Scrub typhus can invade central nervous system. The most common findings of CNS involvement are those of low grade meningitis, however, meningoencephalitis with coma and generalized seizure are also reported to occur in scrub typhus but only rarely. A 47-year old male was admitted to our hospital because of consciousness disturbance. The patient had a fever and rash for seven days before admission. He had been treated for diabetes mellitus for three years. Generalized seizure occurred six times after admission. CSF revealed increase of leukocytes (648/mm3) and protein level, and diffuse slow wave was found on electroencephaolography. The magnetic resonance image of the brain showed dural thickening. We diagnosed his illness as tsutsugamushi disease complicated by meningoencephalitis. After treatment with clarithromycin and an anticonvulsant, he recovered without neurological sequelae. O. tsutsugamushi should be considered as one of the causes of meningoencephalitis in endemic areas.
Brain ; Central Nervous System ; Clarithromycin ; Coma ; Consciousness ; Diabetes Mellitus ; Exanthema ; Fever ; Humans ; Leukocytes ; Male ; Meningitis ; Meningoencephalitis* ; Middle Aged ; Scrub Typhus* ; Seizures

A 30-year-old primigravida with gestational age of 25 weeks and 4 days was admitted for emergency cesarean section. She was diagnosed as pre-eclampsia with fetal distress. We anesthetized the patient through the combined spinal-epidural anesthetic technique, and there was no specific event throughout the surgical procedures and in post anesthetic care unit. Subsequently, she complained of unilateral hearing difficulty in the ward and an otolaryngology consultation was obtained. She was diagnosed with left sudden sensorineural hearing loss in full frequency range after an acoustic examination. She received intravenous and local steroid treatments for 4 weeks. She showed 32 dB on pure tone audiometry after 5 months. However, we could not continue follow-up testing on the patient because she stopped visiting the hospital since the last examination. We reported a case of uncommon unilateral sudden sensorineural hearing loss after a combined spinal-epidural anesthesia for emergency cesarean section.
Acoustics ; Adult ; Anesthesia* ; Audiometry ; Cesarean Section* ; Emergencies* ; Female ; Fetal Distress ; Follow-Up Studies ; Gestational Age ; Hearing ; Hearing Loss ; Hearing Loss, Sensorineural* ; Humans ; Otolaryngology ; Pre-Eclampsia ; Pregnancy

Pseudohypoparathyroidism(PHP) is a genetic disorder characterized by target cell resistance to the effect of parathyroid hormone(PTH). The disorder is classified into type I a, I b, I c and II depending on the phenotype and biochemical findings. In type I a, urinary cyclic AMP and urinary phosphate excretion are not increased after PTH stimulation because of deficient G unit activity in target cells. Deficiency of the G unit is a generalized cellular defect and accounts for the association of other endocrine disorders with type I a PHP. Type I b PHP shows resistance to PTH but not to other hormones and normal phenotypic appearance. In type I c PHP affected children have defect in catalytic unit of adenylate cyclase and in addition to resistance to PTH, resistance to the metabolic effects of TSH, gonadotropins, and glucagon may be detected. Typical appearance of Albright's hereditary osteodystrophy is common in PHP type Ia and Ic. In type II PHP, urinary cyclic AMP response is generated but this does not lead to phosphaturia. We experienced two patients with PHP. One is a 11-year-old girl diagnosed type I a PHP and the other is a 11-year-old boy suspected type I b PHP. They visited emergency room because of tetanic movement. Both patients had no previous history of tetany and showed low serum calcium level, high phosphorus level and high PTH level. The girl had typical features of Albright's hereditary osteodystrophy such as round face, short neck, obese feature, brachydactyly and mental retardation but didn't have basal ganglia calcification on brain CT. The boy showed normal appearance and no mental retardation.
Adenylyl Cyclases ; Basal Ganglia ; Brachydactyly ; Brain ; Calcium ; Child ; Cyclic AMP ; Emergency Service, Hospital ; Female ; Glucagon ; Gonadotropins ; Humans ; Hypophosphatemia, Familial ; Intellectual Disability ; Male ; Neck ; Phenotype ; Phosphorus ; Pseudohypoparathyroidism* ; Tetany

BACKGROUND: The purpose of this study was to evaluate factors associated with the risk of articular surface perforation during anchor placement for arthroscopic acetabular labral repair using follow-up computed tomographic arthrography (CTA). METHODS: Forty-six patients (29 males and 17 females) underwent arthroscopic labral repair using 142 suture anchors (55 large anchors and 87 small anchors). The patients were followed with CTA 1 year postoperatively. Anchor position was assessed by the insertion angle and the distance of the suture anchor tip from the articular cartilage. The incidence of malposition of suture anchors was assessed in follow-up CTA. The location and incidence of malposition were compared between two groups divided according to the diameter of suture anchor. RESULTS: The mean insertion angle and distance were significantly different between the groups. Of the 142 anchors, 15 (11%) were placed in the cartilage-bone transitional zone. Articular involvement was most common at the 3 o'clock position of the suture anchor (six out of 33 anchors, 18.2%). Both the insertion angle and distance showed small values in the articular involvement group. CONCLUSIONS: The radiographic analysis of the placement of suture anchors after arthroscopic labral refixation based on follow-up CTA demonstrates that articular involvement of anchors is related to the location on the acetabular rim (clock position) and anchor diameter.
Acetabulum* ; Arthrography ; Cartilage, Articular ; Follow-Up Studies ; Humans ; Incidence ; Male ; Risk Factors ; Suture Anchors

Systemic capillary leak syndrome (SCLS) is very rare and lethal disease and only 150 cases have been reported after the first publication of its report in 1960 by Clarkson. SCLS is characterized by hemoconcentation and hypoalbuminemia caused by reversible plasma extravasation. Its mechanism is unknown, but transient dysfunction of the endothelium is the most suspected cause and trigger of this event may cause immunologic disarrangement. After recovery of endothelial function, fluid injected during the shock period is redistributed and can cause severe pulmonary edema. SCLS should be considered in patients with acute and severe hypotension with hemoconcentration and hypoalbuminemia without obvious cardiac dysfunction. Especially we should take into account the possibility of SCLS if fluid replacement does not work or the shock state is aggravated despite aggressive fluid resuscitation and vasopressor administration. SCLS itself is a very rare disease; furthermore, SCLS that develops during well-controlled surgery is even more rare. So we report this case with review of the literature.
Anesthesia, General* ; Capillary Leak Syndrome* ; Endothelium ; Humans ; Hypoalbuminemia ; Hypotension ; Plasma ; Publications ; Pulmonary Edema ; Rare Diseases ; Resuscitation ; Shock

PURPOSE: The objective of this study was to investigate the differences of hippocampal volume and shape as well as the functional change between long life experienced taxi drivers and controls of Korean population. MATERIALS AND METHODS: Three-dimensional T1-weighted images and blood oxygen level dependent functional MRI(fMRI) were obtained from 8 subjects, consisting of 4 experienced (20-30 years) taxi drivers and 4 age-matched controls. The hippocampal volume and shape were analyzed with three-dimensional T1-weighted images. In addition, neuronal activities of brain were analyzed using a blood oxygen level dependent fMRI between the two groups. RESULTS: The hippocampal volume showed no statistically significant difference between the two groups (p > 0.05). The left hippocampi of the taxi drivers were slightly elongated with larger head and tail portions than those of the controls (p < 0.05, uncorrected). For the functional MRI, fusiform gyrus was specifically activated in taxi drivers, compared with the control group. CONCLUSION: The structural and functional changes of taxi driver's hippocampus indicate the functional differentiation as a result of occupational dependence on spatial navigation. In other words, the continuous usage of spatial navigation performance may diminish degeneration of hippocampus and the related brain regions.
Brain ; Head ; Hippocampus ; Magnetic Resonance Imaging ; Neurons ; Orientation ; Oxygen

Statistical observation was made on in-patients in the Department of Urology, Keimyung University Medical College and Hospital, Taegu, Korea, during the period from August 1, 1970 through July 31, 1980. 1. Among 2,798 cases of in-patients, 2,138 cases were male and 660 cases were female with a ratio of 3.2: 1. Most common diseases were ureter stone (14. 8%), bladder tumor (7.1%) and renal tuberculosis (6.4%) in order. 2. Of 2.798 in-patients, operation was done in 2,226 cases. 3. Of 2,226 operation cases, T.U.R.(15. 1%) was the most common operation: nephrectomy(11. 1%). ureterolithotomy (10. 5%) and hydrocelectomy (7. 1%) were performed.
Daegu ; Female ; Humans ; Korea ; Male ; Tuberculosis, Renal ; Ureter ; Urinary Bladder Neoplasms ; Urology*

BACKGROUND AND OBJECTIVES: The effective management of tinnitus should start with an accurate diagnosis, but no concensus has been developed in Korea concerning how to measure the features of tinnitus. This study surveyed otologists in the training hospitals and hospitals specialized in otologic care in Korea to identify the current status in the assessment of patients with tinnitus. SUBJECTS AND METHOD: The questionnaire on the assessment of tinnitus was sent by email to otologists in training and to specialized hospitals specializing in otologics in Korea. The questionnaire included inquiry about various types of tests conducted, such as the audiologic test, tinnitus test, blood test, radiologic test, and the methods of history taking and physical examination for somatic tinnitus. RESULTS: Regarding the audiologic assessment of tinnitus, all the otologist were using pure tone audiometry, 97% speech audiometry, and 87% tinnitus test. For the psychophysical measure of tinnitus, both loudness and pitch matching were conducted by all the otologists. The performance rate of blood test were 38.5%, and the most preferred radiologic test in pulsatile tinnitus was temporal bone computed tomography (59%). Finally, the rate of investigation including the history taking and physical examination of somatic tinnitus was between 74-84%. CONCLUSION: Our results showed that although the tests perfermed by otologists varied, the essential tests for assessing tinnitus were commonly practiced. We analyzed the current status of tinnitus assessment and supplemented guidlines to help measure tinnitus. Further concensus on tinnitus diagnosis is needed, particularly about the standadized and unified principles.
Audiometry ; Audiometry, Speech ; Diagnosis ; Electronic Mail ; Hematologic Tests ; Humans ; Korea ; Physical Examination ; Surveys and Questionnaires ; Temporal Bone ; Tinnitus*

PURPOSE: To construct and validate the short-form benign prostatic hypertropy (BPH) health-related quality-of-life (HRQL) questionnaire which is more practical in use and as informative as the 35-item standard form questionnaire previously validated. MATERIALS AND METHODS: First the 9 items for the short form questionnaire were selected from the 35-item standard form questionnaire that includes lower urinary tract symptom (LUTS) related, physical, emotional, general helth percepton, sexual domains by the experts. The developed short form questions were divided into two domains; physical and emotional. This short form questionnaire was tested for reliablity, and validity in a total of 197 men who visited the urology clinics of the eight university medical centers in Korea with LUTS. RESULTS: The short form questionnaire was practical in use (completion rate; 98%, duration of completion at inclusion; 5.19min), and the level of comprehension was not affected by age or degree of education. On the test-retest reliability, high correlations (r=0.49-0.78) and high Cronbach's alpha (>0.745) of two domains were observed, supporting the satisfactory internal consistency, reliability. As the validity, the standard form and short form questionnaire were highly correlated (r=0.52-0.76) and the significant difference were noted in the domain sums and total sum regarding the LUTS severity (p<0.001). CONCLUSIONS: The newly constructed short form questionnaire is good for assessment BPH HRQL including patients' perceived physical, and emotional status easy to administer, accurate, reproducible and responsive to change according to symptom severity. This questionnaire can be used in patients with LUTS practically and offer the valuable clinical information to the physician.
Academic Medical Centers ; Comprehension ; Education ; Humans ; Korea ; Male ; Quality of Life* ; Surveys and Questionnaires ; Urinary Tract ; Urology

Three external quality assesment trials which composed of 12 control materials(12 chemical materials) for interlaboratory quality control assesment in urinalysis were performed with 446, participants, in each, in the year of 2003. The response rate were 92.4% (414/448), 91.9% (419/456) and 91.3% (408/447), in the first, the second and the third trials, in each. The test items include pH, glucose, protein, ketone, bilirubin, blood, urobilinogen, nitrite, leukocyte estrase and specific gravity. The survey results are summarized as follows: 1. The chemical quality control test in urinalysis revealed generally good concordance. 2. The percentage of using urinalysis analyzer was slightly increased as 86.8% and the distribution of using reagent strip was similar to the previous year.
Bilirubin ; Equidae ; Glucose ; Hydrogen-Ion Concentration ; Korea* ; Leukocytes ; Quality Control ; Reagent Strips ; Specific Gravity ; Urinalysis* ; Urobilinogen