Kaohsiung J Med Sci
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Kaohsiung J Med Sci · Sep 2007
Case ReportsBiloma following transcatheter arterial chemoembolization with microspheres: a case report.
We report a case of intrahepatic biloma following transcatheter arterial chemoembolization (TACE) with microspheres in a 44-year-old male patient. He was diagnosed with hepatocellular carcinoma with satellite nodules and intrahepatic duct invasion in August 2004. TACE was performed with a mixture of lipiodol, epirubicin hydrochloride, and mitomycin followed by microspheres as devascularizing material. ⋯ However, fever and diarrhea developed 2 weeks after the third TACE. Biloma with infection was diagnosed and was then treated successfully with percutaneous drainage and antibiotics. Embolization using microspheres at the proximal right hepatic artery was considered to have been the jeopardizing etiologic factor of biloma formation.
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Kaohsiung J Med Sci · Sep 2007
Transesophageal echocardiography and laryngeal mask airway for placement of permanent central venous catheter in cancer patients with radiographically unidentifiable SVC-RA junction: effectiveness and safety.
In patients who require a permanent central venous catheter (PCVC), the usual aim is to put the catheter tip at the superior vena cava and right atrium (SVC-RA) junction. However, there is no study regarding how to guide the positioning of the catheter tip when the SVC-RA junction cannot be identified on chest radiograph. The objectives of this prospective study were: (1) to investigate the incidence and etiologies of radiographically undetermined SVC-RA junctions in cancer patients undergoing PCVC implantation; and (2) to evaluate the feasibility, effectiveness and safety of combined transesophageal echocardiography (TEE) and laryngeal mask airway (LMA) to guide the positioning of catheters during implantations in patients without this radiographic landmark. ⋯ All had the catheter tip positioned in the anatomic SVC-RA junction under TEE guidance. In conclusion, 16% of cancer patients requiring PCVC implantation had no identifiable SVC-RA junction on chest radiograph and most causes were cancer-unrelated. In patients without a radiographically identifiable SVC-RA junction, guidance by TEE under LMA general anesthesia is a feasible, safe and effective management to position a PCVC at the SVC-RA junction.
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The ingestion of foreign bodies such as coins, fish bones, plastic toy parts, batteries, and needles is common in children. Although the majority of ingested foreign bodies pass through the gastrointestinal tract unaided, some children require either nonsurgical or surgical intervention. The medical records of children who presented to the pediatric emergency department of a single tertiary referral center between December 2001 and May 2006 were reviewed. ⋯ There were no major complications caused by foreign body ingestion or endoscopic procedures. The outcome of all patients was uneventful without morbidity or mortality. In our experience, endoscopic removal of foreign bodies under general anesthesia is an effective and safe method in children; the method also prevents erosion and perforation of the gastrointestinal tract.