No abstract available.
Bone Marrow* ; Necrosis*

Moyamoya disease is a cerebrovascular disorder characterized by internal carotid arteries' occlusion or stenosis. Its etiology remains unknown, and it occurs more frequently in Asian countries than western countries. It can occur at any age, and approximately 50% of patients are children. Initial manifestations of moyamoya disease are very different according to age. In general, cerebral ischemic symptoms like transient ischemic attacks (TIA) are the most common manifestation of children. It is a chronic progressive disease and cause recurrent stroke, so early diagnosis and management is very important. We report a case of moyamoya disease without TIA, in a 7 years old female child presenting as unusual symptoms, such as walking difficulty and dysarthria.
Asian Continental Ancestry Group ; Cerebrovascular Disorders ; Child ; Constriction, Pathologic ; Dysarthria ; Early Diagnosis ; Female ; Humans ; Ischemic Attack, Transient* ; Moyamoya Disease* ; Stroke ; Walking

Background: Effective treatment of Graves’ disease during pregnancy is important because uncontrolled hyperthyroidism is associated with increased fetal and maternal morbidity and mortality. While there have been case reports of patients with Graves’ disease who failed to achieve euthyroid state during pregnancy, anesthesiologists rarely encounter patients with uncontrolled hyperthyroidism undergoing urgent Cesarean section.Case: A 31-year-old pregnant patient had uncontrolled hyperthyroidism due to Graves’ disease despite medical treatment. Her signs and symptoms suggested fetal distress and aggravation of the disease, leading to hospitalization. After a failed induction for vaginal delivery, an urgent Cesarean section was performed under spinal anesthesia via an interlaminar approach using 9 mg of 0.5% heavy bupivacaine and 20 μg of fentanyl. It resulted in successful delivery, with no perioperative complications for the mother and neonate. Conclusions This case demonstrates that spinal anesthesia may provide clinical stability to patients with uncontrolled hyperthyroidism undergoing urgent Cesarean section.

BACKGROUND: The urea breath test (UBT) is regarded as a highly reliable, noninvasive tool for diagnosing Helicobacter pylori infection. We compared a recently developed low-dose 38 mg 13C-urea capsule, which is able to eliminate oral urease effects and does not require positional changes during the test, with the conventionally used 100 mg 13C-urea tablet method. METHODS: Thirty-nine volunteers were tested under informed consent with both 13C-UBT methods, Helifinder(R) and UBiT-IR300(R), with a minimum 2-week washout period. The pre-ingestion and 20-minute post-ingestion breath samples were analyzed with an isotope ratio mass spectrometer for Helifinder, and a nondispersive isotope-selective infrared spectrophotometer for UBiT samples. RESULTS: Helifinder method showed excellent agreement with UBiT among 19 positive and 20 negative cases (weighted kappa value, 1.0). Helifinder results (y) showed good agreement but with a proportional bias compared to UBiT results (x) by Passing and Bablok method (y=0.551 X -0.255, r=0.74, P<0.0001). CONCLUSIONS: Since the low-dose 38 mg 13C-urea capsule (Helifinder) test, which is more convenient and economic, showed comparable results with the conventional UBiT method, it can be used as an alternative for the diagnosis of H. pylori infection.
Bias (Epidemiology) ; Breath Tests ; Diagnosis ; Helicobacter pylori* ; Helicobacter* ; Informed Consent ; Urea* ; Urease ; Volunteers

A dog (5.6 kg, 4-year-old, castrated male, Miniature pinscher) with diffuse symmetric alopecia on the chest and excessive scales was referred to Veterinary Medical Teaching Hospital of Chungnam National University, Korea. On physical examination, diffuse alopecia on ventral aspect of the neck and caudomedial thighs, and severe scales were presented. Dermatologic tests of lesions revealed bacterial infections. Histopathologically, atrophy of hair bulb was observed in the severely alopecic lesion of caudomedial thighs. ACTH stimulation test was performed to differentiate the endocrine disorder related to generalized alopecia. The pre-ACTH serum testosterone and progesterone concentrations were above normal ranges and the post-ACTH serum testosterone concentration was high. The pre- and post-ACTH serum estradiol and cortisol concentrations were within normal ranges. Canine pattern alopecia was diagnosed based on history, physical examination, hormonal assay and dermatohistopathologic examination. After 3 months of melatonin administration, multifocal alopecia on the trunk was improved and general hair regrowth was identified.
Adrenocorticotropic Hormone ; Alopecia ; Alopecia Areata ; Animals ; Atrophy ; Bacterial Infections ; Dogs ; Estradiol ; Hair ; Hospitals, Teaching ; Humans ; Hydrocortisone ; Korea ; Male ; Melatonin ; Neck ; Physical Examination ; Preschool Child ; Progesterone ; Reference Values ; Testosterone ; Thigh ; Thorax ; Weights and Measures

Nephrectomy is performed for the treatment of kidney cancer or for the purpose of kidney transplantation. Generally, kidney function decreases after nephrectomy. It is well known that the incidence of cardiovascular disease increases and ultimately the mortality rate increases when kidney function decreases. Therefore, when renal mass is detected, partial nephrectomy (PN) is preferred over radical nephrectomy (RN) to preserve kidney function as much as possible. However, recent studies have shown that PN does not have a survival benefit in all patients compared to RN. Meanwhile, numerous studies for living kidney donors showed that kidney donation itself did not increase the risk of diabetes, high blood pressure, cardiovascular disease, and mortality. However, recent studies have shown that kidney donors have higher incidence of cardiovascular disease and higher mortality rates than the general populations. It is yet difficult to find a conclusion in these debates. We have to make a clinical decision rest on the balance of potential benefits and harms of competing treatments, personalized to the individual patient.

BACKGROUND: Early detection of underlying renal dysfunction among emergency patients is important, particularly before imaging studies using contrast media. The estimated glomerular filtration rate (eGFR) calculated from creatinine values is useful in situations requiring rapid evaluation and detection of renal impairment. METHODS: We evaluated the concordance of eGFR determined using the whole blood creatinine test by Nova CCX (Cr-CCX WB; Nova Biomedical, USA) method and the serum creatinine test by Roche Integra 800 (Cr-RE Serum; Roche Diagnostics, Switzerland) enzymatic method, which is known to be traceable to the isotope dilution mass spectrometric (ID-MS) reference method. RESULTS: Compared to Cr-RE Serum (x), Cr-CCX WB (y) showed good correlation but unacceptable total error and negative proportional bias (Deming regression, y=0.92x+0.02; r=0.98; n=61). However, when we adjusted the Cr-CCX WB values with a new slope and offset derived from the Deming regression analysis with Cr-RE Serum, the concordance rate improved from 0.77 to 0.93 (as measured by kappa statistics), and total errors became acceptable except at 1 level. When we used the ID-MS traceable eGFR formula, the Nova CCX demonstrated sufficient sensitivity (93.5%) and specificity (100%) for the detection of renal dysfunction (eGFR less than 60 mL/min/1.73 m2) in patients. CONCLUSIONS: We concluded that if we adjusted the harmonizing factors of Nova CCX according to the ID-MS traceable method, then the Nova CCX might be a relatively accurate point-of-care creatinine analyzer for detecting renal dysfunction among patients undergoing urgent imaging studies with radiological contrast media.
Bias (Epidemiology) ; Contrast Media ; Creatinine ; Emergencies ; Glomerular Filtration Rate ; Humans ; Sensitivity and Specificity

BACKGROUND: Early diagnosis and treatment of acute coronary syndrome(ACS) encompassing acute myocardial infarction(AMI) and unstable angina(UA) is very important. Cardiac troponin T(cTnT) is known to be more specific to myocardium, and the level increases early and persistently during the period of 7 to 14 days after the onset of symptoms. The aim of this study was to evaluate the usefulness of cTnT for the diagnosis of ACS comparing with other biochemical markers. METHODS: The precision, linearity, lower limit of detection and interferences for cTnT by electrochemiluminescence were evaluated. cTnT and other conventional cardiac markers were determined for 128 AMI, 96 UA and 72 stable angina(SA) patients. The medical records of these patients were reviewed. RESULTS: cTnT-positive rates in AMI patients were 87.5-100% in all periods. cTnT positive rate was maintained as 100% from 3 hours to 96 hours after heart attack. Although CK-MB positive rate was as high as 85.7% at 6 hours, it decreased after 61 hours. The positive rate of LD and LD isoenzyme were very low(33.8-75%). In UA patients, mean positive rates of cTnT and CK-MB were 22.6% and 22.9% respectively. For the diagnosis of ACS comparing with SA, the sensitivity and specificity of cTnT were 63% and 94%(cut-off, 0.1 microgram/ml), meanwhile these of CK-MB were 53% and 90%, respectively(cut-off, 5 microgram/ml). CONCLUSIONS: cTnT was more useful and sensitive than CK-MB, LD, or LD isoenzyme. ACS also could be diagnosed with cTnT and CK-MB with sufficiently high specificity. cTnT seemed to be slightly more specific than CK-MB for the diagnosis of ACS.
Acute Coronary Syndrome* ; Angina, Unstable ; Biomarkers ; Diagnosis ; Early Diagnosis ; Heart ; Humans ; Limit of Detection ; Medical Records ; Myocardial Infarction ; Myocardium ; Sensitivity and Specificity ; Troponin T* ; Troponin*

Anaplastic carcinomas of the pancreas, also known as pleomorphic, sarcomatoid, or undifferentiated carcinomas, are in most cases variants of duct-derived carcinomas. However, their appearance is so distinctive and their behavior so aggressive that a distinction from the ordinary ductal adenocarcinoma is warranted. They comprise about 7% of all non-endocrine pancreatic malignancies. Most tumors are large and apparently more likely to involve the body or tail of the pancreas rather than the head. Most patients are above the age of 50 at the time of diagnosis, and there is a distinct male predilection. Here we report on a 50-year woman who diagnosed pathologically as a anaplastic carcinoma of the pancreas. The patient underwent Whipple's operation because of a distal common bile duct cancer 6 years ago. Distal pancreatectomy and splenectomy were performed. The patient was discharged with a good general condition.
Adenocarcinoma ; Carcinoma* ; Common Bile Duct* ; Diagnosis ; Female ; Head ; Humans ; Male ; Pancreas* ; Pancreatectomy ; Splenectomy

OBJECTIVE: Enteroviruses are major causes of aseptic meningitis in children. This study aimed to describe the clinical manifestations of enteroviral meningitis according to the presence of cerebrospinal fluid (CSF) pleocytosis, and to investigate the factors influencing the CSF pleocytosis in children with this condition. METHODS: Eighty children with enteroviral meningitis treated at Soonchunhyang University Hospitals in Seoul and Bucheon between July 2012 and August 2013 were enrolled. The patients were diagnosed by reverse transcription-polymerase chain reaction (RT-PCR), and the clinical variables were compared according to the presence of CSF pleocytosis. RESULTS: Of the 80 patients, 54 (67.5%) and 26 (32.5%) patients had and did not have CSF pleocytosis, respectively. Forty-eight (60%) patients were male, and the median age was 63 months (range, 2 to 192 months). Seventy-six (95%), 67 (83.7%), 51 (63.7), and 2 (2.5%) patients presented with fever, headache, vomiting, and seizure, respectively. Increased CSF protein and pressure were associated with CSF pleocytosis. However, age, peripheral white blood cell count, C-reactive protein, CSF glucose, CSF/serum glucose ratio, and onset-puncture time interval were not associated with the presence of CSF pleocytosis. CONCLUSION: This study demonstrated a high proportion of non-pleocytic enteroviral meningitis in children, and identified several clinical manifestations that were associated with CSF pleocytosis. The findings of this study may help us better understand the characteristics of the disease and facilitate early diagnosis and treatment of enteroviral meningitis. During the outbreak seasons of enteroviral meningitis, the importance of continuous surveillance of enteroviruses and rapid RT-PCR testing should be emphasized.
C-Reactive Protein ; Cerebrospinal Fluid* ; Child* ; Early Diagnosis ; Enterovirus ; Fever ; Glucose ; Gyeonggi-do ; Headache ; Hospitals, University ; Humans ; Leukocyte Count ; Leukocytosis* ; Male ; Meningitis* ; Meningitis, Aseptic ; Pediatrics ; Seasons ; Seizures ; Seoul ; Vomiting