We report two rare cases treated with coiling after rapid regrowth (within a month) of an aneurysm remnant on the middle cerebral artery (MCA) trunk after incomplete surgical clipping. The first case, a 47-year-old man with subarachonoid hemorrhage (SAH) (Hunt-Hess grade II, Fisher grade III) underwent clipping of a ruptured saccular aneurysm with a wide neck on the right early frontal branch arising from the MCA trunk. Incomplete clipping with a 1 mm sized remnant neck was performed to avoid sacrificing the lenticulostriate artery. In a follow-up cerebral angiogram on postoperative day 30, a rapid regrowth of the aneurysm remnant was observed, and on that day, complete obliteration was obtained by rescue endovascular treatment. The second case, a 48-year-old healthy woman with SAH (Hunt-Hess grade II, Fisher grade III) underwent clipping of an anteroposteriorly projecting bilobulated aneurysm on the left M1. Incomplete clipping with a minimal remnant neck was performed. In follow-up digital subtraction angiogram on postoperative day 30, a rapid regrowth of an aneurysm remnant involving only a part of the initial aneurysm near the neck was observed, and on that day, complete obliteration was obtained by rescue coiling. These patients were both discharged without any neurological deficits.

We report two rare cases treated with coiling after rapid regrowth (within a month) of an aneurysm remnant on the middle cerebral artery (MCA) trunk after incomplete surgical clipping. The first case, a 47-year-old man with subarachonoid hemorrhage (SAH) (Hunt-Hess grade II, Fisher grade III) underwent clipping of a ruptured saccular aneurysm with a wide neck on the right early frontal branch arising from the MCA trunk. Incomplete clipping with a 1 mm sized remnant neck was performed to avoid sacrificing the lenticulostriate artery. In a follow-up cerebral angiogram on postoperative day 30, a rapid regrowth of the aneurysm remnant was observed, and on that day, complete obliteration was obtained by rescue endovascular treatment. The second case, a 48-year-old healthy woman with SAH (Hunt-Hess grade II, Fisher grade III) underwent clipping of an anteroposteriorly projecting bilobulated aneurysm on the left M1. Incomplete clipping with a minimal remnant neck was performed. In follow-up digital subtraction angiogram on postoperative day 30, a rapid regrowth of an aneurysm remnant involving only a part of the initial aneurysm near the neck was observed, and on that day, complete obliteration was obtained by rescue coiling. These patients were both discharged without any neurological deficits.

Two cases of congenital anterior urethral diverticula which have occurred in a 4 year-old and one month-oldboys are presented. Etiology, diagnostic procedures, and its clinical results are briefly reviewed.
Diverticulum

BACKGROUND: We compared elderly and adult patients and tried to find a way to make an early diagnosis and proper management for elderly patients with altered mental status in the emergency department(ED). METHODS: During one year, two groups -123 elderly patients over 65 years and 127 adult patients from 20 to 64 years who visited ED in National Police Hospital(NPH)-were selected. Sex, age, arrival time after symptom onset, means of transportation, underlying diseases, causative disease, time of notification to other departments, and pattern of discharge of two groups were analyzed. RESULTS: The average age of the elderly and the adults were 76.43+/-9.51 and 42.12+/-15.0(yrs), respectively. As for the means of transportation, 84% of the elderly used a 911 ambulance service, and 11% used other emergency services. The average times from symptom onset to arrival for two groups were 124 minutes and 69 minutes, respectively. 86.99% of the elderly and 68.38% of the adults had underlying diseases. As for final diagnosis, cerebrovascular disease for the elderly and cardiovascular disease for the adults were the main causes. When patients left the hospital, rate of transfer to other hospital was higher in the elderly(60.2%), and rate of discharge was higher in the adults(15.8%). CONCLUSION: The elderly patients had more intracranial causes and needed longer time for diagnosis than the adult patients. In the case of the patients with intracranial cause who needed an emergency care, they were usually diagnosed at the secondary medical facility and then transferred to the other hospitals for proper treatment causing bad effect on the prognosis of the treatment due to time delay.
Adult ; Aged ; Ambulances ; Cardiovascular Diseases ; Early Diagnosis ; Emergencies ; Emergency Medical Services ; Humans ; Police ; Prognosis ; Transportation

Klippel-Trenaunay-Weber syndrome(KTWS) is a rare, and sporadically occurring disorder characterized by hemihypertrophy(unilateral limb hypertrophy), varicose veins, hemangiomas and occasionally arteriovenous malformations. In 1900, noted French physicians Klippel and Trenaunay first described the syndrome in 2 patients presenting with port-wine stains and varicosities of extremities associated with hypertrophy of the affected limb's bones and soft tissues. There are other, and less frequent abnormalities. These may include limbs that are atrophic, fingers and toes that are disproportionately large or small, digits that are webbed(syndactyly), and too many digits(polydactyly), or too few digits(oligodactyly). The hemangiomas can occur in internal organs including the intestinal and the urinary tract systems. The exact cause of KTWS remains to be elucidated, although several theories exist. Most cases are sporadic, although a few cases in the literature report a multifactorial patterns of inheritance. We report a case of Klippel-Trenaunay-Weber syndrome in a 3-year-old boy who had hypertrophy of the left facial bones and tissues, large hemangiomas on the right trunk and back, and hypertrophy of the right upper and lower limb's soft tissues.
Arteriovenous Malformations ; Child, Preschool ; Extremities ; Facial Bones ; Fingers ; Hemangioma ; Humans ; Hypertrophy ; Klippel-Trenaunay-Weber Syndrome* ; Male ; Malformations of Cortical Development* ; Port-Wine Stain ; Toes ; Urinary Tract ; Varicose Veins ; Wills

Bile canaliculi is closely related to the cytoskeleton; actin filament web, microtubules and cytokeratin intermediate filaments. To understand how cytoskeletal alteration affects bile canalicular structure, the investigators injected cytochalasin B and colchicine into mice intraperitoneally to inhibit the polymerization of actin filaments and microtubules respectively, and observed the structural changes of bile canaliculi and hepatocytes with transmission and scanning electron microscopes. Bile canaliculi were dilatated and microvilli were decreased in number and length after injection of cytochalasin B and colchicine. Some bile canaliculi branched irregularly after colchicine treatment. Actin filament web in the canalicular ectoplasm was disrupted leaving granular zone after cytochalasin B treatment, but was intact after colchicine treatment. Intermediate filament bundles located at angles to the canalicular membrane appeared after colchicine treatment. Intercellular junctions delimiting bile canaliculi were intact after colchicine treatment, however were disrupted after cytochalsin B treatment. Focal junctions resembling desmosome were formed between microvilli after colchicine treatment. In both cytochalasin B and colchicine treated groups, lumen of rough endoplasmic reticulum were dilated, Golgi apparatus became prominent, and lipid droplets were appeared in the cytoplasm. These results suggest that both intact actin filaments and microtubules are necessary to keep the structural integrity of bile canaliculi.
Actin Cytoskeleton ; Animals ; Bile Canaliculi* ; Bile* ; Colchicine* ; Cytochalasin B* ; Cytoplasm ; Cytoskeleton ; Desmosomes ; Endoplasmic Reticulum, Rough ; Golgi Apparatus ; Hepatocytes* ; Humans ; Intercellular Junctions ; Intermediate Filaments ; Keratins ; Liver* ; Membranes ; Mice* ; Microtubules ; Microvilli ; Polymerization ; Polymers ; Research Personnel

Spinal arachnoid cysts are relatively uncommon lesions that may be either intradural or extradural, while intradural spinal arachnoid cysts are even less common. The cysts are filled with clear, and colorless fluid nearly identical to cerebrospinal fluid. The origin of these cysts remains unclear although congenital, traumatic, and inflammatory causes have been postulated. These cysts are usually asymptomatic but may produce symptoms by compressing the spinal cord or nerve roots suddenly or progressively. The treatment of choice is surgical excision or fenestration, which is indicated when there are features of cord compression. We report a case of a thoracic spinal intradural arachnoid cyst in 13-year-old girl with chest pain.
Adolescent ; Arachnoid Cysts ; Arachnoid* ; Cerebrospinal Fluid ; Chest Pain* ; Female ; Humans ; Spinal Cord ; Thorax*

OBJECTIVES: The purpose of this study was to evaluate psychological effects of an outbreak of Middle East respiratory syndrome (MERS), a newly emerged infectious disease, on doctors. METHODS: After the MERS outbreak was over, we conducted an online survey of doctors who worked at the hospitals in which exposure to MERS cases had been confirmed or who were directly involved in MERS diagnosis and treatment. The Patient Health Questionnaires-9 (PHQ-9) and the Impact of Event Scale-Revised (IES-R) assessment methods were used to assess the severity of depressive and posttraumatic stress symptoms among the 64 doctors participating in the survey. RESULTS: The results of the survey indicate that 26.6% (n=17) of participants exhibited depressive symptoms and 7.8% (n=5) had post-traumatic stress symptoms. The doctors employed at hospitals with MERS cases had higher PHQ-9 and IES-R mean scores than those in doctors were not so employed. In contrast, there was no significant difference in those test scores between doctors who participated directly in MERS diagnosis and treatment and those doctors who did not. CONCLUSION: The survey demonstrated that 28.1% (n=18) of doctors involved in MERS care suffered from depressive or posttraumatic stress symptoms, even though the MERS infection was being controlled. Working at a hospital with MERS cases was the primary determinant of the adverse psychological outcomes among doctors ; however, direct participation in the diagnosis and care of MERS patients was not significantly related to such outcomes.
Communicable Diseases ; Communicable Diseases, Emerging ; Coronavirus Infections* ; Depression ; Diagnosis* ; Humans ; Middle East*

Carbamazepine (CBZ) is one of the most commonly used antiepileptic agents. With its potent effects against seizure or neuropathic pain, it also has several undesirable adverse events. CBZ has been known to induce hepatotoxicity because the drug is mainly metabolized through hepatic system, and asymptomatic liver enzyme elevation occurs in 5~10% of patients receiving CBZ. There are several cases of symptomatic hepatitis or hepatic necrosis by CBZ, however, reports of chronic cholangitis associated with CBZ medication are rare. Here, we present a case of chronic recurrent cholangitis by CBZ with pathological evidence.
Anticonvulsants ; Carbamazepine* ; Cholangitis* ; Hepatitis ; Humans ; Liver ; Necrosis ; Neuralgia ; Seizures

BACKGROUND: In our outpatient clinic, we sometimes encounter basal cell carcinoma (BCC) patients that have a history of laser treatment without skin biopsy at private clinics. OBJECTIVE: To investigate BCC that recurred after laser ablation. METHODS: We performed a retrospective analysis of clinical reports of 635 BCC patients biopsy-proven from January 1997 to December 2012. Histopathological examination for BCC that recurred after laser ablation was done. RESULTS: Out of 635, 85 had a history of one or more laser treatments for BCC before visiting our hospital. The mean age of patients was 66.3 years, and the ratio of male to female was 1 : 1.24. The most common site was the face (91.1%). Out of 85, 19 were treated by dermatologists and 8 by non-dermatologists. Out of 85, 58 did not remember the doctor's specialty. Histopathological examination for BCC showed basaloid tumor cell nests and peripheral palisading in all patients and pigment deposits in over two third of the patients. One patient had accompanying intradermal nevocytic nests without transformation of nevus cell to basal cell carcinoma. CONCLUSION: BCC can be misdiagnosed as pigmented nevus and subsequently mistreated with laser ablation. Skin biopsy or dermoscopy should be considered to make a correct diagnosis when an ambiguous pigmented lesion is detected in a patient.
Ambulatory Care Facilities ; Biopsy ; Carcinoma, Basal Cell* ; Dermoscopy ; Diagnosis ; Female ; Humans ; Laser Therapy* ; Male ; Nevus ; Nevus, Pigmented ; Retrospective Studies ; Skin