Although most cases of posterior reversible encephalopathy syndrome (PRES) are reversible, irreversible lesions as a form of hemorrhage or infarction have been described. PRES as a complication of systemic lupus erythematosus (PRES-SLE) is associated with hypertension or use of immunosuppressive agents. We present a case of recurrent atypical PRES-SLE, which showed restricted diffusion in the first manifestation of SLE, resulted in parenchymal hemorrhagic transformations in the recurrent episode.
Diffusion ; Hemorrhage ; Humans ; Hypertension ; Immunosuppressive Agents ; Infarction ; Lupus Erythematosus, Systemic

BACKGROUND AND OBJECTIVES: It is critical to distinguish benign from malignant thyroid nodule and to select a patient for surgery. Fine needle aspiration cytology(FNAC) and various radiologic techniques are used in the evaluation of thyroid nodule. The purpose of this study is to evaluate the diagnostic accuracy of preoperative FNAC, ultrasonography(US) and computed tomography(CT) in thyroid nodule, and to identify the reliable factors of radiologic imaging in the differential diagnosis of thyroid nodule. MATERIALS AND METHOD: Retrospectively, we reviewed 34 patients among 50 patients with thyroid nodule who were evaluated by FNAC, US and CT and operated on at our Department from June 1995 to December 1998. By comparing the preoperative FNAC results, US and CT findings with postoperative pathologic diagnosis, the results were as followed. RESULTS: Overall diagnostic accuracy of FNAC, US, and CT was 84.4%, 88.2%, 79.4%. Solid nature, ill defined margin, calcification, lymphadenopathy on US imaging indicated the possibility of malignancy. Solid nature, ill defined margin, lymphadenopathy on CT imaging indicated the possibility of malignancy. CONCLUSION: This study suggests that FNAC has a high sensitivity(75.0%) and specificity(93.8%) rate and it is therefore a valuable initial diagnostic procedure. US has higher diagnostic accuracy than computued tomography.
Biopsy, Fine-Needle ; Diagnosis* ; Diagnosis, Differential ; Humans ; Lymphatic Diseases ; Retrospective Studies ; Thyroid Gland* ; Thyroid Nodule* ; Ultrasonography*

BACKGROUND AND OBJECTIVES: There are many controversies about the extent of thyroidectomy and neck dissection in cases of thyroid cancer. Hypocalcemia is one of serious complications after total thyroidectomy. The on-set of hypocalcemia depends on many factors and different literature cites variable incidence. This study was performed to evaluate the incidence of postoperative hypocalcemia and the safety of total thyroidectomy with central neck dissection in thyroid cancer. MATERIALS AND METHODS: We conducted a retrospective chart review of 17 patients who underwent total thyroidectomy for thyroid malignancies from June 1995 to December 1998. Routine central neck dissection was performed and modified radical neck dissection was done in cases with positive neck node. We analyzed the onset-time of hypocalcemia, serum albumin level, hypocalcemic incidence according to the number of identified and autotransplanted parathyroid glands, lowest calcium level, clinical features and duration of calcium replacement in hypocalcemic patients. RESULTS: The incidence of postoperative hypocalcemia was 76.5% (13/17)and most cases (58.9%)occurred on the first postoperative day. The serum albumin level was lower on the first postoperative day than on the third postoperative day. The average number of identified parathyroid glands was three, and the more parathyroid glands there are, the less hypocalcemia we found. Parathyroid gland autotransplantation were performed in 12 cases. Symptomatic transient hypocalcemia occurred in 6 cases (35.2%). Asymptomatic transient hypocalcemia occurred in 6 cases (35.2%). Permanent hypocalcemia occurred in 1 case (5.9%). CONCLUSION: The incidence of postoperative hypocalcemia was relatively high but half of them were asymptomatic. There are no need for thyroid hormone replacement in asymptomatic transient hypocalcemic patients and that we found total thyroidectomy with central neck dissection is a safe procedure in most of thyroid malignancies.
Autografts ; Calcium ; Humans ; Hypocalcemia* ; Incidence ; Neck Dissection* ; Neck* ; Parathyroid Glands ; Retrospective Studies ; Serum Albumin ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy*

Emergency physicians often have to treat patients suffering from testicular pain. Testicular torsion is a critical disease which can, in the worst situation, require orchiectomy. Testicular torsion is more common among neonates and adolescents than adults, and there are very few adults reported to have testicular torsion. There are several cases of testicular torsion among adults aged 20 to 40. However, there have been almost no reports of patients with testicular torsion over the age of 50. Patients over the age of 50 have a greater possibility of a delayed diagnosis. Therefore, they also have a greater possibility of requiring an orchiectomy. In our case, 57-year-old male patient complained of testicular pain that developed during his sleep after golf practice. After exploratory surgery, he was diagnosed as having testicular torsion. In conclusion, emergency physicians should consider the possibility of testicular torsion when older adults complain of testicular pain. Also, patients who suffer from intermittent testicular pain show higher rates of developing testicular torsion.
Adolescent ; Adult ; Aged ; Delayed Diagnosis ; Emergencies ; Golf ; Humans ; Infant, Newborn ; Male ; Middle Aged ; Orchiectomy ; Scrotum ; Spermatic Cord Torsion ; Stress, Psychological

PURPOSE: To know the feasibility of ED observation unit treatment for acute pyelonephritis (APN) in women with diabetes or older age. METHODS: From January 2006 to February 2007, we enrolled adult women APN patients with diabetes or older age (65 years old or more) prospectively, and managed them with predetermined written protocol including intravenous ciprofloxacin, anti-pyretics, anti-emetics, and hydration. After 6 hour observation, we evaluated the patients to be admitted or not according to the protocol (the after group). From May 2003 to December 2005, data of ED visited APN patients were collected retrospectively for comparison (the before group). We compared the admission rates, re-visits to ED, and ultimate admission rates in older or diabetic patients in the before- and after-protocol group. RESULTS: 55 and 39 diabetic cases were enrolled respectively in the before- and after group respectively. The initial admission rate in diabetic patients was significantly lower in the after group (31.6% vs 76.4% p<0.001) and the revisit rate was not significantly different (p=0.586). In older patients, 95 and 57 cases were enrolled respectively. The initial admission rate was significantly lower in after group (69.5% vs 42.1%) and the revisit rate was not statistically different (p=0.452). CONCLUSION: For diabetic and older women patients with APN, ED observation unit treatment protocol can be applied safely and shows significant decrease in admission rate.
Adult ; Aged* ; Antiemetics ; Ciprofloxacin ; Clinical Protocols* ; Diabetes Mellitus ; Female* ; Humans ; Prospective Studies ; Pyelonephritis* ; Retrospective Studies

Fluconazole is a fungistatic agent that is used for treating systemic and superficial fungal infections like onychomycosis and tinea pedis. Various adverse effects of fluconazole have been reported regardless of the total dosage and the duration of treatment. We consider the number of patients who visit the emergency room with nonspecific symptoms that are related to antifungal agents are not inconsiderable. In this case, 44-year-old male patient experienced mental change during taking fluconazole to treat tinea pedis. The understanding of the side effects and the drug interactions with antifungal agents like fluconazole can help to treat patients with nonspecific symptoms that are related to antifungal agents.
Adult ; Antifungal Agents ; Consciousness ; Drug Interactions ; Emergencies ; Fluconazole ; Humans ; Hyperammonemia ; Male ; Onychomycosis ; Tinea ; Tinea Pedis

PURPOSE: Studies on the relationship of metabolic syndrome (MS) and prostate cancer are controversial. We evaluated the association between MS and prostate cancer characteristics in patients who underwent transrectal ultrasound-guided prostate biopsy. MATERIALS AND METHODS: From October 2003 to May 2011, patients with a prostate-specific antigen (PSA) value> or =4 ng/ml or abnormal digital rectal examination (DRE) result underwent transrectal ultrasound-guided prostate biopsy. MS was diagnosed according to the Adult Treatment Panel III. Clinicopathologic factors including PSA, DRE, prostate volume, age, waist circumference, body mass index (BMI), lipid profiles, fasting blood sugar level, and MS were considered for analysis. RESULTS: Three hundred fifty-four patients were enrolled (mean age, 68.86+/-8.95 years; mean PSA, 13.97+/-20.42 ng/ml). Seventy-five patients (21.2%) had MS and 90 patients (25.4%) were diagnosed as having prostate cancer, including 27 (30%) with MS and 63 (70%) without MS. Total PSA value and prostate volume were significant predictors for prostate cancer. However, MS and BMI were not significantly related to increased cancer risk. Prostate cancer patients with MS had significantly lower Gleason scores (average, 6.63+/-1.92) than did prostate cancer patients without MS (average, 7.54+/-1.71; p=0.029). CONCLUSIONS: Presence of MS was associated with a significantly decreased risk of high-grade prostate cancer. A larger, prospective, multicenter investigation is mandatory to clarify the relationship between MS and prostate cancer.
Adult ; Biopsy ; Blood Glucose ; Body Mass Index ; Digital Rectal Examination ; Fasting ; Humans ; Neoplasm Grading ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Waist Circumference

Percutaneous needle aspiration biopsy is a relatively simple and safe procedure for the diagnosis of lung and mediastinal lesions. Systemic air embolism during and after percutaneous needle aspiration biopsy of the lung is very rare; however, it is still a complication that can cause fatal outcomes, such as cerebral infarction and myocardial infarction. Here, we report a 72-year-old woman who suffered a change in consciousness immediately after receiving a percutaneous needle aspiration biopsy for the pathologic examination of pulmonary nodules found during a routine health medical examination. She had left side weakness and ST segment elevation on an electrocardiogram. After a high concentration of oxygen, she recovered from neurological symptoms and electrocardiographic abnormalities. The authors report a case of air embolism occurring simultaneously in the brain and coronary arteries after percutaneous needle aspiration biopsy.
Aged ; Biopsy ; Biopsy, Needle* ; Brain ; Cerebral Infarction ; Consciousness ; Coronary Vessels ; Diagnosis ; Electrocardiography ; Embolism ; Embolism, Air* ; Fatal Outcome ; Female ; Humans ; Intracranial Embolism ; Lung* ; Myocardial Infarction ; Needles* ; Oxygen

The borderline tumor is not benign but has low malignant potential, which accounts for 10-15% of all ovarian tumors. The mucinous borderline tumors make up approximately 40% of all borderline tumors. About 5% of mature cystic teratomas of ovary include some with mucinous cystadenoma. The malignant transformation is occurred in about 1-3% of patients who have a mature cystic teratoma. There has been reported frequently about the malignant transformation of a mature cystic teratoma. After the first description of a patient with mucinous borderline tumor associated with a mature cystic teratoma in 1988, the borderline tumorous change of a mature cystic teratoma has been reported rarely. This report presents a patient with atypical proliferating mucinous tumor arising in a mature cystic teratoma.
Cystadenoma, Mucinous ; Female ; Humans ; Mucins ; Ovary ; Teratoma*

Nontuberculous mycobacterial (NTM) diseases are increasing worldwide. However NTM lung disease in organ transplant recipients has been rarely reported. Here, we report 2 cases of NTM lung disease in heart transplant recipients. A 37-year-old man, who had undergone a heart transplant one year previous, was admitted to hospital due to a cough. Chest CT scan showed multiple centrilobular nodules in both lower lungs. In his sputum, M. abscessus was repeatedly identified by rpoB gene analysis. The patient improved after treatment with clarithromycin, imipenem, and amikacin. An additional patient, a 53-year-old woman who had undergone a heart transplant 4 years prior and who suffered from bronchiectasis, was admitted because of purulent sputum. The patient's chest CT scan revealed aggravated bronchiectasis; M. intracellulare was isolated repeatedly in her sputum. Treatment was successfully completed with clarithromycin, ethambutol, and ciprofloxacin. NTM lung disease should be considered as a potential opportunistic infection in organ transplant recipients.
Adult ; Amikacin ; Bronchiectasis ; Ciprofloxacin ; Clarithromycin ; Cough ; Ethambutol ; Female ; Heart ; Heart Transplantation ; Humans ; Imipenem ; Lung ; Lung Diseases ; Middle Aged ; Nontuberculous Mycobacteria ; Opportunistic Infections ; Sputum ; Thorax ; Transplants