Kawasaki disease (KD) is an acute multisystemic vasculitis, which occurs in children of less than 10 years of age. Recently, KD has become the leading cause of acquired heart diseases in children in the developed world, with coronary artery aneurysms occurring in up to 25% of untreated cases. A number of publications described patients for whom the diagnosis was delayed since the symptoms did not fulfill the required criteria to be diagnosed as KD, and, consequently heightened cardiac complications resulted. These cases are known as atypical or incomplete KD. The following case report describes patients with atypical KD, whose initial presentation mimicked a cervical lymphadenitis. Empiric antibiotics were prescribed in these cases with unsatisfactory response, initially. An awareness of this entity with its manifestations is warranted by otolaryngologists who may well be the first doctor on the scene. Prompt and early treatment with aspirin and intravenous immunoglobulin may decrease morbidity and potential mortality of this enigmatic disease.
Aneurysm ; Anti-Bacterial Agents ; Aspirin ; Child ; Coronary Vessels ; Diagnosis ; Heart Diseases ; Humans ; Immunoglobulins ; Lymphadenitis* ; Mortality ; Mucocutaneous Lymph Node Syndrome* ; Vasculitis

No abstract available.

Humans ; Orthognathic Surgery

A case of primary carcinoid tumor of the liver with striking central fibrous scar in a 61-year-old male is reported. Tumor cells contained electron dense secretory granules with an average diameter 150~200 nm which demonstrated positive immunohistochemical reaction for neuron-specific enolase, synaptophysin and chromogranin. The stellate central scar was observed in various hepatic tumors including focal nodular hyperplasia, fibrolamellar carcinoma, or sclerosing hepatocellular carcinoma, but have not been reported in carcinoid tumor.
Carcinoid Tumor* ; Carcinoma, Hepatocellular ; Cicatrix ; Focal Nodular Hyperplasia ; Humans ; Liver ; Male ; Middle Aged ; Phosphopyruvate Hydratase ; Secretory Vesicles ; Strikes, Employee ; Synaptophysin

PURPOSE: To evaluate factors that influence morbidity and mortality in colorectal injuries. METHODS: We reviewed the medical records of 59 patients who underwent emergency operation in JNUH from Jan. 1988 through Dec. 1997. Univariate and multivariate analyses were used to calculate the prognostic significance of the following variables: sex, age, time to operation, preoperative shock, penetrating abdominal trauma index (PATI), APACHE II score, site of injury, organ injury scale (OIS), Flint grade, associated intraabdominal injuries, the sum of transfusion during 48hours of preoperative and postoperative period and operative method. RESULTS: Univariate analysis showed that colorectal organ iujury scale, and operative method were related to the complication, and preoperative shock, APACHE II score, PATI, and transfusion in 48hrs of injury were related to the mortality of colorectal injury. Multivariate logistic regression analysis showed that colorectal organ injury scale (2 vs 1) was significant risk factor in the development of complication, and the odds ratios were 5.0 and 1.69 respectively. The sum of transfusion in 48hours of injury was a only significant risk factor in the mortality and the odds ratio was 1.5. CONCLUSIONS: We concluded that preoperative condition was very important and preservation of hemodynamic stability was critical in improvement of prognosis. We also concluded that the shortening of operative time and proper management of associated injury may reduce the development of complication and even death.
APACHE ; Emergencies ; Hemodynamics ; Humans ; Logistic Models ; Medical Records ; Mortality ; Multivariate Analysis ; Odds Ratio ; Operative Time ; Postoperative Period ; Prognosis ; Risk Factors* ; Shock

Anti-N-methyl D-aspartate receptor (anti-NMDAR) encephalitis, recently recognized as a form of paraneoplastic encephalitis, is characterized by a prodromal phase of unspecific illness with fever that resembles a viral disease. The prodromal phase is followed by seizures, disturbed consciousness, psychiatric features, prominent abnormal movements, and autonomic imbalance. Here, we report a case of anti-NMDAR encephalitis with initial symptoms of epilepsia partialis continua in the absence of tumor. Briefly, a 3-year-old girl was admitted to the hospital due to right-sided, complex partial seizures without preceding febrile illness. The seizures evolved into epilepsia partialis continua and were accompanied by epileptiform discharges from the left frontal area. Three weeks after admission, the patient's seizures were reduced with antiepileptic drugs; however, she developed sleep disturbances, cognitive decline, noticeable oro-lingual-facial dyskinesia, and choreoathetoid movements. Anti-NMDAR encephalitis was confirmed by positive detection of NMDAR antibodies in the patient's serum and cerebrospinal fluid, and her condition slowly improved with immunoglobulin, methylprednisolone, and rituximab. At present, the patient is no longer taking multiple antiepileptic or antihypertensive drugs. Moreover, the patient showed gradual improvement of motor and cognitive function. This case serves as an example that a diagnosis of anti-NMDAR encephalitis should be considered when children with uncontrolled seizures develop dyskinesias without evidence of malignant tumor. In these cases, aggressive immunotherapies are needed to improve the outcome of anti-NMDAR encephalitis.
Anti-N-Methyl-D-Aspartate Receptor Encephalitis* ; Antibodies ; Anticonvulsants ; Antihypertensive Agents ; Cerebrospinal Fluid ; Child* ; Child, Preschool ; Cognition ; Consciousness ; D-Aspartic Acid ; Diagnosis ; Dyskinesias ; Encephalitis ; Epilepsia Partialis Continua* ; Female ; Fever ; Humans ; Immunoglobulins ; Immunotherapy ; Korea* ; Methylprednisolone ; Rituximab ; Seizures ; Virus Diseases

Squamous papilloma is a benign proliferation of stratified squamous epithelium, resulting in a papillary or verruciform mass. Verrucous carcinoma is a differentiated variant of squamous cell carcinoma and may present diagnostic difficulties as it may be erroneously diagnosed as squamous papilloma. Squamous papilloma is similar to other oral mucosa malignancy in microscopic view. So, it is difficult to distinguish between squamous cell papilloma and other oral mucosa malignancy. Here are three patients. they were diagnosed as squamous papilloma initially, but the lesion was recurred. In recurred lesion, verrucous carcinoma or squamous cell carcinoma were found. So we report that recurred oral mucosa malignency(verrucous carcinoma or squamous cell carcinoma) which was diagnosed as squamous papilloma.
Carcinoma, Squamous Cell ; Carcinoma, Verrucous ; Epithelium ; Humans ; Mouth Mucosa* ; Papilloma*

BACKGROUND/AIMS: This study was performed to investigate the clinical and serological characteristics of toxocariasis in the Pohang region. METHODS: A total of 145 patients with peripheral eosinophilia (> 450 cells/microL) were enrolled and divided into two groups based on Toxocara excretory-secretory IgG enzyme-linked immunosorbent assay (ELISA) positivity, and the clinical features and serologic markers were compared between the two groups. RESULTS: The seropositive rate of Toxocara was 62.1%. The serum total eosinophils (p = 0.038), total IgE level (p < 0.01), Dermatophagoides farinae (Df) seropositivity rate (p < 0.01), frequency of eosinophilic tissue infiltration in the lung or liver (p < 0.01), and ingestion of raw cow meat or liver (p < 0.01) were higher in seropositive patients than in seronegative patients. However, the presence of asthma and rhinitis (p < 0.01) were more frequent in seronegative patients. Among seropositive patients, positive correlations were observed between serum total IgE, total eosinophils, and the optical density value of the Toxocara IgG ELISA (p < 0.01; p = 0.015, respectively). The specific IgE to Df was significantly higher (p < 0.01) than that to Dermatophagoides pteronyssinus (Dp), suggesting a cross reaction between the Df antigen and the Toxocara antigen. CONCLUSIONS: Patients who have elevated serum total IgE and have eosinophilia without allergic disease might have toxocariasis. The lower frequency of asthma or rhinitis and a tendency for higher specific IgE to Df than that to Dp could be useful findings for the diagnosis of toxocariasis in patients with eosinophilia.
Asthma ; Cross Reactions ; Dermatophagoides farinae ; Dermatophagoides pteronyssinus ; Eating ; Enzyme-Linked Immunosorbent Assay ; Eosinophilia ; Eosinophils ; Humans ; Immunoglobulin E ; Immunoglobulin G ; Liver ; Lung ; Meat ; Pyroglyphidae ; Rhinitis ; Toxocara ; Toxocara canis ; Toxocariasis

BACKGROUND: Ski injuries depend on many factors which involve the skier's skill, the skiing environment, and skier's equipment. The purpose of this study was to determine the factors associated with fractures by skiing accident. SUBJECT: We evaluated 566 patients with ski injuries who visited to the emergency post located in the YongPyong Ski Resorts from Nov. 1996 to Feb. 1997. Among the patients,379 patients had no fracture(group I) and 187 patients had fracture(group II). RESULT: There was no differences in mean age and sex ratio between two groups. Fractures of the lower extremities were more common than the upper extremities. Slipping was the most common injury mechanism. arming-up was done in 40% of group I and in 17% of group II. The fracture injuries were more common in the skier with intermediate(45%) skill than the beginner(29%) and the ones with advanced skill(12%). The slope with intermediate difficulty was the most frequent site of fracture accidents. The fracture group tended to choose the slope beyond their skiing ability. CONCLUSION: Our results suggest that fracture during skiing can be prevented if skiers do warming-up prior to skiing and choose slope appropriate to their skiing skill.
Emergencies ; Health Resorts ; Humans ; Lower Extremity ; Sex Ratio ; Skiing ; Upper Extremity

Kimura's disease is a rare inflammatory disorder of unknown etiology primarily seen in young Asian males. It is characterized by painless subcutaneous masses, blood and tissue eosinophilia, and markedly elevated serum immunoglobulin E (IgE) levels. Clinically, the subcutaneous nodules occur predominantly in the head and neck. However, we report the case of a five-year-old boy presenting with an asymptomatic solitary brown pigmented nodule on the left buttock diagnosed with Kimura's disease. Here we describe the diagnosis and treatment of this unusual case.
Asian Continental Ancestry Group ; Buttocks ; Child, Preschool ; Eosinophilia ; Head ; Humans ; Immunoglobulin E ; Immunoglobulins ; Male ; Neck