient developed empyema due to an infection with carbapenem-resistant Acinetobacter baumannii. Hydropneumothorax was detected and managed by a tube thoracotomy. However, persistent air leakage through the chest tube was observed due to the presence of a bronchopleural fistula (BPF). As hypercapnic respiratory failure had progressed and the large air leak did not diminish by conservative management, a pumpless extracorporeal lung assist (pECLA) device was inserted. The pECLA allowed the patient to be weaned from mechanical ventilation and the BPF to heal. The present case shows the effective application of pECLA in a patient with empyema complicated with BPF and severe hypercapnic respiratory failure. pECLA enabled us to minimize airway pressure to aid in the closure of the BPF in the mechanically ventilated patient.
Acinetobacter baumannii ; Bronchial Fistula ; Carbon Dioxide* ; Carbon* ; Chest Tubes ; Empyema* ; Fistula ; Humans ; Hydropneumothorax ; Hypercapnia ; Lung ; Lung Neoplasms ; Respiration, Artificial ; Respiratory Insufficiency ; Thoracotomy

PURPOSE: In order to assess the incidence and radiologic findings of herniation pit of the femur neck in Korean. IVlaterials and Methods:In 152 macerated femurs of 88 cadavers, and randomly selected 115 hips of 70 patients, the presence of herniation pit was determi ned by using fluoroscopy and radiography. It was then examined by CT for inspection of overlying surface and its opening was confirmed by inserting thin steal wire under the fluoroscopic guidance. RESULTS: Seventeen herniation pits in 15 macerated femurs of 13 cadavers were noted. (14.8%, 13/88). Two of 13 individuals showed bilaterality. All lesions were found only in males. Six herniation pit in 6 femurs of 6 patients (8.6%, 6/70) were also noted. All lesions were on anterosuperior aspect of. femur neck. Plain radiographs of macerated femurs revealed well marginated and thin sclerosis in 15 lesions. Of all 23 lesions, CTshowed cortical breakdown in 3, and overlying cortical thickening in 8. In 15 macerated femurs, roughed area of cortex was found in anterosuperior aspect of femur in all cases, and tiny openings(diameter less than 1 mm) related to cystic lesions were confirmed in 9 lesions. CONCLUSION: The incidence of herniation pits was 14.8% in 88 cadaver, and 8.6% in 70 patients. All were males.
Cadaver ; Femur Neck* ; Femur* ; Fluoroscopy ; Hip ; Humans ; Incidence* ; Male ; Radiography ; Sclerosis

No abstract available.
Asthma*

Better palliative management of patients with disseminated cancer has prolonged their lives but has raised the incidence of pathologic fractures in their variable lives. The essence of treatment is to prolong life, maintain comfort, and stabilize the patient with metastatic disease. The treatment of pathologic fractures with internal fixation has long been accepted by orthopedic surgeons and the benefits afforded to the patient are well known, so adequate fixation is essential. A combination of methylmethacrylate and internal fixation devices can greatly enhance the stability of fixation, because diseased bone is a poor base on which to insert an internal fixation device. The authors have treated 19 cases of the pathologic fracture of spine, humerus and femur by use of bone cement with and without internal fixation devices. The results are as follwed. 1. All cases utilized methylmethacrylate and there was no complication in methylmethacrylate in itself. 2. All cases had received various type of ancillary treatment: radiation in 9 cases, chemotherapy in 4 cases and in 8 cases, conservative pain control. 3. In spinal pathologic fracture with paraplegia or neurologic deficiency, the patients could walk with walker at an average of two weeks after operation. 4. Among the 19 cases, the pain was relieved markedly and ambulation was possible easily and early after operation in 16 cases. 5. Among the 19 cases, two survived less than 2 months, 7 surrived from 2 month to 3 month, five survived from 3 months to 6 months, four survived from 6 months to a year and one survived more than a year.
Drug Therapy ; Femur ; Fractures, Spontaneous ; Humans ; Humerus ; Incidence ; Internal Fixators ; Methylmethacrylate ; Orthopedics ; Paraplegia ; Spine ; Surgeons ; Walkers ; Walking

Torsion of a mucocele of the vermiform appendix is an extremely rare condition and also a rare cause of an acute abdomen with a clinical presentation that is indistinguishable from acute appendicitis, and thus, the condition is diagnosed during operation. Here, the authors describe the case of a 78-year-old female, who presented with intermittent abdominal pain. The appendix had a pelvic position and the torsion was counterclockwise. In addition, the torsion was associated with mucocele of the appendix, which was considered a secondary factor of torsion. Appendectomy and drainage were performed.
Abdomen, Acute ; Abdominal Pain ; Aged ; Appendectomy ; Appendicitis ; Appendix ; Drainage ; Female ; Humans ; Mucocele ; Torsion Abnormality

PURPOSE: Although considered uncommon, periprosthetic fracture of the femur after hip arthroplasty is a serious complication that can be difficult to treat. Authors analyzed the types of fracture and modality of treatment. MATERIALS AND METHODS: Between Jan. 1983 and Dec. 1997, 17 cases of postoperative periprosthetic fractures had been treated at our hospital. These cases were followed up for an average of 58 (13-123) months. The fractures were classified according to Duncan and Masri classification. Three cases of type A, and 6 cases of type B1, 3 cases of type B2, 3 cases of type B3 and 2 cases of type C. The 3 cases of type A and 2 cases oftype B1 were conservative treatments. The 4 cases of type B1 were treated with open reduction and internal fixation with bone graft. The 3 cases of type B2 and 3 cases in type B3 were treated with long stem revision. The 2 cases of type C were treated with open reduction and internal fixation with bone graft. RESULTS: Bony union happened in all cases. The results according to Beals and Tower criteria were excellent in 12 cases, good in 3 cases and poor in 2 cases. CONCLUSIONS: The most frequent cause of periprostic fracture was trauma and other causes were loosening and osteolysis. Proper treatment method of periprosthetic fracture were important for stability of femoral stem
Arthroplasty ; Arthroplasty, Replacement, Hip* ; Classification ; Femur* ; Hip ; Osteolysis ; Periprosthetic Fractures ; Transplants

PURPOSE: We evaluated the capability of MR in the diagnosis of anomalous pulmonary venous connection (APVC). MATERIALS AND METHODS: The patient group consisted of 11 total APVC and 8 partial APVC diagnosed with MR. Echocardiography was performed in all cases, cardiac angiography in 12 cases and operation in 12 cases. We compared MR findings with those of operation, echocard iography and cardiac angiography. RESULTS: In surgically proven 12 cases, diagnostic accuracy of preoperative MR, echocardiography and cardiac angiography was 100%, 67% and 63%, respectively. In the remaining cases, MR findings well correlated with those of echocardiography or cardiac angiography. Stenosis of common pulmonary vein or superior vena cava was identified in 4 cases. In one patient, MR depicted associated cor triatriatum clearly. CONCLUSION: MR is an effective modallty in depicting anomalous pulmonary venous con nections.
Angiography ; Constriction, Pathologic ; Cor Triatriatum ; Diagnosis ; Echocardiography ; Humans ; Pulmonary Veins ; Vena Cava, Superior

Epidemiology, pathology, diagnosis and treatment of gastric carcinoma has been revised recently. The authors analysed 3,170 cases of gastric carcinoma which were diagosed with fiberoptic biopsy or resected specimens from 1968 to 1988 in Pusan area. The specimen were collected from Pusan National University Hospital, Pusan Paik Hospital and other general hospitals in Pusan city. The results obtained were summarized as follows; 1) The time trend indicated that difference in the annual fluctuation of requency of gastric carcinoma during last 21 years was not statistically significant. But it was noticed that by comparing the following the two decades (1970~1979 and 1980~1988) the frequency of gastric carcinoma decreased in male, in middle age and in intestinal type. 2) Morbidity of gastric carcinoma increased in both sexes by aging, and this tendency was more marked in male and in intestinal type in female and in diffuse type. 3) In general the gastric carcinoma involved more frequently distal portion than proximal portion of the stomach was characterized predominantly by male, older patients and intestinal type. 4) Carcinoma with Borrmann type I and II were characterized predominantly by male, older patients and intestinal type. With Borrmann type III and IV, female, young patients and diffuse type were found more frequently. From the above results, the authors concluded that the pathological and epidemiological findings of gastric carcinoma among Koreans in Pusan area showed a transition moving from high risk to low risk area of gastric carcinoma.
Female ; Male ; Humans ; Biopsy

No abstract available.
Arthritis, Rheumatoid* ; Humans ; Neuroma*

Patients in the intensive care unit (ICU) easily have large amounts of extracellular fluids, such as edema or ascites, because of cardiovascular instability under septic conditions and also have high risk of malnutrition while staying in the ICU. Traditional nutritional assessment parameters like body mass index have a limitation in ICU patients due to muscle atrophy and decrease of lean body mass. Bioimpedence analyses (BIA) can be used to assess body composition and are useful in performance of nutritional assessments in ICU patients. BIA can simply and noninvasively estimate body composition (total body water, extracellular water, intracellular water, body cell mass, and free fat mass etc.) by sending a weak electric current through the body. In particular, phase angle (PhA, phase difference between the voltage applied to the impedance and the current driven through it), one of the parameters of BIA, is related to cell membrane integrity or cell size. Low PhA can possibly imply malnutrition and PhA has been reported as a useful indicator of clinical outcomes or prognosis of severe patients. Additional study with clinical application of BIA in ICU patients is needed in order to confirm the usefulness of BIA.
Ascites ; Body Composition ; Body Mass Index ; Body Water ; Cell Membrane ; Cell Size ; Critical Illness* ; Edema ; Electric Impedance* ; Extracellular Fluid ; Humans ; Intensive Care Units ; Malnutrition ; Muscular Atrophy ; Nutrition Assessment ; Nutritional Support ; Prognosis