Dural arteriovenous fistulas (AVFs) are uncommon, representing only 10% to 15% of all intracranial AVFs. Here we present the case of a patient with cerebral infarction who experienced a dural AVF after craniotomy for superficial temporal artery (STA) to middle cerebral artery (MCA) bypass surgery. A 48-year-old man presented with dysarthria and right side hemiparesis. A brain magnetic resonance imaging scan revealed multiple acute infarctions and severe stenosis of the left MCA. Therefore, STA-MCA bypass surgery was performed. A follow-up angiography performed 2 weeks after the surgery showed an abnormal vascular channel from the left middle meningeal artery (MMA) to the middle meningeal vein (MMV) just anterior to the border of the craniotomy margin. This fistula originated from a screw used for cranial fixation. The screw injured the MMA and MMV, and this resulted in the formation of a fistula. The fistula was successfully treated with transarterial embolization. Surgeons should be careful when fixing bones with screws and plates as fistulas can develop if vessels are injured.
Angiography ; Brain ; Central Nervous System Vascular Malformations* ; Cerebral Infarction ; Cerebral Revascularization ; Constriction, Pathologic ; Craniotomy ; Dysarthria ; Fistula ; Follow-Up Studies ; Humans ; Infarction ; Magnetic Resonance Imaging ; Meningeal Arteries ; Middle Aged ; Middle Cerebral Artery* ; Paresis ; Temporal Arteries* ; Veins

Inhalation of toxic gases can lead to pneumonitis. It has been known that methane gas intoxication causes loss of consciousness or asphyxia. There is, however, a paucity of information about acute pulmonary toxicity from methane gas inhalation. A 21-year-old man was presented with respiratory distress after an accidental exposure to methane gas for one minute. He came in with a drowsy mentality and hypoxemia. Mechanical ventilation was applied immediately. The patient's symptoms and chest radiographic findings were consistent with acute pneumonitis. He recovered spontaneously and was discharged after 5 days without other specific treatment. His pulmonary function test, 4 days after methane gas exposure, revealed a restrictive ventilatory defect. In conclusion, acute pulmonary injury can occur with a restrictive ventilator defect after a short exposure to methane gas. The lung injury was spontaneously resolved without any significant sequela.
Anoxia ; Asphyxia ; Gases ; Inhalation ; Lung Injury ; Methane ; Pneumonia ; Porphyrins ; Respiration, Artificial ; Respiratory Function Tests ; Respiratory Insufficiency ; Smoke Inhalation Injury ; Thorax ; Unconsciousness ; Ventilators, Mechanical

BACKGROUND AND OBJECTIVES: Several predictors of recurrence of atrial fibrillation (AF) after ablation have been identified, including age, type of AF, hypertension, left atrial diameter and impaired left ventricular ejection fraction. The aim of this study was to investigate whether the atherosclerotic plaque thickness of the thoracic aorta is associated with a recurrence of AF after circumferential pulmonary vein ablation (CPVA). SUBJECTS AND METHODS: Among patients with drug-refractory paroxysmal or persistent AF, 105 consecutive (mean age 58+/-11 years, male : female=76 : 29) patients who underwent transesophageal echocardiography and CPVA were studied. The relationships between the recurrence of AF and variables, including clinical characteristics, plaque thickness of the thoracic aorta, laboratory findings and echocardiographic parameters were evaluated. RESULTS: A univariate analysis showed that the presence of diabetes {hazard ratio (HR)=3.425; 95% confidence interval (CI), 1.422-8.249, p=0.006}, ischemic heart disease (HR=4.549; 95% CI, 1.679-12.322, p=0.003), duration of AF (HR=1.010; 95% CI, 1.001-1.018, p=0.025), type of AF (HR=2.412, 95% CI=1.042-5.584, p=0.040) and aortic plaque thickness with > or =4 mm (HR=9.514; 95% CI, 3.419-26.105, p<0.001) were significantly associated with the recurrence of AF after ablation. In Cox multivariate regression analysis, only the aortic plaque thickness (with > or =4 mm) was an independent predictor of recurrence of AF after ablation (HR=7.250, 95% CI=1.906-27.580, p=0.004). CONCLUSION: Significantly increased aortic plaque thickness can be a predictable marker of recurrence of AF after CPVA.
Aorta, Thoracic ; Atherosclerosis ; Atrial Fibrillation ; Catheter Ablation ; Echocardiography, Transesophageal ; Humans ; Hypertension ; Male ; Myocardial Ischemia ; Plaque, Atherosclerotic ; Pulmonary Veins ; Recurrence ; Stroke Volume

An azygos vein aneurysm is a very rare cause of a posterior mediastinal mass. Once the diagnosis has been confirmed, no treatment is usually required. However, the aneurysm can thrombose, and this may lead pulmonary thromboembolism, or the aneurysm may rupture. In these instances, the excision of the mass is recommended. Video-assisted thoracic surgery techniques have considerably improved. If it is necessary to remove the aneurysm, video-assisted thoracic surgery may be a good option for surgical treatment. We report a case of an aneurysm of the azygos arch that was successfully resected by video-assisted thoracic surgery.
Aneurysm ; Azygos Vein ; Mediastinum ; Pulmonary Embolism ; Rupture ; Thoracic Surgery, Video-Assisted

An azygos vein aneurysm is a very rare cause of a posterior mediastinal mass. Once the diagnosis has been confirmed, no treatment is usually required. However, the aneurysm can thrombose, and this may lead pulmonary thromboembolism, or the aneurysm may rupture. In these instances, the excision of the mass is recommended. Video-assisted thoracic surgery techniques have considerably improved. If it is necessary to remove the aneurysm, video-assisted thoracic surgery may be a good option for surgical treatment. We report a case of an aneurysm of the azygos arch that was successfully resected by video-assisted thoracic surgery.
Aneurysm ; Azygos Vein ; Mediastinum ; Pulmonary Embolism ; Rupture ; Thoracic Surgery, Video-Assisted

BACKGROUND: Pulmonary embolism (PE) is a common clinical problem in the West that is associated with substantial morbidity and mortality. The diagnostic modality has been changed since 2001. This study retrospectively reviewed the PE mortality with the aim of identifying the risk factors associated with mortality since the multidetector computed tomography (MDCT) was introduced. METHODS: We analyzed 105 patients with acute PE proven by multidetector CT or ventilation perfusion scan. The primary outcome measure was the all-cause mortality at 3 months. The prognostic effect of the baseline factors on survival was assessed by multivariate analysis. RESULTS: The main risk factors were prolonged immobilization, stroke, cancer and obesity. Forty nine percent of patients had 3 or more risk factors. The overall mortality at 3 months was 18.1%. Multivariate analysis revealed low diastolic blood pressure and the existence of cancer to be independent factors significantly associated with mortality. Forty two PE patients were examined for the coagulation inhibitors. Four of these patients had a protein C deficiency (9.5%), and 11 had a protein S deficiency (26%). CONCLUSION: PE is an important clinical problem with a high mortality rate. Close monitoring may be necessary in patients with the risk factors.
Blood Pressure ; Hospitals, Teaching ; Humans ; Immobilization ; Multidetector Computed Tomography ; Multivariate Analysis ; Obesity ; Outcome Assessment (Health Care) ; Perfusion ; Prognosis ; Protein C Deficiency ; Protein S Deficiency ; Pulmonary Embolism ; Retrospective Studies ; Risk Factors ; Stroke ; Thrombophilia ; Venous Thrombosis ; Ventilation

Seafood is a vehicle for the transmission of intoxication. The Neptunea are sublittoral species of the marine prosobranch mollusk. Tetramine toxin is found in the salivary gland of Neuptunea. A woman developed blurred vision, dizziness, headache, diarrhea, numbness and gait disturbance one hour after ingesting conchs. Neurological examination showed dysesthesia, and motor weakness. Laboratory and electrophysiological studies were normal. The next day, she recovered from her symptoms. We report a patient with dysesthesia and motor weakness due to Neuptunea species' tetramine toxin.
Diarrhea ; Dizziness ; Female ; Gait ; Headache ; Humans ; Hypesthesia ; Mollusca ; Neurologic Examination ; Paresthesia ; Salivary Glands ; Seafood

Head and neck cancers have never been systematically studied for clinical purposes yet in Korea. This epidemiological survey on head and neck cancer patients was undertaken from January to December 2001 in 79 otorhinolaryngology resident-training hospitals nationwide. The number of head and neck cancer patients was 1,063 cases in the year. The largest proportion of cases arose in the larynx, as many as 488 cases, which accounted for 45.9%. It was followed by, in order of frequency, oral cavity (16.5%), oropharynx (10.0%), and hypopharynx (9.5%). The male:female ratio was 5:1, and the mean age was 60.3 yr. Surgery was the predominant treatment modality in head and neck cancers: 204 (21.5%) cases were treated with only surgery, 198 (20.8%) cases were treated with surgery and radiotherapy, 207 cases (21.8%) were treated with combined therapy of surgery, radiotherapy, and chemotherapy. Larynx and hypopharynx cancers had a stronger relationship with smoking and alcohol drinking than other primary site cancers. Of them, 21 cases were found to be metastasized at the time of diagnosis into the lung, gastrointestinal tract, bone, or brain. Coexisting second primary malignancies were found in 23 cases. At the time of diagnosis, a total of 354 cases had cervical lymph node metastasis accounting for 42.0%.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Alcohol Drinking/epidemiology ; Carcinoma, Squamous Cell/epidemiology* ; Child ; Female ; Head and Neck Neoplasms/epidemiology* ; Health Surveys ; Human ; Korea/epidemiology ; Male ; Middle Aged ; Neoplasm Metastasis ; Neoplasms, Second Primary/epidemiology ; Occupations ; Registries/statistics & numerical data ; Risk Factors ; Smoking/epidemiology

BACKGROUND/AIMS: The first episode of variceal bleeding is one of the most frequent causes of death in patients with liver cirrhosis. The Child-Pugh(CP) scoring system has been widely accepted for prognostic assessment. Recently, MELD has been known to be better than the CP scoring system for predicting mortality in patients with end-stage liver diseases. The Rockall risk scoring system was developed to predict the outcome of upper GI bleeding including variceal bleeding. The aim of this study was to investigate the mortality rate of first variceal bleeding and the predictability of each scoring system. METHODS: We evaluated the 6-week mortality rate, rebleeding rate, and 1-year mortality rate of all the 136 patients with acute variceal bleeding without previous episode of hemorrhage between January 1, 1998 and December 31, 2000. The CP score, MELD score, and Rockall score were estimated and analyzed. RESULTS: Among 136 patients, 35 patients with hepatoma and 8 patients with follow-up loss were excluded. Six-week mortality rate, 1-year mortality rate, and rebleeding rate of first variceal bleeding were 24.7%, 35.5%, and 12.9%, respectively. The c-statistics of CP, MELD, and Rockall score for predicting 6-week mortality rate were 0.809 (p<0.001, 95% CI, 0.720-0.898), 0.804 (p<0.001, 95% CI, 0.696-0.911), 0.787 (p<0.001, 95% CI, 0.683-0.890), respectively. For 1-year mortality rate, c-statistics were 0.765 (p<0.005, 95% CI, 0.665-0.865), 0.780 (p<0.005, 95% CI, 0.676-0.883), 0.730 (p<0.01, 95% CI, 0.627-0.834), respectively. CONCLUSION: The CP, MELD, and Rockall scores were reliable measures of mortality risk in patients with first variceal bleeding. The CP classification is useful in its easy applicability.
Adult ; Aged ; Aged, 80 and over ; English Abstract ; Esophageal and Gastric Varices/*complications ; Female ; Gastrointestinal Hemorrhage/*etiology/mortality ; Human ; Liver Cirrhosis/complications ; Male ; Middle Aged ; Prognosis ; Recurrence ; Risk Factors ; Survival Rate

PURPOSE: To evaluate the enhancement patterns revealed by dual-phase CT, and other characteristic features of nodular hepatic involvement of malignant lymphoma, and to determine the usefulness of this imaging modality in the differentiatial diagnosis of hepatic masses. MATERIALS AND METHODS: Seven cases that pathologically confirmed as nodular hepatic involvements of malignant lymphoma among patients who underwent dual-phase CT for the staging or follow-up of malignant lymphoma, and two that confirmed as primary lymphoma among patients who underwent dual-phase CT for differential diagnosis of nodular hepatic masses were evaluated. There were eight cases of non-Hodgkin 's lymphoma (NHL) and one of Hodgkin 's disease(HD). The findings were analysed in terms of the number, size, and contour pattern of the masses, the enhancement pattern seen on dual-phase CT, and whether or not the vascular structure of the mass was normal. RESULTS: Primary lymphomas were present in two patients(single mass, n=1; multiple nodules, n=1) and secondary lymphomas in seven (single mass, n=6; multiple nodules, n=1). The maximum size of main masses was mean 5.1(range, 2-12) cm, and the contor was smooth in three cases, ill-defined in three and lobulated in three. During the early phase, five patients showed homogeneous low attenuation, and heterogeneous enhancement was observed in four. During the late phase, three of the five showed peripheral enhancement and the other two showed the same low attenuation, while two of the four showed central low attenuation, one showed iso attenuation, and one showed heterogeneous enhancement. In four of the patients whose main mass was larger than the mean, vascular shadow passed through the mass (left portal vein, n=2; branches of the right portal vein, n=1; and branches of the hepatic artery, n=1). CONCLUSION: Where dual-phase CT demonstrated nodular hepatic involvement of malignant lymphoma, contrast enhancement varied and so differentiation from other hepatic masses such as metastatic adenocarcinoma and hepatocellular carcinoma was therefore difficult. Homogeneity and a lack of necrosis, even though a mass is large and has a smooth well-defined contour, no capsulation and normal vasculature, may suggest the nodular hepatic involvement of malignant lymphoma.
Adenocarcinoma ; Carcinoma, Hepatocellular ; Diagnosis ; Diagnosis, Differential ; Follow-Up Studies ; Hepatic Artery ; Humans ; Lymphoma ; Necrosis ; Portal Vein