No abstract available.
Lithotripsy* ; Ureter*

No abstract available.
Rhabdomyosarcoma, Embryonal*

PURPOSE: We performed this study to evaluate the clinical characteristics, including risk factors and etiologic subtypes, of ischemic stroke in young adults. METHODS: One hundred thirty-two patients with acute ischemic stroke and between 15 and 44 years of age who visited the Emergency Department of Samsung Medical Center from January 1999 to December 2003 were included. We retrospectively reviewed their medical records and the result of brain CT, brain MRI/MRA, transcranial doppler sonography, echocardiography, electrocardiography, and laboratory studies for coagulopathy, autoimmune disease, and vasculitis according to the Young-age Stroke Protocol of Samsung Medical Center. Stroke subtypes were classified based on the TOAST criteria. RESULTS: In this study, men (77.3%) significantly outnumbered women. The prevalence of cigarette smoking, habitual alcohol ingestion, hyperlipidemia, and DM was significantly higher in men than women. Stroke subtypes were large-artery thrombosis 26.5%, small-artery occlusive disease 20.5%, cardioembolism 17.4%, other determined etiologies 12.7%, and undetermined causes 22.7%. Among the 17 patients with other determined etiologies, arterial dissection (9 patients) was most common. Our Young-age Stroke Protocol identified a clinically significant result in only one patient. CONCLUSION: Smoking and alcohol ingestion were the most important risk factors. The proportion of large-artery thrombosis and small-artery occlusion was relatively high compared to previous western studies. Arterial dissection was the most common cause in other determined etiologies. The current Young-age Stroke Protocol has limited value for stroke in young Korean adults.
Adult ; Autoimmune Diseases ; Brain ; Eating ; Echocardiography ; Electrocardiography ; Emergency Service, Hospital ; Female ; Humans ; Hyperlipidemias ; Male ; Medical Records ; Prevalence ; Retrospective Studies ; Risk Factors ; Smoke ; Smoking ; Stroke* ; Thrombosis ; Ultrasonography, Doppler, Transcranial ; Vasculitis ; Young Adult*

PURPOSE: For tachycardic patients not in need of immediate cardioversion, the International Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care emphasize specific rhythm diagnosis and avoidance of simplistic overuse of adenosine. The purpose of this study was to identify the rhythms for which adenosine was inappropriately prescribed at the emergency department after the International Guidelines 2000 had been adopted. METHODS: We retrospectively investigated 128 tachycardic patients who had been prescribed adenosine at the emergency department from September 2000 to March 2003. Patients were divided into two groups. The Appropriate Use Group was comprised of patients for whom had been prescribed for narrow QRS-complex tachycardia on the initial ECG. The Inappropriate Use Group was comprised of patients for whom adenosine had been prescribed for atrial fibrillation, atrial flutter, atrial tachycardia, sinus tachycardia, and wide QRS-complex tachycardia of unknown origin on the initial ECG. RESULTS: Of the 128 patients, 31 (24.2%) were in the Inappropriate Use Group. Among them, atrial fibrillation was involved in 15, atrial flutter in 3, atrial tachycardia in 2, sinus tachycardia in 8, and wide QRS-complex tachycardia of unknown origin in 3. CONCLUSION: Approximately 24% of the emergency department patients who were treated with adenosine received the medication unnecessarily for atrial fibrillation, atrial flutter, atrial tachycardia, sinus tachycardia, and wide QRS-complex tachycardia of unknown origin. Additional education on electrocardiographic recognition of tachyarrhythmias, and the Tachycardia Algorithms of Guidelines 2000 may be necessary for residents of emergency department.
Adenosine* ; Atrial Fibrillation ; Atrial Flutter ; Cardiopulmonary Resuscitation ; Diagnosis ; Education ; Electric Countershock ; Electrocardiography ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Retrospective Studies ; Tachycardia ; Tachycardia, Sinus

Purpose: This study investigated the utility of second-line contrast-enhanced ultrasonography (CEUS) using Sonazoid in Liver Imaging Reporting and Data System category 3 (LR-3) and 4 (LR-4) observations on gadoxetate-enhanced magnetic resonance imaging (MRI). Methods: This retrospective study included LR-3 or LR-4 observations on gadoxetate-enhanced MRI subsequently evaluated with CEUS from 2013 to 2017. The presence of MRI features, CEUSarterial phase hyperenhancement (CEUS-APHE), and Kupffer phase defect (KPD) was evaluated. Multivariable logistic regression analysis was performed to identify significant imaging features associated with the diagnosis of hepatocellular carcinoma (HCC). The optimal diagnostic criteria were investigated using the McNemar test. Results: In total, 104 patients with 104 observations (63 HCCs) were included. The presence of both CEUS-APHE and KPD on CEUS enabled the additional detection of 42.3% (11/26) of LR-3 HCCs and 78.4% (29/37) of LR-4 HCCs. Transitional phase (TP) hypointensity (adjusted odds ratio [OR], 10.59; P<0.001), restricted diffusion (adjusted OR, 7.55; P=0.004), and KPD (adjusted OR, 7.16; P=0.003) were significant imaging features for HCC diagnosis. The presence of at least two significant imaging features was optimal for HCC diagnosis (sensitivity, specificity, and accuracy: 88.9%, 78.1%, and 84.6%, respectively), with significantly higher sensitivity than the presence of both CEUS-APHE and KPD (sensitivity, specificity, and accuracy: 63.5% [P=0.001], 92.7% [P=0.077], and 75.0% [P=0.089], respectively). Conclusion The combined interpretation of gadoxetate-enhanced MRI and second-line CEUS using Sonazoid, focusing on TP hypointensity, restricted diffusion, and KPD, may be optimal for further characterizing LR-3 and LR-4 observations.

A prognosis of hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is dismal that the median survival is 2 to 4 months without treatment. Sorafenib, the standard regimen of advanced HCC, can prolong median survival only 1.5 months. A 50-year-old man with a history of chronic hepatitis B was diagnosed advanced HCC with PVTT. By a multidisciplinary medical team approach, the combination of 3-demensional conformal radiation therapy with sequential sorafenib was challenged. 4 months after initiation of treatment, he achieved partial response as modified response evaluation criteria in solid tumors criteria. Sorafenib was continued so far, and stable disease has been maintained up to now, without significant adverse effect.
Carcinoma, Hepatocellular* ; Hepatitis B, Chronic ; Humans ; Middle Aged ; Portal Vein* ; Prognosis* ; Response Evaluation Criteria in Solid Tumors ; Thrombosis

Pure red cell aplasia (PRCA) and autoimmune hemolytic anemia (AIHA) have rarely been reported as an extrahepatic manifestation of acute hepatitis A (AHA). We report herein a case of AHA complicated by both PRCA and AIHA. A 49-year-old female with a diagnosis of AHA presented with severe anemia (hemoglobin level, 6.9 g/dL) during her clinical course. A diagnostic workup revealed AIHA and PRCA as the cause of the anemia. The patient was treated with an initial transfusion and corticosteroid therapy. Her anemia and liver function test were completely recovered by 9 months after the initial presentation. We review the clinical features and therapeutic strategies for this rare case of extrahepatic manifestation of AHA.
Acute Disease ; Adult ; Anemia, Hemolytic, Autoimmune/*complications/*diagnosis/drug therapy ; Antineoplastic Agents, Hormonal/therapeutic use ; Bone Marrow/pathology ; Female ; Hepatitis A/*complications/*diagnosis ; Humans ; Male ; Middle Aged ; Prednisolone/therapeutic use ; Red-Cell Aplasia, Pure/*complications/*diagnosis/drug therapy ; Treatment Outcome ; Young Adult

Neuroleptic malignant syndrome and serotonin syndrome share many common clinical features, and the term "Neurotoxic syndrome" can be used when a clear distinction cannot be made between the two. Here we present a case of 19-year-old man who experienced serotonin syndrome caused by sertraline intake, and consecutive neuroleptic malignant syndrome by risperidone. This case suggests that these two syndromes can be concomitantly induced in some patients who are susceptible to these drugs. Clinicians may have to pay close attention to this problem when prescribing drugs to patients who previously showed sensitivity to CNS-acting drugs.
Antipsychotic Agents ; Humans ; Neuroleptic Malignant Syndrome ; Risperidone* ; Serotonin Syndrome ; Sertraline* ; Young Adult

Neuroleptic malignant syndrome and serotonin syndrome share many common clinical features, and the term "Neurotoxic syndrome" can be used when a clear distinction cannot be made between the two. Here we present a case of 19-year-old man who experienced serotonin syndrome caused by sertraline intake, and consecutive neuroleptic malignant syndrome by risperidone. This case suggests that these two syndromes can be concomitantly induced in some patients who are susceptible to these drugs. Clinicians may have to pay close attention to this problem when prescribing drugs to patients who previously showed sensitivity to CNS-acting drugs.
Antipsychotic Agents ; Humans ; Neuroleptic Malignant Syndrome ; Risperidone* ; Serotonin Syndrome ; Sertraline* ; Young Adult

A spontaneous subcapsular hematoma of the liver is an unusual clinical phenomenon and is usually associated with trauma, surgery, tumor or pregnancy. We report a case of a recurrent spontaneous subcapsular hematoma of the liver without an identifiable cause. A 52-year-old female presented to the emergency room with acute abdominal pain localized in the right upper quadrant area. Diagnostic workup revealed a subcapsular hematoma in the segment 8 area. The laboratory evaluation was also normal. She was managed conservatively. However, two months later another episode of abdominal pain in the right upper quadrant recurred. Diagnostic workup showed recurrence of a subcapsular hematoma in the segment 6 area. Follow-up evaluation revealed resorption of the previous subcapsular hematomas, as well as a new lesion in the segment 1 area. Herein, we discuss potential causes of this spontaneous subcapsular hematoma of the liver.
Abdominal Pain ; Emergency Service, Hospital ; Female ; Follow-Up Studies ; Hematoma* ; Humans ; Liver* ; Middle Aged ; Pregnancy ; Recurrence ; Tamoxifen