Recent Increase of Human Granulocytic Anaplasmosis and Co-Infection with Scrub Typhus or Korean Hemorrhagic Fever with Renal Syndrome in Korea

We report 17 patients with human granulocytic anaplasmosis between January 2015 and September 2018 at two tertiary university hospitals in Korea. Monthly incidence peaked in May and June. Among these patients, we identified three who were co-infected with scrub typhus, and one patient with hemorrhagic fever with renal syndrome.

Isolated Mass-Forming IgG4-Related Cholangitis as an Initial Clinical Presentation of Systemic IgG4-Related Disease

IgG4-related disease (IgG4-RD) may involve multiple organs. Although it usually presents as diffuse organ involvement, localized mass-forming lesions have been occasionally encountered in pancreas. However, the same pattern has been seldom reported in biliary tract. A 61-year-old male showed a hilar bile duct mass with multiple enlarged lymph nodes in imaging studies and he underwent trisectionectomy under impression of cholangiocarcinoma. Gross examination revealed a mass-like lesion around hilar bile duct. Histopathologically, dense lymphoplasmacytic infiltration and storiform fibrosis were identified without evidence of malignancy. Immunohistochemical stain demonstrated rich IgG4-positive plasma cell infiltration. Follow-up imaging studies disclosed multiple enlarged lymph nodes with involvement of pancreas and perisplenic soft tissue. The lesions have been significantly reduced after steroid treatment, which suggests multi-organ involvement of systemic IgG4-RD. Here, we report an unusual localized mass-forming IgG4-related cholangitis as an initial presentation of IgG4-RD, which was biliary manifestation of systemic IgG4-related autoimmune disease.

Scoparone interferes with STAT3-induced proliferation of vascular smooth muscle cells

Scoparone, which is a major constituent of Artemisia capillaries, has been identified as an anticoagulant, hypolipidemic, vasorelaxant, anti-oxidant and anti-inflammatory drug, and it is used for the traditional treatment of neonatal jaundice. Therefore, we hypothesized that scoparone could suppress the proliferation of VSMCs by interfering with STAT3 signaling. We found that the proliferation of these cells was significantly attenuated by scoparone in a dose-dependent manner. Scoparone markedly reduced the serum-stimulated accumulation of cells in the S phase and concomitantly increased the proportion of cells in the G0/G1 phase, which was consistent with the reduced expression of cyclin D1, phosphorylated Rb and survivin in the VSMCs. Cell adhesion markers, such as MCP-1 and ICAM-1, were significantly reduced by scoparone. Interestingly, this compound attenuated the increase in cyclin D promoter activity by inhibiting the activities of both the WT and active forms of STAT3. Similarly, the expression of a cell proliferation marker induced by PDGF was decreased by scoparone with no change in the phosphorylation of JAK2 or Src. On the basis of the immunofluorescence staining results, STAT3 proteins phosphorylated by PDGF were predominantly localized to the nucleus and were markedly reduced in the scoparone-treated cells. In summary, scoparone blocks the accumulation of STAT3 transported from the cytosol to the nucleus, leading to the suppression of VSMC proliferation through G1 phase arrest and the inhibition of Rb phosphorylation. This activity occurs independent of the form of STAT3 and upstream of kinases, such as Jak and Src, which are correlated with abnormal vascular remodeling due to the presence of an excess of growth factors following vascular injury. These data provide convincing evidence that scoparone may be a new preventative agent for the treatment of cardiovascular diseases.

Fabrication of an alpha-lipoic acid-eluting poly-(D,L-lactide-co-caprolactone) cuff for the inhibition of neointimal formation

The purpose of this study was to develop a novel polymer cuff for the local delivery of alpha-lipoic acid (ALA) to inhibit neointimal formation in vivo. The polymer cuff was fabricated by incorporating the ALA into poly-(D,L-lactide-co-caprolactone) 40:60 (PLC), with or without methoxy polyethylene glycol (MethoxyPEG). The release kinetics of ALA and in vitro degradation by hydrolysis were analyzed by HPLC and field emission scanning electron microscopy (FE-SEM), respectively. In vivo evaluation of the effect of the ALA-containing polymer cuff was carried out using a rat femoral artery cuff injury model. At 24 h, 48% or 87% of the ALA was released from PCL cuffs with or without MethoxyPEG. FE-SEM results indicated that ALA was blended homogenously in the PLC with MethoxyPEG, whereas ALA was distributed on the surface of the PLC cuff without MethoxyPEG. The PLC cuff with MethoxyPEG showed prolonged and controlled release of ALA in PBS, in contrast to the PLC cuff without MethoxyPEG. Both ALA-containing polymer cuffs had a significant effect on the inhibition of neointimal formation in rat femoral artery. Novel ALA-containing polymer cuffs made of PLC were found to be biocompatible and effective in inhibiting neointimal formation in vivo. Polymer cuffs containing MethoxyPEG allowed the release of ALA for one additional week, and the rate of drug release from the PLC could be controlled by changing the composition of the polymer. These findings demonstrate that polymer cuffs may be an easy tool for the evaluation of anti-restenotic agents in animal models.

Effects of Angiotensin-Converting Enzyme Inhibitor on Arterial Stiffness, Diastolic Function, and Exercise Performance in Patients with Hypertension

BACKGROUND: The aim of this study was to investigate the relations between arterial stiffness, diastolic function, and exercise performance and the effects of angiotensin-converting enzyme inhibitor(ACEI), perindopril, in these three areas in patients with hypertension(HT). METHODS: A total of 39 patients(60.9+/-4.9 years, 23 males) with a newly diagnosed or untreated HT, stage I, were enrolled. Arterial stiffness measured by pulse wave velocity, diastolic function measured by echocardiography, and exercise performance and hemodynamic parameters measured by a treadmill exercise test were compared before and after 6 months of medical treatment with an ACEI. RESULTS: The parameters for arterial stiffness, diastolic function, and exercise performance did not show significant correlations with each other at baseline. Systolic(from 147.6+/-6.5mmHg to 134.3+/-9.6mmHg, p<0.001) and diastolic blood pressures(from 87.7+/-7.5mmHg to 82.9+/-6.2mmHg, p<0.001) decreased significantly after 6 months of ACEI treatment. Except for duration of total exercise time, the parameters for arterial stiffness, diastolic function, and the hemodynamic response to exercise also improved significantly after 6 months of ACEI treatment. CONCLUSION: Though the parameters for arterial stiffness, diastolic function, and exercise performance were not asso- ciated with each other at baseline, they all improved significantly after 6 months of medical treatment with an ACEI in elderly patients with stage I HT. The results of this study suggest the possibility of additional benefits of ACEI beyond lowering blood pressure.

Novel LMNA Gene Mutation in a Patient With Atypical Werner's Syndrome

Hutchinson-Gilford progeria syndrome (HGPS) and Werner's syndrome are representative types of progeroid syndrome. LMNA (Lamin A/C) gene mutation with atypical Werner's syndrome have recently been reported. Atypical Werner's syndrome with the severe metabolic complications, the extent of the lipodystrophy is associated with A133L mutation in the LMNA gene and these patients present with phenotypically heterogeneous disorders. We experienced a 15-yr-old Korean female with progeroid features, generalized lipodystrophy, hypertriglyceridemia, fatty liver, steatohepatitis, and type 2 diabetes mellitus. Skin fibroblasts from the patient showed marked abnormal nuclear morphology, compared with that from normal persons. Gene analysis revealed that this patient had T506del of exon 2 in the LMNA gene. We report here the first case of atypical Werner's syndrome with frameshift mutation that was caused by T506del.

Stages of Change in Smoking Cessation and Factors Related to Re-smoking after Coronary Artery Bypass Graft Surgery / 간호학회지

PURPOSE: The purpose of this study was to investigate the stages of change in smoking cessation after a Coronary Artery Bypass Graft(CABG) and to identify the related factors. METHODS: The subjects (n=157) were patients who underwent a CABG in a university hospital from March 1998 to October 2005 and were smokers before the CABG. Data was collected viachart review and a telephone interview, and analyzed with descriptive statistics, Chi2 test, one-way ANOVA, and Kruskal-Wallis procedure by the SPSS/PC win 12.0 program. RESULTS: The subjects smoked for an average of 34 years (21 cigarettes per day) before surgery. Eleven percent of the subjects were in pre-contemplation, 6.4% in contemplation, 13.5% in preparation, 4.5% in action, and 64.5% in the maintenance stage. Nicotine dependence and selfefficacy were different among the groups with different stages of change in smoking cessation. Nicotine dependence was the lowest (p=0.00) and self-efficacy was the highest (p=0.00) in the maintenance stage. The number of subjects in pre-contemplation and contemplation significantly increased 6 years after surgery(p=0.05). CONCLUSIONS: To implement effective smoking cessation interventions for CABG patients, the intervention should be developed to accommodate individual readiness for smoking cessation, especially so for those who had a CABG more than 6 years previously.

Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting for Diabetics with Multivessel Coronary Artery Disease: The Korean Multicenter Revascularization Registry (KORR)

This study was designed to assess the relative merits of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in multivessel coronary artery disease (MVCAD), particularly for Korean diabetics. Among 3,279 patients with MVCAD who were recommended for revascularization were enrolled from nine centers in Korea, 2,154 were selected after statistical adjustments for the disparities between two groups. Survival rates were not significantly different for three years between two groups. Among diabetic patients, the three-year mortality rate in PCI group was 1.9-fold higher than that of CABG group, although it was not statistically significant (PCI 19.8%, CABG 11.4%, p=0.14). The three-year mortality rate was similar between the two groups in non-diabetics (PCI 8.3%, CABG 10.0%, p=0.50). The 30-day rate of cerebrovascular event was higher in CABG group, for both diabetic (CABG 3.6%, PCI 0.0%, p<0.001) and non-diabetic patients (CABG 2.4%, PCI 0.0%, p<0.001). Short- and long-term revascularization rates were higher in PCI group than in CABG group. As a conclusion, this Korean registry demonstrates that PCI was associated with comparable survival rates and lower short-term morbidity, but a greater requirement for repeated revascularization compared with CABG in Korean diabetics.

A Case of Acute Poststreptococcal Glomerulonephritis Accompanied with Acute Pyelonephritis

Acute poststreptococcal glomerulonephritis(APSGN) is the most common form of postinfectious glomerulonephritis, and acute pyelonephritis(APN) is the most severe form of urinary tract infection in childhood. However, the concurrence of two diseases is uncommon in the literature. We describe a case of APSGN accompanied with APN in a 5-year-old female who presented with fever, left flank pain, headache and facial edema. Urinalysis showed pyuria, microscopic hematuria, and mild proteinuira. Serial urine cultures grew Escherichia coli. (99m)Tc-DMSA renal scan revealed a cortical defect in the upper pole of left kidney. She had a history of preceding pharyngitis, in addition, showed high blood pressure, high anti-streptolysin O titer, and low serum complement levels. The patient improved completely with supportive treatment, including antibiotic and antihypertensive therapy. These findings suggested that APSGN and APN could be manifested simultaneously or be superimposed on each other.

Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting for Patients with Multivessel Coronary Artery Disease: The Korean Multicenter Revascularization Registry(KORR)

BACKGROUND AND OBJECTIVE: Despite many multicenter trials on percutaneous coronary intervention (PCI), versus coronary artery bypass surgery (CABG), in multivessel coronary artery disease (MVCAD), the most appropriate treatment remains a matter of debate. Moreover, studies comparing the 2 strategies in eastern society are rare. The aim of this study was to assess the relative merits of PCI and CABG in MVCAD in the post-stent era. SUBJECTS AND METHODS: Patients, with MVCAD, indicated for revascularization were enrolled from 9 centers in Korea. Out of the 3,279 patients in the registry, 2102 (CABG 609 patients, PCI 1,493 patients) were selected for a comparison of their outcomes, after a statistical adjustments for the disparity for 6 independent risk factors, for the prognosis between the two groups. RESULTS: There was no significantly different in the 3 year survival rates between PCI and CABG groups. In the diabetic patients, the 3-year mortality rate in PCI group was 1.6-fold higher than in the CABG group, although it was not statistically significant (PCI 19.8%, CABG 12.5%, p=0.24). The incidence of cerebrovascular events (CVE) was higher in the CABG group. The thirty-day death rate, myocardial infarction or CVE were higher in the CABG group (PCI 1.3%, CABG 4.2%, p<0.001). Both the long and short-term revascularization rates were higher in PCI group compared to CABG group. CONCLUSION: Our Korean registry demonstrated a comparable survival rate between the PCI and CABG groups. A PCI was associated with a lower early morbidity, but with a greater need for repeated revascularization compared to a CABG.

The comparison of intra-abdominal fat distance (I-A Fat Distance) and visceral adipose tissue area (VAT) or visceral fat to skeletal muscle area ratio (VMR) measured by computed tomography (CT) / 대한내과학회지

BACKGROUND: Visceral fat accumulation plays a major role in metabolic syndrome and increased cardiovascular risks. Clinical evaluation of visceral fat by CT is not widely used because of high cost, low availability, and ionizing radiation risk, and alternative means are required. To assess the usefulness of ultrasound measurement of I-A fat distance for the evaluation of visceral obesity, we compared several length-associated parameters (I-A fat distance, I-A fat distance to thigh muscle length ratio, and I-A fat distance to abdominal subcutaneous fat length ratio) with area-associated parameters (VAT, visceral fat to subcutaneous fat area ratio [VSR] and VMR) measured by CT. METHODS: We evaluated 65 patients with type 2 diabetes (34 men and 31 postmenopausal women). CT scans were obtained at the L4-5 level and the mid-portion between greater trochanter and upper margin patella. I-A fat distance was defined as the distance between the internal face of rectus muscle and the anterior wall of the aorta. Also ultrasonography for measurement of I-A fat distance was performed in 20 men of subjects. RESULTS: Of the various parameters examined, I-A fat distance was most closely correlated with the VAT (r=0.76, p<0.001) and VMR (r=0.71, p<0.001) but not VSR (r=0.18, p=0.22). This distance positively correlated with serum triglyceride and free fatty acids in men (r=0.56 and r=0.59, p<0.05, respectively), and with uric acid (r=0.70, p<0.05), fasting insulin levels (r=0.70, p<0.001), insulin resistance index by HOMA (r=0.69, p<0.001), systolic blood pressure (SBP) (r=0.73, p<0.05), and diastolic blood pressure (DBP) (r=0.85, p<0.001) in women. When the clinical and laboratory data was considered by tertiles of I-A distance, serum uric acid, fasting insulin levels, insulin resistance index (HOMA), BMI, waist or hip circumference, SBP, and DBP were significantly higher in the top tertile, but not WHR. I-A fat distance measured by ultrasonography significantly correlated with VAT, VSR, and VMR (r=0.79, r=0.71, and r=0.79, p<0.05, respectively). CONCLUSION: These results suggest that 1) I-A fat distance may substitute for the VAT in assessment of visceral fat content and may be relatively good parameter indicative of visceral obesity and/or insulin resistance, and 2) several parameters (e.g., VAT, VSR, and VMR) related with visceral fat by CT may be replaced with ultrasonographic I-A fat distance.

A case of dumping syndrome presenting as hypoglycemic shock with dramatic improvement by octreotide treatment / 대한내과학회지

Following gastric surgery, 25~50% of patients experience dumping symptoms. Early dumping usually involves both gastro-intestinal and vasomotor complaints, while late dumping involves mainly the latter. Management is mainly achieved by dietary modification. Drug therapy has been investigated without consistent success. However, the somatostatin analogue octreotide alleviates dumping by slowing gastric emptying, inhibiting insulin release, decreasing enteric peptide secretion and intestinal absorption of water and sodium, slowing monosaccharide absorption, increasing gut transit time and preventing hemodynamic changes. We report a case with the place of octreotide in the medical management of the dumping syndrome. The patient was 71-year-old male who had taken total gastrectomy for gastric cancer in 1987. He had been well except intermittent abdominal pain for 8 years after total gastrectomy. But he had suffered from sudden symptoms such as hypoglycemic shock and fainting, which start 2~3 hours after ingesting of a meal for recent 5 years. Studies for diagnosing insulinoma were all negative. We start diet modification and medication such as acarbose to him with impression of dumping syndrome, but there were no improvement of his symptoms. Then we start octreotide, 50 g, given subcutaneously, three-times per day, 30 min prior to each meal. His symptom was dramatically improved.

Insulin resistance can predict the risk of metabolic syndrome / 대한내과학회지

BACKGROUND : This study was initiated to evaluate the prevalence of metabolic syndrome and its components as risk factors for cardiovascular disease according to insulin resistance in the Korean adult population. METHODS : This study was conducted as a branch of the Korean Metabolic Syndrome (KMS) Study: 1,091 individuals aged 30 79 years participating in medical check-up in Korea Association of Health (KAH) were included in this study. We checked fasting blood sugar, fasting insulin, proinsulin, lipid profiles (total cholesterol, triglyceride, LDL-cholesterol, HDL-cholesterol), body mass index, waist circumference, blood pressure, carotid intima-media thickness (IMT) and abdominal ultrasonography. We divided all of the examinees into three groups (insulin sensitive, intermediate, resistant tertiles) according to their degree of insulin resistance and correlated this with the prevalence of metabolic syndrome. RESULTS : The relative risk of metabolic syndrome was 84.1-fold higher in the insulin resistant tertile group compared to the insulin sensitive tertile group. Diabetes mellitus or impaired fasting glucose (IFG) was 10.2-fold; hypertension, 1.8-fold; dyslipidemia, 2.8-fold; hypercholesterolemia, 2.5-fold; fatty liver, 3.0-fold. Abdominal obesity rather than general obesity was more contributory to insulin resistance. CONCLUSION : Although this is a cross-sectional study, we can show that insulin resistance is one of the most-striking risk factors in metabolic syndrome and can be used as a predictor of cardiovascular diseases. Furthermore, we should monitor the healthy insulin-resistant population to prevent ongoing cardiovascular diseases. More prolonged data should be gained to refine the correlations of insulin resistance to metabolic syndrome.

Subglottic Stenosis in Wegener's granulomatosis: A Case Report / 대한류마티스학회지

Wegener's granulomatosis (WG)is a multisystemic inflammatory disease characterized by necrotizing granulomatous inflammation and vasculitis of unknown etiology which classically affects the upper airway,lung,and kidney.Subglottic stenosis (SGS)is rare and occurs independently of other features of active WG. SGS can be a life-threatening manifestation of disease,and prompt diagnosis is essential.Since the presenting symptoms of SGS can be nonspecific,SGS should be considered in the differential diagnosis of any patient with WG who has increasing dyspnea,voice change,or cough.Although both surgical and medical treatments have been utilized,the optimal therapeutic approach to SGS in patients with WG has not been determined.So far,a case of WG with SGS has not been reported in Korea.Recently,we experienced a case of 59-year-old woman with SGS in WG.She responded to prednisolone and methotrexate therapy and did not require surgical intervention.So we report this case with a review of literatures.

The Fungicidal Effect of Apolactoferrin on Aspergillus fumigatus / 감염

BACKGROUND: The incidence of aspergillosis is rising with the increased use of antimicrobial agents and immunosuppressive drugs for the treatment of malignant diseases, acquired immunodeficiency syndrome, or organ transplant recipients. However, treatment failures are also increasing which brings up the need for the development of new and more effective agents and/or compounds which support the activity of common antifungal agents. Apolactoferrin is one of the nonspecific host defence factors present in saliva that exhibit antifungal activity. We studied the in vitro antifungal effect of apolactoferrin in combination with amphotericin-B against Aspergillus fumigatus. METHODS: Preparation of the inoculum and the growth conditions used were those recommended by the National Committee for Clinical Laboratory Standards M38-P (Conidium-forming filamentous fungi: proposed standard). Aspergillus fumigatus test inoculum was prepared to a concentration of 0.4 X 104~5 X 104 cells/mL. Appropriate concentrations of the antifungal agents were added to the wells (50 microliter) and after inoculation, plates were incubated for 48 h at 35Celsius. Turbidity measurement was performed at 48 h at 630 nm and the MIC was defined as the lowest concentration of antifungal agents that inhibited growth of the organism as detected visually. RESULTS: In the combination of experiments, we observed a pronounced cooperative activity against growth of Aspergillus fumigatus by using apolactoferrin and amphotericin-B. The MIC of amphotericin-B was reduced by 1/10 in the presence of apolactoferrin. CONCLUSION: The combined use of apolactoferrin and amphotericin-B against severe infections with Aspergillus fumigatus is an attractive therapeutic option. Clinical studies to further elucidate the potential utility of this combination therapy have been initiated.

Four Cases of Posttransplant Lymphoproliferative Disease (PTLD) Following Renal Transplantation / 대한이식학회지

Posttransplant lymphoproliferative disorder (PTLD) is now a well-documented and serious complication of organ transplantation, ranging from polyclonal lymphoid hyperplasia to malignant lymphoma. PTLD is due to the combined effects of lymphoid proliferation induced by Epstein-Barr virus (EBV) infection, and the disruption of normal immume control by cytotoxic T cells. It is also strongly related to the potency and the cumulative doses of immunosuppressants and the type of organ transplantation. We report four cases of PTLD after renal transplantation, for whom three cases were EBV-positive by in situ hybridization.

Effect of Antenatal Magnesium Sulfate Administration on Neonatal Mortality and Morbidity in Very Low Birth Weight Infants

PURPOSE: We investigated whether in utero exposure to magnesium sulfate is associated with lower incidence of neonatal mortality, morbidity, and neurodevelopmental abnormalities in very low birth weight infants. METHODS: We evaluated 172 infants with birth weight less than 1,500g. According to the maternal receipt of magnesium sulfate, we divided into two groups. We reviewed the medical records of mothers and their babies to evaluate clinical outcome. RESULTS: Of 172 infants, 58(GA 30.0+/-2.3weeks, BW 1,20+/-2221g) received magnesium sulfate prior to delivery for tocolysis or preeclampsia(study group). The remaining 114(GA 29.6+/-2.3weeks, BW 1,220 +/-198g) served as the control group. Neonatal mortality was not significantly different between the two groups(12.5% vs 26.0%). There was no significant difference between the two groups in neonatal complications' RDS(52.4% vs 67.6%), BPD(16.7% vs 29.6%), apnea(52.4% vs 67.6%), IVH(23.8% vs 31.0%), PVL(4.8% vs 11.3%), NEC(7.1% vs 7.0%), ROP(26.8% vs 41.2%), and neal infection(33.3% vs 54.9%). The duration of ventilator therapy(10.9+/-7.3 vs 14.2+/-10.6 days), oxygen administration(20.2+/-20.0 vs 24.3+/-19.9 days) and admission(51.5+/-16.9 vs 54.6+/-16.7 days) were not different. Among 64 patients in whom follow up evaluation was possible more than 1 year, the incidence of cerebral palsy or developmental delay was not different(12.0% vs 12.8%). CONCLUSION: Maternal receipt of magnesium sulfate does not seem to be associated with an appreciably reduced risk of neonatal mortality, morbidity, and neurodevelopmental abnormalities in very low birth weight infants. (Abbreviations. GA, gestational age, BW, birth weight; RDS, respiratory distress syndrome; BPD, bronchopulmonary dysplasia, IVH, intraventricular hemorrhage; PVL, periventricular leukomalacia; NEC, necrotizing enterocolitis; ROP, retinopathy of prematurity)

A Case of Congenital Lymphedema

Congenital lymphedema is a rare disorder of unknown etiology which affects the extremities, preponderantly the lower extremities, at or immediately after birth. We experienced a case of congenital lymphedema in a newborn with generalized edema on the left lower extremity. We performed lymphangioscintigraphy and MRI for diagnosis. Microlymphaticovenous anastomosis was done on 16 days after birth and the patient showed clinical improvement. We report this case with brief review of the related literature.

A Case of Conjoined Twin / 대한주산의학회잡지

Conjoined twins occur when there is imcomplete fission of the inner cell mass later at approximately 13 to 15 days after fertilization. The earlist case in the literat.ure appears to be that of the Biddenden Maids who were born in England in 1100. since then over two hundred cases of successful separation were reported on literature. And also successful separation cases were reported by Seung et al.(1991) in Korea. Conjoined twins occur between one in 50,000 to 100,000 births but real incidence is one in 200,000 because two thirds are stillbirth or died immediately after birth. The conjoined twins are not associated with maternal age, race or family history and 70 % of them are females. We experienced a case of conjoined twins with omphalopagus and performed surgical separation. A brief review of related literatures was done.

Subclavian Catheterization in the Pediatric Patients

PURPOSE: Central venous catheters are used to deliver antibiotics, chemotherapeutic agents, and parenteral nutrition for a extended period of time as well as to draw samples in immunocompromised patients to minimize the discomfort with sampling and the risk of introducing infections. Hickman/Broviac catheters or implantable devices have been used in pediatric patients. This study is aimed to evaluate the safety and clinical efficacy of subclavian catheterization which has advantages of low cost without need of general anesthesia or skillful surgeon. METHODS: Between August 1994 and October 1995, subclavian venous catheters were inserted in 22 patients. The age ranged from 3 months to 17 years (median 9 years 5 months). Patients weight ranged from 5.7kg to 57.0kg (median 27.5kg). Nineteen patients had various malignancies. Arrow multi-lumen/ two-lumen central venous catheters were used. Without general anesthesia, pediatricians inserted the subclavian catheters by blind puncture at bedside after administering 0.035mg/kg of midazolam and 0.05mg/kg of morphine sulfate. Emla cream was applied at the puncture site one hour prior to the procedure. We retrospectively evaluated the patient characteristics and complications associated with catheter placement and maintenance. RESULTS: The median duration of catheter placement was 53 days, with a range of 6 to 175 days. In early series, 2 cases of pneumothorax and a case of hemothorax occured during the catheter insertion. Occlusion and infection of catheters occured in 11 and 6 patients, respectively. Twenty catheters were removed: no need to continue, 7; patient death, 4; inadvertent removal, 4; complete occlusion 3 and 2 cases of catheter-related infections. CONCLUSIONS: Subclavian catheterization is a safe, cost-effective, easy-to-perform technique of providing long-term venous access which can be done by pediatrician at bedside without the risk of general anesthesia.