Acute cerebral infarctions are rare in children, however, they can occur as a complication of a Mycoplasma pneumoniae (MP) infection due to direct invasion, vasculitis, or a hypercoagulable state. We report on the case of a 5-year-old boy who had an extensive stroke in multiple cerebrovascular territories 10 days after the diagnosis of MP infection. Based on the suspicion that the cerebral infarction was associated with a macrolide-resistant MP infection, the patient was treated with levofloxacin, methyl-prednisolone, intravenous immunoglobulin, and enoxaparin. Despite this medical management, cerebral vascular narrowing progressed and a decompressive craniectomy became necessary for the patient's survival. According to laboratory tests, brain magnetic resonance imaging, and clinical manifestations, the cerebral infarction in this case appeared to be due to the combined effects of hypercoagulability and cytokineinduced vascular inflammation.
Brain ; Cerebral Infarction* ; Child ; Child, Preschool ; Decompressive Craniectomy ; Diagnosis ; Enoxaparin ; Humans ; Immunoglobulins ; Inflammation ; Levofloxacin ; Magnetic Resonance Imaging ; Male ; Mycoplasma pneumoniae* ; Mycoplasma* ; Pneumonia, Mycoplasma* ; Stroke ; Thrombophilia ; Thrombosis ; Vasculitis

Although pulmonary artery aneurysms are a rare vascular anomaly, they are seen in a wide variety of conditions, such as congenital heart disease, infection, trauma, pulmonary hypertension, cystic medial necrosis and generalized vasculitis. To our knowledge, mycotic aneurysms caused by pulmonary actinomycosis have not been reported in the radiologic literature. Herein, a case of pulmonary actinomycosis complicated by mycotic aneurysm is presented. On CT scans, this case showed focal aneurysmal dilatation of a peripheral pulmonary artery within necrotizing pneumonia of the right lower lobe, which was successfully treated with transcatheter embolization using wire coils.
Actinomycosis/*complications ; Aged ; Aneurysm, Infected/*etiology/*radiography/therapy ; Embolization, Therapeutic ; Human ; Male ; Pneumonia, Bacterial/*complications ; *Pulmonary Artery ; Treatment Outcome

Methods: Three hundred and sixty-nine students in art high school completed a battery of measures, including the Korean version of the KMPAI, State-Trait Anxiety Inventory (STAI), Liebowitz Social Anxiety Scale (LSAS), Center for Epidemiologic Studies-Depression Scale (CES-D), and Frost Multidimensional Perfectionism Scale-Korean version (FMPS-K). The construct validity of the Korean version of KMPAI was examined by performing explorative factor analysis. The reliability was assessed by the internal consistency using Cronbach’s alpha. Results: Explorative factor analysis for the construct validity showed that the Korean version of KMPAI was composed of seven factors (factor 1: Worry/dread and Negative cognitions; factor 2: Proximal somatic anxiety and Worry about performance; factor 3: Depression/hopelessness; factor 4: Parental empathy–Memory–Controllability; factor 5: Generational transmission of anxiety;factor 6: Trust; factor 7: Rumination), explaining 61% of the total variance. The T Concurrent validity with the other scales (STAI, LASA, CES-D, and FMPS-K) was statistically significant. The Cronbach’s alpha value for the internal consistency of the Korean version of KMPAI was excellent (r=0.961). Conclusion The Korean version of the KMPAI is a reliable and valid instrument for measuring music performance anxiety in Korea.

BACKGROUND: P wave dispersion (PWD) and P wave duration have been used to evaluate the discontinuous propagation of sinus impulse and the prolongation of atrial conduction time, respectively. This study was conducted to compare the change of the maximal P wave duration (Pmax) and PWD according to the treatment strategy used in patients with an acute myocardial infarction (AMI). METHODS: We retrospectively evaluated 86 patients that experienced an AMI. Patients were classified into three groups according to the treatment strategy: primary percutaneous coronary intervention (PCI), thrombolytic therapy, and delayed PCI. ECGs that were obtained from all patients on admission and on the second day were analyzed. The Pmax and minimum P wave duration (Pmin) were measured from a 12-lead ECG. The PWD was calculated as the difference between the Pmax and Pmin. RESULT: There was no significant difference in the age, gender, medication, coronary risk factor, ejection fraction, left atrial diameter, basal Pmax and PWD among the groups. However, there were significant differences in P max and PWD between the primary PCI group and the other groups on the second day after hospital admission. In the thrombolytic therapy and delayed PCI groups, the PWD was significantly lower in the patients with a patent infarct-related artery (IRA) than in patients without a patent IRA on the second day after hospital admission. CONCLUSIONS: These findings suggest that a primary PCI decreased the Pmax and PWD more than thrombolytic therapy or a delayed PCI.
Arteries ; Electrocardiography ; Humans ; Myocardial Infarction* ; Percutaneous Coronary Intervention ; Retrospective Studies ; Risk Factors ; Thrombolytic Therapy

Many patients regard tonsillectomy as a minor operation because it is performed frequently. Although tonsillectomy is considered a relatively safe surgical procedure, numerous complications have been described. The common complications are hemorrhage, infection, and following anesthesia, aspiration, cardiac arrhythmia, and laryngeal trauma. Cervicofacial emphysema and pneumomediastinum are rarely observed sequelae of surgical intervention in the upper aerodigestive tract. Although these complications resolve spontaneously in most cases, a few cases result in tension pneumothorax and other life-threatening conditions. Symptoms include chest pain, neck pain, dyspnea and odynophagia. Treatment involves frequent assessment of the airway and extent of the emphysema. The authors of the present study report of a patient who developed pneumomediastinum shortly after an adenotonsillectomy as well as a review of the related literature.
Anesthesia ; Arrhythmias, Cardiac ; Chest Pain ; Dyspnea ; Emphysema ; Hemorrhage ; Humans ; Mediastinal Emphysema ; Neck Pain ; Pneumothorax ; Subcutaneous Emphysema ; Tonsillectomy

We experienced a case of primary gastric tuberculosis presented with melena. A 61-year-old male was admitted with epigastric pain and melena. Upper endoscopy revealed an irregular shaped gastric ulcer on the posterior wall of the body. Histological examination of endoscopic specimen revealed chronic inflammation with fibrosis, granulomas and acid-fast bacilli. Cultures for acid-fast bacilli subsequently grew Mycobacterium tuberculosis. There was no evidence of the tuberculous lesion anywhere else. Primary gastric tuberculosis remains an extremely uncommon clinical entity; the definitive diagnosis is made by biopsy and positive culture for the organism. We report a case of primary gastric tuberculosis with review of the literature.
Biopsy ; Diagnosis ; Endoscopy ; Fibrosis ; Granuloma ; Humans ; Inflammation ; Male ; Melena* ; Middle Aged ; Mycobacterium tuberculosis ; Stomach Ulcer ; Tuberculosis*

BACKGROUND: The aim of this study was to investigate the hepatic pathology of HBx transgenic mice. METHODS: The gross and histological examinations were done in 125 HBx transgenic mice and 34 non-transgenic littermates. RESULTS: The incidence of a hepatic tumor was in-creased in the HBx transgenic mice older than 7 months and the overall incidence of a hepatic tumor was 62.2% (51/82) in the 13-18 months group of the HBx transgenic mice. The size of the hepatic tumor was 2.06+/-.92 mm in the 7-12 months group and 4.94+/-.05 mm in the 13-18 months group of HBx transgenic mice. All hepatic tumors were hepatocellular carcinomas and the histological patterns of hepatocellular carcinoma were either solid (84.2%, 48/57) or trabecular (15.8%, 9/57). Dysplastic changes in the hepatocytes were evident in 59.2% (74/125) of the HBx transgenic mice. There was lymphocyte infiltration, necrosis, fatty metamorphosis in both the dysplastic and tumor areas of the HBx transgenic mice. Vascular ectasia was identified in the tumor area of the HBx transgenic mice. CONCLUSIONS: The pathological findings of the HBx transgenic mice were dysplastic changes in the hepatocytes and development of a hepatocellular carcinoma associated with lymphocyte infiltration, necrosis, fatty metamorphosis in the dysplastic area and tumor area of the HBx transgenic mice.
Animals ; Carcinoma, Hepatocellular ; Dilatation, Pathologic ; Hepatitis B virus* ; Hepatitis B* ; Hepatitis* ; Hepatocytes ; Incidence ; Liver* ; Lymphocytes ; Mice ; Mice, Transgenic* ; Necrosis ; Pathology

PURPOSE: A maximum P-wave duration (Pmax) of > or = 110msec and a P-wave dispersion (PWD) > or = 40msec are accepted indicators of a disturbance in interatrial conduction and an inhomogeneous propagation of the sinus impulse, respectively. The left atrial (LA) volume has been reported to be strongly associated with a systolic and diastolic dysfunction and is considered to be an index of atrial remodeling. We aimed to investigate the relationship between LA volume and Pmax or PWD in patients with congestive heart failure (CHF). PATIENTS AND METHODS: Sixty-one patients with CHF were enrolled in this study. The study population was classified into four groups: two groups were divided according to the Pmax (> or = 110msec or < 110ms), and the other two groups were formed based on the PWD (> or = 40msec or < 40msec). The left atrial volume index (LAVi) was measured by three-dimensional (3-D) transthoracic echocardiography. The Pmax and PWD were measured from a 12-lead electrocardiogram. RESULTS: There were significant differences in the ejection fraction (EF), diastolic function, and LAVi between patients with a Pmax > or = 110ms or a PWD > or = 40ms and those with a Pmax < 110ms or a PWD < 40ms. The LAVi was independently associated with a disturbance in interatrial conduction and an inhomogeneous propagation of the sinus impulse. The LAVi can be used to identify patients with a disturbance in interatrial conduction and an inhomogeneous propagation of the sinus impulse with reasonably good accuracy. CONCLUSION: We concluded that a disturbance in interatrial conduction and an inhomogenous propagation of the sinus impulse in patients with CHF is associated with an increase in the LA volume and a deleterious systolic and diastolic dysfunction.
Aged ; *Atrial Function, Left ; *Cardiac Volume ; Echocardiography ; *Electrocardiography ; Female ; Heart Failure/*physiopathology/ultrasonography ; Humans ; Male ; Middle Aged ; Sinus Arrest, Cardiac/ultrasonography

Arteriovenous malformation (A-V malformation) is defined as an abnormal connection between arteries and veins that lead to A-V shunting with an intervening network of vessels. A-V malformation is a rare condition, and spontaneous regression is also rare. A-V malformation becomes symptomatic when the surrounding tissue and osseous structures are negatively affected. A-V malformation has a high recurrence rate and is relatively hard to treat. In this case, a huge mass with pulsatile and bruit on the medial plantar area were observed. With the diagnosis of A-V malformation in accordance with the results from ultrasonography, magnetic resonance imaging and computed tomography angiography, and mass excision with feeding vessel ligation through plantar midfoot approach was completed successfully.
Angiography ; Arteries ; Arteriovenous Malformations* ; Diagnosis ; Foot* ; Ligation ; Magnetic Resonance Imaging ; Recurrence ; Ultrasonography ; Veins

A large symptomatic and unresolved pancreatic pseudocyst is treated surgically by internal drainage to a neighboring adherent viscus. Recently the various minimal invasive approaches have been used to treat this condition. A 30- year-old man who had been in clinical follow-up for a chronic pancreatitis. For the necrotizing pancreatitis, the patient had undergone surgical debridement and external drainage 5 years, and 3 years ago, respectively. Abdominal ultrasonography and computed tomography revealed 8.2x7.7 cm sized pseudocyst in the body of pancreas. Endoscopic internal fistula formation was tried, but it was failed due to bleeding. We underwent adhesiotomy and cystogastrostomy totally with laparoscopic techniques. The patient started a diet on the 5th postoperative day and discharged on the 11th postoperative day. There was no postoperative complicationand no recurrence during 6 months. Laparoscopic cystogastrostomy is safe and feasible method in the pancreatic pseudocyst even in case of severe abdominal adhesion.
Debridement ; Diet ; Drainage ; Fistula ; Follow-Up Studies ; Hemorrhage ; Humans ; Pancreas ; Pancreatic Pseudocyst* ; Pancreatitis ; Pancreatitis, Chronic ; Recurrence ; Ultrasonography