A Case Report on Successful Nonsurgical Treatment Using Antibiotics Alone in Aortic Stent Infection Diagnosed by Positron Emission Tomography / 감염과화학요법

Aortic stent infection is a rare problem, but severe sequelae such as stent occlusion, aortic necrosis and rupture, and life-threatening sepsis can occur. Surgical removal and antibiotic therapy has been the mainstay of treatment, but the management of stent infection still remains controversial as to the time of removal operation or the prognosis regarding the use of antibiotics alone as the treatment modality. Recently, we experienced a case of delayed aortic stent infection that was treated with antibiotics alone. A 68-year-old man presented with unexplained fever of several days' duration. The patient had a history of having had an aortic stent inserted 8 years ago due to traumatic aortic rupture. Blood culture was positive for Staphylococcus aureus and positron emission tomography revealed focal intense nodular uptake at medial and inferior aspect of the aortic arch. He was therefore diagnosed with aortic stent infection due to Staphylococcus aureus and was successfully treated with name of antibiotics alone without recourse to surgery.

A Scanning Electron Microscopic Study about Crush Injured Vasospasm after Freezing Therapy

The histologically confirmed endothelial damage (HCED) may lead to vasospasm, which increases the failure rate of microvascular anastomosis. Recently, vascular freezing has been reported to be the most effective and lasting method of alleviating or preventing vessel constriction in virgin microvessels. We question whether the application of freezing designed to relieve vasospasm is possible in microvessels accompanying with underlying acute endothelial damages without any harmful effects. We produced an experimental model with histologically confirmed endothelial damage and vasospasm in Sprague-Dawley rat. In crush injury group(group I, n = 15), the determined crushing load (0.07 J) was applied to femoral artery. In crush injury-freezing group(group II, n = 15), crushed arteries was frozen with ethyl chloride at 30 minutes after applying the crush injury. Gross and scanning electron microscopic appearances were inspected in both experimental groups on the 2nd, 14th and 30th day after the operation. In group I, vasospasm around the crushed segments were continued but in group II, the vasospasm disappeared immediately after vascular freezing, maintained its expansion even at postoperative 2, 14 and 30 days. On scanning electron microscopic examination, endothelium in group II showed slightly slower regeneration velocity but near complete regeneration was achieved at postoperative day 30. Regenerated endothelial cell in group II was more atypically shaped but arranged longitudinally at postoperative day 30. In conclusion, freezing with ethyl chloride could be a useful tool to reliably revert vasospasm without inducing thrombus even in acute endothelial damaged vessels after crush injury.

Radiologic Findings of Deep Seated Cere b ral Arteriovenous

PURPOSE: To analyze the radiologic-especially angiographic-findings of deep seated cerebral arteriovenous malformation(AVM) involving nonvisualized straight sinus. MATERIALS AND METHODS: In six patients aged between 15 and 53 years with deep seated cerebral AVM, CT and MR images were retrospectively analyzed with regard to the following features : the presence of straight sinus, the location of AVM, and the occurrence of hemorrhage. Angiograms were analyzed for venous drainage routes of AVM, the appearance of veins, the presence of falcine sinus and venous drainage from normal deep brain parenchyme. In four patients who had undergone intravascular embolization therapy, pre- and post- embolization angiograms were compared. RESULTS: CT and MR images showed neither straight sinus nor thrombosis. AVMs were deeply seated in the brain, and in all cases there was cerebral hemorrhage. Angiograms disclosed that venous drainage of all AVMs occurred via the veins of Galen. In one case, venous flow via the falcine sinus to the superior sagittal sinus was noted, but in others, retrograde flow in the deep venous system was observed. Marked collateral routes followed in response to the obstruction of straight sinus included the basal vein of Rosenthal, the internal occipital, internal cerebral, and cerebellar hemispheric veins (which are Galenic afferents), and the inferior sagittal s-inus. In all patients, contralateral routes were partially involved. Venous drainage from normal deep parenchyme through the transcerebral veins to the superficial venous system was noted, and in one case, s-traight sinus which had been observed on an angiogram five years earlier was no longer present. CONCLUSION: Angiography offers effective evaluation of the dynamic aspect of venous flow in cases involving deep-seated AVM, and of normal deep parenchyme in cases in which AVM involves nonvisualized straight sinus. Before intravascular treatment of AVM, venous flow must be carefully analyzed.

Dynamic MRI of Internal Derangement of Temporomandibular Joint

PURPOSE: To evaluate the value of fast field echo(FE) technique in accesing temporOmandibular joint(TMJ) dynamics. MATERIALS AND METHODS: A series of 120 TMJ MRI examinations of 60 symptomatic patients was performed. The fast FE technique was used to provide dynamic images of the TMJs in various phase of mouth opening with a step-bite-block. RESULTS: Among 120 cases, there were 30 cases which were normal, 21 cases of anterior displacement with reduction, 66 cases of anterior displacement without reduction, 11 cases of deformity of menisci, 23 cases of bony deformity, and 3 cases of medial displacement. The menisci and condyles were clearly delineated and the motions of the menisci during jaw opening were well evaluated in both normal and pathologic conditions. CONCLUSION: The dynamic TMJ MRI scan using fast FE technique permits both fast scanning and study of joint dynamics as well as TMJ anatomy.