Thrombus-in-transit appears to increase the risk of mortality compared to pulmonary embolism alone and can require alteration in therapeutic plan. We present the case of a biatrial thromboembolus caught in transit across a patent foramen ovale diagnosed by intraoperative transesophageal echocardiogram in a 69-year-old female with acute pulmonary embolism and subsequent acute cerebral infarction. We suggest that echocardiography should be performed in a patient with suspected pulmonary thromboembolism to evaluate right heart function and diagnose emboli in transit.
Aged ; Cerebral Infarction ; Echocardiography ; Female ; Foramen Ovale, Patent* ; Heart ; Humans ; Mortality ; Pulmonary Embolism* ; Thrombosis*

Emphysematous pyelonephritis (EPN) is a necrotizing infection of the renal parenchyma and its surrounding tissues that results in the accumulation of gas in the renal parenchyma, collecting system or perinephric tissue. EPN is a potentially life-threatening condition, which is most commonly associated with poorly controlled diabetes. We describe a case of emphysematous pyelonephritis associated with emphysematous ureteritis and cystitis in a 68-year-old diabetic woman, who was cured with medical treatment and surgical intervention.
Aged ; Cystitis ; Female ; Humans ; Pyelonephritis ; Ureter

There has been a great improvement in height and weight of Korean children owing to economic development over the last 25 years. This study aimed to evaluate the penile length of Korean children today and to compare it with a previous Korean study reported in 1987. The cross-sectional study was conducted with 909 Korean boys aged 0-14 years who had been brought to outpatient clinics of five tertiary hospitals (Busan, Ulsan, and Changwon) between September 2013 and May 2015. The stretched penile length (SPL) was measured and the testicular size was measured using orchidometry (mL). Student's t-test or Mann-Whitney U test was used to compare the result of our study and the study reported in 1987. SPL of Korean children gradually increased from 4.1 ± 0.8 cm at 0-1 year old to 9.6 ± 3.0 cm at 13-14 years old, the most rapidly during the age of 13. While body weight and testicular size significantly increased from 1987 in most of age groups, there were no significant changes in SPL although there was in some age groups. Height decreased in the infants < 1 year old and increased in the children > 6 years old. With the great economic development over the last quarter century in Korea, height, body weight, and testicular size of children significantly increased but there was no significant change in SPL except penile growth pattern.
Ambulatory Care Facilities ; Anthropometry ; Body Height ; Body Weight ; Child* ; Cross-Sectional Studies ; Economic Development ; Humans ; Infant ; Korea ; Male ; Penis ; Tertiary Care Centers ; Ulsan

PURPOSE: To investigate the causes of varicocele recurrence and assess the use of embolization and subinguinal varicocelectomy in its treatment in patients with angiography and subinguinal varicocelectomy. MATERIALS AND METHODS: The present study involved 15 patients with recurrent varicoceles. The mean patient age was 21.2 years (range: 12-42 years). Preoperative angiography was performed in 11 patients. Embolization was used in patients with patent internal spermatic veins (ISVs). Patients without patent ISVs or preoperative angiography underwent magnification-assisted subinguinal varicocelectomy which included testicular retrieval and ligation of all collateral veins except arteries and deferential veins. RESULTS: Seven among 11 patients (64%) which had preoperative angiography had patent ISVs and underwent embolization and 8 patients underwent subinguinal varicocelectomy. Of those 8 patients, 6 had dilated ISVs and external spermatic veins (ESVs), one had dilated ISVs and gubernacular veins, and one had dilated ISVs, ESVs and gubernacular veins. No patient experienced recurrence or testis atrophy. CONCLUSION: Patent ISVs or collateral veins may be the cause of recurrence after varicocelectomy. Angiographic embolization was successful in 64% of recurrent varicoceles patients with patent ISVs. However, microscope-assisted subinguinal varicocelectomy may be the best overall treatment for patients with recurrent varicoceles.
Adolescent ; Adult ; Angiography ; Child ; Humans ; Male ; Spermatic Cord/radiography/surgery ; Urogenital Surgical Procedures ; Varicocele/*radiography/*surgery ; Young Adult

Acute generalized exanthematous pustulosis is a rare, drug-induced disease that is occasionally accompanied by acute renal failure. It is characterized by the abrupt onset of widespread pustules on an erythematous base and rapid spontaneous healing. We report a case involving a 47-year-old male who presented with exanthematous pustules after taking medication. Azotemia was found in the resulting blood test. We were able to achieve the final diagnosis by skin biopsy. After instructing the patient not to take the previous medication, oral steroids were prescribed. He recovered within 2 weeks with just desquamations remaining.
Acute Generalized Exanthematous Pustulosis ; Acute Kidney Injury ; Azotemia ; Biopsy ; Hematologic Tests ; Humans ; Male ; Middle Aged ; Skin ; Steroids

Internal iliac artery aneurysm (IIAA) is a type of abdominal aneurysm that is a rare cause of lower urinary tract symptoms because of its anatomic location. If diagnosed after rupture, it can be lethal and surgery is mandatory. A 57-year-old male presented with acute urinary retention and syncope. An intra-abdominal mass initially thought to be an aneurysm was apparent by ultrasound. A computed tomography scan of the abdomen confirmed an internal iliac artery aneurysm accompanied by rupture. The patient was discharged without any complications within 20 days after receiving a vascular graft and resection of the aneurysm.
Abdomen ; Aneurysm ; Humans ; Iliac Aneurysm ; Iliac Artery ; Lower Urinary Tract Symptoms ; Male ; Middle Aged ; Rupture ; Syncope ; Transplants ; Urinary Retention

PURPOSE: To evaluate the effectiveness of magnification-assisted subinguinal varicocelectomy (MASV) with testicular delivery in children with severe varicocele. MATERIALS AND METHODS: We retrospectively analyzed the clinical data of 23 children 15 years or younger (mean age, 12.3+/-1.8 years) who underwent MASV with testicular delivery and ligation of all collateral veins except arteries and deferential veins between January 2010 and January 2014. All patients had grade 3 varicocele on the left side. Varicocelectomy was decided upon due to scrotal hypotrophy (n=14, 60.9%), the existence of mass (n=6, 26.1%, including 1 recurrent case), and discomfort (n=3, 13.0%). The preservation of internal spermatic artery (ISA) was successful in 8 patients (34.8%). The mean follow-up time was 10.8+/-6.6 months. RESULTS: The surgical success rate of varicocelectomy was 100%. The overall symptom resolution rate was 91.3%. The scrotal mass and discomfort disappeared, but testicular catch-up growth did not occur in 2 among 14 patients with scrotal hypotrophy. The left testis volume increased from 6.5+/-4.3 mL to 10.6+/-7.5 mL (p=0.003). There were no significant inter-group differences in terms of the surgical success rate, symptom resolution, and catch-up growth between the ISA preservation group and the ligation group. None of the subjects demonstrated testicular atrophy or hydrocele after surgery. CONCLUSIONS: MASV with testicular delivery is an effective and safe method for children with severe varicocele.
Arteries ; Atrophy ; Child* ; Follow-Up Studies ; Humans ; Ligation ; Recurrence ; Retrospective Studies ; Testis ; Treatment Outcome ; Varicocele ; Veins

PURPOSE: To evaluate the effectiveness of magnification-assisted subinguinal varicocelectomy (MASV) with testicular delivery in children with severe varicocele. MATERIALS AND METHODS: We retrospectively analyzed the clinical data of 23 children 15 years or younger (mean age, 12.3+/-1.8 years) who underwent MASV with testicular delivery and ligation of all collateral veins except arteries and deferential veins between January 2010 and January 2014. All patients had grade 3 varicocele on the left side. Varicocelectomy was decided upon due to scrotal hypotrophy (n=14, 60.9%), the existence of mass (n=6, 26.1%, including 1 recurrent case), and discomfort (n=3, 13.0%). The preservation of internal spermatic artery (ISA) was successful in 8 patients (34.8%). The mean follow-up time was 10.8+/-6.6 months. RESULTS: The surgical success rate of varicocelectomy was 100%. The overall symptom resolution rate was 91.3%. The scrotal mass and discomfort disappeared, but testicular catch-up growth did not occur in 2 among 14 patients with scrotal hypotrophy. The left testis volume increased from 6.5+/-4.3 mL to 10.6+/-7.5 mL (p=0.003). There were no significant inter-group differences in terms of the surgical success rate, symptom resolution, and catch-up growth between the ISA preservation group and the ligation group. None of the subjects demonstrated testicular atrophy or hydrocele after surgery. CONCLUSIONS: MASV with testicular delivery is an effective and safe method for children with severe varicocele.
Arteries ; Atrophy ; Child* ; Follow-Up Studies ; Humans ; Ligation ; Recurrence ; Retrospective Studies ; Testis ; Treatment Outcome ; Varicocele ; Veins

Extramedullary plasmacytoma (EMP) is a common plasma cell tumor often involving the upper aerodigestive tract. Although extremely rare, mediastinal involvement is possible. An 81-year-old man was presented to our emergency department with chest and back pain with weakness in both legs. Chest X-ray showed a large mass in the upper right mediastinum; subsequently, computed tomography and magnetic resonance imaging evaluated the mass. He was diagnosed with mediastinal EMP, which progressed to spinal cord compression. The patient was treated with radiotherapy and chemotherapy. Spinal cord compression, due to metastatic tumor, is an emergency clinical situation that requires prompt diagnosis and treatment. Emergency medicine physicians should be aware of the clinical presentation and complications associated with EMP.
Aged, 80 and over ; Back Pain ; Diagnosis ; Drug Therapy ; Emergencies ; Emergency Medicine ; Emergency Service, Hospital ; Humans ; Leg ; Magnetic Resonance Imaging ; Mediastinum ; Multiple Myeloma ; Plasmacytoma* ; Radiotherapy ; Spinal Cord Compression* ; Spinal Cord* ; Thorax

PURPOSE: We analyzed the usefulness of vacuum-assisted closure (VAC) dressing to facilitate the healing of difficult wounds by comparing the results of conventional dressings. MATERIALS AND METHODS: We selected 20 cases for the experimental group (VAC group) and 20 cases for the control group (conventional dressing), and investigated the change in wound size, formation of granulation tissue, and duration of wound healing in the two groups. RESULTS: In the VAC group, the size of wound decreased from 60.2+/-59.1 cm2 to 29.7+/-18.8 cm2 (p=0.001). In the control group, it decreased from 60.3+/-83.3 cm2 to 34.4+/-47.6 cm2 (p=0.04). For formation of granulation, it increased from 1.2+/-0.4 to 2.7+/-0.6 (p=0.001) in the VAC group and from 1.2+/-0.4 to 2.4+/-0.5 in the control group. For the duration of healing, it took 17.5+/-8.3 days for the VAC group and 22.9+/-22.0 days in the control group (p=0.857). However there were no statistically significant differences in all the parameters between the 2 groups (p>0.05). CONCLUSION: The clinical application of VAC to difficult wound yield comparable results in terms of a decrease in wound size, formation of granulation, and the duration of healing. VAC dressing could be an alternative treatment option for a difficult wound considering the advantage of saving medical human resources.
Bandages ; Granulation Tissue ; Humans ; Imidazoles ; Negative-Pressure Wound Therapy ; Nitro Compounds ; Wound Healing