The lung nodule is one of the pleuropulmonary menifestations in rheumatoid arthritis. We report here a case exhibiting hydropneumothorax due to a bronchoplerual fistula resulting from a ruptured rheumatoid lung nodule complicated with a aspergilloma in it. A 39 year-old man with rheumatoid arthritis was admitted because of cough for one month. Multiple subcutaneous nodules were noted and multiple lung nodules were seen on chest X-ray, Peripheral white cells were 9,600/mm3 with 1896 of eosinophils. The percutaneous needle aspiration biopsy of the largest lung nodule of right upper lobe showed massive necrosis without acid fast bacillus, fungus, or malignant cell. Three months after discharge, air-meniscus sign was seen on the biopsied lung nodule on X-ray. Five months later, the patient was readmitted due to dyspnea and chest pain and simple chest X-ray showed hydropneumothorax on the right side. The pneumothorax was not healed after closed thoracotomy and tube drainage, and high fever developed. The pleural fluid culture revealed Pseudomonas aeroginosa and Aspergillus fumigatus. Seventy days after admission, exploratory thoracotomy was done. Aspergilloma was found in the cavitated lung nodule which was ruptured into the pleural cavity through bronchopleural fistula.
Adult ; Arthritis, Rheumatoid* ; Aspergillus fumigatus ; Bacillus ; Biopsy, Needle ; Chest Pain ; Cough ; Drainage ; Dyspnea ; Eosinophilia* ; Eosinophils ; Fever ; Fistula* ; Fungi ; Humans ; Hydropneumothorax ; Lung* ; Necrosis ; Needles ; Pleural Cavity ; Pneumothorax ; Pseudomonas ; Thoracotomy ; Thorax

PURPOSE: To report a case of iatrogenic exotropia caused by accidental excision of medial rectus muscle during functional endoscopic sinus surgery (FESS), which was successfully corrected by sequential surgical intervention (superior and inferior rectus muscle transposition followed by lateral rectus muscle recession). CASE SUMMARY: Forty one year old male patient visited our clinic with large exotropia of the right eye developed after functional endoscopic sinus surgery (FESS) which was performed one year ago. At the initial visit in our clinic, there was a large exotropia (95 PD) of the right eye and transection of the medial rectus muscle was observed at the orbital MRI. In order to correct this large iatrogenic exotropia, sequential surgery was planned. Initially, full-tendon transposition of the right superior and inferior rectus muscle was performed which reduced the deviation to 35 PD. Six weeks after the initial surgery, 7 mm right lateral rectus muscle recession was additionally performed, which resulted in exotropia of 10 PD. Diplopia was also improved and the patient was esthetically satisfied with the result. CONCLUSIONS: Even in a case of iatrogenic exotropia following one year after an accidental excision of medial rectus muscle during intranasal sinus surgery, sequential surgery such as transposition of superior and inferior rectus muscle followed by lateral rectus muscle recession can result in satisfying cosmetic and functional improvement.
Cosmetics ; Diplopia ; Exotropia ; Eye ; Humans ; Male ; Muscles ; Orbit

Objectives: Food literacy (FL) can be an important concept that embodies the nutritional capabilities of individuals. The purpose of this study was to introduce the definition and core elements of FL from previous literature, to summarize measurement tools and intervention programs with FL, and to suggest the direction of future research and programs to integrate the concept of FL. Methods: The literature review was conducted through PubMed and Google Scholar databases by combining the search term ‘food literacy’ with ‘definition’, ‘measurement’, ‘questionnaire’, ‘intervention’, and ‘program’. Among the 94 papers primarily reviewed 31 manuscripts that suited the purpose of the study were used for analyses. Results: There is no consensus on the definition of FL that encompasses the multidimensional aspects of the concept. The definitions of FL were slightly different depending on the authors, and the interpretation of the core elements also varied. Based on the review, we propose a framework of FL that is in line with the current discussion among international researchers. This focuses on the core elements adapted from health literacy, namely functional, interactive, and critical FL. Specifically, we suggest some detailed elements for interactive and critical FL, which were often the subject of divergent views among researchers in previous literature. We found that most of the tools in the reviewed literature provided information on validity and reliability and were developed for a specific target population. Also, most of the tools were focused on functional FL. Similarly, most of the interventions targeted functional FL. Conclusions This study reviewed the definition and core elements of FL, available measurement tools, and intervention programs using validated tools. We propose the development of tools with sound reliability and validity that encompass the three core elements of FL for different age groups. This will help to understand whether improving food literacy can translate into better nutritional intake and health status among individuals and communities.

Objectives: Food literacy (FL) can be an important concept that embodies the nutritional capabilities of individuals. The purpose of this study was to introduce the definition and core elements of FL from previous literature, to summarize measurement tools and intervention programs with FL, and to suggest the direction of future research and programs to integrate the concept of FL. Methods: The literature review was conducted through PubMed and Google Scholar databases by combining the search term ‘food literacy’ with ‘definition’, ‘measurement’, ‘questionnaire’, ‘intervention’, and ‘program’. Among the 94 papers primarily reviewed 31 manuscripts that suited the purpose of the study were used for analyses. Results: There is no consensus on the definition of FL that encompasses the multidimensional aspects of the concept. The definitions of FL were slightly different depending on the authors, and the interpretation of the core elements also varied. Based on the review, we propose a framework of FL that is in line with the current discussion among international researchers. This focuses on the core elements adapted from health literacy, namely functional, interactive, and critical FL. Specifically, we suggest some detailed elements for interactive and critical FL, which were often the subject of divergent views among researchers in previous literature. We found that most of the tools in the reviewed literature provided information on validity and reliability and were developed for a specific target population. Also, most of the tools were focused on functional FL. Similarly, most of the interventions targeted functional FL. Conclusions This study reviewed the definition and core elements of FL, available measurement tools, and intervention programs using validated tools. We propose the development of tools with sound reliability and validity that encompass the three core elements of FL for different age groups. This will help to understand whether improving food literacy can translate into better nutritional intake and health status among individuals and communities.

A previously healthy 12-month-old girl presented to the emergency department with vomiting of water beads (superabsorbent polymer). The girl did not have clinical or radiographic signs of residual foreign bodies or intestinal obstruction. Point-of-care ultrasound showed well-demarcated, round, and hypoechoic materials in the stomach and first part of the duodenum, indicating ingested beads. Subsequently, the beads were retrieved by the esophagogastroduodenoscopy. Because water beads can be readily found with point-of-care ultrasound, the use of this imaging modality can expedite endoscopic intervention and avoid surgical removal of foreign bodies.

Bronchial mucoepidermoid carcinoma is uncommon, representing 0.2% of all lung tumors. The disease usually presents with symptoms of airway obstruction and recurrent pneumonia. It is commonly classified into two grades in Korea, low and high. We report a case of a bronchial mucoepidermoid carcinoma in a 40-year-old woman who complained of symptoms of an upper respiratory infection. The histological grade after a bronchoscopic biopsy was intermediate. A left upper lobectomy was performed as treatment. The TNM stage of this case was IA (T1N0M0). In addition, 25 cases of bronchial mucoepidermoid carcinoma from 1984 in Korea are also reviewed from the viewpoint of the relationship between the histological grade, TNM stage and clinical course of the tumor.
Adult ; Airway Obstruction ; Biopsy ; Carcinoma, Mucoepidermoid ; Female ; Humans ; Korea ; Lung ; Pneumonia

Wegener's granulomatosis is a systemic vasculitis of the medium and small arteries, as well as of the venules, arterioles, and occasionally large arteries, and primarily involves the upper and lower respiratory tracts and the kidneys. Renal symptoms of Wegener's granulomatosis are indistinguishable from those of vasculitis such as Henoch-Schonlein purpura and microscopic polyangiitis. This case, though initially diagnosed as Henoch-Schonlein purpura, was confirmed as Wegener's granulomatosis from a lung biopsy fifteen years after the initial diagnosis. We report this case with a review of the literature.
Arteries ; Arterioles ; Biopsy ; Delayed Diagnosis* ; Diagnosis ; Kidney ; Lung ; Microscopic Polyangiitis ; Purpura, Schoenlein-Henoch* ; Respiratory System ; Systemic Vasculitis ; Vasculitis ; Venules ; Wegener Granulomatosis*

Wegener's granulomatosis is a systemic vasculitis of the medium and small arteries, as well as of the venules, arterioles, and occasionally large arteries, and primarily involves the upper and lower respiratory tracts and the kidneys. Renal symptoms of Wegener's granulomatosis are indistinguishable from those of vasculitis such as Henoch-Schonlein purpura and microscopic polyangiitis. This case, though initially diagnosed as Henoch-Schonlein purpura, was confirmed as Wegener's granulomatosis from a lung biopsy fifteen years after the initial diagnosis. We report this case with a review of the literature.
Arteries ; Arterioles ; Biopsy ; Delayed Diagnosis* ; Diagnosis ; Kidney ; Lung ; Microscopic Polyangiitis ; Purpura, Schoenlein-Henoch* ; Respiratory System ; Systemic Vasculitis ; Vasculitis ; Venules ; Wegener Granulomatosis*

PURPOSE: Behcet's disease (BD) theoretically affects all sizes and types of blood vessels and results in multi-organ involvement. However, renal BD has not been fully characterized, though the kidneys are histologically rich in blood vessels. MATERIALS AND METHODS: A total of 2007 patients who fulfilled the diagnostic criteria for BD were enrolled in this study. We reviewed the medical records and test results of the BD patients and used univariate and multivariate logistic regression analyses to determine the clinical significance of renal involvement in BD. RESULTS: Among the 2007 BD patients, we noted hematuria in 412 (20.5%) and proteinuria in 29 (1.4%). Univariate analysis showed that the BD patients with hematuria were predominantly female and older, had higher erythrocyte sedimentation rates (ESRs), and more frequently presented with genital ulcerations. BD patients with proteinuria had higher ESR levels compared to BD patients without proteinuria. In the multivariate analysis, age, sex, and ESR were found to be significantly associated with hematuria in BD patients, whereas only ESR was associated with proteinuria in BD patients. We also found that IgA nephropathy was the most common pathologic diagnosis in 12 renal BD patients who underwent renal biopsies. CONCLUSION: We suggest that routine urinalysis and serum renal function tests be performed for the early detection of renal BD, especially in older female BD patients with recurrent hematuria, high ESR levels, and frequent genital ulcers, as well as in BD patients with proteinuria and high ESR levels.
Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Behcet Syndrome/*complications/epidemiology/*metabolism ; Biopsy ; Female ; Glomerulonephritis, IGA/complications/diagnosis ; Hematuria/complications/diagnosis ; Humans ; Kidney/*pathology ; Kidney Diseases/*diagnosis ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Proteinuria/complications/diagnosis ; Republic of Korea ; Young Adult

PURPOSE: Early detection and appropriate treatment of pelvic inflammatory disease (PID) are important to prevent adverse sequelae. The purpose of this study was to evaluate the usefulness of computed tomography (CT) for diagnosis of PID in an emergency department (ED). METHODS: We undertook a retrospective review of patients with acute low abdominal pain who were checked by abdominal CT in the ED at a tertiary hospital between June 2009 and December 2009. Inclusion criteria were PID on CT or non specific findings on CT and a consultation to the gynecology department. Exclusion criteria were age less than 15 years, age greater than 60 years, definite other causes for the acute low abdominal pain seen on CT, intact virginity, and transfer to another hospital. We compared clinical characteristics and laboratory findings between group A (clinically diagnosed PID patients) and group B (non-PID patients). We calculated sensitivity and specificity of CT findings to predict clinical diagnosis of PID. RESULTS: A total of 68 patients were enrolled in this study. Median age was 31 years (24-39). Group A consisted of 51 patients; group B of 17 patients. Cervical motion tenderness (p=0.001) and WBC count (p=0.013) were significantly different between the two groups. The accuracy of PID findings on CT for predicting the clinical diagnosis of PID was 85.29%. The sensitivity and specificity were 92.16% and 64.71%, respectively. Leukorrhea had a sensitivity of 76.47% and a specificity of 47.06%. Cervical motion tenderness had a sensitivity of 87.18% and a specificity of 75%. CONCLUSION: Abdominal CT performed in the ED is a useful method for the clinical diagnosis of PID.
Abdominal Pain ; Emergencies ; Female ; Gynecology ; Humans ; Leukorrhea ; Pelvic Inflammatory Disease ; Retrospective Studies ; Sensitivity and Specificity ; Sexual Abstinence ; Tertiary Care Centers ; Tomography, Spiral Computed