A complete fracture dislocation at the cervicothoracic junction is rare and accompanied by severe spinal cord injury. This region is difficult to image with plain radiography, and to immobilize with external orthosis due to the biomechanical forces exerted in this transitional portion of the spinal column. We experienced a rare case in 52-year-old male victim of a car accident. He sustained paraplegia, and complained of dyspnea and neck pain of 10 days duration at another hospital. The delayed clinical rediagnosis was a C6 and 7 spinous process fracture and a cervicothoracic fracture dislocation, with complete transection of spinal cord, which was based on a clinical examination, simple radiography, CT and MRI. Skeletal traction was immediately applied, followed by a posterior pedicle screw to stabilize the spine and secure the grafts. Rehabilitation was initiated and the dysphagia and dyspnea, due to aspiration pneumonia, were improved, but no neurologic recovery was made after the 1st postoperative year.
Deglutition Disorders ; Dislocations ; Dyspnea ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neck Pain ; Orthotic Devices ; Paraplegia ; Pneumonia, Aspiration ; Radiography ; Rehabilitation ; Spinal Cord ; Spinal Cord Injuries ; Spine ; Traction ; Transplants

We conducted this cohort analytic study to determine whether women with unexplained elevations of maternal serum hCG at 15-18 weeks' gestation are at increased risk for pregnancy complications and adverse perinatal outcomes. The inclusion criteria were a singleton gestation, a confirmed gestational age, and an hCG level greater than 2.0 multiples of the median (MoM). The exclusion criteria were fetal anomalies, an abnormal karyotype, molar pregnancy, and an MSAFP level greater than 2.5 multiples of the median (MoM). A group of randomly selected women with hCG levels under 2.0 MoM served as controls. Patients with elevated levels of hCG had a significantly higher risk for PIH (17.9% versus 4.5%; P <.05) and preterm delivery (17.9% versus 3.5%; P<, 05) than control. But no significant differences were observed in the incidence of intrauterine growth restriction and low birth weight and in the newborn weight. We suggested that pregnancies with unexplained elevated hCG levels should be regarded as high-risk pregnancies. And these patients require careful monitoring with adequate obstetric management.
Abnormal Karyotype ; Chorionic Gonadotropin* ; Cohort Studies ; Female ; Gestational Age ; Humans* ; Hydatidiform Mole ; Incidence ; Infant, Low Birth Weight ; Infant, Newborn ; Pregnancy ; Pregnancy Complications ; Pregnancy Outcome* ; Pregnancy* ; Pregnancy, High-Risk

BACKGROUND: Recently elderly people have increased in Korea and increased demands of medical service. This study was carried out to identify diseases and health service utilization patterns of geriatric inpatients to provide better understanding and basis planning to meet the needs of expanding geriatric population. METHOD: We use data of `Patient Survey in Korea` in 1999 and analyzed characteristics of disease structure and utilization patterns of health care service of 54,013 cases of discharged patients aged 65 years or more. RESULT: The proportion of the elderly in total discharged patients is 14.7%. Male to female ratio is 1:1.3 and most common age group was between 65 and 69 years old. 84.2% of elderly patients were admitted at secondary or tertiary health care facilities. The most common disease in geriatric inpatients is malig- nancy in male and vascular disease in female. The average duration of hospitalization is 14.2 days. They stay longer than the nation wide average hospital length and stay longest when they are admitted by mental and behavioral disorders. CONCLUSION: Geriatric patients are admitted mostly with chronic degenerative diseases such as neoplasm and vascular disease. Elders prefer to be admitted to tertiary hospitals and oriental hospitals. They stay more in hospital.
Aged ; Delivery of Health Care ; Female ; Health Services* ; Hospitalization ; Humans ; Inpatients* ; Korea ; Male ; Tertiary Care Centers ; Vascular Diseases

Pneumatosis cystoides intestinalis is a rare gastrointestinal complication with multiple gas-filled cysts in the submucosa or subserosa of the bowel wall. It can occur as primary or secondary disease with other etiology. Although this disease is usually asymptomatic and found incidentally during radiologic or endoscopic examination, it can be a cause of severe problem such as obstruction or pneumoperitoneum. We report a case of pneumatosis cystoides intestinalis in a 45-year-old male with chronic diarrhea and abdominal discomfort.

Intraosseous epidermoid inclusion cyst is a very rare cystic lesion of the bone, that has been reported primarily in middle-aged men. A congenital etiology has been proposed, although post-traumatic or iatrogenic events remain the most prevalent hypotheses. A 61-year-old woman visited Soonchunhyang University Gumi Hospital complaining of painful swelling of her right middle finger. Radiologic findings of the lesion showed a well-defined, lytic, expansile lesion originating at the tip of the distal phalanx. Preoperative imaging suggested benign cartilage tumors such as enchondroma or acute osteomyelitis. Intralesional curettage, culture, and biopsy were performed. Histopathological analysis demonstrated stratified squamous epithelium with keratinized cellular debris, consistent with a diagnosis of digital intraosseous epidermoid inclusion cyst. We present a case of an epidermoid inclusion cyst originating at the tip of the distal phalanx of the right middle finger.

Pneumatosis cystoides intestinalis is a rare gastrointestinal complication with multiple gas-filled cysts in the submucosa or subserosa of the bowel wall. It can occur as primary or secondary disease with other etiology. Although this disease is usually asymptomatic and found incidentally during radiologic or endoscopic examination, it can be a cause of severe problem such as obstruction or pneumoperitoneum. We report a case of pneumatosis cystoides intestinalis in a 45-year-old male with chronic diarrhea and abdominal discomfort.

Intraosseous epidermoid inclusion cyst is a very rare cystic lesion of the bone, that has been reported primarily in middle-aged men. A congenital etiology has been proposed, although post-traumatic or iatrogenic events remain the most prevalent hypotheses. A 61-year-old woman visited Soonchunhyang University Gumi Hospital complaining of painful swelling of her right middle finger. Radiologic findings of the lesion showed a well-defined, lytic, expansile lesion originating at the tip of the distal phalanx. Preoperative imaging suggested benign cartilage tumors such as enchondroma or acute osteomyelitis. Intralesional curettage, culture, and biopsy were performed. Histopathological analysis demonstrated stratified squamous epithelium with keratinized cellular debris, consistent with a diagnosis of digital intraosseous epidermoid inclusion cyst. We present a case of an epidermoid inclusion cyst originating at the tip of the distal phalanx of the right middle finger.

Endometriosis is a common disease affecting females of reproductive age. Intestinal involvement has been estimated to occur in 15% to 37% of females with endometriosis. Unlike endometriosis of large intestine, it is very rare for the condition to manifest as small bowel obstruction caused by intestinal endometriosis. Preoperative diagnosis of intestinal endometriosis is very difficult. This disorder should be considered in the differential diagnosis of females of child-bearing age with symptoms of bowel obstruction. We report a 44-year-old woman who presented with symptoms and signs of acute small bowel obstruction. A segmental resection of the small bowel was performed with end to end anastomosis. Pathologic examination demonstrated acute small bowel obstruction secondary to intestinal endometriosis. The patient died on the second day after the surgery because her condition worsened. Intestinal endometriosis also should be included in the differential diagnosis of bowel obstruction for the prompt treatment.

Cerebral arterial embolism which resulted in total occlusion of right proximal middle cerebral artery was occured in 33 years old female patients with severe mitral stenosis and atrial fibrillation during percutaneous mitral balloon valvuloplasty(PMV). The occluded artery could be detected by transfemoral carotid angiography and recanalized immediately by intra-arterial infusion of urokinase. There were no cerebral hemorrhage by CT scan after intra-arterial urokinase infusion and the patients discharged without any neurologic sequale 7 days after thrombolysis. We report a case of successful recanalization with intraarterial infusion of urokinase in patient with cerebral arterial embolism occurred during PMV.
Adult ; Angiography ; Arteries ; Atrial Fibrillation ; Cerebral Hemorrhage ; Embolism* ; Female ; Humans ; Infusions, Intra-Arterial* ; Intracranial Embolism ; Middle Cerebral Artery ; Mitral Valve Stenosis ; Tomography, X-Ray Computed ; Urokinase-Type Plasminogen Activator*

BACKGROUND: Spontaneous hemopneumothorax is characterized by the accumulation of air and more than 400 mL of blood in pleural cavity without any apparent cause. It is a rare disease and can cause life-threatening situation. We analyzed clinical reviews of two medical centers to aid in optimal management. MATERIAL AND METHOD: Retrospective review between March 2003 and August 2010 with 18 spontaneous hemopneumothorax patients was made. RESULT: These 18 patients were comprised of 15 male and 3 female with average 24.6 years (range 15~46 years). Almost patients (16) underwent a closed thoracostomy initially and 15 patients received video-assisted thoracic surgery (VATS). Mean postoperative chest tube removal was 2.9 days and one complication was post-removal pneumothorax. During the follow-up periods there were no other complications and recurrence. CONCLUSION: Proper initial diagnosis and management of spontaneous hemopneumothorax prevent significant hypovolemic shock. Video-assisted thoracic surgery should be considered an early surgical management in spontaneous hemopneumothorax. However conservative manage without bleb excision may be effective in selected patients.
Blister ; Chest Tubes ; Female ; Follow-Up Studies ; Hemopneumothorax ; Hemothorax ; Humans ; Male ; Pleural Cavity ; Pneumothorax ; Rare Diseases ; Retrospective Studies ; Shock ; Thoracic Surgery, Video-Assisted ; Thoracostomy