PURPOSE: To report a case of Miller Fisher syndrome in a pediatric patient with gastroenteritis associated with seroconversion of Campylobacter jejuni titer during the development of neurological symptoms and positive anti-GQ1b IgG. CASE SUMMARY: An 8-year-old male patient visited our clinic with bilateral ophthalmoplegia, diplopia, and ptosis of the right upper lid. He had experienced gastroenteritis one week previous, and antibodies to Campylobacter jejuni were detected in his plasma. Ophthalmic examination revealed a corrected visual acuity of 20/20 in both eyes. Ocular motor examination revealed limitations in all positions of gaze. Neurologic examination demonstrated areflexia and ataxia. The serologic anti-GQ1b IgG test was positive. Intravenous immunoglobulin and steroid pulse therapy were started. Extraocular movement, ptosis, and ataxia gradually improved after one month of treatment. CONCLUSIONS: We confirmed a case of Miller Fisher syndrome in a pediatric patient with bilateral ophthalmoplegia, ptosis, and a positive anti-GQ1b antibody test.
Antibodies ; Ataxia ; Campylobacter jejuni ; Child ; Diplopia ; Gastroenteritis ; Humans ; Immunoglobulin G* ; Immunoglobulins ; Male ; Miller Fisher Syndrome* ; Neurologic Examination ; Ophthalmoplegia ; Plasma ; Visual Acuity

No abstract available.
Humans ; Pituitary Neoplasms*

BACKGROUND: Serratia marcescens is a well-known cause of nosocomial infections. We investigated an outbreak of S.marcescens infections in a surgical intensive care unit (SICU) and identified the source of the outbreak using pulsed-field gel electrophoresis (PFGE). METHODS: A total of 39 isolates of S.marcescens were included in this study: 28 isolates from the patients in the SICU and epidemiologically-unrelated 11 isolates from the patients in the general wards from May through August, 2003 at Gyeongsang National University Hospital. Twenty-six of the 28 isolates in the SICU were from the urine collected from indwelling urinary catheters. Fifty-six environmental samples, such as the hands of healthcare workers and urinals were cultured to identify the source of infection. Antimicrobial susceptibility tests by Vitek GNS card (bioMerieux) and PFGE were performed to identify the clonality of the isolates. RESULTS: Twenty of the 28 S. marcescens isolated from the patients in the SICU showed the identical PFGE fingerprint pattern and two isolates had a closely-related pattern with the outbreak strain. The isolates from urine in the SICU were resistant to almost all the antibiotics tested except imipenem and cotrimoxazole. Nine of the 11 isolates from the general wards had PFGE patterns and antimicrobial susceptibility results different from those of the outbreak clone. Five samples from used-urinals and one from disinfected-urinal of 56 environmental samples grew S.marcescens that were resistant to the all antibiotics tested except imipenem and cotrimoxazole. CONCLUSION: The outbreak of urinary tract infections in SICU was due to a clonal spread of a single strain of S.marcescens that was multiple resistant to antibiotics except imipenem and cotrimoxazole. The source of outbreak appeared to be inadequately disinfected urinals.
Anti-Bacterial Agents ; Clone Cells ; Cross Infection ; Delivery of Health Care ; Dermatoglyphics ; Electrophoresis, Gel, Pulsed-Field* ; Epidemiology ; Hand ; Humans ; Imipenem ; Intensive Care Units* ; Critical Care* ; Patients' Rooms ; Serratia marcescens* ; Serratia* ; Trimethoprim, Sulfamethoxazole Drug Combination ; Urinary Catheters ; Urinary Tract Infections* ; Urinary Tract*

The Korean Thyroid Imaging Reporting and Data System (K-TIRADS) is an ultrasound-based risk stratification system for thyroid nodules that has been widely applied for the diagnosis and management of thyroid nodules since 2016. This review article provides an overview of the use of the K-TIRADS compared with other risk stratification systems. Moreover, this review describes the challenges in the clinical application of the K-TIRADS, as well as future development directions toward the personalized management of patients with thyroid nodules.

The Korean Thyroid Imaging Reporting and Data System (K-TIRADS) is an ultrasound-based risk stratification system for thyroid nodules that has been widely applied for the diagnosis and management of thyroid nodules since 2016. This review article provides an overview of the use of the K-TIRADS compared with other risk stratification systems. Moreover, this review describes the challenges in the clinical application of the K-TIRADS, as well as future development directions toward the personalized management of patients with thyroid nodules.

Purpose: The purpose of this study was to determine the usefulness of two-dimensional shear wave elastography (2D SWE) in the assessment of liver stiffness (LS) and dispersion slope (DS) to evaluate hepatic fibrosis and the treatment response in patients with autoimmune hepatitis (AIH). Methods: Patients diagnosed with AIH who underwent 2D SWE between June 2014 and June 2021 were enrolled in this retrospective study. The patients were classified into four groups according to the histologic stage of fibrosis (F1-F4). The baseline characteristics, laboratory test results, histologic results, and 2D SWE results were analyzed. The diagnostic performance of LS measurements in hepatic fibrosis staging was investigated, and variables were compared before and after steroid treatment for AIH. Results: In total, 69 patients were analyzed. The LS values differed according to the stage of liver fibrosis (P<0.001). The area under the curve for LS was 0.903, 0.815, and 0.854 for ≥F2, ≥F3, and F4, respectively. The diagnostic performance of LS measurements was significantly greater than that of serum biomarkers, except for fibrosis index-4 for F4 (P<0.05). Significant differences were observed in follow-up examinations in both the LS value and DS in patients who received steroid therapy (P=0.012 and P=0.011, respectively). Conclusion In conclusion, 2D SWE is a useful method for the assessment of hepatic fibrosis in patients with AIH. In follow-up examinations, LS and DS can be used as reliable parameters to evaluate the treatment response of AIH.

BACKGROUND: A central venous catheter (CVC) is commonly used for administering chemotherapy to cancer patients. The institutional guideline of the Gyeongsang National University Hospital (GNUH) for blood culture analysis of indwelling CVC patients recommended 6 sets (2 from the periphery and 4 from each lumen). We analyzed the usefulness of this guideline, because complying with this recommendation requires an abundant amount of the sample and it is both inconvenient and expensive. METHODS: Adult patients (age: > or =18 yr old) who were admitted to the cancer center of GNUH between January 2011 and April 2012 were requested to have their blood culture analysis done. The positive rate, contamination rate, and distribution of microorganisms were compared according to the number of requested sets. The positive results of the stipulated 6 sets were analyzed. RESULTS: A total of 5,263 blood cultures were analyzed during the study period; of them, 74.4% were requests of 2 sets and 20.0% were requests of 6 sets. The positive rates in 2 set requests and 6 set requests were 8.0% and 14.3%, respectively (P<0.001). The requests for 6 sets were repeated about 5 times. All 6 sets showed positive in 16 cases (9.1%), whereas a part of the 6 sets was positive in 18 cases (10.3%). CONCLUSIONS: Although the positive rate was relatively high in the 6 set-requested groups, they had to be repeatedly requested. Microbial growth in a part of the 6-set requests was observed in a very small proportion (10.3%) of the patients, indicating that the benefit of blood culture of 6 sets is very low.
Adult ; Central Venous Catheters ; Humans ; Sepsis

Immunoglobulin G4 (IgG4)-related disease (IgG4RD) is a relatively recently recognized entity that is histopathologically characterized by an extensive infiltration of lymphocytes and IgG4-positive plasma cells with dense fibrosis. IgG4RD is now known to affect any organ system, and a few cases of gastrointestinal lesions have also been reported. However, solitary IgG4RD of the stomach is still very rare. Furthermore, as it can mimic malignant conditions, it is important to recognize this disease to avoid unnecessary surgery. Herein, we present a case of IgG4RD presenting as an isolated subepithelial mass in the stomach.
Fibrosis ; Granuloma, Plasma Cell* ; Immunoglobulins* ; Lymphocytes ; Plasma Cells ; Stomach* ; Unnecessary Procedures

OBJECTIVE: The authors present a retrospective analysis of gamma knife radiosurgery for thalamotomy for Parkinsonian tremor to determine the efficacy of the procedure, to review radiological findings of radiosurgical lesioning and to assess the risk of complications. METHODS: Radiosurgical thalamotomy with gamma knife was performed in one men and nine women. The target was nucleus ventralis intermedius following classic anatomical landmarks. The median age of the patients was 68 years(range 53-85). A mean radiation dose of 148Gy(range 140-168) was delivered using a 4-mm collimator. Patients were followed for a mean of 35 months(range 21-47). Independent neurological evaluation of tremor was based on the change in the Unified Parkinson's Disease Rating Scale tremor score(UPDRS, question 16, 20, 21) and the subjective satisfaction. The radiological follow-up period of the available five cases ranged from 6 to 13 months(mean 6). RESULTS: Nine patients(90%) showed the decrease in the sum of UPDRS. In the patient's subjective satisfaction, five(50%) showed excellent improvement, three(30%) good improvement and one(10%) mild improvement respectively. No response was observed in one patient. The mean time to onset of improvement was 3.5 months (range 1-14). There were no neurological complications. Follow-up magnetic resonance image showed the target-shaped lesion with a ring enhancement, of which location was matched to that of gamma knife planning. CONCLUSION: Gamma knife radiosurgery for thalamotomy offers acceptable tremor control with minimal risk to patients unsuited for open surgery, however, larger consecutive series and long-term follow-up are mandatory.
Female ; Follow-Up Studies ; Humans ; Male ; Parkinson Disease ; Radiosurgery* ; Retrospective Studies ; Tremor*

PURPOSE: To identify the correlation between early postoperative stereoacuity and surgical outcome in intermittent exotropia. METHODS: The medical records of 74 patients who underwent unilateral lateral rectus recession or bilateral lateral rectus recession for intermittent exotropia with a minimum postoperative follow-up of 3 years were retrospectively reviewed. Postoperative stereoacuity was measured using the vectogram test and Titmus test at 1 month post-operative. The deviation angle was measured at near and at distance using a prism cover test. Patients were divided into two groups according to post-operative angle deviation, and stereoacuity was analyzed in both groups. RESULTS: Sixty patients showed no suppression at distance at 1 month post-operative follow-up. Of these, 55 patients (85.9%) belonged to the success group and 5 patients (50.0%) belonged to the recurrence group. The post-operative suppression test and the surgical outcome exhibited a significant association (p = 0.017). 53 patients showed normal stereoacuity 1 month after surgery. Of these, 49 patients (76.6%) belonged to the success group and 4 patients (40.0%) belonged to the recurrence group (p = 0.017). Post-operative stereoacuity and surgical outcome exhibited a significant association (p = 0.026). CONCLUSIONS: Post-operative suppression test results at distance and stereoacuity at near may be helpful in predicting surgical outcomes of patients with intermittent exotropia.
Exotropia* ; Follow-Up Studies ; Humans ; Medical Records ; Recurrence ; Retrospective Studies