Pyriform sinus fistula (PSF) is a persistent embryologic third or fourth pharyngeal pouch, which typically presents as a congenital sinus tract that originates from the pyriform sinus. PSF is among the most uncommon congenital malformation of the neck. The usual clinical manifestations are either acute thyroiditis or abscess, usually on the left side of the neck. We report a case of PSF in a 9-year old female with a left cervical abscess who had been diagnosed by barium esophagogram and treated endoscopically by injection of histoacryl.
Abscess ; Barium ; Child ; Enbucrilate* ; Female ; Fistula* ; Humans ; Neck ; Pyriform Sinus* ; Thyroid Gland ; Thyroiditis

Heat stroke, a medical emergency, occurs when the body's thermal regulation is upset and unable to dissipate adequate amounts of heat with a rise in body temperature. It is characterized by hyperyrexia, with a core temperature of 40degrees C or more, hot dry skin, and central nervous system disturbance and usually results in rhabdomyolysis and multiorgan failure. Our case, a 43-year-old healthy male, was caused by a marathon, half course, on a sunny day in late summer. He suddenly fell down on the road and was delivered to a nearby hospital, where a seizure developed. He was transfered to our hospital and then displayed Central Nervous System disturbance, hot dry skin, acute liver failure, rhabdomyolysis, anuric acute renal failure, and disseminated intravasculular coagulopathy. He was treated with general supportive care and hemofiltration. Despite the aggressive management, he died of shock on the fifth day after admission.
Acute Kidney Injury ; Adult ; Body Temperature ; Central Nervous System ; Emergencies ; Heat Stroke* ; Hemofiltration ; Hot Temperature* ; Humans ; Liver Failure, Acute ; Male ; Rhabdomyolysis ; Seizures ; Shock ; Skin

Esophageal perforation is a rare disease, which require emergent diagnosis and therapeutic procedure. In this paper, we present one case of esophageal perforation by traction of toothbrush which was swallowed during pharyngeal irritation. After the toothbrush was inserted to stomach by gastroscope, gastrostomy was performed for removal of toothbrush and the esophageal perforation was repaired by operation.
Diagnosis ; Esophageal Perforation* ; Gastroscopes ; Gastrostomy ; Rare Diseases ; Stomach ; Traction

No abstract available.
Population Characteristics* ; Thyroid Gland* ; Thyroiditis*

PURPOSE: The aim of this study was to analyze factors affecting success of endotracheal intubation (ETI) in emergency department (ED) patients, and to investigate usefulness of expected difficult direct laryngoscopy for expectation of a bad Glidescope(R) view. METHODS: ETI data using Glidescope(R) were collected at two EDs over a period of 64 months. We accessed intubator's training level, expected difficulty with laryngoscopy, method, and glottis exposure grade. Based on these variables, we analyzed the intubation success rates. And we examined the correlation between glottis exposure grade using Glidescope(R) and factors for expectation of difficult direct laryngoscopy. RESULTS: A total of 613 ETIs attempts using Glidecope(R) were recorded. The overall success rate was 83.4%. In logistic regression analysis, expected difficult laryngoscopy, intubator's training level, and glottic exposure grade were independent predictive factors for successful ETI using Glidescope(R). The Cormack-Lehane grade I via Glidescope(R) was observed in 89.1% of total ETI attempts. In subgroup analysis, bad glottis exposure status showed a significantly low success rate irrespective of intubator's training level. Among the predicting factors for difficult laryngoscopy, morbid obesity, limited neck extension, and limited mouth opening showed an association with the degree of glottic exposure via Glidescope(R). CONCLUSION: The glottic exposure grade was the most important factor related to successful ETI using Glidescope(R). Morbid obesity, limited neck extension, and limited mouth opening showed a significant association with bad glottis exposure under Glidescope(R), Therefore, we need to identify these findings. Even if in good glottis view, junior physicians showed a lower rate of ETI success using Glidescope, therefore, measurements to improve the ability of junior physicians should be implemented.
Emergencies ; Glottis ; Humans ; Intubation ; Intubation, Intratracheal ; Laryngoscopes ; Laryngoscopy ; Logistic Models ; Medical Staff, Hospital ; Mouth ; Neck ; Obesity, Morbid

PURPOSE: The aims of this study were to evaluate the clinical manifestations and prognosis of the syndromic and nonsyndromic intrahepatic bile duct paucity (IHBDP). METHODS: We studied histology of 42 infants with neonatal cholestasis. Fourteen patients were diagnosed as IHBDP. We evaluated the clinical manifestations, courses and prognosis retrospectively. RESULTS: Underlying disease of the 42 infants with neonatal cholestasis were biliary atresia in 23, intrahepatic bile duct paucity in 14 (Alagille syndrome in 4 and nonsyndromic IHBDP in 10), neonatal hepatitis in 5 infants. The mean ratio of the bile ducts per portal tract was 0.087 (range: 0~0.5). The manifestations in 4 patients with Alagille syndrome demonstrated as follows: characteristic face in 3, chronic cholestasis in 4, posterior embryotoxon in 2, vertebral anomalies in 2, peripheral pulmonary stenosis in 2. One of 4 patients of Alagille syndrome improved cholestasis and the other 3 patients were remained their cholestasis and growth retardation. All patients of the nonsyndromic IHBDP were idiopathic. Seven out of 8 patients of nonsyndromic IHBDP showed improvement of cholestasis, and one patient received liver transplantation due to cirrhosis. CONCLUSION: This study suggested that IHBDP should be considered in the differential diagnosis of neonatal cholestasis. The outcome of idiopathic IHBDP was better than predicted.
Alagille Syndrome ; Bile Ducts ; Bile Ducts, Intrahepatic* ; Biliary Atresia ; Cholestasis ; Diagnosis, Differential ; Fibrosis ; Hepatitis ; Humans ; Infant ; Liver Transplantation ; Prognosis ; Pulmonary Valve Stenosis ; Retrospective Studies

BACKGROUND: The authors of this study wanted to confirm the prognostic implication of the histologic subtype; further, we wanted to explore the expression of phosphorylated extracellular signal-regulated kinase 1/2 (pERK) in papillary renal cell carcinoma (PRCC) and determine its clinicopathologic and prognostic significance. METHODS: A total of 45 patients who underwent nephrectomy for PRCC were enrolled in this study. The hematoxylin and eosin slides were reviewed and pERK immunohistochemistry was performed. RESULTS: Type 2 PRCC was significantly correlated with a larger tumor size (p=0.030), a higher nuclear grade (p<0.001), a more advanced tumor stage (p=0.041) and more frequent distant metastasis (p=0.019). The tumors were pERK-low (0 and 1+) in 30 cases (66.7%) and pERK-high (2+) in 15 cases (33.3%). The pERK-high PRCC was significantly associated with a smaller tumor size (p=0.001) and an earlier tumor stage (p=0.004). On the univariate analysis, the histologic subtype, the TNM stage and the pERK status were significantly associated with progression-free survival (PFS). Multivariate analysis showed that the histologic subtype (hazard ratio 22.81, p=0.042) and the TNM stage (hazard ratio 23.48, p=0.009) were independent prognostic factors for PFS. CONCLUSIONS: Type 2 PRCC, together with the TNM stage, was identified as one of independent poor prognostic factors for PFS. The pERK status was a prognostic factor for PFS on the univariate analysis, but not on the multivariate analysis.
Neoplasm Metastasis

Peripheral nerve sheath tumors (PNSTs) are heterogeneous tumor groups of peripheral nerves that originate from either Schwann cells or modified Schwann cells, fibroblasts, or perineural cells. In this study, signalment and clinical data such as tumor location and size were evaluated for 15 cases of PNSTs collected from local animal hospitals. The mean age of dogs with malignant PNST was higher than that of dogs with benign PNST. Additionally, the male to female ratio in dogs with PNST was 1 : 4. In dogs with PNST, the primary sites of involvement were the hindlimb, forelimb, around the mammary glands, the neck, and the abdomen. Histiopathologic examination revealed that eight PNSTs were benign and seven were malignant. The tumor cells were composed of loosely to densely arranged interlacing bundles and wavy spindle cells arranged in short bundles, palisading, and whirling. High mitotic figures, local invasion, multifocal necrosis and atypical multinucleated giant cells were observed in malignant PNST cases. All PNSTs showed immunoreactivity for vimentin and S-100. However, only 93.3% and 73.3% were immunoreactive for NSE and GFAP, respectively. Overall, these results indicated that immunohistochemical markers such as vimentin, S-100 and NSE could help confirm the diagnosis of canine PNSTs.
Abdomen ; Animals ; Diagnosis ; Dogs* ; Female ; Fibroblasts ; Forelimb ; Giant Cells ; Hindlimb ; Hospitals, Animal ; Humans ; Immunohistochemistry ; Male ; Mammary Glands, Human ; Neck ; Necrosis ; Nerve Sheath Neoplasms* ; Peripheral Nerves* ; Schwann Cells ; Vimentin

PURPOSE: To determine the histopathologic changes occurring in normal pig organs after percutaneous injection of hot saline. MATERIALS AND METHODS: Under sonographic guidance, the livers, the gallbladders, kidneys, stomachs, and lungs of ten pigs weighing 15-20kg were punctured with a fine needle. Physiologic saline mixed with contrast medium and Lipiodol was heated to 100 degreeC and injected under fluoroscopic guidance. One to four weeks after injection, the animals were sacrificed and histopathologic examination was performed to investigate acute and chronic tissue responses. RESULTS: In all organs, coagulation necroses developed during the acute phase. Histopathologic changes observed four weeks after injection were as follows: in the liver, most damage was restored, though central necrosis persisted; in the kidney, parenchymal and uroepithelial damage fully recovered, and in the gallbladder and stomach, superficially located damage also fully recovered. In the lung, however, extensive pneumonic infiltration developed during the chronic phase. Fluoroscpoic examination revealed that saline in the liver or kidneys tended to leak easily into blood vessels, the bile duct, or ureter, and corresponding regions showed mild to moderate damage during the acute phase which fully recovered in the chronic phase. CONCLUSION: In normal pigs, significant chronic damage after the injection of hot saline mixture occurred only in the lungs.
Animals ; Bile Ducts ; Blood Vessels ; Ethiodized Oil ; Gallbladder ; Hot Temperature ; Kidney ; Liver ; Lung ; Necrosis ; Needles ; Stomach ; Swine* ; Ultrasonography ; Ureter

PURPOSE: This study was performed to improve cardiopulmonary resuscitation(CPR) training strategies for occupational groups, through the analysis of first responders' characteristics, knowledge and attitudes concerning CPR. METHODS: The occupational groups expected to have some training on rescue and emergency care in Korea were regarded as the first responders. In particular, this study focused on nurse-teachers, traffic policemen, and industrial safety supervisors, taxi drivers and restaurant workers as potential first responders, clerical workers comprised the control group. The subjects were given a questionnaire to answer over the internet. RESULTS: First responders' knowledge on CPR was significantly higher than that of the control group. First responders' attitude on CPR was more affirmative compared with the control group. In first responder group, nurse-teachers, traffic policemen and industrial safety supervisors had a higher fund of knowledge and more positive attitudes when compared to taxi drivers and restaurant workers. CONCLUSION: More training for first responders in CPR and emergency care is required given the likelihood of medical emergencies arising while on duty. Taxi drivers and restaurant workers' knowledge on CPR were found to be inadequate based on our survey questionnaire. Thus, it is necessary to strengthen CPR training for these individuals and groups.
Cardiopulmonary Resuscitation* ; Emergencies ; Emergency Medical Services ; Financial Management ; Humans ; Internet ; Korea ; Occupational Groups ; Surveys and Questionnaires ; Restaurants