Scrub typhus (Tsutsugamushi disease)is an acute febrile systemic illness caused by Rickettsia tsutsugamushi that is transmitted to humans by the bite of larval-stage trombiculid mites (chiggers). The authors analyzed chest radiographic findings of scrub typhus in 160 patients in Ulsan area. One hundred and eight (67.5%) of160 patients showed abnormal findings which included lung lesions in 108 patients (67.5%), cardiomegaly in 37 patients (23.1%), lymphadenopathy in 25 patients (15.6%) and pleural effusion in 11 patients (6.9%). Among the lung lesions, interstitial patterns were seen in 107 patients (66.9%), mostly fine or medium reticulonodular, and air-space patterns in 14 patients(8.8%) and combined interstitial and air-space patterns in 13 patients (8.1%). Sixty-four patients(40%) had combined chest radiographic findings. The typical chest radiographic findings of scrub typhus would be helpful in evaluation of the causes of acute febrile illness that occur during late fall in the endemic area.
Cardiomegaly ; Humans ; Lung ; Lymphatic Diseases ; Orientia tsutsugamushi ; Pleural Effusion ; Radiography, Thoracic* ; Scrub Typhus* ; Thorax* ; Trombiculidae ; Ulsan*

No abstract available.
Hysterectomy*

Hypothalamic hamartoma is a congenital anomaly presenting precocious puberty, gelastic seizure and mental retardation. Other possible accompanying anomalies are cleft palate, tetralogy of Fallot, skeletal malformation and anal malformation. But the patient describing here manifested gelastic seizure only with isosignal mass of 1.5cm in diameter situated just behind optic chiasm in T1WI and T2WI of MRI. His EEG showed multifocal spike and sharp waves at left frontal and central area with asymmetric sleep spindles. The seizure has been refractory to conventional antiepileptic drugs. He is now on Lamotrigine, a newly developed antiepileptic drug available.
Anticonvulsants ; Arteriovenous Malformations ; Cleft Palate ; Electroencephalography ; Hamartoma* ; Humans ; Intellectual Disability ; Magnetic Resonance Imaging ; Optic Chiasm ; Paraplegia ; Puberty, Precocious ; Seizures* ; Spine ; Tetralogy of Fallot

We reviewed 27 patients wlth cerebellar infarction which was demonstrated by brain CT and/or MRI. Infarction occurred in the territory of posterior inferior cerebellar artery (PICAj in 16 patients, and the territory of the superior cerebellar artery(SCA) was involved in 5 patients. Antenor inferior cerebellar artery(AICA) infarcts occurred in 3 patients. Both PICA and SCA temtories were involved in 2 patients. In the remaining 1 patient, the infarct encompassed the borderzone between the SCA and PICA territories. The main symptoms and signs were sudden onset of vertigo, dizziness, nausea, vomiting, dysmetria, ataxia, nystagmus, and headache. There were signs of associated brain stem infarction or occipitotemporal infarction; rostral basilar artery syndrome, classic SCA syndrome, Wallenberg syndrome, internuclear ophthalmoplegia, facial palsy, hearing impairment. Presumed cerebral embolism was the main stroke mechanism in the SCA terntories. Six patients with brainstem compression or brainstem involvement showed consciousness deterioration, and only one of them died as a result of extensive cerebellar infarctions involving both SCA and PICA territories Cerebellar infarction may run a more benign course than previously thought.
Arteries ; Ataxia ; Basilar Artery ; Brain ; Brain Stem ; Brain Stem Infarctions ; Cerebellar Ataxia ; Consciousness ; Dizziness ; Facial Paralysis ; Headache ; Hearing Loss ; Humans ; Infarction* ; Intracranial Embolism ; Lateral Medullary Syndrome ; Magnetic Resonance Imaging ; Nausea ; Ocular Motility Disorders ; Pica ; Stroke ; Vertigo ; Vomiting

A 13-year-old girl was transferred from a private clinic to our emergency department due to lower abdominal pain and acute urinary retention. Radiologic evaluation showed an imperforate hymen with hematocolpometra. In the emergency department, an imperforate hymen is a rare cause of acute urinary retention. Usually, the diagnosis of a congenital inperforate hymen can be made by inspection of the perineum; however, in many cases, an extensive radiologic evaluation must be performed because of misdiagnosis. The emergency physician should consider an imperforate hymen in girls with lower abdominal pain and urinary retention.
Abdominal Pain* ; Adolescent ; Diagnosis ; Diagnostic Errors ; Emergencies ; Emergency Service, Hospital ; Female ; Humans ; Hymen* ; Perineum ; Urinary Retention*

BACKGROUND: Low functional nephron mass and graft kidney-recipient body size mismatch can lead to poor graft function. To examine the impact of the ratios of the surrogates to recipient body surface area (BSA) and body weight on graft function within 5 years post-transplantation, we measured the graft kidney volume, using computed tomography with 3-dimensional reconstruction before transplantation, and measured the graft kidney weight during surgery in living donor kidney transplantation (LDKT). METHODS: Between February 2004 and November 2013, 142 LDKT recipients without delayed graft function, acute rejection, or infection within 5 years of transplantation were included. The graft function and its relations with graft kidney volume and its weight were analyzed. RESULTS: The graft kidney volume/recipient BSA ratio showed correlation with the estimated glomerular filtration rate (eGFR) of recipients after 3 years post-transplantation. We found a difference in the graft function between recipients with a graft kidney volume/recipient BSA ratio of > or =80.4 mL/m2 and those with a ratio of <80.4 mL/m2 (P<0.05). Multivariate analysis showed that the graft kidney volume/recipient BSA ratio, the graft kidney weight/recipient body weight ratio, donor age, donor eGFR, and donor/recipient BSA ratio are independent predictors of graft function at each period of transplantation (P<0.05). CONCLUSIONS: The graft kidney volume of living donors may predict graft function and during living donor and recipient matching, both the potential volume of the donated kidney and the body size of the recipient should be considered.
Body Size ; Body Surface Area ; Body Weight ; Delayed Graft Function ; Glomerular Filtration Rate ; Humans ; Kidney Transplantation* ; Kidney* ; Living Donors* ; Multivariate Analysis ; Nephrons ; Tissue Donors ; Transplants*

Malignant mixed miillerian tumors(MMMTs) are uncommon neoplasms of the female genital tract that are histologically defined by the presence of malignant epithelial and stromal elements. MMMTs can arise hom the uterine body, cervix, vagina, ovary, and fallopian tube and constitute less than 1% of all overian malignancies. These tumors are usually advanced when diagnosed and follow an aggressive clinical course. We had experienced a cas#e of MMMT of the ovary and presented with a brief review of literature.
Cervix Uteri ; Fallopian Tubes ; Female ; Humans ; Ovary* ; Vagina

PURPOSE: The purpose of this study was to investigate the feasibility and the optimal conditions of radiofrequency (RF) ablation by using the stent-type electrode upon the saphenous vein of goats for the endovenous treatment of varicose veins. MATERIALS AND METHODS: A self-expandable nitinol stent electrode (6 mm diameter, 2 cm length, cell size; 1.3x2 mm) was designed to expose the distal 1cm segment to allow for contact with the venous wall. The proximal part of the electrode was connected to the RF generator by insulated copper wires located within the stent electode introducer. Initially, to optimize the power setting, ablation of 6 saphenous veins in 3 goats was performed with power settings of 10, 20 and 30 W. Pull back rate of the electrode was 2 and 4 cm/min for each power level, respectively. The goats were sacrificed 4-6 weeks later and histologic examinations of the saphenous veins were done. For the second part of the experiment, RF ablation of 4 saphenous veins from 2 goats was done by applying the optimal power, based upon the first examination; these procedure was performed with variable pull back rates. Again, the goats were sacrificed 1-6 weeks later and histologic examinations were done. RESULTS: Endovenous ablation of the goat saphenous veins at 20 W caused complete obliteration without complication. There was incomplete occlusion at 10 W, and there were vessel perforation, extravasation, and adjacent tissue injury at 30 W. In second part of the study, the complete circumferential obliteration of the vein was demonstrated at a pull back rate of 1 cm/min and 3 cm/min with the power of 20 W. CONCLUSION: The stent-type electrode may be useful in endovenous RF ablation for treatment of varicose veins. For stents with a diameter of 6 mm, the optional combination of 20 W of power with a pull back rate of 1-3 cm/min produced the most favorable results. Further study and clinical investigations are warranted.
Catheter Ablation* ; Cell Size ; Copper ; Electrodes* ; Goats* ; Saphenous Vein ; Stents ; Varicose Veins* ; Veins

PURPOSE: The purpose of this study is to investigated the clinico-toxicological characteristics of patients with acute organophosphate intoxication requiring Mechanical Ventilation. METHODS: We reviewed retrospectively the medical records of patients with acute organophosphate intoxication in our emergency center from January 2002 to December 2003. We compare to toxicologic characteristics, laboratory findings, patients managements, complications, and outcomes between Mechanical Ventilation group (MV group) and non-Mechanical Ventilation group (non MV group) RESULTS: Thirty-six patients are investigated. Twelve patients were the MV group and twenty-four patients were non MV group. In the MV group, patients had more CNS symptoms(83%), higher SAPS II(43.5) and also had abnormal laboratory findings (leukocytosis, high glucose level, high Pco2, and lower pH). Cholinesterase level at presentation was not significant difference between MV group and non MV group, but total amount and administration time of atropine and 2-PAM was significantly different. Respiratory complication and intermediate syndrome were common in the MV group. CONCLUSION: We suggest that the patients having CNS and/or nicotinic symptoms following organophosphate intoxication, is a potential patient group requiring intensive care with mechanical ventilation. Additionally we think that hypercarbia due to respiratory weakness or paralysis and mental status change is important factors to decide the application of mechanical ventilation.
Atropine ; Cholinesterases ; Emergencies ; Glucose ; Humans ; Critical Care ; Medical Records ; Paralysis ; Respiration, Artificial* ; Retrospective Studies ; Ventilation

PURPOSE: Acute appendicitis is one of the more challenging disease entities to diagnose. Early and correct diagnosis is necessary to decrease morbidity and mortality. The diagnosis of acute appendicitis does not depend on a single modality because it is often difficult and the symptoms of appendicitis can change with time. The Alvarado score is a sensitive and specific tool for diagnosis of appendicitis. But the effectiveness of a single Alvarado score for diagnosis of acute appendicitis can be less meaningful due to diagnostic difficulties. The purpose of this study was to evaluate the usefulness of repeatedly checked Alvarado scores in acute abdomen patients as a diagnostic tool for acute appendicitis. METHODS: A total of 196 patents who visited our ER with acute abdominal pain between March 2008 and February 2009 were enrolled. Emergency physicians checked the initial Alvarado score and re-checked that score after 3 hours of observation. We prospectively compared the results between (a) the initial and the 3 hours Alvarado scores and (b) the final pathology. RESULTS: We measured diagnostic for the initial Alvarado score and the 3 hours Alvarado score groups. The sensitivities of the two groups for detecting appendcitis were 85.1% and 92.0%, respectively; specificities were 81.6% and 89.0%; positive predictive values were 78.7% and 87.0%; negative predictive values were 87.3% and 93.3%; accuracy scores were 83.2% and 90.3%. All diagnostic values of the 3 hours Alvarado score group were superior to those of the initial Alvarado score group. CONCLUSION: Repeatedly checked Alvarado scores provides a superior diagnostic accuracy to the initial Alvarado score alone. Thus, we can say that repeatedly checked 3 hours Alvarado scores are more useful for diagnosing acute appendicitis than an initial, one-time checking of the Alvarado score. This new scoring system will be particularly useful to physicians who are working in health care facilities where computerized tomography or ultra-sonography is not available.
Abdomen, Acute ; Abdominal Pain ; Appendicitis ; Delivery of Health Care ; Diagnosis, Differential ; Emergencies ; Humans ; Mass Screening ; Prospective Studies ; Severity of Illness Index