Pseudotumor cerebri syndrome is characterized clinically by raised intracranial pressure without ventriculomegaly. Several conditions known to interfere with CSF absorption pathways at the level of the arachnoid villi can produce the pseudotumor cerebri syndrome. Systemic lupus erythematosus (SLE) is an autoimmune, inflammatory and chronic disorder characterized by multi-organ involvement including the nervous system. Clinical evidence of central nervous system involvement includes headache, seizure, psychosis and altered mental status. However, pseudotumor cerebri syndrome has been reported infrequently as a primary feature of central nervous system involvement or a complication of SLE. A 19 year-old female was admitted with seizure preceded by headache and blurred vision. Ophthalmoscopic examination showed papilledema. The diagnosis of pseudotumor cerebri syndrome was confirmed by increased intracranial pressure(>550mmH2O) in the absence of any abnormal radiological findings of the brain. We described a 19-year-old girl whose first clinical manifestation was pseudotumor cerebri syndrome, which was diagnosed as SLE later. Therefore pseudotumor cerebri syndrome may be the part of the spectrum of clinical manifestation of SLE.
Absorption ; Arachnoid ; Brain ; Central Nervous System ; Diagnosis ; Female ; Headache ; Humans ; Intracranial Pressure ; Lupus Erythematosus, Systemic* ; Nervous System ; Papilledema ; Pseudotumor Cerebri* ; Psychotic Disorders ; Seizures ; Young Adult

Pseudotumor cerebri syndrome is characterized clinically by raised intracranial pressure without ventriculomegaly. Several conditions known to interfere with CSF absorption pathways at the level of the arachnoid villi can produce the pseudotumor cerebri syndrome. Systemic lupus erythematosus (SLE) is an autoimmune, inflammatory and chronic disorder characterized by multi-organ involvement including the nervous system. Clinical evidence of central nervous system involvement includes headache, seizure, psychosis and altered mental status. However, pseudotumor cerebri syndrome has been reported infrequently as a primary feature of central nervous system involvement or a complication of SLE. A 19 year-old female was admitted with seizure preceded by headache and blurred vision. Ophthalmoscopic examination showed papilledema. The diagnosis of pseudotumor cerebri syndrome was confirmed by increased intracranial pressure(>550mmH2O) in the absence of any abnormal radiological findings of the brain. We described a 19-year-old girl whose first clinical manifestation was pseudotumor cerebri syndrome, which was diagnosed as SLE later. Therefore pseudotumor cerebri syndrome may be the part of the spectrum of clinical manifestation of SLE.
Absorption ; Arachnoid ; Brain ; Central Nervous System ; Diagnosis ; Female ; Headache ; Humans ; Intracranial Pressure ; Lupus Erythematosus, Systemic* ; Nervous System ; Papilledema ; Pseudotumor Cerebri* ; Psychotic Disorders ; Seizures ; Young Adult

PURPOSE: We investigated the clinical difference between single infection and coinfection with respiratory virus in hospitalized children with acute respiratory tract infections. METHODS: We reviewed 727 patients who were admitted with the diagnosis of acute respiratory infection at the Department of Pediatrics, Bundang Jesaeng Hospital between January and December of 2014. Diagnoses were made using the multiplex reverse transcriptase polymerase chain reaction (RT-PCR) assay targeting 16 viruses in nasopharyngeal swabs. Subjects were classified as the single virus infection and coinfection groups. RESULTS: A total of 439 patients were enrolled; 359 (77.2%) under 24 months. Single virus was detected in 279 (63.6%). Coinfection with multiple virus was detected in 160 (36.4%): 126 (28.7%) with 2 viruses, 30 (6.8%), and 4 (0.9%) with 3 to 4 viruses. Viral coinfection was detected in 28 samples (17.5%), with respiratory syncytial virus (RSV) A and rhinovirus being the most dominating combination. There were no clinical differences between the single infection and coinfection groups, except sputum and the frequency of high RSV load. Sputum was significantly more frequent in the coinfection group (P=0.043), and the frequency of high RSV load was significantly higher in the single infection group (P=0.029). Disease severity (high fever, the duration of fever [≥5 days], and the length of hospital stay [≥5 days], O₂ therapy) did not differ significantly between both groups. RSV was a frequent virus of single infection during winter. Coinfection was most common in winter. CONCLUSION: There were no clinical differences between single infection and coinfection, except sputum and the frequency of high RSV load.
Child ; Child, Hospitalized ; Coinfection* ; Diagnosis ; Fever ; Humans ; Length of Stay ; Multiplex Polymerase Chain Reaction ; Pediatrics ; Respiratory Syncytial Viruses ; Respiratory Tract Infections ; Reverse Transcriptase Polymerase Chain Reaction ; Rhinovirus ; Sputum

Peripheral nervous system involvement is common in systemic vasculitis, occurring most frequently in the polyarteritis nodosa (PAN) group of disorders and in rheumatoid vasculitis. Within the polyarteritis nodosa group of systemic necrotizing vasculitides, three subgroups have been described: classic polyarteritis nodosa, Churg-Strauss syndrome, and an overlap syndrome. Three patients with evidence of systemic vasculitis and peripheral neuropathy were clinically and electrophysiologically investigated. All cases presented clinically with mononeuropathy multiples considered typical pattern of ischemic involvement of the peripheral nerve. The causes included polyarteritis nodosa, its Churg-strauss variant, and the overlap syndrome. Pain and weakness were frequent symptoms. Nerve conduction studies were abnormal In all cases. Necrotizing vasculitis was present as pathologic findings in two cases. All patients were treated with prednisolone alone or in combination with other immunosuppressive agents or with plasmapheresis.
Churg-Strauss Syndrome ; Humans ; Immunosuppressive Agents ; Mononeuropathies* ; Neural Conduction ; Peripheral Nerves ; Peripheral Nervous System ; Peripheral Nervous System Diseases ; Plasmapheresis ; Polyarteritis Nodosa ; Prednisolone ; Rheumatoid Vasculitis ; Systemic Vasculitis ; Vasculitis*

PURPOSE: The study evaluated elastography, a technique that allows differentiation between pathological and normal tissue by determination of tissue hardness. METHODS: From March 2009 to April 2010, 25 consecutive patients with thyroid nodules who were referred for surgical treatment were examined in this prospective study. Thirty nodules in these patients were examined by conventional ultrasound, ultrasound elastography, and fine needle aspiration cytology. Lesions were scored (1~3) according to hardness based on the Ueno classification system. The final diagnosis was based on histopathologic results. RESULTS: Of the 30 thyroid nodules, four were classified as benign and 26 were malignant. Two of the nodules with an elastography score of 1 were benign and 17 nodules whose elastography score was 3 were malignant. Two benign nodules and nine malignant nodules had an elastography score of 2. Applying an elastography score exceeding 2 as a indicator for malignancy determined that the sensitivity and specificity of the ultrasound elastography was 100.0% and 50.0%, respectively, the positive and negativepredictive values were 92.9% and 100.0%, respectively, and the accuracy of the technique was 93.3%. CONCLUSION: Ultrasound elastography may be a useful adjunct to ultrasonography in the identification of indeterminate thyroid nodules for which tissue diagnosis is required.
Biopsy, Fine-Needle ; Classification ; Diagnosis ; Diagnosis, Differential* ; Elasticity Imaging Techniques* ; Hardness ; Humans ; Prospective Studies ; Sensitivity and Specificity ; Thyroid Gland* ; Thyroid Nodule* ; Ultrasonography*

Two cases of incomplete transverse vaginal septum with a small opening in the upper third of vagina were presented. One case was a patient presenting at 31 years of age for evaluation of primary infertility and oligomenorrhea. Diagnosis was made by hysterosalpingography, tranvaginal ultrasonography, MRI, and diagnostic pelviscopy for evaluation of abnormality of endopelvic organs. The patient was treated with surgical resection of septum (simple septectomy). Examination 3 months later demonstrated narrowing of the vaginal lumen. Another case was a patient presenting intrauterine pregnancy at 8 weeks and 2 days accompanying transverse vaginal septum with small opening. She had previous septotomy history and presented postoperative scarring. She had septectomy and anastomosis of the mucosa, and presented postoperative narrowing again about a month postoperatively. In this report we describe the two cases of transverse vaginal septum. We also reviewed the literature including diagnostic and treatment guidelines. Prevention of postoperative scarring is the most important factor in management of transverse vaginal septum. For that, first of all, initial septectomy should be done with approximation of the mucosa and postoperative dilatation is necessary. Importance of the initial accurate septectomy is too important to be over-emphasized.
Cicatrix ; Constriction, Pathologic* ; Diagnosis ; Dilatation ; Female ; Humans ; Hysterosalpingography ; Infertility ; Magnetic Resonance Imaging ; Mucous Membrane ; Oligomenorrhea ; Pregnancy ; Ultrasonography ; Vagina

This study aims to determine the effects of formaldehyde exposure on self-reported symptoms of respiratory-eye mucosa and integumentary system during anatomy practices among Korean medical students. Data were collected using the web-based survey. Study subjects in 1st and 2nd grade medical student, and having anatomy dissection in medical college and medical graduate school. A total of 463 students from the 14 medical college and medical graduate school participated in this study. The results show that 261 (56.4%) of the participants responded feeling discomfort above moderate at anatomy dissection. After anatomy dissection, 104 (43.2%) students responded aggravating the symptom allergic rhinitis, xerophthalmia and so on. 209 (95.0%) of them responded the new symptom's appearance. In the result of multiple logistic regression, women (OR: 2.000, 95% CI: 1.169~3.421) and the students with feeling discomfort (OR: 3.190, 95% CI: 1.807~5.632) were more likely to increase the risk of pre-existing respiratory · eye mucosal system symptom's aggravation than the counter parts. For pre-existing integumentary system symptom's aggravation, risk is significantly higher in elder age group (OR: 2.612, 95% CI: 1.187~5.750) and with disapproval protective equipments (OR: 2.217, 1.006~4.885). In case of new symptom's appearance, people with feeling discomfort above moderate (OR: 5.097, 95% CI: 1.075~24.160) in respiratory · eye mucosal system were more likely to increase the risk of new symptom's appearance. And for integumentary system, risk was higher in people with feeling discomfort (OR: 1.921, 95% CI: 1.218~3.031), in woman (OR: 1.711, 1.090~2.686) and without enough protective equipments preparation (OR: 1.953, 1.189~3.210). This study confirms the protective equipments for minimizing exposure from chemicals for cytological fixation (e,g formaldehyde) is not worn enough and students in anatomy dissection experience discomfort and disease after anatomy dissection. Therefore, this study indicates that the safe guideline in anatomy dissection should be enhanced and institutional strategy to protect student's right of health should be provided.
Female ; Formaldehyde* ; Humans ; Integumentary System* ; Logistic Models ; Mucous Membrane* ; Rhinitis, Allergic ; Students, Medical* ; Xerophthalmia

Extramammary Paget's disease (EMPD) is an intraepithelial neoplastic disorder which is included as a rare malignant condition. However, it sometimes shows aggressive behavior of local recurrence and coexisting malignancy. We had experienced nine cases of EMPD involving the scrotum for seven years. Two cases of them presented metastasis. The first case presented extensive inguinal lymph node metastasis with underlying adnexal adenocarcinoma one year after wide local excision. The second case initially presented multiple metastasis to the liver and in the lymph node. The latter, showing fulminant progression with liver metastasis, may be only the second case reported in English literature. EMPD is considered as a malignant neoplasm with aggressive behavior from initial presentation. Because wide local excision of the lesion alone may be occasionally insufficient, a careful follow-up must be done to detect recurrence or internal malignancy.
Aged ; Case Report ; Fatal Outcome ; Female ; Human ; Liver Neoplasms/secondary* ; Magnetic Resonance Imaging ; Male ; Paget's Disease, Extramammary/surgery ; Paget's Disease, Extramammary/pathology* ; Testicular Neoplasms/surgery ; Testicular Neoplasms/pathology*

BACKGROUND AND OBJECTIVES: Effective myocardial reperfusion following primary percutaneous coronary intervention for AMI, in lesions with a thrombus, is limited by distal embolization and slow/no reflow phenomenon. We evaluated the safety and efficacy of a thrombus reduction technique, using the export aspiration catheter for thrombosuction prior to primary PCI for AMI. SUBJECTS AND METHODS: We analyzed 61 AMI patients who had a thrombus burden on angiography, after having undergone primary PCI, either with or without EAC (EAC group; n=31, 24 males, mean ages 54.7+/-11.8 years)(control group; n=31, 20 males, mean ages 65.5+/-12.2 years). After the primary PCI, the angiographic findings and clinical outcomes at 1 and 6 months were recorded. RESULTS: The procedural and angiographic success rates were 100 (31/31) and 93.5 (29/31), and 100 (31/31) and 87.1% (27/31), respectively. After PCI, the recovery rate to TIMI 3 flow was higher in the EAC than the control group (26/31 vs. 20/31, p<0.05), and the corrected TIMI frame count was less in the EAC than the control group (23.9+/-15.1 vs. 34.8+/-22.5, p<0.05). However, there were no different in the TIMI perfusion grade between the two groups. Although there was no statistical significance, distal embolization was more commonly observed in control (16.1%, 5/31) than the EAC group (0/31)(p=0.056). There were no differences in the incidences of MACE at 1 (0 vs. 7.7%, p=0.237) and 6 months (6.9 vs. 0%, p=0.500) between two groups. In the 31 patients who underwent successful thrombosuction, gross thrombi were obtained from 25 (80.6%). CONCLUSION: In AMI, the use of thrombosuction, with EAC prior to PCI, provides a simple, rapid and potentially effective method for removal of the thrombus burden and restoration of coronary flow.
Angiography ; Catheters* ; Humans ; Incidence ; Male ; Myocardial Infarction* ; Myocardial Reperfusion ; Percutaneous Coronary Intervention* ; Perfusion ; Thrombosis

The High grade endometrial stromal sarcoma is very rare. It has occasional local recurrence, which might be arisen from endometrial stroma, from adenomyosis, rarely from endometriosis. We experienced this infrequent malignant tumor in a 33 years old woman showing invasion to endometrium, cervix, adenomyosis and even penetration to the uterine serosa. She underwent total abdominal hysterectomy with bilateral salpinogo-oophorectomy followed by cisplatin-epirubicin chemotherapy. Metastatic pulmonary lesion was found after hysterectomy. The authors report this case with the clinicopathologic findings and brief review of literatures.
Adenomyosis ; Adult ; Cervix Uteri ; Drug Therapy ; Endometriosis ; Endometrium ; Epirubicin ; Female ; Humans ; Hysterectomy ; Lung* ; Recurrence ; Sarcoma, Endometrial Stromal* ; Serous Membrane