Human Q fever, a zoonosis caused by Coxiella burnetii, presents with diverse clinical manifestations ranging from mild self-limited febrile illnesses to life-threatening complications such as endocarditis or vascular infection. Although acute Q fever is a benign illness with a low mortality rate, a large-scale outbreak of Q fever in the Netherlands led to concerns about the possibility of blood transfusion-related transmission or obstetric complications in pregnant women. Furthermore, a small minority (< 5%) of patients with asymptomatic or symptomatic infection progress to chronic Q fever. Chronic Q fever is fatal in 5–50% of patients if left untreated. In South Korea, Q fever in humans was designated as a notifiable infectious disease in 2006, and the number of Q fever cases has increased sharply since 2015. Nonetheless, it is still considered a neglected and under-recognized infectious disease. In this review, recent trends of human and animal Q fever in South Korea, and public health concerns regarding Q fever outbreaks are reviewed, and we consider how a One Health approach could be applied as a preventive measure to prepare for zoonotic Q fever outbreaks.

Purpose: Alpha-fetoprotein (AFP) is a prognostic marker for hepatocellular carcinoma (HCC). We investigated the prognostic value of AFP levels in patients who achieved complete response (CR) to transarterial chemoembolization (TACE) for HCC. Materials and Methods: Between 2005 and 2018, 890 patients with HCC who achieved a CR to TACE were recruited. An AFP responder was defined as a patient who showed elevated levels of AFP (>10 ng/mL) during TACE, but showed normalization or a >50% reduction in AFP levels after achieving a CR. Results: Among the recruited patients, 569 (63.9%) with naïve HCC and 321 (36.1%) with recurrent HCC after complete resection were treated. Before TACE, 305 (34.3%) patients had multiple tumors, 219 (24.6%) had a maximal tumor size >3 cm, and 22 (2.5%) had portal vein tumor thrombosis. The median AFP level after achieving a CR was 6.36 ng/mL. After a CR, 473 (53.1%) patients experienced recurrence, and 417 (46.9%) died [median progression-free survival (PFS) and overall survival (OS) of 16.3 and 62.8 months, respectively]. High AFP levels at CR (>20 ng/mL) were independently associated with a shorter PFS [hazard ratio (HR)=1.403] and OS (HR=1.284), together with tumor multiplicity at TACE (HR=1.518 and 1.666, respectively). AFP non-responders at CR (76.2%, n=359 of 471) showed a shorter PFS (median 10.5 months vs. 15.5 months, HR=1.375) and OS (median 41.4 months vs. 61.8 months, HR=1.424) than AFP responders (all p=0.001). Conclusion High AFP levels and AFP non-responders were independently associated with poor outcomes after TACE. AFP holds clinical implications for detailed risk stratification upon achieving a CR after TACE.

Background: Early neurological deterioration is a critical determinant of functional outcome in patients with acute minor ischemic stroke. This study aimed to identify clinical predictors of early neurological deterioration in patients with acute minor ischemic stroke. Methods: A total of 739 patients who experienced acute minor ischemic stroke symptoms between January 2014 and December 2018 were enrolled in this study. All patients were presented within a 4.5-hour time window of stroke symptom onset. Early neurological deterioration was defined as an increment of at least one point in motor power or total National Institute of Health Stroke Scale (NIHSS) score deterioration ≥ 2 points within 3 days after admission. Unfavorable functional outcome was defined as a modified Rankin Scale score of ≥ 2 at 90 days after stroke onset. Demographic characteristics, risk factors for vascular diseases, stroke severity, stroke subtypes, and neuroimaging parameters were analyzed. Regression analysis was used to determine clinical predictors of early neurological deterioration. Results: Of the 739 patients, 78 (10.5%) patients had early neurological deterioration. Among the 78 patients with early neurological deterioration, 61 (78.2%) had unfavorable functional outcome at 90 days after stroke onset. In contrast, 131 of the remaining 661 (19.8%) patients without early neurological deterioration had unfavorable functional outcome. Multivariate analysis identified hemorrhagic transformation (odds ratio, 3.8; 95% confidence interval, 1.4-10.5; P = 0.010), higher NIHSS score at admission (odds ratio, 1.4; 95% confidence interval, 1.1-1.7; P = 0.003), arterial stenosis (odds ratio, 2.0; 95% confidence interval, 1.2-3.5; P = 0.014) and occlusion (odds ratio, 2.6; 95% confidence interval, 1.4-4.8; P = 0.004) in the territory of stroke as significant predictors of early neurological deterioration. Conclusions: The results of this study suggest that hemorrhagic transformation, higher NIHSS score at admission, and arterial steno-occlusive lesions in the territory of stroke are independent predictors of early neurological deterioration in patients with acute minor ischemic stroke.

Anti-tuberculosis drugs can produce levels of hepatotoxicity ranging from mild elevation of aminotransferase to severe acute hepatitis. A few cases of drug-induced autoimmune hepatitis or the drug reaction with eosinophilia and systemic symptom (DRESS) syndrome by anti-tuberculosis medications have been reported. However, concomitant occurrence of these two disorders has not been reported. Here, we present a case of severe acute hepatitis with DRESS syndrome and autoimmune hepatitis resulting from primary standard anti-tuberculosis drugs. Both conditions were successfully treated with a systemic steroid regimen.
Antitubercular Agents ; Drug Hypersensitivity Syndrome ; Eosinophilia* ; Ethambutol* ; Hepatitis ; Hepatitis, Autoimmune* ; Isoniazid*

Phlegmonous esophagogastritis is a rare bacterial infection that has been reported to result in mortality. The pathophysiology of phlegmonous gastrointestinal infection is unclear, but some predisposing factors are reported. Those include immunocompromised status, alcohol abuse, malignancy and uncontrolled diabetes mellitus. We report two cases of phlegmonous esophagogastritis with newly diagnosed diabetes mellitus. A 26-year-old woman and a 56-year-old woman individually visited our hospital for sore throat, neck pain and fever. The laboratory findings of both patients demonstrated leukocytosis, and elevated serum glucose levels. HbA1c of both patients was above 11%. Enhanced computed tomography of young woman showed submucosal edema with intramural abscess along the esophagus and stomach, and that of older woman showed the same defined to esophagus. In both cases, empirical antibiotic therapy with intravenous third generation cephalosporin and metronidazole were started. Later, we identified Klebsiella pneumonia through pus culture in both cases. The symptoms of case 1 improved with conservative management with antibiotics only. However, case 2 required surgical drainage and esophagectomy. Early radiologic diagnosis of this disease and accurate identification of pathogens are important factors for good prognosis. Therefore, we emphasize suspicion of such a rare disease is needed, especially when the patient has risk factors such as diabetes mellitus.
Abscess ; Adult ; Alcoholism ; Anti-Bacterial Agents ; Bacterial Infections ; Blood Glucose ; Causality ; Cellulitis* ; Diabetes Mellitus ; Diagnosis ; Drainage ; Edema ; Esophagectomy ; Esophagus ; Female ; Fever ; Humans ; Klebsiella ; Leukocytosis ; Metronidazole ; Middle Aged ; Mortality ; Neck Pain ; Pharyngitis ; Pneumonia ; Prognosis ; Rare Diseases ; Risk Factors ; Stomach ; Suppuration

No abstract available.
Hepatitis C* ; Interferons* ; Polymyositis*

A Hyalinizing Trabecular Tumor (HTT) is a very rare tumor. We report one case that was confirmed to be HTT after an operation. A 44-year-old female visited our hospital with about a 1.3-cm-sized mass on the left thyroid. Fine Needle Aspiration Biopsy (FNAB) indicated papillary thyroid cancer. After a left hemithyroidectomy, a frozen section biopsy reported the possibility of HTT. Therefore, we did not proceed with the surgery. According to the final report, she was diagnosed with HTT. Five lymph nodes were dissected and were found to be benign. Thyroid transcription factor-1 and neuron specific enolase were positive, and in addition calcitonin was negative. Ki-67 was recorded to be less than 5%. She was discharged without any complication. HTT is benign in most cases, but the possibility of malignancy should be considered. Because it is hard to differentiate between it and PTC or MTC, an accurate diagnosis through histologic examination of specimens and surgical resection is necessary.
Adult ; Biopsy ; Biopsy, Fine-Needle ; Calcitonin ; Diagnosis ; Female ; Frozen Sections ; Humans ; Hyalin* ; Lymph Nodes ; Phosphopyruvate Hydratase ; Thyroid Gland* ; Thyroid Neoplasms

Interdigitating dendritic cell sarcoma (IDCS) is a very rare disease around the world and its prognosis is known to be aggressive. This reports a case diagnosed as IDCS of the axillary region treated in Soonchunhyang University Hospital. A 57-year-old female visited Soonchunhyang University Hospital with a left axillary mass. The mass was hard and fixed. Computed tomography observed a 7 cm lymph node at the left axilla, and core biopsy suspected sarcoma. In another study, there was no specific finding except the axillary lesion. Left axillary lymph node dissection (level I, II) was conducted and the pathologic report finally showed IDCS. The patient was treated with only radiotherapy and followed up without recurrence for 13 months up to now. IDCS is a very rare sarcoma that is hard to diagnose and progresses fast. Thus, treatment is very difficult. Proper treatment can be better established after more experiences.
Axilla ; Biopsy ; Dendritic Cell Sarcoma, Interdigitating ; Dendritic Cells ; Female ; Humans ; Lymph Node Excision ; Lymph Nodes ; Middle Aged ; Polyenes ; Prognosis ; Rare Diseases ; Recurrence ; Sarcoma

A careful approach is required for managing esophageal perforation after thyroidectomy, and esophageal perforation can cause serious infectious complications. However, reports on the treatment and management of esophageal perforation after thyroidectomy are lacking. We report here on a case of esophageal perforation that was successfully managed using vacuum-assisted closure. A patient underwent total thyroidectomy for papillary carcinoma. Near the lower pole of the left thyroid, a metastatic lymph node with direct invasion to the esophagus was detected. The esophageal wall, which was injured during lymph node dissection, was repaired. An esophageal leak occurred on the 5th postoperative day, and a 1 cm sized esophageal wall defect was identified. After irrigation, the defect was primary repaired, and the wound was closed using a vacuum assisted closure system. The patient was kept in a oral-fasting state, and subsequent wound dressing with vacuum change was repeated every 3~4 days. During this period, gradual formation of granulation tissue was noted. After negative leakage was confirmed by an esophagogram on the 18th postoperative day, the patient resumed an oral intake. The wound was closed successfully on the 22nd postoperative day, and the patient was safely discharged one week later. In conclusion, vacuum assisted wound closure could reduce the risk of infection and also induce granulation tissue. We think this could be an alternative treatment strategy for esophageal perforation after thyroidectomy.
Bandages ; Carcinoma, Papillary ; Esophageal Perforation* ; Esophagus ; Granulation Tissue ; Humans ; Lymph Node Excision ; Lymph Nodes ; Negative-Pressure Wound Therapy ; Thyroid Gland ; Thyroidectomy* ; Vacuum ; Wounds and Injuries

PURPOSE: Childhood obesity can be complicated by hypertension, hyperlipidemia, non-alcoholic fatty liver disease, and diabetes mellitus. The aim of this study was to evaluate the prevalence of obesity and metabolic complications of children and adolescents based on the degree of obesity. METHODS: We analyzed the records of 8,880 students who received student health examinations between May 2006 and October 2008 at the Eulji General Hospital. The prevalence of obesity was evaluated by the body mass index and obesity index. A total of 1,076 obese students had blood tests. We analyzed aspartate aminotransferase (AST), alanine aminotransferase (ALT), fasting glucose, total cholesterol, and blood pressure according to the degree of obesity. RESULTS: According to the body mass index, the overall prevalence of obesity was 7.2% (7.8% of male and 6.5% of female students). Based on the obesity index, 12.3% of students (mild: 6.3%, moderate: 5.0%, and severe: 1.0%) were obese. The prevalence of hypercholesterolemia, ALT elevation, and hypertension were increased as a function of the degree of obesity (p<0.05), but hyperglycemia showed no significant differences (p=0.298). The overall prevalence of ALT elevation was 17.7% (mild obese group, 10.4%; moderate obese group, 20.5%; and severe obese group, 46.8%). The prevalence of hypercholesterolemia, hypertension, and hyperglycemia were significantly higher in the elevated ALT group (24.7%, 42.6%, and 5.2%, respectively) compared to the normal ALT group (11.1%, 29.8%, and 2.0%, respectively; p<0.05). CONCLUSION: Hypercholesterolemia, liver function test abnormalities, and hypertension were associated with the degree of obesity. We should focus our attention on managing obese children and adolescents to prevent metabolic complications.
Adolescent ; Alanine Transaminase ; Aspartate Aminotransferases ; Blood Pressure ; Body Mass Index ; Child ; Cholesterol ; Diabetes Mellitus ; Fasting ; Fatty Liver ; Female ; Glucose ; Hematologic Tests ; Hospitals, General ; Humans ; Hypercholesterolemia ; Hyperglycemia ; Hyperlipidemias ; Hypertension ; Liver Function Tests ; Male ; Obesity ; Prevalence