Microscopic polyangiitis is a systemic small-vessel vasculitis, which may involve multiple organs, but cardiac involvement is relatively rare. We report a case of microscopic polyangiitis with multiple organ involvement, in which myocardial infarction was the early manifestation of the disease. A 53-year-old man presented with sudden papulovesicular eruptions and swellings on the face, posterior neck, dorsa of both hands and fingers, and with diffuse erythematous patches on the back. He had suffered from renal dysfunction, arthralgia, and hypertension for more than 8 years. He had been admitted to the department of cardiology for acute myocardial infarction and had suffered from recurrent gastrointestinal bleeding, renal failure, acute pancreatitis and sepsis during the admission. Histopathologically, small-vessel leukocytoclastic vasculitis with out granuloma was seen. Direct immunofluorescence showed no immune deposite. A high serum level of P-ANCA was detected by ELISA.
Acute Kidney Injury ; Antibodies, Antineutrophil Cytoplasmic ; Arthralgia ; Cardiology ; Enzyme-Linked Immunosorbent Assay ; Fingers ; Fluorescent Antibody Technique, Direct ; Granuloma ; Hand ; Hemorrhage ; Humans ; Hypertension ; Microscopic Polyangiitis* ; Middle Aged ; Myocardial Infarction* ; Neck ; Pancreatitis ; Sepsis ; Vasculitis

Malignant fibrous histiocytoma (MFH) of the liver is uncommon, representing less than 1% of the primary malignant lesions of the liver. We report primary MFH of the liver in a 59-year-old woman. The tumor, measuring 9.0 9.0 6.0 cm, was located in the left lobe of the liver. It showed multiple areas of hemorrhage and necrosis. Microscopically, the tumor consisted of plump spindle cells haphazardly arranged in short fascicle and focal storiform pattern. Multiple bizarre giant cells were also noted. Immunohistochemically, many of the tumor cells were positive for vimentin and alpha1-antitrypsin but negative for epithelial markers. Ultrastructurally, the tumor cells showed fibroblastic and histiocytic features.
Female ; Fibroblasts ; Giant Cells ; Hemorrhage ; Histiocytoma, Malignant Fibrous* ; Humans ; Liver* ; Microscopy, Electron ; Middle Aged ; Necrosis ; Vimentin

OBJECTIVES: Our aims of this study is to analyze the clinical characteristics and the prognos is of the disease which develops in patient swith chronic liver disease as acutely exacerbated hepat it is accompanied by myosit is. Finally we try to identify and is olate the causative agent. METHODS: The patient swith chronic liver diseases, who developed muscle weakness and paralysis, were classified to group A or group B, according to the level of creatinine kinase ( CK) activity. The group A consists of patients with less than 3-fold increase of normal CK activity and the group B includes patients with over 3-fold increase of it. We evaluated clinical characteristics, blood chemistry, clinical course, and causes of deathin patients of study groups, compared with those of patients with chronic liver disease with normal CK activity as controls. The causative agent was suggested by conventional culture and RT-PCR analysis in two cases of group B. RESULTS: 1. There was no significant differences in age, sex, underlying disease, or liver function test bet ween control and study group ( control and group A or B) before entry. 2. The clinical symptoms and signs , such as drowsy mental state, generalized weakness/myalgia caused by hepatic encephalopathy and myositis , occurred frequently in the study group. 3. Significant elevation of aspartic acid transaminase (AST ) and alaninetr ans aminase ( ALT ) was noted in Group B. AST / ALT ratio is over 2 in group A or B. Synthetic function of the liver such as prothrombin time ( PT ) or serum albumin level is significantly decreased. Blood urea nitrogen ( BUN) and creatinine were increased as a result of impaired renal function. 4. Culture of coxs ackievirus was positive by immunofluor escence as say IFA) as a caus ative agent and also was positive in reverse transcription-polymerase chain reaction (RT-PCR) analys is using universal primer of enterovirus in two recent cases of group B. 5. Death rate increased significantly in study group, compared with that of control group ( 20.7% versus 5.6%). Major cause of death, 12 patients died of which, is hepatic failure. CONCLUSION: The patients with chronic liver disease abruptly developed a exacerbated hepaticdys function and muscle paralysis and/or weakness. This exacerbated hepatitis accompanied by myositis was suggested to be caused by coxsackie B viral infection. Furthermore, this infection increase deathrate and resulted in poor prognosis. Thus, further study should be continue to confirm the causative agent and classify the subtype.
Aspartic Acid ; Blood Urea Nitrogen ; Cause of Death ; Chemistry, Clinical ; Creatinine ; Enterovirus ; Hepatic Encephalopathy ; Hepatitis* ; Humans ; Liver Diseases* ; Liver Failure ; Liver Function Tests ; Liver* ; Mortality ; Muscle Weakness ; Myositis* ; Paralysis ; Phosphotransferases ; Prognosis ; Prothrombin Time ; Serum Albumin

The technique of radial artery cannulation and its complications are well documented, but serious complications are rare. This is a report of one case of amputation of wrist due to finger necrosis developed from the radial artery cannulation in patient who had craniectomy surgery. This 52-year-old 79 kg male underwent subdural hematoma removal surgery. Right radial artery cannulation was carried out percutaneously using 22 gauge Teflon extracath needle after modified Allen's test appeared to be positive. It was intermittently flushed by heparinized solution. His arterial blood pressure was maintained 100/70-110/80 mmHg and 5 units of banked whole blood and 1 unit of fresh frozen plasma were transfused during 8-hours operation. Cannula was removed on the 9th hour after operation because that was obstructed. On the 12th hour after removal of cannula, his right hand noted to be cool and cyanotic. So, warm towel and hot bag applied continuously on the right hand and the right stellate ganglion block was carried out every day for 4 times. However, on the 10th day after removal of cannula, necrotic change of all fingers of the right hand became worse and skin of fingers were shrunken. Therefore, disarticulation of the right wrist carried out on the 71th day of his hospitalization.
Amputation* ; Arterial Pressure ; Catheterization* ; Catheters ; Disarticulation ; Extremities* ; Fingers ; Hand ; Hematoma, Subdural ; Heparin ; Hospitalization ; Humans ; Male ; Middle Aged ; Necrosis ; Needles ; Plasma ; Polytetrafluoroethylene ; Radial Artery* ; Skin ; Stellate Ganglion ; Wrist

Benign hemangioma of the mediastinum is rare. This slowly growing tumor is described as well circumscribed, cystic, hemorrhagic tumor. Histologically it can be differentiated into capillary or cavernous form. We present a case of mediastinal hemangioma. A 20-year-old-man was presented with a slowly growing posterior mediastinal mass of 6 years duration, 8x6 cm in size. The mass was relatively well defined but focally invasive. Microscopically, it was differentiated into vessels of capillary, cavernous, and venous patterns. A solid cellular proliferation with inconspicuous capillary lumens was focally seen. The stroma between variable-sized vessels showed marked myxoid change associated with some smooth muscle bundles and adipose tissue. Ultrastructurally, areas of solid cellular proliferation showed formation of lumens. These lumens were lined by active endothelial cells showing plasmalemmal vesicles and Weibel-Palade bodies on the abluminal surface.
Adipose Tissue ; Capillaries ; Cell Proliferation ; Endothelial Cells ; Hemangioma* ; Mediastinum ; Muscle, Smooth ; Weibel-Palade Bodies

Lidocaline if frequently administered as a component of an anesthetic : for local or regional nerve blocks, to mitigate the autonomic response to laryngoscopy and tracheal intubation, to suppress the cough reflex, and for antiarrythmic therapy. Diazepam dectease the potential central nervous system (CNS) toxicity of local anesthetic agents but -may modify the sitmulant action of lidocaine in addition to their own cardiovascular depressant. The potential cardiovascular toxicity of local anesthetics may be enhanced by the concomitant administration of diazepam. This study was designed to investigate the effects of lidocaine dose and pretreated diazepam to cardiovascular system and plasma concentration of lidocaine. Lidocaine in 100 mcg/kg/min, 200 mcg/kg/min, and 300 mcg/kg/min was given by sequential infusion to dogs anesthetized with halothane-nitrous oxide (Group I). And in group II, after diazepam pretreatment, lidocaine was infused by same way when lidocaine was administered in 100 mcg/kg/min, the low plasma levels (3.97+/-0.22-4.48+/-0.36 mcg/ml) caused a little reduction in cardiovascular hemodynamics. As administered in 200 mcg/kg/min, 300 mcg/kg/min, the higher plasma levels (7.50+/-0.66-11.83+/-0.59 mcg/ml) reduced mean arterial pressure (MAP), cardiac index (CI), stroke index (SI), left ventricular stroke work index (LVSWI), and right ventricular stroke work index (PVSWI) and incresed pulmonary artery wedge pressure (PAWP), central venous pressure (CVP), systemic vascular resistance index (SVRI), but was assciated with little changes of heart rate (HR), mean pulmonary artery pressure (MPAP), and pulmonary vascular resistance index (PVM). When lidocaine with pretreated diazepam was administered in 100 mcg/kg/min, the low plasma level, the lower level than when only lidocaine administered. reduced MAP, but was not changed other cardiovascular hemodynamics. While lidocaine was infused in 200 mcg/kg/min, 300 mcg/kg/min in dogs pretreated diazepam, the higher plasma level (7.64+/-0.79-13.79+/-0.82 mcg/ml) was maintained and was associated with reduced CI, SI, LVSWI and incresed PAWP, CVP, SVRI but was a little changes of HR, MPAP, PVRI. After CaCl2 administeration, CI, SI, SVRI, LVSWI was recovered but PAWP, UP was rather incresed than recovered. The foregoing results demonstrate that pretreated diazepam imposes no additional burden on cardiovascular system when a infusion of large dose of lidocaine is given to dogs anesthetized with halothanenitrous oxide. But caution may be advised if the addition of lidocaine is indicated in subjects who have impared autonomic nervous system and who are in hypercarbic, hypoxic, or acidotic states.
Anesthetics ; Anesthetics, Local ; Animals ; Arterial Pressure ; Autonomic Nervous System ; Cardiovascular System* ; Central Nervous System ; Central Venous Pressure ; Cough ; Diazepam* ; Dogs* ; Heart Rate ; Hemodynamics ; Intubation ; Laryngoscopy ; Lidocaine* ; Nerve Block ; Plasma* ; Pulmonary Artery ; Pulmonary Wedge Pressure ; Reflex ; Stroke ; Vascular Resistance

The purpose of this study is to verify severity of asthma in asthmatic patients through through the arterial blood gas analysis. Subjects were consisted of 103 patients (74 boys and 29 girls), between 2~13 years of ages. Clinically, asthmatic patients were classified into 6 groups, i, e., group 0(no rhonchi), group 1(rhonchi only), group 2(mild attack), group 3(moderate attack), group 4(severe attack), group 5(respiratory failure with disturbance of consciousness). PH kept normal range in the group 0, group 1, group 1 and group 3,but began decrease in the group 4.There was linear fall in Po2 and began decrease in the group 3. HCO3- maintained normal level through the whole range. BE showed acidemia on the whole, and began distinctive decrease in the group 4 and group 5, especially. Hypoxemia, hypercapnia and acidemia were common in patients in severe attacks with disturbance of consciousness.
Anoxia ; Asthma ; Blood Gas Analysis* ; Child* ; Consciousness ; Humans ; Hydrogen-Ion Concentration ; Hypercapnia ; Reference Values

The National Forensic Hospital is the only forensic psychiatric hospital in Korea. As of January 2016, the average number of patients assigned to each psychiatrist is more than 120. In this situation, the role of psychopharmacologic treatment becomes very important. To investigate the prescription patterns of major psychotropic medications (i.e., antipsychotics, mood stabilizers, and antidepressants), we reviewed the medical records of the patients diagnosed with schizophrenia and schizoaffective disorder who were admitted in January 2016. The data from 418 patients (403 with schizophrenia and 15 with schizoaffective disorder) were retrospectively collected and analyzed. The average number of major psychotropic medications prescribed for each patient during hospitalization was as follows: antipsychotics, 3.5±1.8; mood stabilizers, 0.5±0.7; and antidepressants, 0.5±0.8. The three most frequently prescribed antipsychotics were risperidone (21.7%), olanzapine (15.5%), and quetiapine (14.4%). More than half of the patients (233, 55.9%) were prescribed an antipsychotic polypharmacy regimen. This study found that patients with schizophrenia and schizoaffective disorder in forensic psychiatric hospital tend to be prescribed many psychotropic medications.
Antidepressive Agents ; Antipsychotic Agents ; Forensic Psychiatry ; Hospitalization ; Hospitals, Psychiatric ; Humans ; Inpatients* ; Korea ; Medical Records ; Polypharmacy ; Prescriptions ; Psychiatry ; Psychopharmacology ; Psychotic Disorders* ; Quetiapine Fumarate ; Retrospective Studies ; Risperidone ; Schizophrenia*

PURPOSE: The purposes of this article are to identify CT findings distinguishing nasal polyps, that are the most common cause of the nasal polypiod lesions, from other nasal cavity masses and to identify differential points between benign and malignant masses of nasal cavity. MATERIALS AND METHODS: We classified 567 cases of pathologically proved nasal cavity masses into 4 different groups on CT according to the sites of origin and surrounding bone changes. RESULT: The nasal polyps were the most common cause of nasal cavity masses(515/567). Group I had a high diagnostic specificity for the nasal polyps (513/515, 99.6%) although inverted papilloma (8/522) and malignant melanoma(1/522) showed similar CT appearances. The representitive nasal mass of Group Ila was the inverted papilloma (15/24, 66.5% of the inverted papilloma). Group III pattern was seen in 3 cases of benign minor salivary gland tumor and 2 cases of pyogenic granuloma. Group IV suggested malignancy and thus was mostly observed in malignant tumors except I case of inverted papilloma and 1 case of granulomatous necrosis. CONCLUSION: The differential diagnosis between nasal polyps and the other nasal cavity masses is possible by characteristic bone changes and their sites of origin revealed on CT. In addition, it is possible to differentiate malignant masses from benign in most cases.
Diagnosis, Differential* ; Granuloma, Pyogenic ; Nasal Cavity* ; Nasal Polyps* ; Necrosis ; Papilloma, Inverted ; Salivary Glands, Minor ; Sensitivity and Specificity

Chronic hepatitis associated with the idiopathic hypereosinophilic syndrome has been very rarely reported worldwide. Recently, we experienced a case of chronic hepatitis with piecemeal necrosis as the clinical feature of the idiopathic hypereosinophilic syndrome. The patient was a 49-year-old woman who complained of a mild fever, nausea, vomiting, and pain in the right upper quadrant. The eosinophil count of peripheral blood increased up to 14,020/microliter (64% of WBC). Liver biopsy specimen showed severe porto-periportal inflammation with marked eosinophilic infiltration and ballooning degeneration of hepatocytes. Corticosteroid therapy significantly normalized the eosinophil count of peripheral blood.
Biopsy ; Eosinophils ; Female ; Fever ; Hepatitis, Chronic* ; Hepatocytes ; Humans ; Hypereosinophilic Syndrome* ; Inflammation ; Liver ; Middle Aged ; Nausea ; Necrosis ; Vomiting