Multisystem inflammatory syndrome in children and adults (MIS-C/A) was rarely reported as a complication of coronavirus disease 2019 (COVID-19) and potential adverse events following COVID-19 vaccination. Recently, the case definition of MIS-C/A was developed by the Brighton Collaboration Network. However, only a limited number of adult patients with MIS-A following immunization have been reported, and there is still little evidence for adequate treatment. A 57-year-old man presented with fever, headache, vomiting, and hypotension 24 days after receiving the second COVID-19 vaccination with the PfizerBioNTech vaccine. According to the Brighton Collaboration Case Definition, the patient met a definitive case of MIS-A after vaccination (level 1 of diagnostic certainty). After administration of medium-dose prednisolone (20 mg/d) with colchicine (1.2 mg/d), all symptoms and signs improved rapidly. The dose of prednisolone was gradually tapered from the third week, and the patient confirmed a full recovery without medication after 8 weeks.This is the first report showing that low-dose steroids in combination with colchicine may be an effective treatment option for MIS-A after vaccination.

PURPOSE: This study was performed to evaluate the changes in the IL-1beta and the IL-6 concentrations in cerebrospinal fluid (CSF) after initial successful cardiopulmonary resuscitation (CPR), to examine the difference in the IL-1beta and the IL-6 concentrations in CSF between the cerebral performance category (CPC) 1-2 group and CPC 3-5 group after successful CPR, and to identify early makers predicting the outcome after successful CPR. METHODS: We studied prospectively 10 patients with spontaneous circulation after CPR. Samples of CSF were taken at 20 min, 4 hr, 24 hr, and 48 hr after restoration of spontaneous circulation. The control group was consisted of the nonspecific 6 patients in brain computed tomography and CSF finding among the visited patients in emergency department with complaints of headache. The CSF IL-1beta and IL-6 were measured by using enzyme-linked immunosorbent assays. RESULTS: 1) The concentrations of CSF IL-6 for CPC 3-5 were higher in the successful CPR group than in the control group. 2) In the severely neurologically disabled group (CPC 3-5), the concentrations of CSF IL-6 were significantly higher at 20 min 4 hr, 24 hr and 48 hr after successful CPR than they were in the mildly neurologically disabled group(CPC 1-2). 3) The concentrations of CSF IL-6 in the severely neurologically disabled group (CPC 3-5) reached peak levels at 24 hours after successful CPR. 4) The concentrations of CSF IL-1beta did not differ between the two groups. CONCLUSION: Our study indicates that CSF IL-6 is increased more in the severely neurologically disabled group (CPC 3-5) than it is in the mildly neurologically disabled group (CPC 1-2) after successful CPR. We found a significant relationship between the concentration of CSF IL-6 and initial outcome for the CPR patient. Thus, we suggest that CSF IL-6 might play a role in brain ischemic-reperfusion injury and might be used as a prognostic marker after successful CPR.
Brain ; Cardiopulmonary Resuscitation ; Cerebrospinal Fluid ; Emergency Service, Hospital ; Enzyme-Linked Immunosorbent Assay ; Headache ; Heart Arrest* ; Humans ; Hypoxia-Ischemia, Brain* ; Interleukin-1beta ; Interleukin-6 ; Prospective Studies

Lingual nerve injury is a rare complication of general anesthesia. The causes of lingual nerve injury following general anesthesia are multifactorial; possible mechanisms may include difficult laryngoscopy, prolonged anterior mandibular displacement, improper placement of the oropharyngeal airway, macroglossia and tongue compression. In this report, we have described a case of bilateral lingual nerve injury that was associated with orotracheal intubation for open reduction and internal fixation of the left distal radius fracture in a 61-year-old woman. In this case, early treatment with dexamethasone effectively aided the recovery of the injured lingual nerve.
Anesthesia, General ; Dexamethasone ; Female ; Humans ; Intubation ; Laryngoscopy ; Lingual Nerve Injuries ; Lingual Nerve ; Macroglossia ; Middle Aged ; Radius Fractures ; Tongue

Riedels thyroiditis is a rare variant of thyroiditis that is characterized by replacement of the normal thyroid parenchyma by extensive fibrosis. Typically, the thyroid is diffusely involved and a painless, hard anterior neck mass shows clinical features similar to those of anaplastic thyroid carcinoma, that is, a rapidly enlarging, hard, fixed thyroid mass and symptoms such as dysphagia, dysphonia, and dyspnea. We encountered a case of Riedels thyroiditis in a 41-year-old female patient with a longstanding benign thyroid nodule for 6 years; she subsequently presented with a rapidly growing, hard, fixed, thyroid mass mimicking anaplastic thyroid cancer. The clinical features were indistinguishable from those of anaplastic transformation, but open biopsy excluded anaplastic thyroid cancer. After surgery, the final diagnosis of Riedels thyroiditis was made based on typical microscopic findings and immunohistochemical studies. We have reported this case and reviewed the related literature.
Adult ; Biopsy ; Deglutition Disorders ; Diagnosis ; Dysphonia ; Dyspnea ; Female ; Fibrosis ; Humans ; Neck ; Thyroid Carcinoma, Anaplastic ; Thyroid Gland* ; Thyroid Nodule ; Thyroiditis*

PURPOSE: Thyrotoxic periodic paralysis (TPP) is not an uncommon disorder in patient with acute muscle weakness in the emergency department. However, many patients with TPP are misdiagnosed, leading to improper treatment. So, we analyze the clinical characteristics of TPP to make diagnosis and treatment properly. METHODS: The medical records of the patients confirmed as TPP by using thyroid function test from January 1998 to December 2002 were reviewed retrospectively. RESULTS: TPP occurs predominantly in males, especially young males, during dawn or morning. It's predisposing factors were heavy meals, physical exertion and alcohol drinking. Most patients were hypokalemic and in a normal acid-base state. Systolic hypertension and tachycardia were common in TPP because of the hyperadrenergic state. When hyperthyroidism was conversed to normal thyroid state, paralysis did not occur. CONCLUSION: There were several clinical clues to the diagnosis of TPP. Rapid and accurate diagnosis of TPP is important, so emergency physicians must know its clinical characteristics.
Alcohol Drinking ; Causality ; Diagnosis ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Hypertension ; Hyperthyroidism ; Male ; Meals ; Medical Records ; Muscle Weakness ; Paralysis* ; Physical Exertion ; Retrospective Studies ; Tachycardia ; Thyroid Function Tests ; Thyroid Gland ; Thyrotoxicosis

BACKGROUND: Incidents of suicide attempts and acute poisonings in the elderly population is rising. This study com- pared elderly and younger patients to investigate the influence of age on the clinical nature of acute poisoning. METHODS: We retrospectively investigated 147 patients with acute poisoning who visited the emergency department within 6 hours of exposure. Patients were divided into two groups, young adult(20-40 yrs) and elderly(> or =55 yrs). Information on type of toxic material, age, sex, duration of time to arrive to the emergency department(ED) after poisoning, cause of poisoning, usage of activated charcoal and gastric lavage, previous suicide attempts, and past psy- chiatric history were collected. And, the mean arterial pressure, respiratory rate, base excess, aspartate aminotransfe- rase(AST), serum creatinine, rate of discharge against medical advice, intensive care unit(ICU) admission rate, discharge rate, duration in ICU, usage of mechanical ventilator, and death rate were analyzed. Initial and final Poisoning Severity Scores(PSS) of each patient were calculated. RESULTS: The mean age of the young adult group and the elderly group were 30.6+/-6.1 yrs and 66.6+/-8.2 yrs, respectively. Cause of poisoning was accidental more often in the elderly group than in the young adult group. AST and creatinine levels were higher and base excess was lower in the elderly group. ICU admission rate, duration in ICU, usage of mechanical ventilator, death rate, and initial and final PSS were all higher in the elderly group as well. CONCLUSION: This study showed that the PSS and death rate from acute poisoning were higher in the elderly group than in the young adult group.
Aged ; Arterial Pressure ; Aspartic Acid ; Charcoal ; Creatinine ; Emergencies ; Gastric Lavage ; Humans ; Critical Care ; Respiratory Rate ; Retrospective Studies ; Suicide ; Ventilators, Mechanical ; Young Adult

PURPOSE: This study was conducted to see the effect of alcohol ingestion on clinical features of acute drug intoxicated patients. METHODS: We prospectively investigated drug intoxicated patients who visited the emergency department 6 hours after acute poisoning from January 2004 to December 2007. Patients were classified into two groups according to serum alcohol levels: an alcohol group (serum alcohol level>10 mg/dl) and a non-alcohol group. The type of toxic material, age, sex, duration of time to arrive to the emergency department (ED) after poisoning, mean arterial pressure, respiratory rate, base excess level, AST level, serum creatinine level, cause of poisoning, suicide attempt, past psychiatric history, discharge against medical advice rate, and admission rate were checked. The initial and final Poisoning Severity Score (PSS), the Glasgow coma scale, the length of stay in the intensive care unit (ICU), the usage of a mechanical ventilator, and death rate were also checked. RESULTS: The study enrolled 222 intoxicated patients of which 75 fell into the non-alcohol group and 147 into the alcohol group. Alcohol ingestion of acute poisoning in males was higher than in females. The AST level and discharge against medical advice rates in the alcohol group were higher than the non-alcohol group. The base excess level, length of stay in ICU, past psychiatric history rate, and admission rates in the non-alcohol group were higher than the alcohol group. The PSS were not correlated with alcohol consumption between the two groups. CONCLUSION: Alcohol ingestion is not associated with PSS. However, alcohol ingestion is commonly found in acute drug intoxicated patients. The discharge against medical advice rate in the alcohol group was higher than the non-alcohol group.
Alcohol Drinking ; Arterial Pressure ; Creatinine ; Eating ; Emergencies ; Female ; Glasgow Coma Scale ; Humans ; Intensive Care Units ; Length of Stay ; Male ; Prospective Studies ; Respiratory Rate ; Severity of Illness Index ; Suicide ; Ventilators, Mechanical

PURPOSE: Numerous reports have suggested that apoptosis may play an important role in postresuscitation syndrome. The aim of this study is to assess the levels of molecules that are associated with apoptosis in the serum of patients who underwent successful resuscitation after cardiac arrest. METHODS: The serum levels of cytochrome c, tumor necrosis factor type 1 receptor (TNF-R1) and Fas ligand in 11 patients were measured at 0, 4, 12, 24, 48 and 72 hours after successful resuscitation. The primary endpoint consisted of survival to hospital discharge. Ten healthy volunteers were also evaluated as a control group. RESULTS: Patients with successful resuscitation had increased levels of cytochrome c and TNF-R1 at 0, 4, 12, 24 and 48 hours after return of spontaneous circulation (ROSC), as compared with those levels of the healthy volunteers (p<0.05). Higher levels of TNF-R1 at 12, 24 and 48 hours after ROSC were found in the non-survivors as compared to those levels of the survivors (p=0.01, 0.03, 0.02). The Fas ligand level at ROSC was also higher in the patients with successful resuscitation (p=0.00). However, the Fas ligand levels at 24, 48 and 72 hours after ROSC were lower in the patients with successful resuscitation than those levels in the healthy volunteers. CONCLUSION: These results suggest that apoptosis belonging to the TNF-R1 and cytochrome c pathways may be involved in the pathogenesis of postresuscitation syndrome. The serum levels of the death-receptor TNF-R1 could serve to quantitate the severity of injury and to prognosticate the survival outcomes.
Apoptosis ; Cardiopulmonary Resuscitation ; Cytochromes ; Cytochromes c ; Fas Ligand Protein ; Heart Arrest ; Humans ; Receptors, Tumor Necrosis Factor, Type I ; Resuscitation ; Survivors ; Tumor Necrosis Factor-alpha

BACKGROUD/OBEJECTIVES: It is hypothesized that obese people with dyslipidemia is more likely to have increased oxidative stress and decreased antioxidant status, in comparison with the controls who were obese without dyslipidemia. Thus, the aims of the present study were to determine the dietary intakes, plasma adipokines, and antioxidative systems between obese with dyslipidemia and obese without dyslipidemia were investigated. SUBJECTS/METHODS: Female subjects who were between 20 and 55 years old, and whose BMI was 23 or greater were recruited. Subjects who met the criteria of BMI > or = 23, total cholesterol > or = 200 mg/dL, LDL cholesterol > or = 130 mg/dL, and TG > or = 110 mg/dL were categorized Obese with dyslipidemia. Anthropometric measurements and blood biochemical tests were conducted. The diet survey was conducted by a trained dietitian using two days of 24 hour dietary recall. The lipid peroxidation, the plasma total antioxidant capacity (TAC), the activities of antioxidantive enzymes, and various antioxidantive vitamins levels were determined. RESULTS: Plasma adiponectin and leptin levels were also determined. There were no significant differences for age, Body Mass index (BMI), and body fat (%), waist-size between two groups. Obese with dyslipidemia had significantly high levels of total cholesterol, triglyceride, LDL-cholesterol, the ratio of total cholesterol/HDL-C, and the ratio of HDL-C/LDL-C, respectively. Blood alkaline phosphatase level was statistically different between the two groups (P < 0.05). No statistical significance in dietary intake between two groups was shown. In case of obese with dyslipidemia group, the levels of GSH-Px (P < 0.05) and catalase (P < 0.05) as well as adjusted blood retinol (P < 0.05) and tocopherol level (P < 0.05) were significantly low. However, the plasma concentration of leptin was significantly high (P < 0.05). CONCLUSIONS: Obesity with dyslipidemia was shown to have high arthtrogenic index, depleted antioxidant status, and higher blood leptin levels which suggest higher risks of oxidative stress and cardiovascular diseases.
Adipokines* ; Adiponectin ; Adipose Tissue ; Alkaline Phosphatase ; Body Mass Index ; Cardiovascular Diseases ; Catalase ; Cholesterol ; Cholesterol, LDL ; Diet Surveys ; Dyslipidemias* ; Female ; Humans ; Leptin ; Lipid Peroxidation ; Nutritionists ; Obesity ; Overweight* ; Oxidative Stress ; Plasma* ; Tocopherols ; Triglycerides ; Vitamin A ; Vitamins

BACKGROUD/OBEJECTIVES: It is hypothesized that obese people with dyslipidemia is more likely to have increased oxidative stress and decreased antioxidant status, in comparison with the controls who were obese without dyslipidemia. Thus, the aims of the present study were to determine the dietary intakes, plasma adipokines, and antioxidative systems between obese with dyslipidemia and obese without dyslipidemia were investigated. SUBJECTS/METHODS: Female subjects who were between 20 and 55 years old, and whose BMI was 23 or greater were recruited. Subjects who met the criteria of BMI > or = 23, total cholesterol > or = 200 mg/dL, LDL cholesterol > or = 130 mg/dL, and TG > or = 110 mg/dL were categorized Obese with dyslipidemia. Anthropometric measurements and blood biochemical tests were conducted. The diet survey was conducted by a trained dietitian using two days of 24 hour dietary recall. The lipid peroxidation, the plasma total antioxidant capacity (TAC), the activities of antioxidantive enzymes, and various antioxidantive vitamins levels were determined. RESULTS: Plasma adiponectin and leptin levels were also determined. There were no significant differences for age, Body Mass index (BMI), and body fat (%), waist-size between two groups. Obese with dyslipidemia had significantly high levels of total cholesterol, triglyceride, LDL-cholesterol, the ratio of total cholesterol/HDL-C, and the ratio of HDL-C/LDL-C, respectively. Blood alkaline phosphatase level was statistically different between the two groups (P < 0.05). No statistical significance in dietary intake between two groups was shown. In case of obese with dyslipidemia group, the levels of GSH-Px (P < 0.05) and catalase (P < 0.05) as well as adjusted blood retinol (P < 0.05) and tocopherol level (P < 0.05) were significantly low. However, the plasma concentration of leptin was significantly high (P < 0.05). CONCLUSIONS: Obesity with dyslipidemia was shown to have high arthtrogenic index, depleted antioxidant status, and higher blood leptin levels which suggest higher risks of oxidative stress and cardiovascular diseases.
Adipokines* ; Adiponectin ; Adipose Tissue ; Alkaline Phosphatase ; Body Mass Index ; Cardiovascular Diseases ; Catalase ; Cholesterol ; Cholesterol, LDL ; Diet Surveys ; Dyslipidemias* ; Female ; Humans ; Leptin ; Lipid Peroxidation ; Nutritionists ; Obesity ; Overweight* ; Oxidative Stress ; Plasma* ; Tocopherols ; Triglycerides ; Vitamin A ; Vitamins