A type I Arnold-Chiari malformation (ACM1) is characterized by herniation of cerebellar tonsils at least 3 mm below the plane of the foramen magnum and can present with various clinical symptoms, frequently occipital headache, lower cranial nerve palsy, or ataxia. However, syncope has rarely been described as an initial manifestation of ACM1. An 18-year-old girl experienced a falling to the ground with a loss of consciousness for a minute. The fall occurred with a sensation of vertigo when she was extending her neck to pick up a shuttlecock. Electroencephalography, autonomic function tests, and echocardiography did not demonstrate abnormalities. An magnetic resonance image showed a ACM1. A second-degree atrioventricular block was noted on the initial 24-hour EKG, but not on the second and the third ones taken after neck movement had been restricted by a brace. The initiation of syncope with a sensation of vertigo during excessive head movement and the absence of any other common causes of syncope except for the transient second-degree atrioventricular block disappearing after restriction of neck movement raise the possibility that the syncope was due to the ACM1. Therefore, we recommend that a differential diagnosis of syncope should include ACM1 on the initial evaluation.
Adolescent ; Arnold-Chiari Malformation* ; Ataxia ; Atrioventricular Block ; Braces ; Cranial Nerve Diseases ; Diagnosis, Differential ; Echocardiography ; Electrocardiography ; Electroencephalography ; Female ; Foramen Magnum ; Head Movements ; Headache ; Humans ; Magnetic Resonance Imaging ; Neck ; Palatine Tonsil ; Sensation ; Syncope* ; Unconsciousness ; Vertigo

BACKGROUND: The development of new drugs or alternative therapies effective against methicillin-resistant Staphylococcus aureus (MRSA) is of great importance, and various natural anti-MRSA products are good candidates for combination therapies. We evaluated the antibacterial activities of a Phellinus baumii ethyl acetate extract (PBEAE) and its synergistic effects with beta-lactams against MRSA. METHODS: The broth microdilution method was used to determine the minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) of the PBEAE. The PBEAE synergistic effects were determined by evaluating the MICs of anti-staphylococcal antibiotic mixtures, with or without PBEAE. Anti-MRSA synergistic bactericidal effects of the PBEAE and beta-lactams were assessed by time-killing assay. An ELISA was used to determine the effect of the PBEAE on penicillin binding protein (PBP)2a production. RESULTS: The MICs and MBCs of PBEAE against MRSA were 256-512 and 1,024-2,048 microg/mL, respectively. The PBEAE significantly reduced MICs of all beta-lactams tested, including oxacillin, cefazolin, cefepime, and penicillin. However, the PBEAE had little or no effect on the activity of non-beta-lactams. Time-killing assays showed that the synergistic effects of two beta-lactams (oxacillin and cefazolin) with the PBEAE were bactericidal in nature (Deltalog10 colony forming unit/mL at 24 hr: 2.34-2.87 and 2.10-3.04, respectively). The PBEAE induced a dose-dependent decrease in PBP2a production by MRSA, suggesting that the inhibition of PBP2a production was a major synergistic mechanism between the beta-lactams and the PBEAE. CONCLUSIONS: PBEAE can enhance the efficacy of beta-lactams for combined therapy in patients infected with MRSA.
Acetates/chemistry ; Agaricales/*chemistry/metabolism ; Anti-Infective Agents/chemistry/*pharmacology ; Drug Synergism ; Enzyme-Linked Immunosorbent Assay ; Methicillin-Resistant Staphylococcus aureus/*drug effects/metabolism ; Microbial Sensitivity Tests ; Penicillin-Binding Proteins/analysis/metabolism ; Plant Extracts/chemistry/*pharmacology ; beta-Lactams/*pharmacology

Status epilepticus is commonly defined as a condition characterized by an epileptic seizure that is so frequently repeated or so prolonged as to produce a fixed and enduring epileptic condition. Common etiologies are brain tumor, CNS infection, vascular insults, trauma, withdrawal of antiepileptic drug, and metabolic disturbance such as hypoglycemia, hypocalcemia, hyponatremia and hyperosmolarity caused by hyperglycemia, hypernatremia, and uremic encephalopathy etc. Although some cases of epilepsia partialis continua in the patient with nonketotic hyperglycemia were reported in the previous literature, we could hardly find the report that generalized convulsive status epilepticus was the initial symptom of nonketotic hypergycemia. We recently experienced three eases of nonketotic hyperglycemia who manifested generalized convulsive status epilepticus as a initial clinical feature. Two cases were completely controlled within a few hours after the correction of hyperglycemia and intravenous dilantinization. Another case was needed an additional phenobarbital administration to control the status epilepticus. In all cases, afterthen no further seizure occurred under the normal serum glucose level without use of antiepileptics.
Anticonvulsants ; Blood Glucose ; Brain Neoplasms ; Epilepsia Partialis Continua ; Epilepsy ; Humans ; Hyperglycemia* ; Hypernatremia ; Hypocalcemia ; Hypoglycemia ; Hyponatremia ; Phenobarbital ; Phenytoin ; Seizures ; Status Epilepticus*

Injuries from sea urchins are induced by from penetration of the calcareous spines into the skin. Apart from the transient episode of excruciating pain, there is usually no residual disability. Complications arise, however, when spines are embedded over bony prominences, or within joints. Two cases are reported with injury and protracted disability of fingers resulting from contact with the purple sea urchin, Anthocidaris crassispina, a common echinoderm inhabitant of the Korean east coast. After a latent period of several months in both cases, Case 1 presented as caseating granulomas in the synovium and case 2 exhibited as the usual soft tissue nonsynovial foreign body and noncaseating granulomas. There appears to be a paucity of published data regarding the effects of puncture wounds caused by the spines of this animal. The granulomas have appeared after a latent interval of several months in a proportion of the sufferers, suggests a delayed hyperserisitivity reaction similar to that produced by Mycobacterium species.
Animals ; Anthocidaris ; Bites and Stings* ; Fingers ; Foreign Bodies ; Granuloma ; Hand* ; Hypersensitivity, Delayed ; Inflammation* ; Joints ; Mycobacterium ; Punctures ; Sea Urchins* ; Skin ; Spine ; Strongylocentrotus purpuratus ; Synovial Membrane ; Wounds and Injuries

PURPOSE: To determine the usefulness of magnetic resonance imaging (MRI) after computed tomography (CT) inpatients with focal hepatic lesion. MATERIALS AND METHODS: We evaluated 100 patients with 103 focal hepaticlesions. The diagnosis of each lesion was made pathologically (n=19), or radiologically and clinically (n=84), andthe findings were as follows: he-mangioma (n=53), hepatocellular carcinoma (n=17), metastasis (n=10), cyst (n=5),regenerative nodule (n=3), and adenomatous hyperplasia (n=3). The patients underwent conventional CT (n=25),two-phase spi-ral CT (n=17) or three-phase spiral CT (n=61). MRI was performed using conventional T1- andT2-weighted imaging and dynamic contrast enhancement. The value of MRI after CT was assigned to one of fourgrades, according to the consensus of three radiologists: grade I (decisive), grade II (helpful), grade III (notadditional), or grade IV (confused). RESULTS: The outcome of MRI of 103 lesions was grade I in 14 cases(14%), IIin 34 (33%), III in 49 (48%), and IV in 6 (6%). MRI was not helpful (grade III or IV) in 40% (10/25), 47% (8/17),and 61%(31/61) of lesions after conventional, two-phase spiral, and three-phase spiral CT, respectively. Grade IIIor IV lesions were present in 45% of hemangiomas (24/53), 59% of hepatocellular carcinomas (10/17), and 80% ofcases in which metastasis had occurred(8/10). CONCLUSION: MRI after CT in patients with focal hepatic lesion washelpful in less than half of all cases. It was particularly valuable for patients who did not undergo three-phasespiral CT and in whom hemangioma was suspected.
Carcinoma, Hepatocellular ; Consensus ; Diagnosis ; Hemangioma ; Humans ; Hyperplasia ; Inpatients ; Magnetic Resonance Imaging* ; Neoplasm Metastasis ; Tomography, Spiral Computed

Purpose: This study examined the utility of preliminary magnetic resonance imaging (MRI) measurements in the ultrasound-guided L4 selective nerve root block. Materials and Methods: As a retrospective study, 71 patients, who met the criteria for outpatient visits from March 2016 to December 2017, were included. From March 2016 to February 2017, 31 patients who underwent an L4 nerve root block without MRI were classified as group A, and 40 patients who underwent an L4 nerve root block through MRI measurements from March 2017 to December 2017 were classified as group B. Group A was injected under ultrasound-guidance through the pararadicular approach without a pre-interventional MRI evaluation, and group B was injected under ultrasound-guidance according to the preliminary MRI measurements. The results were assessed using the numeric rating scale scores before, three hours, and two, six, and 12 weeks after the procedure. Results: At three hours after the procedure, the proportion of patients better than good results were 51.6% in group A and 67.5% in group B. At two weeks after the procedure, the proportion of patients with better than good results were 48.4% and 70.0% in groups A and B, respectively; 58.1% and 62.5% of patient of groups A and B, respectively, showed better than good results after six weeks. In 12 weeks after the procedure, the results of group A and B were 67.7% and 62.5%, respectively. At three hours and two weeks after the procedure, group B showed significant symptom improvement than group A (p<0.05). The procedures were repeated 2.8 and 1.7 times in groups A and B, respectively, between two and six weeks for satisfactory pain relief (p<0.05). Conclusion A pre-interventional MRI evaluation might improve pain relief within the initial two weeks after ultrasound-guided L4 selective nerve root block by improving the success rate of the procedure.

This paper reviews previous studies on the treatment of osteoporotic vertebral compression fractures in elderly patients to determine what factors should be considered for successful treatment. In osteoporotic vertebral compression fractures, the primary treatment is conservative treatments. Other treatments include osteoporosis treatment, pain control, orthosis, and physical therapy. Recently, percutaneous catheterization or balloon plasty is performed for rapid pain recovery and early ambulation. Percutaneous catheterization or balloon posterior plasty is effective in reducing pain and improving the activity ability. Surgical treatment should be considered in cases of nonunion or osteonecrosis, dent, deformation, and spinal cord compression after conservative treatment has failed. In surgical treatment, posterior spinal fixation and vertebroplasty are more advantageous in terms of the amount of bleeding, operation time compared to the anterior approach, but the most appropriate method should be selected through the patient's condition and understanding of each surgical method.
Aged ; Catheterization ; Catheters ; Early Ambulation ; Fractures, Compression ; Hemorrhage ; Humans ; Methods ; Orthotic Devices ; Osteonecrosis ; Osteoporosis ; Spinal Cord Compression ; Vertebroplasty

BACKGROUND: The purpose of this study is to evaluate results of superior labrum anterior to posterior (SLAP) repairs and debridement of type II SLAP lesions combined with Bankart lesions. METHODS: Between 2010 and 2014, total 58 patients with anterior shoulder instability due to a Bankart lesion combined with a type II SLAP lesion were enrolled. Patients were divided into two groups: group C consisted of 30 patients, each with a communicated Bankart and type II SLAP lesion and group NC consisted of 28 patients, each with a non-communicated Bankart and type II SLAP lesion. Bankart repairs were performed for all patients. SLAP lesions were repaired in group C and debrided in group NC. Clinical results were analysed to compare groups C and NC by using the visual analogue scale pain score, American Shoulder and Elbow Surgeons score, Constant scores, Rowe score for instability and range of motion assessments. RESULTS: The clinical scores were improved in both groups at final follow-up. Also, there were no differences between two groups. No significant difference was found in terms of the range of motion measured at the last follow-up. The number of suture anchors used was significantly higher in group C than in group NC (5.6 vs. 3.8; p=0.021). CONCLUSIONS: In this study, it is considered that Bankart repair and SLAP debridement could be a treatment option in patients with a non-communicated type II SLAP lesion combined with a Bankart lesion (study design: IV, therapeutic study, case series).
Debridement ; Elbow ; Follow-Up Studies ; Humans ; Range of Motion, Articular ; Shoulder ; Surgeons ; Suture Anchors

PURPOSE: To describe the usefulness of small bowel enteroclysis using a hemodialysis blood pump. MATERIALS AND METHODS: Over a 16 month period, 135 double contrast small bowel enteroclysis examinations were performed in132 patients using a hemodialysis blood pump. Following intubation of the proximal jejunum, barium at a dilutionof 50% and 0.5% methylcellulose were infused at a constant rate using a hemodialysis blood pump and multiple spotfilms of the small intestine were obtained. Success rate, quality of radiographs, positive findings, fluoroscopitime and complications were evaluated. RESULTS: Only two of 135 examinations (1.5%) failed due to lack ofcooperation by the patient. Rates of good distensability were 97.6% in the proximal portion, 91.2% in the minportion and 52% in the distal portion and rates of good transparency were 96%, 84% and 56% respectively.Transparency and distensability of the small intestine were better in proximal than distal small bowel. Theradiographs showed positive findings in 25% of cases. The mean fluoroscopic time was 21 min, 10 sec(8min,22sec-57min, 30sec). No major complication was found during or after exam ination. CONCLUSION: It spite of thelong fluoroscopic time and invasiveness, double contrast small bowel enteroclysis is useful for the evaluation ofsmall bowel disease. The infusion of barium and methylcellulose using a hemodialysis blood pump give radiographsof good quality.
Barium ; Humans ; Intestine, Small ; Intubation ; Jejunum ; Methylcellulose ; Renal Dialysis*

PURPOSE: This study was undertaken to develop directions for research on nursing practice education and also for standardization of contents of Fundamental Nursing Practice (FNP) by identifying and analyzing the present content and inconsistency in FNP textbooks. METHOD: Eleven FNP textbooks published between 2007 and 2013 were selected and itemized nursing contents were compared and analyzed. Nursing professors and practicingnurses prioritized contents identified from an actual condition survey based on theoretical reason and clinical guides for each item. RESULTS: Inconsistencies were found for 34 domains with 219 sub items and of them, 21 domains and 84 items needed to be standardized. Number of items that showed consistency between professors and nurses (ICC > or = .800) was 29 (34.5%) and for complete consistency (ICC=1), 4 (4.8%). Number of items that showed inconsistency between the groups (ICC< .600) was 30 (35.7%) and very low consistency (ICC=0), 10 (11.9%). CONCLUSION: The results indicate a difference between understood validity of content by professors and by nurses and technical differences among FNP textbooks. Therefore confirmation of the items needing to be standardized and differences in understanding content by professors and by nurses shows a need for standardization of practice education between course and clinical practice. These results provide basic data for developing standardized form of FNP education.
Education* ; Education, Nursing ; Nursing*