Tsutsugamushi disease (Scrub typhus) is an acute febrile illness caused by infection with Orientia tsutsugamushi and characterized by focal or disseminated vasculitis, which may involve the lungs, heart, liver and central nervous system. Tsutsugamushi meningitis are reported worldwide, but central diabetes insipidus associated with CNS involvement have not been reported. A 53-year-old female diagnosed with tsutsugamushi disease showed polyuria during therapy with doxycycline. After injection of vasopressin, urine output was decreased and urine osmolarity was increased. So, we diagnosed as central diabetic insipidus. We report a case of central diabetes insipidus occurring during therapy for tsutsugamushi disease.
Central Nervous System ; Diabetes Insipidus ; Diabetes Insipidus, Neurogenic ; Doxycycline ; Female ; Heart ; Humans ; Liver ; Lung ; Meningitis ; Middle Aged ; Orientia tsutsugamushi ; Osmolar Concentration ; Polyuria ; Scrub Typhus ; Vasculitis ; Vasopressins

Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is characterized by congenital aplasia of the uterus and the upper part of the vagina in women showing normal development of secondary sexual characteristics and a normal 46, XX karyotype. MRKH syndrome usually remains undetected until the patient presents with primary amenorrhea despite normal female sexual development. MRKH syndrome is the second frequent cause of primary amenorrhea. There have been several reports concerning gynecologic disease in MRKH syndrome, but there has been few case about MRKH syndrome with gonadal agenesis. We report an exceptional association between bilateral ovarian agenesis 46,XX and MRKH syndrome. A 27-year-old woman who presented with primary amenorrhea and absence of secondary sexual development. She had normal, 46XX karyotype, but no upper vagina, uterus and both ovary. And there was no urogenital and skeletal malformation. She was diagnosed as the atypical form of MRKH syndrome (bilateral gonadal agenesis 46 XX).
Abnormalities, Multiple ; Adult ; Amenorrhea ; Female ; Genital Diseases, Female ; Gonadal Dysgenesis ; Gonads ; Humans ; Karyotype ; Kidney ; Mullerian Ducts ; Ovary ; Sexual Development ; Somites ; Spine ; Uterus ; Vagina

A 77-year old woman was referred to hospital with dyspnea and chest dull pain for 5 months. The chest radiograph showed a mass located in the mediastinum. Trachea was deviated to right side. Chest computed tomography showed an enhancing large mass at the middle mediastinum. Endobronchial ultrasonography showed hyperechoic mediastinal mass. We performed endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA). Histologic finding was thyroid tissue with a benign looking papilla. Ectopic thyroid is an uncommon embryological aberration characterized by the presence of thyroid tissue in a site other than in its usual pretracheal region. It occurs along the path of descent of the developing thyroid primodium from the foramen cecum. It is extremely rare for mediastinal ectopic thyroid tissue diagnosised by EBUS-TBNA, so we report here on a case of mediastinal ectopic thyroid and we review the relevant medical literature.
Biopsy, Needle ; Bronchoscopy ; Cecum ; Dyspnea ; Female ; Humans ; Mediastinal Neoplasms ; Mediastinum ; Needles ; Thorax ; Thyroid Dysgenesis ; Thyroid Gland ; Trachea

Pulmonary embolism is caused by various conditions including genetic and acquired factors, and among them, C and S protein deficiency are known as a cause of pulmonary embolism although their incidences are low. Apical hypertrophic cardiomyopathy is known as a subtype of hypertrophic cardiomyopathies which was reported to be a cause of diastolic heart failure or thromboembolism by activating coagulation system, and this may have an effect on developing pulmonary embolism. We report this since we experienced a case of both C and S protein deficiencies in a patient with apical hypertrophic cardiomyopathy who was diagnosed as pulmonary embolism and has been examined to find the cause of the disease.
Cardiomyopathy, Hypertrophic ; Heart Failure, Diastolic ; Humans ; Incidence ; Protein C ; Protein C Deficiency ; Protein Deficiency ; Protein S Deficiency ; Pulmonary Embolism ; Thromboembolism

OBJECTIVES: To describe the surgical technique according to personal experience, the effectiveness and safety of HoLEP. MATERIALS & METHODS: From May 2010 to April 2011, 120 consecutive patients treated with HoLEP were enrolled in this study. All patients was evaluated by digital rectal examination (DRE), transrectal ultrasonography (TRUS), serum PSA preoperatively. International Prostate Symptom Score (IPSS), peak urinary flow rate (Qmax), and postvoid residual urine (PVR) were documented preoperatively and 3 months postoperatively. The perioperative data and complications were analyzed. All procedures of HoLEP was done by single surgeon. RESULTS: The mean patient age was 68.0 (50-82), and the average operation time was 71.6 minutes (range, 30-150). Mean prostate volume was 54.1 ml (range, 20-120) and mean resected tissue weight was 7.9 g (range, 2-30). Postoperatively, IPSS and PVR decreased and Qmax increased significantly. Postoperative complications were transient incontinence, urinary retention, hematuria, urinary tract infection, urethral stricture and bladder neck contracture, and intraoperative complication was minor capsular perforation. HoLEP is a method that may completely remove prostatic adenoma tissues. In particular, its clinical effectiveness is excellent regardless of prostatic size, and it is effective even in cases with prostate volume of 100 ml or more. However, about 50 cases are needed to reach the experienced level. CONCLUSIONS: HoLEP was found to be effective and safe regardless of prostatic size. The author believe HoLEP is a size independent gold standard for BPH surgery.
Contracture ; Digital Rectal Examination ; Hematuria ; Holmium ; Humans ; Intraoperative Complications ; Lasers, Solid-State ; Neck ; Postoperative Complications ; Prostate ; Prostatic Hyperplasia ; Retention (Psychology) ; Urethral Stricture ; Urinary Bladder ; Urinary Incontinence ; Urinary Tract Infections

OBJECTIVES: To determine which factors are changed in the thyroid cancer postoperative care and how quality of life compared between patients who had undergone modified radical neck dissection and selective neck dissection. METHODS: Prospectively, total 151 patients who diagnosed as thyroid cancer and underwent 16 modified radical neck dissection (mRND) or 135 selective neck dissection (SND) were evaluated for shoulder function, neck mobility, and quality of life and degree of depression at baseline, 2 days and 1 week postoperatively. All patients performed neck and shoulder stretching exercise three times a day beginning the morning following surgery. Shoulder function was assessed with the Constant's shoulder scale. Quality of life was assessed with the SF36v2 questionnaire. And depression was assessed with Beck depression inventory (BDI). RESULTS: The disability scores of patients were significantly worse for neck range of motion (ROM), shoulder pain, ADL, shoulder ROM, shoulder abduction power, total score of Constant's shoulder scale, physical function domain in SF-36v2 and BDI score & grade 2 days after the surgeries. SF36v2 domain score was no significantly difference between two groups. CONCLUSION: The mRND and SND are risk factors for neck ROM limitation, shoulder dysfunction, and onset of depression. In comparison between mRND and SND, more deterioration in ADL, shoulder abduction power, total score of Constant's shoulder scale are associated with modified radical neck dissection. More study is needed about usefulness of the stretching exercise in shoulder pain onset through comparison with control group.
Activities of Daily Living ; Depression ; Humans ; Neck ; Neck Dissection ; Postoperative Care ; Prospective Studies ; Quality of Life ; Surveys and Questionnaires ; Range of Motion, Articular ; Risk Factors ; Shoulder ; Shoulder Pain ; Thyroid Gland ; Thyroid Neoplasms

OBJECTIVES: Improvement of liver synthetic function and the incidence of complication in the patients with hepatitis B-related liver cirrhosis is important. In this study, we study whether antiviral therapy was effective in patients with hepatitis B-related liver cirrhosis. METHODS: 103 patients with hepatitis B-related liver cirrhosis treated with lamivudine 100mg daily over 6 months and followed up over 30 months. 71 patients were positive for serum HBeAg. HBeAg, HBV DNA , CBC, prothrombin time, biochemistry, ultrasonography and endoscopy were tested every 6 months. RESULTS: The medians of ALT, albumin improved after 6 months and then aggravated after 18 months, but they didn't aggravated at 30 months compared with initial test. The median of Child-turcotte-pugh (CTP) score imporved after 6 months and then aggravated after 12 months, but they didn't aggravated at 30 months compared with initial test. The CTP score improved (2 point reduction) in 29 patients. The finding of ultrasonography didn't aggravaed (improved or didn't changed) in 58 patients. The 5 year incidence rate of hepatocelluar carcinoma was 8.3%. CONCLUSIONS: The antiviral therapy in patients with hepatitis B-related liver cirrhosis is improved CTP score and biochmical data. The improvement is more useful in decompensated cirrhosis the compensated cirrhosis. The incidence of hepatocellular carcinoma decreases than other studies. Therefore, the antiviral medication in patients with hepatitis B-related liver cirrhosis is helpful to consider more aggressively.
Antiviral Agents ; Biochemistry ; Carcinoma, Hepatocellular ; Cytidine Triphosphate ; DNA ; Endoscopy ; Fibrosis ; Hepatitis ; Hepatitis B e Antigens ; Hepatitis B, Chronic ; Humans ; Incidence ; Lamivudine ; Liver ; Liver Cirrhosis ; Prothrombin Time

OBJECTIVES: Fatigue, anxiety and depression are common psychiatric symptoms in epilepsy patients. The aim of this study is to evaluate the relationship between fatigue and anxiety and depression in epilepsy patients. METHODS: Subjects were 39 patients with epilepsy. The degrees of fatigue, anxiety and depression were evaluated by using Fatigue Severity Scale (FSS) and Hospital Anxiety and Depression Scale (HADS) respectively. Univariate regression analysis was performed to assess the relationship of fatigue to anxiety and depression. RESULTS: In patients with epilepsy, the prevalence rate of fatigue was 66.7%, and the prevalence rates of moderate to severe degree of anxiety and depression were 10.3% and 25.6% respectively. Fatigue was significantly correlated with anxiety in epilepsy patients (P < 0.01). However there was no relationship between fatigue and depression. CONCLUSIONS: Fatigue may be correlated with anxiety in epilepsy patients.
Anxiety ; Depression ; Epilepsy ; Fatigue ; Humans ; Prevalence

OBJECTIVES: To study epidemiologic characteristics and prognostic factors of emergency laparotomy patients due to abdominal trauma. METHODS: From Jan 2006 to Dec 2008, 116 patients enrolled in this study. Inclusion criteria for patients were abdominal trauma patients with emergency laparotomy. Age, sex, ED access, transportation, previous history, time, injured organ, combined injury, initial mental status, revised trauma score, laboratory finding, mortality ware reviewed. RESULTS: Trauma was most common at 40s and at night. Men has three time more common than women. Trauma etiology was traffic accident (64 cases, 55.2%), stab injuries (31 cases, 26.7%), violence (11 cases, 9.5%). Most commonly injured organs were the small intestine, the mesentery was a following. Combined injuries were extremities fractures, head and neck injuries, chest trauma, pelvis trauma, respectively. The average time of prehospital interval was 186.49 +/- 233.29 minutes and Emergency department stay time was 270.50 +/- 180.08 minutes. The average hospitalization was 22.84 +/- 38.02 days. In a univariate logistic regression study, age (odds ratio [OR]: 1.364), systolic blood pressure below 90mmHg (OR 4.460), Hemoglobin (OR 2.380), Revised trauma score (OR 0.902), initial mental status (OR 3.394) were significant prognostic factor. CONCLUSIONS: The result of this study indicated that age, systolic blood pressure below 90mmHg, hemoglobin, revised trauma score, initial mental status were prognostic factor of emergency laparotomy patients due to abdominal trauma. When treating patients with abdominal trauma, we could be considered these prognostic factors. In addition, to establish therapeutic plan will be helpful.
Accidents, Traffic ; Blood Pressure ; Emergencies ; Extremities ; Female ; Head ; Hemoglobins ; Hospitalization ; Humans ; Intestine, Small ; Laparotomy ; Logistic Models ; Male ; Mesentery ; Neck Injuries ; Pelvis ; Thorax ; Transportation ; Violence

OBJECTIVES: To investigate the results of AdvancedSurface Ablation (ASA) coupled with "smoothing" to smoothen ablation surface after covering masking fluid. METHODS: ASA was performed in 48 eyes that had myopic refractive error. The case with ablation depth over 100 microm was assigned into subgroup. Mean refractive error was -5.71 +/- 1.25D and mean ablation depth was 101.74 +/- 11.15 microm. Smoothing was performed in all patients (mean time 15.59 +/- 1.34 seconds, mean diameter 8.60 +/- 0.21 mm). RESULTS: Mean refractive error was -0.16 +/- 0.42D, -0.30 +/- 0.40D at postoperative 3 and 6 months. 92% and 96% of patients had an uncorrected visual acuity (UCVA) of 1.0 or better at postoperative 3 and 6 months, respectively. There was no statistically significant difference in magnitude of high order aberrations at postoperative 6 months. Cornea was maintained clear in the majority. CONCLUSIONS: Excellent results were obtained by ASA coupled with "smoothing" in high myopia patients. And subgroup with ablation depth over 100 microm was also obtained satisfactory results.
Cornea ; Eye ; Humans ; Masks ; Myopia ; Refractive Errors ; Visual Acuity