Epidural emphysema and pneumoscrotum with subcutaneous emphysema are rare in a child past the neonatal period. Their most common causes are bronchial asthma and respiratory infection. Here, we report an 18-month-old boy who was presented with severe air leak, consisting of epidural emphysema, pneumoscrotum, subcutaneous emphysema, and pneumomediastinum, complicated by a bronchial foreign body. The air leak was resolved dramatically after removing the foreign body.
Asthma ; Child ; Emphysema* ; Epidural Space ; Foreign Bodies* ; Humans ; Infant ; Male ; Mediastinal Emphysema ; Subcutaneous Emphysema

A pulmonary thromboembolism (PTE), which is a sudden blockage in a pulmonary artery, usually due to a blood clot, is rare in children. The clinical presentation is often subtle or masked by the underlying clinical condition and the condition must be suspected during clinical testing. Although the choice of treatment depends on the clinical presentation, anticoagulation is the mainstay of therapy for children with PTE. We report the case of a healthy 1-month-old boy who presented with hemoptysis without hemodynamic instability. He was diagnosed based on chest computed tomography with angiography and 99mTc macroaggregated albumin lung perfusion scintigraphy and treated with low-molecular-weight heparin.
Angiography ; Child ; Hemodynamics ; Hemoptysis ; Heparin, Low-Molecular-Weight ; Humans ; Infant* ; Infant, Newborn ; Lung ; Male ; Masks ; Perfusion Imaging ; Pulmonary Artery ; Pulmonary Embolism* ; Thorax

BACKGROUND: Hybrid coronary revascularization (HCR) was developed to combine the advantages of coronary artery bypass graft (CABG) with percutaneous coronary intervention (PCI). However, it is still controversial whether it is more optimal to perform CABG or PCI first. The purpose of this study was to compare the clinical outcomes of these 2 approaches. METHODS: Eighty patients who underwent HCR from May 2010 to December 2015 were enrolled in this retrospective analysis. The CABG-first group comprised 12 patients and the PCI-first group comprised 68 patients. Outcomes of interest included in-hospital perioperative factors, major adverse cardiac and cerebrovascular events (MACCEs), and the incidence of repeated revascularization, especially for the target vessel lesion. RESULTS: No significant difference was found in the amount of postoperative bleeding (p=0.239). The incidence of MACCEs was similar between the CABG-first and PCI-first groups (1 of 12 [8.3%] vs. 5 of 68 [7.4%], p>0.999). Repeated revascularization was performed on 3 patients (25%) in the CABG-first and 9 patients (13.2%) in the PCI-first group (p=0.376). CONCLUSION: There were no significant differences in postoperative and medium-term outcomes between the CABG-first and PCI-first groups. Based on these results, it can be inferred that it is safe to opt for either CABG or PCI as the primary procedure in 2-stage HCR.
Coronary Artery Bypass* ; Coronary Artery Disease ; Coronary Vessels* ; Hemorrhage ; Humans ; Incidence ; Percutaneous Coronary Intervention ; Retrospective Studies ; Transplants

PURPOSE: A splenic abscess is a rare disease, but appears to be increasing in frequency. The key to successful treatment is early diagnosis, effective antibiotics treatment and surgical management when needed. This study was intended to clarify the clinico-pathological and radiological findings of splenic abscesses from their therapeutic aspects. METHODS: Between Jan. 1993 and Dec. 2003, the outcomes of 8 splenic abscess patients were retrospectively analyzed. RESULTS: The male to female ratio was 6: 2, with a mean age of 57 years, ranging from 34 to 70 years. Predisposing conditions were identified in 7, including diabetes mellitus, steroid medication, chronic alcoholism, infective endocarditis and lymphoma. As chief complaints, fever/chills was present in 2, left upper quadrant pain/tenderness in 4, diffuse abdominal pain in 1 and dyspnea in 1, with leukocytosis found in 6 (75%). Ultrasonography or computed tomography detected left pleural effusion, splenomegaly and splenic abscess in 7 (88%). The solitary to multiple ratio was 2: 6. An emergency laparotomy for peritonitis detected a solitary abscess rupture in 1. The original site of infection was detected in 5, including endocarditis, dental abscess, urinary tract infection and pancreatitis in 2. Blood cultures were positive in 3 (43%), with Escherichia coli in 1 and Streptococcus viridans in 2. 3 (75%) of 4 specimens had positive culture results, including Pseudomonas, Streptoccus viridans and Enterococcus. 1 (25%) had pathogens identical to bacteria isolated form the blood culture. 1 was identified as mixed infection, with actinomycosis. A splenectomy was performed in 5, including 2 with a distal pancreatectomy, intraoperative fine needle aspiration in a lymphoma and endoscope-guided aspiration in a gastrosplenic fistula. One lymphoma patient, with multiple abscesses, died of aspiration pneumonia during chemotherapy. CONCLUSION: A splenic abscess is rare, and failure of early diagnose and institution of treatment is fatal. Although patients have various underlying diseases, a splenic abscess can develop arising from a dental abscess in a healthy man. Percutaneous drainage may not be suitable for multiple or hilar locations; therefore, a splenectomy, with appropriate antibiotics, is the definitive treatment. A less-invasive treatment modality can be considered, taking into account the patient's clinical situation from an immunological aspect for preservation of the spleen.
Abdominal Pain ; Abscess* ; Actinomycosis ; Alcoholism ; Anti-Bacterial Agents ; Bacteria ; Biopsy, Fine-Needle ; Coinfection ; Diabetes Mellitus ; Drainage ; Drug Therapy ; Dyspnea ; Early Diagnosis ; Emergencies ; Endocarditis ; Enterococcus ; Escherichia coli ; Female ; Fistula ; Humans ; Laparotomy ; Leukocytosis ; Lymphoma ; Male ; Pancreatectomy ; Pancreatitis ; Peritonitis ; Pleural Effusion ; Pneumonia, Aspiration ; Pseudomonas ; Rare Diseases ; Retrospective Studies ; Rupture ; Schools, Medical* ; Spleen ; Splenectomy ; Splenic Diseases ; Splenomegaly ; Ultrasonography ; Urinary Tract Infections ; Viridans Streptococci

PURPOSE: To compare the efficacy of 14 gauge(G) Vim-Silverman needle biopsy with that of 16G automatic gunbiopsy for kidneys and to determine the optimal needle size for renal biopsy. MATERIALS AND METHODS: Weretrospectively reviewed the pathologic and medical records of 119 (110 native, 9 allograft) patients who hadundergone 14G Vim-Silverman needle biopsy and 71 (34 native, 37 allograft) who had undergone 16G automatic gunbiopsy. The number of retrieved glomeruli and post-biopsy complications were compared between the two groups. Exvivo renal biopsies of a dog were performed using an automatic gun mounted with 14G-20G needles and the numbers ofretrieved glomeruli were compared. RESULTS: The number (mean+/-standard deviation) of retrieved glomeruli perbiopsy in native/allograft/total kidneys was 32.1+/-20.9/24.0+/-15.2/31.5+/-20.6 in the 14G Vim-Silverman needlebiopsy group, and 26.9+/-16.2/14.3+/-10.1/20.9+/-14.9 in the 16G automatic gun biopsy group. In the dog, the numberof retrieved glomeruli per biopsy was 17.2+/-6.3/9.2+/-3.9/5.7+/-4.5/3.9+/-2.6 in the 14G/16G/18G/20G groups,respectively. CONCLUSION: Although significantly more glomeruli were retrieved in the 14G Vim-Silverman needlebiopsy group, the number retrieved in the 16G automatic gun biopsy group was sufficient for adequate pathologicinterpretation. Experimental study suggests that when an 18G automatic gun is used, sufficient glomeruli areretrieved.
Animals* ; Biopsy* ; Biopsy, Needle ; Dogs ; Humans ; Kidney ; Medical Records ; Needles*

BACKGROUND: This study was carried out to determine the effect of the kinds and concentration of cryoprotectants and freezing temperature on the survival rate of frozen erythrocytes. METHODS: Erythrocytes mixed with three different concentrations of amylopectin, k-carrageenan, dextran and hydroxyethylstarch as cryoprotectants were frozen at -10, -30, -50 and -196degrees, respectively, and thawed at 35degrees. The survival rate of frozen erythrocytes was determined by hemoglobin concentration of supernatant of thawed erythrocytes. Morphological changes were observed by scanning electron microscopy. RESULTS: Frozen erythrocytes with amylopectin or k-carrageenan showed relatively low survival rate (<40%). In case of erythrocytes with dextran, the survival rate of erythrocytes with 30% dextran showed significantly increased survival rate compared with 20% or 25% dextran (p<0.05). The survival rates of erythrocytes with 30% dextran and freezing temperature of -10degrees, -50degrees and -196degrees showed 80.44%, 73.61% and 88.84%, respectively. Frozen erythrocytes with hydroxyethylstarch showed significantly high survival rate with freezing temperature of -196degrees (hydroxyethylstarch conc. 20%: survival rate 66.26%, 25%: 64.51%, 30%: 86.22%) compared with other freezing temperature. Most of frozen erythrocytes with amylopectin of k-carrageenan were changed to spherocytes by freezing process. The change to echinocytes of erythrocytes with dextran was decreased according to the increasing concentration of dextran. The change to stomatocytes of erythrocytes with hydroxyethylstarch was decreased according to the increasing concentration of dextran. CONCLUSION: It was found that the kinds and concetration of cryoprotectants and freezing temperature affected the survival rate and morphological change of erythrocytes. Dextran or hydroxyethylstarch could increase the survival rate of frozen erythrocytes over 80% by protection of erythrocytes from the physical, chemical stress during freezing process.
Amylopectin ; Cryopreservation ; Dextrans ; Erythrocytes* ; Freezing ; Humans* ; Microscopy, Electron, Scanning ; Spherocytes ; Survival Rate*

Varicella zoster virus (VZV) causes two diseases: Varicella, a generalized, primary infection, and herpes zoster (zoster), a secondary infection caused by latent VZV reactivation. Zoster can also be caused by latent VZV reactivation after a varicella vaccination. The complications associated with varicella include cutaneous infections, which are the most common, as well as pulmonary and neurological involvement. However, a deep venous thrombosis (DVT) has been rarely described as a varicella-associated complication. Here, we describe the case of a child with varicella zoster who developed a DVT that completely resolved after intravenous acyclovir and subcutaneous low-molecular-weight heparin treatment.
Acyclovir ; Chickenpox ; Chickenpox Vaccine ; Child ; Coinfection ; Heparin, Low-Molecular-Weight ; Herpes Zoster ; Herpesvirus 3, Human ; Humans ; Vaccination ; Venous Thrombosis

Varicella zoster virus (VZV) causes two diseases: Varicella, a generalized, primary infection, and herpes zoster (zoster), a secondary infection caused by latent VZV reactivation. Zoster can also be caused by latent VZV reactivation after a varicella vaccination. The complications associated with varicella include cutaneous infections, which are the most common, as well as pulmonary and neurological involvement. However, a deep venous thrombosis (DVT) has been rarely described as a varicella-associated complication. Here, we describe the case of a child with varicella zoster who developed a DVT that completely resolved after intravenous acyclovir and subcutaneous low-molecular-weight heparin treatment.
Acyclovir ; Chickenpox ; Chickenpox Vaccine ; Child ; Coinfection ; Heparin, Low-Molecular-Weight ; Herpes Zoster ; Herpesvirus 3, Human ; Humans ; Vaccination ; Venous Thrombosis

OBJECTIVE: To evaluate the expressions of Ki-67, p53 and p21 waf1/cip1 according to the age and the histologic type of preinvasive and invasive cervical lesions. MATERIAL AND METHOD: Microwave-oven-processed formalin-fixed, paraffin-embedded, cervical biopsy specimens and hysterectomy specimens were obtained from 1997 to 1998 at the Soonchunhyang university Chunan hospital. These included 55 cervical intraepithelial neoplasm(CIN I-III), 14 invasive squamous cell carcinoma and 3 adenocarcinoma, and immunohistochemically evaluated by monoclonal MIB-1 antibody, monoclonal p53 antibody, and monoclonal p21 antibody. Positive index was expressed as a percentage of strong staining cells per 300 counted cells in evenly strong staining area. RESULT: Ki-67, p53 and p21 protein were expressed in the nuclei. Ki-67 was specifically expressed in all phases of cell cycles in proliferating cells. p21 expression was not seen in CIN I and CIN II, but was increased with increasing histologic grade. According to the age, Ki-67 expression was significantly higher in 30 > or =aged group than 30 < or = aged group, but p53 expresson was not significantly different according to age groups, and p21 expression was significantly lower in 50 < or = aged group than 30 > or =aged group. CONCLUSION: Conclusions of this study indicate that cell proliferating rate is higher in young age groups than old age groups. p53 expression was not significantly different according to age and histologic grade. These indicates that mutation of the p53 gene may be associated with the development of cervical cancer, but not associated with the progression of cervical cancer. Besides, p21 expression was increased in increasing histologic grade, but decreased in old aged women. Further study of this paradoxical increase in p21 expression in cervical carcinoma is necessary to clarify the mechanisms of p53 indepent pathway.
Adenocarcinoma ; Biopsy ; Carcinoma, Squamous Cell ; Cell Cycle ; Cell Proliferation* ; Chungcheongnam-do ; Female ; Genes, p53 ; Humans ; Hysterectomy ; Uterine Cervical Neoplasms

BACKGROUND: The nasal mucosa is degenerated by inflammations, physical stimulations such as cessation of air flow, and other chemical stimulations. And it is regenerated regularly by newly differentiated cells. OBJECTIVES: In order to investigate the morphologic changes of the nasal mucosa and regenerating activities in sinusitis. MATERIALS AND METHODS: The authors made animal models of acute maxillary sinusitis by obstructing the natural ostium of maxillary sinus of rabbit and inoculating Staphylococcus aureus colonies. Each contralateral side was used as control. The rabbits were sacrificed after 1, 2, and 3 weeks. Morphologic changes of the nasal mucosa and regenerating activities of the olfactory mucosa were observed with Hematoxylin-eosin staining and immunohistochemistry using BrdU. RESULTS: Purulent sinusitis was developed in all rabbits. Light microscopy showed that nasal mucosa revealed inflammatory changes such as edema, inflammatory cell infiltration, goblet cell metaplasia, polypoid change, epithelial ulceration, and submucosal connective tissue proliferation. BrdU-labelled cells were observed mainly in the basal cell layer of the olfactory mucosa, and their numbers in the control sides were significantly higher than in the experimental sides. CONCLUSION: These results indicate that acute infection of the maxillary sinus induces inflammatory changes of both respiratory and olfactory mucosa of the nose and decreases the regenerating activity of olfactory mucosa.
Bromodeoxyuridine ; Connective Tissue ; Edema ; Goblet Cells ; Immunohistochemistry ; Inflammation ; Maxillary Sinus* ; Maxillary Sinusitis* ; Metaplasia ; Microscopy ; Models, Animal ; Nasal Mucosa* ; Nose ; Olfactory Mucosa ; Physical Stimulation ; Rabbits* ; Sinusitis ; Staphylococcus aureus ; Stimulation, Chemical ; Ulcer