Noroviruses have been recognized as the leading cause of epidemic and sporadic gastroenteritis since the advent of molecular diagnostic technique. They have been documented in 5-31% of pediatric patients hospitalized with gastroenteritis. Although norovirus gastroenteritis is typically mild and self-limited, it causes severe, but sometimes fatal, conditions in the vulnerable population such as immunocompromised patients, young children, and the elderly. Bowel perforation due to norovirus infection is rare. We report a case of small bowel perforation with norovirus gastroenteritis in the infant with Down syndrome during the hospitalization with pneumonia. Severe dehydration may cause bowel ischemia and could have triggered bowel perforation in this case. Physicians should be alert to the potential surgical complications followed by severe acute diarrhea, especially in high risk groups.
Aged ; Child ; Dehydration ; Diarrhea ; Down Syndrome ; Gastroenteritis* ; Hospitalization ; Humans ; Immunocompromised Host ; Infant* ; Ischemia ; Molecular Diagnostic Techniques ; Norovirus* ; Pneumonia ; Vulnerable Populations

Adenoid cystic carcinoma (ACC) is a rare malignant tumor. Its incidence is less than 1 percent of all head and neck malignancies and approximately 10 percent of all salivary neoplasms. There are no clear guidelines for the treatment of ACC, but a combination of surgery and postoperative radiotherapy has been usually recommended. Subglottic cancer has a lower incidence than does laryngeal cancer, whose incidence is in the range of 4 to 6 percent of all cancers of the larynx. Because of the rarity of this tumor in the larynx, no series has been large enough to permit statistical evaluation of treatment. We report a case of adenoid cystic carcinoma on subglottis, which was treated with surgical excision and postoperative radiotherapy. The relevant literature is briefly reviewed.
Adenoids* ; Carcinoma, Adenoid Cystic* ; Head ; Incidence ; Laryngeal Neoplasms ; Larynx ; Neck ; Radiotherapy

Fine-needle aspiration biopsy (FNAB) is a safe, simple, repeatable and cost-effective method, and has excellent sensitivity and specificity. Thus, it is generally used as a primary study for the diseases of salivary gland, thyroid gland, and cervical lymph node in the head and neck area. FNAB has a small number of contraindications and complications, but most of the complications are minor complications. However, uncommon complications had been reported in the literature. In this report, we describe a 63 yearold woman who experienced dyspnea caused by diffuse intracapsular hemorrhage of thyroid gland after FNAB.
Airway Obstruction ; Biopsy* ; Biopsy, Fine-Needle* ; Dyspnea ; Female ; Head ; Hemorrhage* ; Humans ; Lymph Nodes ; Neck ; Salivary Glands ; Sensitivity and Specificity ; Thyroid Gland*

BACKGROUND AND OBJECTIVES: Disabling positional vertigo (DPV) refers to the cross-compression of the eighth cranial nerve from vessels in the posterior fossa which causes symptoms of vestibular disturbances. The most common symptom is a whirling sensation that is worse when the head is in a specific position and is abated with total bed rest. Many patients with DPV also have symptoms of auditory nerve and/or adjacent cranial nerve involvement, such as tinnitus, hearing disturbance, geniculate neuralgia, facial twitching. To analyze DPV, the authors reviewed patients with DPV who underwent microvascular decompression (MVD) in our institution. SUBJECTS AND METHOD: A retrospective study was performed on 11 patients with DPV who underwent MVD from January 2002 to September 2007. Information was collected on sex, age, symptoms, offending vessels, the success rate, surgical complications. RESULTS: Three patients were male and eight were female. Their mean age was 55.1 years (range 37-70). The most common offending vessel was AICA in 7 cases (64%) and second vessel was PICA in 3 cases (27%). Only one case (9%) had a vein. Patterns of improvement after MVD could be divided into 3 clinical types. There was complete recovery after operation in 8 cases, partial recovery in 2 cases, and recovery failure in 1 case. There were no major complications except hearing impairment in 1 case. CONCLUSION: This study shows that MVD provides a high rate of success with low morbidity, and can be regarded as one effective procedure for DPV.
Bed Rest ; Cochlear Nerve ; Cranial Nerves ; Female ; Glycosaminoglycans ; Head ; Hearing ; Hearing Loss ; Herpes Zoster Oticus ; Humans ; Male ; Microvascular Decompression Surgery ; Pica ; Retrospective Studies ; Sensation ; Tinnitus ; Veins ; Vertigo ; Vestibulocochlear Nerve

BACKGROUND AND OBJECTIVES: With the availability of more sensitive ultrasonography, a larger number of nonpalpable thyroid nodule can be detected. But it is controversial that USG-FNA should be routinely used to incidentally detect nonpalpable thyroid nodule. The purpose of this study is to investigate the clinical significance of thyroid incidentaloma and the usefulness of the USG-FNA in the management of thyroid incidentaloma. SUBJECTS AND METHOD: A retrospective study was performed on 208 patients who underwent USG-FNA for thyroid incidentaloma smaller than 1.5 cm from 2001 to 2005. The cytologic findings were compared with the ultrasonographic findings and the surgical pathology. RESULTS: Suspicious malignant sonographic findings were detected in 48 cases. And in 10 cases, more than two malignant findings were detected. Of the 208 cases, 159 cases were cytologically diagnosed as benign lesion (76.4%), 7 cases as follicular neoplasm (3.3%), 33 cases as malignancy (15.8%), and 9 cases as inadequate specimen (4.4%). Of the 40 cases with follicular neoplasm and malignant cytology, 37 cases underwent surgery and 30 cases were confirmed to malignancy on the postoperative pathologic diagnosis. In the cases diagnosed to malignancy on pathology, extracapsular extension was present in 9 cases (30%), and nodal metastasis in 8 cases (26.7%). The sensitivity, specificity, and accuracy of the USG-FNA for malignancy were 93.3%, 71.4%, and 89.1%, respectively. CONCLUSION: USG-FNA is a useful diagnostic tool in the management of thyroid incidentaloma especially when more than two suspicious malignant sonographic findings need to be detected. The clinical characteristics is not significantly different between palpable and nonpalpable nodules.
Biopsy, Fine-Needle* ; Diagnosis ; Humans ; Neoplasm Metastasis ; Pathology ; Pathology, Surgical ; Retrospective Studies ; Sensitivity and Specificity ; Thyroid Gland* ; Thyroid Nodule* ; Ultrasonography

OBJECTIVE: This study aimed to compare the demographic characteristics and trauma service structures and processes of hospitals in 15 countries across the Asia Pacific, and to provide baseline data for the integrated trauma database: the Pan-Asian Trauma Outcomes Study (PATOS).METHODS: Medical directors and emergency physicians at PATOS-participating hospitals in countries across the Asia Pacific were surveyed through a standardized questionnaire. General information, trauma care system data, and trauma emergency department (ED) outcomes at each hospital were collected by email and analyzed using descriptive statistics.RESULTS: Survey data from 35 hospitals across 15 countries were collected from archived data between June 2014 and July 2015. Designated trauma centers were identified as the highest hospital level for trauma patients in 70% of surveyed countries. Half of the hospitals surveyed had special teams for trauma care, and almost all prepared activation protocol documents for these teams. Most hospitals offered specialized trauma education programs, and 72.7% of hospitals had a hospital-based trauma registry. The total number of trauma patients visiting the ED across 25 of the hospitals was 300,376. The overall survival-to-discharge rate was 97.2%; however, it varied greatly between 85.1% and 99.7%. The difference between survival-to-discharge rates of moderate and severe injury groups was highest in Taiwan (41.8%) and lowest in Thailand (18.6%).CONCLUSION: Trauma care systems and ED outcomes vary widely among surveyed hospitals and countries. This information is useful to build further detailed, systematic platforms for trauma surveillance and evidence-based trauma care policies.
Asia ; Asian Continental Ancestry Group ; Cross-Sectional Studies ; Education ; Electronic Mail ; Emergencies ; Emergency Service, Hospital ; Epidemiology ; Humans ; Physician Executives ; Taiwan ; Thailand ; Trauma Centers

On page 47, the definition of stroke progression was erroneously described in the previous version of article.

Characteristics of stroke cases, acute stroke care, and outcomes after stroke differ according to geographical and cultural background. To provide epidemiological and clinical data on stroke care in South Korea, we analyzed a prospective multicenter clinical stroke registry, the Clinical Research Center for Stroke-Fifth Division (CRCS-5). Patients were 58% male with a mean age of 67.2+/-12.9 years and median National Institutes of Health Stroke Scale score of 3 [1-8] points. Over the 6 years of operation, temporal trends were documented including increasing utilization of recanalization treatment with shorter onset-to-arrival delay and decremental length of stay. Acute recanalization treatment was performed in 12.7% of cases with endovascular treatment utilized in 36%, but the proportion of endovascular recanalization varied across centers. Door-to-IV alteplase delay had a median of 45 [33-68] min. The rate of symptomatic hemorrhagic transformation (HT) was 7%, and that of any HT was 27% among recanalization-treated cases. Early neurological deterioration occurred in 15% of cases and were associated with longer length of stay and poorer 3-month outcomes. The proportion of mRS scores of 0-1 was 42% on discharge, 50% at 3 months, and 55% at 1 year after the index stroke. Recurrent stroke up to 1 year occurred in 4.5% of patients; the rate was higher among older individuals and those with neurologically severe deficits. The above findings will be compared with other Asian and US registry data in this article.
Asian Continental Ancestry Group ; Humans ; Korea ; Length of Stay ; Male ; National Institutes of Health (U.S.) ; Stroke ; Tissue Plasminogen Activator