Sarcoidosis is a systemic disease of unknown etiology that may affect any organ in the body. The nervous system is involved in 5-16% of cases of sarcoidosis. Here, we report a case of intramedullary sarcoidosis presenting with delayed spinal cord swelling after laminoplasty for the treatment of compressive cervical myelopathy. A 56-year-old woman was admitted to our hospital complaining of upper extremity pain and gait disturbance. The patient had undergone laminoplasty for compressive cervical myelopathy 3 months previously. Follow-up magnetic resonance imaging revealed a large solitary intramedullary lesion with associated extensive cord swelling, signal changes, and heterogeneous enhancement of spinal cord from C2 to C7. Spinal cord biopsy revealed non-necrotizing granulomas with signs of chronic inflammation. The final diagnosis of sarcoidosis was based upon laboratory data, imaging findings, histological findings, and the exclusion of other diagnoses. Awareness of such presentations and a high degree of suspicion of sarcoidosis may help arrive at the correct diagnosis.
Biopsy ; Diagnosis ; Female ; Follow-Up Studies ; Gait ; Granuloma ; Humans ; Inflammation ; Magnetic Resonance Imaging ; Middle Aged ; Nervous System ; Sarcoidosis* ; Spinal Cord Diseases* ; Spinal Cord* ; Upper Extremity

PURPOSE: In 2000, the American Heart Association and International Liaison Committee on Resuscitation published guidelines for CPR (Cardiopulmonary Resuscitation), and these guidelines were revised in 2005. Many physicians perform CPR differently than suggested by these guidelines. We investigated guideline conformation rates for CPR by non-emergency physicians. METHODS: From January 1st, 2005, to December 31st, 2005, and from January 1st, 2007, to September 30th, 2007, 103 in-hospital CPR cases were enrolled. We separated the 103 cases into two groups: 2005 patients and 2007 patients. Fifty-two cases in the 2005 group and 51 cases in the 2007 group were enrolled. The defibrillation method, defibrillation energy, epinephrine use, and atropine use were analyzed. RESULTS: Nineteen cases (82.6%) in the 2005 group and three cases (21.4%) in the 2007 group were performed using the appropriate defibrillation method (p=0.0002). Seventeen cases (73.9%) in the 2005 group and four cases (28.6%) in the 2007 group received the appropriate defibrillation energy (p=0.0069). Seven cases (14.0%) in the 2005 group and 16 cases (32.0%) in the 2007 group used the appropriate epinephrine dose (p=0.0325). Fourteen cases (28.0%) in the 2005 patient group and 14 cases (29.2%) in the 2007 patient group used the appropriate atropine dose (p=0.8983). CONCLUSION: Although CPR guidelines were renewed in 2005, many physicians do not follow these guidelines. We suggest that adequate information, education, feedback, and further study are needed for guideline conformation.
American Heart Association ; Atropine ; Cardiopulmonary Resuscitation ; Electric Countershock ; Epinephrine ; Humans ; Resuscitation

Although tubal pregnancy is increasing, primary ovarian ectopic pregnancy has remained a rare event. However, recent reports suggest an increasing incidence to both tubal and term pregnancies. Ovarian pregnancy occurs within the ovary and on the corpus luteum. Earlier diagnosis is now possible, owing to the availability of highly specific radioimmunoassay for human chorionic gonadotrophin and the development of transvaginal ultrasonography. Clinical and even intraoperative diagnosis is difficult and confirmation may be made only by microscopic examination of the tissue specimen. Current understanding of the etiological factors, classification, possible pathogenesis, clinical presentation, diagnostic steps, reevaluation of diagnostic criteria, preferred management and future fertility are detailed. The therapy is surgical and currently more conservative than in the past, because of improvement in operative laparoscopy. We report a case of primary ovarian pregnancy treated conservatively under laparoscopic surgery with a brief review of literature.
Chorion ; Classification ; Corpus Luteum ; Diagnosis ; Female ; Fertility ; Humans ; Incidence ; Laparoscopy ; Ovary ; Pregnancy ; Pregnancy, Ectopic* ; Pregnancy, Tubal ; Radioimmunoassay ; Ultrasonography

Meralgia paresthetica (MP), first described in 1878, is a sensory mononeuropathy of the lateral femoral cutaneous nerve (LFCN) characterized by pain, tingling, numbness, and paresthesias localized to the anterolateral thigh. There are many etiologies for MP, including those that are spontaneous (idiopathic, metabolic or mechanical) and iatrogenic (surgery, trauma). A 46-year-old female came to our emergency department (ED) with a right hip pain that developed after two days of an altered mental status from high amounts of multiple drugs (benzodiazepine, SSRI, and antipsychotics) to commit suicide. Her past medical and surgical histories were unremarkable. In addition, her vital signs were stable and her electrocardiography was unremarkable. On the other hand, laboratory tests showed an elevated creatinine kinase 14787 IU/L (normal range, 26~140 IU/L) and urine myoglobin >1000 ng/mL (normal range, 0~10 ng/mL). She was admitted to our ED for the management of rhabdomyolysis. The patient didn't slip down and slept on her right side for a long period. An initial pelvis and femur x-ray ruled out a fracture and a straight leg raise test was negative. We took a lumbar spine x-ray to rule out a herniated intervertebral disk because she complained of pain in the second and third lumbar distribution of her right thigh. These x-rays were unremarkable. We presumed she had a hip and thigh contusion and gave her painkillers, but her symptoms did not improved. After a day, the patient complained of numbness (5/10) rather than pain. We then suspected peripheral neuropathy. Her electromyography and nerve conduction velocity confirmed right LFCN neuropathy, MP. MP is often clinically diagnosed and treated conservatively. It is a neurologic disorder due to the entrapment of the LFCN. This case shows that a long period lacking in movement can cause MP. In future cases, the possibility of peripheral neuropathy should be considered, especially in mentally altered patients after drug intoxication.
Contusions ; Creatinine ; Electrocardiography ; Electromyography ; Emergencies ; Female ; Femur ; Hand ; Hip ; Humans ; Hypesthesia ; Intervertebral Disc ; Leg ; Mononeuropathies ; Myoglobin ; Nerve Compression Syndromes ; Nervous System Diseases ; Neural Conduction ; Paresthesia ; Pelvis ; Peripheral Nervous System Diseases ; Phosphotransferases ; Porphyrins ; Spine ; Suicide ; Thigh ; Vital Signs

Cervical incompetence is one of the main contributors to repeated pregnancy loss and preterm delivery. Typically it results in progressive cervical dilatation, leading to a painless second or early third trimester abortion. Emergency cerclage can be used in the setting of advanced cervical incompetence, even when fetal membranes bulge through the dilated cervix. To facilitate the procedure, various techniques have been developed to replace the fetal membranes into the uterine cavity. We performed six successful cases of emergency cerclage combined with amnioreduction in advanced incompetent internal os of cervix (IIOC). Interval from emergency cerclage to delivery was 8.1 +/- 2.4 weeks (range 4-10 weeks) and we delivered viable fetuses in all but one. Hereby we report our experiences with a brief review of literature.
Cervix Uteri ; Emergencies* ; Extraembryonic Membranes ; Female ; Fetus ; Humans ; Labor Stage, First ; Pregnancy ; Pregnancy Trimester, Third

Extrapelvic endometriosis is a fairly rare phenomenon. The majority of extrapelvic endometriosis involves scar tissue following obstetric or gynecologic procedures. Abdominal wall endometriosis secondary to cesarean section is a very rare condition, being reported in less than 0.5% of patients undergoing cesarean section. It has a distinct presentation and treatment. An abdominal mass with noncyclical symptoms is a common presentation. Imaging techniques are nonspecific and needle biopsy may confirm the diagnosis. Wide excision is the treatment of choice for abdominal wall endometriosis as well as for recurrent lesions. A patient with a history of cesarean section presented with a painful, enlarging mass. The pain was cyclic and aggravated just prior to menstruation. The patient was treated with surgical scar excision pathologically confirmed as endometriosis. We present this case with a brief review of literature.
Abdominal Wall ; Biopsy, Needle ; Cesarean Section ; Cicatrix* ; Diagnosis ; Endometriosis* ; Female ; Humans ; Menstruation ; Pregnancy

No abstract available.
Humans

OBJECTIVES: To determine the impacts of Diagnosis-Related Groups/Prospective Payment System (DRG/PPS) on the quality of care in cases of Cesarean section and to describe the policy implications for the early stabilization of DRG/PPS in Korea. METHODS: Data was collected from the medical records of 380 patients who had undergone Cesarean sections in 40 hospitals participating in the DRG/PPS Demonstration Program since 1999. Cesarean sections were performed in 122 patients of the FFS(Fee-For-Service) group and 258 patients of the DRG/PPS group. Measurements of quality used included essential tests of pre- and post-operation, and the PPI(Physician Performance Index) score. The PPI was developed by two obstetricians. RESULTS: Univariate analysis demonstrated significant differences in PPI scores according to the payment systems. With respect to the mean of PPI scores, a higher score was found in the DRG/PPS group than in the FFS group. However, the adjusted effect did not show significant differences between the FFS group and the DRG/PPS group. CONCLUSION: This study suggested that the problem of poor quality may not be related to the implementation of DRG/PPS in Cesarean section. However, this study did not consider the validity and reliability of the process measurement, and it did not exclude the possibility of data omission in medical records.
Cesarean Section* ; Female ; Humans ; Korea ; Medical Records ; Pregnancy ; Reproducibility of Results

Carcinoma of the prostate is a common malignancy affecting elderly men. Lung metastasis from prostate cancer occurs frequently, but tumor metastasis to the central bronchi that clinically mimics primary bronchogenic carcinoma are very rare. We report a 73-year old man with endobronchial metastasis from prostatic carcinoma presented with respiratory symptom cough. Diagnosis of issues taken from materials which were used for bronchoscopic biopsy and prostate biopsy and immunohistochemical staining for prostate specific antigen(PSA) confirmed a case of endobronchial metastasis from prostatic carcinoma. Hormonal therapy(LHRH agonist) was applied to this patient.
Aged ; Biopsy ; Bronchi ; Carcinoma, Bronchogenic ; Cough ; Diagnosis ; Humans ; Lung ; Male ; Neoplasm Metastasis* ; Prostate ; Prostatic Neoplasms

Loeffler's endocarditis is a recognized complication of diseases associated with eosinophilia. This disease is considered to be a part of the idiopathic hypereosinophilic syndrome, which is characterized by persistently elevated blood eosinohil counts with symptoms and signs of organ involvement especially in the heart, nervous system, and bone marrow. We have experienced a case of Loeffler's endocarditis in a 51 years old man who complained of leg pain due to acute closure of left iliac artery by emboli. We found left ventricular mural thrombus by echocardiography and confirmed Loeffler's endocarditis by endomyocardial biopsy. We present a case with the review of literatures.
Biopsy ; Bone Marrow ; Echocardiography ; Eosinophilia ; Heart ; Humans ; Hypereosinophilic Syndrome* ; Iliac Artery* ; Leg ; Middle Aged ; Nervous System ; Thromboembolism ; Thrombosis