Paget-Schroetter syndrome accompanied by pulmonary thromboembolism: A case report.

A 17-year-old male, who was involved in a baseball club, presented to our emergency department with the complaint of gradual onset of swelling of his right arm. Contrast-enhanced computed tomography showed obstruction of the proximal portion of the right subclavian vein and pulmonary thromboembolism. Venography confirmed an occluded right subclavian vein. The patient was diagnosed with right subclavian vein thrombosis, which is referred to as Paget-Schroetter syndrome (PSS). An ultrasonography for the affected subclavian vein was helpful not only for making an accurate diagnosis of PSS, but also for verifying dynamic venous flow changes depending on the forearm position. .

[Contribution of clinical laboratories to the diabetes care team--efforts in our hospital].

The traditional role of clinical laboratory technicians is to perform biochemical and physiological tests quickly and accurately in the laboratory. Currently, however, clinical laboratory technicians should look out outside the laboratory because of marked changes in circumstances, such as recent advances of medical technology and the development of the team approach to medical care by many medical specialists. The team approach for diabetic patients is a representative case, in which clinical laboratory technicians can play an active role more than before. At our Sumitomo Hospital, clinical laboratory technicians joined the diabetes care team in 2004. Our activities are wide-ranging, for instance, individual advice regarding laboratory tests, group lectures and making individual data sheet that shows graphs of the improvement of test values, named "Valuable Information". We here describe the present activities in our hospital, evaluate the problems and issues, and discuss the favorable image of clinical laboratory technicians expected in the future.

Severe optic neuropathy caused by dichloromethane inhalation.

PURPOSE: In this paper, we report a case of severe optic neuropathy caused by dichloromethane inhalation. CASE: A 65-year-old man fell unconsciousness while cleaning a dichloromethane tank containing a small amount of dichloromethane (purity greater than 99%) and was transported to the emergency department of our hospital, after which he was treated with hyperbaric oxygen therapy. After 1 month, narrowing of the visual field in both eyes was noted and the patient was referred to our department for additional examinations. Visual acuity was 0.3 in both eyes, which demonstrated normal reactions to light, while the critical flicker frequency (CFF) values were 30 and 25 Hz in the right and left eye, respectively. There were no abnormal findings shown in slit-lamp and fundus examinations, except for a mild cataract. Concentric contractions of the visual field by 10 degrees in both eyes were shown by a Goldmann perimetry examination, while an electroretinogram (ERG) and visual evoked cortical potential (VECP) examination exhibited nearly normal results. We diagnosed the condition as optic neuropathy caused by organic solvent poisoning, based on the decreased visual acuity, decreased CFF values, and visual-field narrowing. Although the patient was treated with vitamin B(12), visual disturbance, optic nerve atrophy, and results of VECP examinations worsened in both eyes, whereas ERG examination results were normal. CONCLUSIONS: Based on our findings, we considered that the central nervous system, including the optic nerve, was more severely damaged than the retina due to the normal findings in the ocular fundus and ERG examinations. Since dichloromethane produces carbon monoxide when catabolized in the liver, carbon monoxide toxicity together with the direct toxic effect of dichloromethane were considered to contribute to optic neuropathy in this case. The outcome for the present patient was poor.