Objective: To identify the CT findings associated with treatment failure after antibiotic therapy for acute appendicitis. Materials and Methods: Altogether, 198 patients who received antibiotic therapy for appendicitis were identified by searching the hospital’s surgery database. Selection criteria for antibiotic therapy were uncomplicated appendicitis with an appendiceal diameter equal to or less than 11 mm. The 86 patients included in the study were divided into a treatment success group and a treatment failure group. Treatment failure was defined as a resistance to antibiotic therapy or recurrent appendicitis during a 1-year follow-up period. Two radiologists independently evaluated the following CT findings: appendix–location, involved extent, maximal diameter, thickness, wall enhancement, focal wall defect, periappendiceal fat infiltration, and so on. For the quantitative analysis, two readers independently measured the CT values at the least attenuated wall of the appendix by drawing a round region of interest on the enhanced CT (HUpost) and non-enhanced CT (HUpre). The degree of appendiceal wall enhancement (HUsub) was calculated as the subtracted value between HUpost and HU pre. A logistic regression analysis was used to identify the CT findings associated with treatment failure. Results: Sixty-four of 86 (74.4%) patients were successfully treated with antibiotic therapy, with treatment failure occurring in the remaining 22 (25.5%). The treatment failure group showed a higher frequency of hypoenhancement of the appendiceal wall than the success group (31.8% vs. 7.8%; p = 0.005). Upon quantitative analysis, both HU post (46.7 ± 21.3 HU vs. 58.9 ± 22.0 HU; p = 0.027) and HUsub (26.9 ± 17.3 HU vs. 35.4 ± 16.6 HU; p = 0.042) values were significantly lower in the treatment failure group than in the success group. Conclusion Hypoenhancement of the appendiceal wall was significantly associated with treatment failure after antibiotic therapy for acute appendicitis.

BACKGROUND: Phadiatop test has been introduced as a single test for screening the atopics who were sensitized to common inhalant allergens. MATERIAL AND METHOD: We compared the clinical efficiency of Phadiatop test and total IgE level for defining presence of atopy in 136 asthmatic subjects. The presence of atopy was defined by skin prick test done with 10 common inhalant allergens. More than 2+ skin reactivity was defined as having atopy. Phadiatop test and total IgE level in serum were measured using Pharmacia CAP systems. RESULT: 109 out of 136 subjects had more than 2+ skin reactivity to at least one allergen and another 27 subjects had 1+ or negative skin reactivity to allergens. The performance characteristics of Phadiatop test for screening atopy was superior than total IgE level, with sensitivity(91.7% vs. 82.6%), positive predictive value(94.3% vs. 86.5%) and concordance rate(89.0 % vs. 75.7% ). Specificity and negative predictive value of the Phadistop test were acceptable and higher than that of total IgE level. CONCLUSION: These results suggested that Ph adiatop may be simple and useful for screening atopic status in Korean asthmatic subjects.
Allergens ; Hydrogen-Ion Concentration ; Immunoglobulin E ; Mass Screening* ; Sensitivity and Specificity ; Skin

PURPOSE: Wilms' tumor typically affects young children, with more than 80% of patients identified before 5 years of age. We evaluated the clinical features of Wilms' tumor according to age. MATERIALS AND METHODS: According to their age, 27 patients with Wilms' tumor who underwent radical nephrectomy were classified into group I (under 24 months: n=15), group II (24-48 months: n=4), and group III (over 48 months: n=8), respectively. We retrospectively reviewed tumor size, pathologic features, renal vein invasion, renal capsule invasion, bilaterality, lymphovascular invasion, stage, complete resection, and survival rate. RESULTS: The mean age of groups I, II, and III was 12.5+/-7.0 (range, 1-20), 33.3+/-5.7 (range, 24-39) and 126.9+/-89.1 (range, 54-300) months, respectively. Bilaterality (p<0.001) and male sexuality (p=0.039) were significantly related to early diagnostic age. Tumor stage (p=0.036) and blastema component (p=0.027) increased with age. Bilaterality and incomplete resection of Wilms' tumor were related to larger size (p<0.001) and vessel/lymph node invasion (p=0.02), respectively. There were no significant differences in tumor volume, anaplasia, capsule invasion, lymph node invasion, vessel invasion, complete resection, laterality, or recurrence according to age. There was also no significant difference in the survival rate according to age. CONCLUSIONS: Tumor stage and blastema component of Wilm's tumor increased with age. Bilaterality and male sexuality were related to an early diagnostic age. There was no significant difference in the survival rate according to age.
Age of Onset ; Anaplasia ; Child ; Glycosaminoglycans ; Humans ; Lymph Nodes ; Male ; Nephrectomy ; Recurrence ; Renal Veins ; Retrospective Studies ; Sexuality ; Survival Rate ; Tumor Burden ; Wilms Tumor

OBJECTIVES: We sought to examine the diverse factors associated with aneurysms of the posterior circulation. In addition, the results of conventional craniotomy were compared with those of endovascular treatment. METHODS: One hundred and one patients with posterior circulation aneurysms were selected for study inclusion. The factors that might affect the clinical outcomes were studied , such as the initial Hunt-Hess (H-H) grade, aneurysm location, size of the aneurysm, and therapeutic modalities. In addition, the morbidity and mortality rates were analyzed. The treatment outcomes were evaluated using the Glasgow Outcome Scale (GOS) 6 months after the initial insult. RESULTS: The patient population consisted of 67 women and 34 men, with a mean age of 52 (range 28-81 years). The overall morbidity and mortality rates at 6 months were 13.9% (14/101) and 17.8% (18/101), respectively. Sixty-one operations (60.3%) were performed, and 32 patients were treated with endovascular therapy. Forty-two (85.7%) of the 49 patients that had initial H-H grades of I and II had a better prognosis (GOS more than 4) than those with poor H-H grades (P<0.001). Patients that underwent endovascular treatment had better outcomes than those that had clipping (P=0.032). There was no significant difference in outcome according to the size of the aneurysm, location of the aneurysm, or the age of the patients. CONCLUSIONS: The results of this study showed that the factors affecting the prognosis were the initial HH grade and treatment modality. Considering the very high mortality rate in patients with rebleeding, early management may help improve the prognosis of patients with posterior circulation aneurysms. Endovascular therapy should be considered the primary treatment modality in patients with posterior circulation aneurysms.
Aneurysm ; Craniotomy ; Female ; Glasgow Outcome Scale ; Humans ; Intracranial Aneurysm ; Male ; Prognosis

Neurosyphilis is a rare infection of the brain and spinal cord caused by a spirochete named Treponema pallidum. We describe the magnetic resonance imaging of a 53-year-old man with syphilis who manifested as both meningovascular, and spinal meningomyelitic types, which involved the optic, trigeminal, facial and vestibulocochlear nerves, both middle and left posterior cerebral arteries, thoracic spinal cord and meninges of the lumbar spine. This case report suggests that neurosyphilis should be considered as a possible diagnosis in patients showing complex brain and spinal imaging features. These features include enhancing meningeal lesions with multiple cranial nerve involvement, stenoses in large to medium size cerebral arteries, and intramedullary and meningeal lesions of spine.
Brain ; Cerebral Arteries ; Cerebral Infarction* ; Constriction, Pathologic ; Cranial Nerve Diseases* ; Cranial Nerves ; Diagnosis ; HIV* ; Humans ; Magnetic Resonance Imaging* ; Meninges ; Meningitis ; Middle Aged ; Neurosyphilis* ; Posterior Cerebral Artery ; Spinal Cord ; Spine ; Spirochaetales ; Syphilis ; Tabes Dorsalis ; Treponema pallidum ; Vestibulocochlear Nerve

Although congenital renal tumors are rare, congenital mesoblastic nephroma (CMN) is the most common renal tumor in early infancy. It is non-metastatic, well differentiated, amenable to surgical removal, and carries a good prognosis. Polyhydramnios has been detected in most of the published cases of CMN. However, we experienced a rare case of fetal CMN associated with oligohydramnios. A 28-yr old woman at 34 weeks of gestation was referred to our hospital for oligohydramnios and a fetal abdominal mass. An ultrasonography revealed a huge, well-encapsulated mass arising from the right kidney. An emergency cesarean section was performed due to fetal distress. After birth, despite intensive neonatal care, the baby died because of renal failure, disseminated intravascular coagulopathy, pulmonary edema, together with other problems.
Pregnancy ; Oligohydramnios/*diagnosis/therapy ; Nephroma, Mesoblastic/*diagnosis/therapy ; Kidney Neoplasms/*diagnosis/therapy ; Infant, Newborn ; Humans ; Fetal Diseases/etiology/prevention & control ; Female ; Fatal Outcome ; Cesarean Section ; Adult

Fibrovascular polyps are rare benign intraluminal tumors that usually arise from the cervical esophagus. These often present as very large sized pedunculated polyps and cause symptoms including dysphagia and respiratory distress. Generally, large polyps are surgically excised, while endoscopic resection is limited to smaller polyps. Herein, we present a giant fibrovascular polyp of the esophagus treated successfully by endoscopic resection.
Deglutition Disorders ; Esophagus* ; Polyps*

Background: Although neuromyelitis optica spectrum disorder (NMOSD) is known to be a rare disease, its prevalence and incidence have not yet been studied in Korea. We performed a population-based study to examine the prevalence and incidence of NMOSD in Korea using data from the Korean National Health Insurance (NHI) claims database. Methods: Data from 2013 to 2017 were obtained, with a washout period set as 2013 and 2014. The prevalence and incidence of NMOSD in 2016 and 2017 were calculated using population census data. Subjects were divided into 5 groups at 15-year intervals, depending on the age at which the diagnostic code was entered. The relative risk (RR) for each age group was compared with the oldest (≥ 60 years) age group. Results: The overall prevalence was estimated to be 3.36 and 3.56 per 100,000 individuals, with an incidence of 0.41 and 0.65 per 100,000 individuals-year in 2016 and 2017, respectively. The mean age was 43.08 (standard deviation, 14.56) years, and the ratio of male to females was 1:4.7. The incidence was higher in female individuals aged between 30 and 59 years (RR, 2.8–3.05; P < 0.05). Conclusion Nationwide prevalence of NMOSD in Korea was 3.36 and 3.56/100,000 and its incidence was 0.41 and 0.65/100,000-year in 2016 and 2017 respectively.

We report a case of acute upper limb ischemia suspected to have originated from methicillin-resistant Staphylococcus epidermidis native valve endocarditis in a 57-year-old man who had complained of sudden-onset fever and pain in the right hand. 3D computed tomography of the right upper extremity detected a thrombus occluding the brachial artery. Echocardiography showed a large vegetation on the aortic valve. Thus, we suspected, clinically, brachial artery occlusion by septic emboli originating from a large vegetation of the aortic valve. The patient was treated with intravenous antibiotics for the suspected methicillin-resistant Staphylococcus epidermidis-native valve endocarditis with a combination of percutaneous aspiration thromboembolectomy and selective intra-arterial thrombolysis for acute thromboembolic occlusion in the right upper limb. The large vegetation of the aortic valve resolved without surgery and aortic regurgitation improved. The patient recovered uneventfully with no complications, including septic embolism, over the following 11 months.
Anti-Bacterial Agents ; Aortic Valve ; Aortic Valve Insufficiency ; Brachial Artery ; Echocardiography ; Embolism ; Endocarditis* ; Fever ; Hand ; Humans ; Ischemia* ; Methicillin Resistance ; Middle Aged ; Staphylococcus ; Staphylococcus epidermidis* ; Thromboembolism ; Thrombosis ; Upper Extremity*

Castleman's disease is an uncommon disorder characterized by benign proliferation of the lymphoid tissue that occurs most commonly in the mediastinum. Although unusual locations and manifestations have been reported, involvement of the renal parenchyma and sinus, and moreover, manifestations as cardiac tamponade are extremely rare. Here, we present a rare case of Castleman's disease in the renal parenchyma and sinus that also accompanied cardiac tamponade.
Cardiac Tamponade/*diagnosis/pathology ; Diagnosis, Differential ; Diagnostic Imaging ; Giant Lymph Node Hyperplasia/*diagnosis/pathology/surgery ; Humans ; Kidney Diseases/*diagnosis/pathology/surgery ; Male ; Middle Aged ; Nephrectomy