A 74-year-old man presented with recurrent vomiting and aspiration pneumonia in the left lower lobe. He entered the intensive care unit to manage the pneumonia and septic shock. Although a percutaneous endoscopic gastrostomy tube was implanted for recurrent vomiting, vomiting and aspiration recurred frequently during admission. Subsequently, he complained of neck pain when in an upright position. A videofluoroscopic swallowing study showed compression of the esophagus by cervical osteophytes and tracheal aspiration caused by an abnormality at the laryngeal inlet. Cervical spine X-rays and computed tomography showed anterior cervical osteophytes at the C3-6 levels. Surgical decompression was scheduled, but was cancelled due to his frailty. Unfortunately, further recurrent vomiting and aspiration resulted in respiratory arrest leading to hypoxic brain damage and death. Physicians should consider cervical spine disease, such as diffuse skeletal hyperostosis as an uncommon cause of recurrent aspiration pneumonia.
Aged ; Bays ; Decompression, Surgical ; Deglutition ; Esophagus ; Gastrostomy ; Humans ; Hyperostosis ; Hypoxia, Brain ; Intensive Care Units ; Neck Pain ; Osteophyte* ; Pneumonia ; Pneumonia, Aspiration* ; Shock, Septic ; Spine ; Vomiting

No abstract available.
Anti-Bacterial Agents* ; Dysentery, Bacillary*

No abstract available.
Neck Dissection* ; Neck*

A 74-year-old man presented with recurrent vomiting and aspiration pneumonia in the left lower lobe. He entered the intensive care unit to manage the pneumonia and septic shock. Although a percutaneous endoscopic gastrostomy tube was implanted for recurrent vomiting, vomiting and aspiration recurred frequently during admission. Subsequently, he complained of neck pain when in an upright position. A videofluoroscopic swallowing study showed compression of the esophagus by cervical osteophytes and tracheal aspiration caused by an abnormality at the laryngeal inlet. Cervical spine X-rays and computed tomography showed anterior cervical osteophytes at the C3-6 levels. Surgical decompression was scheduled, but was cancelled due to his frailty. Unfortunately, further recurrent vomiting and aspiration resulted in respiratory arrest leading to hypoxic brain damage and death. Physicians should consider cervical spine disease, such as diffuse skeletal hyperostosis as an uncommon cause of recurrent aspiration pneumonia.
Aged ; Bays ; Decompression, Surgical ; Deglutition ; Esophagus ; Gastrostomy ; Humans ; Hyperostosis ; Hypoxia, Brain ; Intensive Care Units ; Neck Pain ; Osteophyte ; Pneumonia ; Pneumonia, Aspiration ; Shock, Septic ; Spine ; Vomiting

In connective tissue diseases, autoantibodies cause pulmonary interstitial inflammation and fibrosis, and patients require treatment with an immunosuppressive agent such as a steroid. Dermatomyositis is an incurable, uncommon form of connective tissue disease that occasionally causes diffuse pulmonary inflammation leading to acute severe respiratory failure. In such cases, the prognosis is very poor despite treatment with high-dose steroid. In the present case, a 46-year-old man was admitted to our hospital with dyspnea. He was diagnosed with dermatomyositis combined with cryptogenic organizing pneumonia (COP) with respiratory failure and underwent treatment with steroid and an immunosuppressive agent, but the COP was not improved. However, the respiratory failure did improve after treatment with intravenous immunoglobulin, which therefore can be considered a treatment option in cases where steroids and immunosuppressive agents are ineffective.
Autoantibodies ; Connective Tissue Diseases ; Cryptogenic Organizing Pneumonia* ; Dermatomyositis* ; Dyspnea ; Fibrosis ; Humans ; Immunoglobulins* ; Immunosuppressive Agents ; Inflammation ; Lung Diseases, Interstitial ; Middle Aged ; Pneumonia ; Prognosis ; Respiratory Insufficiency ; Steroids

Mosaic trisomy 14 syndrome is a well-known but unusual chromosomal abnormality with a distinct and recognizable phenotype. Array comparative genomic hybridization (CGH) analysis has recently become a widely used method for detecting DNA copy number changes, in place of traditional karyotype analysis. However, the array CGH shows a limitation for detecting the low-level mosaicism. Here, we report the detailed clinical and cytogenetic findings of patient with low-frequency mosaic trisomy 14, initially considered normal based on usual cut-off levels of array CGH, but confirmed by G-banding karyotyping. Our patient had global developmental delay, short stature, congenital heart disease, craniofacial dysmorphic features, and dark skin patches over her whole body. Estimated mosaicism proportion was 23.3% by G-banding karyotyping and 18.0% by array CGH.
Chromosome Aberrations ; Chromosomes, Human, Pair 14 ; Comparative Genomic Hybridization ; Cytogenetics ; DNA Copy Number Variations ; Heart Diseases ; Humans ; Hypogonadism ; Intellectual Disability ; Karyotype ; Karyotyping ; Mitochondrial Diseases ; Mosaicism ; Ophthalmoplegia ; Phenotype ; Skin ; Trisomy

A cadaveric study was performed to investigate the relationship between disc degeneration and morphological changes in the intervertebral foramen of cervical spine, including the effect on the nerve root. Seven fresh frozen human cadavers were dissected from C1 to T1, preserving the ligaments, capsules, intervertebral disc and the neural structures. The specimens were scanned with MRI and then scanned through CT scan in the upright position. Direct mid-sagittal and 45 degree oblique images were obtained to measure the dimension of the intervertebral disc height, foraminal height, width, area and segmental angles. Disc degeneration was inversely correlated with disc height. There was a significant correlation between disc degeneration and foraminal width (p<0.005) and foraminal area (p< 0.05), but not with foraminal height. Disc height was correlated with foraminal width but not with height. The segmental angles were decreased more in advanced degenerated discs. There was a correlation between nerve root compression and decreased foraminal width and area (p<0.005). This information and critical dimensions of the intervertebral foramen for nerve root compression should help in the diagnosis of foraminal stenosis of the cervical spine in patients presenting with cervical spondylosis and radiculopathy.
Adult ; Aged ; Aged, 80 and over ; Cadaver ; Female ; Human ; Intervertebral Disk/*pathology/radiography ; Magnetic Resonance Imaging/*methods ; Male ; Middle Aged ; Spine/*pathology/radiography ; Support, Non-U.S. Gov't ; Tomography, X-Ray Computed/*methods

Clavicular fracture is common injury in the upper extremity, but ipsilateral proximal, distal or middle-third clavicular fractures which occur simultaneously are an extremely rare. Seven cases have been reported in the English and Japanese literatures, but it has never been reported in Korea. We report a case of ipsilateral proximal and distal clavicular fracture caused by fall from height and describe its presumed mechanism, diagnosis, treatment with a review of literatures.
Asian Continental Ancestry Group ; Clavicle ; Humans ; Korea ; Upper Extremity

PURPOSE: A longitudinal study was conducted to explore flora colonization and oral glucose high-risk newborns during the first 7 days after birth. METHODS: Oral secretions of hospitalized newborns were obtained for microbial cultures and glucose test at days 1-7 after birth. RESULTS: Among the total 112 newborns, 40% were girls and 73% were premature. Mean gestational age was 34.4±3.2 weeks and weight was 2,266±697.5 grams. The most common flora included Streptococcus (28.2%), Methicillin-resistant Staphylococcus aureus (MRSA, 10.9%), Staphylococcus (6.0%) and Coagulase- Negative Staphylococcus (CNS, 4.0%). The average oral glucose level was 29.2±23.0mg/dl~58.2±39.5mg/dl. Newborns with higher oral glucose than serum (crude odds ratio [ORc] =1.75; 95% confidence interval [CI] =1.03-2.97), phototherapy (ORc=3.30; 95% CI=2.29-4.76) and prone position (ORc= 2.04; 95% CI=1.13-3.69) were more likely to be colonized. Having oral tubes (ORc=0.42; 95% CI=0.29-0.59), parental nutrition (ORc=0.21; 95% CI=0.13-0.32) and antibiotics (ORc=0.51; 95% CI=0.36-0.73) had protective effects. For oral glucose statistical significances existed on time effect among newborns with Streptococcus (F=9.78, p=.024), MRSA (F=7.60, p=.037) or CNS (F=11.15, p=.019) and interaction between time and colonization among newborns with all of four flora (F=2.73, p=.029) or colonization with only Staphylococcus (F=2.91, p=.034). CONCLUSION: High-risk newborns develop flora colonization at an early period of life. Their clinical features were associated with types and time of oral flora colonization. They need close monitoring and multifaceted intervention to improve oral environment and infection control.
Anti-Bacterial Agents ; Colon* ; Female ; Gestational Age ; Glucose* ; Humans ; Infant, Newborn* ; Infection Control ; Longitudinal Studies ; Methicillin-Resistant Staphylococcus aureus ; Mouth ; Odds Ratio ; Parents ; Parturition ; Phototherapy ; Prone Position ; Staphylococcus ; Streptococcus

Type IV collagenases are thought to play a role in the proteolysis of the basement membrane and the extracellular matrix by the malignant cells that occur early in the development of invasive tumors. In several human tumors, including breast, colonic, ovarian, and hepatocellular carcinomas, type IV collagenase expression has been positively correlated with tumor invasiveness. In this study, we examined the expression and the activation of 72 kDa type IV collagenase in cancerous and normal tissues of the colon and, we attempted to clarify its clinical significance in 45 cases of human colorectal cancer by using northern blot analysis and gelatin zymography.This study showed that the level of 72 kDa type IV collagenase mRNA was increased in colorectal cancer and that this increase was associated with increased enzymatic activity. While there was a difference in the expression and the activation of this enzyme between T2 and T3, this enzyme activity did not show a definite correlation with cancer progress as measured by the depth of tumor invasion and lymph node metastasis.
Basement Membrane ; Blotting, Northern ; Breast ; Carcinoma, Hepatocellular ; Collagenases ; Colon ; Colorectal Neoplasms* ; Extracellular Matrix ; Gelatin ; Humans* ; Lymph Nodes ; Matrix Metalloproteinase 2* ; Neoplasm Metastasis ; Proteolysis ; RNA, Messenger