Spinal epidural abscesses were evaluated using Gadolinium-enhanced magnetic resonance imaging (MRI) in 19 surgically and clinically confirmed cases, including 13 with tuberculous spondylitis and 6 with pyogenic spondylitis. We observed rim enhancement patterns in 10 patients and diffuse enhancement patterns in 9 patients. The spread patterns were localized to ventral or dorsal epidural space and encircled entire epidural space. We conclude that rim enhancement indicates abscess and diffuse enhancement indicates granulation tissue and fibrosis. Tuberculous epidural abscess spreads to ventral epidural space and pyogenic epidural abscess encircles entire epidural space.
Abscess ; Epidural Abscess* ; Epidural Space ; Fibrosis ; Granulation Tissue ; Humans ; Magnetic Resonance Imaging* ; Spondylitis

PURPOSE: To evaluate the incidence of sacral insufficiency fracture in osteoporotic patients with compression fracture of the thoracolumbar (T-L) spine on magnetic resonance image (MRI), and to analyze the correlation of variable clinical factors and the incidence of sacral insufficiency fracture. MATERIALS AND METHODS: We retrospectively reviewed 160 patients (27 men, 133 women; age range of 50 to 89 years) who underwent spinal MRI and had compression fracture of the T-L spine. Compression fractures due to trauma or tumor were excluded. We evaluated the incidence of sacral insufficiency fracture according to the patients' age, sex, number of compression fractures, and the existence of bone marrow edema pattern of compression fracture. During the same period, we evaluated the incidence of spinal compression fracture in the patients of pelvic insufficiency fracture. RESULTS: Out of the 160 patients who had compression fracture in the T-L spine, 17 (10.6%) had insufficiency fracture of the sacrum. Compression fracture occurred almost 5 times more frequently in women (27:133), but the incidence of sacral insufficiency fracture was 2/27 for men (7.4%) and 15/133 for women (11.3%), with no statistically significant difference (p = 0.80). According to age, the ratio of insufficiency fracture to compression fracture was 0% (0/23) in the 50's, 10.6% (7/66) in the 60's, 12.5% (7/56) in the 70's, and 20.0% (3/15) in the 80's. In respect of single and multiple compression fracture, the incidence of sacral insufficiency fracture was 8/65 for men (12.3%) and 9/95 for women (9.5%), showing no significant difference (p=0.37). In the patients with and without compression fracture with bone marrow edema, insufficiency fracture occurred in 5/76 (6.6%) and 12/84 (14.3%), respectively. On the other hand, of the 67 patients who had pelvic insufficiency fracture, 27 (40.3%) also had spinal compression fracture. CONCLUSION: About 10% of the patients with osteoporotic compression fracture in the T/L spine also had pelvic sacral insufficiency fracture, which was not uncommon. These findings suggest the need to consider the possibility of pelvic sacral insufficiency fracture in cases of T/L spinal MRI for patients with osteoporotic compression fracture.
Bone Marrow ; Edema ; Female ; Fractures, Compression* ; Fractures, Stress* ; Hand ; Humans ; Incidence* ; Magnetic Resonance Imaging ; Male ; Osteoporosis ; Retrospective Studies ; Sacrum ; Spine*

Penicillin resistance in Streptococcus pneumoniae has increased sharply within the past few years and extended-spectrum cephalosporins haute been recommended for the empiric therapy of bacterial meningitis. However, therapeutic failure are being reported with increasing frequency due to extended-spectrum cephalosporin-resistant strains. We report two cases of meningitis caused by S. pneumoniae resistant to penicillin and cefotaxime. Both patients were recovered after ceftriaxone and vancomycin treatment, but one of them was left with neurological sequelae because of a delay in the institution of an antibiotic therapy appropriate for resistant pneumococci. This report indicates that extended-spectrum cephalosporin-resistance must be considered In all clinical isolates of S. pneumoniae and in vitro susceptibility testings should be performed promptly and accurately to detect antibiotic resistance.
Cefotaxime ; Ceftriaxone ; Cephalosporins ; Drug Resistance, Microbial ; Humans ; Meningitis* ; Meningitis, Bacterial ; Penicillin Resistance ; Penicillins ; Pneumonia ; Streptococcus pneumoniae* ; Streptococcus* ; Vancomycin

Well differentiated papillary mesothelioma (WDPM) is an unusual variant of epithelial mesothelioma. Most WDPMs exhibit either benign or indolent behavior. Making the differential diagnosis between this rare tumor and serous papillary carcinoma can be problematic. We report here on a case of a 43-year-old woman with a WDPM of the surface. She presented to our hospital for a routine gynecologic evaluation, and she had no specific symptoms or a history of asbestos exposure. Gynecologic ultrasonography revealed a right ovarian mass that measured 6 x 3.8 x 3 cm in size. No ascites was detected. Right salpingo-oophorectomy was performed; grossly, the tumor was a yellowish firm, multinodular mass. Microscopically, the tumor consisted of numerous papillae that were lined by a single layer of uniform mesothelial cells. Nuclear pleomorphism and mitoses were not found. On immunohistochemical study, the tumor cells were positive for calretinin and cytokeratin, but they were negative for CEA. It is important to differentiate WDPM from serous papillary carcinoma or other malignant tumors to avoid treating them as malignant tumors.
Adult ; Asbestos ; Ascites ; Calbindin 2 ; Carcinoma, Papillary ; Diagnosis, Differential ; Female ; Humans ; Keratins ; Mesothelioma* ; Mitosis ; Ovary ; Ultrasonography

STATEMENT OF PROBLEM: Insertion of endosseous implants in the atrophic maxilla is often complicated because of lack of supporting bone. Augmentation of the floor of the maxillary sinus with autogenous bone & bone substitute graft has been proven to be a reliable treatment modality, at least in the short term. The aim of this study is to evaluate the factors of implant survival rate associated with maxillary sinus lift with grafts. MATERIAL AND METHODS: The sinus floor was augmented with bone grafts derived from modified Caldwell-luctechnique (71 subject, 93 sinus, 180 implants), the autogenous bone or autogenous + Bio-oss. Before implant installation the width and height of the alveolar crest were increased in the first stage procedure in 10 patients while in the other 61 patients augmentation and implant installation could be performed simultaneously width and height of the alveolar crest > 4 mm) or delayed installation. RESULTS: In all case bone volume was sufficients for implant insertion. 14 of 180 inserted implants were lost during follow up and the healing period Patient received implant supported overdenture (5 patients) or fixed bridge (62 patients). CONCLUSION: Within the limit of the result of this study, we conclude that bone grafting of the floor of the maxillary sinus floor with bone for the insertion of implants might be a reliable treatment modality and the autogenous bone graft and delayed installation method might be the factors for good results.
Bone Substitutes ; Bone Transplantation ; Denture, Overlay ; Denture, Partial, Fixed ; Floors and Floorcoverings ; Follow-Up Studies ; Humans ; Maxilla ; Maxillary Sinus ; Minerals ; Retrospective Studies ; Survival Rate ; Transplants

PURPOSE: This study aimed to determine the amino acids composition, safety and efficacy of formulas recently developed by Korean dairy companies for children with inherited metabolic disorder. METHODS: The determination of amino acids concentration was performed on eight Korean formula samples. The samples were hydrolyzed with 6N HCL or performic acid and analyzed by amino acid analyzer. RESULTS: No phenylalanine, methionine or leucine was observed in PKU-1 and PKU-2 Formulas, Methionine-Free and Leucine-Free Formula, respectively. BCAA-Free Formula was free from leucine, isoleucine, and valine and MPA Formula did not contain methionine and valine. Protein-Free formula did not include any amino acids. UCD Formula contained arginine but was free of alanine, aspartic acid, glutamic acid, glycine, histidine, proline and serine. Methionine-Free Formula contained higher amounts of cystine and tyrosine was higher in PKU-1 and 2 Formulas. The amounts of isoleucine and threonine were minimal in MPA Formula. CONCLUSION: This study confirmed that the eight special formulas, developed for the first time by a Korean dairy company for children with inherited metabolic disorder contain appropriate amino acids with proper contents. Both the total amino acid amounts and specific amino acid concentrations of the formulas were appropriate for related diseases, which could be used safely by the patients with inherited metabolic disorder. For UCD Formula that contains arginine, we suggest that arginine be removed from the formula in order to use for any urea cycle defect patients before the specific diagnosis is made.
Alanine ; Amino Acids ; Arginine ; Aspartic Acid ; Child* ; Cystine ; Diagnosis ; Glutamic Acid ; Glycine ; Histidine ; Humans ; Isoleucine ; Leucine ; Methionine ; Phenylalanine ; Proline ; Serine ; Threonine ; Tyrosine ; Urea ; Valine

A 45-year-old woman was admitted with the diagnosis of diabetic ketoacidosis (DKA). During the hospital course, fluctuation of blood pressure accompanying with headache and palpitation was noted. The diagnosis of pheochromocytoma was proven by elevated urinary catecholamine and its metabolite, and confirmed histologically after right adrenalectomy. Mild glucose intolerance is known to be associated with pheochromocytoma in many cases. However, acute diabetic complication such as DKA has been reported in only 4 cases, mainly in Japanese. We think this is the first case of pheochromocytoma manifested DKA in Korea, so we report this with literature review.
Adrenalectomy ; Asian Continental Ancestry Group ; Blood Pressure ; Diabetes Complications ; Diabetic Ketoacidosis* ; Diagnosis ; Female ; Glucose Intolerance ; Headache ; Humans ; Korea ; Middle Aged ; Pheochromocytoma*

The use of totally implantable central venous access devices (chemoport) has increased with the development of chemotherapeutic agents in oncologic patients, especially with no venous access site. However, there can be various complications such as port site infection, thromboembolism, injury of central vein, fracture of catheter, and migration of catheter. We report a rare case of migration of catheter to right atrium due to the separation of the catheter from the chemoport.
Catheters ; Heart Atria ; Humans ; Thromboembolism ; Veins

Hypoglycemia is caused by poor oral intake, excessive exercise, alcohol abuse and inaccurate use of a hypoglycemic agent or insulin in patients that have history of diabetes mellitus (DM), especially in the elderly. Severe hypoglycemia has a variety of different symptoms or signs from focal neurologic deficits to severe coma, or death. It can be difficult to differentiate hypoglycemia-induced symptoms or signs, and stroke or cardiovascular disease in acute setting. Transient hypoglycemic hemiparesis is an infrequent case in the emergency department (ED), which is frequently misdiagnosed for stroke. When patients with decreased mental status or hemiparesis are admitted to the ED, a routine blood sugar test is essential. Hypoglycemic hemiparesis if unrecognized can result in permanent neurological damage. Therefore, it is important to detect hypoglycemia early and treat it appropriately.
Aged ; Alcoholism ; Blood Glucose ; Cardiovascular Diseases ; Coma ; Diabetes Mellitus ; Emergencies ; Humans ; Hypoglycemia ; Insulin ; Neurologic Manifestations ; Paresis ; Stroke

PURPOSE: We sought to predict the future incidence and health expenditures of cataract surgery in the Republic of Korea. METHODS: From 2011 to 2015, National Health Insurance claims data were used to estimate the incidence and prevalence changes of cataract surgery according to demographic characteristics (year, sex, residence, and age). Based on the above results and changes in future population distribution, we estimated the incidence of cataract surgery by 2030. Considering the cost of cataract surgery from 2011 to 2015, we also predicted future health expenditures for cataract surgery. RESULTS: A total of 2,236,107 eyes of 1,591,176 patients underwent cataract surgery from 2011 to 2015. The total number of operated eyes per year increased, from 427,729 to 492,700 (+15%), and the number of patients increased from 306,710 to 346,056 (+12%) from 2011 to 2015. The cost of cataract surgery reimbursed by the National Health Insurance Service (NHIS) increased from 408,307,530,900 won ($360 million) to 449,334,367,080 won ($399 million) (+9%). The future prevalence of cataract surgery was predicted to reach 562,003 in 2030 from 346,056 in 2015. The cost of cataract surgery is expected to increase from 449 billion won ($399 million) in 2015 to 641 billion won ($570 million) in 2030. CONCLUSIONS: Cataract surgery and medical expenses will increase due to social aging. Therefore, we need policies to secure medical resources and expand insurance indications.
Aging ; Cataract ; Demography ; Health Expenditures ; Humans ; Incidence ; Insurance ; National Health Programs ; Prevalence ; Republic of Korea