Tetanus is a rare disease in the developed countries, including Korea, as a result of nearly universal active immunization. Because many physicians have little experience with its diagnosis and management, misdiagnosis and therapeutic delay may result in catastrophic consequences. We report one case of generalized tetanus. A previously healthy 35-year-old man was admitted to the emergency department because of stiffness on jaw and neck. board-like abdomen, extended and rigid both legs, chest tightness, and dyspnea. Seven days before admission, he was injured on the right thing at work. In the emergency department, he was given 5,000 units of human tetanus immunoglobulin intramuscularly, as well as diazepam 2 mg/hr intravenously. On the second hospital day, tracheostomy was performed. Ten days later, his condition was improved. Twenty eight days after admission, he was discharged without any complication.
Abdomen ; Adult ; Developed Countries ; Diagnosis ; Diagnostic Errors ; Diazepam ; Dyspnea ; Emergency Service, Hospital ; Humans ; Immunoglobulins ; Jaw ; Korea ; Leg ; Neck ; Rare Diseases ; Tetanus* ; Thorax ; Tracheostomy ; Vaccination

No abstract available.
Sepsis* ; Serratia marcescens* ; Serratia*

No abstract available.
Upper Extremity Deep Vein Thrombosis

Ameloblastoma ; Ameloblasts ; Cell Proliferation ; Epithelial Cells ; Jaw ; Keratins ; Mitosis ; Neoplasm Metastasis ; Recurrence

Metaplastic breast carcinoma is very rare, and metaplastic carcinoma with chondroid differentiation is even rarer. Here, we report a case of metaplastic carcinoma with extensive chondroid differentiation mimicking chondrosarcoma that was challenging to diagnose. The tumor was characterized by an abundant chondromyxoid matrix. The definitive area of classic invasive ductal carcinoma was minimal. The peripheral portion of the tumor showed increased cellularity with pleomorphism and definitive invasive growth. Tumor cells in the chondrosarcomatous areas were diffusely immunoreactive for S-100 protein, patchy positive for cytokeratin, but negative for epithelial membrane antigen (EMA). Tumor cells in carcinomatous areas were diffusely positive for cytokeratin, S-100 protein, and patchy positive for EMA. In both areas, tumor cells were negative for smooth muscle actin (SMA) and CD34, while oncoprotein p53 was overexpressed. When pathologists encounter breast tumors with chondroid differentiation, careful sampling and immunohistochemistry for cytokeratin and SMA are most helpful to differentiate metaplastic carcinoma from malignant phyllodes tumor and malignant adenomyoepithelioma.
S100 Proteins/chemistry ; Neoplasm Metastasis ; Muscle, Smooth/pathology ; Middle Aged ; Metaplasia ; Keratins/metabolism ; Immunohistochemistry ; Humans ; Female ; Cell Differentiation ; Carcinoma/*complications/metabolism/pathology ; CA-15-3 Antigen/metabolism ; Breast Neoplasms/complications/metabolism/*pathology ; Antigens, CD34/biosynthesis ; Actins/metabolism

Female ; Humans ; Male ; Molar ; Molar, Third ; Tooth ; Tooth, Impacted ; Young Adult

The normal volume hydrocephalus is a serious, late complication of cerebrospinal fluid shunting procedures. It is characterized by persistent symptoms of headaches, vomiting and/or lethargy in shunted patients and is associated with normal-sized or slightly decreased ventricles. The subependymal gliosis that has been described in experimental and human hydrocephalus was offered as an explanation for the increased elastance in this condition. This 21-yearold male was shunted at 13 years of age for hydrocephalus secondary to pineal gland tumor. He remained asymptomatic for approximately 7 years before admission, when headaches and vomiting developed. A brain CT showed nearly normal-sized ventricles and spinal tapping documented elevated intracranial pressure (300mg CSF). A metrizamide shuntgram suggested obstruction of distal abdominal shunt catheter. After a revision of the distal shunt catheter, the patient became asymptomatic. On follow-up brain CT, no significant decrease in ventricle size was noted.
Brain ; Catheters ; Cerebrospinal Fluid Shunts ; Follow-Up Studies ; Glioma, Subependymal ; Headache ; Humans ; Hydrocephalus* ; Intracranial Hypertension ; Lethargy ; Male ; Metrizamide ; Pinealoma ; Spinal Puncture ; Vomiting

PURPOSE: To evaluate the clinical usefulness of a home-made histographic analysis system using a lung volume controller. MATERIALS AND METHODS:Our study involved ten healthy volunteers, ten emphysema patients, and two idio-pathic pulmonary fibrosis (IPF) patients. Using a home-made lung volume controller, images were obtained in the upper, middle, and lower lung zones at 70%, 50%, and 20% of vital capacity. Electron beam tomography was used and scanning parameters were single slice mode, 10-mm slice thickness, 0.4-second scan time, and 35 -cm field of view. Using a home-made semi-automated program, pulmonary parenchyma was isolated and a histogram then obtained. Seven histographic parameters, namely mean density (MD), density at maximal frequency (DMF), maximal ascending gradient (MAG), maximal ascending gradient density (MAGD), maxi-mal descending gradient (MDG), maximal descending gradient density (MDGD), and full width at half maxi-mum (FWHM) were derived from the histogram. We compared normal controls with abnormal groups includ-ing emphysema and IPF patients at the same respiration levels. RESULTS: A normal histographic zone with +/-1 standard deviation was obtained. Histographic curves of normal controls shifted toward the high density level, and the width of the normal zone increased as the level of inspi-ration decreased. In ten normal controls, MD, DMF, MAG, MAGD, MDG, MDGD, and FWHM readings at a 70% inspiration level were lower than those at 20% (p<0.05). At the same level of inspiration, histograms of emphysema patients were located at a lower density area than those of normal controls. As inspiration status decreased, histograms of emphysema patients showed diminished shift compared with those of normal con-trols. At 50% and 20% inspiration levels, the MD, DMF, and MAGD readings of emphysema patients were significantly lower than those of normal controls (p<0.05). Compared with those of normal controls, his-tograms of the two IPF patients obtained at three inspiration levels were located in an area of higher density. CONCLUSION: Using a home-made histographic analysis system which included a lung volume controller, pa-tients with diffuse parenchymal lung disease could be distinguished from normal controls. The method may be useful for the diagnosis and follow up of diffuse parenchymal lung diseases.
Diagnosis ; Emphysema ; Healthy Volunteers ; Humans ; Lung Diseases* ; Lung Diseases, Interstitial ; Lung* ; Pilot Projects* ; Pulmonary Emphysema ; Pulmonary Fibrosis ; Reading ; Respiration ; Tomography, X-Ray Computed ; Vital Capacity

Purpose: Catheter associated urinary tract infection (CAUTI) frequently occurs in the patients with an indwelling Foley catheter, and it can cause serious morbidity or mortality. However, there have been no reports about quorum sensing mechanisms in indwelling Foley catheter. It's our purpose to find out the quorum sensing mechanisms of isolated bacteria from biofilm in Foley catheters. Materials and Methods: Silicone Foley catheters were placed in 90 patients with neurogenic bladders. At the 3rd, 5th, 7th, 14th and 30th day after the catheters were placed, the catheters were removed and the biofilm formations were evaluated by routine culture and microscopy. The ygaG gene, which was reported to be an autoinducer synthase gene was carried out cloning in E. coli. The quantity of the mRNA expression of the ygaG gene was analyzed according to the time by competitive reverse transcription polymerase chain reaction (RT-PCR). Results: 289 different types of bacteria were isolated by cultivation. The most common species were Pseudomonas, Klebsiella, Serratia, Proteus and Escherichia species. The autoinducer synthase gene, such as the ygaG gene for Escherichia coli, was detected by RT-PCR. On competitive RT-PCR of the ygaG gene, the mRNA expression was 3.77x10(9)copies/microliter at the 3rd day, 5.94x10(7)copies/microliter at the 5th day, 8.07x10(7)copies/microliter at the 7th day, 2.51x10(6)copies/microliter at the 14th day and 6.81x10(8)copies/microliter at the 30th day. Therefore, the expression of the autoinducer synthase gene was observed at the early insertion period and it was then maintained. Conclusions: This is the first study to document the autoinducer synthase gene expression associated quorum sensing mechanism in CAUTI. The quorum sensing mechanism may be a new target for the management of CAUTI.
Anti-Bacterial Agents ; Bacteria ; Biofilms ; Catheters* ; Clone Cells ; Cloning, Organism ; Escherichia ; Escherichia coli ; Gene Expression* ; Humans ; Klebsiella ; Microscopy ; Mortality ; Polymerase Chain Reaction ; Proteus ; Pseudomonas ; Quorum Sensing* ; Reverse Transcription ; RNA, Messenger ; Serratia ; Silicones ; Urinary Bladder ; Urinary Tract Infections* ; Urinary Tract*

A leiomyosarcoma of the spermatic cord is an extremely rare tumor. A 73-year-old man complained of a soft, palpable mass in the right inguinal canal. Transinguinal radical orchiectomy was performed and histologic examination revealed leiomyosarcoma originating from the spermatic cord. Distant metastases were not observed by further examinations. At 7 months postoperatively, a local recurrence developed. Reoperative wide resection was performed and a negative margin was obtained. At 9 months reoperatively, there has been no recurrence or metastasis.
Aged ; Humans ; Inguinal Canal ; Leiomyosarcoma ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; Orchiectomy ; Recurrence ; Spermatic Cord