STUDY OBJECTIVE: We evaluate the clinical characteristics and natural history of patients presenting with spontaneous pneumomediastinum (SPNM) . DESIGN: A retrospective case series was conducted to identify patients diagnosed with SPNM. ICD-7(J98.2) discharge codes were used for Jan. 1993 to Aug. 1996 at four institutions , and emergency department(ED) records and admission charts were reviewed. Clinical features, interventions, complications, setting, etiology, symptoms, and length of hospital stay were recorded. PARTICIPANTS: All ED patients more than 12 years old with a diagnosis of SPNM. RESULTS: Thirteen cases were identified. Age range was 14 to 58 years(mean 24 years). Presenting symptoms were chest pain in eight(62%), dyspnea in six(46%), both symptoms in three(23%), no complaints in three(23%). Seven(54%) patients complained only of throat discomfort. Seven(54%) had subcutaneous emphysema, and two(15.3%) had a small pneumothorax. Two(15.3%) were smokers. Three(23%) had normal esophagograms and another three had normal chest CT findings. Two cases(15.3%) were associated with inhalational drug use and three cases were due to exercise. Nine cases(69%) had a history of "Valsalva-type" maneuver. Two patients(15%) had a history of antituberculous treatment and one(7.7.%) had suffered from bronchial asthma. Mean hospital days were 7.3 days(range 3 to 14), none of all needed any intervention. Specifically, no patient developed a subsequent pneumothorax or airway compromise. Seven cases(54%) were received prophylactic antibiotics. CONCLUSION: Most simple SPNM cases are benign disease and most of them(78%) had shown typical chest pain, dyspnea and subcutaneous emphysema. Inhalational drug use is not a main cause of SPNM yet, but increase in use of bronchoinhalers is a suspicous cause of SPNM.
Anti-Bacterial Agents ; Asthma ; Chest Pain ; Child ; Diagnosis ; Dyspnea ; Emergencies ; Humans ; Length of Stay ; Mediastinal Emphysema* ; Natural History* ; Pharynx ; Pneumothorax ; Retrospective Studies ; Subcutaneous Emphysema ; Tomography, X-Ray Computed

BACKGROUND: The growing number of spinal cord injured individuals facing old age makes the understanding of age related limitations increasingly important. This study was to investigate the age-related differences in rehabilitation outcome according to the level of cervical spinal cord injury and each category of activity of daily living(ADL). METHODS: Subjects were 79 adults with tetraplegia all of whom were admitted in National Rehabilitation Hospital. The level of injury was classified into upper cervical(C4, C5), mid-cervical(C6), and lower cervical(C7, C8) spinal cord injury. Eight ADL categories including feeding, grooming, bathing, dressing, toileting, bed-transfer, toilet/tub transfer, and indoor mobility were assessed using the scale of Spinal Cord Independence Measure. Age related differences were examined by separating the sample into two age groups(> or =40 and <40 years) RESULTS: There was no age related difference in rehabilitation outcome in upper cervical cord injury patients. In mid-cervical cord injury level, ADL capacities differed only in the feeding and grooming activities. In lower cervical cord injury level, older patients showed lower rehabilitation outcome than younger counterparts in all ADL categories examined. CONCLUSION: Along with injury level, age should be considered when formulating rehabilitation plans and functional prognostic statements in tetraplegic patients.
Activities of Daily Living ; Adult ; Animals ; Bandages ; Baths ; Grooming ; Humans ; Quadriplegia ; Rehabilitation* ; Spinal Cord Injuries* ; Spinal Cord* ; Treatment Outcome*

Pulmonary Embolism, one of the causes of maternal death, is a life threatening disease that needs early and accurate diagnosis. We have exprerienced a case of a fatal pulmonary embolism which was diagnosed by lung perfusion scan on the postoperative 1 day after cesarean delivery and was managed with heparin therapy. We present this case with a brief review of literatures.
Diagnosis ; Heparin ; Lung ; Maternal Death ; Perfusion ; Pulmonary Embolism*

Polyotia is an extremely rare type of the auricular malformation that is characterized by a large accessory ear. A 3-year-old girl presented to us with bilateral auricular abnormalities and underwent two-stage corrective operation for polyotia. In this report, we present the surgical details and postoperative outcomes of polyotia correction in the patient. Relevant literature is reviewed.
Child, Preschool ; Congenital Abnormalities ; Ear ; Ear Auricle ; Female ; Humans

Incidental adnexal masses considered indeterminate for malignancy are commonly observed on ultrasonography. Multiparametric MRI is the imaging modality of choice for the evaluation of sonographically indeterminate adnexal masses. Conventional MRI enables a confident pathologic diagnosis of various benign lesions due to accurate tissue characterization of fat, blood, fibrous tissue, and solid components. Additionally, functional imaging sequences, including perfusion- and diffusion-weighted imaging, improve the diagnostic efficacy of conventional MRI in differentiating benign from malignant adnexal masses. The ovarian-adnexal reporting and data system (O-RADS) MRI was recently designed to provide consistent interpretations in assigning risk of malignancy to ovarian and other adnexal masses, and to provide a management recommendation for each risk category. In this review, we describe the clinical application of multiparametric MRI for the evaluation of adnexal masses and introduce the O-RADS MRI risk stratification system.

Incidental adnexal masses considered indeterminate for malignancy are commonly observed on ultrasonography. Multiparametric MRI is the imaging modality of choice for the evaluation of sonographically indeterminate adnexal masses. Conventional MRI enables a confident pathologic diagnosis of various benign lesions due to accurate tissue characterization of fat, blood, fibrous tissue, and solid components. Additionally, functional imaging sequences, including perfusion- and diffusion-weighted imaging, improve the diagnostic efficacy of conventional MRI in differentiating benign from malignant adnexal masses. The ovarian-adnexal reporting and data system (O-RADS) MRI was recently designed to provide consistent interpretations in assigning risk of malignancy to ovarian and other adnexal masses, and to provide a management recommendation for each risk category. In this review, we describe the clinical application of multiparametric MRI for the evaluation of adnexal masses and introduce the O-RADS MRI risk stratification system.

PURPOSE: To evaluate the imaging findings of endometrial stromal sarcoma (ESS) according to histopathologic grade. MATERIALS AND METHODS: Six patients with pathologically proven ESS were included in this study. The histopathologic diagnosis was low-grade ESS for three patients and high-grade ESS for the three others. Preoperative CT or MR images were evaluated in terms of tumor size, location, growth pattern, the presence of hemorrhage or necrosis, status of the endometrial cavity, and invasion of surrounding structures. The imaging features of ESSs, which varied according to their histopathologic grade, were compared. RESULTS: The mean maximal diameter of low-and high-grade ESSs was 6 cm and 11.2 cm, respectively. All three low-grade ESSs were located mainly in the myometrium, but two high-grade ESSs were situated in the endometrial cavity and associated with focal tumor extension into the myometrium. One high-grade ESS had completely replaced the uterus. Low-grade ESSs were relatively well-defined, but high-grade ESSs had an irregular and lobulated margin. Intratumoral hemorrhage and necrosis were, respectively, found in two and three high-grade ESSs. Widening of the endometrial cavity was noted in all three high-grade ESSs, and lymph node metastasis had occurred in one. CONCLUSION: The imaging findings of ESS vary from a well-defined intramural mass to a bulky infiltrating mass, and depend on their histopathologic grade.
Animals ; Diagnosis ; Female ; Hemorrhage ; Humans ; Lymph Nodes ; Magnetic Resonance Imaging* ; Mice ; Myometrium ; Necrosis ; Neoplasm Metastasis ; Sarcoma ; Sarcoma, Endometrial Stromal* ; Uterine Neoplasms ; Uterus

OBJECTIVE: To investigate the immediate effect of a single session of whole body vibration (WBV) on lower extremity spasticity in children with cerebral palsy (CP). METHODS: Seventeen children with spastic CP were included. A single session of WBV was administered: 10-minute WBV, 1-minute rest, and 10-minute WBV. The effects of WBV were clinically assessed with the Modified Ashworth Scale (MAS) and Modified Tardieu Scale (MTS) before and immediately, 30 minutes, 1 hour, 2 hours, 3 hours, and 4 hours after WBV. RESULTS: Spasticity of the ankle plantarflexor, as assessed by MAS and MTS scores, was reduced after WBV. Post-hoc analysis demonstrated that, compared to baseline, the MAS significantly improved for a period of 1 hour after WBV, and the R1 and R2–R1 of the MTS significantly improved for a period of 2 hours after WBV. CONCLUSION: A single session of WBV improves spasticity of ankle plantarflexors for 1–2 hours in children with CP. Future studies are needed to test whether WBV is an effective preparation before physiotherapy and occupational therapy.
Ankle ; Cerebral Palsy* ; Child* ; Humans ; Lower Extremity ; Muscle Spasticity* ; Occupational Therapy ; Vibration*

Primary malignant lesions of the vagina are uncommon and represent approximately 1 -2% of all gynecologic malignancies. About 2% of all malignant vaginal lesions are primary sarcomas, the most common of these being leiomyosarcoma. We report the CT and MR imaging findings in a 41-year-old woman with vaginal leiomyosarcoma presenting as a bulky solid mass which caused expansion of the vaginal canal.
Adult ; Female ; Humans ; Leiomyosarcoma* ; Magnetic Resonance Imaging* ; Sarcoma ; Vagina*

PURPOSE: This study was aimed to investigate the contamination rates of blood culture in a neonatal intensive care unit (NICU) and to examine the clinical characteristics related to the contamination. METHODS: Eight hundred thirty cases of blood culture performed from March 2013 to February 2014 were analyzed. We evaluated the contamination rates of blood culture by blood sampling sites and compared the clinical characteristics such as real name system and body weights of the contaminated cases and those of non-contaminated ones. The clinical characteristics were retrospectively reviewed by medical records. RESULTS: The overall contamination rate was 3.6% (30/830). The contamination rates by blood sampling sites were as follows: peripheral vein 15.6% (10/64), peripheral artery 2.6% (20/759), and umbilical arterial catheter 0% (0/7). There was no difference in the contamination rates between cases with and without real name system (P =0.484). However, there were significant differences in the contamination rates by the physicians who performed the culture (P =0.038) and body weight (<1,000 g vs. > or =1,000 g) at the time of blood culture (P<0.001). CONCLUSIONS: These results suggest that neonates with a body weight less than 1,000 g have more risks of the contamination of blood culture. Furthermore, there is a necessity to provide blood culture performers with active feedbacks and individualized education plans that can help diminish blood culture contamination rates. Prospective studies in a systematic manner that can be applied in actual clinical settings are needed in order to figure out factors that can diminish the contamination rates of blood culture in NICU.
Arteries ; Body Weight ; Catheters ; Education ; Humans ; Infant, Newborn* ; Intensive Care, Neonatal ; Medical Records ; Prospective Studies ; Retrospective Studies ; Veins