Syphilitic aortitis, passing out of our mind, is the most common systemic manifestation of late syphilis and is more typically manifestated 10 to 30 years afterward. This diagnosis has been made less frequently in recent decades than in the past, because of public awareness of syphilis and screening program. Treponema pallidum lodge within vasa vasorum, especially ascending aorta cause the histologic changes, which are responsible for the three major forms of symptomatic cardiovascular syphilis, including aortic insufficiency, coronary ostial stenosis, and aortic aneurysm. We experienced a case of syphilitic aortitis with aortic insufficiency and aortic aneurysm in a 48-year-old man presented with progressive dyspnea. Echocardiography, chest CT, and later surgical correction were performed and surgical specimen revealed the histologic finding consistent with syphilitic aortitis. We report this case with a review of the literature.
Aorta ; Aortic Aneurysm* ; Aortitis ; Constriction, Pathologic ; Diagnosis ; Dyspnea ; Echocardiography ; Humans ; Mass Screening ; Middle Aged ; Syphilis ; Syphilis, Cardiovascular* ; Tomography, X-Ray Computed ; Treponema pallidum ; Vasa Vasorum

Esophageal abscess caused by acute phlegmonous esophagitis is rare but life-threatening. Rapid abscess drainage is an important part of the treatment, and endoscope-assisted intra-luminal abscess drainage is frequently performed. Although endoscopic drainage is less invasive than surgery, it has the potential to cause esophageal stricture as a complication. We present a rare case of esophageal stricture as a complication of intra-luminal drainage and evaluate a method to minimize the incidence of esophageal stricture complications.

Langerhans cell histiocytosis (LCH) is a rare disease of the monocyte-macrophage system involving clonal proliferation of Langerhans cells. Central nervous system (CNS) involvement of LCH occurs in 10-57% of all LCH cases. This disease is known to present in two ways in the CNS: intracranial tumorous lesions or intracranial nontumorous lesions (neurodegeneration). We report here an LCH patient who developed gait disturbance and dysarthria due to neurodegenerative lesions associated with LCH.
Central Nervous System ; Dysarthria ; Gait ; Histiocytosis, Langerhans-Cell ; Humans ; Langerhans Cells ; Rare Diseases

Spontaneous intracerebral hemorrhage is very rare in patients with neurofibromatosis type 1. A 30-year-old woman was referred to our hospital for evaluation of headaches, nausea, and vomiting. She was diagnosed with neurofibromatosis type 1 and a spontaneous intracerebral hemorrhage. She was treated with conservative management, including antihypertensive medications for 32 months. However, because of sustained hypertension, we performed screening tests for a pheochromocytoma. The 24 hr urine VMA and urine metanephrines were elevated. Abdominal CT showed a right adrenal mass, 7.5 x 5.8 cm in size.. After a successful resection of the tumor, the hypertension resolved without medication for > 1 year. This case illustrates that delayed diagnosis and treatment of pheochromocytoma can cause serious complications from hypertension, such as cerebrovascular hemorrhage. Thus, in patients with neurofibromatosis and hypertension, screening for pheochromocytoma is important for the early detection of an adrenal tumor.
Adult ; Cerebral Hemorrhage ; Delayed Diagnosis ; Female ; Headache ; Hemorrhage ; Humans ; Hypertension ; Mass Screening ; Nausea ; Neurofibromatoses ; Neurofibromatosis 1 ; Pheochromocytoma ; Vomiting

Amebic colitis is a disease revealing diverse clinical manifestations and endoscopic gross features and often confused with other types of colitis. In case of misdiagnosis as an idiopathic inflammatory bowel disease or delayed recognition of intestinal amebiasis, an undesirable outcome may occur resulting from erroneous administration of steroids or delayed antiamebic treatment. To demonstrate the pitfalls in the diagnosis and treatment of intestinal amebiasis, 3 cases of amebic colitis with atypical clinical manifestations are presented in this paper. In conclusion, despite the low sensitivities of routine stool examination for parasite and histopathologic confirmation in biopsy specimen, every effort must be made to find amebic trophozoites either in fresh stool or biopsy specimens for prompt and correct diagnosis of amebic colitis when we manage patients with chronic intestinal ulcerations, even though their clinical course and endoscopic findings are not typical of amebiasis. Moreover, following initial successful anti-amebic therapy, more careful clinical, endoscopical, and parasitological follow-up should be done for the early detection of recurrence.
Adult ; Aged ; Aged, 80 and over ; Colitis, Ulcerative/diagnosis ; Diagnosis, Differential ; Diarrhea/etiology ; Dysentery, Amebic/complications/drug therapy/*pathology ; Female ; Humans ; Inflammatory Bowel Diseases/diagnosis ; Male ; Middle Aged

Myoclonus is one of the rare complications after the neuroaxial blockade. We report a patient who developed propriospinal myoclonus following cervical epidural steroid injection. An outpatient, 73-years-old man, complaining of a tingling sensation from the right shoulder of supraspinatous region to the ipsilateral hand, particularly along the C6 dermatome, visited our pain clinic center. In cervical magnetic resonance imaging scan, the disc between 6th and 7th cervical vertebrae was herniated and pressed the nerves to the right side. We performed cervical epidural steroid injection, using triamcinolone acetonide 40 mg with 0.25% bupivacaine HCL 5 ml. After the first injection, he had no problem, but following the second injection, myoclonic movements were developed and lasted for 6 hours along only the right side of the whole body without other neurologic complications. The myoclonic movement improved by intravenous injection of clonazepam 0.5 mg and the patient completely recovered without any neurologic sequelae on that day.
Bupivacaine ; Cervical Vertebrae ; Clonazepam ; Female ; Hand ; Humans ; Injections, Intravenous ; Magnetic Resonance Imaging ; Myoclonus ; Outpatients ; Pain Clinics ; Sensation ; Shoulder ; Triamcinolone Acetonide

Myoclonus is one of the rare complications after the neuroaxial blockade. We report a patient who developed propriospinal myoclonus following cervical epidural steroid injection. An outpatient, 73-years-old man, complaining of a tingling sensation from the right shoulder of supraspinatous region to the ipsilateral hand, particularly along the C6 dermatome, visited our pain clinic center. In cervical magnetic resonance imaging scan, the disc between 6th and 7th cervical vertebrae was herniated and pressed the nerves to the right side. We performed cervical epidural steroid injection, using triamcinolone acetonide 40 mg with 0.25% bupivacaine HCL 5 ml. After the first injection, he had no problem, but following the second injection, myoclonic movements were developed and lasted for 6 hours along only the right side of the whole body without other neurologic complications. The myoclonic movement improved by intravenous injection of clonazepam 0.5 mg and the patient completely recovered without any neurologic sequelae on that day.
Bupivacaine ; Cervical Vertebrae ; Clonazepam ; Female ; Hand ; Humans ; Injections, Intravenous ; Magnetic Resonance Imaging ; Myoclonus ; Outpatients ; Pain Clinics ; Sensation ; Shoulder ; Triamcinolone Acetonide

Background: Arteriovenous malformation (AVM) which is a high-blood-flow lesion with connections between arteries and veins without an intervening capillary bed, is difficult to manage. The ear is the second most common site of extracranial AVM. However, studies regarding the management of this condition remain lacking. The purpose of this study was to share managing experiences in our center and to investigate the treatment effect through a retrospective analysis of cases. Methods: Among 265 patients with AVM treated in our vascular anomalies center between January 2008 and January 2021, 10 patients with auricular AVM were included in the study to investigate the lesion distribution, clinical stage, and treatment methods by performing a retrospective evaluation. Results: Among 10 patients, five patients had AVMs distributed in the upper half of the ear, one patient in the lower half of the ear, and four patients in whole ear, respectively. Seven patients had Schobinger stage II, and three had stage III. One patient received surgical treatment only, four patients received sclerotherapy only, and five patients received both surgical treatment and sclerotherapy. The posttreatment status was checked as controlled in two patients, improved in seven patients, persistent in one patient. There were no worsening patients. Conclusion Auricular AVM is a disease that is difficult to manage by one specific department, thus requiring a collaborative management effort from multidisciplinary team.

Background: Arteriovenous malformation (AVM) which is a high-blood-flow lesion with connections between arteries and veins without an intervening capillary bed, is difficult to manage. The ear is the second most common site of extracranial AVM. However, studies regarding the management of this condition remain lacking. The purpose of this study was to share managing experiences in our center and to investigate the treatment effect through a retrospective analysis of cases. Methods: Among 265 patients with AVM treated in our vascular anomalies center between January 2008 and January 2021, 10 patients with auricular AVM were included in the study to investigate the lesion distribution, clinical stage, and treatment methods by performing a retrospective evaluation. Results: Among 10 patients, five patients had AVMs distributed in the upper half of the ear, one patient in the lower half of the ear, and four patients in whole ear, respectively. Seven patients had Schobinger stage II, and three had stage III. One patient received surgical treatment only, four patients received sclerotherapy only, and five patients received both surgical treatment and sclerotherapy. The posttreatment status was checked as controlled in two patients, improved in seven patients, persistent in one patient. There were no worsening patients. Conclusion Auricular AVM is a disease that is difficult to manage by one specific department, thus requiring a collaborative management effort from multidisciplinary team.

BACKGROUND: To determine the prevalence and the associated factors of microalbuminuria in Korean subjects with newly diagnosed type 2 diabetes mellitus. METHODS: A total of 304 patients with newly diagnosed type 2 diabetes mellitus that visited Anam Hospital, Korea University Medical Center, were studied cross-sectionally for the presence of microalbuminuria and other micro- and macrovascular complications. Microalbuminuria was calculated by the amount of albumin excretion in the urine for 24 hrs (30-299 mg/24hr) or by the albumin creatinine ratio in a spot urine sample (30-299 mg/g creatinine). Subjects were divided into two groups: the normoalbuminuria group and the microalbuminuria group. RESULTS: The prevalence of microalbuminuria, normoalbuminuria and overt proteinuria in patients with newly diagnosed type 2 diabetes mellitus was 17.1%, 80.3% and 2.6%. respectively. Microalbuminuria was significantly correlated with the body mass index (BMI), fasting insulin level, fasting C-peptide level and triglyceride level. The number of metabolic syndrome components was significantly correlated with the amount of microalbuminuria. In patients with microalbuminuria and without retinopathy, the correlation of microalbuminuria and the presence of metabolic syndrome was also significant. CONCLUSIONS: The prevalence of microalbuminuria in 304 Korean patients with newly diagnosed type 2 diabetes mellitus was 17.1%, and microalbuminuria had a correlation with the BMI, fasting insulin level, fasting C-peptide level, HOMA level, triglyceride level and the presence of metabolic syndrome.
Academic Medical Centers ; Body Mass Index ; C-Peptide ; Creatinine ; Diabetes Mellitus ; Diabetes Mellitus, Type 2* ; Fasting ; Humans ; Insulin ; Korea* ; Prevalence* ; Proteinuria ; Triglycerides