Kimura's disease is a chronic inflammatory soft tissue disorder with peripheral eosinophila and high serum IgE. It might be associated with nephrotic syndrome. We report a 6-year-old boy with Kimura's disease and the concurrent steroid dependant minimal change nephrotic syndrome. With levamisole treatment fot 24 months, tumor progression and relapse of the associated nephrotic syndrome were not observed.
Child ; Humans ; Immunoglobulin E ; Levamisole ; Nephrosis, Lipoid ; Nephrotic Syndrome ; Recurrence

Ketosis-prone diabetes includes heterogeneous disease groups characterized by provoked or unprovoked ketoacidosis (ketosis), with a typical phenotype of autoimmune type 1 diabetes. As the incidence of obesity and type 2 diabetes is universally increasing, the rate of type 2 diabetes in diabetic ketoacidosis in children and adolescents is exptected to increase rapidly. The clinical presentation of atypical ketoacidosis with type 2 diabetes has been reported mostly in adults. We recently experienced a case of a 10-year-old obese girl with new-onset type 2 diabetes who initially presented with severe diabetic ketoacidosis, and introduce it with literature reviews.
Adolescent ; Adult ; Child ; Diabetes Mellitus, Type 2 ; Diabetic Ketoacidosis ; Humans ; Incidence ; Ketosis ; Obesity ; Phenotype

Ketosis-prone diabetes includes heterogeneous disease groups characterized by provoked or unprovoked ketoacidosis (ketosis), with a typical phenotype of autoimmune type 1 diabetes. As the incidence of obesity and type 2 diabetes is universally increasing, the rate of type 2 diabetes in diabetic ketoacidosis in children and adolescents is exptected to increase rapidly. The clinical presentation of atypical ketoacidosis with type 2 diabetes has been reported mostly in adults. We recently experienced a case of a 10-year-old obese girl with new-onset type 2 diabetes who initially presented with severe diabetic ketoacidosis, and introduce it with literature reviews.
Adolescent ; Adult ; Child ; Diabetes Mellitus, Type 2 ; Diabetic Ketoacidosis ; Humans ; Incidence ; Ketosis ; Obesity ; Phenotype

Brachiocephalic venous aneurysm (BVA) development is an extremely rare, particularly as a primary vascular disorder. BVAs may be misinterpreted as lymphadenopathies owing to the variable degrees of enhancement seen in imaging studies, especially among patients with underlying malignancy. We report a BVA that mimicked lymph node metastasis on CT in a 60-year-old female who had undergone subtotal gastrectomy for stomach cancer. After followup chest CT with different bolus times and Doppler ultrasonography, a venous aneurysm originating from the brachiocephalic vein was diagnosed. We emphasize that, to make an accurate diagnosis, physicians should be aware of the potential diagnostic pitfalls and have a high index of suspicion for BVA when encountering certain lesions in the cervical area.

Esophageal leiomyoma is a benign tumor that accounts for two-thirds of esophageal benign tumors. In general, patients with esophageal leiomyoma are asymptomatic; however, as the tumor grows in size, symptoms such as dysphagia, chest discomfort, obstruction, or bleeding can appear. A 65-year-old man visited our clinic to receive treatment for a subepithelial tumor in the lower esophagus, which was incidentally found during endoscopy for work-up of chest discomfort and indigestion. On endoscopic ultrasonography (EUS), the tumor was 2.6×1.9 cm in size, with a cystic lesion located in the submucosal and proper muscle layers and thick cystic wall. Therefore, it was highly likely to be a duplication cyst. As the patient had symptoms such as chest discomfort, surgical resection was performed. The tumor was finally diagnosed as a leiomyoma with cystic degeneration. Leiomyoma with cystic change that has similar EUS features to duplication cyst is rare. Thus, we report the case with a literature review.

Esophageal leiomyoma is a benign tumor that accounts for two-thirds of esophageal benign tumors. In general, patients with esophageal leiomyoma are asymptomatic; however, as the tumor grows in size, symptoms such as dysphagia, chest discomfort, obstruction, or bleeding can appear. A 65-year-old man visited our clinic to receive treatment for a subepithelial tumor in the lower esophagus, which was incidentally found during endoscopy for work-up of chest discomfort and indigestion. On endoscopic ultrasonography (EUS), the tumor was 2.6×1.9 cm in size, with a cystic lesion located in the submucosal and proper muscle layers and thick cystic wall. Therefore, it was highly likely to be a duplication cyst. As the patient had symptoms such as chest discomfort, surgical resection was performed. The tumor was finally diagnosed as a leiomyoma with cystic degeneration. Leiomyoma with cystic change that has similar EUS features to duplication cyst is rare. Thus, we report the case with a literature review.

OBJECTIVES: We aimed to develop a common health information exchange (HIE) platform that can provide integrated services for implementing the HIE infrastructure in addition to guidelines for participating in an HIE network in South Korea. METHODS: By exploiting the Health Level 7 (HL7) Clinical Document Architecture (CDA) and Integrating the Healthcare Enterprise (IHE) Cross-enterprise Document Sharing-b (XDS.b) profile, we defined the architectural model, exchanging data items and their standardization, messaging standards, and privacy and security guidelines, for a secure, nationwide, interoperable HIE. We then developed a service-oriented common HIE platform to minimize the effort and difficulty of fulfilling the standard requirements for participating in the HIE network. The common platform supports open application program interfaces (APIs) for implementing a document registry, a document repository, a document consumer, and a master patient index. It could also be used for testing environments for the implementation of standard requirements. RESULTS: As the initial phase of implementing a nationwide HIE network in South Korea, we built a regional network for workers' compensation (WC) hospitals and their collaborating clinics to share referral and care record summaries to ensure the continuity of care for industrially injured workers, using the common HIE platform and verifying the feasibility of our technologies. CONCLUSIONS: We expect to expand the HIE network on a national scale with rapid support for implementing HL7 and IHE standards in South Korea.
Computer Security ; Computer Systems ; Continuity of Patient Care ; Delivery of Health Care ; Electronic Health Records ; Health Level Seven ; Humans ; Information Services* ; Korea ; Privacy ; Referral and Consultation ; Workers' Compensation

A 77-year-old man visited our department because of dizziness from one month ago. Dizziness was continuous and non-whirling and this type of dizziness was the first time. He also complained of tinnitus and hearing impairment of the right ear. On physical examination, he showed spontaneous left-beating horizontal and torsional nystagmus and rightward head thrust was positive. He was admitted under the first impression of right vestibular neuritis. On inner ear MRI, there was a well-demarcated 2.5x2.3 cm sized mass of right cerebellopontine angle. This mass showed somewhat low signal intensity in both T1 and T2-weighted image and modest enhancement with Gadolinum. And approximately 4.5x3 cm sized mass could be seen in the simple chest roentgenogram. On chest CT, there was a poorly demarcated 3x2.5 cm sized mass in left lower lobe of lung. The patient was diagnosed as small cell lung cancer with brain metastasis by Per-Cutaneous Needle Aspiration of lung. In spite of radiotherapy and concurrent chemotherapy, he expired after 5 months.
Aged ; Brain ; Cerebellopontine Angle ; Dizziness ; Drug Therapy ; Ear ; Ear, Inner ; Head ; Hearing Loss ; Humans ; Lung ; Magnetic Resonance Imaging ; Needles ; Neoplasm Metastasis ; Physical Examination ; Radiotherapy ; Small Cell Lung Carcinoma* ; Thorax ; Tinnitus ; Tomography, X-Ray Computed ; Vestibular Neuronitis*

Ineffective cerebral perfusion by low cardiac output may cause various types of dizziness like mild lightheadedness, vertigo or presyncope, and sometimes it can be the only heralding symptom. Differential diagnosis with other causes of dizziness is important because the symptom may progress into life-threatening bradyarrythmia and loss of consciousness. There are several literatures that reporting the association between cardiac disease and dizziness and their improvement with treatment of cardiac problem including pacemaker placement. But these are only indirect evidences to explain the cause-symptom relationship. We experienced 48-year old woman who has had recurrent dizziness of rotatory type lasting for about 5 seconds since first year, and then diagnosed atrioventricular block after. She has been having anti-hypertension medications for 2 years. She didn't have any abnormalities in electrocardiography, chest x-ray, or routine blood tests. There were no abnormalities in vestibular function test and electronystgmography. Her result of 24-hour Holter monitoring clearly elucidated temporal relationship between arrhythmia and her episodic symptoms of dizziness. The authors report a case with review of literatures about cardiogenic dizziness.
Arrhythmias, Cardiac ; Atrioventricular Block ; Cardiac Output, Low ; Diagnosis, Differential ; Dizziness ; Electrocardiography ; Electrocardiography, Ambulatory ; Female ; Heart Diseases ; Hematologic Tests ; Humans ; Perfusion ; Syncope ; Thorax ; Unconsciousness ; Vertigo ; Vestibular Function Tests

Traumatic pseudoaneurysms in the head and neck region are very rare. Particularyly, pseudoaneurysms of the internal maxillary artery are known to be very rare. The authors report a 20-year old male who was diagnosed as having a pseudoaneurysm of the internal maxillary artery. The cause was assumed to be a mandible ramus fracture. When he visited our emergency room, we did not consider a pseudoaneurysm because of his other life-threatening conditions. Fortunately, he re-visited our hosipital before the aneurysm ruptured. He was diagnosed with angiography and was treated by using embolization with glue. The rupture of the pseudoaneurysm could have caused a life-threatening hemorrhage.
Adhesives ; Aneurysm ; Aneurysm, False ; Angiography ; Emergencies ; Head ; Hemorrhage ; Humans ; Male ; Mandible ; Maxillary Artery ; Neck ; Rupture