Bilateral nonfunctioning-carcinoma of adrenal cortex is extremely rare and its prognosis is poor. We report a 43-year-old man hospitalized with complaints of both flank pain and generalized weakness. There were no endocrinoloeical abnormalities except for a slightly increase in serum norepinephrine. Ultrasonoeraphy. computerized tomography and MRI revealed bilateral huge adrenal masses with no metastasis evidence. Under the impression of bilateral nonfunctioning adrenocortical carcinoma. inevitable partial resection of right adrenal mass. adjuvant chemotherapy (o. p'-DDD) end radiotherapy were performed.
Adrenal Cortex ; Adrenocortical Carcinoma* ; Adult ; Chemotherapy, Adjuvant ; Flank Pain ; Humans ; Magnetic Resonance Imaging ; Neoplasm Metastasis ; Norepinephrine ; Prognosis ; Radiotherapy

Familial intracranial aneurysm is rare. We have clipped two posterior circulation intracranial aneurysms in mother and son. Mother was 48 years old and presented with severe headache and drowsy mentality. A basilar artery bifurcation aneurysm was found on DSA(digital subtraction angiography) and successfully clipped with transsylvian pterional approach. Her son was 24-year-old and presented with seizure and drowsy mentality. An aneurysmal sac was found on the bifurcation of vertebral artery and posterior inferior cerebellar artery. We have clipped it successfully with far lateral suboccipital approach. The authors recommended the use of screening test, such as MRIand high resolution CT, on the group of patients with the characteristic features of familial intracranial aneurysm.
Aneurysm* ; Arteries ; Basilar Artery ; Headache ; Humans ; Intracranial Aneurysm ; Mass Screening ; Middle Aged ; Mothers* ; Seizures ; Vertebral Artery ; Young Adult

PURPOSE: To investigate the age group characteristics of children who visited the emergency department with acute poisoning by ingestion. METHODS: We reviewed children under 19 years who visited the emergency department for acute poisoning by ingestion from 2012 to 2017. The children were divided into 3 age groups; infants (0-1 years), preschoolers (2-5 years), and schoolers (6-18 years). Clinical characteristics, intentional ingestion, involved substances (drugs, household products, artificial substances, and pesticides), decontamination and antidote therapy, and outcomes of the 3 age groups were compared. We also performed multivariable logistic regression analysis to identify factors associated with hospitalization. RESULTS: A total of 622 children with acute poisoning by ingestion were analyzed. Their annual proportions to overall pediatric emergency patients ranged from 0.3% to 0.4%. Age distribution showed bimodal peaks at 0-2 years and 15-17 years. The infants showed lower frequency of girls, intentional ingestion, ingestion of drugs, performance of decontamination and antidote therapy, and hospitalization than 2 older groups (P < 0.001). Most decontamination, antidote therapy, and hospitalization occurred in the schoolers (P < 0.001). The most frequently reported substances were household cleaning substances in the infants (18.2%), antihistamines in the preschoolers (15.8%), and analgesics in the schoolers (37.5%). The factors associated with hospitalization were intentional ingestion (adjusted odds ratio [aOR], 7.08; 95% confidence interval [CI], 2.85-17.61; P = 0.001) and schoolers (aOR, 2.33; 95% CI, 1.10-7.53; P = 0.031; compared with infants). Only 1 in-hospital mortality was found in a boy aged 2 years who ingested methomyl. CONCLUSION: Infants may experience non-intentional ingestion, ingestion of non-pharmacologic substances (especially household cleaning substances), discharge without decontamination and antidote therapy more frequently than older children. Thus, we need age group-specific, preventive and therapeutic plans for children with acute poisoning.
Adolescent ; Age Distribution ; Analgesics ; Child ; Decontamination ; Eating ; Emergencies ; Emergency Service, Hospital ; Epidemiology ; Family Characteristics ; Female ; Histamine Antagonists ; Hospital Mortality ; Hospitalization ; Household Products ; Humans ; Infant ; Logistic Models ; Male ; Methomyl ; Odds Ratio ; Poisoning

BACKGROUND: Atrial fibrillation (AF) is thought to beget AF by shortening atrial refractoriness and reversal of rate adaptation of atrial refractoriness. This phenomenon of electrophysiologic remodeling of the atria during AF has been reported to play a major role in inducibility and stability of AF. METHODS: Thirty-one patients with induced AF lasting >1 second during electrophysiologic study for documented or suspected supraventricular or ventricular tachycardia were included in this study. All the patients had no structural heart disease and history of AF. High right atrium (HRA) burst pacing or extra-stimulation was applied to induce AF. Eleven patients with AF sustained >or=3 min was grouped into Group I and 20 patients with AF <3 min into Group II. P wave duration and amplitude, left atrial (LA) size, atrial refractory period (ARP), intraatrial conduction time (IACT) from HRA electrode catheter to His bundle electrode catheter and characteristics of atrial activities during induced AF were compared between 2 groups. RESULTS: There was no difference in the distribution of underlying cardiac arrhythmias. P wave durations and amplitudes and echocardiographic LA sizes were similar between 2 groups. ARPs and IACTs in group I and II were similar (198.0 +/- 23.9 ms vs. 200.8 +/- 23.0 ms; 38.7 +/- 8.5 ms vs. 38.6 +/- 9.5 ms, respectively). During AF, mean interval of atrial activities in group I was significantly shorter than group II (156.6 +/- 24.2 ms vs. 187.6 +/- 28.0 ms, p<0.01). The degree of irregularity of atrial activities during AF was significantly higher in group I than group II (16.9 +/- 8.7 vs. 9.8 +/- 5.0, p<0.05). The duration of the atrial activities was wider in group I than group II (81.4 +/- 17.5 ms vs. 53.9 +/- 12.4 ms, p<0.001) and the amplitude was lower in group I than group II (56.1 +/- 36.0% vs. 109.0 +/- 51.8%, p<0.05), and the degree of fractionation was greater in group I than group II (4.8 +/- 1.1 vs. 3.2 +/- 0.5, p<0.05). CONCLUSION: These results suggest that shortening of atrial refractoriness and lengthening of local conduction time at the time of or shortly after induction of AF may play a major role in the induction and stabilization of AF.
Arrhythmias, Cardiac ; Atrial Fibrillation* ; Bundle of His ; Catheters ; Echocardiography ; Electrodes ; Electrophysiology ; Heart Atria ; Heart Diseases ; Humans ; Tachycardia, Ventricular

Congenital cystic adenomatoid malformation of the Lung(CCAM) is characterized by anomalous fetal development of terminal respiratory structures, resulting in an adenomatoid proliferation of bronchiolar elements and cystic formation. CCAM was first described and differentiated from other cystic lung disease in the English literature by Ch'in and Tang in 1949. CCAM is a rare, potentially lethal form of congenital pulmonary cystic disease and the salient features of lesion are an irregular network of terminal respiratory bronchiole-like structures and macrocysts variably lined by pseudostratified ciliated columnar epithelium and simple cuboidal epithelium. Adult presentation of CCAM of the lung is so tare that only 9 cases have been reported in the literature of date. The pathogenesis of CCAM remains disputed and reseachers have variously proposed that the lesion represents a developmental anomaly, hamartoma, or a form of pulmonary dysplasia. Van Dijk and Wagenvoort divided CCAM into three subtypes: cystic, intermediated, and solid. These correspond to types I, II, and III of Stocker. In adults, the evaluation of cystic or multicystic lung disease requires consideration of a differential diagnosis including the acquired lesions of lung abscess, cavitary neoplasm or inflammatory mass, bullous disease, bronchiectasis, and postinflammatory pneumatocele. Congenital lesions such as sequestration, bronchopulmonary-foregut anomalies, and bronchogenic cyst are also encounted. The definitive treatment for CCAM is complete removal of the involved lobe. Partial lobectomy leads to multiple complications, including severe post-operative infection. We report a case of CCAM in a 14-year-old female presentated with a pneumothorax and large bullae, who was treated by surgical remove of the involved lobe.
Adolescent ; Adult ; Bronchiectasis ; Bronchogenic Cyst ; Cystic Adenomatoid Malformation of Lung, Congenital* ; Diagnosis, Differential ; Epithelium ; Female ; Fetal Development ; Hamartoma ; Humans ; Lung Abscess ; Lung Diseases ; Lung* ; Pneumothorax