In cryptogenic stroke patients, early detection of new-onset atrial fibrillation (AF) and recurrent stroke is required to prevent poor clinical outcomes. Therefore, we investigated the predictors of new-onset AF and recurrent stroke in cryptogenic stroke patients without previously diagnosed AF. In total, 390 patients who were diagnosed with stroke and non-sustained atrial tachycardia (NSAT) on 24-hour Holter monitoring were followed up to assess new-onset AF and recurrent stroke. The 5-year event-free survival as well as the predictors of recurrent stroke or new-onset AF were investigated. Based on receiver operating characteristic analysis, frequent premature atrial contractions (PACs) were defined as PACs >44 beats/day. The median follow-up period was 35 months. The composite event rate was 11.5%. In Kaplan-Meier analysis, the 5-year cumulative incidence of composite events was higher in cryptogenic stroke patients with frequent PACs than in those without frequent PACs. Multivariate analysis revealed that current smoking, increased left atrial volume index, and frequent PACs were poor prognostic predictors of composite event, and frequent PACs were an independent poor prognostic factor of new-onset AF in cryptogenic stroke patients. Therefore, frequent PACs might be associated with poor clinical outcomes (new-onset AF and recurrent stroke) in cryptogenic stroke patients with concomitant NSAT.

A 6-year-old boy with underlying hemolytic anemia of unknown etiology, atopic dermatitis, and recurrent urticaria visited our hospital because of acute respiratory failure induced by influenza A. Despite mechanical ventilation after endotracheal intubation along with inhalation of nitric oxide, respiratory acidosis and hypoxemia persisted. Veno-venous extracorporeal membrane oxygenation (VV ECMO) insertion was performed to provide respiratory support. After performing flexible bronchoscopy, we found that thick mucus plugs were obstructing the right bronchus intermedius and the upper lobe orifice. After bronchial washing and removal of the plugs, we were able to wean the patient off VV ECMO and transfer him to the general ward. He was discharged without any neurologic or pulmonary sequelae.
Acidosis, Respiratory ; Anemia, Hemolytic ; Anoxia ; Bronchi ; Bronchitis ; Bronchoscopy ; Child ; Dermatitis, Atopic ; Extracorporeal Membrane Oxygenation ; Humans ; Influenza A virus ; Influenza, Human ; Inhalation ; Intubation, Intratracheal ; Male ; Mucus ; Nitric Oxide ; Patients' Rooms ; Plastics ; Pneumonia ; Respiration, Artificial ; Respiratory Insufficiency ; Urticaria

Acute cerebral infarctions are rare in children, however, they can occur as a complication of a Mycoplasma pneumoniae (MP) infection due to direct invasion, vasculitis, or a hypercoagulable state. We report on the case of a 5-year-old boy who had an extensive stroke in multiple cerebrovascular territories 10 days after the diagnosis of MP infection. Based on the suspicion that the cerebral infarction was associated with a macrolide-resistant MP infection, the patient was treated with levofloxacin, methyl-prednisolone, intravenous immunoglobulin, and enoxaparin. Despite this medical management, cerebral vascular narrowing progressed and a decompressive craniectomy became necessary for the patient's survival. According to laboratory tests, brain magnetic resonance imaging, and clinical manifestations, the cerebral infarction in this case appeared to be due to the combined effects of hypercoagulability and cytokineinduced vascular inflammation.
Brain ; Cerebral Infarction* ; Child ; Child, Preschool ; Decompressive Craniectomy ; Diagnosis ; Enoxaparin ; Humans ; Immunoglobulins ; Inflammation ; Levofloxacin ; Magnetic Resonance Imaging ; Male ; Mycoplasma pneumoniae* ; Mycoplasma* ; Pneumonia, Mycoplasma* ; Stroke ; Thrombophilia ; Thrombosis ; Vasculitis

Acute cerebral infarctions are rare in children, however, they can occur as a complication of a Mycoplasma pneumoniae (MP) infection due to direct invasion, vasculitis, or a hypercoagulable state. We report on the case of a 5-year-old boy who had an extensive stroke in multiple cerebrovascular territories 10 days after the diagnosis of MP infection. Based on the suspicion that the cerebral infarction was associated with a macrolide-resistant MP infection, the patient was treated with levofloxacin, methyl-prednisolone, intravenous immunoglobulin, and enoxaparin. Despite this medical management, cerebral vascular narrowing progressed and a decompressive craniectomy became necessary for the patient's survival. According to laboratory tests, brain magnetic resonance imaging, and clinical manifestations, the cerebral infarction in this case appeared to be due to the combined effects of hypercoagulability and cytokineinduced vascular inflammation.
Brain ; Cerebral Infarction ; Child ; Child, Preschool ; Decompressive Craniectomy ; Diagnosis ; Enoxaparin ; Humans ; Immunoglobulins ; Inflammation ; Levofloxacin ; Magnetic Resonance Imaging ; Male ; Mycoplasma pneumoniae ; Mycoplasma ; Pneumonia, Mycoplasma ; Stroke ; Thrombophilia ; Thrombosis ; Vasculitis

Immunoglobulin G4-related sclerosing disease (IgG4-SD) is currently recognized as a distinct systemic disease involving various organs. We reported the imaging findings of a case of pathologically confirmed IgG4-SD involving bilateral palatine tonsils. CT and MRI showed diffuse enlargement of both palatine tonsils with homogeneous contrast enhancement. Focal contour bulging was noted in the right palatine tonsil. Lesions appeared as isointense on T1-weighted and slightly hyperintense on T2-weighted MRI images, as compared with muscle. The T2-weighted MRI image showed a striated pattern in both tonsils. Despite its rare occurrence, IgG4-SD should be included in the differential diagnoses of patients with symptomatic bilateral tonsillar hypertrophy that is non-responsive to medication.
Diagnosis, Differential ; Female ; Humans ; Hypertrophy/pathology ; Immunoglobulin G/*immunology ; Magnetic Resonance Imaging/methods ; Middle Aged ; Palatine Tonsil/*pathology ; Retrospective Studies ; Sclerosis/diagnosis/*pathology

PURPOSE: This study aimed to study the antibody response of Japanese encephalitis vaccination in children using different kinds of vaccines (inactivated vaccine, live attenuated vaccine or interchanged) and evaluate the effectiveness of the vaccines to provide the basis of efficient immunization schedule of Japanese encephalitis. METHODS: Measurement of the neutralization antibody (NTAb) titers following Japanese encephalitis vaccination using different vaccines for 170 children, 2-6 year of age, who visited six university hospitals and are confirmed by immunization records. RESULTS: Among 170 children who were given primary immunization on Japanese encephalitis, 103 children were given inactivated vaccine, 64 children were given live attenuated vaccine and 3 children were given interchangeably. NTAb titers were more than 1:10 in all children of three groups. The geographic mean antibody titer was 322 in inactivated vaccine group and 266 in live attenuated vaccine group. However, there was no significant difference between two groups. In both groups, the NTAb titer showed the peak at 1-4 months after the third immunization and declined. The NTAb titers of three children who were given two kinds of vaccines alternately were 1:135, 1:632, and 1:2511, respectively. CONCLUSION: According to the results of this study in children younger than 6 years old, there is no significant difference in effectiveness between inactivated and live attenuated vaccines. However, further studies for the changes of antibody titers for a longer period of time on larger population are required.
Antibodies, Neutralizing ; Antibody Formation ; Asian Continental Ancestry Group* ; Child ; Cohort Studies* ; Encephalitis, Japanese* ; Hospitals, University ; Humans ; Immunization ; Immunization Schedule ; Prospective Studies* ; Vaccination ; Vaccines ; Vaccines, Attenuated

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a familial cardiac arrhythmia that is related to RYR2 or CASQ2 gene mutation. It occurs in patients with structurally normal heart and causes exercise-emotion-triggered syncope and sudden cardiac death. We experienced a case of CPVT in an 11 year-old female patient who was admitted for sudden cardiovascular collapse. The initial electrocardiogram (ECG) on emergency department revealed ventricular fibrillation. After multiple defibrillations, sinus rhythm was restored. However, recurrent ventricular fibrillation occurred during insertion of nasogastric tube without sedation in coronary care unit. On ECG monitoring, bidirectional ventricular tachycardia occurred with sinus tachycardia and then degenerated into ventricular fibrillation. To our knowledge, there has been no previous case report of CPVT triggered by sinus tachycardia in Korea. Therefore, we report the case as well as a review of the literature.
Catecholamines/*metabolism ; Child ; Electrocardiography ; Female ; Humans ; Tachycardia, Ventricular/*diagnosis/genetics/pathology

This study was performed to examine the health risks according to the obesity types based upon body mass index (BMI) and waist circumference (WC) cutoffs. The subjects were 8,966 adults aged 40-79 years from the 1998, 2001 and 2005 Korean National Health and Nutrition Examination Surveys. The subjects were classified into 4 types of obesity groups based on BMI and WC: BMIWC (BMI > or = 25 kg/m2 and WC >or = 90 cm for males and > or = 85 cm for females), WC (BMI < 25 kg/m2 and > or = 90 cm for males and > or = 85 cm for females), BMI (BMI >or = 25 kg/m2 and < 90 cm for males and < 85 cm for females), normal (BMI < 25 kg/m2 and < 90 cm for males and < 85 cm for females) groups. More than half (n = 5,103) of the subjects fell into the normal group and BMIWC group accounts for 58%, followed by BMI group of 27% and WC group of 16%. Mean ages of subjects were highest in WC group and lowest in BMI group. Blood levels of total cholesterol, triglyceride, LDL-cholesterol and glucose, and blood pressures were higher and HDL-cholesterol was lower in 3 types of obesity groups (BMIWC, WC, BMI) than in the normal group. Among the 3 obesity groups, energy and fat intake was significantly higher in BMIWC than in normal group in males, however, no differences were found among the 4 groups in females. The three obesity groups had greater odds ratios for hypertension, diabetes mellitus, hypercholesterolemia, hyper-LDL-cholesterolemia, hypo-HDL-cholesterolemia, hypertriglyceridemia, and metabolic syndrome compared to the normal group. Among 3 obesity groups, BMIWC group had the highest odds ratios for hypertension, diabetes mellitus, and metabolic syndrome. Especially BMIWC and WC groups showed the highest odds ratios for diabetes mellitus and metabolic syndrome, suggesting the potential role of abdominal obesity in diabetes mellitus and metabolic syndrome. Our data indicate that different types of obesity may show different degrees of health risks. The appropriate selection and use of obesity indexes may be effective for management of obesity as well as obesityrelated diseases.
Adult ; Aged ; Body Mass Index ; Cholesterol ; Diabetes Mellitus ; Female ; Glucose ; Humans ; Hypercholesterolemia ; Hypertension ; Hypertriglyceridemia ; Male ; Obesity ; Obesity, Abdominal ; Odds Ratio ; Waist Circumference

A stent fracture combined with a coronary artery aneurysm is a rare event. As these events can lead to a harmful outcome, such as the development of myocardial ischemia by in-stent restenosis or thrombosis, repeated coronary intervention may be required. We report a case of a stent fracture combined with a coronary artery aneurysm. The fracture was thought to have developed by mechanical stress produced from a change of regional wall motion after an anteroseptal myocardial infarction. As detected by the use of intravascular ultrasound, neither in-stent restenosis nor a thrombus in the fractured stent was present. A cardiac magnetic resonance image showed that no viable myocardium in the anteroseptal wall was present. Therefore, the patient underwent medical treatment without intervention of the fractured stent.
Aneurysm ; Anterior Wall Myocardial Infarction ; Coronary Vessels ; Humans ; Magnetic Resonance Spectroscopy ; Myocardial Ischemia ; Myocardium ; Stents ; Stress, Mechanical ; Thrombosis

PURPOSE: To evaluate the effectiveness of the reaspiration or rebiopsy of pulmonary lesions (second PCNA) in cases where the pathologic results are inconclusive upon initial percutaneous needle aspiration biopsy (PCNA). MATERIALS AND METHODS: A total of 364 PCNA cases (350 initial PCNA, 14 second PCNA) were performed under CT or fluoroscopy guidance for all the 350 patients enrolled. The procedure was performed by either using an automated biopsy gun with a 20-G needle (298 cases) or a 20-G aspiration needle (66 cases). The pathologic agreement rates between the initial and second PCNA, as well as the causes for a second PCNA, were evaluated. Finally the type and rate of complication were also evaluated. RESULTS: The second PCNA rate was 4.0% (14/350). The causes for a second PCNA, following the initial PCNA included unexpected pathologic results (n = 7) and inconclusive pathologic results (n = 7). Of the seven cases which had unexpected pathologic results from their initial PCNAs, five had similar pathologic results after a second PCNA. Also, of the seven cases of inconclusive pathologic results, such as atypical cells, the scanty cellularity or necrosis upon an initial PCNA, six cases revealed a malignancy on a second PCNA. The overall complication rate, including both the initial and second PCNAs was 14.0% (51/364). CONCLUSION: A second PCNA was performed to help resolve the exact diagnosis for a pulmonary lesion in cases of inconclusive pathologic results upon an initial PCNA.
Biopsy ; Biopsy, Needle ; Fluoroscopy ; Humans ; Lung Diseases ; Necrosis ; Needles ; Proliferating Cell Nuclear Antigen ; Tomography, X-Ray Computed