BACKGROUND: Fever is a very common complication that has been related to poor outcomes after aneurysmal subarachnoid hemorrhage (aSAH). The incidence of acalculous cholecystitis is reportedly 0.5%–5% in critically ill patients, and cerebrovascular disease is a risk factor for acute cholecystitis (AC). However, abdominal evaluations are not typically performed for febrile patients who have recently undergone aSAH surgeries. In this study, we discuss our experiences with febrile aSAH patients who were eventually diagnosed with AC. METHODS: We retrospectively reviewed 192 consecutive patients who underwent aSAH from January 2009 to December 2012. We evaluated their characteristics, vital signs, laboratory findings, radiologic images, and pathological data from hospitalization. We defined fever as a body temperature of >38.3℃, according to the Society of Critical Care Medicine guidelines. We categorized the causes of fever and compared them between patients with and without AC. RESULTS: Of the 192 enrolled patients, two had a history of cholecystectomy, and eight (4.2%) were eventually diagnosed with AC. Among them, six patients had undergone laparoscopic cholecystectomy. In their pathological findings, two patients showed findings consistent with coexistent chronic cholecystitis, and two showed necrotic changes to the gall bladder. Patients with AC tended to have higher white blood cell counts, aspartame aminotransferase levels, and C-reactive protein levels than patients with fevers from other causes. Predictors of AC in the aSAH group were diabetes mellitus (odds ratio [OR], 8.758; P = 0.033) and the initial consecutive fasting time (OR, 1.325; P = 0.024). CONCLUSIONS: AC may cause fever in patients with aSAH. When patients with aSAH have a fever, diabetes mellitus and a long fasting time, AC should be suspected. A high degree of suspicion and a thorough abdominal examination of febrile aSAH patients allow for prompt diagnosis and treatment of this condition. Additionally, physicians should attempt to decrease the fasting time in aSAH patients.
Acalculous Cholecystitis ; Aneurysm* ; Aspartame ; Body Temperature ; C-Reactive Protein ; Cerebrovascular Disorders ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Cholecystitis, Acute* ; Critical Care ; Critical Illness ; Diabetes Mellitus ; Diagnosis ; Fasting ; Fever* ; Hospitalization ; Humans ; Incidence ; Intensive Care Units ; Leukocyte Count ; Prognosis ; Retrospective Studies ; Risk Factors ; Subarachnoid Hemorrhage* ; Urinary Bladder ; Vital Signs

Impetigo herpetiformis is a form of pustular psoriasis that occurs during pregnancy and may be life-threatening. The pathogenesis and etiology of impetigo herpetiformis is not clear, but several reports have associated onset of this disorder with hypocalcemia, hypoparathyroidism, and the use of oral contraceptives. The typical lesions are erythematous patches that are studded with tiny superficial pustules particularly coalescing at their margins causing pain, and a burning sensation. Laboratory findings include an elevated erythrocyte sedimentation rate, increased peripheral blood leukocyte counts, hypoalbuminemia, and in severe cases, hypocalcemia. The histopathology is the same as that of pustula psoriasis. Our patient, a 31 year-old female (Intra Uterine Pregnancy 28 weeks), was admitted to our hospital due to generalized skin eruption and severe constitutional symptoms. Her clinical features, laboratory and histopathologic findings were compatible with that of impetigo herpetiformis. In spite of our all efforts, intrauterine fetal death was noted at her 33rd week of pregnancy. We report a case of impetigo herpetiformis terminating in fetal death with the review of literature.
Adult ; Blood Sedimentation ; Burns ; Contraceptives, Oral ; Female ; Fetal Death* ; Humans ; Hypoalbuminemia ; Hypocalcemia ; Hypoparathyroidism ; Impetigo* ; Leukocyte Count ; Pregnancy ; Psoriasis ; Sensation ; Skin

BACKGROUND: Erythema multiforme is an inflammatory disorder of the skin which may be characterized by erythematous papules, plaques, vesicles, and 'target-like' annular lesions. Mucosal lesions may occur. Symmetric irivolvement of the extrernities, especially the dorsurn of the hands and feet, and face is the classic pattern of cutaneous distribution. Palmoplantar lesions of erythema multiforme are relatively uricornmon. OBJECTIVE: Our purpose was to investigate the clinical and histopathological characteristics of erythema multiforme involving the palm and sole. METHODS: Thirty one cases of erythema multiforme involving the palm and sole, and thirty cases involving other sites wer collected and analysed with particular reference to epidemiological data, type and distribution of the skin lesion and histopathological characteristics. RESULTS: 1. The median ages of both groups were the early thirties. There were no sexual predominances. 2. The clinical features of erythema multiforme involving the palm and sole were relatively mild and showed atypical skin lesions including macules and papules compared with erythema multiforme involving the other sites. 3. The histopathological changes of the palmoplantar group were also mild, especially the epidermal changes which included keratinocytes necrosis, subepidermal blisters, focal parakeratosis, extensive epidermal necrosis and xocytosis etc. 4. The most important and consistent histopathological finding of the palmoplantar erythema multiforme group was lymphocyte tagging along the basernent membrane, which was found consistently apart from one case. CONCLUSION: We investigated the clinical and histopathological features of erythema multiforme involving the palm and sole. They showed mild clinical features and atypical skin lesions cornpared with other group. The histopathological spectrum of this group was diverse, and reflected the early stage of pathomecha nisms of erythema multiforme. Among them, lyrnphocyte tagging was the most important and censistent finding in palmoplantar erythema multiforme.
Blister ; Erythema Multiforme* ; Erythema* ; Foot ; Hand ; Keratinocytes ; Lymphocytes ; Membranes ; Necrosis ; Parakeratosis ; Skin

The polyglandular autoimmune syndrome designates the dysfunction of endocrine and nonendocrine system involving two or more organs on the basis of an autoimmune mechanism. The autoimmune nature of these diseases has been based on the presence of lymphocytic infiltration in the affected gland, organ specific autoantibodies in the serum, cellular immune defects and an association with the HLA DR/DQ genes or immune response genes. This syndrome is usually classified into three classes and their etiology or pathogenesis is still not completely understood. A 28-year-old woman developed vitiligo and insulin dependent diabetes mellitus during the treatment of Graves' disease with antithyroid drug. She had a tendency of spontaneous ketonemia and serum c-peptide levels were low(0.21, 0.16ng/mL: fasting and glucagon stimulated). Thyrotrophin binding inhibitor immunoglobulin and pancreas iIslet cell cytoplasmic antibody were positive. We report here a case of polyglandular autoimmune syndrome, type III manifesting Graves' disease, vitiligo, and insulin dependent diabetes mellitus.
Adult ; Autoantibodies ; Bone Diseases ; C-Peptide ; Cytoplasm ; Diabetes Mellitus ; Fasting ; Female ; Genes, MHC Class II ; Giant Cells ; Glucagon ; Granuloma ; Graves Disease ; Humans ; Immunoglobulins ; Insulin ; Ketosis ; Pancreas ; Pedigree ; Thyrotropin ; Vitiligo

We examined an urban population's awareness of dietary guidelines to determine whether they perceived them to be necessary, and identified the factors affecting this awareness and perceived necessity. Data were collected via physical examinations and face-to-face interviews. Health indicators were collected from health examinations, and information on individual characteristics, including awareness, perceived necessity, and dietary status were obtained from the interviews. The subjects' sociodemographic, health and dietary status were examined as potential factors influencing awareness and perceived necessity. Descriptive statistics, contingency tables, and logistic regression modeling were used in the analysis. Low awareness of the dietary guidelines was displayed by the elderly and poorly educated individuals, and those without a spouse. Most people who were not aware of the dietary guidelines thought the guidelines unnecessary. Males with hypertension and lower hemoglobin levels, and females with less education had low awareness. Elderly females with lower bone density had less perceived necessity. Males and females with poor dietary status reported low perceived necessity.
Aged ; Bone Density ; Education ; Female ; Humans ; Hypertension ; Logistic Models ; Male ; Nutrition Policy* ; Physical Examination ; Spouses

OBJECTIVES: This cross-sectional study aimed to compare early postmenopausal women with late menopausal women in respect to body composition as a major determinant of calcaneal bone density. METHODS: Areal bone density was measured at os calcis with peripheral dual energy X-ray absorptiometry. Soft lean mass and fat mass were measured using bioelectric impedance in 109 postmenopausal women aged 45 to 84 years. RESULTS: When age and height were adjusted, the variance of calcaneal bone density was better explained by fat mass (15%) than by soft lean mass (7%) in early postmenopausal women. In contrast, soft lean mass (17%) explained the variance of calcaneal bone density better than fat mass (11%) in late postmenopausal women. However, interaction terms between years since menopause (YSM) and soft lean mass or fat mass were not statistically significant in multiple linear regression model for total postmenopausal subject. CONCLUSION: The findings of this study suggest that fat mass is the major determinant of calcaneal bone density in early postmenopausal women, whereas fat free mass is more important determinant of calcaneal bone density in late postmenopausal women.
Absorptiometry, Photon ; Body Composition* ; Bone Density* ; Calcaneus ; Cross-Sectional Studies ; Electric Impedance ; Female ; Humans ; Linear Models ; Menopause* ; Postmenopause

PURPOSE: This study was to determine the incidence and severity of venous irriation in patients receiving vinorelbine tartrate (Navelbine ) in combination chemotherapy. MATERIAL AND METHODS: Twenty four patients histologically confirmed non-small cell lung cancer were enrolled in this study who receiving vinorelbine in combination chemotherapy through a peripheral vein from Oct. 1997 to Mar. 1999 with retrospective study design method. One group was 6~10 minutes infusion rate, the other was 10~20 minutes infusion rate with the same free-flow intravenous infusion. RESULTS: A total of 126 infusions were observed in this study. Sixty-two infusions were admi nistered at the 6~10 minutes, and 64 infusions were administered at the 10~20 minutes. The incidence of any venous irritation was 3.2% (2/62) in the group that received the infusion in 6~10 minutes and 10.9% (7/64) in 10~20 minutes (p=0.164), so we could not acquire any statistical significance. However the incidence of severe venous irritation (grade 3, 4) was 0% (0/62) in 6~10 minutes infusion group and 9.4% (6/64) in 10~20 minutes infusion group. There was a significant difference between two groups (p=0.028) CONCLUSION: Our results suggest that venous irritation associated with vinorelbine tartrate infusion can be reduced by shorter duration of administration and vinorelbine tartrate might be recom mended to administer at 6~10 minutes infusion in clinical practice.
Carcinoma, Non-Small-Cell Lung ; Drug Therapy, Combination ; Humans ; Incidence* ; Infusions, Intravenous ; Retrospective Studies ; Veins

BACKGROUND: The overexpression of cyclin D1 and galectin-3 and the loss of p27 in thyroid cancers have recently been reported by many studies. The S-phase kinase associated protein 2 (skp2) plays an important role in the degradation of p27. We compared the correlation of the expressions of galectin-3, p27, cyclin D1 and skp2 in thyroid lesions. METHODS: Sixty five cases were included in this study and immunohistochemical staining for galectin-3, skp2, p27 and cyclin D1 was performed. RESULTS: The expression of galectin-3 increased in the order of nodular hyperplasia, follicular adenoma, follicular carcinoma and papillary carcinoma (p<0.01). The expression rate of skp2 was 0% for nodular hyperplasia, 16.7% for follicular adenoma, 33.3% for follicular carcinoma and 16.7% for papillary carcinoma. The loss of the expression of p27 was more frequently detected in papillary carcinoma as compared with nodular hyperplasia (p<0.01). The increased expression of cyclin D1 was noted in follicular adenoma and carcinoma as compared with nodular hyperplasia (p=0.043). The expression of galectin-3 was related with the loss of a p27 expression (p<0.01), and the expression of skp2 was related with the expression of the cyclin D1 (p=0.022). CONCLUSIONS: Galectin-3 appears to be the most useful marker for making the diagnosis of thyroid lesions. The loss of a p27 expression can help differentiate nodular hyperplasia and papillary carcinoma, and the determining the expression of cyclin D1 may be helpful for the differential diagnosis of nodular hyperplasia and follicular neoplasm.
Diagnosis, Differential ; Adenoma ; Thyroid Neoplasms

PURPOSE: To estimate the shape of root and pulp canal using a dental cone beam computed tomography (CBCT) and to evaluate the accuracy of imaging reformation. MATERIALS AND METHODS: CBCT images were obtained with incisors, premolars, and molars as the destination by using PSR 9000NTM Dental CT system (Asahi Roentgen Ind. Co., Ltd, Kyoto, Japan) and i-CAT (Imaging Sciences International, Inc, USA) cone beam CT unit that have different kind of detector and field of view, and compared these with the shape and the size of actual root and root canal. RESULTS: When the measuring value of cone beam computed tomography concerning to each root's bucco-lingual diameter and mesio-distal diameter was compared with the value of the actual root, it reveals an error range -0.49 ~+0.63 mm at PSR900N and -0.97~+1.14 mm at i-CAT(P.0.05). It was possible to identify and measure PSR 9000NTM Dental CT system to the limit 0.48+/-0.06 mm (P.0.05) and i-CAT CBCT to the limit 0.86+/-0.09 mm (P.0.05) on estimating the size and the shape of root canal. Two kinds of CBCT images revealed the useful reproducibility to estimate the shape of root, but there was the difference to estimate the shape of root according to apparatus. The reproducibility of root shape in the image of three-dimensions at PSR 900N is low such as 0.65 mm in a case of minute root canal. CONCLUSIONS: CBCT images revealed higher accuracy of the imaging reformation for root and pulp and clinically CBCT is a useful diagnostic tool for the assessment of root and canal. However, there are different qualities of imaging reformation according to CBCT apparatus and limitation of reproducibility for minute root canals.
Bicuspid ; Cone-Beam Computed Tomography* ; Dental Pulp Cavity* ; Incisor ; Molar ; Radiography, Dental ; Tomography, X-Ray Computed ; Tooth*

Pseudohypoparathyroidism(PHP) is a genetic disorder characterized by target cell resistance to the effect of parathyroid hormone(PTH). The disorder is classified into type I a, I b, I c and II depending on the phenotype and biochemical findings. In type I a, urinary cyclic AMP and urinary phosphate excretion are not increased after PTH stimulation because of deficient G unit activity in target cells. Deficiency of the G unit is a generalized cellular defect and accounts for the association of other endocrine disorders with type I a PHP. Type I b PHP shows resistance to PTH but not to other hormones and normal phenotypic appearance. In type I c PHP affected children have defect in catalytic unit of adenylate cyclase and in addition to resistance to PTH, resistance to the metabolic effects of TSH, gonadotropins, and glucagon may be detected. Typical appearance of Albright's hereditary osteodystrophy is common in PHP type Ia and Ic. In type II PHP, urinary cyclic AMP response is generated but this does not lead to phosphaturia. We experienced two patients with PHP. One is a 11-year-old girl diagnosed type I a PHP and the other is a 11-year-old boy suspected type I b PHP. They visited emergency room because of tetanic movement. Both patients had no previous history of tetany and showed low serum calcium level, high phosphorus level and high PTH level. The girl had typical features of Albright's hereditary osteodystrophy such as round face, short neck, obese feature, brachydactyly and mental retardation but didn't have basal ganglia calcification on brain CT. The boy showed normal appearance and no mental retardation.
Adenylyl Cyclases ; Basal Ganglia ; Brachydactyly ; Brain ; Calcium ; Child ; Cyclic AMP ; Emergency Service, Hospital ; Female ; Glucagon ; Gonadotropins ; Humans ; Hypophosphatemia, Familial ; Intellectual Disability ; Male ; Neck ; Phenotype ; Phosphorus ; Pseudohypoparathyroidism* ; Tetany