There has been a worldwide pandemic infection of influenza A (H1N1) since June 2009. A 23-year-old female presented with fever and sore throat and was diagnosed as having influenza A (H1N1) infection. After 2 days of illness, she had headache, nausea, and neck stiffness. Cerebrospinal-fluid findings were consistent with viral infection, and brain MRI revealed intense signals in both frontotemporal cortices. During her illness she developed repetitive seizures, which were considered to be status epilepticus.
Brain ; Encephalitis ; Encephalitis, Viral ; Female ; Fever ; Headache ; Humans ; Influenza, Human ; Nausea ; Neck ; Pandemics ; Pharyngitis ; Seizures ; Status Epilepticus ; Young Adult

Adrenal myelolipomas are rare, benign tumors cornposed of mature fat and bone marrow elements. Most are small, asymptomatic tumors found incidentally at postmortem examination, Fine needle aspiration biopsy can be used to confirm the diagnosis and avoid an unnecessary operation. We report a case of adrenal myelolipoma confirmed by fine needle aspiration biopsy. A 77-year-old woman with complaining of upper abdominal pain for 2 days was found to have an adrenal mass. She took dexamethasone frequently for 3 years due to multiple arthralgia. Ultrasono-graphy showed a 6cm-sized, suprarenal mass and a stone in the gall bladder with thickened wall. Computed tomography and magnetic resonance imaging scan also presented a suprarenal mass. Endocrinologic results were within normal limits. Adrenal myelolipoma was confirmed by computed tomography-guided fine needle aspiration biopsy without surgery.
Abdominal Pain ; Aged ; Arthralgia ; Autopsy ; Biopsy ; Biopsy, Fine-Needle ; Biopsy, Needle* ; Bone Marrow ; Dexamethasone ; Diagnosis ; Female ; Humans ; Magnetic Resonance Imaging ; Myelolipoma* ; Urinary Bladder

PURPOSE: Spontaneous Intracranial Hypotension (SIH) is rare condition and may accompany other clinical symptoms which inhibit accurate diagnosis in an emergency department (ER). Only a few studies have reported the clinical characteristics and root causes associated with SIH. This study evaluates the rate of accuracy of SIH diagnosis and compares clinical characteristics and diagnostic test results for correct versus incorrect diagnosis groups. METHODS: Medical records of SIH patients admitted to an emergency department (ER) over a twelve year period were retrospectively reviewed. Patients were grouped as having received correct or incorrect diagnosis, and their clinical characteristics and diagnostic test results were compared. In the incorrect diagnosis group, the number of times they were misdiagnosed, and the specialties of the clinic (s) they visited prior to arrival at this ER were reviewed. RESULTS: Adhering to the inclusion criteria of our study, 72 patients were enrolled with 54 patients in the correct diagnosis group and 18 patients in the incorrect diagnosis group. Of the twenty one cases in the incorrect diagnosis group, the majority 7 cases (33.3%) had been examined by an emergency physician. Among the clinical symptoms observed, there was significant variability in the location of the headache (p=0.020) and time interval between symptom onset and diagnosis (p=0.035). CONCLUSION: There were no differences in most of the clinical observations and diagnostic test results between the correct and incorrect diagnosis groups. To improve the correct diagnosis rate, it is suggested to have 'SIH' included as a differential diagnosis when encountering patients reporting headache in the emergency department. Emergency physicians should be required to recognize clinical SIH characteristics such as orthostatic headache.
Diagnosis, Differential ; Diagnostic Errors ; Diagnostic Tests, Routine ; Emergencies ; Headache ; Humans ; Intracranial Hypotension ; Medical Records ; Retrospective Studies

Gastric tuberculosis is a rare disease and is usually secondary to pulmonary or intestinal tuberculosis. Only a few cases of gastric tuberculosis have been reported in the literature. In most cases, gastric tuberculosis exists as an ulcerating lesion, whereby the clinical symptom is non-specific and similar to that of a peptic ulcer. The diagnosis af gastric tuberculosis is based on either positive histological or bacteriological study. Submucasal tumors resembling gastric tuberculosis has been reported extremely rare in incidence. In this study we report a case of a young woman admitted with intermittent abdominal pain due to gastric tuberculosis presenting as submucosal tumor in the greater curvature of the lower body. After gastric resection, a histological examination revealed chronic granulomatous inflammation with caseation necrosis which is consistent with tuberculosis. There was no evidence of the tuberculous lesion anywhere else. The patient was put on antituberculosis medications. The patient's follow-up observation in the clinic was uneventful.
Abdominal Pain ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Incidence ; Inflammation ; Necrosis ; Peptic Ulcer ; Rare Diseases ; Tuberculosis* ; Ulcer

Follicular variant papillary thyroid cancer (FVPTC) is the second most common subtype after conventional PTC. We compared ultrasonographic (US) features of FVPTC to those of conventional PTC according to tumor size. We reviewed US findings, pathologic reports, and medical charts of 249 PTC patients with surgically proven disease (83 FVPTCs, 166 conventional PTCs) at our institution from January 2007 to December 2012. FVPTCs were divided into PTC-like and follicular neoplasm (FN)-like based on sonographic characteristics. PTC-like features were defined as having at least one malignant feature (taller-than-wide shape, infiltrative margin, marked hypoechogenicity, and micro-calcifications), whereas FN-like cancers showed oval solid features without malignant features. FVPTCs showed a higher rate of FN-like features than conventional PTCs. Of 166 conventional PTCs, 13 (7.8%) had FN-like features and 153 (92.2%) had PTC-like features, whereas of the 83 FVPTCs, 31 (37.3%) had FN-like features and 52 (62.7%) had PTC-like features. Macro-FVPTCs showed a higher rate of FN-like features than micro-FVPTCs (P < 0.001). Of 21 macro-FVPTCs, 18 (85.7%) had FN-like features and 3 (14.3%) had PTC-like features, whereas of the 62 micro-FVPTCs, 13 (21%) had FN-like features and 49 (79%) had PTC-like features. There were no differences in multifocality, extrathyroidal invasion, and lymph node metastasis between PTC-like FVPTCs and FN-like FVPTCs. FVPTCs showed fewer sonographic malignant features than conventional PTCs. In particular, FVPTCs larger than 1 cm had a more frequent benign sonographic appearance. Therefore, if fine-needle aspiration result is suspicious for PTC in a nodule larger than 1 cm with no suspicious US features, the possibility of FVPTC might be considered.
Adult ; Carcinoma, Papillary, Follicular/*diagnostic imaging/pathology ; Demography ; Female ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Thyroid Neoplasms/*diagnostic imaging/pathology ; *Ultrasonography

PURPOSE: To compare outcomes of humeral shaft fractures fixed with locking compression plate and those fixed with dynamic compression plate in elderly patients. MATERIALS AND METHODS: Nineteen consecutive elderly patients with a fracture of the humeral diaphysis were evaluated retrospectively. Ten patients had been fixed with LC-DCP, and nine had been fixed with LCP. Radiological and clinical results were compared and comparison of implants was done. RESULTS: Loosening of the plate occurred in one case each from the LCP group and the LC-DCP group. The rest of the patients achieved union uneventfully without any complications. Union rate, clinical score and hardware were not significantly different between the two groups. One patient who developed loosening in the LC DCP underwent reoperation whereas one patient with loosening in the LCP was successfully managed conservatively. CONCLUSION: Principle of fracture fixation was more important than plate selection in humeral shaft fracture of elderly patient.
Aged* ; Diaphyses ; Fracture Fixation ; Humans ; Humerus ; Osteoporosis ; Reoperation ; Retrospective Studies

A case of gastric anisakiasis due to the larva of Pseudoterranova decipiences was con- firmed by a gastroendoscopic examination. A long whitish nematode larva invading the stomach wall (fundus) was discovered and was extracted using biopsy forceps after 3 days to the onset of symptoms. The worm was 42.6 X 1.1 mm size, and was identified as being a the 4th stage larva of P. decipiens, based upon its morphological characteristics, The patient, residing in Seoul, was a 51-year-old housewife, who complained of severe epi- gastric pain and recalled that she had previously eaten the raw flesh of an Astroconger myriaster in a Japanese restaurant (sushi Bar). This study probably emerges as the 7th human case of gastric anisakiasis of pseudoterranoviasis in Korea.
Anisakiasis ; Asian Continental Ancestry Group ; Biopsy ; Humans* ; Korea ; Larva* ; Middle Aged ; Restaurants ; Seoul ; Stomach ; Surgical Instruments

PURPOSE: The results of Sugioka's transtrochanteric rotational osteotomy are controversial. While many Japanese studies have reported favorable results, European and American studies have been disappointing. We present the results of Sugioka's rotational osteotomy for extensive osteonecrosis of the femoral head in young patients. METHODS AND MATERIALS: Between April. 1994 and May. 2004, Sugioka's osteotomy was performed for osteonecrosis involving a large part of the weight bearing area on 49 hips (46 patients). Of these 49 hips, 45 (43 patients) were available for follow-up. The patients were followed up for at least 2 years with an average of 52 months (range: 24-132 months). The major causes of osteonecrosis were chronic alcohol abuse in 33 hips. The mean age of the patients at the time of surgery was 31 years (range: 21-46), and the male to female ratio was 39:6. Six, 17 and 22 hips were classified as stage IIA, IIb and III using the Ficat and Alert classification, respectively. RESULTS: Thirty three of the 45 hips (74%) survived clinically and radiologically. Of these, the clinical results were excellent, good and fair in 15, 12 and 6 hips, respectively. Major complications were encountered in 12 hips [Progressive severe varus deformity in 7 hips (15%)], femur neck fracture in 3 hips (6%) and deep infection in 2 hips (4%). Among these 12 hips, seven hips (15%) required secondary THA. Five other hips (11%) were also subsequently converted to THA due to progressive collapse of the femoral head after the transtrochanteric osteotomy. CONCLUSION: Transtrochanteric osteotomy can be used to treat osteonecrosis of the femoral head in young patients with extensive necrotic lesions of the femoral head. However, Sugioka osteotomy should be used with caution due to its high incidence of complications.
Alcoholism ; Asian Continental Ancestry Group ; Congenital Abnormalities ; Female ; Femoral Neck Fractures ; Follow-Up Studies ; Head ; Hip ; Hip Joint ; Humans ; Incidence ; Male ; Osteonecrosis ; Osteotomy ; Tacrine ; Weight-Bearing

PURPOSE: This study analysed the incidence and the degree of an acetabular retroversion in a dysplastic hip. MATERIALS AND METHODS: 28 cases of dysplastic hips, in whom the CE angle was <20 degrees, and 20 cases of control group with a normal CE angle were enrolled in this study. Four cuts among the CT images (most superior cut of the femoral head, middle cut of the proximal half, middle portion, and middle cut of the distal half of the femoral head) were used to measure the acetabular anteversion. RESULTS: In the control group, anteversion of four cuts (form the cranial to caudal) were observed with an average of 4.1, 10.3, 16.5, 19.7degrees, and there was one case with a retroversion. In the dysplastic hips, the average anteversion angles were 4.4, 11.0, 17.9, 20.8degrees, and 9 cases with retroversion were discovered. In all cases showing retroversion, an overlapping of the acetabular anterior and posterior wall (cross-over sign) was observed on the simple pelvis AP radiography. CONCLUSION: There was a 32% incidence of acetabular retroversion, which was much higher than the control group (p<0.05). Therefore, in order to prevent an over-correction of the retroversion, which may cause impingement, the presence and the amount of retroversion must be recognized using CT before performing a periacetabular osteotomy.
Acetabulum* ; Head ; Hip* ; Incidence* ; Osteotomy ; Pelvis ; Radiography

Background: It is well known that a large number of patients with diabetes also have dyslipidemia, which significantly increases the risk of cardiovascular disease (CVD). This study aimed to evaluate the efficacy and safety of combination drugs consisting of metformin and atorvastatin, widely used as therapeutic agents for diabetes and dyslipidemia. Methods: This randomized, double-blind, placebo-controlled, parallel-group and phase III multicenter study included adults with glycosylated hemoglobin (HbA1c) levels >7.0% and <10.0%, low-density lipoprotein cholesterol (LDL-C) >100 and <250 mg/dL. One hundred eighty-five eligible subjects were randomized to the combination group (metformin+atorvastatin), metformin group (metformin+atorvastatin placebo), and atorvastatin group (atorvastatin+metformin placebo). The primary efficacy endpoints were the percent changes in HbA1c and LDL-C levels from baseline at the end of the treatment. Results: After 16 weeks of treatment compared to baseline, HbA1c showed a significant difference of 0.94% compared to the atorvastatin group in the combination group (0.35% vs. −0.58%, respectively; P<0.0001), whereas the proportion of patients with increased HbA1c was also 62% and 15%, respectively, showing a significant difference (P<0.001). The combination group also showed a significant decrease in LDL-C levels compared to the metformin group (−55.20% vs. −7.69%, P<0.001) without previously unknown adverse drug events. Conclusion The addition of atorvastatin to metformin improved HbA1c and LDL-C levels to a significant extent compared to metformin or atorvastatin alone in diabetes and dyslipidemia patients. This study also suggested metformin’s preventive effect on the glucose-elevating potential of atorvastatin in patients with type 2 diabetes mellitus and dyslipidemia, insufficiently controlled with exercise and diet. Metformin and atorvastatin combination might be an effective treatment in reducing the CVD risk in patients with both diabetes and dyslipidemia because of its lowering effect on LDL-C and glucose.