No abstract available.

No abstract available.

Acute gluteal compartment syndrome (AGCS) is a rare condition associated with trauma, drug abuse, alcohol intoxication, prolonged immobilization, hip arthroplasty and epidural anesthesia. We report the case of a 42-year-old woman presenting severe buttock pain following decreased lower extremity motor function after an incident whereby she rolled down a flight of stairs. We performed fasciotomy of the gluteal fascia in order to provide relief from acute gluteal compartment syndrome. At the 2 month follow up visit her sensory and motor function had improved. Acute gluteal compartment syndrome is a rare condition which can result in misdiagnosis or delayed diagnosis. Careful consideration is needed for patients suffering severe buttock pain.
Adult ; Anesthesia, Epidural ; Arthroplasty ; Buttocks ; Compartment Syndromes ; Delayed Diagnosis ; Diagnostic Errors ; Fascia ; Female ; Follow-Up Studies ; Hip ; Humans ; Immobilization ; Lower Extremity ; Sciatic Nerve ; Stress, Psychological ; Substance-Related Disorders

Acute gluteal compartment syndrome (AGCS) is a rare condition associated with trauma, drug abuse, alcohol intoxication, prolonged immobilization, hip arthroplasty and epidural anesthesia. We report the case of a 42-year-old woman presenting severe buttock pain following decreased lower extremity motor function after an incident whereby she rolled down a flight of stairs. We performed fasciotomy of the gluteal fascia in order to provide relief from acute gluteal compartment syndrome. At the 2 month follow up visit her sensory and motor function had improved. Acute gluteal compartment syndrome is a rare condition which can result in misdiagnosis or delayed diagnosis. Careful consideration is needed for patients suffering severe buttock pain.
Adult ; Anesthesia, Epidural ; Arthroplasty ; Buttocks ; Compartment Syndromes ; Delayed Diagnosis ; Diagnostic Errors ; Fascia ; Female ; Follow-Up Studies ; Hip ; Humans ; Immobilization ; Lower Extremity ; Sciatic Nerve ; Stress, Psychological ; Substance-Related Disorders

OBJECTIVE: Dural arteriovenous fistulas (dAVFs) at the superior sagittal sinus (SSS) are very rare. Endovascular treatment alone often fails to eliminate the fistula because of the midline location of the SSS, the eloquent venous drainage and the multiple bilateral arterial feeders. Surgical extirpation of dAVFs is not recommended in all cases because of the considerable risks involved. We report here on a case of dAVF at the SSS with patent sinus drainage and retrograde leptomeningeal venous drainage, and this was selectively disconnected using an aneurysmal clip under intraoperative Doppler monitoring. The neurological symptoms vanished during the 2 years of follow-up, and no further progression of the dAVF has been found. The methods of converting aggressive dAVFs to benign forms are relatively safe and simple. Therefore, this simple and effective method could be recommended for older aged patients with high intraoperative risk.
Aneurysm ; Central Nervous System Vascular Malformations* ; Drainage ; Fistula ; Follow-Up Studies ; Humans ; Superior Sagittal Sinus*

Background: The accurate pathologic diagnosis and subtyping of high-grade endometrial carcinoma are often problematic, due to its atypical and overlapping histopathological features. Methods: Three pathologists reviewed 21 surgically resected cases of advancedstage endometrial carcinoma. The primary diagnosis was based only on hematoxylin and eosin stained slides. When a discrepancy arose, a secondary diagnosis was made by additional review of immunohistochemical (IHC) stains. Finally, three pathologists discussed all cases and rendered a consensus diagnosis. Results: The primary diagnoses were identical in 13/21 cases (62%). The secondary diagnosis based on the addition of IHC results was concordant in four of eight discrepant cases. Among four cases with discrepancies occurring in this step, two cases subsequently reached a consensus diagnosis after a thorough discussion between three reviewers. Next-generation sequencing (NGS) study was performed in two cases in which it was difficult to distinguish between serous carcinoma and endometrioid carcinoma. Based on the sequencing results, a final diagnosis of serous carcinoma was rendered. The overall kappa for concordance between the original and consensus diagnosis was 0.566 (moderate agreement). Conclusions We investigated stepwise changes in interobserver diagnostic reproducibility in advanced-stage endometrial carcinoma. We demonstrated the utility of IHC and NGS study results in the histopathological diagnosis of advanced-stage endometrial carcinoma.

Rapid ammonia elevation in blood with accompanying mental change should be considered as a true medical emergency. In such a case, action leading to immediate diagnosis and the earliest possible treatment must occur in order to minimize permanent brain damage. Hyperornithinemia- Hyperammonemia-Homocitrullinuria (HHH) syndrome is a rare inborn errors of metabolism and autosomal recessive metabolic disorder caused by a deficiency of the mitochondrial ornithine transporter at the cellular level. Emergency physicians should take account of the possibility of HHH syndrome in patients with unreasonable hyperammonemia coupled with altered mental status. We report a case of a 59-year old man who presented with headache, nausea, vomiting and altered mental status. His serologic test showed hyperornithinemia, hyperammomemia, and homocitrullinuria. He was treated with fluid therapy and hemodialysis. His clinical manifestation improved and he was discharged after hemodialysis
Amino Acid Transport Systems, Basic ; Ammonia ; Brain ; Emergencies ; Fluid Therapy ; Headache ; Humans ; Hyperammonemia ; Metabolism, Inborn Errors ; Nausea ; Ornithine ; Renal Dialysis ; Serologic Tests ; Urea Cycle Disorders, Inborn ; Vomiting

PURPOSE: To evaluate the utility of ultrasound-assisted lumbar puncture in the emergency department. METHODS: This was a prospective randomized controlled trial. We enrolled patients who were 18 years of age or older from May to August 2007. Patients were divided into a classic lumbar puncture group (group A) and an ultrasoundassisted lumbar puncture group (group B). We compared the frequency of attempting the procedure, the procedure time, the failure rate of lumbar puncture, and the traumatic lumbar puncture between groups. RESULTS: Sixty-one patients were enrolled in the study. Thirty-two patients were in group A and 29 patients were in group B. There were 6 cases of failed lumbar puncture in group A and one case in group B (p=0.07), and there were 3 cases of traumatic lumbar puncture in group A, and one case in group B (p=0.35). It took 8.6+/-8.4 minutes to accomplish lumbar puncture in group A compared to 8.2+/-6.4 minutes in group B (p=0.85). Overall, the frequency of attempting the procedure was 2.3+/-1.8 in group A and, 1.6 +/-1.1 in group B (p=0.66). In elderly patients (age> or =60 years) the frequency of attempting the procedure was 4.0+/-2.5 in group A and 1.6+/-0.5 in group B (p=0.03). There were 4 cases of failed lumbar puncture in group A but none in group B. CONCLUSION: Emergency physicians did not generally attempt ultrasound-assisted lumbar puncture in the emergency department. For elderly patients(> or =60 years), however, it was an available tool for emergency physicians and employed more frequently.
Adult ; Aged ; Emergencies ; Humans ; Prospective Studies ; Spinal Puncture

We report on two cases of pericentric inversion of X chromosome. The cases were found in a 40-year- old man with azoospermia and in a family of a 38-year-old pregnant woman. The first case with 46,Y,inv(X)(p22.1q27) had concentrations of LH, prolactin, estradiol, and testosterone that were within normal ranges; however, FSH levels were elevated. Testis biopsy revealed maturation arrest at the primary and secondary spermatocytes without spermatozoa. There were no microdeletions in the 6 loci of chromosome Y. For the second case, the cytogenetic study of the pregnant woman referring for advanced maternal age and a family history of inversion X chromosome was 46,X,inv(X)(p22.11q27.2). The karyotype of her fetus was 46,X,inv(X)(p22.1q27). Among other family members, the karyotypes of an older sister in pregnancy and her fetus were 46,X,inv(X)(p22.11q27.2), and 46,Y,inv(X), respectively. The proband's father was 46,Y,inv(X)(p22.11q27.2). All carriers in the family discussed above were fertile and phenotypically normal. In addition, the ratio of inactivation of inv(X) by RBG-banding was discordant between the two sisters, with the older sister having only 4.1% of cells carrying inactivated inv(X) while the proband had a 69.5% incidence of late replicating inv(X). Therefore, we suggest that the cause of azoospermia in the first case might be related to inversion X chromosome with positional effect. Also, the family of the second case showing normal phenotype of the balanced inv(X) might be not affected any positional effect of genes.
Adult ; Azoospermia ; Biopsy ; Cytogenetics ; Estradiol ; Fathers ; Female ; Fetus ; Humans ; Incidence ; Karyotype ; Lifting ; Male ; Maternal Age ; Phenotype ; Pregnancy ; Pregnant Women ; Prenatal Diagnosis ; Prolactin ; Siblings ; Spermatocytes ; Spermatozoa ; Testis ; Testosterone ; X Chromosome

Schizophyllum commune is a mold in phylum Basidiomycota and is an uncommon human pathogen. Sinusitis and allergic bronchopulmonary mycosis are the two major diseases caused by S. commune. Although there have been several reports of invasive fungal diseases, most of them were invasive sinusitis. We present a case of invasive fungal pneumonia due to S. commune, developed in a patient with acute myeloid leukemia presenting neutropenic fever. The diagnosis was made by characteristic macroscopic and microscopic findings of fungal isolate and was confirmed via sequencing of internal transcribed spacer region. The patient was improved after 8 weeks of antifungal therapy based on the susceptibility result.We propose that S. commune should be considered as an emerging pathogen of invasive fungal pneumonia when a patient is under immunocompromised state. We also reviewed global literatures focused on the invasive fungal diseases caused by S. commune