Adenotonsillar hypertrophy is the leading cause of childhood obstructive sleep apnea. Obstructive sleep apnea syndrome in child-hood, however, can occur from various causes such as obesity or craniofacial abnormalities. Childhood obstructive sleep apnea syndrome can be accompanied by enuresis, parasomnias and behavior problems. For patients with the symptoms of snoring and apnea, obstructive sleep apnea should be suspected and diagnosed properly. In addition, the evaluation of complications and proper treatment are indispensable. When the cause of childhood obstructive sleep apnea is adenotonsillar hypertrophy, symptoms can be improved by surgical methods. If the cause is other than adenotonsillar hypertrophy, such as obesity, it should be treated with other therapeutic modalities, like nasal continuous positive airway pressure (nCPAP), weight reduction and modification of life style. This paper reports a case of nCPAP used to manage severe sleep apnea when it was not resolved after adenoidectomy and tonsillectomy. Differential diagnosis of narcolepsy in a case with excessive daytime sleepiness and reflections on accompanying enuresis and parasomnia were also described.
Adenoidectomy ; Apnea ; Child ; Continuous Positive Airway Pressure ; Craniofacial Abnormalities ; Diagnosis, Differential ; Enuresis ; Humans ; Hypertrophy ; Life Style ; Narcolepsy ; Obesity ; Parasomnias ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive* ; Snoring ; Tonsillectomy ; Weight Loss

No abstract available.
Nevus*

No abstract available.
Ascites* ; Hernia, Umbilical* ; Leiomyoma*

Tubulointerstitial nephritis (TIN) is the most common form of renal involvement in IgG4-related disease. It is characterized by a dominant infiltrate of IgG4-positive plasma cells in the interstitium and storiform fibrosis. Demonstration of IgG4-positive plasma cells is essential for diagnosis, but the number of IgG4-positive cells and the ratio of IgG4-positive/IgG-positive plasma cells may vary from case to case and depending on the methods of tissue sampling even in the same case. IgG4-positive plasma cells can be seen in TIN associated with systemic lupus erythematosus, Sjogren syndrome, or anti-neutrophil cytoplasmic antibody-associated vasculitis, which further add diagnostic confusion and difficulties. To have a more clear view of IgG4-TIN and to delineate differential points from other TIN with IgG4-positive plasma cell infiltrates, clinical and histological features of IgG4-TIN and its mimickers were reviewed. In the rear part, cases suggesting overlap of IgG4-TIN and its mimickers and glomerulonephritis associated with IgG4-TIN were briefly described.
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis ; Diagnosis ; Fibrosis ; Glomerulonephritis ; Glomerulonephritis, Membranous ; Lupus Erythematosus, Systemic ; Lupus Nephritis ; Nephritis, Interstitial* ; Plasma Cells ; Sjogren's Syndrome ; Tin

C3 glomerulopathy is a renal disorder involving dysregulation of alternative pathway complement activation. In most instances, a membranoproliferative pattern of glomerular injury with a prevalence of C3 deposition is observed by immunofluorescence microscopy. Dense deposit disease (DDD) and C3 glomerulonephritis (C3GN) are subclasses of C3 glomerulopathy that are distinguishable by electron microscopy. Highly electron-dense transformation of glomerular basement membrane is characteristic of DDD. C3GN should be differentiated from post-infectious glomerulonephritis and other immune complex-mediated glomerulonephritides showing C3 deposits.
Complement Activation ; Complement Pathway, Alternative ; Dichlorodiphenyldichloroethane ; Glomerular Basement Membrane ; Glomerulonephritis ; Glomerulonephritis, Membranoproliferative ; Microscopy, Electron ; Microscopy, Fluorescence ; Pathology ; Prevalence

Torsion of the gallbladder is a rare condition that is difficult to diagnose preoperatively, but prompt surgical intervention is necessary to avoid possible sepsis and death. A 36-year-old pregnant woman presented to Emergency Department with a constant epigastric pain at 17 weeks of gestation. Abdominal ultrasonography and magnetic resonance imaging demonstrated a distended gallbladder that contained no stones but had mild wall thickening. Laparoscopic cholecystectomy using three ports was performed under the impression of an acalculous cholecystitis. The gallbladder was found to be rotated 180 degrees clockwise on gallbladder mesentery and to be gangrenous. The postoperative course was uneventful and the patient was discharged on the 4th day after surgery. It is important to keep in mind gallbladder torsion in the differential diagnosis from acute cholecystitis when the patient has an acute onset of abdominal pain and a severely distended gallbldder. Prompt cholecystectomy via a laparoscopic approach should be performed.
Abdominal Pain ; Acalculous Cholecystitis ; Adult ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis, Acute ; Diagnosis, Differential ; Emergencies ; Female ; Gallbladder* ; Humans ; Magnetic Resonance Imaging ; Mesentery ; Morphinans ; Pregnancy* ; Pregnant Women ; Sepsis ; Torsion Abnormality ; Ultrasonography

PURPOSE: The cornea of the keratoconus patient that is one of the contraindications in refractive surgery shows severe topographic asymmetry and the lower curvature is much steeper than the upper one. In this study, we evaluated whether the mild to moderate topographic asymmetry which does not fall under the Rabinowitz-McDonnell's keratoconus criteria(I-S value>3.0 D) would affect the LASIK results. METHODS: The maximal diopter difference in central 3 mm-zone(MDD-3) of the pre-LASIK topography, the postoperative best uncorrected visual acuity(UCVA) and the postoperative best corrected visual acuity(BCVA) were analyzed in 248 eyes of 124 patients retrospectively. We divided the patients into 2 groups according to the magnitude of MDD-3(MDD-3<1.0 D in group 1 and MDD-3> OR =1.0 D in group 2). In the same manner, the patients were divided into 2 groups according to the magnitude of MDD-5(MDD-5<1.0 D in group A and MDD-5> OR =1.0 D in group B) using 5 mm-zone. RESULTS: Between group 1 and 2, statistically significant difference was not observed in postoperative UCVA and BCVA(p>0.05). Between group A and B, statistically significant difference was not observed in postoperative UCVA and BCVA(p>0.05), either. CONCLUSIONS: This suggests that the mild pre-LASIK topographic asymmetry would not affect the visual acuity after LASIK.
Cornea ; Humans ; Keratoconus ; Keratomileusis, Laser In Situ* ; Refractive Surgical Procedures ; Retrospective Studies ; Visual Acuity

PURPOSE: To report the effectiveness of Minocin sclerotherapy in the treatment of renal cysts. MATERIALS AND METHODS: We performed minocin sclerotherapy to 19 patients with 21 renal cysts composed of 17 cases of solitary renal cyst and three cases of multiple renal cyst and one case of polycystic kidney comfirmed by ultrasound and CT. After aspiration of cyst fluid, if the amount was less than 50ml, 500mg of minocin was mixed with 3ml of normal saline,if more than 50ml, 1000mg of minocin mixed with 5ml of normal saline were injected, and each case was followed-up over 3 months by ultrasound. RESULTS: Of all 21 renal cysts, 14 cases were followed-up three months after minocin sclerotherapy. In 12 of 14 cases, the size of the cysts decreased by 10% or collapsed completely. Of the remaining two cases, one collapsed after 6 months while the other recurred after 6months. Three cases were followed up after 20 months and only one of them recurred. 19 of all 21 cases(91%) were cured, and two of 21 cases(9%) were recurred. Pain was the only complaint. and four of 10'cases needed analgesics. CONCLUSION: Sclerotherapy with minocin has low recurrence-rate and low complication, and relatively early high cure-rate.
Analgesics ; Cyst Fluid ; Humans ; Minocycline* ; Polycystic Kidney Diseases ; Sclerotherapy* ; Ultrasonography

Myotonic dystrophy (MD) is a systemic disease that affects any level of the gastrointestinal tract. Due to its rare occurrence, achalasia could be misdiagnosed due to symptoms being similar to gastroesophageal reflux (GERD). Moreover, there is no known appropriate treatment for achalasia in patients with MD. A 58-year-old man was diagnosed with type 1 MD. He complained of dyspepsia and chest pain, which showed no improvement even after administering GERD medication. Secondary achalasia was subsequently diagnosed after examining the lower esophageal sphincter by performing a video fluoroscopic-swallowing study (VFSS) and high-resolution manometry. Thereafter, the patient was successfully treated with balloon dilatation, and showed significant improvements in the symptoms. The patient remained well for 1 year. We report a rare case of secondary achalasia in an MD patient. Our study validates that VFSS might be useful for the early diagnosis of achalasia, and esophageal intervention (such as balloon dilatation) should be considered on confirmation of the affliction.

Patients with dysphagia often have difficulty in supplying adequate nutrition orally, and thus they often use gastrostomy for nutrition support. If the nutrition affects the deterioration of the disease, as in amyotrophic lateral sclerosis, the majority of patients will have a gastrostomy tube for proper nutrition. To prevent complications from gastrostomy tubes, it is important to educate the caregiver or patient about how to properly manage it. If these patients opt for home care because of financial or cultural reasons, it will be difficult for their healthcare team to observe them closely, leading to complications due to lax tube management. In this case, appropriate management education becomes more important. This paper reports an extremely rare case of duodenal intussusception caused by a migrated percutaneous radiologic gastrostomy (PRG) tube in a patient with amyotrophic lateral sclerosis (ALS) using simultaneous oral and enteral nutrition. The patient was treated successfully with urgent tube removal using the air reduction maneuver. This case highlights the importance of gastrostomy management.
Amyotrophic Lateral Sclerosis ; Caregivers ; Deglutition Disorders ; Education ; Enteral Nutrition ; Gastrostomy* ; Home Care Services ; Humans ; Intussusception* ; Motor Neuron Disease ; Patient Care Team