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

No abstract available.
Peripheral Vascular Diseases*

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*

PURPOSE: Recent guidelines for sepsis treatment emphasizes the need for early recognition of disease, leading to the development of the MEDS scoring system. However, there has been no prospective validation or comparison against other scoring systems. Therefore, we prospectively validated the MEDS scoring system and compared it withMultiple Organ Dysfunction Score (MODS) and Sepsisrelated Organ Failure Assessment (SOFA) scoring systems. METHODS: MEDS, MODS, and SOFA scores of 288 patients who were suspected to have systemic infection were calculated at the times of their emergency department visits, and clinical data of the patients were reviewed after six months. Results: MEDS, MODS, and SOFA scoring systems were all valid in the prediction of mortality according to logistic regression analysis. The results of probit analysis revealed significant and direct relationships between the scores and the mortality rate and demonstrated the parallelism of the mortality prediction of the three scoring systems. The cut-off values for the MEDS scoring system successfully divided subjects into five groups according to their risk for death. And the MEDS score well predicted the admission to ward or intensive care unit in survived patients. CONCLUSION: MEDS, MODS, and SOFA scor all were good predictors of outcome for patients with suspected sepsis and showed the same degree of predictive power. The MEDS scoring system, however, featured ease of calculation and definite clinical cut-off values which were useful in guiding decisions about treatment options. It also was well correlated with the prognosis of survived patients. We believe it to be the most useful and appropriate clinical prediction tool in cases of suspected sepsis in the emergency department.
Emergencies* ; Emergency Service, Hospital* ; Humans ; Intensive Care Units ; Logistic Models ; Mortality* ; Multiple Organ Failure ; Organ Dysfunction Scores ; Prognosis ; Prospective Studies ; Research Design ; Sepsis*

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

Hepatoid carcinoma is a rare type of malignant tumor resembling hepatocellular carcinoma that arises in extrahepatic sites.(stomach, lung, ovary, pancreas, bladder and renal pelvis). Hepatoid carcinoma of the ovary is an extremely rare ovarian tumor, first described by Ishikura and Scully in 1987. Histologically it is important to differentiate this entity from other oxyphil tumors of the ovary as it requires aggressive treatment. We have experienced a case of hepatoid carcinoma of the ovary in 69-year-old postmenopausal woman, who has been treated with operation and adjuvant Taxol - cisplatin chemotherapy. We present this case with brief review of literatures.
Aged ; Carcinoma, Hepatocellular ; Cisplatin ; Drug Therapy ; Female ; Humans ; Lung ; Ovary* ; Paclitaxel ; Pancreas ; Urinary Bladder