We report a case of atlantoaxial subluxation with bilateral high-riding vertebral artery with narrow isthmus. Because of the potential risk of bilateral vertebral artery injury, we performed atlantoaxial fixation using rod and screw instead of transarticular screw fixation. Although postoperative computed tomography reconstruction demonstrated slight breach of bilateral vertebral artery groove, postoperative angiography showed no evidence of vertebral artery injury. Though technically demanding, atlantoaxial fixation using rod and screw can be a one of the treatment options for atlantoaxial instability with bilateral high riding vertebral artery.
Angiography ; Vertebral Artery*

PURPOSE: This study was conducted to assess how extreme obesity affects 30-day mortality in this patient group. METHODS: A total of 802 patients who underwent emergency gastrointestinal surgery from January 2007 to December 2017 were retrospectively reviewed. Patients were divided into three groups according to their body mass index (BMI): group 1, normal weight (BMI: 18.5~22.9 kg/m²); group 2, overweight (BMI: 23.0~29.9 kg/m²); and group 3, obesity (BMI≥30 kg/m²). Patients with a BMI under 18.5 were excluded from the analysis. Chi-squared test, Fisher's exact test, Kaplan-Meier survival analysis, and the log-rank test were used to assess and compare 30-day mortality rates between groups. RESULTS: The mortality rates of group 1, group 2, and group 3 were 11.3%, 9.0%, and 26.9%, respectively (P < 0.017). The mortality rate did not differ significantly between group 1 and 2 (11.3% vs. 9.0%; P=0.341), but group 1 and 2 showed better survival rates than group 3 (11.3% vs. 26.9%; P=0.028, 9.0% vs. 26.9%; P=0.011). Kaplan-Meier survival analysis revealed that group 3 had higher mortality than the other two groups (P=0.001). CONCLUSION: Obesity (BMI≥30 kg/m²) was one of the risk factors influencing critically ill patients who underwent emergency surgery.
Body Mass Index ; Critical Illness* ; Emergencies ; Humans ; Kaplan-Meier Estimate ; Mortality* ; Obesity* ; Overweight ; Retrospective Studies ; Risk Factors ; Survival Rate

No abstract available.
Female ; Humans ; Myiasis

Systemic lupus erythematous (SLE) is systemic autoimmune disease of unknown etiology. SLE involve all part of heart but clinically important myocarditis is an unusual feature and is potentially fatal complication of SLE. We describe the woman who had diagnosed as SLE, 5 years ago and in that time, she had sinus tachycardia, mild dyspnea, chest discomfort, and depressed left ventricular function. She was diagnosed to myocarditis clinically and was treated by high-dose corticosteroids of intravenous pulse methylprednisolone. After treatment, she improved and showed improvement of left ventricular function. However, a sudden pneumomediastinum was occurred without trauma, and she died. The cause of pneumomediastinum was unexplained. We report a sudden pneumomediastinum in the course of lupus myocarditis presenting as sinus tachycardia with review of literature.
Female ; Humans

OBJECTIVE: This study was designed to assess sequential association between right ventricular systolic pressure and cardiothoracic (C/T) ratio of chest radiography in systemic sclerosis (SSc) patients and inferred pulmonary arterial hypertension by increased C/T ratio and right ventricular systolic pressure. METHODS: Twenty-eight consecutive patients with confirmed SSc (22 females, 6 males; mean age 51.1+/-2.1 years), with a mean time of 91.0+/-6.7 months from SSc diagnosis, were prospectively included in the study. C/T ratio was obtained by chest radiography with an interval of two years. The first C/T ratio was taken at diagnosis and second C/T ratio was taken at the time of enrollment. The enrolled subjects were agree to undergo echocardiography and measurement of brain natriuretic peptide. RESULTS: In 24 SSc patients with normal right ventricular systolic pressure, 10 SSc patients had increased C/T ratio, the other four SSc patients with increased right ventricular systolic pressure by echocardiography, had increased C/T ratio all together. In four SSc patients with increased right ventricular systolic pressure, one patient had resting dyspnea, taken cardiac catheterization and confirmed as pulmonary hypertension and the other three patients had no clinical symptoms. The increased right ventricular systolic pressure is related to the increase of C/T ratio (>0.55) in chest radiography (p<0.05) and increased brain natriuretic peptide in blood (p<0.05). CONCLUSION: The increase of C/T ratio (>0.55) in chest radiography was associated with increased right ventricular systolic pressure measured by echocardiography and inferred a role in early detection of asymptomatic pulmonary arterial hypertension in SSc patients.
Blood Pressure* ; Cardiac Catheterization ; Cardiac Catheters ; Diagnosis ; Dyspnea ; Echocardiography ; Female ; Humans ; Hypertension ; Hypertension, Pulmonary ; Male ; Natriuretic Peptide, Brain ; Prospective Studies ; Radiography ; Scleroderma, Systemic* ; Thorax

Systemic lupus erythematosus (SLE) is an autoimmune disease that affects various organs, so it is easily confused with other diseases and thus misdiagnosed. SLE is defined only by classification criteria and not by diagnostic criteria, so other diseases must be excluded before SLE can be diagnosed. We report a case of peripheral T cell lymphoma that mimicked SLE initially.
Anemia, Hemolytic* ; Autoimmune Diseases ; Classification ; Lupus Erythematosus, Systemic ; Lymphoma ; Lymphoma, T-Cell, Peripheral*

Pigmented villonodular synovitis is a benign tumor arising from synovial fibroblasts or histiocytes. There are diffuse and localized forms: the former involves the entire synovium and the latter consists of nodules, small tumefactions, or pedunculated masses. The knee is the joint most commonly affected and the clinical diagnosis is difficult, so initial misdiagnosis is common. We report a case of pigmented villonodular synovitis developing in the knee of rheumatoid arthritis (RA) patient, mistaken for an RA flare-up.
Arthritis, Rheumatoid ; Diagnosis ; Diagnostic Errors ; Fibroblasts ; Histiocytes ; Humans ; Joints ; Knee ; Synovial Membrane ; Synovitis, Pigmented Villonodular

Objective: Decompressive craniectomy (DC) is one of the treatment modalities in severe traumatic brain injury (TBI), however, there was a lack of evidence for optimal craniectomy size. The authors aimed to investigate optimal DC size and analyze clinical outcome according to craniectomy size. Methods: We retrospectively reviewed the medical data of 87 patients with a space occupying lesion following TBI who underwent unilateral DC. Craniectomy size was measured by anterior-posterior (AP) diameter and surface estimate (SE). Mortality, clinical outcome, and complications were collected and analyzed according to craniectomy size. Results: Nineteen patients (21.8%) died and 35 patients (40.2%) had a favorable outcome at last follow-up (a mean duration, 30.3±39.4 months; range, 0.2–132.6 months). Receiver operating curve analyses identified AP diameter more than 12.5 cm (area under the curve [AUC]=0.740; p=0.002) and SE more than 98.0 cm2 (AUC=0.752;p=0.001) as cut-off values for survival, and AP diameter more than 13.4 cm (AUC=0.650; p=0.018) and SE more than 107.3 cm2 (AUC=0.685; p=0.003) for favorable outcome. Large craniectomy resulted in a significantly lower mortality rate and a higher rate of favorable outcome than small craniectomy (p=0.005 and p=0.014, respectively). However, procedure related bleeding occurred more frequently in the large craniectomy group (p=0.044). Conclusion Unilateral DC size is associated with clinical outcome of patients with a space occupying lesion following severe TBI. Large craniectomy is needed for survival and favorable outcome.

Pigmented villonodular synovitis is a benign tumor arising from synovial fibroblasts or histiocytes. There are diffuse and localized forms: the former involves the entire synovium and the latter consists of nodules, small tumefactions, or pedunculated masses. The knee is the joint most commonly affected and the clinical diagnosis is difficult, so initial misdiagnosis is common. We report a case of pigmented villonodular synovitis developing in the knee of rheumatoid arthritis (RA) patient, mistaken for an RA flare-up.

BACKGROUND AND OBJECTIVES: The aims of this study were to evaluate the anatomical features of patients with obstructive sleep apnea syndrome (OSAS) using upper airway computed tomography (CT) in the awake state, and to analyze the correlation between anatomical features and severity of polysomnography (PSG) findings. MATERIALS AND METHODS: Sixty-eight patients presenting with snoring and sleep apnea were included, and upper airway CT in the awake state and PSG were performed in all patients. The average apnea-hypopnea index (AHI) and minimal arterial oxygen saturation (minSaO2) values were calculated. The axial and sagittal images from the level of the nasopharynx to that of the hypopharynx were obtained and measured. The correlations of the anatomical parameters with AHI and minSaO2 were statistically analyzed. RESULTS: The significant parameters correlated with AHI were nasopharynx anterior-posterior (A-P) diameter and transverse diameter, soft palate transverse diameter, uvula length, tongue length, lingual transverse diameter, and hypopharynx A-P diameter & transverse di-ameter. The parameters correlated with minSaO2 were nasopharynx transverse diameter and lingual transverse diameter. Conclusions: Upper airway analysis using CT in awake OSAS patients provides anatomical parameters which correlate with the severity of OSAS. Therefore, upper airway CT in the awake state may be helpful in diagnosing OSAS.
Airway Obstruction ; Humans ; Hypopharynx ; Nasopharynx ; Oxygen ; Palate, Soft ; Polysomnography ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive ; Snoring ; Tongue ; Uvula ; Wakefulness