No abstract available.
Breast Diseases* ; Breast*

PURPOSE: Computed tomography (CT) is the standard diagnostic method employed in cases of blunt head trauma, and repeat CT (RCT) scans are very often obtained in order to monitor for acute progression of intracranial pathology. The purpose of this study was to retrospectively evaluate the utility of the routine RCT scans in patients with traumatic brain injury (TBI), and to suggest the guidelines for RCT scans of the head. METHODS: The trauma registry and medical records of patients who were admitted to the emergency department of our university hospital from January 2004 to December 2006 were retrospectively reviewed. All patients admitted with TBI who received RCT scans of head were enrolled in this study. Results of initial head CT scans, indications for RCT (routine vs. neurologic change), and neurosurgical interventions (craniotomy and extraventricular drainage) were recorded. For patients who received worsened or unchanged subsequent RCT scans, the scans were compared and independent predictors of a worsened RCT were identified by stepwise logistic regression. Patients were categorized according to the Glasgow Coma Scale (GCS) as having mild (GCS 14-15), moderate (GCS 9-13), or severe (GCS< or =8) head injury. RESULTS: All inclusion criteria were met in 338 patients. Most (70.7%, n=239) RCT scans were preformed on a routine basis, whereas 29.3% (n=99) were ordered in response to neurological change. One hundred eleven (32.8%) patients showed signs of worsening on RCT, and 62 (13.8%) required neurosurgical intervention. Risk factors associated with worsening on CT evaluations were coagulopathy; skull fracture; multiple lesions; and an initial diagnosis of acute subdural hematoma, acute epidural hematoma, or hemorrhagic contusion. No patient with a mild or moderate TBI without neurological deterioration underwent an neurosurgical intervention after routine RCT. However, of the 48 patients with severe TBI who underwent routine RCT, the repeat scanning led to neurosurgical intervention in 5 patients (10.4%). CONCLUSION: In patients with mild and moderate TBI without clinical deterioration, routine RCT does not alter management and is unnecessary. Nevertheless, conclusions about patients with moderate TBI should be drawn with caution. Routine RCT is unequivocally indicated for patients with severe TBI, because the results sometimes dictate neurosurgical intervention even in the absence of obvious neurological deterioration.
Brain Injuries* ; Brain* ; Contusions ; Craniocerebral Trauma ; Diagnosis ; Emergencies* ; Emergency Service, Hospital ; Glasgow Coma Scale ; Head ; Hematoma ; Hematoma, Subdural, Acute ; Humans ; Logistic Models ; Medical Records ; Pathology ; Retrospective Studies ; Risk Factors ; Skull Fractures ; Tomography, X-Ray Computed

Ectopic pancreas rarely produces clinical symptoms. Most commonly reported symptoms were abdominal pain, epigastric discomfort, nausea, vomiting, and bleeding. However, presentation of specific symptoms due to its size and location, including obstructive jaundice, and pyloric obstruction are possible. Ectopic pancreas is subject to various pathological changes occurring in the pancreas itself; namely, cyst, pancreatitis, hemorrhage, necrosis, and neoplastic change. We present a case of 60-year old woman with right upper quadrant pain in whom the surgical pathologic diagnosis was ectopic pancreas of the stomach complicated by pancreatitis and pseudocyst formation.
Abdominal Pain ; Diagnosis ; Female ; Hemorrhage ; Humans ; Jaundice, Obstructive ; Middle Aged ; Nausea ; Necrosis ; Pancreas* ; Pancreatitis* ; Stomach ; Vomiting

Idiopathic myelofibrosis is characterized by replacement of the bone marrow with fibrous tissue and the development of extramedullary hematopoiesis. The latter involves mainly the spleen and liver but also occurs in lymph nodes, kidneys, retroperitoneal fat, and more rarely, the skin. We report a 48-year-old male with idiopathic myelofibrosis who was admitted due to numerous papules and nodules on his trunk. The skin lesions were histologically defined as cutaneous extramedullary hematopoiesis.
Bone Marrow ; Dermis ; Hematopoiesis, Extramedullary* ; Humans ; Intra-Abdominal Fat ; Kidney ; Liver ; Lymph Nodes ; Male ; Middle Aged ; Primary Myelofibrosis* ; Skin ; Spleen

BACKGROUND: Vasovagal syncope has been believed to account for the majority of syncope of unknown origin (SUO). Head-up tilt test (HUT) has been well recognized as a useful test in the evaluation of SUO. The purpose of this study was to determine the predictors of HUT to develop a less time-consuming test protocol and get an information on the pathophysiology of vasovagal syncope. METHODS: Eighty five patients (mean age, 43+/-18 years: 47 men, 38 women) underwent a 80 degree HUT without or with isoproterenol infusion (2 migcrogram/min and 5 migcrogram/min, each for 6 minutes) for unexplained syncope or pre-syncope. Positive HUT was defined as symptomatic hypotension (systolic blood pressure < or = 80 mm Hg) and/or symptomatic bradycardia (< or = 45/min for > or = 10 seconds) or asystole > or = 3 seconds. The patients were divided into two groups according to the result of the HUT: Group I included 47 patients (M:F=25:22) with positive result, Group II, 38 patients (M:F=22:16) with negative result. RESULTS: Group I patients had more episodes of syncope than Group II (3.1+/-2.5/year vs. 2.0+/-2.1/year, p<0.05). There were no significant differences between the 2 groups in the heart rate (HR), systolic and diastolic blood pressure (BP) at the baseline supine position. BP after tilt was not significantly different between 2 groups except for systolic BP at 6 minutes after tilt, which was significantly lower in Group I than Group II (109.5+/-17.5 mm Hg vs. 118.1+/-18.2 mm Hg, p<0.05).However, HR after tilt was significantly faster in Group I than Group II (81.1+/-15.1/min vs. 74.2+/-14.9/min, p<0.05 at 2 minutes after tilt; 83.7+/-14.4/min vs. 74.6+/-14.7/min, p<0.01 at 4 minutes after tilt). The increase in HR was greater in Group I than Group II (19.9+/-12.6/min vs. 12.8+/-10.6/min, p<0.001). In the prediction of positive HUT with HR rise above 14/min during the early 6 minute of baseline head-up tilting, the specificity, sensitivity, and positive predictive value were 63.2%, 70.2%, and 70.2%, respectively. CONCLUSION: In patients with SUO, positive HUT can be predicted with the early HR response during head-up tilt. This result shows that vasovagal syncope is triggered by exaggerated HR response to the decreased venous return and allow us to develop a less time-consuming HUT protocol.
Blood Pressure ; Bradycardia ; Heart Arrest ; Heart Rate ; Humans ; Hypotension ; Isoproterenol ; Male ; Sensitivity and Specificity ; Supine Position ; Syncope* ; Syncope, Vasovagal