No abstract available.
Hand* ; Osteomyelitis*

Acrodermatitis enteropathica, an autosomal recessive disease, usually presents with severe acral and circumorificial dermatitis, diarrhea, alopecia, intercurrent bacterial infection during early infancy, and is eventually fatal if left untreated. We report a case of acrodermatitis enteropathica in a 2-month-old male infant who presented with chronic diarrhea not responsive to conventional therapy and developed disseminated intravascular coagulation (DIC). He showed the characteristic eczematoid skin lesions, chronic diarrhea, failure to thrive, and low serum zinc concenturation. Zn2+ was administered with dramatic improvement of skin lesions, DIC and diarrhea. He rapidly catched up normal growth and development on continuing zinc supplementation.
Acrodermatitis* ; Alopecia ; Bacterial Infections ; Dacarbazine ; Dermatitis ; Diarrhea* ; Disseminated Intravascular Coagulation* ; Failure to Thrive ; Growth and Development ; Humans ; Infant ; Male ; Skin ; Zinc

PURPOSE: We aimed to identify microbiological characteristics in patients with acute prostatitis after transrectal prostate biopsy to provide guidance in the review of prevention and treatment protocols. MATERIALS AND METHODS: A retrospective analysis of medical records was performed in 1,814 cases who underwent prostate biopsy at Seoul St. Mary's Hospital and St. Vincent's Hospital over a 5 year period from 2006 to 2011. Cases in which acute prostatitis occurred within 7 days after the biopsy were investigated. Before starting treatment with antibiotics, sample collections were done for culture of urine and blood. Culture and drug susceptibility was identified by use of a method established by the Clinical and Laboratory Standards Institute. RESULTS: A total of 1,814 biopsy procedures were performed in 1,541 patients. For 1,246 patients, the procedure was the first biopsy, whereas for 295 patients it was a repeat biopsy. Twenty-one patients (1.36%) were identified as having acute bacterial prostatitis after the biopsy. Fifteen patients (1.2%) had acute prostatitis after the first biopsy, and 6 patients (2.03%) experienced acute prostatitis after a repeat biopsy. Even though the incidence of acute bacterial prostatitis was higher after repeat biopsy than that after the first biopsy, there was no statistically significant intergroup difference in terms of incidence (chi2=1.223, p=0.269). When the collected urine and blood samples were cultured, Escherichia coli was found in samples from 15 patients (71.4%), Klebsiella pneumoniae in 3 patients (14.3%), Enterobacter intermedius in 1 patient (4.8%), E. aerogenes in 1 patient (4.8%), and Pseudomonas aeruginosa in 1 patient (4.8%). A fluoroquinolone-resistant strain was confirmed in 5 cases (23.8%) in total. Three cases of E. coli and 1 case of Klebsiella had extended-spectrum beta-lactamase activity. CONCLUSIONS: Empirical treatment of acute prostatitis should be done with consideration of geographical prevalence and drug resistance. This study will provide meaningful information for the management of acute prostatitis after transrectal prostate biopsy.
Acute Disease ; Anti-Bacterial Agents ; beta-Lactamases ; Biopsy ; Drug Resistance ; Enterobacter ; Escherichia coli ; Humans ; Incidence ; Klebsiella ; Klebsiella pneumoniae ; Medical Records ; Prevalence ; Prostate ; Prostatitis ; Pseudomonas aeruginosa ; Retrospective Studies ; Sprains and Strains

Internuclear ophthalmoplegia(INO) is characterized by the adduction deficit on lateral gaze associated with dissociated nystagmus of an abducting eye and caused by the lesion in the medial longitudinal fasciculus(MLF). It occurs unilaterally or bilaterally in infarction of brain stem and multiple sclerosis. Ocular myasthenia is a localized form of myasthenia involving extraocular, levator palpebrae perioris, and/or orbicularis oculi muscles. It is frequently confused with a variety of ocular mortility disorders including INO. We experienced 2 patients who had bilateral wall-eyes and diplopia. One was a true bilateral INO due to hypertensive brain stem infarction(Wall-eyed bilateral INO) and the other was a myasthenic bilateral pseudo-INO. Diagnosis was made by Tensilon test, repetitive nerve stimulation test of orbicularis oculi muscles, and serum antibody assay in latter case.
Brain Stem ; Diagnosis ; Diplopia ; Edrophonium ; Exotropia* ; Humans ; Infarction ; Multiple Sclerosis ; Muscles ; Nystagmus, Pathologic ; Ocular Motility Disorders ; Ophthalmoplegia*

PURPOSE: Papillary thyroid microcarcinomas (PTMCs) have the same histological features as papillary thyroid cancer, but they are 1.0 cm or less in diameter. They can metastasize to the regional lymph nodes and distant sites, but its ability to cause significant morbidity and mortality has been questioned. Because of this reason, the extent of thyroid tumor resection remains an issue of controversy. This study is aimed at identifying the statistically significant factors that are associated with recurrence and we also wanted to devise an appropriate surgical treatment plan for PTMC patients. METHODS: The retrospective review (350 cases, 1990.1~2004. 11) was obtained from Seoul National University Hospital (SNUH). The mean age at the time of diagnosis was 46.5± 11.0 (yrs) (range: 12~75). The mean overall length of follow- up was 37.70± 36.03 months (range: 1~169). The PTMCs were treated with total and subtotal thyroidectomy or lobectomy. The invasiveness and lymph node metastasis (LNM) from 350 PTMCs were analyzed according to the size, multiplicity, bilaterality of the tumor and the perithyroidal invasion. Fishers exact test and the exact logistic regression test were used for the stratified analysis. RESULTS: 350 of the 2187 papillary carcinoma were PTMCs. There were 296 females (84.6%) and 54 males (15.4%) in the study. Invasion into the perithyroidal tissue was common (128/336, 38.1%). There were 68 patients with LNM among the 312 total patients (21.7%). The group with either perithyroidal invasion or LNM showed a significantly higher recurrence rate than those group having neither one (4.8% vs. 10.9%, 4.5% vs. 19.1%, respectively). Even for tumor smaller than 1 cm, a larger-sized tumor resulted in a poorer prognosis. CONCLUSION: PTMC is an early stage carcinoma with the capability of tissue invasion, lymph node metastasis and multiplicity. Based on this study, total thyroidectomy is recommended for significant portion of the PTMCs. Furthermore, more careful imaging studies (such as neck ultrasonography or neck CT scan) are needed to detect contralateral lesions or neck lymph node metastasis.
Carcinoma, Papillary ; Diagnosis ; Female ; Humans ; Logistic Models ; Lymph Nodes ; Male ; Mortality ; Neck ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Retrospective Studies ; Seoul ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroidectomy ; Ultrasonography

PURPOSE: Endoscopic thyroidectomy has recently been widely used in clinical practice. The operative method can be classified into CO2gas insufflation and the gasless technique. This study assessed the safety of low pressure CO2gas insufflation (up to 6 mmHg) by performing continuous measurement of the end-tidal CO2 (ETCO2) pressure. METHODS: From March 2003 to October 2006, 95 patients (90 hemithyroidectomies and 5 total thyroidectomies) underwent endoscopic thyroidectomy. The low pressure CO2gas insufflation technique was applied in all cases. The ETCO2 pressure of the patients was measured by capnometry at the time of a pre-gas insufflation status (0 minutes) and at the time of post-CO2gas insufflation (30 minutes) and then it was measured every 30 minutes with also performing capnograms. We analyzed the ETCO2 pressure at the time of the pre-CO2gas insufflation status (0 min) and we compared this with that of each status by using paired T-test. RESULTS: For all 95 cases, the mean patient age was 36.2+/-9.1 (range: 21~57 years), the mean tumor size was 1.7+/-1.1 (range: 0.1~4.5 cm) and the mean operative time was 135.0+/-46.1 (range: 50~340 min). The mean ETCO2 pressure (mmHg) was 33.0+/-3.9 at the time of pre-CO2gas insufflation status (0 min); the mean ETCO2 pressure was 31.1+/-3.7 at 30 min (n=95), 33.5+/-3.7 at 60 min (n=95), 35.2+/-3.6 at 90 min (n=95), 34.9+/-3.7 at 120 min (n=90), 34.6+/-3.8 at 150 min (n=70), 34.1+/-3.4 at 180 min (n=40), 34.3+/-5.2 at 210 min (n=15) and 34.0+/-4.2 at 240 min (n=9). There was a significant difference the early post-CO2gas insufflation status (P<0.05 at 30 min, 90 min, 120 min), but there was no significant difference in the late post-CO2gas insufflation status (P>0.05; at 60 min, 150 min, 180 min, 210 min, 240 min). At each time point, the ETCO2 pressures were all within the normal range. CONCLUSION: We successfully performed endoscopic thyroidectomy with using the low pressure CO2gas insufflation technique and there were no significant complications. We think that performing endoscopic thyroidectomy with using the low pressure CO2gas insufflation technique is a safe procedure.
Humans ; Insufflation* ; Operative Time ; Prospective Studies* ; Reference Values ; Thyroidectomy*

Infectious mononucleosis is an acute infectious disease occurring predominantly in older children and young adults due to primary Epstein-Barr virus infection. The clinical picture is extremely variable in both severity and duration. The disease in children is generally mild. It is characterized clinically by fever, exudative or membranous pharyngitis, generalized lymphadenopathy, and splenomegaly. Rarely, it complicates neurologic involvement such as cranial nerve palsy, meningoencephalitis, and transverse myelitis, hematologic involvement such as hemolytic anemia, immune thrombocytopenic purpura, and aplastic anemia, rupture of spleen, myocarditis, interstitial pneumonia, and orchitis, etc. We experienced a case of infectious mononucleosis with pleural effusion and ascites in a 5-year-old male with the chief complaint of fever, sore throat and vomiting 3 days prior to admission. The diagnosis was made on the clinical findings, immunologic findings and the typical findings of peripheral blood smear. On peripheral blood smear, leukocytosis with atypical lymphocytosis were seen. On immunologic study, anti-VCA IgM and IgG were positive by ELISA method. We reported this case and reviewed related literatures briefly.
Anemia, Aplastic ; Anemia, Hemolytic ; Ascites* ; Child ; Child, Preschool ; Communicable Diseases ; Cranial Nerve Diseases ; Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Fever ; Herpesvirus 4, Human ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Infectious Mononucleosis* ; Leukocytosis ; Lung Diseases, Interstitial ; Lymphatic Diseases ; Lymphocytosis ; Male ; Meningoencephalitis ; Myelitis, Transverse ; Myocarditis ; Orchitis ; Pharyngitis ; Pleural Effusion* ; Purpura, Thrombocytopenic, Idiopathic ; Rupture ; Spleen ; Splenomegaly ; Vomiting ; Young Adult

An 18-year-old man suffered heat stroke after continuous working for 26 hours on his first day in an aluminium utensil plant in August 1998. His job was to put a pressed aluminium utensil on the conveyer before the process of spray painting. The ranges of temperature and relative humidity measured at the local weather-station during the patient' s working period were 23.6-30.2 degrees C, 49-87 % respectively. On arrival the patient was comatose and suffered generalized seizure three times. His rectal temperature was 41.2 degrees C . blood pressure was 90/60 mmHg, pulse was 148 beats/minute and respiratory rate was 28 times/minute. The serum level of AST was 421 IU/L. ALT was 205 IU/L, LDH was 1,160 IU/L. myoglobin was higher than 500 ng/mL. OK was higher than 2,000 IU/L. He recovered consciousness 7th day of admission and discharged after 2 months but cerebellar dysarthria was remained. The patient felt himself several prodromal symptoms of heat stroke and he showed awkward behavior considered to be drowsiness, but the patient and his co-workers neglected them. This case report shows that heat stroke can be occurred in a condition that ambient temperature, humidity, and working load are not extreme. A thorough health education and management concerned with guidelines on salt and water intake, detection of early symptoms of heat-related illness, prompt body cooling and rapid transportation to a hospital is necessary.
Adolescent ; Blood Pressure ; Coma ; Consciousness ; Drinking ; Dysarthria ; Health Education ; Heat Stroke* ; Hot Temperature* ; Humans ; Humidity ; Myoglobin ; Paint ; Paintings ; Plants* ; Prodromal Symptoms ; Respiratory Rate ; Seizures ; Sleep Stages ; Transportation

Background: Several biomarkers are measured in the interstitial fluid (IF) obtained from suction blisters that are used by dermatologists. As abnormal lipid levels can cause health problems, several studies have investigated the composition and distribution of lipids and lipoproteins in IF. However, to date, no study has focused on examining lipid profiles in the postprandial state. Objective: This study aimed to compare postprandial changes in serum lipid profiles and IF obtained from suction blisters and investigated their correlation. Methods: Fasting and postprandial levels of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides were measured in paired serum samples. IF was obtained from suction blisters from 20 healthy men using enzymatic-colorimetric methods. Results: The IF/serum ratios of TC, HDL-C, and LDL-C remained unchanged postoperatively. Postprandial levels of HDL-C and LDL-C decreased in the serum but not in IF. In both fasting and postprandial states, TC, HDL-C, and LDL-C levels in the serum were positively correlated with those in the IF. Conclusion The results of this study showed that lipoprotein cholesterol levels measured from suction blister fluids could be used as a biomarker to predict their serum levels regardless of food intake. Therefore, suction blister fluid sampling can be considered as a method to monitor serum lipid concentrations.

Background: We aim to compare the clinical characteristics and subjectively reported symptoms of the acute coronavirus disease (COVID) phase and those of the post-acute COVID phase to examine varying factors that affect the number of persistent symptoms and their categories. Methods: We categorized 1,122 patients who visited the post coronavirus disease 2019 (COVID-19) clinic into two groups: “acute group” (< 4 weeks following diagnosis of COVID-19) and “post-acute group” (> 4 weeks following diagnosis of COVID-19). We statistically compared clinical characteristics between the two groups and determined which factors are associated with the number of persistent symptoms and their categories. Results: The persistent symptoms of post COVID-19 conditions were classified into three categories as follows: Category A (the prevalence of symptoms is higher in the acute-visit group than in the post-acute-visit group), Category B (the prevalence of symptoms is not different between the two groups) and Category C (the prevalence of symptoms is higher in the post-acute-visit group than in the acute-visit group). Category A mainly included respiratory symptoms. Category B had generalized weakness, weight loss, cardiologic symptoms, hypogeusia, hyposmia, anxiety, and various gastrointestinal symptoms. Category C included fatigue, decreased attention, depression, blurred vision, hair loss, and sexual dysfunction.Anxiety, depression, fatigue and age were also associated with the number of symptoms and their categories, and anxiety is the most correlated factor (P < 0.001) among them. Conclusion The persistent symptoms of post COVID-19 condition involve multi-organ and continue for four weeks or greater. Therefore, long-term observation and multidisciplinary interventions are essential for patients with post COVID-19 conditions.