Sweet's syndrome, or acute febrile neutrophilic dermatosis, is an unusual disease characterized by fever, leukocytosis, and distinctive skin lesions. Common complications include arthralgia, arthritis, conjunctivitis, and iridocyclitis. However, the involvement of the central nervous system in this disease, termed `neuro-Sweet syndrome' is rarely reported. We present a patient with recurrent encephalitis for 15 years, accompanied with neutrophilic dermatosis, and characterized by HLA-B54 and Cw1, with good responsiveness to corticosteroid.
Arthralgia ; Arthritis ; Central Nervous System ; Conjunctivitis ; Encephalitis ; Fever ; Humans ; Iridocyclitis ; Leukocytosis ; Neutrophils ; Skin ; Skin Diseases ; Sweet Syndrome

Osmotic myelinolysis syndrome in central nervous system is classified into central pontine myelinolysis(CPM) and extrapontine myelinolysis(EPM). The former can cause a spastic quadriplegia, pseudobulbar palsy, and varying degree of mental disorder, but the latter a movement disorder(tremor, dystonia, parkinsonism, and chorea, etc), behavior change(mood instability, personality change, agitated delirium, and disinhibition, etc), and cognitive dysfunction. Although a few cases of asymptomatic CPM have been reported, asymptomatic EPM were rare. A 67-year-old woman with diabetes mellitus and old cerebral infarction has suffered from the common bile duct stone. She had hyponatremia(Na=126mEq/L) on admission and was corrected rapidly. Incidental findings of her brain MRI showed EPM. We experienced a case of bilateral middle cerebellar peduncle myelinolysis incidentally without neurological presentations and report a rare case of asymptomatic EPM recoverd in diabetic woman after rapid correction of hyponatremia.
Aged ; Brain ; Central Nervous System ; Cerebral Infarction ; Chorea ; Common Bile Duct ; Delirium ; Diabetes Mellitus ; Dihydroergotamine ; Dystonia ; Female ; Humans ; Hyponatremia ; Incidental Findings ; Magnetic Resonance Imaging ; Mental Disorders ; Myelinolysis, Central Pontine* ; Parkinsonian Disorders ; Pseudobulbar Palsy ; Quadriplegia

OBJECTIVES: People at ultra-high risk for psychosis have heterogenous character and different long-term outcomes. We divided ultra-high risk subjects into two subgroups by presence of familial history and tried to find different pattern of functional connectivity of the default mode network (DMN) between the two groups in order to examine the effects familial loading. METHODS: Eleven subjects at clinical-high risk (CHR) group with familial history of psychiatric illness and nineteen subjects of CHR group without familial history were recruited. All the subjects were scanned using resting-state functional magnetic resonance imaging. A posterior cingulate cortex was the seed region of the analysis, and the DMN of the both high risk group were analyzed with voxel-wise two sample T test. RESULTS: The CHR group with familial history showed greater functional connectivity in the precuneus area in contrast with the other high risk subjects (peak-level t=5.49, p<0.001). There were no significant differences in total score on the Positive and Negative Syndrome Scale and Scales of Psychosis-risk Syndrome between the two groups. CONCLUSION: The study suggests that the abnormalities of functional connectivity between precuneus and posterior cingulate area may be associated with the genetic vulnerability of high risk trait.
Gyrus Cinguli ; Magnetic Resonance Imaging ; Pilot Projects ; Psychotic Disorders ; Seeds ; Weights and Measures

PURPOSE: To tabulate underlying disease and to assess the clinical significance of CT-diagnosed spontaneouspneumonediastinum. MATERIALS AND METHODS: We retrospectively reviewed CT scans and medical records of 11consecutive patients with spontaneous pneumomediastinum, and analyzed their clinical history and course, and infive cases, pulmonary function. CT scans of 126 patients with idiopathic pulmonary fibrosis (IPF) collected whilethe 11 consecutive patients were being treated were analyzed for the prevalence of pneumomediastinum. We analyzedCT findings with respect to the amount and distribution of air in the mediastinum, and the presence or absence ofair outside the mediastinum. RESULTS: In the 11 patients, underlying diseases were IPF (n=4), bronchiolitisobliterans organizing pneumonia (BOOP)(n=2), bronchiectasis (n=2), tuberculous tracheal stenosis (n=1), andpulmonary tuberculosis with bullous emphysema (n=1); there was one without associated disease. Of the 126 patientswith IPF, four (3.2%) showed spontaneous pneumomediastinum. All ten with underlying diseases had severe dyspnea.In five patients, a pulmonary function test showed marked impairment. Two of four patients with IPF and both withBOOP died within 2 months of CT scanning, whereas the remaining six showed clinical improvement. The detectionrate of pneumomediastinum on plain chest radiograph was 82% (9/11). CT showed that mediastinal air was mostfrequently found in the retrosternal space. There were four cases of pneumothorax and two of subcutaneousemphysema. CONCLUSION: Spontaneous pneumomediastinum might be associated with idiopathic pulmonary fibrosis andmight be a poor prognostic factor in patients with IPF or BOOP.
Bronchiectasis ; Cryptogenic Organizing Pneumonia ; Emphysema ; Humans ; Idiopathic Pulmonary Fibrosis ; Mediastinal Emphysema* ; Mediastinum ; Medical Records ; Pneumonia ; Pneumothorax ; Prevalence ; Radiography, Thoracic ; Respiratory Function Tests ; Retrospective Studies ; Tomography, X-Ray Computed ; Tracheal Stenosis ; Tuberculosis

Deep vein thrombosis and pulmonary embolism are serious and fatal complications in orthopedic surgery. Most cases of symptomatic pulmonary embolism in knee surgery have been reported after total knee arthroplasty, but rarely after patella fracture. We report on a case of symptomatic pulmonary embolism after surgical treatment of a patella fracture in a 42-year-old female patient.
Adult ; Arthroplasty ; Enclomiphene ; Female ; Humans ; Knee ; Patella* ; Pulmonary Embolism* ; Venous Thrombosis

PURPOSE: To compare the CT findings of mycobacterial infection other than tuberculosis (MOTT) with those of tuberculosis (TB). MATERIALS AND METHODS: The chest CT scans of 30 immunocompetent patients with culture-proven pulmonary MOTT (M:F=11:19; mean age, 51.2 yrs.) and of 24 patients with active tuberculosis (M:F=12:12; mean age, 42.5 yrs.) were analyzed by two radiologists; decisions were reached by consensus. RESULTS: Common findings for both MOTT and TB included bronchogenicaly-spread bronchogenic spread nodular lesion (93.3% for MOTT, 100 % for TB), bronchiectasis (90%, 83.3%), bronchial wall thickening (66.7%, 54.2%), granuloma (63.3%, 75%), parenchymal scarring (53.3%, 54.2), and mediastinal lym-phadenopathy (50%, 37.5 %). Less commonly observed findings were emphysema (46.7%, 29.7%), atelectasis (36.7%, 29.2%), narrowing of a major airway (23.3%, 25%), consolidation (23.3 %, 29.2 %), and pleural disease (16.7%, 29.2%). Except for cavity (30%, 53.3%; p< .05), the frequencies of each finding were not right middle lobe (40%, 16.7%), right lower lobe (63.3%, 33.3%) and lingula division (53.3 %, 25%) was sig-nificantly more common in MOTT than in TB (p < .05). The number of lobes in which bronchiectasis and bronchial wall thickening were involved was greater in MOTT(3.20) than in TB(2.04) (p=.011). CONCLUSION: Although the CT findings of MOTT and TB overlap considerably, cavities are more common in TB, while in MOTT, bronchiectasis in the lower lung zone is more common and bronchiectasis tends to be more extensive.
Bronchiectasis ; Cicatrix ; Consensus ; Emphysema ; Granuloma ; Humans ; Lung ; Pleural Diseases ; Pulmonary Atelectasis ; Tomography, X-Ray Computed ; Tuberculosis*

PURPOSE: To describe the clinical and radiologic findings of all-trans-retinoic acid (ATRA) syndrome in acute promyelocytic leukemia. MATERIALS AND METHODS: Among 21 patients with acute promyelocytic leukemia who were treated with all-trans- retinoic acid between 1995 and 1998, we retrospectively evaluated the cases of four with ATRA syn-drome. Two were male and two were female, and their mean age was 58 years. The clinical and radiologic findings of chest radiography (n=4) and HRCT (n=1) were analyzed. RESULTS: Between seven and 13 days after ATRA treatment, dry cough, dyspnea and high fever developed in all patients. The WBC count in peripheral blood was significantly higher [2.9 -25.3(mean, 10.8)-fold] than before ATRA treatment, and in all patients, chest radiography revealed ill-defined consolidation and pleural effu-sion. Kerley 's B line (n=3) and hilar enlargement (n=3) were also seen, and in one patient, HRCT demonstrated septal line thickening. Among four patients treated with prednisolone and Ara-C,three recovered and one CONCLUSION: In acute promyelocytic patients treated with all-trans-retinoic acid, radiologic findings of ill-de-fined consolidation, pleural effusion, hilar prominence and Kerley 's B line may suggest ATRA syndrome. The early diagnosis of this will improve the patients' prognosis.
Cough ; Dyspnea ; Early Diagnosis ; Female ; Fever ; Humans ; Leukemia, Promyelocytic, Acute* ; Male ; Pleural Effusion ; Prednisolone ; Prognosis ; Radiography ; Retrospective Studies ; Thorax ; Tretinoin

Alveolar soft-part sarcoma is a rare soft tissue sarcoma of young adults with unknown histogenesis, and the organ most frequently involved in metastasis is the lung. We report the CT findings of three patients of pulmonary metastases of alveolar soft-part sarcoma, which manifested as clearly enhanced pulmonary nodules or masses. On enhanced scans, some of the masses were seen to contain dilated and tortuous intratumoral vessels.
Adult ; Case Report ; Female ; Human ; Lung Neoplasms/blood supply/*radiography/*secondary ; Male ; Sarcoma, Alveolar Soft Part/blood supply/*radiography/*secondary ; *Tomography, X-Ray Computed

No abstract available.
Lichen Planus ; Lichens

INTRODUCTION: The practicing of patient-centered medical services means a change in the pattern of the nature of doctor-patient relationship. The doctor oriented relationship is now moving to the pattern that patients resolve problems autonomously and participate in the decision-making in medical services. Authors performed this study to investigate the patient centeredness and influencing variables in medical students. METHODS: Authors recruited 94 medical students before psychiatric clinical clerkship and all subjects were assessed by structured questionales including socio-demographic data, frequency of receiving doctor-patient relationship lectures, Minnesota multiphasic personality inventory (MMPI), Meyers-Briggs type indicator (MBTI), the authoritarian personality scale (AP), job satisfaction scale (JS), patient practitioner orientation scale (PPOS), problem-solving decision-making scale (PSDM), and Beisecker locus of authority in decision-making scale (BLAS), and the questionnaire of JS, PPOS, PSDM, and BLAS were rechecked after psychiatric clinical clerkship. RESULTS: After psychiatric clinical clerkship, the score of JS, PPOS were higher than before. The group who had a good memory for taking a doctor-patient relationship lecture showed higher scores of the BLAS and PSDM than unexposed group. The AP was related with MBTI, correlated with the subscale of MMPI, however, inversely correlated with PPOS after psychiatric clinical clerkship. CONCLUSION: The authoritarian personality trait was related not only with other personality trait including introversion and psychopathic deviation (Pd) but also with patient-centeredness. Taking a lecture in doctor-patient relationship is positively related to the patient-centeredness.
Clinical Clerkship ; Humans ; Introversion (Psychology) ; Job Satisfaction ; Lectures ; Memory ; MMPI ; Surveys and Questionnaires ; Students, Medical*