The most common endogenous cause of Cushing's syndrome is Cushing's disease. The evaluation of patients with suspected Cushing's disease and syndrome requires an understanding of the proper use and limitations of the tests commonly included in the diagnostic work-up. The best screening test for Cushing's syndrome is a 24-hour urine collection with analysis for urinary free cortisol excretion. Low-dose and high-dose dexamethasone suppression tests, corticotropin assays, a corticotropin-release hormone stimulation test and inferior petrosal sinus cathaterization may be required for a definitive diagnosis. MRI is useful in localizing the lesion but some limitations. Surgical removal of the lesion by a trans-sphenoidal appraoch is usually successful, but long-term follow-up is required. We report a case of Cushing disease which shows such typical clinical characteristics of Cushing syndrome as weight gain, skin lesions, truncal obesity, striae, hypertension.
Adrenocorticotropic Hormone ; Cushing Syndrome ; Dexamethasone ; Diagnosis ; Follow-Up Studies ; Humans ; Hydrocortisone ; Hypertension ; Magnetic Resonance Imaging ; Mass Screening ; Obesity ; Petrosal Sinus Sampling* ; Pituitary ACTH Hypersecretion* ; Skin ; Urine Specimen Collection ; Weight Gain

No abstract available.
Humerus* ; Osteotomy*

No abstract available.
Chondroma* ; Humans ; Young Adult*

No abstract available.
Kyphosis* ; Spine* ; Tuberculosis*

No abstract available.
Fractures, Open*

BACKGROUND: This study analysed patterns of requests for repeated blood cultures and the microorganisms isolated in follow-up cultures. METHODS: The frequencies and intervals of repeated blood cultures performed during January and February of 2010 at seven university-affiliated hospitals in Korea were evaluated. Results of microbiological cultures at follow-up were analysed with respect to pathogen replication, immune clearance, appearance of new pathogens, and skin contaminants. RESULTS: Among 3,072 patients who received repeated blood cultures, the average number of requests was 3.2. Of the 5,241 follow-up blood culture events recorded, durations of 1, 2, and 3 days between cultures were identified for 23.1%, 21.4%, and 15.0% of events, respectively. Relative to each initial culture, persistent pathogen growth in subsequent culture(s) accounted for 2.3% of events, whereas immune clearance was confirmed in 8.5% of events. Previously undetected pathogens were isolated in 5.2% of the follow-up cultures, the majority of which grew after an interval of six days. Skin contaminants were detected in 7.6% of the repeated cultures, and 76.1% of the follow-ups displayed no growth of microorganisms. CONCLUSION: The most common numbers of repeat culture requests were two and three, and these were typically performed within three days of the initial culture. Among the follow-up cultures, new pathogens were identified in 5.2%, and the majority of this group likely presented for follow-up during a new disease episode.
Follow-Up Studies ; Humans ; Korea ; Sepsis ; Skin

The mortality rate of patients with acute graft versus host disease (GVHD) after liver transplantation is very high. Autoimmune hepatitis and diabetes mellitus (DM) is the risk factors of GVHD. Human leukocyte antigen (HLA)-homozygote donor with one way donor-recipient HLA matching is on the risk of fatal GVHD following living donor liver transplantation (LDLT). If recipient has more than one risk factors of GVHD and is going to LDLT, HLA typing is needed to identify donor-dominant one-way HLA matching and helpful to diagnose and treat early and survival of patient will be improved. We report a case of GVHD after liver transplantation for hepatocellular carcinoma and DM who received an allograft from his HLA-homozygous son.
Carcinoma, Hepatocellular ; Diabetes Mellitus ; Graft vs Host Disease ; Hepatitis, Autoimmune ; Histocompatibility Testing ; HLA Antigens ; Humans ; Leukocytes ; Liver ; Liver Transplantation ; Living Donors ; Risk Factors ; Tissue Donors ; Transplantation, Homologous ; Transplants

BACKGROUND: This study was designed to evaluate the effects of continuous infusion of ondansetron on postoperative nausea and vomiting (PONV) in patients receiving intravenous patient controlled analgesia (IV-PCA) following laparoscopic gynecological surgery. METHODS: Sixty ASA class I and II patients scheduled for gynecological laparoscopic surgery were randomly divided into the following 3 groups that received the specified dosages of ondansetron mixed with IV-PCA: placebo (group 1), ondansetron 8 mg (group 2), ondansetron 16 mg (group 3). The incidences of nausea, vomiting, visual analogue scale (VAS), and side effects were then recorded in the recovery room, 24 h, 48 h and 72 h postoperatively. RESULTS: There were no significant differences in the occurrence of nausea between group 1 and 2. However, the incidence of nausea in group 3 was significantly lower than in group 1 at 24 h and 48 h after surgery. In addition, significant differences in the occurrence of vomiting were observed among the three groups. However, with the exception of pruritus, no side effects were observed in any of the groups. CONCLUSIONS: IV-PCA mixed with 16 mg of ondansetron effectively prevented nausea at 24 h and 48 h after gynecologic laparoscopic surgery.
Alfentanil ; Analgesia ; Analgesia, Patient-Controlled ; Female ; Gynecologic Surgical Procedures ; Humans ; Incidence ; Laparoscopy ; Nausea ; Ondansetron ; Postoperative Nausea and Vomiting ; Pruritus ; Recovery Room ; Vomiting

BACKGROUND: The aim of this study was to compare the streamlined liner of the pharynx airway (SLIPA), a new supraglottic airway device (SGA), with the laryngeal mask airway ProSeal(TM) (PLMA) during general anesthesia. METHODS: Sixty patients were randomly allocated to two groups; a PLMA group (n = 30) or a SLIPA group (n = 30). Ease of use, first insertion success rate, hemodynamic responses to insertion, ventilatory efficiency and positioning confirmed by fiberoptic bronchoscopy were assessed. Lung mechanics data were collected with side stream spirometry at 10 minutes after insertion. We also compared the incidence of blood stain, incidence and severity of postoperative sore throat and other complications. RESULTS: First attempt success rates were 93.3% and 73.3%, and mean insertion time was 7.3 sec and 10.5 sec in PLMA and SLIPA. There was a significant rise in all of hemodynamic response from the pre-insertion value at one minute following insertion of SLIPA. But, insertion of PLMA was no significant rise in hemodynamic response. There was no statistically significant difference in the mean maximum sealing pressure, gas leakage, lung mechanics data, gastric distension, postoperative sore throat and other complication between the two groups. Blood stain were noted on the surface of the device in 40% (n = 12) in the SLIPA vs. 6.7% (n = 2) in the PLMA. CONCLUSIONS: The SLIPA is a useful alternative to the PLMA and have comparable efficacy and complication rates. If we acquire the skill to use, SLIPA may be considered as primary SGA devices during surgery under general anesthesia.
Anesthesia ; Anesthesia, General ; Blood Stains ; Bronchoscopy ; Hemodynamics ; Humans ; Incidence ; Laryngeal Masks ; Lung ; Mechanics ; Pharyngitis ; Pharynx ; Rivers ; Spirometry

Seizure associated with antiemetics is rare. We report seizure associated with a 5-HT3 receptor antagonist in a 38 years old female. The patient underwent ureterorenoscopic lithotripsy due to left upper ureter stone. After operation, the patient complained of nausea in the postanesthetic recovery unit. In order to subside symptom, the patient was administrated 5-HT3 receptor antagonist, palonosetron, 0.075 mg intravenously. Shortly after administration of that, the patient developed generalized tonic-clonic seizures. The symptom was subsided after midazolam and thiopental sodium were injected. But 40 minutes later, seizure recurred and subsided with midazolam again. The patient recovered completely without any specific sequelae.
Antiemetics ; Female ; Humans ; Injections, Intravenous ; Isoquinolines ; Lithotripsy ; Midazolam ; Nausea ; Quinuclidines ; Receptors, Serotonin, 5-HT3 ; Seizures ; Thiopental ; Ureter